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   Table of Contents - Current issue
January-March 2018
Volume 30 | Issue 1
Page Nos. 1-48

Online since Tuesday, March 20, 2018

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Ascitic calprotectin as a diagnostic marker for spontaneous bacterial peritonitis in hepatitis C virus cirrhotic Egyptian patients p. 1
Ahmed A Heikl, Mahmoud M El-Nokeety, Eman Roshdy, Abeer Mohey
Background The gold standard for the diagnosis of spontaneous bacterial peritonitis (SBP) is a polymorphonuclear leukocyte (PMNL) count of 250/mm3or more. Accurate and early diagnosis of SBP is important to decrease the mortality and complications in patients with cirrhosis. Aims The aim of this study was to evaluate the accuracy of ascitic fluid calprotectin as a diagnostic marker for the detection of SBP. Patients and methods Seventy Egyptian patients with liver cirrhosis and ascites were enrolled; these patients were divided into two groups: 50 patients with SBP and 20 patients with no SBP on the basis of an elevated ascitic PMNL count of 250 cells/mm3 or more. Ascitic samples were examined for PMNL count, culture, chemistry, and calprotectin concentrations in all patients. Results Calprotectin levels in ascitic fluid were correlated significantly with PMNLs and significantly higher in patients with SBP than non-SBP (P<0.001), with the best cutoff value for the detection of SBP of 783 ng/ml with a sensitivity, a specificity, a positive predictive value and negative predictive value, and an accuracy of 90, 100, 100, 80, and 92.9%, respectively. Conclusion Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of SBP and considered a surrogate marker for PMNL.
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Is serum apelin related to portal hemodynamics in patients with liver cirrhosis? p. 8
Ashraf G Dala, Osama M Ebied, Gamal Y Abo-Raia
Background Apelin is the endogenous ligand of the angiotensin-like receptor. The expression of apelin–APJ (apelin receptor) signaling is associated with the development of portal hypertension (PH) and contributes toward the formation of Porto systemic collaterals and splanchnic neovascularization in PH. Aims We aimed to study the relationship between apelin and portal hemodynamics in cirrhotic patients. Patients and methods Thus study included 60 cirrhotic patients from Menoufia University Hospitals (Egypt) and 20 healthy volunteers as a control group. Participants underwent a physical examination and laboratory investigations [complete blood count, urea, creatinine, alanine transaminase, aspartate transaminase (AST), serum albumin, bilirubin, international normalized ratio, hepatitis C virus antibody, hepatitis B virus antigen, hepatitis C virus PCR, alpha feto protein (AFP), and serum level of apelin]. Abdominal ultrasonographic studies of portal vein diameter, splenic size, and portal hemodynamics were carried out for all participants. Child–Pugh score, model for end-stage liver disease score, and AST/platelet (PLT) index were calculated for all participants. Results Serum apelin was highly significantly elevated in cirrhotics than in controls, with a P value of 0.001. Serum apelin was significantly correlated to some laboratory parameters in cirrhotics such as PLT count, alanine transaminase, AST, γ-glutamyl transferase, and bilirubin, with P value less than 0.05. There was a positive correlation between serum apelin level and the degree of liver fibrosis estimated by the AST/PLT index. Serum apelin was significantly correlated to portal vein diameter and portal flow velocity, with a P value less than 0.05, and highly significantly correlated to splenomegaly, with a P value of 0.001. The optimal cut-off point of serum apelin for the prediction of PH in cirrhotics is 2550 ng/dl, with a sensitivity of 89%, a specificity of 65%, and an accuracy of 81%. Conclusion Serum apelin is elevated in patients with cirrhosis and PH, and a positive correlation is found between serum apelin and the degree of hepatic fibrosis. Measurement of serum apelin represents a rapid, noninvasive method for the prediction of PH in cirrhotics and can assess the degree of hepatic fibrosis.
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Association of serum ferritin with insulin resistance in offsprings of type 2 diabetics p. 13
Usama A Khalil, Fayroz O Seliem, Alsayed Alnahal, Mohamed Awad, Ayman M.E.M Sadek, Mohamed S Fawzy
Context Type 2 diabetes is prevalent worldwide, and insulin resistance (IR) is considered the main player in its pathogenesis. Previous studies suggested a link between iron and IR. Aim The aim was to study serum ferritin level in nondiabetic offsprings, with and without impaired glucose tolerance, of diabetic patients and its relation to IR. Settings and design This is a cross-sectional case–control study carried out in the Internal Medicine Department, Zagazig University Hospitals. Patients and methods A total of 25 completely healthy individuals as a control group and 50 offsprings of patients with type 2 diabetes as a case group were included in the study. The case group was further divided into normal and impaired glucose tolerant offspring subgroups after glucose tolerance test. All of them underwent thorough clinical examination; routine laboratory investigation including complete blood count, liver and kidney function tests, fasting and postprandial blood glucose, serum ferritin, and fasting insulin by enzyme-linked immunosorbent assay; calculation of BMI; and homeostasis model assessment-estimated insulin resistance (HOMA-IR). Statistical package for the social sciences for windows (version 16) was used for statistical analysis. Results Significant increase in mean±SD of serum ferritin, fasting insulin, HOMA-IR, and fasting and postprandial blood glucose levels in impaired glucose tolerant offspring subgroup was observed as compared with both control group and normal glucose tolerant offspring subgroup. Significant positive correlation was found between serum ferritin versus each of BMI, fasting insulin, fasting, postprandial blood glucose, and HOMA-IR in impaired glucose tolerant offspring subgroup. Conclusion Elevated serum ferritin levels in nondiabetic offsprings with impaired glucose tolerance may play a role in the pathogenesis of IR state, which may progress to type 2 diabetes.
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Serum vaspin: as a predictor of ischemic heart disease in Egyptian hemodialysis patients p. 18
Hayam H Mansour, Amal H Ibrahim, Nagwa A Mohamed, Omaima M Ali, Sherif A Nassib
Background Vaspin is a compensatory adipokine with anti-inflammatory properties that can improve insulin sensitivity and plays a cardioprotective role. Aim The aim of this study was to evaluate the level of vaspin in patients with end-stage renal disease on hemodialysis (HD) and to determine whether it has any relation to the presence of ischemic heart disease (IHD) in these patients. Patients and methods The study was carried out on 45 HD patients who were divided into 15 patients with risk factors of developing IHD (group I) and 30 patients (group II) proved to have IHD by echocardiography and ECG compared with 20 healthy individuals (group III). Results We found that the mean±SD of serum vaspin was significantly lower in HD patients with IHD (0.57±0.27) ng/ml compared with the control group (0.74±0.20) ng/ml and there was a negative correlation between serum vaspin and serum creatinine in group I and group II. Also, an receiver operating characteristics study for patients with IHD (group II) yielded a vaspin cut-off value of 0.410 ng/ml with a sensitivity of 40%, a specificity of 100%, a positive predictive value of 100%, and an negative predictive value of 53%, whereas the cut-off value for serum vaspin was 0.485 ng/ml in patients at risk of developing IHD, with a sensitivity of 100%, a specificity of 85%, a positive predictive value of 83%, and an negative predictive value of 100%. Conclusion Lower vaspin level is associated independently with IHD in HD patients and can be used as a predictor of IHD in patients with end-stage renal disease.
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Primary bile reflux gastritis versus Helicobacter pylori gastritis: a comparative study p. 23
Enaase A.M.E Barakat, Neven F Abbas, Nashwa Y El-Kholi
Background Bile reflux gastritis (BRG) is a common disorder, with few data on its pathophysiology and clinical course, whereas Helicobacter pylori is the well-known, commonest cause of chronic gastritis. Aim The aim of this study was to compare between BRG and H. pylori-related gastritis, as regards demographic data, comorbid conditions, and pattern of upper gastrointestinal involvement. Patients and methods It included 130 patients with endoscopic features of gastritis, subdivided into three groups: group A with BRG (56 patients); group B with H. pylori gastritis (58 patients); group C with gastritis in the presence of both H. pylori and bile reflux (16 patients). Statistical analysis was made to compare between the three groups as regards demographic data, history, and examination findings including endoscopic findings. Results BRG is more common among younger age (21–30 years) and elderly patients (71–80 years), whereas H. pylori gastritis is more common in patients in the middle age group (31–60 years), the female/male ratio was 1.5 : 1 in patients with BRG, 1 : 1 in H. pylori gastritis. Nausea was the commonest symptom in patients with BRG (69.6%), whereas epigastric pain/discomfort was the commonest symptom (77.6%) in H. pylori gastritis. Diabetes was found to be more common in patients with H. pylori gastritis (29.3%) followed by BRG (26.8%), whereas obesity was more common in patients with BRG (76.8%) followed by H. pylori gastritis (65.5%). Endoscopy showed antral gastritis in cases with BRG (57.1%), pangastritis in H. pylori and mixed etiology gastritis (60.3 and 68.8%, respectively), reflux esophagitis in both BRG and H. pylori gastritis (41.1 and 44.8%, respectively), higher than mixed etiology gastritis (25%). Endoscopic Barrett’s mucosa was diagnosed in 10.7% of cases with BRG and 12.1% of cases with H. pylori gastritis. Duodenitis, duodenal erosions, or ulcerations were more common in cases with mixed etiology gastritis (62.5%), than in H. pylori gastritis (24.1%), followed by BRG (14.3%). Conclusion BRG is a common, underdiagnosed condition, with distinct clinical and endoscopic features from H. pylori gastritis.
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Serum selenium level in acute myocardial infarction p. 28
Abdallah I Ali Kelani, Hanan S El-Deen Mohammed, Mona M Soliman, Marwa Sayed, Hala M El-Badre, Mai A Fathi
Introduction Although remarkable developments have been made in the management of cardiovascular disease, myocardial infarction (MI) remains the most common cause of death worldwide. MI is an acute condition of myocardial cell death that occurs as a result of imbalance between the coronary blood supply and myocardial requirements. Lipid peroxidation and excessive production of reactive oxygen species (ROS), such as superoxide anions (O2−) and hydrogen peroxide, play a major role in the mechanism of MI. ROS directly damage the cell membrane and cause cell necrosis. However, ROS also stimulate signal transfer to upregulate inflammatory cytokines, for example, tumor necrosis factor-α in the ischemic area and the neighboring myocardium. Aim The aims of this article were: (a) to determine serum selenium (Se) and the cut-off value in acute MI patients and the correlation between serum Se and other cardiac biomarkers such as troponin, creatine kinase (CK), creatine kinase myocardial brand (CK-MB), C-reactive protein, and lipogram; and (b) to determine the most predictor risk factor of MI. Materials and methods The study was carried out on 120 individuals (60 patients and 60 controls). The patients presented to the Internal Medicine Department and Coronary Care Unit at Assiut University Hospital. The healthy controls were selected and matched for age and sex, and only those who were found to be in good health and free from any signs of chronic diseases or disorders were included. Results The main finding of this analysis that there is a statistical difference between patients and controls in serum Se as the mean Se level in patients was 80.3±20.5 and in controls it was 97.2±14.0 and P value of less than 0.001, Thus, serum Se is significantly low in MI patients. Also, there was no statistical difference in serum Se in terms of sex, smoking, accompanying diseases (diabetes or hypertension), or type of infarction. Conclusion This study supports a significant association between deficient serum Se concentration with cut-off value of up to 84 ng/ml and MI. Strikingly, the most predictor of MI is serum Se, followed by total cholesterol, diabetes mellitus, low-density lipoprotein, and hypertension.
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Seroprevalence of acute hepatitis C virus infection among mortuary workers and ambulance drivers in Plateau State, Nigeria p. 35
Jeremiah M Uruku, Amos Dangana, Idris-Abdullahi Nasir, Bibiana N Egenti, Nimzing Lohya, Enenche S Iyalla, Kadiri Ezra, Emmanuel O Falade
Nigeria is one of the countries highly endemic for viral hepatitis. However, data on the prevalence of hepatitis C virus (HCV) infection among mortuary workers and ambulance drivers has not been documented. Hence, this study sought to determine the seroprevalence of HCV among mortuary workers and ambulance drivers in Plateau State, North Central Nigeria. Between December 2015 and February 2016, a total of 80 blood samples were collected from mortuary workers and ambulance drivers with the view to test for HCV antibody using rapid immunochromatographic test (ICT) and enzyme-linked immunosorbent assay for anti-HCV immunoglobulin M. Three milliliter of blood was collected from each patient and the serum was separated out and used for the screening. A self-administered questionnaire was used to access the patients’ sociodemographic variables. Of the 80 samples analyzed, five (6.3%) were positive for HCV using the rapid immunochromatographic assay, while two (2.5%) were positive for anti-HCV immunoglobulin M. There was no statistical association between seroprevalence of HCV with age and sex of patients. However, the seroprevalence of HCV was significantly associated with contact with blood, number of sexual partners, use of gloves, and history of sexually transmitted infections (P<0.05). The HCV seroprevalence of 2.5% among mortuary workers and ambulance drivers was relatively low; however, this suggests that the patients are at-risk group for occupational infection due to HCV.
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Leprosy, a Pleitropic infectious disease: a challenging diagnosis p. 40
Manal El Meniawy, Mervat Essam, Ymna Khaled
This is a case report of 22-year-old man who was suffering from epididymo-orchitis for more than 2 years. Several months after the onset of the condition, the patient developed bilateral upper-limb and lower-limb numbness and tingling sensation with hypothesia, which was further complicated by nonhealing foot ulcer, arthralgia, and generalized maculopapular skin rash. The patient was initially managed as rheumatoid arthritis associated with vasculitis, which was later diagnosed as lepromatous leprosy. Musculoskeletal complaints are not exclusive to only autoimmune diseases; it can also be observed in several disorders, such as infectious diseases. It is challenging for any physician to properly diagnose patients with leprosy as differentiating leprosy from other systemic rheumatic disease is pivotal.
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Small cell carcinoma lung presented as both Pancoast and superior vena cava syndrome: a case report Highly accessed article p. 43
Rajdeep Basu, Sukalpa Chaudhuri, Soumitra Ghosh
Superior vena cava (SVC) syndrome occurs because of SVC obstruction by mediastinal mass, with features of venous stasis and Pancoast syndrome manifested by tumour of the lung apex with features of invasion to adjacent bones, soft tissues and the nervous system. Small cell carcinoma lung is commonly found to cause SVC syndrome, Pancoast is a rare association. Only a few cases have been reported so far. In this report, we focus on a 45-year-old male patient who presented with both Pancoast and SVC syndrome because of small cell carcinoma of the lung.
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Dengue fever p. 47
Nadia A Abdelkader
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