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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.
  4 7,130 554
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 1,422 261
CASE REPORTS
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 1,211 141
ORIGINAL ARTICLES
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 1,561 247
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 2,364 361
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 3,942 213
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 1,350 129
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 1,547 161
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 1,124 130
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 1,276 168
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.
  1 1,383 162
Left main coronary artery thrombosis revealing angio-Behçet syndrome
Jihen Ayari, Mohamed S Mourali, Abdjalil Farhati, Rachid Mechmeche
April-June 2014, 26(2):88-90
DOI:10.4103/1110-7782.139578  
Although acute myocardial infarction commonly results from coronary atherothrombosis, there are several other etiologies that should be taken initially into account, especially in young adults without significant atherosclerotic risk factors. Thrombophilia and coronary arteritis are, in this context, examples of etiologies that should be looked after. Through this article, we present a case of Behçet's disease with arterial involvement diagnosed after myocardial infarction resulting from thrombosis of the left main coronary artery in a 38-year-old young man without any particular past medical history.
  1 1,611 154
ORIGINAL ARTICLES
Some risk factors of gallstone formation after laparoscopic sleeve gastrectomy and the role of ezetimibe versus ursodeoxycholic acid in its prevention
Alaa Elgamal, Ahmad Tarek Fawzy
April-June 2014, 26(2):75-79
DOI:10.4103/1110-7782.139548  
Aims Obese patients are at increased risk for gallstones during rapid weight loss and after laparoscopic sleeve gastrectomy. The aims of this study were to evaluate the prophylactic effect of ursodeoxycholic acid and ezetimibe for prevention of gallstone formation after sleeve gastrectomy and to identify some risk factors. Settings and design This was a prospective randomized study conducted at Al Rashid Hospital, Kuwait. Patients and methods A total of 215 obese patients were included. Preoperative assessment was performed, including history, examination, obesity evaluation (body weight, BMI, waist circumference), full laboratory work, gastroscopy, and abdominal ultrasonography. After laparoscopic sleeve gastrectomy, patients were divided randomly into: group 1 (control), group 2 (ursodeoxycholic acid), and group 3 (ezetimibe). Patients were scheduled for 3-, 6-, and 12-month visits for assessment of % excess weight loss and abdominal ultrasonography. Results A significant reduction in gallstone formation was found in the ezetimibe group (5.5%) compared with the control group (17.6%). A statistically significant increase in % excess weight loss was observed in patients with gallstones (38.5%) versus patients without gallstones (28.2%). Percentage of gallstone formation during first 6 months postoperatively was double that during the next 6 months in both the control and treatment groups. Conclusion Risk of gallstone formation during the first 6 months after laparoscopic sleeve gastrectomy was double that during the second 6 months. Ezetimibe is effective in reducing relative risk by 70% and ursodeoxycholic acid by 50% versus control; hence, we recommend usage of one of these medications for 1 year postoperatively. Furthermore, we recommend more work on combining both medications together.
  1 2,812 309
Relationship between omentin-1 and carotid intima thickness in type 2 diabetes mellitus
Hend M Tawfeek, Hala M Maghrapy, Fadila M Elsaid, Hanaa Abou Eliazeed
April-June 2014, 26(2):68-74
DOI:10.4103/1110-7782.139547  
Introduction Omentin-1 is a novel adipokine that has a pivotal role in modulating insulin sensitivity, immunity, and inflammation. Adipokines contribute directly to the atherosclerotic process. The current study was conducted to evaluate the serum omentin-1 level in type 2 diabetes mellitus (DM) patients and to evaluate its relationship with carotid intima media thickness (CIMT). Patients and methods Sixty participants were enrolled in the study: 30 patients with type 2 DM and 30 controls with normal glucose levels. Patients were classified into group I, which included 15 patients with CIMT greater than 0.9 mm, and group II, including 15 patients with CIMT less than 0.9 mm. All groups were subjected to full medical history taking, clinical examination, and assessment of fasting blood glucose levels, lipid profile, and serum omentin-1 levels using enzyme-linked immunosorbent assay. BMI and CIMT were also assessed using color Doppler ultrasound. Results Serum omentin-1 levels were significantly decreased in patients with type 2 DM compared with controls and were further decreased in patients with increased CIMT. Omentin-1 levels were negatively correlated with fasting blood sugar, BMI, waist circumference, lipid profile, and CIMT, and were positively correlated with high-density lipoprotein, with r-values of −0.72, −0.9, and −0.81 for fetal bovine serum, BMI, and CIMT, respectively; −0.58, −0.70, and −0.49 for triglyceride, low-density lipoprotein, and cholesterol, respectively; and +0.66 for high-density lipoprotein. Conclusion Serum omentin-1 level is decreased in type 2 DM patients and is negatively correlated with CIMT and BMI. Hence, omentin-1 could serve as a protective marker and predictor for cardiovascular disease. Further study needed to show whether omentin-1 is considered as a risk factor for DM.
  1 1,152 138
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 1,034 123
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 1,507 262
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.
  1 2,306 276
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 1,530 130
The impact of stevioside supplementation on glycemic control and lipid profile in patients with type 2 diabetes: a controlled clinical trial
Nearmeen M Rashad, Mona A.E Abdelsamad, Atef M Amer, Mahmoud Z Sitohy, Mayada M Mousa
January-March 2019, 31(1):22-30
DOI:10.4103/ejim.ejim_68_18  
Background Stevia is a naturally occurring non-nutritive sweetener that has been reported as sugar substitutes for diabetic patients. We aimed to assess the impact of stevia supplementation on glycemic control in patients with type 2 diabetes mellitus (T2DM). Also, we aimed to examine the association between stevia supplementation and anthropometric measures as well as lipid profile in both obese and diabetic patients. Patients and methods The controlled clinical trial included unrelated 150 participants; 40 patients with T2DM and 60 obese patients and 50 healthy controls. Obese patients were then subdivided into two subgroups according to their fasting blood sugar: nondiabetic (n=30) and 30 patients with T2DM. The participants received stevia (4 mg/kg/body weight) as an alternative to artificial sweetener for 24 weeks. Results Our results found that stevioside supplementation for diabetic patients’ increased the total caloric intake and decreased BMI, waist circumference, waist–hip ratio, and fat mass index, in the obese group. Our results have shown a significant increase of BMI, waist circumference, waist–hip ratio, and fat mass index after 24 weeks of stevia supplementation. In the diabetic group, stevioside for 24 weeks improved the lipid profile and glycemic control, fasting plasma glucose, 2-h plasma glucose, fasting serum insulin, homeostasis model assessment of insulin resistance and hemoglobin A1c (HbA1c), as well as total cholesterol, triglycerides, low density lipoprotein-cholesterol, and high density lipoprotein-cholesterol in all studied intervention groups. Logistic regression test revealed that among clinical and laboratory waist circumference, fasting plasma glucose and HbA1c were independent predictors of response to stevioside. Conclusion Stevioside supplementations for 24 weeks improved cardiometabolic risk in diabetic patients. However, in the obese group, stevioside supplementations increased body weight.
  1 188 47
Brachial artery flow-mediated dilation and carotid intima-media thickness for assessment of subclinical atherosclerosis in rheumatoid arthritis
Mona Hussein El Zohri, Salwa S ELGendi, Ghada H Ahmed, Mohammed Zidan Mohammed
July-September 2017, 29(3):132-140
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.
  1 806 94
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.
  1 1,703 160
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.
  1 807 95
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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