This work aimed to investigate peripheral and central hearing function (auditory pathways) in patients with diabetes mellitus (DM). This study included 60 patients with mean age of 39.57±13.89 years and dura¬tion of illness of 7.37±5.15 years. We did routine pure tone audiometry (PTA) along with Auditory-Brainstem Response (ABR) at low and high repetition rate frequencies and Event-Related Potentials (ERPs). Four¬teen patients (23.33%) had tinnitus and 18 patients (30%) had subjec¬tive hearing impairment. PTA reported peripheral auditory neuropathy in 30% (18/60) or (30/120) of ears examined [versus 8.75% (7/80) for control subjects] (P=0.001). Of them, bilateral sensorineural hearing impairment (SNHI) was reported in (72.22%; n=13). The latency of wave I was prolonged in 36.67% indicating auditory neuropathy. The latency of wave III and I-III and III-V inter peak latencies (IPLs) were delayed in 46.67% indicating impairment in the cochlear nucleus. The latency of wave V and III-V and I-V IPLs were delayed in 30% without impairment in wave I or III, indicating impairment in the activity in the nuclei of lateral lemniscus. Compared to control subjects, patients had higher hearing threshold at different frequencies (250-8000 Hz) (P = 0.0001), prolonged absolute latencies of waves I, III and V and I-III, III-V and I-V IPLs at 90dBHL low and high repetition frequencies and N100, N200, P200 and P300 components of ERPs (P = 0.0001) and reduced amplitudes of P200 and P300 (P = 0.0001). No significant differences were identified among different audiologic variables between patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Patients who were uncontrolled on anti-diabetic medications had prolonged I-V IPLs at 90dBHL low (right: P=0.025; left: P=0.041) and high (right: P=0.047; left: P=0.036) repetition frequencies and reduced amplitudes of P300 (right: P=0.050; left: P=0.052). significant correlations were identified between many audiologic variables and demographic- clini¬cal- and laboratory- variables In multivariate analysis and after adjust¬ment of other risk factors, there were increase in the odds for latency of wave III (OR 1.90; 95% Cl 1.02 to 3.55, P = 0.044); I-III (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) and III-V (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) IPLs and amplitude of P300 (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) in relationship to the degree hyperglycemia. We conclude that, patients with DM have higher frequency of peripheral and central hearing impairment (i.e. acoustic nerve, auditory pathway throughout the brainstem till the auditory cortex). The degree of hear¬ing impairment was significantly correlated with glycemic control. This knowledge is important for specialists serving those patients.

This work aimed to investigate peripheral and central hearing function (auditory pathways) in patients with diabetes mellitus (DM). This study included 60 patients with mean age of 39.57±13.89 years and dura¬tion of illness of 7.37±5.15 years. We did routine pure tone audiometry (PTA) along with Auditory-Brainstem Response (ABR) at low and high repetition rate frequencies and Event-Related Potentials (ERPs). Four¬teen patients (23.33%) had tinnitus and 18 patients (30%) had subjec¬tive hearing impairment. PTA reported peripheral auditory neuropathy in 30% (18/60) or (30/120) of ears examined [versus 8.75% (7/80) for control subjects] (P=0.001). Of them, bilateral sensorineural hearing impairment (SNHI) was reported in (72.22%; n=13). The latency of wave I was prolonged in 36.67% indicating auditory neuropathy. The latency of wave III and I-III and III-V inter peak latencies (IPLs) were delayed in 46.67% indicating impairment in the cochlear nucleus. The latency of wave V and III-V and I-V IPLs were delayed in 30% without impairment in wave I or III, indicating impairment in the activity in the nuclei of lateral lemniscus. Compared to control subjects, patients had higher hearing threshold at different frequencies (250-8000 Hz) (P = 0.0001), prolonged absolute latencies of waves I, III and V and I-III, III-V and I-V IPLs at 90dBHL low and high repetition frequencies and N100, N200, P200 and P300 components of ERPs (P = 0.0001) and reduced amplitudes of P200 and P300 (P = 0.0001). No significant differences were identified among different audiologic variables between patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Patients who were uncontrolled on anti-diabetic medications had prolonged I-V IPLs at 90dBHL low (right: P=0.025; left: P=0.041) and high (right: P=0.047; left: P=0.036) repetition frequencies and reduced amplitudes of P300 (right: P=0.050; left: P=0.052). significant correlations were identified between many audiologic variables and demographic- clini¬cal- and laboratory- variables In multivariate analysis and after adjust¬ment of other risk factors, there were increase in the odds for latency of wave III (OR 1.90; 95% Cl 1.02 to 3.55, P = 0.044); I-III (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) and III-V (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) IPLs and amplitude of P300 (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) in relationship to the degree hyperglycemia. We conclude that, patients with DM have higher frequency of peripheral and central hearing impairment (i.e. acoustic nerve, auditory pathway throughout the brainstem till the auditory cortex). The degree of hear¬ing impairment was significantly correlated with glycemic control. This knowledge is important for specialists serving those patients.

This work aimed to investigate peripheral and central hearing function (auditory pathways) in patients with diabetes mellitus (DM). This study included 60 patients with mean age of 39.57±13.89 years and dura¬tion of illness of 7.37±5.15 years. We did routine pure tone audiometry (PTA) along with Auditory-Brainstem Response (ABR) at low and high repetition rate frequencies and Event-Related Potentials (ERPs). Four¬teen patients (23.33%) had tinnitus and 18 patients (30%) had subjec¬tive hearing impairment. PTA reported peripheral auditory neuropathy in 30% (18/60) or (30/120) of ears examined [versus 8.75% (7/80) for control subjects] (P=0.001). Of them, bilateral sensorineural hearing impairment (SNHI) was reported in (72.22%; n=13). The latency of wave I was prolonged in 36.67% indicating auditory neuropathy. The latency of wave III and I-III and III-V inter peak latencies (IPLs) were delayed in 46.67% indicating impairment in the cochlear nucleus. The latency of wave V and III-V and I-V IPLs were delayed in 30% without impairment in wave I or III, indicating impairment in the activity in the nuclei of lateral lemniscus. Compared to control subjects, patients had higher hearing threshold at different frequencies (250-8000 Hz) (P = 0.0001), prolonged absolute latencies of waves I, III and V and I-III, III-V and I-V IPLs at 90dBHL low and high repetition frequencies and N100, N200, P200 and P300 components of ERPs (P = 0.0001) and reduced amplitudes of P200 and P300 (P = 0.0001). No significant differences were identified among different audiologic variables between patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Patients who were uncontrolled on anti-diabetic medications had prolonged I-V IPLs at 90dBHL low (right: P=0.025; left: P=0.041) and high (right: P=0.047; left: P=0.036) repetition frequencies and reduced amplitudes of P300 (right: P=0.050; left: P=0.052). significant correlations were identified between many audiologic variables and demographic- clini¬cal- and laboratory- variables In multivariate analysis and after adjust¬ment of other risk factors, there were increase in the odds for latency of wave III (OR 1.90; 95% Cl 1.02 to 3.55, P = 0.044); I-III (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) and III-V (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) IPLs and amplitude of P300 (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) in relationship to the degree hyperglycemia. We conclude that, patients with DM have higher frequency of peripheral and central hearing impairment (i.e. acoustic nerve, auditory pathway throughout the brainstem till the auditory cortex). The degree of hear¬ing impairment was significantly correlated with glycemic control. This knowledge is important for specialists serving those patients.

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Background: Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells. Objective: to identify the various aetiological factors that stands behind aplastic anemia as a common hematological problem and the various outcomes of those patients along one year. Patients and methods: The study included 80 patients with aplastic anemia who were admitted to the Clinical Hematology Unit of Assuit University Hospital from November 2011 to October 2012. All patients were recruited for careful history and meticulous investigations to detect predisposing factors. Results: 42.5% of all studied aplastic anemia patients had any definite etological or predesposing factor, so considered as idiopathic group while, 57.5% were secondry to chmicels and/or insecticides (22.5%), hepatitis C (15%), systemic lupus erythematosis (SLE) (12.5%) and rheumatoid arthritis (7.5%). The observed outcomes showed that complete recovery in 39%t of he secondry aplastic anemia patients (P0.001), chronicity in 22% while 39% died. However, none of the idiopathic aplastic anemia patients reached recovry, 59% become chronic (P0.001) and 41% died (P0.05). Conclusion: Secondary aplastic anemia patients have a chance for recovery by correcting the primary etiology that is not an option in idiopathic patients. The hope for not recovered aplastic anemia patients is dependency on transfusional support and immunosupressive therapy waiting for a chance in allogeneic stem cell transplantation. The expected outcome of most of unrecovered patients is death unless find early chance for transplantation.So, there is a very potential need for stem cell transplantation center in Assuit University as an important referral center in Upper Egypt.

Background: Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells. Objective: to identify the various aetiological factors that stands behind aplastic anemia as a common hematological problem and the various outcomes of those patients along one year. Patients and methods: The study included 80 patients with aplastic anemia who were admitted to the Clinical Hematology Unit of Assuit University Hospital from November 2011 to October 2012. All patients were recruited for careful history and meticulous investigations to detect predisposing factors. Results: 42.5% of all studied aplastic anemia patients had any definite etological or predesposing factor, so considered as idiopathic group while, 57.5% were secondry to chmicels and/or insecticides (22.5%), hepatitis C (15%), systemic lupus erythematosis (SLE) (12.5%) and rheumatoid arthritis (7.5%). The observed outcomes showed that complete recovery in 39%t of he secondry aplastic anemia patients (P0.001), chronicity in 22% while 39% died. However, none of the idiopathic aplastic anemia patients reached recovry, 59% become chronic (P0.001) and 41% died (P0.05). Conclusion: Secondary aplastic anemia patients have a chance for recovery by correcting the primary etiology that is not an option in idiopathic patients. The hope for not recovered aplastic anemia patients is dependency on transfusional support and immunosupressive therapy waiting for a chance in allogeneic stem cell transplantation. The expected outcome of most of unrecovered patients is death unless find early chance for transplantation.So, there is a very potential need for stem cell transplantation center in Assuit University as an important referral center in Upper Egypt.