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Pulmonary manifestations of adult-onset Still's disease (AOSD) include aseptic pneumonitis, pleural effusions, rarely acute respiratory distress syndrome, and restrictive lung disease. Pulmonary arterial hypertension (PAH) occurs with several rheumatologic diseases, however, has only been reported once in AOSD. We describe a 29-year-old woman with a 9-year history of AOSD, who developed PAH without any other obvious cause. Therefore, we conclude that this is likely a result of pulmonary vascular changes related to AOSD.

Sarcoidosis is a multisystem disease characterized by noncaseating granulomatous reaction frequently involving the lymph nodes, lungs, liver, skin, and eyes. Acute renal failure (ARF) as an isolated manifestation of sarcoidosis is rare. We describe a case of sarcoidosis presenting as transient polyarthritis and ARF due to isolated granulomatous infiltration of the renal parenchyma. Renal biopsy showed granulomatous interstitial nephritis with noncaseating granulomas consistent with sarcoidosis. Bacterial, fungal, and mycobacterial infections were excluded. There was no evidence of extrarenal sarcoid involvement. Prednisone of 60 mg daily resulted in significant improvement in renal function. Because of recurrent flares on steroid taper and steroid toxicity, treatment with infliximab, an anti-tumor necrosis factor-alpha (TNF-alpha) antibody, was instituted and resulted in stabilization of renal function despite steroid taper. Although uncommon, renal sarcoidosis should be considered in the differential diagnosis of acute or chronic renal failure of uncertain etiology, as early diagnosis and treatment can lead to recovery of renal function and prevent interstitial fibrosis. Corticosteroids are mainstay of therapy. Steroid-dependent or refractory cases may respond to other immunosuppressants including anti-TNF-alpha agents.

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Objectives: To determine the prevalence of type-2 diabetes mellitus (DM) in patients with hepatitis C virus (HCV) and B virus (HBV) infections. Materials and Methods: A cross-sectional study of HCV- and HBV-positive patients admitted to King Abdul Aziz University Hospital, Jeddah, Saudi Arabia, was conducted from January 1999 to September 2000. The following data were collected and analysed: demographic data, the presence and type of DM, details of the treatment, body mass index (BMI), family history of DM, serum transaminases, thrombocytopenia, and presence of liver cirrhosis on liver biopsy. A total of 399 patients were included in the study. Results: 165 (41%) were anti-HCV positive and 234 (59%) were HBsAg positive. Type-2 diabetes was present in 35 of 165 (21.2%) patients with HCV infection, and 33 of 234 (14.1%) with HBV infection. 94% of anti-HCV-positive type-2 diabetes were older than 40 years and 6% were younger, while for nondiabetics the corresponding percentages were 55 and 45%, respectively. 76% of HBsAg-positive type-2 diabetics were older than 40 and 24% were younger, while the corresponding percentages for nondiabetics were 27 and 73%, respectively. Anti-HCV-positive type-2 diabetics, when compared to nondiabetics, had a higher BMI, a frequent family history of DM, elevated serum transaminases, thrombocytopenia, and liver cirrhosis on biopsy. HBsAg-positive type-2 diabetics had only a more frequent family history of DM than did nondiabetics. Conclusion: Our findings indicate that type-2 diabetes is more common in patients with an HCV than with an HBV infection.

2020) Synergetic role of senna and fennel extracts as antioxidant, anti-inflammatory and anti-mutagenic agents in irradiated human blood lymphocyte cultures, ABSTRACT Present work aimed to examine antioxidant, anti-inflammatory and anti-mutagenic effects of senna and fennel via synergetic mechanisms against deleterious effects of gamma radiation exposure. Cytogenetic, biochemical and immunological investigations were evaluated in human blood lymphocyte cultures. Samples were divided into Group I: control, Group II: irradiated samples with 3Gy γ-irradiation, Group III: treated samples with a mixture of calcium sennosides and fennel seed extract and Group IV: irradiated treated samples. The results revealed that radiation exposure caused an increment in numbers of micronuclei (MN), nucleoplasmic bridges (NPBs), mono-, and multinucleated cells. Biochemical results revealed a decrease in levels of SOD and CAT enzymes and an increase in LDH level after irradiation. Levels of cytokines (IL-1β, IL-6, IL-8, and TNF-α) were significantly increased in irradiated group. Calcium sennosides and fennel seed extract mixture treatment after radiation exposure succeeded in returning cytokines and antioxidant enzyme levels to their normal levels as compared to control. Also, group IV showed a marvelous improvement in numbers of MN and NPB frequencies. These results indicate that the combination between Calcium sennosides as free radicals scavenger and fennel as an apoptic inducer can be used as a post-radiation treatment against oxidative and inflammation effects of ionizing radiation. ARTICLE HISTORY

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I ONIZING radiation (IR) generate reactive oxygen species (ROS). Imbalance between ROS and antioxidants level leads to oxidative stress. Fortunella margarita (F. magarita) fruit contains a lot of bioactive compounds, such as polysaccharides, flavonoids, phenolic acids, ..etc. Therefore, it has high radical scavenging capacities and strong antioxidant activity. This study was designed to determine the probable efficiency of F. margarita extract against liver damage and sperm abnormalities induced by γ-radiation in male rats. Thirty six rats were divided into 6 groups (6 rats each): control group, treated groups: 14 days F. margarita group and 28 days F. margarita group, irradiated group (Irr): rats were exposed to 6Gy of whole body γ-radiation, pre-treated (14 days F. margarita extract + Irr) group and pre-and post-treated (28 days F. margarita extract + Irr) group. Biochemical investigations included lipid profile: total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C). Liver function enzymes involved analyzing serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT) level, hepatic tissue malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione reduced (GSH) levels. Fertility competence (sperm head, tail and head and tail abnormalities) were recorded. Results obtained revealed the strong efficiency role of F. margarita fruit extract as an antioxidant against hepatotoxicity through enhancement of liver functions ( ALT, AST and GGt), reduction of oxidative stress (MDA, SOD and GSH), and powerful recovering of sperm abnormalities induced by γ-irradiation. Also, adjusting and normalization of TC, HDL-C, LDL-C, VLDL-C and TG have been shown.