• Users Online: 91
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 31 | Issue 4
Page Nos. 389-983

Online since Tuesday, August 18, 2020

Accessed 25,369 times.
View as eBookView issue as eBook
Access StatisticsIssue statistics
RSS FeedRSS
Hide all abstracts  Show selected abstracts  Export selected to  Add to my list
REVIEW ARTICLES  

Extracellular vesicles and systemic lupus erythromatosus Highly accessed article p. 389
Rasha N Omran, Emad M El Shebini, Enas S Zahran, Sabry A Shoeib
DOI:10.4103/ejim.ejim_67_19  
Introduction Extracellular vesicles (EV) have emerged as important ‘nanoshuttles’ of information between cells, carrying proteins, genetic information, and bioactive lipids to modify the phenotype and function of recipient cells. EVs are potential regulators in autoimmune disorders, playing a determinant role in the appearance and maintenance of inflammation. Objective This study aimed to carry out an up-to-date review of the EVs and their relationship with systemic lupus erythromatosus. Data sources Medline databases (PubMed, Medscape, ScienceDirect, EMF-Portal) and all materials available in the Internet till 2018. Study selection This search yielded 275 articles. The articles were studied to perform an up-to-date review of the extracellular vesicles and their relationship with systemic lupus erythromatosus. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was obtained, the eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Data synthesis Comparisons were made by a structured review, with the results tabulated. Conclusion We can safely conclude that EVs play an important role in the complex pathogenesis and management of systemic lupus erythematosus.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

A review of bone marrow niche cellular spectrum Highly accessed article p. 397
Sabry A Shoieb, Mohammad A Abdel Hafez, Alaa E Abd El-Hamid, Walaa Hamdy Ezz
DOI:10.4103/ejim.ejim_68_19  
To perform a narrative review on the role of bone marrow (BM) niche in normal hematopoiesis. MEDLINE databases and Ovid database were searched. The search was performed on 10 October 2018 and included articles published from 2015 to 2018 in English language. The initial search presented 45 articles, which were included in the study. Hematopoietic stem cells which produce a variety of hematopoietic lineage cells throughout the life are located in a specialized microenvironment called the ‘niche’ in the BM where they are governed. Several types of cells in the BM have been suggested to contribute to hematopoietic stem cell niche activity.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Delirium: a common preventable medical disorder in elderly patients p. 403
Afaf Hemeda
DOI:10.4103/ejim.ejim_55_19  
Delirium is one of commonest unmet medical emergencies in clinical practice however, its role in increasing mortality, hospital admission and institutional placement in very obvious. In addition, a link was found between delirium and development of dementia based on the finding that significant number of delirious patients developed persistent cognitive impairment thereafter. Several factors can lead to delirium or aggravate it and consequently primary care physician should be aware by these factors keeping in mind that delirium is still a treatable condition if identified and managed appropriately and urgently.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Excessive use of electronic gadgets: health effects Highly accessed article p. 408
Gurmeet Singh Sarla
DOI:10.4103/ejim.ejim_56_19  
Mobile phones, internet, social networking sites, and texting have changed the way we see the world. There are ∼6.9 billion mobile users, almost as many as people on earth. People who excessively use electronic gadgets develop musculoskeletal disorders. Repetitive strain injury is a chronic condition that develops because of repetitive, forceful, or awkward hand movements for prolonged periods leading to damage to muscles, tendons, and nerves of the neck, shoulder, forearm, and hand, which can cause pain, weakness, numbness, or impairment of motor control. Eyes, neck muscles, arm, and wrist are affected with prolonged use of electronic gadgets. People who use smartphones excessively, because of their reduced amounts of face-to-face interaction, are likely to have a feeling that their social relationships are not supportive and rewarding and that they are not actively contributing to the happiness and well-being of others. The aim of this review article is to study literature and list the problems associated with prolonged use of electronic gadgets and ways to minimize the symptoms owing to increased ‘screen time’. Smartphone overuse may lead to development of repetitive stress injury or overuse syndrome thereby affecting hand function resulting in pain in the thumb. Prolonged use of electronic gadgets may affect the human body adversely. There is a critical need to promote healthy ways of smartphone use, as well as the importance of friendship and family connectedness as a way of promoting the psychological well-being. Physicians should get themselves updated of these new disorders and younger generation needs to be educated adequately about the ergonomic practices and health safety of gadget usage.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Trimester-specific thyroid hormone changes in normal pregnant Egyptian women p. 412
Shrook Mousa, Shereen S El-Sawy, Maged Abdelraouf, Dina Farouk, Laila Rashed, Aasem Saif
DOI:10.4103/ejim.ejim_142_19  
Introduction The range of normal thyroid functions during pregnancy differs between ethnic groups. Establishment of trimester- and assay-specific reference intervals for every population is recommended. Aim Assessement of the changes in thyroid function tests across the different trimesters in normal pregnant Egyptian females. Subjects and methods The study included 150 normal pregnant Egyptian females, recruited from Cairo university hospital antenatal care clinic, with 100 age-matched non-pregnant females, as a control group. Serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured in the three trimesters of pregnancy for every patient. Thyroid peroxidase antibodies (TPO Abs) were also assessed. Our study showed that TSH reference ranges, using the 2.5th and the 97th percentiles, were 0.6–4.3, 0.9-3.7 and 1.0–4.2 mIU/ml for the first, second and third trimesters respectively. The median TSH concentration (50th percentile) was lower in the first trimester (2.1 mIU/ml) in comparison with the second and third trimesters of (2.6 and 2.9 mIU/ml respectively). FT4 reference ranges, using 2.5th to 97th percentile, were 0.9–2 and 0.7–1.4 and 0.6–1.2 ng/dl for the first, second and third trimesters respectively. The median FT4 concentration was higher in the first trimester (1.5 ng/dl) in comparison with the second and third trimesters of (1.1 and 1.0 ng/dl respectively). The percentage of positive TPO Ab was higher in pregnant women than that of age matched non-pregnant ladies (15.3 vs 2%, P<0.001). Conclusion Our study established trimester-specific changes in thyroid hormone reference ranges in normal pregnant Egyptian females. A larger population-based study would help to confirm those ranges.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Cyclophilin A: a novel biomarker for cardiovascular disease in patients with type 2 diabetes p. 416
Manal M Hussain, Emad A.M. Abdel Hady Mohammed, Alyaa A El-Sherbeny, Amira R Shehata
DOI:10.4103/ejim.ejim_147_19  
Background and aims Type 2 diabetes mellitus (DM) is a strong independent risk factor for coronary heart disease. Cyclophilin A (CyPA) is a protein secreted from vascular smooth muscle cells in response to reactive oxygen species. It is suggested that CyPA plays an important role in later stages of atherosclerosis and plaque rupture. It was demonstrated that plasma levels of CyPA are significantly higher in patients with coronary artery disease (CAD) in proportion to severity of disorder. Moreover, several studies have demonstrated a role of CyPA as a biomarker of CADs. Indeed studies revealed significantly higher plasma levels of CyPA in patients with CAD with type 2 DM. Objective To assess the severity of CAD among diabetic and prediabetic patients and predict future cardiovascular events. Patients and methods The study was conducted on 65 patients with CAD diagnosed by coronary angiography, stratified according to GRACE score into low/intermediate/high death risk categories and subdivided into diabetic, prediabetic, and nondiabetic, and 20 age-matched and sex-matched patients, who had normal angiography as a control group. Blood samples were collected for determination of glycated hemoglobin (HbA1c), serum creatinine, cardiac troponin, and CyPA level using double-antibody sandwich enzyme-linked immunosorbent assay technique. Results There were significantly higher levels of CyPA among patient group than control group (P<0.001). Moreover, significantly higher CyPA levels were detected in diabetic group when compared with normal and prediabetic groups (P<0.029). CyPA was positively correlated with HbA1c in all patients and with diabetic patients. HbA1c was negatively correlated with serum creatinine and positively with estimated glomerular filtration rate in prediabetic group and with systolic blood pressure in diabetic group. The number of occluded vessels was positively correlated with both CyPA and HbA1c. The diagnostic sensitivity and specificity of CyPA were 76.92 and 95%, respectively, at a cutoff value of more than 13 ng/ml. Conclusion CyPA can be used as an early predictor of CAD in patients with type 2 DM and also in prediabetic patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Assessment of gestational diabetes in high-risk women attending Assiut University Women Health Hospital, Egypt p. 423
Dina Ali Ahmed, Loobna Farag EL Toony, Ahmed AD El Kader, Alaa Mahmoud Esmail, Wael Ahmed Abass, Hanan El Khated
DOI:10.4103/ejim.ejim_109_19  
Background The prevalence of gestational diabetes mellitus (GDM) has increased dramatically worldwide in the last decades, but unfortunately it was not studied in Egypt. Objective The objective of the study is to assess the prevalence and the risk factors of GDM in Assiut City, Egypt and to assess the better management and follow-up of GDM comparing the results of treatment options on maternal and fetal outcomes. Patients and methods Our study was a prospective cohort study performed between June 2014 and June 2015. The study included 355 nondiabetic pregnant women at 24–28th weeks of gestation. A total of 242 cases had risk factors for GDM who underwent 75 g 2 h oral glucose tolerance test (OGTT). Diagnosis of GDM was carried out according to International Association of the Diabetes and Pregnancy Study Groups criteria. GDM cases were followed up and treatment was modified according to the targets for capillary blood glucose levels. Patients received an education program about the preferred food items and on the importance of physical activities, and if targets are not met within 1–2 weeks of initiation of lifestyle management, then those patients will be grouped into two groups: a group treated with metformin and another group treated with insulin. All participants were followed up till the end of pregnancy especially: maternal outcomes, for example preeclampsia and cesarean delivery. Also, fetal outcomes, for example macrosomia, hypoglycemia, hyperbilirubinemia, neonatal respiratory distress syndrome, and neonatal death. Follow-up of GDM cases was done at 6–12 weeks postpartum by OGTT 75 g glucose to detect progression to type 2 DM. Results Our study has shown that the prevalence rate of GDM was 12.4% among the studied group. Family history of DM was the most prevalent risk factor with a highly significant positive relation that occurred in 73.3% of GDM cases (P<0.001) compared with 32.5% in non-GDM cases. BMI more than 30 was another important risk factor demonstrated in our study as a significant association was found between prevalence of GDM and obesity (BMI >30) was found in 50% of women with GDM (P<0.001) compared with 21.2% in non-GDM cases. Of the studied group, 31.8% had no risk factors for GDM, which shows the importance of usinguniversal screening measures. The prevalence of GDM was higher in those living in urban areas (76.7 vs. 23.3%%), P value 0.045. Our study showed that the most common complications of GDM were cesarean section, which occurred in 33.3% of cases and preeclampsia, which occurred in 23.3% of cases. Regarding fetal complications, the most frequent complications were macrosomia that occurred in 23.35% of cases and hypoglycemia in newborn babies, which occurred in 16.7% of cases. The use of metformin lessened the occurrence of macrosomia in 27.3% of babies compared with 28.6% with the insulin group. Neonatal hypoglycemia occurred less with the use of metformin in 9.1% compared with 28.6% with insulin use. Also, in our study 23.3% (7/30) of GDM cases progressed to type 2 diabetes when 2-h OGTT 75 g glucose was done at 6–12 weeks postpartum. All of them had a family history of DM in first-degree relatives, obese with a BMI of above 30 and started insulin from the start of diagnosis. Conclusion The prevalence of GDM in high-risk women attending Assiut University Women Health Hospital was 12.4% and family history of DM was the most frequent risk factors for GDM. High prevalence of BMI more than 30, past history of previous GDM, and the increasing age of the pregnant women were other important risk factors. Of the GDM women 31.8% had no definite risk factor and this enhances the need for universal screening of all pregnant women instead of selective screening for the high-risk group to pick up more and more cases with GDM. GDM women were more prevalent in urban than in rural areas. Our study showed that the most common maternal complications of GDM were cesarean section, preeclampsia, and postpartum progression to type 2 diabetes. Regarding fetal complications, the most frequent complications were macrosomia and hypoglycemia. Macrosomia occurred less with the usage of metformin compared with the insulin group. Neonatal hypoglycemia occurred less with the use of metformin compared with insulin use. Of the GDM cases 31.8% (7/30) progressed to type 2 DM when OGTT was done at 6–12 weeks postpartum and all of them had a family history of DM in first-degree relatives, obese with a BMI of above 30 and started insulin from the start of diagnosis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Efficacy and disposal of drugs after the expiry date p. 431
Gurmeet S Sarla
DOI:10.4103/ejim.ejim_110_19  
Every drug manufacturer is legally bound to display the date of expiry on all pharmaceutical products. Excluding certain medicines such as nitroglycerin, insulin, epinephrine, and tetracycline, most medicines stored under reasonable conditions retain at least 70–80% of their original potency for at least 1–2 years after the expiration date, even after the container has been opened. The drug is likely to lose some potency after the expiration date, but it is not clear how much potency is lost over a certain period of time past expiration dates. Placing medication in a cool place, such as a refrigerator, will help it remain potent for many years. Even though both the American Medical Association and the Food and Drug Administration do not recommend the dosing of expired pharmaceuticals at this time, discussion of the issue is warranted in order to understand the potential behind some expired drugs. This review article studies the financial implications and reason for stock piling of unused and expired pharmaceuticals, health hazards, common and ideal ways of disposal of unused and expiry medications and the way forward.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The importance of education and training for noninvasive ventilation: suggestions from the literature p. 435
Barbagelata Elena, Perazzo Tommaso, Ferraioli Gianluca, Santo Mario, Nicolini Antonello
DOI:10.4103/ejim.ejim_45_19  
Noninvasive ventilation (NIV) is a commonly used respiratory support. The use of the NIV is expanding over time and, but its knowledge and skills are very important for the proper use of this life-saving support. This study aims to evaluate the available evidences for the education and training of NIV. There are no clinical trials examining the impact of education and training of the NIV as the primary objective. However, few studies with indirect evidences, and evidence from a simulation-based training, and some reviews were found. Organized training to increase NIV skills is also limited mostly within few developed countries. Education and training in NIV have the potential to increase knowledge and skills of the staff. The development of organized education and training program in NIV appears to be the need in several types of disciplines and care environments.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES Top

Evaluation of the Sabadell noninvasive hepatitis C-related cirrhosis early detection index and right lobe diameter to albumin ratio in the prediction of presence of varices in Egyptian cirrhotic patients p. 442
Ghada M Kamal, Amr M Zaghloul, Rania El Aref
DOI:10.4103/ejim.ejim_61_18  
Introduction Portal hypertension in cirrhosis results from progressive fibrotic remodeling of the liver, which increases the resistance to hepatic sinusoidal blood flow. Increased portal venous pressure causes esophageal and gastric varices, which contribute substantially to cirrhosis-related morbidity and mortality. The gold standard in the diagnosis of varices is esophagogastroduodenoscopy, but identification of noninvasive predictors of esophageal varices (OVs) will allow upper gastrointestinal tract endoscopy to be carried out only in a selected group of patients. Different noninvasive parameters including clinical, laboratory, and sonographic predictors are an alternative approach to perform selective screening endoscopy only in patients at high risk. Objective Our objective is to evaluate whether the noninvasive hepatitis C-related cirrhosis early detection (NIHCED) score and the right lobe diameter to albumin ratio can predict the presence of OVs in a group of Egyptian cirrhotic patients. Patients and methods Seventy-five patients with liver cirrhosis were enrolled in the study depending on the clinical evidence of stigmata of chronic liver disease (e.g. jaundice, ascites, palmar erythema, spider naevi, etc.) and ultrasonographic features of liver cirrhosis (e.g. coarse echo texture, shrunken liver, etc.). Results According to the esophagogastroduodenoscopy results, the patients were categorized into two groups: those with OVs (47 patients, 63%) and those without OVs (28 patients, 37%). Receiver operating characteristic curve analysis of the NIHCED score was applied to both groups with a cutoff score of more than 45. The estimation cohort study had a sensitivity of 70%, specificity of 78%, and diagnostic accuracy of 74% with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval, 0.66–0.86). Receiver operating characteristic curve analysis of the right lobe diameter to albumin ratio was applied to both groups with a cutoff score of more than 2.80. The estimation cohort study had a sensitivity of 80%, specificity of 53%, and diagnostic accuracy of 67% with an area under the receiver operating characteristic curve of 0.67 (95% confidence interval, 0.55–0.77). Conclusion The NIHCED score and right lobe diameter to albumin ratio are simple noninvasive predictors of the presence of varices in Egyptian patients with liver cirrhosis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Noninvasive prediction of hepatitis C-associated hepatocellular carcinoma using circulating apolipoproteins p. 451
Hasan El Garem, Gamal Esmat, Rabab Salama, Hanan Fouad, Dina Sabry, Yomna Mostafa, Dalia Omran, Heba Omar
DOI:10.4103/ejim.ejim_26_19  
Background and aims Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. We investigated the potential usefulness of circulating apolipoproteins (Apo-A1 and Apo-A4) in HCC screening and diagnosis. Patients and methods We included 60 adult patients with hepatitis C virus-related chronic liver disease including HCC, in addition to 20 healthy controls. Patients were stratified into three equal groups, with 20 patients each: chronic hepatitis C, posthepatitis C cirrhosis (liver cirrhosis), and HCC. All patients and controls underwent full clinical assessment, laboratory investigations, and evaluation of candidate apolipoproteins by enzyme-linked immunoassay. Results Significantly higher Apo-A1 and Apo-A4 levels were detected in patients with HCC than in those with liver cirrhosis (P<0.001). Receiver operator characteristic curve showed that for HCC diagnosis, a cutoff of 78.6 mg/dl for Apo-A1 yielded 90% sensitivity and 100% specificity and a cutoff of 16.5 mg/dl for Apo-A4 yielded 85% sensitivity and 80% specificity. Furthermore, within HCC group, Apo-A1 was significantly higher in patients with small HCC (>2 cm) than those with large tumors (P=0.01). Lower Apo-A1 level correlated significantly with pylethrombosis (P=0.007). Conclusion Apo-A1 and Apo-A4 are novel biomarkers for HCC screening and diagnosis, with a special discriminative ability for Apo-A1 for those with small tumors and those with pylethrombosis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Role of different direct-acting antiviral drugs on hepatitis C virus-associated mixed cryoglobulinemia in Egyptian patients p. 458
Tarek A Elshazly, Amr M Elrabat, Sahar A.M Ali, Muhammed Diasty, Mohamed El-Desoky
DOI:10.4103/ejim.ejim_41_19  
Background Several extrahepatic manifestations have been reported and mixed cryoglobulinemia is a clonal disorder of B cells which is strongly associated with hepatitis C virus (HCV). New regimens of direct-acting antiviral agents (DAAs) have recently been approved for the treatment of genotype 4 HCV which offer improved results of sustained virologic response (SVR) in the treatment-naive and previously treated patients. Aim To assess the prevalence of cryoglobulinemia for evaluating the efficacy of DAA therapy on it. Patients and methods Patients received one of the following regimens: sofosbuvir, daclatasvir±ribavirin, or sofosbuvir plus ledipasvir±ribavirin follow-up for 24 weeks after treatment. Results A total of 132 patients were involved in our study: 65 men and 67 women. Cryocrit-positive patients clinically presented with clinical manifestations in 32 (53.3%) patients out of the 60 patients. After 12 weeks of DAAs treatment, there was a significant reduction in cryoprecipitate level and rheumatoid factor (RF) level with improvement of glomerular filtration rate, basal C4, and clinical improvement of purpura, Raynaud’s phenomenon, and this was the same when 38 patients continued treatment for 24 weeks. However, comparing 12 and 24-week therapy showed significant improved difference in cryoprecipitate level but improved glomerular filtration rate, basal C4, and decreased level of RF, proteinuria, purpura, and peripheral neuropathy although it did not reach statistical significance Conclusion Cryocrit-positive patients were old age, cirrhotics with long duration of HCV. There is significant improvement of both laboratory and clinical parameters of cryoglobulinemia after SVR12 and more significant after SVR24. There is no significant difference in using different DDA regimen with or without ribavirin on the SVR at either 12 or 24 weeks. So, we advise basal laboratory and clinical parameters of mixed cryoglobulinemia before designing treatment regimens of HCV patients in Egypt.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Value of serum fibronectin for assessment of liver fibrosis in chronic hepatitis C virus patients p. 465
Ahmed A Ghafar, Elsayed Ghoneem, Ramy H Agwa, Ahmed Akef, Ahmad S.H Hasan, Nahed Abdallah
DOI:10.4103/ejim.ejim_46_19  
Background The stage of liver fibrosis is the most important predictive factor for initiation and duration of antiviral treatment, where patients with early fibrosis stages respond to treatment better with a higher sustained virologic response rate. Several noninvasive tests to stage the degree of fibrosis in patients with chronic hepatitis C virus (HCV) infection have been used. No single test is known to have high accuracy and the results of each test must be carefully interpreted. The objective of the study is to evaluate the value of serum fibronectin (FN) as a noninvasive predictor for the assessment of HCV-induced liver fibrosis. Patients and methods A total of 100 patients with chronic HCV infection proved by HCV antibodies and HCV RNA preparing for antiviral treatment were exposed to full history, physical examination, and laboratory assessment. Serum FN level and fibroscan were done for all patients. According to the results of fibroscan, the patients were divided into four groups of liver fibrosis and compared. Results All patients were proved to have HCV viremia with average PCR of 1990.52±3144.29 copies/ml. A statistically significant difference was found as regards FN, fibroscan, and APRI score between patients with fibrosis in comparison to patients without fibrosis. According to fibroscan results, 20 patients were found with fibrosis stage 0, 24 patients with stage 1, 24 patients with stage 2, eight patients with stage 3, and 24 patients with stage 4 (cirrhosis). On comparison of different stages of fibrosis as regards FN level, we found no statistically significant difference between stages. FN have a sensitivity of 67.5% and a specificity of 47.4% with 84.4% positive predictive value. Conclusion FN is a good noninvasive marker for the assessment of liver fibrosis in patients with chronic HCV. Larger scale multicenter studies are needed to assess its validity in the detection of fibrosis caused by causes other than HCV.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effect of direct-acting antivirals on elastographic measures in patients with chronic hepatitis C virus infection p. 473
Mohamed M Sakr, Ahmed I El-Agrody, Hesham A Farrag
DOI:10.4103/ejim.ejim_43_19  
Background Hepatitis C virus (HCV) infection is a worldwide health problem. Liver fibrosis has been a major topic of research for decades. However, recent data have shown the occurrence of fibrosis fall in a wide spectrum of chronic liver diseases. Aim We aimed to evaluate the changes in transient elastography (TE) values of different direct-acting antivirals regimens in HCV chronic liver disease patients. Settings and design This observational analytic study was carried out at the Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. Participants and methods 100 Egyptian chronic hepatitis C patients were recruited into this study. All participants were included according to the inclusion criteria approved by the national committee in Egypt for control of viral hepatitis. They were subjected to a thorough assessment of history and clinical examination, routine investigations, ECG, radiological examination, and TE 2 weeks before treatment initiation, at the end of the course, and 6 months after treatment. Results There was a significant improvement in liver stiffness (LS) values in cirrhotic patients, but they still had cirrhosis, with lower LS values than pretreatment values. This study reported a significant decrease 12 weeks after the end of treatment for LS measurements and validated fibrosis scores such as FIB-4 and APRI. Patients with F4 grade fibrosis showed a significant improvement in the score, and the percentage decreased from 56% before treatment to 42 and 38% after sustained virological response 1 and sustained virological response 2, respectively. Conclusion Direct-acting antivirals based treatment results in a significant improvement in hepatic fibrosis measures, indicated by TE as well as noninvasive fibrosis scores such as fibrosis score (FIB-4) and APRI.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Value of endoscopic ultrasound in prediction of dysplasia in ulcerative colitis p. 480
Amr M Elrabat, Neveen F Ibraheem, Maha M Maher, Fatma A Abozeid, Maha A Abelrahman
DOI:10.4103/ejim.ejim_53_19  
Background Ulcerative colitis (UC) is one of the most common forms of chronic inflammatory bowel disease. Its diagnosis is based on history, clinical, radiological, laboratory, endoscopic, and histological examinations. Endoscopic ultrasound (EUS) is a highly accurate diagnostic endoscopic and radiological modality for assessing of rectal pathology. However, EUS data remain scarce for patients with UC. The aim of this study was to assess the correlation between EUS indices and clinical, endoscopic, and histological scores of inflammation in UC and to evaluate the usefulness of EUS in assessing the activity and dysplasia of UC. Patients and methods A total of 57 patients with UC were cross-sectionally evaluated based on clinical (Truelove score), laboratory [complete blood count (CBC), c reactive protein (CRP), erythrocte sedementaion rate (ESR), and fecal calprotectin], and endoscopic (Mayo score) parameters. The patients were divided into three groups: mild UC, moderate UC, and severe UC. They were subjected to EUS at 10, 20, and 30 cm from the anal verge to assess the correlation between severity of UC and histopathological examination results. Results Total wall thickness (TWT) at 10 cm from the anal verge was positively and highly significantly correlated to histopathological severity in comparison with 20 and 30 cm from anal verge (P=0.001). TWT at 10 cm by EUS was a significant predictor of the histopathological severity of UC (P=0.007). For TWT of the colon at 10 cm from the anal verge, significant discrimination (P=0.02) between severe UC and mild to moderate UC could be achieved by utilizing a cutoff of 3.5 mm with sensitivity of 60.5% and specificity of 85.7%. In addition, highly significant (P=0.006) discrimination of mucosal dysplasia in UC could be achieved using TWT cutoff of 5.05 mm at 10 cm from the anus with sensitivity of 75% and specificity of 94.3%. Conclusion For EUS at 10 cm from the anal verge, TWT cutoff of 3.5 mm can assess histopathological severity of UC, and TWT cutoff of 5.05 mm can predict dysplasia in UC.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Detection of fundic varices obturation by endoscopic ultrasound versus multidetector computed tomography p. 487
Amr Elrabat, Salah El-Gamal, Mohammad M Kashwaa, Mohamed M El-Rakhawy
DOI:10.4103/ejim.ejim_57_19  
Background Gastroesophageal varices (GVs) present in 50% of patients with liver cirrhosis. GVs bleed at a rate of 5–15%, and the 6-week mortality after hemorrhage is 20%. GVs are treated with a tissue adhesive, cyanoacrylate, where repeated sessions are performed 2–4 weeks until obliteration, and eradication is achieved with 2–4 injections using 1–2 ml/ session. Endoscopic ultrasonography (EUS) was found superior to endoscopy in detecting gastric varices. Gastric varices obturation can be detected using CD-EUS to assess blood flow in variceal lumen after cyanoacrylate injection. Multidetector computed tomography (MDCT) is an acceptable imaging modality for abdominal vascular system and assessment of endoscopic therapy of fundal varices. To our knowledge, there is no study for detecting GV obturation yet. The aim of this study to compare between EUS and MDCT in detecting obturation of GV and comparing EUS and upper endoscopy in detection of GV obturation. Patients and methods A total of 22 patients with liver cirrhosis presented with acute GV bleeding for the first time, which was confirmed and managed by upper endoscopy, being carried out in the first 12 h after admission. Then the patients were subjected to monthly gastric varices injection of cyanoacrylate until they appeared to be obturated by upper endoscopy using blunt end of injection catheter sheath to palpate varices. After that EUS and CT were done for evaluation of GV, in addition to perigastric and paragastric collaterals. Results EUS is superior to CT in detecting GV obliteration, with a high significant difference (P=0.04), whereas EUS and upper endoscopy have similar results in detecting the obliteration of GV (P=0.68). There was a statistically significant association between splenic size and GV obliteration (P=0.002) and a significant negative correlation between size of paragastric collaterals and GV obturation. Conclusion EUS is superior to CT in detecting the obliteration of GV.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Sustained virological response 12 versus sustained virological response 24 as evaluation endpoints in chronic hepatitis C virus Egyptian patients treated with sofosbuvir-based regimens p. 495
Maha M Elsabaawy, Khalid Gameel, Heba Eldemerdash, Talaat Zakareia, Mahmoud Eltahawy, Marry Albert, Marwa Fekry, Enas Ouda, Helmy Elshazly, Ashraf Eljaky
DOI:10.4103/ejim.ejim_80_19  
Background The recommended reliance on 12 weeks posttreatment sustained virological response (SVR12) instead of SVR24 was validated for treatment evaluation. Aim Judging claimed concordance between SVR12 and SVR24. Patients and methods In a prospective study, 91 patients received sofosbuvir (SOF)+interferon+ribavirin (RV) for 12 weeks; 52 patients received SOF+RV for 24 weeks; and 56 patients received SOF+simeprevir for 12 weeks. Demographic and laboratory data, transient elastography, treatment regimens, hepatitis C virus RNA at week 4, week 12, and SVR12 and were reported. Patients who failed to achieve undetectable hepatitis C virus RNA at the end of therapy were excluded. Results Concordance between SVR12 and SVR24 was 96.5%, with a positive predictive value of 96.4%. Regarding treatment groups it was found to be 95.6% for SVR24 in SOF+interferon+RV-treated patients, 94.2% in SOF+RV-treated patients, and 100% concordance in SOF+simeprevir-treated patients with insignificant values (P=0.2). In spite of nonsignificance, the reported seven (3.5%) relapsers were mainly male gender (five cases, P=0.9), naïvely treated (five cases, P=0.6), achieved rapid virological response (five cases, P>0.005), with advanced fibrosis (F4) by fibroscan (five cases, P=0.7). Regression analysis failed to detect any predictors of relapse. Conclusion In spite of the high grade of concordance between SVR12 and SVR24, the reported rate of relapsers necessitates the backward commitment to SVR24 as a reliable primary endpoint of treatment response evaluation.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Usefulness of serum osteopontin level as a noninvasive parameter of portal hypertension p. 502
Ayman M Fouad, Nagwa Ramadan, Iman A.E Shaheen, Mohammed A Ismael
DOI:10.4103/ejim.ejim_91_19  
Background Osteopontin (OPN) is a multifunctional protein that is physiologically expressed in the kidney and bone. Plasma OPN levels were shown to predict liver fibrosis in various chronic liver diseases and could be related to the degree of portal hypertension. The aim of the study is to investigate the usefulness of OPN as a noninvasive biomarker of portal hypertension. Patients and methods A case–control study including 90 (45 patients with confirmed liver cirrhosis and 45 normal healthy individuals) patients were enrolled in the study. Laboratory investigations with abdominal ultrasound and duplex of the portal system were carried out for all patients. OPN was measured using the enzyme-linked immunosorbent assay in the plasma. Results Compared with controls, the plasma levels of OPN in cirrhotic patients were significantly high (P<0.001). Also, plasma levels of OPN were significantly high in patients with portal hypertension (P<0.001). The cutoff value of OPN to detect the presence of portal hypertension is 1.65 ng/ml with sensitivity and specificity of 80 and 95.6%, respectively). Conclusion Serum OPN is a good noninvasive parameter to detect portal hypertension.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Predictors of myocardial injury in patients with cirrhosis presenting with upper gastrointestinal bleeding p. 508
Rehab Shaheen, Tarek Gouda, Monir Bahgat, Tarek Selim, Hazem Hakim El-Beltagy El-Menshawy, Elsayed Awad
DOI:10.4103/ejim.ejim_71_18  
Background Myocardial injury in conditions other than coronary artery disease (CAD), known as type 2 myocardial infarction, is mostly related to mismatch between myocardial oxygen supply and demand. Cirrhotic patients with acute upper gastrointestinal bleeding (UGIB) are usually hemodynamically unstable. Hypovolemia, hypotension, and decreased oxygen-carrying capacity as consequences of UGIB may precipitate subclinical heart failure and myocardial injury. Aim of work Assessment of the prevalence and potential risk factors of myocardial injury in patients with liver cirrhosis with acute UGIB. Patients and methods The study was conducted on 132 patients diagnosed with liver cirrhosis presenting by UGIT bleeding at Mansoura University Hospitals during one year. Patients were divided into 2 groups: group 1 (76 patients) with myocardial injury or ischemic heart disease and group 2 (60 patients) without. Results The incidence of myocardial injury in this study (elevated troponin levels above cutoff value and/or ECG changes) was 55% of patients. Troponin I was positive in 25% of patients. ECG ischemic changes were found in 36.3% of patients in the form of ST-segment deviation or T-wave inversion. On univariate analysis, predictors of myocardial injury in patients with UGIB included MELD score and variceal source of GI bleeding. On multivariate analysis variceal source of GI bleeding is an independent predictor of myocardial injury. Variceal bleeding was found in 95 % of the ischemic group versus 63% in the other group. Conclusion More than half of the study patients presented with UGIB have suffered from unnoticed subclinical myocardial injury. Variceal source of GI bleeding was found to be an independent predictor of myocardial injury.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum omentin-1 as a predictor of activity in Crohn’s disease p. 514
Mohammed A Mohammed, Nesreen M Omar
DOI:10.4103/ejim.ejim_82_19  
Background and aim Crohn’s disease (CD) is associated with alterations in fat mass and fat distributions, with changed productions of adipokines, including omentin-1. Omentin-1 may be involved in the pathogenesis of inflammatory bowel disease. The aim was to determine the serum and mucosal omentin-1 levels in CD patients and to evaluate its potential as a marker for disease activity. Patients and methods Seventy-five adult consecutive outpatients, with a confirmed diagnosis of CD, and 45 age-matched, sex-matched, and BMI-matched healthy volunteers were enrolled in this study after written conscious consent and approval by the Institutional Review Board of Mansoura University. CD was diagnosed by conventional clinical, radiological, endoscopic, and histopathological criteria. Serum levels and mucosal mRNA expression of omentin-1 were measured by commercially available kits according to the manufacturer’s protocols. Results Serum omentin-1 and its mucosal gene expression were significantly lower in patients with CD (53.3±12.8) than in healthy controls (72.7±16.8, P˂0.0001). Moreover, serum omentin-1 levels were significantly lower in patients with active CD (36.2±9.6) than in patients in remission (69.2±14.4, P≤0.0001). No significant differences were demonstrated between patients in remission and healthy controls (P>0.05). In CD patients, the decrease in serum omentin-1 was associated with a significantly higher BMI, C-reactive protein, erythrocyte sedimentation rate, Crohn’s disease activity index, simplified endoscopic score for CD and inflammation scores (P≤0.05). Moreover, omentin-1 was much superior to C-reactive protein in predicting CD activity and severity. Conclusion Serum and mucosal expression of omentin-1 might be a reliable surrogate noninvasive marker of disease activity in CD with significantly high sensitivity, specificity, and diagnostic accuracy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The prevalence of Helicobacter pylori cagA (+ve) among patients with gastric cancer: an Egyptian study p. 522
Ahmed N El Mazny, Tarek Hishmat, Ahmed Hussein, Doaa Gaith
DOI:10.4103/ejim.ejim_66_19  
Introduction and aims Gastric cancer is currently the second most common cause of cancer-related death in the world and the fifth most common cancer and the fourth leading cause of cancer-related death in Europe. It has been evident for more than the past 20 years that Helicobacter pylori is involved in the development of gastric adenocarcinoma. The cagA gene of H. pylori is the main virulence factor that leads to the development of gastric adenocarcinoma through the derangement of cellular architecture and signaling. The objective of our work is to study the prevalence of cagA among patients with gastric cancer. Patients and methods This descriptive study was done on 60 patients with gastric cancer underwent serum anti-H. pylori IgM and anti-cagA IgG assessment, computed tomography, upper endoscopy, and biopsy taking, and if needed, computed tomography-guided biopsy, followed by histopathological examination. Results A total of 34 (56.67%) patients were cagA +ve and 26 (43.33%) patients were cagA −ve, with no statistically significant difference regarding sex or age. Conclusion H. pylori cagA plays a significant role in development of gastric cancer, so we recommend not only H. pylori screening but also cagA virulence strain.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Can hepatitis C virus core antigen replace quantitative RNA in the assessment of a sustained virologic response? p. 529
Nevine I Musa, Eslam Safwat, Ramy S Ghait, Heba Aly, Dalia H Abdelhamid
DOI:10.4103/ejim.ejim_88_19  
Background The widespread use of direct-acting antivirals (DAAs) in the treatment of hepatitis C virus (HCV) infection has reduced the need for monitoring HCV-RNA levels because viral kinetics do not predict a sustained virologic response (SVR). However, the performance of cheaper tests, such as the assay to quantify hepatitis C virus core antigen (HCV Ag), has not been determined. Our aim was to assess the accuracy of the HCV core Ag test in predicting the achievement of SVR and its predictive value as a monitoring test in the course of treatment. Patients and methods This prospective study was carried out on 90 patients, chronically infected with HCV, who received DAA therapy. Blood samples were collected and the levels of HCV core Ag and HCV-RNA were measured at baseline and at 12 weeks after the end of treatment. We compared the ability of these assays to predict which patients would achieve SVR12. Results The baseline level of HCV-RNA was 1 688 529.6±994 697.3 IU/ml (range: 312 700–3 491 100 IU/ml) and HCV core Ag was 179.2±83.5 pg/ml (range: 33.5–315.6 pg/ml). HCV Ag became undetectable in 92.2% 12 weeks after the end of treatment, whereas HCV-RNA became undetectable in 87.8% at the end of treatment (P<0001). Seventy-nine out of 90 (87.8%) patients achieved SVR12; the test for HCV Ag identified 63.6% of these patients. Conclusion Measurement of HCV core Ag can monitor the efficacy of DAA therapy for HCV infection. Thus, it can be applied in clinical practice.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Noninvasive parameters for assessment of esophageal varices p. 536
Ehab A.A Elatty, Elsayed I Elshayeb, Mohammed H Badr, Waleed A.E Mousa, Mohammed F El Mansory
DOI:10.4103/ejim.ejim_25_19  
Objective This study aims to assess esophageal varices (EV) by noninvasive parameters in patients with liver cirrhosis. Background The current guidelines recommend the screening of all cirrhotic patients by endoscopy for EV, but repeated endoscopic examinations are unpleasant for patients and have a high cost impact and burden on endoscopic units. Therefore, there is a particular need for noninvasive predictors of EV. Patients and methods A total of 120 cirrhotic patients were enrolled in this study and were divided into three groups: 40 cirrhotic patients with EV and a history of upper gastrointestinal bleeding, 40 cirrhotic patients with EV without a history of upper gastrointestinal bleeding, and 40 cirrhotic patients without EV. All patients in the study were subjected to an assessment of history, clinical examination, routine laboratory investigation, abdominal ultrasound, and upper gastrointestinal endoscopy. Results Serum albumin at cut-off less than 3.65 g/dl, platelet count at cut-off less than 99 000/mm3, platelet count/spleen diameter ratio (PC/SD) at cut-off less than 919.6, aspartate aminotransferase-to-platelet ratio index at cut-off greater than 1.14, spleen longitudinal diameter at cut-off more than 140.5 mm, portal vein diameter at cut-off more than 15.2 mm, and prothrombin time at cut-off more than 15.1 s are significant in the prediction of EV. North Italian Endoscopy Club Index at cut-off more than 25.4, platelet count at cut-off less than 74 000/mm3, and PC/SD at cut-off 851.6 are significant in the prediction of variceal bleeding risk. Conclusion Serum albumin, platelet count, PC/SD ratio, aspartate aminotransferase-to-platelet ratio index, spleen longitudinal diameter, portal vein diameter, prothrombin time, and Child score can provide information that can help in the prediction of the presence of EVs in patients with liver cirrhosis. North Italian Endoscopy Club Index, platelet count, and PC/SD ratio can provide information that can help in the prediction of variceal bleeding risk in patients with liver cirrhosis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Bile carcinoembryonic cell adhesion molecule 6 as a potential diagnostic tool for malignant biliary stenotic lesions p. 544
Mohamed Abd-Elhakim Mahdy, Lobna Abdel Wahid, Alaa S Abd-Elkader, Ramy A Hassan, Hanan M Ahmed
DOI:10.4103/ejim.ejim_107_19  
Aim Validate the biliary carcinoembryonic antigen-related cell adhesion molecule 6 in differentiating malignant from benign biliary lesions. Background The nature of biliary stenosis needs to be diagnosed early and accurately to give the patient the best chance of therapy. Imaging techniques still lack the high accuracy for this purpose. Different biomarkers were postulated to increase the diagnostic accuracy, and of them, carcinoembryonic cell adhesion molecule 6 (CEAM6) in bile was investigated in this study. Patients and methods Forty-four patients with biliary stenosis were enrolled in this prospective study in Assiut University Hospital from 2017 to 2019. CEAM6 concentration in bile and serum was measured using human carcinoembryonic antigen-related cell adhesion molecule 6 ELISA kit from SinoGeneClon Biotech Co. Ltd, and CA19-9 concentration in serum was assessed by the ELISA kit for CA19-9 from USCN Life Science Inc. Results The area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of bile CEAM6 for diagnosis of stricture type among the study population were 0.841, 83, 74, 77, 82, and 78.5%, respectively, at a cut-off value of 6.15 ng/ml. Multivariate analysis showed age, CEAM6, CA19-9, and alkaline phosphatase as good predictors of malignancy. Conclusion CEAM6 in bile could be a good diagnostic tool to detect the nature of biliary stenosis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Gastroduodenal pathology in the light of Helicobacter pylori genotype in Egyptian patients p. 550
Eman Azzam, Ezzat Ali, Shwikar Ahmed, Ahmed Talha
DOI:10.4103/ejim.ejim_99_19  
Context Infection with Helicobacter pylori is associated with gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. Aim The aim of this study was to detect the nature of gastroduodenal pathology in the light of the genotype of the associated H. pylori organism. Materials and methods The study was conducted on 100 patients with upper gastrointestinal tract symptoms; infection with H. pylori was detected by stool antigen test. Moreover, 20 asymptomatic patients, infected with H. pylori, were included in the study as controls. Upper gastrointestinal tract endoscopy was performed in all participants to take biopsies to diagnose the disease microscopically and to determine H. pylori virulence factors [cytotoxin-associated protein A (CagA) and VacA] by PCR. Results Patients infected by H. pylori organisms having CagA-positive genes (41 patients) developed gastritis in 53.7%, peptic ulcer disease (PUD) in 36.6%, and gastric malignancy in 9.8%. Patients infected with organisms that have VacA s1 in addition to CagA genes (19 patients) were found to have gastritis in 21.1%, PUD in 63.2%, and gastric malignancy in 15.8%. However, patients infected with H. pylori organism that have VacAs2 in addition to CagA genes (34 patients) developed gastritis in 79.4%, PUD in 20.6%, and no malignancy. Discussion The presence of VacA s1 gene in addition to CagA significantly increases the virulence of the organism toward development of PUD and gastric malignancy. The presence of VacA s2 gene significantly decreases the virulence of CagA gene to develop PUD and prevent completely its carcinogenicity.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Noninvasive assessment of hepatic fibrosis regression in hepatitis C virus-infected patients treated with sofosbuvir-based therapy p. 556
Ahmed Al-Khattib, Adham El-Nakeeb, Nevine I Musa, Kerolous B.A. Dous, Heba Aly
DOI:10.4103/ejim.ejim_92_19  
Background Accurate evaluation of the degree of liver fibrosis in patients with chronic liver diseases is crucial to make therapeutic decisions and to determine the prognosis of liver disease and also the protocol of further follow-up. Multiple noninvasive methods have been used successfully in the prediction of fibrosis; however, early changes in noninvasive parameters of hepatic fibrosis after effective antiviral therapy are still not well unknown. The aim of the paper was to evaluate early changes in the hepatic fibrosis-related parameters in patients with chronic hepatitis C virus (HCV) infection using shear wave elastography (pSWE) and serum parameters [aspartate aminotransferase-platelet ratio index (APRI) and fibrosis-4 score (FIB4)] before and 24 weeks after sofosbuvir-based antiviral therapy. Materials and methods This is a prospective cohort study that included 109 Egyptian patients with chronic hepatitis C. pSWE values were recorded as well as APRI and FIB4 scores were calculated at baseline and at 12 and 24 weeks after treatment. Results A total of 109 HCV-infected patients were included, with mean age of 45.76±13.91 years. Overall, 25 (22.90%) patients had cirrhosis and were treated with sofosbuvir 400 mg/day, daclatasvir 60 mg/day, and weight-based ribavirin. Moreover, 84 (77.10%) were treated with sofosbuvir 400 mg/day and daclatasvir 60 mg/day. The overall sustained virological response-12 rate was 100%. There were significant improvements in APRI score (from 0.64±0.66 at baseline to 0.26±0.22 at 24 weeks after treatment) and FIB4 score (from 1.77±1.77 at baseline to 1.11±1.04 at 24 weeks after treatment), with P value of 0.0001 in both. In addition, there was a significant reduction in liver stiffness measurements by pSWE 24 weeks after treatment (from 1.72±0.55 m/s at baseline to 1.48±0.44 m/s at 24 weeks after treatment, with P=0.003). Conclusion Sofosbuvir-based treatment regimens for chronic HCV infection result in significant improvement of the fibrosis scores (FIB4 and APRI) 24 weeks after treatment. Moreover, there was a significant reduction in the liver stiffness measurements by pSWE.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Fecal B-cell-activating factor as a new noninvasive marker in the evaluation of ulcerative colitis Egyptian patients: a comparative cross-sectional study p. 563
Hany A Hussein, Rasha S Mohamed
DOI:10.4103/ejim.ejim_118_19  
Background and aim Diagnosis of ulcerative colitis (UC) is suspected clinically and confirmed through endoscopic biopsy. It can be followed-up and assessed by noninvasive biomarkers such as fecal calprotectin. Recently, B-cell-activating factor (BAFF) has been proposed to be a regulator of B-cell and T-cell immune responses and to be associated with inflammatory processes in autoimmunity. The aim of our study was to clarify the role of fecal BAFF as a simple predictor for disease activity and severity in patients with UC. Patients and methods Fifty Egyptian patients with UC were divided into two groups: group I including 40 patients with active UC (newly diagnosed) and group II including 10 patients with inactive UC (previously diagnosed); disease activity was assessed according to the Mayo activity scoring index; fecal BAFF and fecal calprotectin were measured for all patients using enzyme-linked immunosorbent assay. Results Significantly higher levels of Fecal BAFF and fecal calprotectin were found among patients with active UC, as compared with inactive UC patients. Fecal BAFF more than or equal to 50 μg/g had 97.5% sensitivity and 100% specificity in predicting disease activity in comparison with fecal calprotectin, which had a sensitivity and specificity of 90% at a cut off value more than or equal to 47 μg/g. In predicting disease severity, fecal BAFF more than or equal to 340 μg/g had a sensitivity of 95% and specificity of 100%, while fecal calprotectin more than or equal to 170 μg/g had a sensitivity of 80% and specificity of 95%. Conclusion Fecal BAFF is more sensitive and specific in predicting UC activity and severity than fecal calprotectin.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Association between 25-hydroxyvitamin D and hemoglobin A1c levels in patients with type 2 diabetic kidney disease p. 573
Haitham A Azeem, Arafa I Mohammed, Alaa M Hashim
DOI:10.4103/ejim.ejim_65_18  
Introduction Vitamin D is suggested to influence glucose homeostasis. An inverse relationship between serum 25‐hydroxyvitamin D (25(OH)D) and glycemic control in non-chronic kidney disease (CKD) patients with type 2 diabetes was reported. We aimed to examine this association among type 2 diabetes patients with CKD. Objectives To examine the relation between plasma 25-hydroxyvitamin D3 (25(OH)D3) levels and glycemic state in diabetic patients at various stages of CKD. Patients and methods A total of 70 participants (40 men and 30 women) with a mean age of 65.3±11.5 years suffering from type 2 diabetes mellitus with various stages of CKD were recruited. Blood for glycated hemoglobin (HbA1c), serum 25(OH)D3, renal profile, and estimated glomerular filtration rate was drawn at enrollment. Correlation and regression analyses were carried out to assess the relationship of serum 25(OH)D, HbA1c, and other metabolic traits. Results Our study shows the following results: Most of the participants are urban with age range from 50 to 70 years. Forty percent of the participants are with good glycemic control, 30% with moderate control, and 30% with bad control. Fifty percent of the patients were at CKD stage 3. Stage 5 patients differed significantly from stages 1 to 4 patients where they were younger, with lowest mean HbA1C value and a much higher mean 25(OH)D level (around twice of stage 1 patients). Half of the cases are vitamin D deficient, nearly a third of them are insufficient, and about 20% are sufficient. The level of 25(OH)D3 correlates inversely with the level of HbA1C irrespective of estimated glomerular filtration rate or the age of the patients. Conclusion The present study reported a significant inverse relationship between serum 25(OH)D3 and HbA1c levels in type 2 diabetics with suboptimal glycemic control and concomitant different stages of CKD.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The significance of bariatric surgery in Egyptian patients with metabolic syndrome: a multicenter study p. 580
Mohamed A.A Bassiony, Mohamed S Mohamed, Marwan N Elgohary, Abdelrahman M.H Nawar, Emad M Abdelrahman, Ahmed A Elshoura
DOI:10.4103/ejim.ejim_89_19  
Background Obesity and metabolic syndrome (MS) are global health concerns, with high rates of cardiovascular morbidity and mortality. The current guidelines recommend lifestyle modifications as the best initial treatment for obesity and MS. However, lifestyle interventions have modest effects and high 1-year failure rates. Bariatric surgery offers more weight loss with sustained effect in the long term. Aim The aim was to assess the effect of bariatric surgery on MS and all its components and to detect the probable risk factors for persistent MS after bariatric surgery in Egyptian patients. Patients and methods This prospective multicenter study included 250 obese patients who underwent bariatric surgery and completed 1 year of postoperative follow-up. The patients were evaluated preoperatively and at 1, 6, and 12 months postoperatively for presence of MS and its components according to criteria of the third report of National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III). Results and discussion After 1 year of follow-up, the percentages of patients who had MS, obesity, type 2 diabetes mellitus, hypertension, hypertriglyceridemia, and low high-density lipoprotein-cholesterol were significantly decreased from 92, 100, 84, 50, 74, and 50% to 17, 2, 8, 17, 42, and 25%, respectively. Smoking, family history of obesity, and less percentage of excess weight loss were the most important risk factors for persistence of MS after bariatric surgery.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The incidence of type 2 diabetes in patients with bronchial asthma p. 587
Ula M Al-Jarhi, Amira I Mostafa, Alshaimaa R.L.R Alnaggar
DOI:10.4103/ejim.ejim_134_19  
Background The effect of bronchial asthma on development of new-onset type 2 diabetes has not been studied. Aim The aim was to study the association of bronchial asthma and its severity with the incidence of type 2 diabetes after 5 years in patients without diabetes at the disease onset. Patients and methods A total of 200 consecutive patients with a physician diagnosis of bronchial asthma (120 not known to be diabetic and 80 known to have diabetes) presenting to the outpatient chest clinic in Kasr Alainy Hospital were included. Fasting blood glucose, 2 h 75 g oral glucose tolerance test, glycated hemoglobin, and lipid profile were done. Spirometry, blood pressure, BMI, and other risk factors of diabetes were sought. Results Of the 120 nondiabetic patients, 30 patients met at least one criterion of prediabetes and 90 patients met at least one criterion of diabetes. Multivariable regression model demonstrated that forced vital capacity (FVC)%, maximal expiratory flow 75%, and inhaled bronchodilators are independent risk factors for elevated glycated hemoglobin, independent of inhaled or oral corticosteroids, family history, blood pressure, BMI, high-density lipoprotein, and triglycerides. Logistic multivariable regression model demonstrated that FVC% and forced expiratory volume in the first second % are independent risk factors for development of new-onset type 2 diabetes (hazard ratio for FVC%: 1.1589, 95% confidence interval: 1.0684–1.2571, P=0.0004; hazard ratio for forced expiratory volume in the first second %: 0.8754, 95% confidence interval: 0.8155–0.9396, P=0.0002). Conclusion The incidence of diabetes and prediabetes in patients with bronchial asthma who are not known to have diabetes at disease onset is 75 and 25%, respectively. Poor pulmonary function tests were independently associated with new-onset diabetes in such patients. This association is linked to the severity of asthma and not related to treatment.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The expression level of microRNA-122 in patients with type 2 diabetes mellitus in correlation with risk and severity of coronary artery disease p. 593
Nearmeen M Rashad, Tamer M Ezzat, Reem M Allam, Mohamad H Soliman, Mohammed S Yousef
DOI:10.4103/ejim.ejim_125_19  
Background Type 2 diabetes mellitus (T2DM) has reached epidemic proportions worldwide. Coronary artery disease (CAD) is one of the most important causes of mortality worldwide. MicroRNAs (miRNAs) modulate gene expression and is involved in the pathogenesis of T2DM and CAD. The objective of the current study was to explore the expression pattern of miR-122 in T2DM with or without CAD. Moreover, we aimed to evaluate the association between miR-122 and risk and severity of CAD in T2DM. Participants and methods This cross-sectional controlled study enrolled 130 patients with T2DM and 110 control group. The enrolled diabetic patients were classified into two groups: seventy patients without CAD and 60 patients without CAD. All patients were investigated using a 12-lead standard ECG, echocardiography, and coronary arteriography. The serum MiR-122 expression profile was measured using quantitative real-time (qRT) PCR. Results miRNA-122 expression levels were significantly higher in T2DM, in particular patients with T2DM with CAD, compared with the control group. Interestingly, miRNA-122 expression levels were positively correlated with cardiometabolic risks and severity of coronary occlusion. Linear regression analysis test showed that miRNA-122 were independently correlated with high-density lipoprotein, ejection fraction, and uric acid. The power of miRNA-122 expression level to diagnose T2DM among studied participants was evaluated using receiver operating characteristic. The area under curve was 0.997 (95% confidence interval=0.993–1.00), with sensitivity of 96.9% and specificity of 99%, and regarding the power for differentiating patients with T2DM with CAD from patients with T2DM without CAD, the area under curve was 0.832 (95% confidence interval=0.763–0.902), with sensitivity of 93.3% and specificity of 96.86%. Conclusion The miRNA-122 expression levels were higher in the T2DM group compared with controls, in particular patients with CAD. The higher levels of miR-122 expression were strongly correlated with cardiometabolic risk factors and severity of coronary occlusion. Therefore, miR-122 expression levels seem to be a noninvasive biomarker for CAD.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Prevalence of undiagnosed thyroid dysfunction in correlation with Helicobacter pylori infection: cross-talk between Hashimoto’s thyroiditis and Helicobacter pylori p. 602
Nearmeen M Rashad, Ahmed F Gomaa
DOI:10.4103/ejim.ejim_2_19  
Background Worldwide, the prevalence of thyroid dysfunction is increasing and it is one of the leading endocrine disorders. The objective of the present study was to assess the prevalence of undiagnosed thyroid dysfunction and its association with Helicobacter pylori (HP) infection and to clarify the association between HP and Hashimoto’s thyroiditis. Patients and methods A cross-sectional study was conducted among 300 unrelated patients; 187 patients had normal thyroid function and 113 patients had thyroid dysfunction. The patients were stratified into one of the following five groups based on the reference of the normal thyroid function test; thyroid-stimulating hormone and free thyroxine were used as the screening tests to diagnose thyroid dysfunction. HP antigen in the stool and antibodies against cytotoxin-associated gene A (cag-A), anti-thyroid peroxidase (anti-TPO) antibodies, and anti-thyroglobulin (anti-TG) antibodies were measured. Results Our results show that the prevalence of thyroid dysfunction was found in 37.6% of the studied population. The most frequent dysfunction was subclinical hypothyroidism (44.4%), followed by overt hypothyroidism (20.6%). Interestingly, the prevalence was higher in association with HP infection diagnosed by HP antigen and cag-A antibodies. There was statistically significant positive correlation between HP antigen and anti-TPO as well as anti-TG. Regarding cag-A. There were statistically significant positive correlations between antibodies against cag-A and anti-TG as well as anti-TPO. Interestingly, stepwise linear regression analysis showed that serum thyroid-stimulating hormone levels were independently correlated with free thyroxine, HP. Conclusion The higher prevalence of thyroid dysfunction as observed in the current study was associated with Hashimoto’s thyroiditis. Further future multicenter studies with a bigger sample size are needed to validate our findings.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Oxidative stress and risk of polycystic ovarian syndrome in women with epilepsy: implications of malondialdehyde and superoxide dismutase serum levels on female fertility p. 609
Nearmeen M Rashad, Waleed M Reda Ashour, Reem M Allam, Yasser S Saraya, George Emad
DOI:10.4103/ejim.ejim_3_19  
Background Epilepsy is a common neurologic disease and has important implications for women’s fertility, as approximately half of the epileptic women have reproductive disorders. Oxidative stress is a key contributor in the pathogenesis of polycystic ovary syndrome (PCOS) and epilepsy. We aimed to investigate the role of malondialdehyde (MDA) and superoxide dismutase (SOD) serum levels as predictors of PCOS in women with epilepsy (WWE) and to evaluate the possible relationship between oxidative stress and epilepsy characteristics as well as clinicomorphological features of PCOS. Patients and methods A cross-sectional study enrolled 130 WWE. They were classified to two subgroups; women with PCOS (n=50) and women without PCOS (n=80) according to Rotterdam criteria. Metabolic markers and markers of PCOS were measured. Serum MDA and SOD concentrations were estimated by enzyme-linked immunosorbent assay. Results Our results revealed higher levels of MDA and SOD in WWE, in particular, women with PCOS. Moreover, serum MDA and SOD levels were significantly positively correlated with PCOS phenotypes. Linear regression test revealed that Low-density lipoprotein cholesterol (LDL) and luteinizing hormone (LH) were the main predictors of serum MDA levels in PCOS, whereas BMI and LH were the main predictors of serum SOD levels. Regarding antiepileptic medication, there were significantly higher levels of MDA and SOD in patients treated with valproic acid compared with the ones treated with carbamazepine. Conclusion The high levels of MDA and SOD among WWE, in particular, women with PCOS, were positively correlated with obesity indices and PCOS phenotypes. Thus, we recommended avoid using valproic acid in women during childbearing period.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Association of new obesity indices; visceral adiposity index and body adiposity index, with metabolic syndrome parameters in obese patients with or without type 2 diabetes mellitus p. 620
Nearmeen M Rashad, George Emad
DOI:10.4103/ejim.ejim_4_19  
Background Obesity is the cornerstone of metabolic syndrome (MetS); it is not possible to use BMI to differentiate between lean mass and fat mass. We aimed to investigate, for the first time, the possible association of new obesity indices; visceral adiposity index (VAI) and body adiposity index (BAI), with parameters of MetS in Egyptian obese patients. Patients and methods This was a case–control study that included unrelated 150 obese patients and 50 healthy controls. Obese patients were then subdivided into two subgroups, nondiabetic patients (n=85) and 65 patients with type 2 diabetes mellitus. We measured the anthropometric measures; BMI, waist/hip ratio, waist/height ratio, BAI, and VAI. Results Among obese patients, we found significant positive correlations between parameters of MetS and obesity indices. Among obesity indiced, the highly significant positive correlations were found between VAI and parameters of MetS. After adjusting for the traditional risk factors, logistic regression analysis test found that the VAI value was the best predictor of type 2 diabetes mellitus in comparison with BMI and BAI. Receiver operating characteristic curve was used to assess the power of obesity indices; the sensitivity and the specificity of BMI were 94.7 and 99.9%, for VAI, they were 74.4 and 99.9%, and, for BAI, they were 83.3 and 58%, respectively. Conclusion BMI is still the most powerful diagnostic tool for obesity. Although, in certain conditions, where there are limitations of using BMI, we can use other obesity indices, VAI and BAI could be used to discriminate cardiovascular risk among obese patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Thyroid dysfunction in obese adults in relation to nonalcoholic fatty liver disease p. 629
Fatema Abu Bakr Abdel-Moez, Ghada A Mohamed, Wael A Abbas, Mohamed A.A Abozaid, Shymaa Mohammed
DOI:10.4103/ejim.ejim_15_19  
Background Hormones of the thyroid gland play an important role in the regulation of various metabolic processes. Disturbances in thyroid hormone concentrations may lead to hyperlipidemia and obesity, thus contributing to nonalcoholic fatty liver disease (NAFLD). Aim To evaluate thyroid dysfunction and determine its possible relationship to NAFLD in obese adults. Patients and methods Our cross-sectional study recruited 100 obese patients, who were subjected to full medical history, physical examination, abdominal ultrasonography, and routine laboratory tests in addition to liver function and thyroid function tests. NAFLD was recognized on the basis of ultrasonographic findings, and in the absence of other causes of liver disease. Results The patients were divided into two groups: group 1 (65 patients) with NAFLD and group 2 (35 patients) without NAFLD. Out of 100 patients recruited into the study, the most common thyroid dysfunction was overt hypothyroidism (22%), followed by (9%) subclinical hypothyroidism. Twenty-six (40%) patients with NAFLD were found to have thyroid dysfunction, of them eight (12.3%) NAFLD patients had subclinical hypothyroidism, and 18 (27.7%) NAFLD patients had overt hypothyroidism. Although prevalence of thyroid dysfunction (whether overt hypothyroidism or subclinical hypothyroidism) was 22 and 9%, respectively, among patients with obesity, there was nonsignificant positive correlation between BMI and thyroid-stimulating hormone (r=0.051 and P=0.612). Multivariate regression analysis showed that fatty liver, obesity index, and dyslipedemia were predictors of thyroid dysfunction in obese patients. Conclusion Thyroid hypofunction is common in obese patients with NAFLD, which has implications for screening for hypothyroidism in patients with NAFLD and for the administration of appropriate therapy for hypothyroidism.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Prevalence, risks, and comorbidity of thyroid dysfunction: a cross-sectional epidemiological study p. 635
Nearmeen M Rashad, Ghada M Samir
DOI:10.4103/ejim.ejim_22_19  
Background Worldwide, the incidence of individuals with thyroid dysfunction is increasing and represents approximately 30–40% of the patients seen in an endocrine clinic. The undiagnosed thyroid dysfunction may adversely affect the metabolic control and add more risk to already predisposing cardiovascular risk factors. Thus, the objective of the present study was to assess the prevalence of undiagnosed thyroid dysfunction and its association with other comorbidities. Patients and methods A cross-sectional study was conducted on 430 patients who attended the outpatient clinic of Diabetes and Endocrinology, the Internal Medicine Department, Zagazig University Hospitals. All patients underwent clinical and laboratory evaluations. A total of 304 patients had normal thyroid function (euthyroid) and 126 patients had thyroid dysfunction, who were stratified into one of the following groups based on the reference of the normal thyroid function test result: hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism. Thyroid-stimulating hormone and free thyroxine were used as the screening tests to diagnose thyroid dysfunction. Results Our results show the prevalence of thyroid dysfunction was 29.3%. Among thyroid dysfunction groups, the prevalence of subclinical hypothyroidism was 44.4%, hypothyroidism was 20.6%, hyperthyroidism was 19.2%, and subclinical hyperthyroidism was 15.8%. The prevalence of overall thyroid dysfunction among studied patients with type 2 diabetes mellitus was 27.6%, whereas in type 1 diabetes mellitus, the prevalence of overall thyroid dysfunction was 38.7%. Patients with subclinical hypothyroidism and hypothyroidism had a high prevalence of hypertension compared with those with subclinical hyperthyroidism and clinical hyperthyroidism. Approximately 8% of studied pregnant female patients had subclinical hypothyroidism. Among the 15% of female patients in the postpartum period who had thyroid dysfunction, 10% had clinical hypothyroidism and 5% had clinical hyperthyroidism. Among postmenopausal women, 20% had thyroid dysfunction (12% had subclinical hypothyroidism and 8% had clinical hypothyroidism). Conclusion The most frequently undiagnosed thyroid dysfunction was subclinical hypothyroidism. Thyroid dysfunction was common in certain age groups: reproductive age and postmenopausal as well as in patients with diabetes mellitus and hypertension; thus, screening for thyroid disease among those groups of patients should be routinely performed.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Assessment of serum and urinary levels of neutrophil gelatinase-associated lipocalin in correlation with albuminuria in nondiabetic obese patients p. 642
Nearmeen M Rashad, Nora M Said, George Emad, Ahmed F Gomaa, Heba M Kadry
DOI:10.4103/ejim.ejim_23_19  
Background Obesity, a new pandemic, is associated with an increased risk of death and morbidity. Obesity-related glomerulopathy is an increasing cause of end-stage renal disease. Neutrophil gelatinase-associated lipocalin (NGAL) is a neutrophil-expressed inflammatory protein that is increased in different diseases. The objective of the current study was to evaluate the predictive performance of serum and urinary NGAL in obese patients and to clarify its possible relationship with different stages of albuminuria in nondiabetic patients. Patients and methods This cross-sectional study was conducted on 55 obese patients and 40 healthy individuals as a control group. The enrolled patients were divided into three groups according to the level of albuminuria. Serum and urinary NGAL (ng/ml) were measured by enzyme-linked immunosorbent assay kits. Results Serum and urinary NGAL levels were significantly higher in obese (354.44±121.2 and 213.22±10.8, respectively) compared with healthy controls (44.21±11.2 and 13.9±6.3, respectively; P<0.001). Moreover, there were higher significant values of serum NGAL in patients with macroalbuminuria (488.65±44.53) and microalbuminuria (264.33±25.53) compared with patients with normoalbuminuria (122.48±4.53, P<0.001) and higher significant values of urinary NGAL in patients with macroalbuminuria (363.84±32.53) and microalbuminuria (112.19±26.53) compared with patients with normoalbuminuria (32.17±10.53, P<0.001). Serum and urinary NGAL levels were statistically significant predictors of albuminuria among obese patients. In addition, our results observed that BMI, waist/hip ratio, urinary albumin, estimated glomerular filtration rate, and urinary albumin-creatinine ratio were independently correlated with serum NGAL, whereas BMI, waist/hip ratio, and urinary albumin were the only variables that were independently correlated with urinary NGAL. Conclusion The higher levels of serum and urinary NGAL in obese patients compared with healthy group were strongly correlated with urinary albumin-creatinine ratio and cardiometabolic risk factors.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Procalcitonin as a marker of diabetic foot ulcer infection p. 652
Nabil A El-Kafrawy, Mohammed A Shaaban, Mohammed A Korany, Ahmed A Sonbol, Moustafa B Ata
DOI:10.4103/ejim.ejim_29_19  
Background Procalcitonin (PCT), an amino acid protein precursor of calcitonin hormone released by thyroid C cells or other body cells, can be used as a marker for diagnosing infection. PCT has a suggestive role in diagnosing diabetic foot infection alone or in combination with other markers of infection. Objective The aim was to clarify the effectiveness of PCT as a marker for diagnosing of infection in Egyptian patients with diabetic foot ulcer (DFU) in comparison with other inflammatory markers such as C-reactive protein, white blood cell count, and erythrocyte sedimentation rate. Patients and methods This cross-sectional study was carried out at Menoufia University Hospitals, from the period of January 2018 to December 2018. In total, 90 patients were classified into three groups; each group contained 30 patients: group I served as diabetic control without foot ulcers, group II patients had noninfected DFU, and group III patients had infected diabetic foot ulcer (IDFU). Diagnosis of IDFU relied on Infectious Diseases Society of America-International Working Group on the Diabetic Foot classification of diabetic foot infection. Results Serum PCT levels were elevated in DFU groups, with significantly higher in infected more than noninfected DFU. In addition, PCT levels were significantly higher in patients with IDFU compared with traditional markers such as C-reactive protein, erythrocyte sedimentation rate, and white blood cell counts. Conclusion Based on our results, we conclude that PCT has a valuable role in diagnosing infection in DFUs.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Insulin-like growth factor 1 and insulin-like growth factor binding protein-3 as predictive biomarkers of depression and migraine in obese women p. 658
Nearmeen M Rashad, Ahmed F Gomaa, Hanan M Sabry, Amira A Fouad, Shereen M El Shabrawy
DOI:10.4103/ejim.ejim_35_19  
Introduction Obesity and its comorbidity, depression and migraine, are highly prevalent conditions and public health problems of enormous scope that are responsible for the significant quality of life impairment and financial cost. Insulin-like growth factor-1 (IGF-1) and its main binding protein, insulin-like growth factor binding protein-3 (IGFBP-3) are related to metabolic diseases such as growth deficiency, obesity, cancer, neurological, and cardiovascular diseases. The objective of this study was to explore IGF-1 and IGFBP-3 in obesity-associated depression and migraine. Also, we aimed to evaluate the association of IGF-1 and IGFBP-3 with clinical features of depression and migraine. Patients and methods A cross-sectional controlled study included 50 healthy lean control group and 100 obese women who were subdivided into three subgroups: obese without depression and migraine (n=27), patients with depression (n=24), and patients with migraine (n=49). Clinical, neurological, and psychiatric evaluation of all patients was done. We measured IGF-1 and IGFBP-3 by commercial enzyme-linked immunosorbent assay. Results Our study showed a significantly lower level of IGF-1 and IGFBP-3 in obese women compared with lean ones. Even more importantly, obese women with depression as well as migraine had significantly lower IGF-1 and IGFBP-3 than those without depression and migraine. Interestingly, the lower levels of IGF-1 and IGFBP-3 in obese women with depression and migraine were significantly negatively correlated with depression score, BMI, and homeostasis model assessments of insulin resistance. Linear regression analysis test in obese patients showed that BMI and depression scores were independently correlated with serum IGF-1. However, BMI, fasting serum insulin, and depression scores were independently correlated with serum IGFBP-3. Conclusions Obese women with depression and migraine had significantly lower IGF-1 and IGFBP-3 than those without depression and migraine.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effect of vitamin D replacement on cardiometabolic risk factors and electrophysiological pattern of peripheral neuropathy in vitamin D-insufficient or deficient type 2 diabetic patients p. 669
Nearmeen M Rashad, Hanan M Sabry, Ahmed F Gomaa, Amany M Ebaid, Hala G Abomandour, Reem M Allam
DOI:10.4103/ejim.ejim_62_19  
Background Diabetic neuropathy is one of the commonest chronic complications of diabetes seen in routine healthcare and considered the most common cause of peripheral neuropathy all over the world. Vitamin D (VD) deficiency is now recognized as a pandemic disease. This study was designed to explore the levels of 25-hydroxycholecalciferol [25(OH) D] in patients with type 2 diabetes mellitus (T2DM) with peripheral neuropathy. We also aimed to clarify the effect of VD supplementation on cardiometabolic status and electrophysiological pattern of peripheral neuropathy. Patients and methods This clinical trial enrolled 95 patients with T2DM with peripheral neuropathy. The enrolled patients were divided into three groups according to serum 25(OH) D levels. VD deficiency and insufficiency groups received VD supplements (42,000 IU oral VD per week and 500-mg calcium carbonate per day for 12 weeks). Clinical, electrophysiological pattern, and laboratory parameters were evaluated at baseline and after 12 weeks of intervention. Serum 25(OH) D levels were measured by using a competitive enzyme-linked immunosorbent assay kit. Results Our results revealed that, among 95 patients with T2DM with peripheral neuropathy, 32 patients had VD insufficiency [20 ng/ml <25(OH) D <30 ng/ml], 50 patients had VD deficiency [25(OH) D ˂20 ng/ml], and 13 patients had VD sufficiency [25(OH) D >30 ng/ml]. Our results reported that 25(OH) D levels were negatively correlated with cardiometabolic risk factors and Toronto Clinical Scoring System. On the contrary, 25(OH) D levels were positively correlated with nerve conduction velocities (NCV). Stepwise multiple linear regression analysis revealed that glycated hemoglobin and Toronto Clinical Scoring System were the main predictors of 25(OH) D levels among other clinical and laboratory biomarkers. Logistic regression analysis observed that motor NCV and sensory NCV of median nerve and glycated hemoglobin were independent predictors of response to VD supplementation. NCV in studied groups showed that motor NCV and sensory NCV in the median, posterior tibial, and ulnar nerves were significantly decreased in both VD deficiency and insufficiency groups compared with VD sufficiency groups, and supplementation with 42 000 IU oral VD per week and 500-mg calcium carbonate per day for 12 weeks improved cardiometabolic risk factors and electrophysiological pattern of peripheral neuropathy. Conclusion The supplementation of VD for 12 weeks to VD deficiency and insufficiency groups improved the cardiometabolic and electrophysiological pattern of peripheral neuropathy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Thyroid dysfunction in Egyptian patients with hepatitis C virus: prevalence and possible triggering p. 678
Ahmed Fayed, Ahmed Soliman, Mervat Naguib, Hala M Ali, Hemmat Elhaddad
DOI:10.4103/ejim.ejim_64_19  
Background The contribution of chronic hepatitis C virus (HCV) infection per se in thyroid autoimmunity and dysfunction remains controversial. We investigate the prevalence of thyroid disorders and the possible association between thyroid dysfunction and different factors in a cohort of HCV-untreated patients. Patients and methods A total 1050 patients with untreated HCV infection were enrolled in this study. Thyroid function tests, antiperoxidase (TPO-Ab), antithyroglobulin, thyroid ultrasound, real-time PCR to assess HCV RNA viral load, and fibroscan to determine degree of hepatic fibrosis were done. Results Thyroid dysfunction was found in 17.1% of patients: 11.5% hypothyroidism and 5.6% hyperthyroidism. Subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism were detected in 8.6, 2.8, 3.3, and 2.3% of patients, respectively. Thyroid ultrasound showed abnormality in 10.2% of patients. TPO-Ab and antithyroglobulin were positive in 5.1 and 6.4% of patients, respectively. TPO-Ab was more frequently positive in hyperthyroid patients compared with euthyroid (P<0.001) and hypothyroid (P<0.001) patients. Positive TPO-Ab was only significantly associated with thyroid state (P<0.001) and duration of HCV infection (P=0.02). Conclusion The prevalence of thyroid dysfunction is 17.1% among patients with HCV infection. Furthermore, thyroid disorder is related mainly to thyroid autoimmunity independent of age, sex, or level of viremia.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Thyroid autoimmunity is associated with hypothyroid-like symptoms compared with nonautoimmune benign thyroid diseases using a thyroid-specific questionnaire p. 683
Tamer M Elsherbiny
DOI:10.4103/ejim.ejim_78_19  
Background Autoimmune hypothyroidism, also commonly known as Hashimoto thyroiditis (HT), is the most common cause of hypothyroidism in iodine-replete areas. Thyroid autoimmunity was shown to be associated with lower quality of life, higher symptom load, and poor physical and psychological well-being. The aim of this study is to evaluate the disease burden of HT using a thyroid-specific questionnaire, the thyroid patient reported outcomes (ThyPRO). Patients and methods The study included 194 patients, divided into two groups: group 1 included 124 patients with HT stable in euthyroidism 6 months before inclusion in the study, and group 2 included 70 patients with euthyroid benign thyroid disease other than HT. All patients completed a professionally translated, carefully revised version of the ThyPRO questionnaire into Arabic language. All patients had their thyroid stimulating hormone (TSH) measured at inclusion. Anti-thyroperoxidase and/or anti-thyroglobulin antibodies were recorded for each patient where available. Results There were no significant differences between the two studied groups regarding age, sex, and TSH. Both anti-thyroperoxidase and anti-thyroglobulin antibodies were significantly higher in HT group versus group 2. Group 1, HT group, showed significantly higher score in the hypothyroid symptom scale compared with group 2. No significant differences were found regarding the remaining symptom scales. Within hypothyroid symptom score scale, group 1 showed significantly higher scores in dry skin and swollen hands and feet items but not in cold sensitivity and itchy skin questions. Conclusion This study showed that thyroid autoimmunity, independent of thyroid function status, is associated with hypothyroid-like symptoms compared with benign thyroid disease other than HT. This may be caused by a direct or an indirect role of thyroid autoantibodies.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Achieving euthyroidism in hypothyroid patients using levothyroxine improves depressivity and impaired daily life scores using ThyPRO questionnaire p. 689
Tamer M Elsherbiny
DOI:10.4103/ejim.ejim_79_19  
Background Levothyroxine is the recommended treatment to achieve euthyroidism in hypothyroid patients. Achieving euthyroidism was found to improve quality of life in some studies but failed to do so in other studies. Thyroid patient reported outcomes (ThyPRO) is a thyroid-specific health-related quality of life measure. This study aims to assess patient-reported outcomes in levothyroxine-treated hypothyroid patients using ThyPRO. Patients and methods The study included 194 patients, divided into two groups: group 1 included 141 hypothyroid patients with benign thyroid disease treated with l-thyroxine, stable in euthyroidism for at least 6 months, and group 2 included 53 patients with euthyroid benign thyroid disease. All patients completed a professionally translated, carefully revised version of the ThyPRO questionnaire into Arabic language. All patients had their Thyroid stimulating hormone (TSH) measured at inclusion. Anti-thyroperoxidase and/or anti-thyroglobulin antibodies were recorded for each patient where available. Results There were no significant differences between the two studied groups regarding age, sex, and TSH. Anti-thyroperoxidase antibodies were significantly higher in treatment group versus group 2, but anti-thyroglobulin antibodies did not differ among the two studied groups. Group 1, l-thyroxine treatment group, showed significantly lower scores in the goiter symptoms, depressivity, impaired daily life, and hyperthyroid symptom scales compared with group 2. No significant differences were found regarding the remaining symptom scales. Conclusion Hypothyroid patients of different etiologies rendered euthyroid for at least 6 months compared with euthyroid patients with benign thyroid disease have significantly better depression, goiter, impaired daily life scores using a thyroid-specific questionnaire, the ThyPRO, compared with euthyroid benign thyroid disease.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum copeptin as a diagnostic and prognostic biomarker of coronary artery disease among patients with type 2 diabetes mellitus p. 696
Nearmeen M Rashad, Tamer M Ezzat, Reem M Allam, Wesam M.R Ashour, Ayman E Ali, Mohamad H Soliman
DOI:10.4103/ejim.ejim_102_19  
Background Diabetes is one of the major risk factors for coronary artery disease (CAD); hormones implicated in cardiac diseases may play a role in diabetes development. Increased activities of the arginine-vasopressin (AVP) system were shown to be associated with type 2 diabetes mellitus (T2DM). The aim of this study was to estimate the values of serum copeptin as a predictive biomarker of CAD and to assess the correlation between copeptin and cardiometabolic risk factors in patients with T2DM. Patients and methods The case–control study included 110 patients with T2DM and 80 age-matched and sex-matched control group. All the participants were subjected to B-mode ultrasonography of both common carotid arteries to measure carotid intima-media thickness (mm), echocardiography, and coronary arteriography. Serum copeptin levels were measured with a new sandwich immunoassay by using a human copeptin enzyme‐linked immunosorbent assay kit. Results Patients with T2DM had significantly higher serum copeptin levels (7.64±1.98 pmol/l) compared with control groups (4.64±1.11 pmol/l). Serum copeptin levels were significantly higher in patients with CAD (8.64±2.55 pmol/l) compared with patients without CAD (6.36±0.86 pmol/l). Interestingly, copeptin was positively correlated with cardiometabolic risks. The area under the curve of serum copeptin levels in differentiating patient with T2DM from control was 0.768 (P<0.001) and differentiating patient with CAD from the nonischemic group was 0.818 (P<0.001). Conclusion The higher serum level of copeptin in patients with T2DM especially in the patient with CAD is strongly correlated with cardiometabolic risk factors.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum visfatin level in prediabetics and its relation to left ventricular function p. 703
Mohammed Abdel-Hassib, Abdelhaleem A Hassabo, Hossam Elashmawy, Mostafa I.S Mansour
DOI:10.4103/ejim.ejim_119_19  
Introduction Visfatin is a molecule of clinical relevance, released mainly from visceral fat (hence it named as such) and could be a promising biomarker with diagnostic and prognostic significance in metabolic syndrome. Very little is known about visfatin and its relation with prediabetes. Objective The present study was conducted to demonstrate the relationship between serum visfatin level and prediabetes and its relation to left ventricular function. Patients and methods We studied 60 prediabetic patients recently diagnosed according to ADA criteria 2014 and classified into two groups according to the BMI. They were compared with 30 healthy matched controls. All groups underwent complete history taking, general examination, laboratory investigations (including homeostasis model assessment-insulin resistance and serum visfatin level), and two-dimensional transthoracic echo Doppler study at baseline and 8 months thereafter only for the patient groups. Results This study showed that there is a positive correlation between serum visfatin level and prediabetes and left ventricular function. Conclusion Serum visfatin is an early and strong predictor of prediabetes and left ventricular dysfunction.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Sonographic evaluation of enthesopathy in rheumatoid arthritis patients p. 715
Samar Tharwat, Mohammed Kamal Nassar, Asmaa Enein, Muhammad Emran Asad
DOI:10.4103/ejim.ejim_9_19  
Background Rheumatoid arthritis (RA) is one of the most common autoimmune diseases. It affects mainly the synovial membranes of the small joints. However, it may also have extra-articular manifestations. Enthesopathy may occur as one of the extra-articular manifestations of RA and is not clinically detected. Ultrasound (US) is a relatively new tool for the detection of enthesopathy. Aim The aim of this study was to assess the presence and distribution of enthesopathy in RA patients using US. Patients and methods Twenty-nine consecutive patients with RA and 14 age-matched healthy controls were included in this study. All RA patients met the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA. Six entheses sites were evaluated using gray scale and Doppler US with a linear transducer and were scored using the Madrid Sonography Enthesitis Index (MASEI). Results US detected the presence of enthesopathy in patients with RA. There was a statistically significant difference in the enthesopathy score of plantar aponeurosis insertion and Achilles tendon insertion. The total enthesopathy score was statistically significant in patients with RA versus controls. Conclusion US entheseal abnormalities are present in a high percentage of RA patients. US enthesopathy is not associated with disease activity in RA patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The relationship between serum level of matrix metalloproteinase-7 and interstitial lung disease in patients with systemic sclerosis p. 720
Mervat M Abo Gabal, Noha H Shedid, Elham S Mohamed, Warda Abdelfattah
DOI:10.4103/ejim.ejim_93_19  
Background Interstitial lung disease (ILD) remains a leading cause of mortality in systemic sclerosis (SSc). Matrix metalloproteinases (MMPs) play an important role in inflammation, autoimmune diseases and aberrant fibrotic tissue remodeling. Aim The aim of this work was to evaluate the relation between serum level of MMP-7 and ILD in SSc patients. Patients and methods The study was conducted on 30 SSc patients. Pulmonary function tests and chest high-resolution computed tomography were assessed. Degree of fibrosis was assessed according to Warrick severity and extent scores. Serum level of MMP-7 was measured. Results The 30 patients had a mean age of 41.60±11.11 years and disease duration of 3.50±1.81 years; 23 with diffuse and seven with limited subtype. ILD was present in 20 patients. Serum MMP-7 was significantly higher in those with ILD (412.5±52.4 ng/ml) compared with those without (disease control group) (351.4±56.4 ng/ml) (P=0.007). In patients with ILD, MMP-7 was significantly higher in those with ground-glass opacities, honeycombing and reticular infiltration on high-resolution computed tomography; yet, it was comparable among the different grades of pulmonary restriction by pulmonary function test. There was a significant negative correlation between serum MMP-7 level and forced vital capacity and forced expiratory volume in one second (r=−0.46, P<0.05 and r=−0.65, P<0.0001, respectively). Correlations between MMP-7 and Warrick severity and extent were significant (P=0.002 and 0.007, respectively). MMP-7 at a cut-off value of 367.4 ng/ml was 85% sensitive and 80% specific for detection of ILD. Conclusion There is a strong association between serum MMP-7 and the presence, severity and extent of ILD in scleroderma patients. It might be a useful marker for ILD in SSc.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Modifiable cardiovascular risk factors in patients with Behçet’s disease: a multicenter experience p. 726
Emad El-Shebiny, Amira El-Fakharany, Enas Zahran, Sabry Shoeib, Mohamed Salem, Mohammed Elnaggar, Nibal Morad
DOI:10.4103/ejim.ejim_112_19  
Background Vascular involvement in Behçet’s disease (BD) is one of the major causes of mortality and morbidity. Modifiable cardiovascular risk factors such as high blood pressure, dyslipidemia, hyperglycemia, overweight, and smoking have been demonstrated to have a significant impact on cardiovascular disease in the general population with or without other diseases. Objective The aim of this study was to evaluate whether modifiable cardiovascular disease risk factors differ among patients with BD in comparison with the general population. Patients and methods This was a multicenter case–control study carried out on 182 BD patients identified by analysis of the databases of the International Study Group Classification Criteria. The patients were compared with 80 controls matched for age, sex, and study period. Full clinical history taking and medical examination were carried out for all patients, and investigations including lipid profile and blood glucose were carried out and data on hypertension, height, weight, and smoking were collected and recorded. Results Levels of serum low-density lipoprotein (P<0. 005) and cholesterol (P<0.005) were significantly high in the Behçet patient group, but no statistical difference was detected as regards triglycerides, diabetes mellitus, or BMI. Smoking and hypertension increase the risk of cardiovascular manifestations in our patients. The mean±SD age of BD patients was 31.6±9.008, 76.9% were male individuals and 23.1% were female individuals. Conclusion Patients with BD had a high prevalence of cardiovascular comorbidities. Optimal control of blood pressure, lipids and blood sugar with reduction in body weight and stoppage of smoking may be an effective strategy to reduce vascular complications in these populations.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Study of proinflammatory and anti-inflammatory states in myelodysplastic syndrome patients p. 733
Alaa E Hassan, Marwa Tahoon, Hanan Bediera
DOI:10.4103/ejim.ejim_37_19  
Background The myelodysplastic syndrome (MDS) are a group of clonal bone marrow neoplasms characterized by ineffective hematopoiesis, manifested by morphologic dysplasia in hematopoietic cells and by peripheral cytopenia(s) although previous studies have shown cytogenetic and molecular abnormalities, the underlying defect in the molecular pathway for inflammation milieu, extensive apoptosis, and dysplasia observed in the disease is yet to be studied. Aim of the work The aim of this study was to show the proinflammatory [tumor necrosis factor-α (TNF-α)/anti-inflammatory [interleukin-10 (IL-10)] balance in different subclassifications of MDS. Patients and methods From September 2017 through September 2018, serum levels were measured in 49 patients for TNF-α, IL-10 in patients diagnosed as having MDS. Also, these inflammatory cytokines had been measured in 46 apparently healthy participants as matched controls for the study. The diagnosis of MDS was confirmed by a hematopathologist after review of bone marrow aspiration and/or peripheral blood samples. Conventional cytogenetic studies were performed on bone marrow aspirate material using standard G-banding techniques. These patients were then subclassified according to the revised 2016 WHO classification for MDS. Results There is a statically significant difference between MDS patients and control group according to the results of serum level of TNF-α and IL-10. They were higher in MDS patients. Also, there was a statically significant difference between the subclassified groups of MDS patients according the results of serum level of TNF-α and IL-10. TNF-α was higher in MDS with multilineage dysplasia and MDS unclassifiable than the others. Also, IL-10 was higher in MDS with excess blasts 1 and MDS with excess blasts 2 than the others. Conclusion TNF-α and IL-10 are increased in MDS patients indicating an inflammatory disturbance. TNF-α and IL-10 serum level are inversely related to each other in the different subclasses of MDS.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effect of iron therapy on red cell indices and hemoglobin subtypes on patients with beta-thalassemia trait who developed iron-deficiency anemia: a tertiary center experience p. 741
Sawsan M Moeen, Ahmad F Thabet, Marwa M Thabet
DOI:10.4103/ejim.ejim_38_19  
Background The combination of beta-thalassemia trait (BTT) and iron-deficiency anemia (IDA) is an interesting common issue in our country. However, treatment of this condition is challenging. Objectives This prospective observational study was designed to evaluate the effect of oral iron therapy on red cell indices, iron status, and hemoglobin A2 levels in patients with BTT who developed IDA. Patients and methods A total of 50 patients with BTT who developed IDA were included. A complete blood count, iron status, and follow-up hemoglobin electrophoresis by high-performance liquid chromatography were done. The patients with BTT received oral iron therapy of 60 mg elemental iron three times/day for a period of 5 months, and the investigations were repeated after 3 and 5 months of treatment. Results There was a statistically significant increase in hemoglobin level (P<0.001 each), mean corpuscular volume (P<0.001 each), mean corpuscular hemoglobin (P=0.004 and P<0.001, respectively), mean corpuscular hemoglobin concentration (P=0.007 and P=0.001, respectively), serum iron (P<0.001 each), serum ferritin (P<0.001 each), and hemoglobin A2 levels (P=0.001 and P=0.005, respectively), whereas significant decrease in the total iron-binding capacity (P=0.001, and P=0.005, respectively) after the third and fifth month of oral iron therapy. Conclusion It is important to suspect, recognize, and correct IDA in patients with BTT and to repeat hemoglobin electrophoresis after iron therapy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum retinol-binding protein 4 and the risk of ischemic stroke in Egyptian patients with hypothyroidism p. 746
Nearmeen M Rashad, Hanan M Sabry, Samir A Afifi, Maha A Fathy, Amira M El-Helaly, Haitham E.Mohamed
DOI:10.4103/ejim.ejim_131_19  
Objective Ischemic stroke (IS) is one of the major causes of disability and death worldwide. Effective prevention remains the best approach to reduce the burden of stroke. Adipokines can serve as a key messenger to central energy homeostasis and metabolic homeostasis. Retinol-binding protein 4 (RBP4), a retinol transporter, is elevated in insulin resistance. Controversy exists regarding the role of RBP4 in thyroid diseases. The objective of this study was to evaluate serum RBP4 in patients with hypothyroidism and to assess the association of serum RBP4 with susceptibility of IS. Patients and methods This case–control study included 50 healthy individuals as a control group and 90 patients with hypothyroidism, who were stratified into two subgroups: patients with IS and patients without IS. All participants were subjected to history taking and clinical, laboratory, and radiological evaluation. Results Serum RBP4 levels were significantly higher in hypothyroid patient, especially patients with IS, compared with the nonstroke group. Interestingly, serum RBP4 level was positively correlated with vascular and metabolic risk factors. Moreover, diastolic and systolic blood pressures, triglyceride, free T3, as well as thyroid-stimulating hormone, were independently correlated with serum RBP4 by linear regression analysis test. The diagnostic power of serum RBP4 level in differentiating hypothyroidism from controls was revealed at the cutoff value of 12.25, with area under the curve of 0.909 (95% confidence interval: 0.861–0.957). However, the diagnostic power of serum RBP4 level in differentiating hypothyroid patient with IS from those without stroke was revealed at the cutoff values of 11.4, with area under the curve of 0.822 (95% confidence interval: 0.737–0.906). In conclusion, the higher levels of serum RBP4 in hypothyroidism, especially in patients with IS, were associated with metabolic and glucose abnormalities, and thus, it could be used as a promising predictive biomarker of IS in hypothyroidism.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum and expression profiles of glucose-dependent insulinotropic polypeptide in correlation with cardiometabolic risk factors among patients with systemic lupus erythematosus p. 754
Nearmeen M Rashad, Reem M Allam, Amany M Ebaid, Mohammed S Yousef, Maha A Fathy
DOI:10.4103/ejim.ejim_126_19  
Background Premature atherosclerosis has been recognized as a major co-morbid condition in systemic lupus erythematosus (SLE). Glucose-dependent insulinotropic polypeptide (GIP) is closely related to cardiovascular (CV) risk factors. We aimed to evaluate GIP expression level in SLE and to explore the possible associations of GIP expression profile with carotid intima-media thickness and insulin resistance (IR). Patients and methods A cross-sectional controlled study was conducted, comprising 170 patients with SLE and 120 controls. GIP expression level was measured by multiplex polymerase chain reaction. The carotid intimamedia thickness was measured. Serum GIP levels, homeostasis model assessments (HOMA-IR and HOMA-b), fibrinogen, and homocysteine were measured. Results In the patients with SLE with IR, there were significantly higher values of serum GIP (37.99±13.64) compared with patients with SLE without IR (24.61±10.74), as well as the control group (21.7±3.46). In addition, there were significant positive correlations between GIP serum level and cardiovascular risks. Regarding GIP gene expression levels, there were significantly lower levels of GIP gene expression in patients with SLE with IR (1.29±0.72) compared with patients with SLE without IR (2.43±0.61) as well as the control group. Receiver operating characteristic analysis revealed that the diagnostic power of GIP expression was stronger than GIP serum levels in differentiating SLE from control. In conclusion, in the SLE group, there were lower GIP expression and higher serum levels than control, especially in IR subgroup. GIP expression and serum levels were associated with cardiovascular disease pathogenesis and progression.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Association of serum visfatin and its mRNA expression levels with cognitive function and idiopathic intracranial hypertension in obese Egyptian women p. 763
Nearmeen M Rashad, Hanan M Sabry, Amira A Fouad, Samir A Afifi, Maha A Fathy, Amira M El-Helaly
DOI:10.4103/ejim.ejim_133_19  
Background An epidemic of obesity has spread across the globe. Obesity has numerous comorbidities, including airway disease, insulin resistance, type 2 diabetes, cardiovascular disease, atherosclerosis, degenerative neurological disease, cognitive dysfunction, and cancer. Inflammatory cytokine is suggested to play a role in obesity and its complications. The current study aimed to estimate the expression and serum visfatin concentrations in obese Egyptian women. Moreover, we aimed to evaluate the possible association of visfatin gene expression and its serum levels with idiopathic intracranial hypertension (IIH) and cognitive dysfunction Participants and methods This cross-sectional study enrolled 60 obese women and 40 lean healthy women as controls. Obese women were classified according to grades of obesity into three groups. All participants underwent full clinical, neurological, and psychiatric examination. IIH group included patients with intracranial pressure greater than 25 cmH2O (opening pressure measured during lumber puncture in lateral decubitus position). Cognitive function was evaluated by using Montreal Cognitive Assessment scale (MoCA), Arabic version. Estimation of visfatin expression levels was determined by real-time PCR, and serum visfatin concentrations were measured using enzyme-linked immunosorbent assay. Results Our results revealed that obese women had higher values of visfatin expression (1.44±0.29) and serum levels (124.1±) compared with lean women (1.01±0.3 and 46.1±33.8, respectively). The visfatin expression and serum levels were significantly positively correlated with obesity indices, metabolic risks, MoCA, cerebrospinal fluid opening pressure, and cognitive dysfunction. Linear regression test showed that BMI, cerebrospinal fluid opening pressure, and MoCA were the main predictors of both serum and expression levels of visfatin in obese women. The receiver operating characteristic curve analysis revealed that the power of serum visfatin levels was higher than visfatin expression in differentiating obese women from lean ones. Conclusion There was a strong independent association between both higher visfatin expression and serum levels and obesity indices, metabolic risks, IIH, and cognitive dysfunction in obese Egyptian women.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Association of stroke severity, leukocytosis, and infarction size with early neurological deterioration in acute ischemic stroke p. 774
Jehan Saeed, Ghada M Samir, Ahmed F El-Said
DOI:10.4103/ejim.ejim_122_18  
Background About one-third of patients with acute ischemic stroke will endure early neurological deterioration (END), which leads to increased mortality and functional disability. A better understanding of risk factors for END is still required. Objective The aim of this study was to determine the risk factors of END in ischemic stroke patients. Patients and methods One hundred and twenty patients with first ever ischemic stroke were included in this study. All patients were clinically evaluated to determine the risk factors. END was assessed using the National Institute of Health Stroke Scale (NIHSS) after acute ischemic stroke. Laboratory and radiological investigations were done for all patients. Results In all, 35% patients showed clinical END after stroke onset and 65% patients were stable or improved. END patients had statistically significant high body temperature, increased leukocyte count, serum blood glucose, triglycerides, NIHSS at admission, high-sensitivity C-reactive protein, and infarction size. Multivariable logistic regression analysis for different variables showed that leukocyte count, stroke severity using NIHSS, and lesion size were independent factors associated with neurological deterioration. Conclusion Stroke severity, white blood cell, and lesion size of infarction were the only independent factors associated with END.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Factors affecting readmitted patients with acute exacerbation of bronchiectasis p. 779
Fatima Alhamed Alduihi, Abdallah Khoury
DOI:10.4103/ejim.ejim_44_19  
Background Bronchiectasis is an important cause of morbidity and mortality all over the world. Determining the frequency of actual occurrence is particularly misleading and difficult to determine, especially in patients with multiple respiratory disorders, because it can be a result of any primary pulmonary disease. The objective of this study was to evaluate the effect of readmission with acute exacerbation of bronchiectasis (AEB) on the admissions later on, need of long-term O2 and mechanical ventilation, and mortality. Patients and methods This is an observational cohort and prospective study. It was conducted on patients admitted with AEB who achieved modified O’Donnell criteria, and their high-resolution computed tomography showed bronchiectasis on admission at Aleppo University Hospital between September 2017 and January 2019. They were divided into three groups by age. Patients with bronchial asthma, chronic obstructive pulmonary disease, and cystic fibrosis were excluded. Results The study included 90 patients (57 males and 33 females) with a mean age of 52.93±20.437 years. AEB showed a peak of incidence in the age group 41–65 years. Dyspnea is the most common symptom in exacerbations (88.23%) followed by hemoptysis (80.88%). Wheezing had the least frequency on admission (60.29%). Median survival age was 14±0.214 months. We collected information on 136 exacerbations in 90 patients. A total of 31 (34.44%) patients had at least one readmission and 19 (21%) patients died within 12 months of admission to the hospital. Age, smoking, and need of long-term O2 were statistically significant between the two groups of study (P=0.013, <0.0001, and 0.04, respectively). Sex, radiological changes, mortality, and mechanical ventilation have no significance. Conclusion AEB is a common reason for hospitalization, and it correlates with age, smoking, readmission, and need of long-term O2 treatment.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Occult hepatitis C virus infection among Egyptian hemodialysis patients and its potential effect on anemia management p. 783
Mostafa Abdelsalam, Mona M Tawfik, Alaa Habib, Ahmed Abdel-Razik, Nahla Anber, Maysaa Zaki, Mohammad S Marie
DOI:10.4103/ejim.ejim_94_19  
Background Hepatitis C virus (HCV) infection is still a main health problem in hemodialysis (HD) patients. The prevalence of occult hepatitis C infection (OCI) in HD patients may be underestimated, and its possible influence on anemia management has not been studied. We aimed to determine the existence of OCI in Egyptian HD patients as well as its possible effect on anemia management. Patients and methods This cross-sectional multicenter study included 98 HCV-negative HD patients (negative for both anti-HCV antibody and HCV-RNA), 43 anti-HCV-positive HD patients, and 10 volunteer people matched for age and sex as a healthy control group. Serology test for anti-HCV antibody, reverse-transcription PCR for HCV-RNA (both serum and peripheral mononuclear cell (PMNC)), complete blood count (CBC), liver transaminases, serum iron, serum ferritin, and high-sensitivity C-reactive protein (hsCRP) were done. The average erythropoiesis-stimulating agent (ESA) doses were calculated over 6 months, and ESA resistance index was calculated. The frequency of packed red blood corpuscle (RBC) transfusion for each patient was recorded. Results Our HD patients had significant higher levels of serum ferritin (P=0.011), higher serum alanine aminotransferase and aspartate aminotransferase (P=0.002 and 0.006, respectively), higher hsCRP (P<0.0001), and significant lower level of hemoglobin (P<0.0001) compared with the healthy control group. The prevalence of OCI was 8.16% (8 of 98 patients). OCI patients had significant longer dialysis duration, higher transaminases, higher hsCRP, higher serum ferritin, and higher frequency of packed RBCs transfusion (P<0.0001), whereas mean hemoglobin levels and ESA resistance index showed insignificant differences compared with HCV-negative HD patients. Using logistic regression analysis, frequency of packed RBC transfusion and aspartate aminotransferase were the only independent predictors for OCI (P=0.012 and 0.049, respectively), and by multivariate analysis, no significant predictors were found to be associated with anemia in patients with OCI. Conclusion The prevalence of OCI in our study was 8.16%. OCI had no effect on anemia managements.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Urinary cyclophilin A in Egyptian patients with type 2 diabetes and diabetic nephropathy: correlation with urine albumin/creatinine ratio p. 790
Aasem Saif, Eman Elsayed, Amr Shaker, Tarek Ramzy, Basma Zaghlol, Shrook Mousa
DOI:10.4103/ejim.ejim_103_19  
Introduction Albuminuria is commonly used to predict the onset and to follow the progression of diabetic nephropathy (DN), but it lacks both sensitivity and specificity in early stages. Aim We assessed urinary cyclophilin A (CypA) as a biomarker for the diagnosis of DN in Egyptian patients with type 2 diabetes. Patients and methods The study was conducted on 150 Egyptian participants aged 30–65 years; 125 (58 male individuals and 67 female individuals) patients with type 2 diabetes mellitus (diabetes duration>5 years) in different stages of DN and 25 age-matched and sex-matched healthy control participants comprised the study cohort. Estimated glomerular filtration rate and urine albumin/creatinine ratio (ACR) were assessed in all participants. Urinary CypA was measured in the morning specimen. Results Urinary CypA was significantly higher in patients with stage 2 DN, as compared with stage 1 patients (P=0.02) and the control group (P=0.017), with no significant change in urine ACR between stages 1 and 2 (P=0.809). Urinary CypA also showed a steady rise in DN stages 3, 4 and 5 (P<0.001). Urinary CypA had strong positive correlations with creatinine and urine ACR and a strong negative correlation with estimated glomerular filtration rate in patients with DN (P<0.001 for all). Conclusion We suggest that urinary CypA is a good biomarker for early detection of DN in patients with type 2 diabetes. It starts to rise before urine ACR. It also correlates well with the progression of DN. A larger study is needed to confirm its superiority over urine ACR in the early stages of DN.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum osteocalcin level in end-stage renal disease patients on maintenance hemodialysis after parathyroidectomy in relation to parathyroid hormone level p. 795
Soheir A Ellakany, Doaa I Hashaad, Alyaa F Merghany
DOI:10.4103/ejim.ejim_84_19  
Background Parathyroidectomy (PTX) is an effective treatment for refractory hyperparathyroidism in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). However, adynamic bone disease, a possible complication, is associated with persistent bone pain and increased fracture risk. Osteocalcin (OC) is a bone formation marker, produced by osteoblasts, stimulated by parathyroid hormone and active vitamin D, associated with overall survival. Late changes in its level after PTX need to be evaluated. Aim The aim of this study was to determine serum OC and its relation to intact parathyroid hormone (iPTH) in patients on MHD with and without a history of PTX. Patients and methods This case–control study was conducted on 50 patients with ESRD on MHD, subdivided into two groups (group I and group II), according to the history of PTX. Patients having diabetic mellitus or autoimmune disease were excluded. Patients were inquired about manifestations of bone disease. Serum concentrations of ionized total calcium, magnesium, phosphorus, alkaline phosphatase (ALP), iPTH, and OC (by ELISA) were determined. Serum OC concentration was also measured in the samples of 20 healthy participants (group III) to evaluate its reference value. Results Bone fracture was present in nine patients with or without PTX, with no significant difference from the other patients, as regards the studied parameters. Patients with ESRD on MHD had a significantly higher serum OC level than controls (P<0.001). Serum OC in patients who underwent PTX, and with adynamic bone disease (iPTH<150 pg/ml) (group IA), was significantly lower than that in the corresponding subgroup without PTX (group 2A) (P=0.001); similarly, the two subgroups were different, as regards serum ALP (P<0.001) and serum iPTH (P<0.001). There were significant positive correlations between serum OC and total ALP and iPTH in the total patient sample (P<0.001 and <0.001, respectively). Conclusion Adynamic bone disease after PTX in patients on MHD in comparison with those who have not undergone PTX is associated with a lower level of bone formation marker OC.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effects of interleukin-12 gene polymorphism on response to hepatitis B vaccination among hemodialysis Egyptian patients p. 804
Sawsan M Abdel-Moniem, Mohammed A Mohammed, Ziyad M Essam El-Deen, Hanan M Mostafa
DOI:10.4103/ejim.ejim_85_19  
Background Hepatitis B virus (HBV) infection is a major health problem among hemodialysis (HD) patients. Interleukin (IL)-12 gene polymorphisms may be associated with immune response variability to recombinant HBV vaccines. The aim was to determine the correlation between IL-12 gene polymorphism and hepatitis B surface-antibody (HBs-Ab) titer in response to HBV vaccine among HD Egyptian patients. Patients and methods Seventy patients receiving long-term HD and 20 age-matched and sex-matched healthy controls were enrolled. All participants were non-HBV vaccinated and seronegative for HBV and HIV. Recombinant HBV vaccine was given (three-dose scheduled). Thereafter, HBs-Ab titer and IL-12 gene polymorphism were evaluated 8 weeks after the last vaccination dose. Results There was no response (HBs-Ab<10 μIU/ml) in 20% of HD patients and 10% of the controls. HBs-Ab titers showed no significant correlation with duration of HD, BMI, serum albumin, hemoglobin, leucocytic count, parathyroid hormone level, or IL-12 gene polymorphism. Responders to vaccination had significantly lower transferrin saturation and significantly higher levels of urea reduction ratio, Kt/V and lymphopenia. IL-12B genotype frequency was as follows: AA (58.3 vs. 55.6%), AC (37.5%) and CC (4.2 vs. 0%) in responders of either HD or control participants, respectively (P>0.05 for all). Conclusion There was no significant association between IL-12B gene polymorphism and HBs-Ab response in Egyptian HD patients. In HD patients, lymphocytopnea, diabetes mellitus (DM), high transferrin saturation and inefficient HD were associated with HBV vaccine hyporesponsiveness.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Study of serum sclerostin levels and its role in vascular calcification in patients with chronic kidney disease p. 813
Ahmed R Elarbagy, Yassein S Yassein, Mahmoud M Emara, Ahmed A Sonbol, Khaled M Zorkaney, Amera A Sharaf El Deen
DOI:10.4103/ejim.ejim_34_19  
Objective The aim of this work was to study serum sclerostin levels in patients with chronic kidney disease (CKD) not on dialysis and those on regular hemodialysis and its role in vascular calcification. Background CKD, whether starting hemodialysis (HD) or not, is associated with an increase in the risk for vascular calcification, which can only be partially explained by known classical risk factors. Sclerostin is an osteocyte-derived inhibitor of the Wnt pathway and has been shown to play a key role in vascular calcification in patients with CKD. Patients and methods This cross-sectional study was carried out on 80 patients with CKD attending Menoufia University Hospital. Patients were classified into 40 patients with CKD who were not on HD (Group II) and 40 patients with CKD on regular HD more than 6 months (Group III), who were compared with 15 controls (Group I). Abdominal aortic calcification (AAC) was assessed using lateral lumbar radiography. Echocardiography was used to assess aortic valve calcification (AVC) calcification. Patient’s basic clinical and biochemical data were recorded. Serum sclerostin level was measured using commercially available enzyme-linked immunosorbent assay kits. Results Sclerostin levels among the patients with CKD on HD (116.8±0.103.69 Pmol/l) was significantly higher than that of CKD predialysis group (28.63±0.36.26 Pmol/l), which in turn was statistically higher than control group (6.6±0.2.9 Pmol) (P=0.000). AAC was observed in 16 (40%) patients in CKD predialysis group, whereas in CKD on HD group, 26 (65%) patients had AAC. AVC was observed in 14 (35%) patients in CKD predialysis group, whereas in CKD on HD group, 21 (52.5%) patients had AVC. Using binary regression analysis, sclerostin was identified as an independent predictor for the presence of AAC (OR: 1.017; P=0.000) and AVC (OR: 1.013; P=0.001) in patients with CKD. Conclusion Patients with CKD (predialysis and on HD) exhibit an increase in sclerostin levels. Sclerostin expansion correlated positively with vascular and valvular calcification. Sclerostin is an independent risk factor for heart valve calcification and AAC in patients with CKD.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Current characteristics of chronic hepatitis B in Egypt p. 822
Maha M Elsabaawy, Mohammed E Elsherefy, Haitham E Sakr, Dalia Elsabaawy, Helmy Elshazly, Hossam Elezaawy, Gasser I Al Azab, Mahmoud Eltahawy
DOI:10.4103/ejim.ejim_70_19  
Background and aim In the era of hepatitis C virus eradication, Egypt had to pay attention to the two million infected with chronic hepatitis B. This study aimed to observe the current characteristics of chronic hepatitis B virus (HBV) infection in Egypt. Patients and methods This cross-sectional study was conducted on 183 patients with chronic HBV infection. The demographic, epidemiologic, clinical, laboratory, and treatment data were collected from patient registries. Results Positive hepatitis B e-antigen (HBeAg) cases represented 18.04%. They were younger (31.09±8.542–38.22±10.6 years) (P<0.05), with higher alanine aminotransferase (84.91±67.855–53.75±55.575 U/l) (P<0.05) and viral loads (3.58×108±16.49×108–1.74×106±10.1×106 IU/ml) (P<0.05), particularly in chronic active carrier states. Unsafe hygienic procedures (sharing toothbrushes and razors) were the main infective routes (73.7%). Coinfection with hepatitis C virus was documented in 14.7%, along with 16.3% with schistosomal infestation. HBV and hepatitis D virus coinfection was reported in 8.9% of the studied cohort. Radiologically, liver cirrhosis was detected in 44% of cases, with associated splenomegaly in 20.7%. Histologically, 40.2% were found to have significant pathology (A2, F2>2). Thirty (16.3%) cases were outside international guidelines of treatment, only for follow-up. Overall, 70.5% were subjected to lamidine therapy, with unfair responses mainly detected in the HBeAg-positive group (71.4%), who responded marvelously to interferon finite regimens. HBeAg-positive status and schistosomiasis were found to be associated with poor response to oral antivirals by multivariate analysis (P<0.05). Conclusion More classified governmental censorship efforts, notably on private organizations, along with awareness levitation are promptly mandated. Additionally, the poor response to oral antivirals in HBeAg-positive patients signifies sticking to interferon as a first-line treatment option.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Role of endoscopic colonic stent insertion in patients with colonic obstructing malignancy: a single-center study p. 831
Mohammad S Marie, Gad M Behairy
DOI:10.4103/ejim.ejim_161_19  
Background Left-sided colonic malignant lesions have the potential of acute bowel obstruction. Emergency surgery with stoma construction is considered the standard of management. Insertion of colonic stent to allow bowel decompression, primary resection, and re-anastomosis, avoiding the need of colostomy formation, can be an alternative. We describe our experience with the use of colonic stent in left-sided malignant obstruction as a step to relieve the obstruction before definitive surgical intervention. Patients and methods A total of 30 patients with left-sided colonic malignant obstruction were included; 15 patients were offered colonic self-expandable metal stent insertion, and the other fifteen patients were offered emergent surgery. Results Of the 15 patients, 10 (66.6%) had successful stent insertion (technical and clinical). We failed to insert stent in four (26%) patients, and one (6.6%) patient had colonic perforation. All patients with successful colonic stent insertion underwent one-step resection and primary anastomosis. Conclusion Colonic stent for left-sided colonic malignant obstruction represents a valuable procedure for one-step resection and primary anastomosis without the need for colostomy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Frequency of malignant biliary strictures in Upper Egypt: a pilot study p. 836
Adnan A Mohamed, Ahmed M Ali, Mahmoud R Shehata, Wael A Elsewify, Salah Maklad
DOI:10.4103/ejim.ejim_128_19  
Background and aim Biliary strictures are challenging clinical condition for gastroenterologists, radiologists, and surgical specialists. We aimed to find out the frequency of malignant biliary strictures in our institutions. Patients and methods This prospective study included 44 patients with biliary strictures who had undergone endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) in Aswan and Assiut University Hospitals. Results Thirty two patients (72.7%) had malignant strictures where distal stricture was the most frequent (68.8%) followed by hilar (25%) then mid and long segment strictures (3.1% each). Conclusion The vast majority of indeterminate biliary strictures are malignant (72.7%), so all indeterminate bile duct strictures in patients with obstructive jaundice should be considered malignant unless a benign etiology is definitively identifiable.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Tumor necrosis factor-alpha and alpha-fetoprotein as biomarkers for diagnosis and follow-up of hepatocellular carcinoma before and after interventional therapy p. 840
Amr Elrabat, Shahera Eletreby, Ahmed M Ali Zaid, Mohammed H Eldeen Zaghloul
DOI:10.4103/ejim.ejim_73_19  
Introduction Up to 90% of the hepatocellular carcinoma (HCC) cases in Egypt were attributable to hepatitis C virus (HCV) infection. The absolute positive and negative markers for HCC are still deficient. Alpha-fetoprotein (AFP), the most widely used biomarker for early detection and clinical follow-up of patients with HCC, has a sensitivity and a specificity of 41–65% and 80–94%, respectively, even with low cutoff value at 20 ng/ml. High plasma levels of tumor necrosis factor-alpha (TNF-α) are associated with some cancers, and it has an important central role in hepatocarcinogenesis and involved in cancer invasion with or without metastasis. Aim To evaluate the diagnostic accuracy of TNF-α versus AFP as biomarkers for detection of HCC on top of HCV-related cirrhosis and to assess treatment response by using TNF-α and AFP after locoregional intervention of HCC. Patients and methods A total of 27 normal control, 51 cirrhotic patients, and 69 cirrhotic patients with HCC were studied in two phases. Radiofrequency ablation and transarterial chemoembolization were done, and patients were followed up for response and tumor marker values. Results TNF-α in the diagnosis of Egyptian patients with HCC related to HCV cirrhosis had a sensitivity of 100% and a specificity of 94.1% at a cutoff value of more than or equal to 30 pg/ml. Moreover, more than or equal to 15.2% decrement is a good predictor of complete ablation versus partially or failed ablation with a sensitivity of 78.6%, a specificity of 83.3%, and overall accuracy of 80.77%. Conclusion Combined use of TNF-α in addition to AFP increases sensitivity and specificity for early diagnosis of HCC rather than the use of each tumor marker alone. Moreover, TNF-α could be a better noninvasive tumor marker than AFP for assessment of response after locoregional therapy of HCC.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Prognostic value of serum autotaxin in liver cirrhosis and prediction of hepatocellular carcinoma p. 849
Nagwa Ramadan Ahmed, Ahmed Nabil EL-Mazny, Sarah Ahmed Hassan, Laila Ahmed Rashed
DOI:10.4103/ejim.ejim_63_19  
Background Autotaxin is a lysophospholipase D related to liver fibrosis; its clinical role in liver cirrhosis is still unknown or limited. In this study we investigate the relation of autotaxin serum levels and prognosis of liver disease and/or prediction of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) patients. Patients and methods This observational, prospective case–control study included 180 participants, 60 patients with HCV-related liver cirrhosis, 60 HCV noncirrhotic patients, and 60 healthy controls. They were enrolled from inpatients and clinics of a tertiary-care hospital. Baseline characteristics, serum autotaxin, Child–Turcotte–Pugh and model of end-stage liver disease scores were determined. Abdominal ultrasound and upper gastrointestinal endoscopy were done at the beginning of the study. Cirrhotic patients were prospectively followed up for 6 months. Results Patients with liver cirrhosis had the highest level of autotaxin (106±24 μg/ml) compared with noncirrhotic HCV patients (81.9±21 μg/ml) and healthy controls (42.5±11 μg/ml) using one-way analysis of variance test (P=0.000). Spearman’s correlation analysis showed no significant correlation between autotaxin and Child–Turcotte–Pugh score (r=0.02; P<0.70), and model of end-stage liver disease score (r=0.15; P<0.41). At 6 months of follow-up, patients who developed HCC or encephalopathy had significantly higher baseline autotaxin level (141±55 μg/ml; P=0.02, 117±56.6 μg/ml; P=0.000), respectively, than patients who did not (102±34, 90.7±40 μg/ml). Cutoff values of autotaxin for the prediction of HCC and encephalopathy were 95 and 92 μg/ml, respectively, with 91 and 92% sensitivity. Conclusion Autotaxin is a sensitive predictor for the development of HCC and encephalopathy in HCV-related cirrhotic patients. However, it was not related to disease severity.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Association of serum adropin with risk and severity of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus p. 856
Nearmeen M Rashad, Hanan M Sabry, Samir A Afifi, Maha A Fathy
DOI:10.4103/ejim.ejim_130_19  
Background Diabetic peripheral neuropathy (DPN) is the major microvascular complication of type 2 diabetes mellitus (T2DM). Adropin is a peptide hormone that has essential roles in metabolic homeostasis and the pathogenesis of T2DM and its complications. This study was designed to estimate serum adropin levels in patients with T2DM in correlation with risk factors of DPN. The authors also aimed to investigate the association between serum adropin level and clinical and electrophysiological tests of DPN. Patients and methods This case–control study enrolled 100 patients with T2DM (40 diabetic cases without DPN and 60 diabetic cases with DPN) and 50 controls. All participants were subjected to a complete neurological examination. The motor and sensory conduction velocities of the median nerve, ulnar nerve, and common peroneal nerve were measured. The severity of DPN was assessed by Toronto clinical scoring system (TCSS). Serum adropin levels were assessed using an enzyme-linked immunosorbent assay. Results Our results revealed decreased circulating serum adropin levels in patients with T2DM (3.5±1.2), especially diabetic patients with DPN (3.1±1.07), compared with controls (6.1±0.89). There is a negative correlation between serum adropin level and TCSS as well as electrophysiological tests: motor nerve conduction velocity of median and ulnar nerve, sensory nerve conduction velocity of median and ulnar nerve, compound muscle action potential amplitude (median and ulnar nerve), and sensory nerve action potential amplitude (median, ulnar, and perception threshold nerve) (P<0.001*). Conclusion Diabetic patients with DPN had lower values of serum adropin than diabetic patients without DPN, and serum adropin levels were negatively correlated with metabolic risk factors, TCSS, as well as electrophysiological tests of DPN.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Updated ACR Thyroid Imaging Reporting and Data Systems in risk stratification of thyroid nodules: 1-year experience at a Tertiary Care Hospital in Al-Qassim p. 868
Mohammed Ewid, Mervat Naguib, Ali Alamer, Hala El Saka, Sharifa Alduraibi, Abdullah AlGoblan, Elzaki Ahmed
DOI:10.4103/ejim.ejim_143_19  
Background Thyroid imaging reporting and data system (TI-RADS) is assessment of risk stratification of thyroid nodules, using a score. A novel ACR (American College of Radiology) TI-RADS has been recently suggested by American College of Radiology. But, the utility of ACR TI-RADS in risk stratification for thyroid lesion needs further evaluation. Aim Of this study was to evaluate ACR TI-RADS classification in discriminating benign and from other thyroid lesions as detected by fine needle aspiration cytology (FNAC). Methods This retrospective study included all patients referred to our institute for FNAC of a thyroid nodule over 1 year. Thyroid nodules were categorized according to the 2017 ACR TI-RADS. Ultimately, efficacy of ACR TI-RADS in differentiating benign from non-benign nodules was assessed using ROC curve, cross-tabulation, and Chisquare tests. According to the results of FNAC, nodules were classified into 2 groups; benign lesions (Bethesda II) and malignant lesions (Bethesda IV, V). Results The percentages of Bethesda IV and V lesions defined in our ACR-TIRADS were as follows: ACR TI-RADS 1, 2 (0%), ACR TI-RADS 3 (4%), ACR TI-RADS 4 (6.6%), and ACR TI-RADS 5 (22.6%). ROC curve analysis for ACR TI-RADS to differentiate benign from non-benign pathology showed (AUC 0.60, 95% CI: 0.505–0.713). ACR TI-RADS had sensitivity, specificity, positive predictive value and negative predictive value 75%, 62.35 %, 15.7%, 96.3% respectively. Conclusion Differentiation between benign and malignant thyroid lesion can be suggested from the ultrasound based ACR TI-RADS system. FNAC might be deferred in patients having ACR TI-RADS 1 and 2.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Investigation of association of biomarkers of iron metabolism and insulin resistance in Egyptian patients with impaired glucose metabolism and type 2 diabetes p. 874
Ibrahim N El Ebrashy, Olfat Shaker, Sarah I Abdelgalil, Elham M Yousief
DOI:10.4103/ejim.ejim_100_19  
Introduction Type 2 diabetes is an expanding overall medical issue. A large portion of the enthusiasm for the job of supplements in diabetes is fixated on macronutrients, yet a micronutrient, iron, is additionally closely connected with diabetes. Aim To study biomarkers of iron metabolism, including serum ferritin, transferrin saturation, iron, and insulin resistance, in diabetic and prediabetes patients. Patients and methods This is a cross-sectional study directed on a cohort of 50 patients, comprising 25 patients with impaired glucose tolerance and 25 patients recently discovered to have type 2 diabetes mellitus (T2DM), as well as 20 healthy controls of matched age and both sexes. All patients enrolled in the study were subjected to full history taking, full examination, laboratory investigations including iron, total iron-binding capacity, ferritin, insulin, lipid profile, fasting blood glucose, 2-h postprandial glucose, urea, creatinine, complete blood count, alanine aminotransferase, and aspartate aminotransferase. Results We found that patients with T2DM have significant higher body weight and BMI than prediabetes patients and controls, and also statistically significant difference in serum iron between the studied groups, but no statistical significance in serum ferritin between the studied groups. In addition, we found a positive correlation of serum iron and insulin resistance in T2DM, a significant positive correlation of serum ferritin with low-density lipoprotein and negative correlation with high-density lipoprotein in T2DM, positive correlation of ferritin with cholesterol and triglycerides in impaired glucose tolerance group. Moreover, transferrin saturation was negatively correlated with glycated hemoglobin, BMI, and total iron-binding capacity and is positively correlated with iron and creatinine and hemoglobin among the studied groups. Conclusion The distinguished relationship of several markers of iron metabolism with hyperglycemia and insulin resistance recommends that iron stores add to the pathogenesis of IGM and T2DM.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Study of the relationship of thyroid status and frailty in older Egyptian men p. 884
Maha H El Din Ibrahim, Mohamed M Alsebaie, Haidy I Elbendary, Elham M Yousief
DOI:10.4103/ejim.ejim_96_19  
Background This study was conducted in Endocrine and Diabetes Clinic (Cairo University) and National Institute of Diabetes and Endocrinal Glands from 2016 to 2017. Aim To recognize the relationship between thyroid status and frailty in older Egyptian men, as distinguishing proof of contrasts in thyroid function as a hazard factor for frailty gives added chances to recognize men in danger of more unfortunate well- being results. Methods The study included 100 geriatric Egyptians men without overt thyroid disorder. All patients were subjected to medical history and physical measurement including assessment of frailty by using FRAIL scale (Fatigue, Résistance, Ambulation, Illnesses and Loss of weight, with frailty represented by the presence of three or more of these elements), free thyroxine level and thyroid-stimulating hormone. Results The average age of the patients was 67.34±3.42 years. of 100 men, four patients were classified as having overt hyperthyroidism, two patients having overt hypothyroidism (2.0%), 10 patients having subclinical hyperthyroidism (10%), one patient with subclinical hypothyroidism (1.0%), and 83 patients were euthyroid (83%), and 40 men were classified as being frail. The authors found a positive correlation of frailty with age (P<0.001). Conclusion There is a statistically significant association of frailty with smoking (P=0.014) and hypertension (P=0.003). There was no factually noteworthy relationship between frailty and thyroid-stimulating hormone, free T4, and free T3, and no measurably statistically significant difference between frailty and change in thyroid function (P=0.592).
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Albumin-corrected serum calcium and serum parathyroid hormone-related polypeptide determined by enzyme-linked immunosorbent assay in cirrhotic patients with hepatocellular carcinoma – a pilot study p. 896
Ragai M.F.R Fouda, Rania E Sheir, Nora M Selim, Ahmed A Hammad
DOI:10.4103/ejim.ejim_121_19  
Context Parathyroid hormone-related peptide (PTHrP) is produced by many malignant tumors. It is responsible for most cases of hypercalcemia in patients with malignancy. Few published studies shed light on the relation between serum calcium levels and serum PTHrP levels in cirrhotic patients with hepatocellular carcinoma (HCC). Aim The aim of the current work was to evaluate serum PTHrP in cirrhotic patients with HCC and a possible correlation between serum PTHrP levels and albumin-corrected serum calcium levels in these patients. Patients and methods This is a cross-sectional study. The study included 35 cirrhotic patients with HCC (diagnosed depending upon α-fetoprotein and abdominal imaging studies). Data about their serum albumin and albumin-corrected serum calcium levels were collected. Sera of the studied patients were collected for determination of PTHrP levels by enzyme-linked immunosorbent assay (ELISA). Numerical data were summarized in the form of mean±SD. Strength of association between variables was tested using Pearson correlation coefficient. Results Approximately 8.6% of studied patients were hypercalcemic, and no statistically significant positive correlation was detected between serum PTHrP determined by ELISA and albumin-corrected serum calcium in these patients. Conclusion Approximately 8.6% of studied cirrhotic patients with HCC were hypercalcemic. NO statistically significant positive correlation was detected between serum PTHrP determined by ELISA and albumin-corrected serum calcium in these patients. Studies involving a larger number of patients could clarify the exact role of PTHrP in the development of hypercalcemia in cirrhotic patients with HCC.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Assessment of fibroblast growth factor 23 in relation to peripheral arterial disease in type 2 diabetes mellitus p. 902
Mohamed R Halawa, Abeer A Abdalah, Yara M Eid, Merhan S Nasr, Bassem M Mostafa, Nesma H Ahmed
DOI:10.4103/ejim.ejim_52_19  
Background Peripheral arterial disease (PAD) is a major vascular complication and the leading cause of amputation in people with diabetes. Fibroblast growth factor 23 (FGF-23) is a recently discovered 30-kD secreted hormone glycoprotein that plays a role in the complex and tightly regulated mechanisms of mineral metabolism. Increase in serum FGF-23 concentration was an independent predictor of coronary artery diseases in patients with mild chronic kidney disease and of mortality in patients undergoing hemodialysis. Recently, FGF-23 has been found to be associated with total body atherosclerosis and vascular dysfunction. Objective To evaluate the relation between FGF-23 and PAD in patients having type 2 diabetes with normal kidney function. Patients and methods A case–control study was conducted on 120 diabetic patients, where 60 patients having type 2 diabetes with PAD were compared with 60 patients having type 2 diabetes without PAD. All patients were subjected to full history taking, thorough clinical examination, ankle-brachial index assessment, and laboratory measurement of glycated hemoglobin%, estimated glomerular filtration rate, microalbuminuria, lipid profile, serum ionized calcium and phosphorous, and serum FGF-23. Results Significantly higher serum FGF-23 was found in diabetic patients with PAD compared with diabetic patients without PAD. Logistic regression analysis showed that duration of diabetes, triglycerides level, phosphorous level, glycated hemoglobin, and FGF-23 were independent predictors for PAD. Conclusion FGF-23 level was higher in type 2 diabetic patients with PAD, which highlights a possible implication of FGF-23 in the pathogenesis of PAD in type 2 diabetes.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Value of right ventricular dimensions’ swings on weaning from mechanical ventilation p. 908
Soheir Mostafa Kasem Ahamed, Muhammad Hossam El-Din Hassan Maghrapy, Khaled Mohamed Ali Shehata, Samiaa Hamdy Sadek, Samir El-Hadidy Tawfek
DOI:10.4103/ejim.ejim_145_19  
Background Cardiac dysfunction is a common cause of weaning failure. Previous studies focused on the role of LV diastolic dysfunction in the occurrence of weaning failure, and there are no more studies yet interested in RV dysfunction. Herein we evaluate cardiac changes using tissue Doppler echocardiography in critically ill patients during the weaning process and to compare between left and right ventricular functions as a predictor of weaning failure from mechanical ventilation. Methods We recruited 40 mechanically ventilated patients admitted to our ICU in this cross-sectional study. Echocardiography was performed during baseline ventilator settings and during spontaneous breathing trial (SBT) to assess changes in cardiac dimensions and functions. of left and right ventricular contractility and relaxation in this subset of patients. Results Among 40 patients included, there was a significant increase in cardiac dimensions during SBT. There was a statistically significant decrease in LV EF with (P=0.000) during SBT. Also, there was a statistically significant decrease in RV systolic function during SBT. There was a significant increase in the E/E′ ratio of lateral mitral annulus due to the evolution of impaired LV relaxation and diastolic dysfunction (P=0.008). Moreover, the development of right ventricular diastolic dysfunction presented by E/E′ ratio of tricuspid annulus, (P value=0.03). Conclusions RV dysfunction, as detected by systolic wave velocity of anterior tricuspid annulus (S′) by Doppler tissue imaging during SBT, also has good sensitivity and specificity in weaning failure prediction from mechanical ventilation.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The role of interleukin-19 in diabetic nephropathy p. 917
Khaled A Elhefnawy, Ahmed M Salah, Hanaa H Elsaid
DOI:10.4103/ejim.ejim_153_19  
Background Proinflammatory cytokines play an important role in the establishment of arteriolosclerosis and kidney injury. Inflammatory cytokines are involved in the development of microvascular diabetic complications, including diabetic nephropathy (DN). Interleukin-19 (IL-19) has vital functions in many inflammatory processes and also can induce the angiogenesis of endothelial cells. Objective To investigate the role of IL-19 in the development of DN. Patients and methods A total of 112 participants were included and classified into four main groups: group I was the control group, which included 28 age-matched and sex-matched persons; group II included 28 patients with type 2 diabetes without nephropathy (normoalbuminuria); group III included 28 patients with type 2 diabetes with nephropathy (microalbuminuria); and group IV included 28 patient with type 2 diabetes with nephropathy (macroalbuminuria). All participants were subjected to complete blood count, complete urine analysis, fasting and random blood glucose, glycosylated hemoglobin (HbA1c), serum creatinine and urea, urinary albumin excretion rate (UAE), albumin-creatinine ratio (ACR), lipid profile, and serum IL-19 level assays. Results C-reactive protein (CRP) and serum IL-19 levels were significantly higher in diabetic patients compared with controls. IL-19 levels were significantly positively correlated with serum creatinine, ACR, UAE, HbA1c, and CRP. Multivariable logistic regression analysis showed that IL-19 levels were independently associated with patients with DN. Conclusion IL-19 levels were elevated in patients with DN and were positively correlated with ACR, UAE, HbA1c, and CRP. IL-19 may play an important role that contributes to the progression of DN.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum osteoprotegerin as an early marker of chronic kidney disease in hypertensive patients p. 922
Khaled A Elhefnawy, Ezzat M Mohamed, Athar M Abou Yousef, Abeer A Fikry, Hala M Allam
DOI:10.4103/ejim.ejim_169_19  
Background Serum osteoprotegerin (OPG) is a marker of cardiovascular disease. The deterioration of renal function in diabetic patients could be predicted by OPG concentrations, and it was suggested that OPG could be used as a risk marker for chronic kidney disease (CKD) in patients with hypertension. Objective The aim was to investigate the role of serum OPG as an early marker of CKD in hypertensive patients. Patients and methods A total of 144 hypertensive patients were included and classified into two main groups: group I, which included 72 hypertensive patients without CKD [estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2], and group II, which included 72 hypertensive patients with CKD (eGFR<60 ml/min/1.73 m2). All participants of the study were subjected to detail clinical examination and investigations including complete blood count, fasting and random blood glucose, glycosylated hemoglobin, urine analysis, serum creatinine, liver function tests, eGFR, and serum OPG assays. Results Serum OPG levels were significantly higher in hypertensive group with CKD than in hypertensive group without CKD. A significant positive correlation was found between OPG and diastolic blood pressure, duration of hypertension, serum creatinine, and albumin creatinine ratio, whereas there is a negative correlation between OPG and both weight and eGFR. The best cutoff value of serum OPG in prediction of CKD among hypertensive patients is greater than 1.9 ng/ml with sensitivity of 100% and specificity of 100%. Conclusion Serum OPG can serve as an early marker for CKD in hypertensive patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios as noninvasive predictors for renal involvement in systemic lupus erythematosus in health clinics p. 927
Mona M Soliman, Yasmine S Makarem, Ahmed A El Wafaa, Marwa K.A Khairallah
DOI:10.4103/ejim.ejim_149_19  
Objective Renal injury is a prevalent complication related to lupus erythematosus and its occurrence is linked with bad alarms. Yet, a noninvasive procedure to predict renal impairment in health clinics has not been settled. Consequently, the authors postulated that platelet-to-lymphocyte (PLR) ratio and neutrophil-to-lymphocyte ratio (NLR) might be used as valid noninvasive indicators for kidney impairment. Participants and methods In this cross-sectional research, 270 participants were enrolled into the research after exclusion of 70 patients; the included patients were classified into four groups: 80 patients with lupus nephritis (LN) diagnosed by renal biopsy, 12 active lupus patients without renal involvement, 28 lupus patients on remission, and 80 healthy participants as controls. The authors evaluated levels of PLR and NLR in addition to other renal and lupus markers. Results The results have shown that PLR and NLR had significantly higher levels in active lupus patients as in biopsy-proven LN in comparison to inactive systemic lupus erythematosus and control groups. NLR was positively correlated with serum creatinine in patients with LN; however, they did not show significant association with other predictors of renal diseases. The study demonstrated that PLR and NLR had significant association to advanced classes of LN. Furthermore, the receiver-operating characteristic curve showed a higher sensitivity of PLR in early detection of kidney function impairment in LN patients (88.9%) while NLR showed more specificity (87.5%). Conclusion PLR and NLR could act as noninvasive markers for detection of renal involvement in lupus patients in health clinics as for the prediction of renal pathological class.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Peripheral blood neutrophils and upregulated surface expression of interleukin-17 and CD177 in patients with bronchial asthma: an association with fungal allergy p. 934
Eman E Ahmed, Mohamed K Sabry, Hazem E Abd Elbadie, Nermine A Elnour Melek
DOI:10.4103/ejim.ejim_123_19  
Background Asthma is a prevalent debilitating airway disease, with a tremendous effect worldwide. Fungi and their spores are identified as major culprits in allergic asthma (AA) etiology. Peripheral blood neutrophils and interleukin 17 (IL-17), which are considered crucial players in both bronchial asthma and host defense mechanisms against fungi, increase concomitantly; moreover, certain subsets of neutrophils express and even release IL-17. Objectives In this study, we sought to determine the peripheral frequency of certain neutrophil subpopulations, expressing both CD177 and IL-17, among AA patients, particularly those with fungal allergy. Methods This observational study comprised 40 patients with AA (age range 19–60 years) and 20 age-matched and sex-matched healthy controls (age range 20–55 years). All patients had positive allergy skin prick test results, and accordingly, they were further subdivided into two groups (18 reactive to fungal allergens and 22 to other aeroallergens). The frequency of IL-17+CD177+ neutrophils in the peripheral blood was assessed by flow cytometry in all studied participants. Results The authors observed significantly increased frequency of circulating IL-17+CD177+ neutrophils among AA patients (especially mild to moderate cases) compared with healthy controls (43.3±13.9 vs 15.3±4.8). On the contrary, and surprisingly, patients with fungal allergy and those without did not show any difference with respect to this neutrophil subpopulation (44.6±14.4 vs 42.2±13.7). Conclusion Despite limited sample size, we reported elevated IL-17+CD177+ neutrophil proportion in all AA, regardless of fungal aeroallergenicity. This observation points to a role played by this neutrophil subpopulation in asthma pathophysiology, especially the allergic phenotype, and hopefully offer a new therapeutic approach in asthma management.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Vascular endothelial growth factor in systemic lupus erythematosus in correlations with disease activity and nailfold capillaroscopic changes p. 943
Sherin M.H Hamza, Nermeen S. Khalil, Rasha M Hamoda, Marwa A El-Asfahani
DOI:10.4103/ejim.ejim_28_19  
Background Angiogenesis plays a role in the pathogenesis of systemic lupus erythematosus (SLE). Both serum vascular endothelial growth factor (VEGF) and capillaroscopic abnormalities may reflect intensity of microcirculatory changes in the course of SLE. Aims To quantify serum VEGF level and its correlation with microvascular changes, assessed by nailfold capillaroscopy (NFC), and possible relationship with SLE activity. Patients and methods A total of 90 patients with SLE were subjected to detailed medical history and clinical examination and assessment of disease activity using the SLE Disease Activity Index score and organ damage using Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index. Laboratory investigations were done including autoantibodies [anti-nuclear antibody, anti-DNA, anti-cardiolipin (immunoglobulin G and immunoglobulin M), and lupus anticoagulant]. VEGF serum level was measured using enzyme-linked immunosorbent assay. NFC examination was done for recognition of NFC abnormalities. Results Serum VEGF level was elevated in the entire study group (mean of 831±572 ng/l), with a statistically highly significant correlation with Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index and SLE Disease Activity Index score of disease activity (r=0.349, P=0.001, and r=0.897, P<0.001, respectively), together with a significant positive correlation with the presence of nephritis (P=0.002), positive anti-double-stranded DNA (P≤0.001), and consumed C3 and C4 (P≤0.001), which are laboratory markers indicating lupus activity. Moreover, a higher serum VEGF level was associated with severe NFC changes with a statistically highly significant positive correlation with the capillary width (r=0.561, P<0.001), capillary length (r=0.411, P<0.001), and mean capillary density (r=0.308, P=0.003). Conclusion Increased serum VEGF level and progression of NFC score had been directly related to lupus activity and internal organ involvement, especially nephritis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Ultrasonographic abnormalities of wrist and metacarpophalangeal joints in a cohort of Egyptian patients with systemic lupus erythematosus p. 951
Noha H Shedid, Eman A Hafez, Safa A Akram, Hossam M Sakr, Elham S Mohamed
DOI:10.4103/ejim.ejim_164_19  
Background Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by chronic inflammation and autoantibodies, affecting different organs. Musculoskeletal manifestations are one of the most common manifestations in SLE, usually nonerosive and nondeforming. Musculoskeletal ultrasonography (US) can detect synovial inflammation and structural damage lesions. Aim The aim was to detect ultrasound abnormalities of the wrist and metacarpophalangeal (MCP) joints in a cohort of Egyptian patients with SLE and their relation to disease activity. Patients and methods A total of 80 female patients with SLE and 10 age-matched apparently healthy controls were enrolled. Clinical examination and laboratory investigations were done for all patients. US examinations of both wrists and second to fifth MCP joints were done for all participants. Patients were divided according to clinical and US assessments. Results US detected synovitis of MCPs and/or wrist in 63.75% patients compared with 10% of healthy control (P<0.01). Synovitis was identified in most of the patients with SLE who had hand arthralgia when compared with patients without (P<0.01). Conversely, 18.3% of patients had wrist joints tenderness on physical examination with no sonographic abnormalities. Systemic Lupus Erythematosus Disease Activity Index score and dsDNA antibodies were associated with the presence of synovitis. Conclusion US is a valuable tool for assessment of joints in patients with SLE. It helps in detection of inflammation when compared with clinical examination and monitoring disease activity.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The role of sclerostin in knee osteoarthritis and its relation to disease progression p. 958
Amina B Eldin, Elham S Mohamed, Fatma EL Zahraa Hassan
DOI:10.4103/ejim.ejim_108_19  
Background Osteoarthritis (OA) is a common joint disease especially in aging population and is characterized by progressive degeneration of articular cartilage, osteophyte formation, and subsequent joint space narrowing. Sclerostin, a protein product of the SOST gene, secreted mainly by osteocytes causes inhibition of Wnt/β-catenin signaling pathway and bone morphogenetic protein, therefore may affect bone formation and bone remodeling in OA. Aim The aim was to assess serum sclerostin level in patients with knee osteoarthritis (KOA) and its relation to disease severity. Patients and methods A total of 80 participants (50 KOA patients and 30 healthy controls) were recruited in the present study. Sclerostin level in plasma was assessed using an enzyme-linked immunosorbent assay. OA grading was performed using the Kellgren–Lawrence classification. Assessment of physical disability was done by Western Ontario and McMaster universities Arthritis index score and health assessment questionnaire score. Results Plasma sclerostin levels were significantly lower in patients with OA than in healthy controls (P<0.001). Moreover, serum sclerostin level demonstrated a significant inverse correlation with the physical disability score (r=−0.506, P<0.01), age (r=−0.295, P<0.01), disease duration (P<0.05), and radiographic severity of KOA (P<0.001). By univariate regression analysis, sclerostin was one of the strong negative predictors for severity of OA. Conclusion Sclerostin was significantly lower in OA plasma samples when compared with healthy controls. Serum sclerostin level was inversely associated with the physical disability and radiographic severity of KOA. Therefore, sclerostin may be used as a biochemical marker for reflecting disease severity in primary KOA.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum and synovial matrix metalloproteinases 1 and 3 in patients with early rheumatoid arthritis: potentially prospective biomarkers of ultrasonographic joint damage and disease activity p. 965
Maryam A. Abdelrahman, Hossam M Sakr, Menat A.A Shaaban, Naglaa Afifi
DOI:10.4103/ejim.ejim_163_19  
Background Matrix metalloproteinase-1 (MMP-1) and MMP-3 play important roles in the pathogenesis of rheumatoid arthritis (RA) and have been suggested as markers of disease activity and joint damage. Objective The aim was to analyze the clinical significance of MMP-1 and MMP-3 in relation to markers of disease activity and degree of joint destruction in patients with early RA at presentation and after 6 months. Patients and methods Baseline levels of serum MMP-1 and MMP-3 were assessed in 50 patients with early RA (symptoms <1 year), 20 patients with osteoarthritis (OA), and 20 age-matched and sex-matched healthy controls. Serum MPP-1 and MPP-3 were correlated with disease activity markers [erythrocyte sedimentation rate (ESR), C-reactive protein, disease activity score 28–ESR] and radiographic joint damage using simple erosion narrowing score and musculoskeletal ultrasound of wrist and hand joints. Baseline synovial fluid MMP-1 and MMP-3 levels were evaluated for 20 patients indicated for arthrocentesis. Results Baseline serum MMP-1 and MMP-3 were significantly higher in RA group versus OA group and healthy controls (P<0.001). Synovial MMP-1 and MMP-3 levels were significantly higher in RA versus OA group. Serum MMP-1 and MMP-3 levels significantly correlated with rheumatoid factor titers, anticyclic citrullinated peptide, disease activity score 28-ESR score, joint erosions, and Outcome Measures in Rheumatology score of synovitis and Doppler signals. Serum MMP-1 did not correlate with C-reactive protein, but significantly correlated with the number of erosions at presentation and on follow-up. The number of patients with erosions and the number of erosions per patient increased after 6 months and correlated with serum MMP-1 and MMP-3. The best cutoff values of serum MMP-1 and MMP-3 to discriminate between RA and healthy controls were greater than 20 and greater than 50 ng/ml, respectively. Conclusion Elevated serum levels of MMP-1 and MMP-3 can be used as an indicator of disease activity in patients with early RA and can reflect the degree of joint damage and correlate with the number of new joint erosions.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
CASE REPORTS Top

Study of the effect of metformin therapy on thyroid function in type 2 diabetic patients p. 972
Fatema A Abdelmoez, Ghada A Mohamed, Dina M.S Eldine
DOI:10.4103/ejim.ejim_148_19  
Background Metformin, the most widely used antidiabetic drug, is considered as the cornerstone of type 2 diabetes treatments. Surprisingly, a few years ago, it has been reported that serum thyroid-stimulating hormone (TSH) level in hypothyroid patients decreased in response to metformin therapy and increased again when metformin was discontinued. This study was performed at the Diabetic Outpatient Clinic and Internal Medicine Department at Assiut University Hospital during the period between January and June 2017. Aim The study aimed to assess the effect of metformin treatment on TSH in type 2 diabetic patients with or without thyroid dysfunction. Results A total of 100 patients, with type 2 diabetes mellitus, were enrolled in the study. The patients were divided into two groups: group I included 50 patients on metformin therapy and group II included 50 patients without metformin therapy. Their age was equal to or more than 40 years; their duration of diabetic treatment was equal to or more than 5 years. Conclusion In conclusion, there were significant relationships between TSH levels and metformin therapy, obesity, macroangiopathy, and hyperlipidemia, as the treatment with metformin caused suppression of TSH to subnormal levels without any change in free T4 or frees T3 in diabetic patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Multiplicity of hereditary thrombophilic factors inherited from both parents results in child catastrophe p. 979
Afaf Hemeda
DOI:10.4103/ejim.ejim_60_19  
Here we present a rare case of hereditary thrombophilia due to transfer of multiple hereditary thrombophilic factors from father and mother with lethal outcome.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Early addition of rituximab in the management of myositis associated with systemic lupus erythematosus p. 981
Mervat E Behiry, Ahmed Shaker, Kyrillus Shohdy, Fadi Nagy
DOI:10.4103/ejim.ejim_84_18  
Targeting B-cell in systemic lupus erythematosus (SLE) seems to be a promising approach. Although rituximab failed to show efficacy in refractory SLE in clinical trial setting, real-world experience still shows some efficacy in certain situations. A 20-year-old woman was diagnosed with SLE with coexistent myositis. The patient’s muscular condition did not improve on corticosteroids, addition of rituximab could achieve complete response. Introducing rituximab early for the nonrenal manifestations of SLE merits further investigation.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
LETTER TO THE EDITOR Top

Maternal thyroid status and its relation to ferritin and vitamin B12 in Saudi pregnant women p. 983
Mahmood D. Al-Mendalawi
DOI:10.4103/ejim.ejim_104_19  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
Feedback

Subscribe this journal
Submit articles
Most popular articles
Joiu us as a reviewer
Email alerts
Recommend this journal