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   Table of Contents - Current issue
Coverpage
July-September 2017
Volume 29 | Issue 3
Page Nos. 93-148

Online since Friday, September 15, 2017

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REVIEW ARTICLE  

Type 1 diabetes mellitus and enterovirus linkage: search for associated etiopathology Highly accessed article p. 93
Idris Abdullahi Nasir, Anthony U Emeribe, Halima A Shuwa, Maryam M Zakari, Nkechi Onukegbe Peters
DOI:10.4103/ejim.ejim_25_17  
Type 1 diabetes (T1D) is believed to have complex interplay between several enteroviruses (EVs) and host immune system disturbance induced or accelerated by viral pathogenesis. In the past two decades, there has been global upsurge in the incidence of childhood T1D, especially in those less than 5 years. Because of the ubiquity and persistence of EVs in human bowel and their tropism to pancreatic cells, they tend to express certain viral proteins that have propensity for genetic manipulation and activation of autoimmunity that could be potentially linked to T1D. In view of these, we present this review of existing literature in order to analyze the epidemiology and possible association between EV infections, host immune dysfunction, and development of autoimmunity or T1D with the view to encourage the investigation of EV infections and associated virus-induced islet cells autoimmunity and immunopathy in genetically predisposed children.
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ORIGINAL ARTICLES Top

Relation of serum magnesium level to microvascular complications and the components of metabolic syndrome in patients with type 2 diabetes mellitus p. 100
Heba M Yossef, Nashwa S Ghanem, Ula M Al-Jarhi, Ollfat G Shaker
DOI:10.4103/ejim.ejim_22_17  
Background and aim Diabetes mellitus is associated with magnesium (Mg) depletion in intracellular and extracellular compartments. Hypomagnesemia has been suggested to be associated with macrovascular and microvascular complications of diabetes. The effect of the metabolic syndrome (MetS) has markedly increased. Recently, there is increasing evidence that dietary Mg intake and supplementation are inversely associated with the risk for MetS and its components. The aim of this study is to evaluate the relation of Mg level to diabetes, its microvascular complications, and MetS components in Egyptian patients with type 2 diabetes mellitus. Patients and methods The study involved 90 patients older than 35 years who were divided into two groups: 70 patients with type 2 diabetes and 20 patients as control. Patients’ group was subdivided into those with complications (neuropathy, retinopathy, and nephropathy) and those without complications. For every patient, history and clinical examination including blood pressure, waist circumference, testing for peripheral neuropathy, and fundus examination were done. Fasting blood sugar (FBS) and 2-h postprandial blood sugar (2-h PPBS), glycated hemoglobin (HbA1c), albumin/creatinine ratio, creatinine level, total cholesterol, high-density lipoprotein-cholesterol, triglycerides, and serum Mg were obtained. Results Serum Mg was significantly lower in diabetic patients than in control (P=0.007). Hypomagnesemia was detected in 56 (80%) patients and none of control. Mg was lower in patients with complications than in patients without; however, the difference was statistically insignificant. Statistically significant negative correlation between serum Mg with serum cholesterol, triglyceride, creatinine level, albumin/creatinine ratio, FBS, 2-h PPBS, and HbA1c was found. Conclusion Hypomagnesemia is prevalent in diabetic patients. It is associated with diabetic complications and poor glycemic control. High plasma triglycerides, total cholesterol, creatinine level, albuminuria, HbA1c, FBS, and 2-h PPBS are independent correlates of hypomagnesemia.
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Creatinine, cystatin, and combined-based equations in assessment of renal functions in type 2 diabetic Egyptian patients p. 105
Mahmoud M Elnokeety, Amr M Shaker, Ahmed M Fayed
DOI:10.4103/ejim.ejim_26_17  
Background Diabetic nephropathy is the principal single cause of end-stage renal disease. The most important parameter in the clinical evaluation of kidney function is the glomerular filtration rate (GFR), which is generally accepted as the best overall index of kidney function; GFR remains the cornerstone of the clinical evaluation of overall kidney function. Our study was performed to compare between estimated GFR equations based on serum creatinine and/or cystatin C performance in relation to measured GFR using radionuclide study and degree of proteinuria. Patients and methods In our cross-sectional study, 80 adult type 2 diabetic patients, with diabetic nephropathy and proteinuria more than 300 mg/24 h, were included after application of inclusion and exclusion criteria, and subjected to history taking, clinical examination, and laboratory investigation including serum creatinine, cystatin C, 24-h urinary protein/creatinine clearance, and renal isotope technetium-99m-diethylene triamine pentaacetic acid scanning. Results There was a linear correlation between serum creatinine and cystatin C (r=0.867, P=0.000). Cystatin C was better correlated (r=−0.781, P=0.000) with isotopically measured GFR than creatinine (r=−0.106, P=0.348). Cystatin C was better than creatinine in all estimated GFR equations tested in our study [Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Cr 2009, CKD-EPI Cr-Cys 2012, CKD-EPI Cys 2012]. The best performance among all equations tested when compared with isotopically measured GFR was the CKD-EPI Cr-Cyst 2012 (r=0.816, P=0.000). Cystatin C showed a significant negative correlation with hemoglobin level, a finding that could not be established with serum creatinine; there was no significant association of creatinine or cystatin with the level of proteinuria. Conclusion In patients with early overt diabetic nephropathy, serum cystatin C showed a significantly stronger correlation than creatinine with isotopically measured GFR, and among the studied equations for GFR estimation the CKD-EPI Cr-Cyst 2012 equation performed best.
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The relationship between anemia, serum hepcidin levels, and chronic hepatitis C in chronic hemodialysis patients p. 112
Maher A Al-Amir, Ahmed A Hassan, Shahira M Elshafie, Heba M Zein Elabdin, Sara A Taha
DOI:10.4103/ejim.ejim_28_17  
Background Hepcidin is a small peptide that is produced by hepatocytes and circulates in the plasma. It plays a central role in regulating the iron status in the body. Aim The aim of this study was to measure serum hepcidin levels in maintenance hemodialysis (MHD) patients and identify a possible impact of chronic hepatitis C virus (HCV) infection on the severity of anemia. Patients and methods This cross-sectional study was conducted on a cohort of 80 MHD patients (40 HCV positive and 40 HCV negative) and 20 healthy age-matched and sex-matched participants who participated as normal controls. Serum hepcidin and highly-sensitive C-reactive protein were measured in patients to study their possible effect on hematological and inflammatory parameters when compared with the control group. Results MHD patients had significantly higher serum hepcidin levels than did controls. The HCV-positive group had significantly lower serum hepcidin and ferritin levels when compared with the HCV-negative group. All MHD patients had significantly higher levels of serum highly-sensitive C-reactive protein than did controls. Hepcidin was also found to correlate with age and serum ferritin levels among MHD patients. Conclusion Changes in serum hepcidin levels are associated with iron status and microinflammation in MHD patients. If used as a diagnostic tool, it may improve targeting and timing of iron therapy by identifying patients during periods of reticuloendothelial blockage of iron transport. This is important to avoid iron overload, especially in HCV-positive patients, which may otherwise cause liver injury resulting in fibrosis, cirrhosis, and finally HCC. We also revealed the value of ferritin levels, which seemed to play an important role in determining the severity of liver disease related to liver fibrosis and microinflammatory activity.
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Serum chemerin and diabetic retinopathy in type 2 diabetic patients Highly accessed article p. 117
Alaaeldin Abdelsalam Dawood, Osama Abdalah Elmorsy, Hala Mourad Demerdash
DOI:10.4103/ejim.ejim_30_17  
Background Diabetic retinopathy (DR) is one of the microvascular complications of type 2 diabetes mellitus (T2DM). There is a need to find a reliable screening biomarker to help in the early diagnosis of this complication. The aim of the work was to study the relation between serum chemerin and DR in T2DM patients. Patients and methods This study was conducted on 80 T2DM patients in addition to 20 healthy individuals who served as a control group. The participants were grouped into four groups: the T2DM group, the nonproliferative diabetic retinopathy (NPDR) group, the proliferative diabetic retinopathy (PDR) group, and the control group. Laboratory investigations were performed to all participants, which included glycosylated hemoglobin (HbA1c), serum creatinine, lipid profile, urine albumin/creatinine ratio, C-reactive protein (CRP), and serum chemerin. Fundus examination was carried out to all participants by an expert ophthalmologist. Results Serum chemerin was significantly higher in the PDR group compared with the other groups, in the NPDR group compared with the T2DM group and controls, and in the T2DM group compared with controls. There was a positive significant correlation between serum chemerin and BMI, HbA1c, diabetes mellitus duration, serum total cholesterol, triglycerides, low density lipoprotein, and CRP and a negative significant correlation between serum chemerin and high density lipoprotein in diabetic patients. Conclusion From this study, we can conclude that serum chemerin is significantly higher in patients with DR compared with diabetic patients without retinopathy and in PDR patients compared with NPDR patients. There is a positive correlation between serum chemerin and CRP, BMI, and lipid profile.
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B-lymphocyte stimulator: can we consider it a marker for severity of hepatitis C virus-induced B-cell non-Hodgkin lymphoma? p. 122
Yousryeia A Ahmad, Ola Afifi, Safinaz Hussein, Rania Hafez, Eman Salaheldin
DOI:10.4103/ejim.ejim_33_17  
Objective B-lymphocyte stimulator (BLyS) is a member of tumor necrosis factor family. BLyS is essential for the survival of normal and malignant B lymphocyte. Hepatitis C virus (HCV) infection likely represents the early event leading to BLyS upregulation. The aim of this study was to determine the relation between serum BLyS levels and the severity of HCV-related B-cell non-Hodgkin lymphoma (B-NHL). Patients and methods Seventy-eight B-NHL patients both HCV-positive and HCV-negative and 20 patients with HCV infection without lymphoproliferative disorders, in addition to 20 age-matched and sex-matched controls, were included in the study. PCR for HCV, evaluation of levels of soluble BLyS protein in blood, bone marrow aspirate and biopsy with flow cytometry, and lymph node biopsy with immunophenotyping for CD5, CD23, CD10, CD20, and cyclinD1 were performed. Results The serum BLyS levels were significantly higher in B-NHL patients and HCV patients without lymphoproliferative disorders compared with the control group. The serum BLyS levels were statistically significantly higher in aggressive lymphoma patients with HCV-positive infection compared with aggressive lymphoma patients with HCV-negative infection, but there was no statistically significant difference between BLyS levels in indolent B-NHL patients with or without HCV infections. Moreover, there was no statistically significant difference between BLyS levels in aggressive and indolent lymphoma patients with HCV-positive infection. Conclusion BLyS levels are increased in HCV-induced B-NHL but it cannot be considered as a marker for severity of the disease (indolent or aggressive). More studies are needed.
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Screening of incidental kidney disease in normoglycemic, normotensive healthy adults p. 127
Ahmed Yamany, Heba Shehata, Mervat Essameldin, Salwa Ibrahim
DOI:10.4103/ejim.ejim_35_17  
Background and aim Chronic kidney disease is a major public health problem with increased global incidence and prevalence, especially in Egypt, poor quality of life, and high risk of morbidity and mortality. The aim of the work was to determine the prevalence and the risk factors of incidental kidney diseases among apparently healthy adults. Patients and methods A total of 300 healthy normotensive and normoglycemic individuals were assessed for creatinine, proteinuria, and glomerular filtration rate, with correlation to their BMI and systolic and diastolic blood pressures. Results Microalbuminuria was positively correlated to age, BMI, and systolic blood pressure, with a significant P-value of less than 0.001. Conclusion The prevalence estimates and risk factors for those with microalbuminuria as a marker of occult renal disease include age, BMI, high systolic blood pressure, and family history of renal problems.
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Brachial artery flow-mediated dilation and carotid intima-media thickness for assessment of subclinical atherosclerosis in rheumatoid arthritis p. 132
Mona Hussein El Zohri, Salwa S ELGendi, Ghada H Ahmed, Mohammed Zidan Mohammed
DOI:10.4103/ejim.ejim_37_17  
Objective The aim of this study was to assess subclinical atherosclerosis in rheumatoid arthritis (RA) patients using flow-mediated dilation (FMD) and carotid intima–media thickness (CIMT) and find their relation to disease activity. Patients and methods Totally, 30 RA patients without cardiac involvement and 10 controls were included in the study. Disease activity was evaluated using disease activity score 28 (DAS28) score. Low disease activity is defined by DAS28 of 3.2 or less, moderate disease activity as DAS28 3.3–5.3, and severe disease activity as DAS28 of 5.4 or more. Endothelial dysfunction is considered to be present when FMD on B-mode ultrasonography is below 4.5%. CIMT was calculated by measuring the greatest distance between lumen–intima and media–adventitia interface [mean value of two sides (right and left) was taken] using B-mode ultrasonography. Results The mean CIMT was significantly higher in the RA patients (1.8±0.2) than in healthy controls (1.5±0.1) (P=0.001). Taking the mean±SD of the control group (1.6 mm) as the upper limit of the normal CIMT, 22 (73.3%) RA patients and three (30%) controls had abnormal mean CIMT, which was statistically significant. Brachial FMD% in RA patients was significantly lower (22.9±11.0) as compared with controls (35.5±23.2) (P=0.027). A statistically significant positive correlation was observed between CIMT values of patients with age, C-reactive protein, and low-density lipoprotein. There was a significant negative correlation between CIMT and hemoglobin and brachial FMD. FMD% showed a statistically significant negative correlation with age, disease duration, low-density lipoprotein, Framingham cardiovascular risk score, and mean CIMT. Conclusion Carotid ultrasound and endothelial function assessment by means of FMD may be a useful tool to predict the increased risk for cardiovascular disease in patients with RA, which requires aggressive therapy.
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CASE REPORTS Top

Spontaneous lung pneumatocele in an adult with community-acquired pneumonia p. 141
Jyoti Bajpai, Surya Kant, Ajay Kumar Verma, Darshan Kumar Bajaj
DOI:10.4103/ejim.ejim_6_17  
Pulmonary pneumatoceles are thin-walled, air-filled cystic lesions occurring in lung parenchyma. They occur as a sequelae to bacterial infections of the lung, especially bronchopneumonia. They are commonly seen in infants and children. In this article, we report a rare case of pneumatoceles in a 40-year-old adult following staphylococcal community-acquired pneumonia.
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Hodgkin’s lymphoma presenting as autoimmune hemolytic anemia p. 144
Sohaila Fatima, Wajih A Siddiqui, Abdulrahman Alshehri
DOI:10.4103/ejim.ejim_15_17  
Hodgkin’s lymphoma is a B-cell neoplasm, which usually presents with painless lymphadenopathy. Its presentation with autoimmune hemolytic anemia (AIHA) is rare, although the association of AIHA with other lymphoproliferative disorders is well known. Here, we report a case of a patient with warm AIHA who presented in a critical condition to hospital and was diagnosed with HL.
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HISTORY OF MEDICINE Top

Medicine in Roman and Byzantine Egypt (from 30 BC to AD 641) p. 147
Nevine Abd El-Gawad Ali Hasan
DOI:10.4103/ejim.ejim_46_17  
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