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REVIEW ARTICLE
Acute aluminium phosphide poisoning, what is new?
Yatendra Singh, Subhash C Joshi, Vivekanand Satyawali, Abhisek Gupta
July-September 2014, 26(3):99-103
DOI:10.4103/1110-7782.145298  
Aluminium phosphide (AlP) is a cheap solid fumigant and a highly toxic pesticide that is commonly used for grain preservation. AlP has currently generated interest with increasing number of cases in the past four decades because of its increased use for agricultural and nonagricultural purposes, and also its easy availability in the markets has led to its increased misuse to commit suicide. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. The poison affects all systems, shock, cardiac arrhythmias with varied ECG changes and gastrointestinal features being the most prominent. Diagnosis is made on the basis of clinical suspicion, a positive silver nitrate paper test to phosphine, and gastric aspirate and viscera biochemistry. Treatment includes early gastric lavage with potassium permanganate or a combination of coconut oil and sodium bicarbonate, administration of charcoal and palliative care. Specific therapy includes intravenous magnesium sulphate and oral coconut oil. Unfortunately, the lack of a specific antidote results in very high mortality and the key to treatment lies in rapid decontamination and institution of resuscitative measures. This article aims to identify the salient features and mechanism of AlP poisoning along with its management strategies and prognostic variables.
  5 11,641 731
ORIGINAL ARTICLES
Evaluation of serum endoglin as noninvasive marker in hepatocellular carcinoma
Rehab A Mohamed, Hend M Maghraby, Eman M Abd El Salam, Hala M Nageb, Eman E Ahmad, Nagwa A Mohamed
January-March 2015, 27(1):15-20
DOI:10.4103/1110-7782.155832  
Introduction Hepatitis C viral (HCV) infection is a major risk factor for liver cirrhosis, liver failure, and hepatocellular carcinoma (HCC). A number of laboratory-based methods has been developed for the noninvasive diagnostic evaluation of HCC. Endoglin (CD105) is a homodimeric membrane glycoprotein expressed on endothelial cells that can bind to transforming growth factor-b1 and transforming growth factor-b3. Aim of the study The aim of this study was to evaluate the diagnostic value of endoglin and alpha-fetoprotein (AFP) in patients with chronic HCV infection with and without HCC. Patients and methods A total of 50 HCV patients were chosen and divided into two groups, group I (26 cirrhotic patients) and group II (24 HCC patients), and compared with group III (10 healthy volunteers) as controls. For all participants, thorough clinical examination, blood picture, liver function tests, HCV antibody, AFP, and serum endoglin were performed. Abdominal ultrasound, abdominal triphasic computed tomographic (CT) scan, and liver biopsy for those diagnosed HCC by triphasic CT were performed. Results We found highly significant increase in serum endoglin in HCV patients with HCC (group II) compared with HCV patients with liver cirrhosis (group I) and controls (group III). There was significant positive correlation between serum endoglin and aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, and AFP. In addition, there was significant negative correlation between serum endoglin and hemoglobin, albumin, and prothrombin concentration. The cutoff value for serum AFP for which HCC is suspected was greater than 250 ng/ml with sensitivity 79% and specificity 89%, whereas the cutoff value for serum endoglin was greater than 10.57 ng/ml with sensitivity 70% and specificity 81%. Conclusion Serum Endoglin is a promising tumor marker that may be used with serum AFP as noninvasive technique to aid diagnosis of HCC.
  3 1,801 295
CASE REPORTS
An unusual complication of snake bite
Mary Grace, KC Shanoj
April-June 2014, 26(2):91-92
DOI:10.4103/1110-7782.139583  
Anterior pituitary hypofunction is a well-known complication following snake bite. However, central diabetes insipidus as a complication of snake bite is only rarely reported in the literature. We are reporting a case of central diabetes insipidus, which developed as sequelae to viper bite.
  2 1,877 197
Oncocytic adrenal tumour presenting as Cushing syndrome: rare presentation of a rare tumour
Abhishek Singhai, Subodh Banzal
October-December 2014, 26(4):184-185
DOI:10.4103/1110-7782.148180  
Oncocytic neoplasms are well recognized in organs such as the kidney, thyroid and salivary glands. They are seen rarely in other sites such as the adrenal cortex. To date, around 20 cases of oncocytic adrenocortical neoplasm have been reported; most of them were benign and nonfunctioning. We report the case of hypersecreting adrenocortical oncocytoma in a 52-year-old woman. The patient was tested because of cushingoid features. The patient underwent a laparotomy for right adrenal gland mass. The pathology report confirmed adrenocortical oncocytoma.
  2 1,741 171
ORIGINAL ARTICLES
Effect of vitamin D3 in treating hyperthyroidism in patients with graves’ disease
Nermin A Sheriba, Abeer A.A. Elewa, Maram M Mahdy, Ahmed M Bahaa El Din, Nesma A Ibrahim, Dina A Marawan, Tahany M Abd El Moneim
April-June 2017, 29(2):64-70
DOI:10.4103/ejim.ejim_10_17  
Background Graves’ disease (GD) is an autoimmune disease characterized by hyperthyroidism secondary to circulating autoantibodies. Multiple factors contributed to its etiology, including genetic and environmental factors. The role of vitamin D is well-known in calcium metabolism and skeletal homeostasis. Vitamin D was shown to be a modulator in both innate and adaptive immunity. There is a link between vitamin D deficiency and various autoimmune diseases. The prevalence of vitamin D deficiency was reported to be common in patients with GD. Interestingly, vitamin D deficiency is found to be associated with higher thyroid volume in patients with newly-onset GD. However, vitamin D deficiency relationship with GD remains a controversial issue. Objective The objective of this study was to evaluate the effect of vitamin D supplementation in GD with and without ophthalmopathy. Patients and methods A randomized prospective study was conducted on 60 adult patients with GD aged 20–40 years. Group 1 comprised 20 patients with GD receiving a daily dose of 30 mg of methimazole alone. Group 2 comprised 40 patients with GD receiving the same dose of methimazole, supplemented with intramuscular injection of vitamin D3 200 000 IU/month for 3 months. Patients were followed up over a 3-month duration. Results There was hypovitaminosis D in all participants with a percentage of vitamin D deficiency (vitamin D level: <20 ng/ml) of 73.9% in male and 54.1% in female and a vitamin D insufficiency (vitamin D level: 20–29 ng/ml) of 26.1% in male and 45.9% in female. Vitamin D was significantly correlated with thyroid volume and degree of exophthalmos. On vitamin D supplementation, group 2 had significantly lower thyroid volume and better effect on the degree of exophthalmos. Conclusion Vitamin D supplementation for GD has a favorable effect on thyroid volume and on the degree of exophthalmos.
  2 3,229 222
Prevalence and risk factors for gestational diabetes mellitus according to the Diabetes in Pregnancy Study Group India in comparison to International Association of the Diabetes and Pregnancy Study Groups in El-Minya, Egypt
Ghada M El Sagheer, Lamia Hamdi
July-September 2018, 30(3):131-139
DOI:10.4103/ejim.ejim_11_18  
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 Assessment of the prevalence of GDM in El-Minya city, Egypt using the Diabetes in Pregnancy Study Group India (DIPSI) in comparison to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, and assessment of the risk factors for GDM in this locality. Patients and methods There were 700 pregnant women who underwent the 75 g oral glucose tolerance test irrespective of the meal and plasma glucose measurement after 2 h. In the next morning, fasting and 1 h, and 2 h post-75 g oral glucose tolerance test were assessed. Diagnosis of GDM was carried out according to the DIPSI and IADPSG criteria. Results GDM was diagnosed in 62/700 women (8.86%) by DIPSI versus 52/700 (7.43%) by IADPESG. Compared with IADPSG, the sensitivity and specificity of DIPSI were 100 and 98.5%, respectively, while the positive and negative predictive values were 83 and 100%, respectively. The multiple logistic regression analysis has shown that BMI, urban residency, gestational hypertension, previous history of GDM, gestational hypertension, family history of DM, and the educational level less than secondary school were determined as independent risk factors of GDM. Conclusion The GDM prevalence in El-Minya city was 8.86% by DIPSI versus 7.43% by IADPSG with high sensitivity, specificity, and predictive values. The DIPSI could be considered as a simple, single, convenient, and economical method of GDM screening. However, more evaluation in a bigger patient sample is recommended.
  2 1,843 237
Impact of hepcidin, interleukin 6, and other inflammatory markers with respect to erythropoietin on anemia in chronic hemodialysis patients
Ihab A. Ibrahim, Usama M. Mohamad, Hatem A. Darweesh, Amal M. Rashad
January-March 2014, 26(1):6-14
DOI:10.4103/1110-7782.132882  
Background/objective Hepcidin is a peptide hormone produced by the liver and appears to be the master regulator of iron homeostasis. This peptide is upregulated in inflammatory conditions, including uremia. Hepcidin functions to regulate (inhibit) iron transport across the gut mucosa, thereby preventing excess iron absorption and maintaining normal iron levels within the body. In this study, we aimed to investigate hepcidin levels and their relationship with the parameters of iron status, inflammation, anemia therapy, and parameters of dialysis efficiency in hemodialysis patients. Patients and methods Plasma hepcidin-25, inflammatory markers (high-sensitivity C-reactive protein and interleukin 6), and peripheral iron indices (serum iron, total iron-binding capacity, transferrin saturation and serum ferritin) were measured before hemodialysis in 40 end-stage renal disease (ESRD) patients treated with regular hemodialysis in a single dialysis unit as well as in 20 healthy individuals matched for age and sex serving as the control group. Results Plasma levels of hepcidin-25 were significantly higher in hemodialysis patients compared with controls. In a simple correlation analysis, plasma hepcidin levels were positively correlated with ferritin, transferrin saturation, CRP, and interleukin 6; however, it was negatively correlated with hemoglobin, dose of epoitin-α, and dose of iron. Conclusion Serum hepcidin levels were associated with iron status and inflammation in maintenance hemodialysis patients, and the high hepcidin serum levels, found in hemodialysis (HD) patients, are dependent on the magnitude of the inflammatory process and on recombinant human erythropoietin doses. Hepcidin and its regulatory pathways are potential therapeutic targets, which could lead to effective treatment of anemia in chronic hemodialysis.
  2 2,695 400
Fetuin-A and type II diabetes mellitus
Lamyaa Ismail Ahmed, Sabila Gomaa Mousa, Nagwa Abd El-Ghaffar Mohamed, Zeinab Ahmed Yousry, Mayada Rabea Abd-El Khalaa
October-December 2014, 26(4):157-161
DOI:10.4103/1110-7782.148140  
Background The pathophysiology of type II DM is complex; in addition to impaired insulin secretion from Beta-cells, reduced insulin sensitivity was found to play a predominant role in the pathogenesis of the disease. Fetuin-A is a he­patic secretory protein that binds the insulin receptor and inhibits insulin action both in vivo and in vitro. Objective Our aim was to investigate whether serum fetuin-A levels predict the incidence of insulin resistance in type II DM. Patient and methods The present study included 40 patients who had type II diabetes mellitus served as patients group and 40 apparently normal individuals served as control group. All patient and control groups were subjected to the following: full medical history and thorough physical examination, fasting & post prandial blood glucose, urea, creatinine, lipid profile, CRP, insulin and fetuin-A. Results There was highly significant increase in serum insulin, serum fetuin A and HOMA-IR in diabetic group compared with control group. There was significant positive correlation between serum fetuin A and serum insulin, FBG, HbA1c and serum CRP. Also a significant positive correlation between HOMA-IR and serum fetuin A, serum insulin and HbA1c were found. Conclusion We concluded that fetuin-A may play a role in the pathogenesis of type II DM, and high serum fetuin-A has a strong association with IR and glycemic control in type II diabetic patients. Future studies are recommended to establish the possibility of using fetuin-A as a predictor of insulin resistance in type II diabetic patients.
  2 1,877 284
Zinc level and obesity
Doaa S.E. Zaky, Eman A Sultan, Mahmoud F Salim, Rana S Dawod
October-December 2013, 25(4):209-212
DOI:10.4103/1110-7782.124985  
Background Obesity is a chronic condition that is associated with disturbances in the metabolism of zinc. Therefore, the aim of this study was to investigate the relationship between serum zinc level and different clinical and biochemical parameters in obese individuals. Patients and methods Twenty-four individuals with BMI more than 30 kg/m 2 and 14 healthy controls (BMI < 24 kg/m 2 ) were assessed for BMI and waist circumference using anthropometric measurements. Colorimetric tests were carried out for the determination of zinc in serum. Results In this study, BMI and waist circumference were higher in the obese group than in the control group (P < 0.05). The mean serum zinc levels were 92 ± 31.1 and 101 ± 70 μg/dl in the obese group and control group (P > 0.05), respectively. There was a significant negative correlation between the serum zinc level and BMI, waist circumference and low-density lipoprotein (P < 0.05). Conclusion Plasma zinc concentration in obese individuals showed an inverse relationship with the waist circumference and BMI as well as serum low-density lipoprotein-cholesterol and correlated positively with high-density lipoprotein.
  2 2,686 313
REVIEW ARTICLE
The secret of neuroscience boom: Are there secret human experiments in Latin América?
David Salinas Flores
January-March 2016, 28(1):1-4
DOI:10.4103/1110-7782.182942  
About 6 years ago there sparked a phenomenon in science called the neuroscientific boom. Neurologists underpin this phenomenon to cost reduction techniques such as electroencephalograms and to improved noninvasive technology such as functional MRI. But the human brain, the most complex organ in the universe, has not yet been fully investigated with the existing noninvasive technologies. Thus, there is a suspicion that the real reason for this boom is a secret, forced, and illicit human experimentation in Latin America. Physicians should investigate, be alert, and report these potential unethical human experiments to prevent any further damage to the public health of the citizens of Latin societies.
  2 6,875 395
CASE REPORTS
Hemorrhagic bronchial mucosa syndrome
Amit Panjwani
October-December 2015, 27(4):151-153
DOI:10.4103/1110-7782.174944  
Flexible fiberoptic bronchoscopy is a commonly performed procedure that helps in the management of pulmonary disorders. Complications during this procedure are uncommon. An elderly man was subjected to fiberoptic bronchoscopy for the evaluation of his respiratory disorder. He had no clinical, biochemical, or hematological signs of coagulopathies. During the procedure, he developed hemorrhagic bronchial mucosa syndrome after a bout of uncontrolled severe coughing. This is an extremely rare complication of this procedure. A description of this condition and its mechanism is discussed here.
  1 1,839 163
Aluminium phosphide induced acute kidney injury
Quaiser Saif, Ruhi Khan, Aparna Sharma
July-September 2015, 27(3):115-117
DOI:10.4103/1110-7782.157999  
Aluminium phosphide is one of the most common agricultural poisons being consumed in north India. Consumption of a fresh tablet is lethal as no antidote is available. Acute intoxication primarily presents with cardiovascular collapse due to myocardial toxicity. We report here a case of acute severe poisoning along with cardiovascular collapse and oliguria. The patient developed acute kidney injury during the illness (a rare entity in aluminium phosphide poisoning), which completely resolved following prompt conservative treatment.
  1 2,121 199
Splenic abscess: a rare presentation
Mohit Bhatia, Hanumant Lohar, Daksha S Nirhale, Vishal Tomar
April-June 2015, 27(2):78-79
DOI:10.4103/1110-7782.159477  
Splenic abscess is a rare clinical entity with an incidence of 0.2-0.7% in autopsy-based studies. When untreated, splenic abscess is associated with nearly 100% mortality; in treated patients, the mortality rate is 16.6% during the first 90 days. It mostly occurs in patients with neoplasia, immunodeficiency, trauma, diabetes or splenic infarct. The incidence of splenic abscess is thought to be growing because of the increase in the number of immunocompromised patients who are particularly at risk for this disease and also because of the widespread use of diagnostic modalities. However, the optimal treatment for this remains unclear. We present a case of a 42-year-old man diagnosed with multiloculated splenic abscess and was subjected to splenectomy.
  1 1,511 162
Nonreversal of adrenal hypofunction after treatment of adrenal tuberculosis
Bashir Ahmad Laway, Shahnaz Ahmad Mir, Mohd Ashraf Ganie, Feroze Shaheen, Parvaiz Ahmad Shah
January-March 2015, 27(1):42-44
DOI:10.4103/1110-7782.155860  
Tuberculosis of the adrenal glands is a common cause for Addison's disease in developing countries. Whether treatment of tuberculosis normalizes adrenocortical function in these patients is controversial. We are reporting two cases of Addison's disease because of adrenal tuberculosis, in whom treatment with antitubercular drugs did not restore normal adrenal functions. We conclude that treatment of tubercular Addison's disease does not lead to normalization of adrenocortical function.
  1 1,697 243
ORIGINAL ARTICLES
Quality of colonoscopy in children with rectal bleeding in Egypt
Ahmed S Gado, Basel A Ebeid, Aida M Abdelmohsen, Ayman E Eskander, Anthony T Axon
January-March 2015, 27(1):21-25
DOI:10.4103/1110-7782.155841  
Background Colonoscopy is the diagnostic evaluation of choice in cases of rectal bleeding (RB). Colonoscopy in children is different from that in adults, but the technique of the examination is similar. Colonoscopy is a technically demanding procedure with the potential for harm if performance is unsatisfactory, and thus assurance of quality is pivotal. A colonoscopy quality-assurance program was instituted in 2003. Aim The aim of this study was to determine the quality of colonoscopy in children with RB after introducing a colonoscopy quality-assurance program. Patients and methods The study was cross-sectional and hospital-based. It was undertaken between 2010 and 2013 on 107 children who underwent colonoscopy for the evaluation of RB. Results A total of 112 colonoscopies were assessed. A diagnosis was established in 69 (62%) colonoscopies and polyps were detected in 52%. Cecal intubation was achieved in 107 (90%). The main reason for an unsuccessful cecal intubation was poor bowel preparation. The adjusted completion rate was 97%. The mean time to reach the cecum was 16 min. The mean time for completion of the procedure was 31 min. Colon preparation was rated adequate in 63 (56%) colonoscopies. A total of 119 polyps were detected in 58 colonoscopies, with an average of two polyps per colonoscopy (range 1-7). In all, 113 polyps were excised. All polyps were judged to be completely removed in 52 (95%) colonoscopies. Polypectomy was not performed in three colonic examinations with solitary polyps. Five (4%) patients had postprocedural vomiting. There was one (1%) sedation-related complication (respiratory distress), but no procedure-related complications or mortality. Conclusion A high standard of colonoscopy in children with RB can be achieved by introducing a colonoscopy quality-assurance program.
  1 1,334 153
Vaspin in type 2 diabetes in relation to atherosclerosis
Nehal H El-Said, Noha A Sedik, Nagwa A Mohamed
July-September 2014, 26(3):130-135
DOI:10.4103/1110-7782.145314  
Background Vaspin is a novel adipocytokine with insulin-sensitizing effects. However, it is not known whether a correlation exists between human vaspin serum levels and markers of insulin sensitivity and glucose or lipid metabolism. Aim of the work To determine whether there is an association between serum vaspin levels (a novel adipocytokine with insulin-sensitizing effects), type 2 diabetes mellitus (T2D) and atherosclerosis. Patients and methods The study included 40 patients with T2D divided into 20 without hypertension (group 1), 20 with hypertension (group 2) and 15 age-matched and sex-matched healthy control participants (group 3). The serum vaspin level was determined by enzyme-linked immunosorbent assay. Its level was compared between both diabetic patients and controls, and between diabetic patients without hypertension and those with hypertension. All participants were subjected to an imaging procedure in the form of carotid Doppler to measure the intima - media thickness as an early marker of atherosclerosis. Results The serum vaspin level was significantly higher in diabetic patients compared with control participants. There was significant increase in the left carotid intima-media thickness in diabetic patients with hypertension and without hypertension compared with control participants. There was a significant positive correlation between the serum vaspin level and the BMI in diabetic patients with hypertension, a significant negative correlation between the serum vaspin level and the duration of diabetes and a significant negative correlation between the serum vaspin level and HDL in diabetic patients without hypertension. Conclusion There was a significantly high level of serum vaspin in T2D patients. Serum vaspin was shown to be significantly lower in T2D patients with a longer duration of illness. An increased carotid intima-media thickness in diabetic patients was not related to the vaspin level, denoting an underlying combining factor for atherosclerosis in diabetic patients other than vaspin.
  1 1,434 156
Functional and structural abnormalities of the skin microcirculation in hemodialysis patients
Maggie S El-Nahid, Ali M El-Ashmaoui
July-September 2014, 26(3):116-123
DOI:10.4103/1110-7782.145307  
Background The changes that occur at the level of the skin microvessels reflect changes at other microvessels including the cardiac microvessels. Several disease states seem to alter skin microvascular function and structure such as diabetes, hypertension, and hypercholesterolemia. Many of these disease states are frequently encountered in hemodialysis (Hdx) patients. The process of Hdx itself is also associated with vascular abnormalities. It was thus the aim of our study to examine the structure and function of skin microcirculation in Hdx patients. Materials and methods Sixty patients were examined: 20 patients on regular Hdx, younger than 60 years old, with no diabetes, hypertension, or hypercholesterolemia, 20 patients on regular hemodialysis with coexisting hypertension (Htn-Hdx), and 20 young healthy volunteers. The skin microcirculation was assessed using the laser Doppler fluxmetry and the capillaroscope. Results Results showed significant differences in the laser Doppler fluxmetry measurements between the Hdx group and the Htn-Hdx group compared with the control group, with no significant differences in the capillaroscope study. Conclusion The study of skin microcirculation in Hdx patients indicated the presence of functional abnormalities without significant structural changes.
  1 1,854 150
Associations of fetuin-A level with vascular disease in hemodialysis patients with or without type II diabetes mellitus
Amani K Mohamed, Amany M Abdallah, Maha A Hassan, Nagwa A Mohammed, Solaf A Kamel
October-December 2013, 25(4):218-224
DOI:10.4103/1110-7782.124996  
Introduction Fetuin-A is a circulating inhibitor of calcium deposition in the vasculature and may be involved in the pathogenesis of cardiovascular disease. Low plasma fetuin-A level is independently associated with increased risk for cardiovascular disease mortality among men and women without diabetes; in addition, low level of fetuin-A is linked to mortality in patients on dialysis. Aim of the study The aim of the study was to investigate the role of fetuin-A as a marker for microvascular and macrovascular diseases in a high-risk population of end-stage renal disease patients on dialysis, with and without diabetes mellitus. Patients and methods This study included 30 end-stage renal disease patients on regular hemodialysis, with and without diabetes and 10 age-matched and sex-matched apparently healthy controls. All patients were subjected to careful history-taking, including history of strokes and acute myocardial infarction and thorough physical examinations, and cardiac assessment was performed using ECG and ECHO. Routine laboratory tests were performed, such as hemoglobin, fasting blood glucose, serum creatinine, serum urea, serum Na, serum K, uric acid, serum cholesterol, serum triglycerides, serum aspartate aminotransferase, serum alanine aminotransferase, serum albumin, serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), serum iron, total iron binding capacity (TIBC), and serum fetuin-A. Results The study showed significant statistical decrease in serum fetuin-A level in chronic renal failure (CRF) and diabetes patients with vascular strokes when compared with CRF patients and CRF patients with diabetes without history of vascular strokes. There was significant positive correlation between fetuin-A and hemoglobin, serum Ca, serum albumin, TIBC, and total protein (TP), whereas there was significant negative correlation between fetuin-A and serum cholesterol, serum triglyceride (TG), fasting blood glucose (FBG), serum urea, serum creatinine, serum uric acis (UA), iPTH, serum Na, and serum K. No correlation was found between fetuin-A and age or BMI. Conclusion Our findings suggest a unique role for fetuin-A deficiency as a biomarker of vascular diseases in the setting of CRF and type 2 diabetes mellitus.
  1 1,875 286
Noninvasive predictors of large esophageal varices: is there an emerging role of aspartate aminotransferase-to-platelet ratio index in hepatocellular carcinoma?
Heba Sedrak, Rania Khalifa, Ahmed Elkafrawy, Hany Elewa
October-December 2015, 27(4):139-146
DOI:10.4103/1110-7782.174935  
Background and aim Variceal size has been identified to be closely related to variceal bleeding. Repeated endoscopic examinations have a great burden on endoscopic units and cost-implication issues. Our aim was to evaluate the role of AST to platelet ratio index (APRI) in predicting the existence of large esophageal varices (EV) in hepatitis C virus-related liver cirrhotic patients. Patients and methods Seventy four patients with liver cirrhosis were prospectively recruited. Laboratory data, CTP, MELD and APRI, also ultrasonographic and endoscopic findings are performed and investigated whether associated with the size and bleeding of EV. Results Patients were divided into two groups; group 1 with small varices and group 2 with large varices. Group 2 had significantly prolonged prothrombin time, splenomegaly, ascites, higher Child score compared to group 1. CTP was associated with variceal bleeding (P = 0.028). While APRI was a poor predictor both for the presence of LVs and bleeding yet it revealed favorable results with bleeding EVs in patients with HCC with AUC (0.61). APRI was a good predictor for the presence of HCC and number of focal lesions with AURC (0.651, 0.61 respectively). Conclusion Splenomegaly, CTP, ascites could be used as noninvasive predictors for large EVs. However, at the moment, these tests could not substitute for endoscopy. Although APRI is a poor predictor for the size and bleeding of EV, yet it might have a role in prediction of HCC and number of focal lesions.
  1 1,390 234
Sevelamer hydrochloride and coronary artery calcification in chronic hemodialysis patients: a new mechanism of action
Bahaa Eldin Zayed, Hussein El-Fishawy, Amal R Al-Shihaby, Mohamed A Salem, Usama A.A. Sharaf El Din, Mona Mansour
October-December 2015, 27(4):133-138
DOI:10.4103/1110-7782.174928  
Background The non-calcium-based phosphate binder sevelamer hydrochloride was developed to provide chronic kidney disease patients with a polymer capable of managing hyperphosphatemia without an increase in the calcium load. These beneficial effects were postulated as the mechanism of decreased progression of vascular calcification observed with such compounds. Our objective was to investigate the effect of low-dose sevelamer hydrochloride against calcium carbonate as phosphate binders on the coronary artery calcification score (CCS) and the fibroblast growth factor 23 (FGF23) level in patients receiving regular hemodialysis for more than 1 year, in a trial to find out a novel mechanism for the decreased vascular calcification observed during sevelamer use. Patients and methods A total of 80 hemodialysis patients were allocated into two groups each of 40 patients. The first group received sevelamer hydrochloride 2400 mg/day (group 1), whereas the second continued on calcium carbonate 1500 mg/day (group 2). For each patient, coronary artery calcification was estimated twice, once before admission to the study and again at the end of the study period using noncontrast computed tomography. Serum calcium, phosphorus, intact parathyroid hormone (PTH), lipids, and FGF23 were also assessed in these two situations. Results Beside the significant decrease in serum calcium and phosphorus levels after the use of sevelamer for 6 months, there was a significant decrease in levels of FGF23 and the rate of CCS progress in group 1. Serum levels of total and low-density lipoprotein cholesterol decreased significantly in group 1. The serum PTH level did not show a significant change in either group. CCS showed a significant positive correlation with FGF23, but there was no significant correlation with serum calcium, serum phosphorus, or serum PTH in both groups. Conclusion Sevelamer hydrochloride suppressed the progression of coronary artery calcification, and decreased the FGF23 level significantly. The significant correlation between the serum FGF23 level and the CCS in the absence of any significant correlation between the latter on the one hand and the serum calcium, the serum phosphorus, or the serum PTH on the other might highlight a novel mechanism of action of sevelamer on the CCS.
  1 1,166 1,537
Plasma renalase as a biomarker of acute kidney injury after cardiac surgery
Ihab A Ibrahim, Hossam A Sayed, Amal A Mohammed
July-September 2016, 28(3):91-98
DOI:10.4103/1110-7782.200966  
Background Renal ischemia/reperfusion injury is a major cause of acute renal failure. The lack of validated early biomarkers for predicting acute kidney injury (AKI) has hampered our ability to initiate potentially preventive and therapeutic measures in an opportune way. We tested the hypothesis that plasma renalase is an early biomarker for ischemic renal injury after cardiac surgery. Patients and methods We prospectively evaluated 40 adult patients who underwent cardiac surgery. Patients were divided into the AKI group and the non-AKI group on the basis of whether they developed postoperative AKI within 48 h after surgery. Plasma renalase levels were measured before surgery and 24 h after surgery. The primary outcome was AKI diagnosed using the Acute Kidney Injury Network criteria. Results Twenty-five (62.5%) patients developed AKI after surgery. Plasma renalase decreased significantly from a mean of 1.2±0.46 ng/ml at baseline to 0.9±0.42 ng/ml 24 h after cardiopulmonary bypass, with a mean %change of 27±14.8 in the AKI group. Univariate analysis showed a significant correlation between AKI and the following: %change in plasma renalase, cardiopulmonary bypass time, and aortic cross-clamp time. Receiver operating characteristic curve analysis revealed that for %change in plasma renalase concentrations at 24 h, the area under the curve was 0 · 9, sensitivity was 0.92, specificity was 0 · 87, and likelihood ratio was 7.07 for a cutoff value of 9% change. Conclusion Plasma renalase %change is more valid compared with renalase before or after procedure and neutrophil gelatinase-associated lipocalin in the prediction of AKI and represents a novel and highly predictive early biomarker for AKI after cardiac surgery.
  1 1,111 159
Etiology and prevalence of fatigue in chronic liver disease: clinical view
Zakaria A Salama, Samar K Darweesh, Hany M Shehab, Manal A Abd-Elhameed
April-June 2016, 28(2):78-85
DOI:10.4103/1110-7782.193892  
Introduction and aim Fatigue is one of the most common and prominent symptoms in liver cirrhosis and was reported in 60–80% of these patients. The study outcome was to prospectively evaluate the etiology and the degree of fatigue and how to improve it in chronic liver disease patients. Patients and methods A prospective cross-sectional study on fatigue in chronic liver diseases was conducted on 500 patients: 475 patients had hepatitis C virus (HCV) and 25 had combined HCV and hepatitis B virus. They were divided into five groups: group 1 included 100 patients with chronic hepatitis, group 2 included 100 patients with Child class A cirrhosis, group 3 included 100 patients with Child class B cirrhosis, group 4 included 100 patients with Child class C cirrhosis, and group 5 included 100 patients with hepatocellular carcinoma (HCC). They were administered the Fatigue Impact Scale and the Fatigue Severity Scale questionnaires (translated into Arabic) as well as subjected to laboratory investigations, abdominal ultrasonography, and upper endoscopy. Results All (100%) patients complained of longstanding fatigue. HCC had the highest prevalence of high fatigue (65%) and Child class C cirrhosis had the longest fatigue duration. Female sex and anemia were significantly related to both the Fatigue Impact Scale and the Fatigue Severity Scale in each group separately and all patients collectively. Age had a significant relation with all patients collectively but not separately. Fatigue scores were related to Child score but not related to liver profile, α-fetoprotein, varices, ascites, and HCV load. Conclusion Correction of anemia, not liver profile, helps in alleviating fatigue in cirrhotic patients. Female patients suffered from fatigue more frequently compared with male patients. HCC patients had highest fatigue and patients with Child class C cirrhosis had longest fatigue indices.
  1 1,345 169
The value of YKL-40 in ischemic heart disease patients
Doaa S.E Zaky, Fatma M Mabrouk, Eman R Zaki, Olfat M Hendy
April-June 2016, 28(2):71-77
DOI:10.4103/1110-7782.193891  
Introduction Atherosclerotic coronary artery disease is considered to be the most common cause of myocardial ischemia. YKL-40, a chitin-binding acute phase glycoprotein, has been found to be expressed by macrophages in atherosclerotic plaques. The YKL-40 could potentially be a new useful biomarker to monitor severity and predict early diagnosis of acute coronary syndrome (ACS) in ischemic heart disease (IHD) patients. Aim The aim of this study was to measure the level of serum YKL-40 in IHD patients and to clarify its role as a potentially beneficial diagnostic marker in those patients. Patients and methods Serum YKL-40 was measured in 60 IHD patients and 30 healthy controls. According to chest pain analysis, ECG changes, and cardiac enzymes, the IHD patients were categorized into patients with stable angina and patients with ACS. Results The median level of YKL-40 (pg/ml) was significantly elevated in patients with IHD compared with the control group (2080 (575.5–5974.6) vs 522.6 (133.2–769.5), respectively; P<0.001). The median level of YKL-40 was also significantly higher in patients with ACS compared with patients with stable angina (2436 (576–5975) vs 1015 (675–1822), respectively; P˂0.001). There was a positive correlation between YKL-40 levels and high-sensitivity C-reactive protein (mg/dl) in all studied groups of IHD patients. However, no significant correlation was detected between YKL-40 and age, systolic or diastolic blood pressure, and lipid profile in patients with IHD. Conclusion YKL-40 might play an important role as a diagnostic and prognostic marker in patients with IHD and in patients with ACS.
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The value of noninvasive scoring systems for the diagnosis of advanced fibrosis in Egyptian patients with nonalcoholic fatty liver disease
Rokaya A Mohamed, Mona I Nabih, Mohamed B ElShobaky, Hany M Khattab
October-December 2014, 26(4):162-169
DOI:10.4103/1110-7782.148151  
Background and objectives Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease that includes a spectrum of liver diseases ranging from simple steatosis to steatohepatitis, fibrosis, and cirrhosis. Liver biopsy is the current gold standard for the assessment of fibrosis in patients with NAFLD. However, it is an invasive procedure and not free from complications. We aimed to analyze the diagnostic performance of simple noninvasive scoring systems for the detection of fibrosis in Egyptian patients with NAFLD. Patients and methods Seventy-six patients with biopsy-proven NAFLD were included in the study. Noninvasive scoring systems included AST/ALT ratio (AAR), APRI score, BARD score, FIB-4 score, and NAFLD fibrosis score (NFS). Patients were classified into two groups according to the grade of fibrosis in liver biopsy. Group 1 included 57 patients with no or mild fibrosis (stage 0-2) and group 2 included 19 patients with advanced fibrosis (stage 3-4). The sensitivity, specificity, positive predictive values, negative predictive values, and diagnostic accuracy for relevant cut-offs and area under receiver operating characteristic curves were determined. Results The area under receiver operating characteristic curves for advanced fibrosis were 0.936 for the FIB-4 score, 0.916 for NFS, 0.907 for the APRI score, 0.840 for AAR, and 0.556 for the BARD score. NFS and the FIB-4 score showed the best diagnostic accuracy (92.6 and 89.7%, respectively), followed by the APRI score (75%), AAR (40.8%), and the BARD score (39.5%). Conclusion FIB-4 and NFS can be used reliably to diagnose or exclude advanced fibrosis in NAFLD and thus reduce the burden of liver biopsies.
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REVIEW ARTICLE
Extracellular vesicles: fundamentals and clinical relevance
Wael Nassar, Mervat El-Ansary, Mostafa Abdel Aziz, Ehab El-Hakim
January-March 2015, 27(1):1-7
DOI:10.4103/1110-7782.155824  
All types of cells of eukaryotic organisms produce and release small nanovesicles into their extracellular environment. Early studies have described these vesicles as 'garbage bags' only to remove obsolete cellular molecules. Valadi and colleagues, in 2007, were the first to discover the capability of circulating extracellular vesicles (EVs) to horizontally transfer functioning gene information between cells. These extracellular vesicles express components responsible for angiogenesis promotion, stromal remodeling, chemoresistance, genetic exchange, and signaling pathway activation through growth factor/receptor transfer. EVs represent an important mode of intercellular communication by serving as vehicles for transfer between cells of membrane and cytosolic proteins, lipids, signaling proteins, and RNAs. They contribute to physiology and pathology, and they have a myriad of potential clinical applications in health and disease. Moreover, vesicles can pass the blood-brain barrier and may perhaps even be considered as naturally occurring liposomes. These cell-derived EVs not only represent a central mediator of the disease microenvironment, but their presence in the peripheral circulation may serve as a surrogate for disease biopsies, enabling real-time diagnosis and disease monitoring. In this review, we'll be addressing the characteristics of different types of extracellular EVs, as well as their clinical relevance and potential as diagnostic markers, and also define therapeutic options.
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* Source: CrossRef
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