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  Most popular articles (Since January 27, 2014)

 
 
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REVIEW ARTICLE
Food allergy ( the invisible hoe)
Fardous Soliman
March 2013, 25(1):1-9
DOI:10.7123/01.EJIM.0000426470.14786.32   
  6,300 334 -
CME
MCQ Questions and answers

September 2013, 25(3):164-0
DOI:10.7123/01.EJIM.0000433329.92031.29   
  667 2,954 -
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.
  2,986 338 3
ORIGINAL ARTICLES
Diagnosis of spontaneous bacterial peritonitis
Naglaa A El-Gendy, Naglaa A Tawfeek, Rayyh A Saleh, Enas E Radwan, Eman E Ahmad, Rehab A Mohammed
April-June 2014, 26(2):53-59
DOI:10.4103/1110-7782.139525  
Background Spontaneous infection of ascites is a severe complication of ascites and must be actively searched for. Many studies have been carried out on inflammatory markers and their levels in serum and ascitic fluid such as complement 3 (C3), complement 4 (C4), high-sensitive C-reactive protein (CRP), and procalcitonin, and have identified their role in the diagnosis of spontaneous bacterial peritonitis (SBP). The aim of our study was to measure and compare the serum and ascitic fluid levels of procalcitonin, high-sensitive CRP, C3, and C4 in patients with SBP and patients without SBP. Patients and methods This case-control study was carried out on 10 patients with cirrhotic ascites who were admitted with SBP and 20 patients with cirrhotic ascites with no existing evidence of SBP. Serum and ascitic fluid levels of C3, C4, high-sensitive CRP, and procalcitonin were determined using the enzyme-linked immunosorbent assay method. Results The mean ± SD of the serum levels of C3, C4, high-sensitive CRP, and procalcitonin were 3.38 ± 2.12, 0.36 ± 0.25, 18.76 ± 6.37, and 136.79 ± 58.14, respectively, in group I, whereas their levels in group II were 2.04 ± 1.98, 0.36 ± 0.29, 16.80 ± 5.97, and 147.78 ± 58.65, respectively. The mean ± SD of their ascitic fluid levels were 0.21 ± 0.14, 1.84 ± 1.69, 1.96 ± 1.15, and 162.43 ± 82.51, whereas their levels in group II were 0.46 ± 1.01, 2.07 ± 1.93, 2.98 ± 5.90, and 180.51 ± 93.70, respectively. Surprisingly, all these results were statistically insignificant. However, an ascetic fluid polymorph nuclear leukocyte count higher than 200/mm 3 has sensitivity, specificity, positive predictive value, and negative predictive value of 100% in the diagnosis of SBP. Conclusion An ascitic polymorph nuclear leukocyte count higher than 200/ml was the accurate marker for the diagnosis of SBP.
  3,055 248 -
REVIEW ARTICLE
Thyroxine mimetics
Randa F Salam
October-December 2013, 25(4):171-176
DOI:10.4103/1110-7782.124969  
Thyroid hormones influence heart rate, serum lipids, metabolic rate, body weight, and multiple aspects of lipid, carbohydrate, protein, and mineral metabolism. Although increased thyroid hormone levels can improve serum lipid profiles and reduce fat, these positive effects are counterbalanced by the harmful effects on the heart, muscle, and bone. Thus, attempts to use thyroid hormones for cholesterol-lowering and weight loss purposes have so far been limited. However, over the past decade, thyroid hormone analogs that are capable of uncoupling the beneficial effects from the deleterious effects have been developed. Such drugs could serve as powerful new tools to address two of the largest medical problems, namely atherosclerosis and obesity. Aggressive reduction in LDL-cholesterol by the use of statins is a cornerstone of preventive cardiovascular risk, but additional therapies to prevent atherosclerosis and its clinical sequelae are still needed. Thyromimetics selective for the liver or the thyroid hormone receptor isoform β1 constitute a novel approach to treat dyslipidemia. In preclinical studies, selective thyromimetics were clearly shown to reduce plasma cholesterol and protect from atherosclerosis through the upregulation of hepatic LDL receptor and promotion of the so-called reverse cholesterol transport. Notably, there is the first evidence from on-going clinical trials that selective thyromimetics may reduce plasma cholesterol in humans also. Most importantly, thyromimetics has a synergistic action when used in combination with 3-hydroxy-3-methylglutaryl CoA reductase inhibitors. Animal data have further suggested that thyromimetics might be useful in the treatment of obesity, hepatic steatosis, and atherosclerosis.
  1,453 1,724 -
The management of constipation-related functional gastrointestinal disorder (constipation-predominant irritable bowel syndrome)
Amal F Radwan, Nagwa R Ahmed, Eman A Sultan
October-December 2015, 27(4):127-132
DOI:10.4103/1110-7782.174926  
The terminology constipation-related functional gastrointestinal disorders was applied to embrace two conditions - constipation-predominant irritable bowel syndrome (IBS-C) and chronic constipation - because of the similarity in the etiology between the two conditions. The cardinal symptoms of IBS-C are abdominal pain or discomfort associated with constipation. The current symptom-based Rome III criteria are used to confirm the diagnosis. Many patients with IBS-C initially treat their symptoms with lifestyle modifications and exclusion diets, together with treatment of symptoms such as constipation by using fiber supplements, over-the-counter laxatives, or probiotics. Less commonly, the patients may also undergo various forms of psychotherapy. Despite these therapeutic modalities, many IBS patients are disappointed with their symptomatic response. There are several drugs that are being proposed for its treatment in the future, one of which is linaclotide, a 14-amino acid synthetic peptide that improves stool frequency and consistency and intestinal transit. Four-week treatment with Bifidobacterium lactis showed superior results when compared with placebo in decreasing the abdominal distention and improving orocecal and colonic transit.
  904 1,751 -
Liver transplantation for nontransplant physicians
Amany AbdelMaqsod Sholkamy
October-December 2014, 26(4):139-144
DOI:10.4103/1110-7782.148105  
Many of the nontransplant physicians who manage hepatic patients (internists and hepatologists) keep asking about liver transplantation. The purpose of this article is to highlight important topics a nontransplant colleague may require in his practice. There are many topics in this respect; however, three most important topics need to be highlighted; those are; the time of referral to transplantation, the indications and contraindications and the metabolic issues regarding a transplanted patient. Still, there are no clear guidelines for the management of many of the metabolic issues regarding liver transplanted patients. And this why, collaborative efforts of transplant and nontransplant physicians are needed to conduct multicenter, long term randomized controlled trials and proper follow up programs.
  935 1,698 -
ORIGINAL ARTICLES
The impact of obesity on walking and physical performance
Manal K Youssef
April-June 2014, 26(2):40-44
DOI:10.4103/1110-7782.139519  
Background Obesity-induced limitations of the cardiopulmonary and the metabolic systems, resulting in exertional dyspnea, contribute to the limitations in the functional capacity frequently observed in obese individuals. In addition, the sedentary lifestyle often adopted by these individuals further compounds and contributes to impaired exercise tolerance. Aim of the study The current study was conducted to detect the effect of lifestyle modification in the form of weight reduction by diet and aerobic exercise on walking and physical performance. Patients and methods Twenty obese participants were included in this study. Their ages ranged from 25 to 43 years. All participants were evaluated before the first session of physical therapy program and at the end of the program after 2 months of exercise and a low-caloric diet of 25 kcal/kg actual weight/day through physical evaluation, which included anthropometric measurements, BMI, inspiratory capacity, and a physical performance test, which includes four tests (15-m rapid walking test, a timed up-and-go test, and stair climbing and stair descending tests). Results Analysis of data revealed significant improvement in the parameters assessed as follows: weight decreased from 81.3 ± 8.5 to 68.00 ± 4.50 kg (P ≤ 0.001); BMI decreased from 29.8 ± 2.0 to 24.1 ± 2.0 kg/m 2 (P ≤ 0.001); waist circumference decreased from 120.3 ± 14.4 to 112.3 ± 9.6 cm (P = 0.053); hip circumference decreased from 121.3 ± 6.1 to 112.6 ± 11.4 cm (P = 0.009); inspiratory capacity increased from 14.4 ± 2.7 to 21.0 ± 2.3 s (P ≤ 0.001); time of 15 m walk decreased from 21.2 ± 1.7 to 15.5 ± 2.1 s; timed up-and-go test decreased from 24.1 ± 2.8 to 15.3 ± 2.3 s; stair climbing time decreased from 45.3 ± 6.5 to 34.2 ± 2.6 s; stair descending time decreased from 36.2 ± 2.3 to 27.2 ± 2.1 s. Hence, the total physical performance increased from 31.9 ± 10.3 to 23.0 ± 8.5 s (P ≤ 0.001) and consequently improved the quality of life. Conclusion Lifestyle modification in the form of a low-caloric diet accompanied by exercise has a positive effect on physical performance and consequently on the quality of life.
  2,324 220 -
Seminal parameters before and during combined antiviral (pegylated interferon α-2a and ribavirin) treatment in chronic hepatitis C virus patients in upper Egypt
Hussein M Ghanem, Nashaat N Ismaeel, Alaa F Haseeb, Waleed M Nabawy, Mohamed Rehan, Hala Shreen
July-September 2014, 26(3):104-109
DOI:10.4103/1110-7782.145302  
Background Some reports suggest that chronic hepatitis C virus (HCV) infection and its combined antiviral therapy could alter seminal parameters, and so chronic HCV infection may influence male fertility. Aim The aim of this study was to evaluate seminal parameters before and during combined antiviral (pegylated interferon α-2a+ribavirin) treatment in chronic HCV patients. Because of the possible teratogenic effect of ribavirin, contraception is mandatory during therapy. This study was conducted on 40 male chronic HCV patients (PCR based), age 20-58 years: 30 patients were given combined therapy (group 1) and 10 were not given treatment (group 2); 10 normal controls were included (group 3). The seminal fluid (volume, concentration, motility, and morphology) was analyzed. Parameters were determined at the beginning, and in group 1, they were reassessed after 12 weeks of therapy. Results Semen abnormalities were common at baseline with further impairment during antiviral therapy in group 1: oligoasthenoteratozoospermia was detected in 15 patients, asthenozoospermia in six, and athenoteratozoospermia in six (sperm density: BL, 59.2 ± 40.7 × 106/ml; week 12, 26.7 ± 22.4 × 106/ml; progressive motility: BL, 44.5 ± 15.2%; week 12, 31.2 ± 12.5%). The proportion of sperm without motility reached its peak after 12 weeks of therapy. The percentage of abnormal forms was BL 14 ± 0.04% and week 12 16.8 ± 5.2%, with further increase during therapy. In group 2, oligoasthenoteratozoospermia was present in three patients, asthenozoospermia in three, and athenoteratozoospermia in two. The density was 46.7 ± 32.4 × 106/ml, and the progressive motility 40 ± 10.7%. The percentage of abnormal forms was 13.5 ± 1.6%. In group 3, there was no oligoasthenoteratozoospermia, one patient had asthenozoospermia, and one had athenoteratozoospermia. The density was 95.2 ± 28.7 × 106/ml, and the progressive motility 57.2 ± 18.2%. The percentage of abnormal forms was 9.5 ± 2.8%. Conclusion Semen abnormalities were common in chronic HCV patients, with further impairment during combined antiviral therapy.
  2,301 175 -
REVIEW ARTICLE
Sarcopenia and the syndrome of frailty
Ajay Kumar Gupta, Siddhartha Mishra
October-December 2016, 28(4):133-139
DOI:10.4103/1110-7782.203297  
Sarcopenia is the process of loss of body mass, specifically the musculoskeletal tissue, with age, which ultimately leads to a syndrome of clinical entity poorly defined as frailty. It is probably as old as humanity itself. Functionally, frailty is described as a syndrome characterized by a progressive decrease in the body's reserve and declining resistance to stressors, possibly because of declining capacity of multiple physiologic systems resulting in higher vulnerability morbidity and mortality. Ayurveda also mentions morbidity occurring with advancing age and various options for its management. Elixirs are recommended in Ayurveda, popularly called ‘rasayana’, for recovery from the symptoms of frailty. Worldwide, because of the wide demographic profile, the process of ageing exerts its effects on geriatric populations at different ages. Europeans were the first to paraphrase the word frailty for the ageing process. With better medical care and nutrition, a substantial subset of populations survives longer than 60 years or longer worldwide. The most relevant aspect of the recognition of syndrome of frailty is that the process is, to some extent, reversible, provided that adequate attention is paid and a timely intervention is performed for the needy subset of population, which is likely to improve the quality of life markedly, besides resulting in an increased life span.
  699 1,591 -
Celiac disease
Dina I Shehab
June 2013, 25(2):53-62
DOI:10.7123/01.EJIM.0000429397.19027.b6   
Purpose of review

The aim of this review was to summarize recent advances in celiac disease (CD) published between 2006 and 2012.

Recent findings

CD affects ∼1% of most populations but remains largely unrecognized. During the past year, research has shown that the prevalence of CD has increased dramatically and not merely because of increased detection. Moreover, undiagnosed CD may be associated with increased mortality. Significant progress has been made in understanding how gliadin peptides can cross the intestinal border and access the immune system. New deamidated gliadin peptide antibodies have better diagnostic accuracy over other tests. The inclusion of duodenal bulb biopsy specimens may increase the rate of CD detection. Finally, refractory CD, although rare, is associated with a poor prognosis. The use of novel highly efficient exogenous prolyl endoproteases enzymes may help patients deal with occasional lapses in their diet or may protect highly sensitive individuals from inadvertent presence of gluten in food products. Nevertheless, the efficiency of this approach still needs precise assessment.

Conclusion

Mortality rates among patients with untreated CD increase two-fold every year as they age (gastrointestinal malignancies) and most can be prevented/reversed with early diagnosis and initiation of a gluten-free diet. CD is a global health problem that requires a multidisciplinary and increasingly cooperative multinational research effort.

  2,004 176 -
ORIGINAL ARTICLES
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.
  1,784 288 1
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.
  1,746 220 1
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.
  1,806 151 -
ORIGINAL ARTICLES
Urinary albumin excretion and progression of renal disease with impaired fibrinolytic activity in type 2 diabetes mellitus
Ebtessam Zakaria, Maha Hossam Al-Din, Nashwa S Ghanem, Noha A Sadik, Maha Assem, Fatma Taha
July-September 2015, 27(3):108-114
DOI:10.4103/1110-7782.165450  
Background Diabetic nephropathy is one of the major causes of end-stage renal disease. As impaired fibrinolysis can increase renal fibrosis, we investigated the relationship of impaired fibrinolysis, as assessed by the ratio of plasminogen activator inhibitor-1 (PAI-1) to tissue-type plasminogen activator (t-PA) with urinary albumin excretion (UAE) and renal disease progression in type 2 diabetes. Patients and methods A total of 50 patients with type 2 diabetes and 10 healthy control individuals were included in the study. Participants were subdivided according to UAE. Group 1 (G1) represented control individuals. Group 2 (G2) included patients without albuminuria. Group 3 (G3) included patients with microalbuminuria. Group 4 (G4) included patients with macroalbuminuria. Creatinine clearance and UAE were calculated. PAI-1 and t-PA were measured using an enzyme-linked immunosorbent assay kit, and the PAI-1/t-PA ratio was calculated as an index of impaired fibrinolysis. Results PAI-1 was highly elevated significantly in G4 when compared with the other groups, with a mean of 87.40 ± 17.03 IU/ml against 28.00 ± 6.98 IU/ml in G1, 46.4 ± 7.99 IU/ml in G2, and 64.10 ± 18.26 IU/ml in G3 (P < 0.001). Also, the serum level of t-PA in G4 was highly elevated significantly when compared with G1 and G2 with means of 16.85 ± 5.63 IU/ml against 7.95 ± 1.91 IU/ml and 10.45 ± 2.63 IU/ml, respectively (P < 0.001). The ratio of PAI-1/t-PA in G4 was significantly higher when compared with G1 (mean of 5.94 ± 2.81 against 3.54 ± 0.43; P = 0.01). PAI-1 and t-PA showed a significant positive correlation with UAE. Receiver operating characteristics curve analysis revealed that only PAI-1 and t-PA were significant discriminated factors for microalbuminuria and macroalbuminuria (P < 0.001). Conclusion Serum levels of PAI-1 and t-PA and the PAI-1/t-PA ratio were significantly increased in diabetic patients with higher UAE. Impaired fibrinolysis and increased UAE were associated with renal disease progression.
  1,816 91 -
Liver ultrasound scanning in the detection of hepatic steatosis and fibrosis in NASH patients
Mona Hegazy, Abeer Mostafa
August 2012, 24(2):27-31
DOI:10.7123/01.EJIM.0000419544.37462.5f   
Background

Nonalcoholic fatty liver disease (NAFLD) has become the most prevalent cause of liver disease in western countries. The development of nonalcoholic steatohepatitis (NASH) and fibrosis identifies the risk group with an increased incidence of liver-related deaths.

Aim

The aim of the present study is to investigate how accurately liver ultrasound (US) can contribute toward the prediction of the severity of liver damage in NAFLD, and to determine whether it may be an easily available, inexpensive, noninterventional, widely used screening method.

Methods

Fifty-four obese patients with variable degrees of BMI were recruited in the present study. Assessment of full medical history, anthropometric measurements, biochemical studies, abdominal US, liver biopsy for histological examination, and determination of the NAFLD activity score (NAS) score were carried out on all patients to identify NASH patients . Liver steatosis was evaluated using liver US, and graded according to a semiquantitative scale from 1 to 4. Liver histological examination was carried out to identify patients with NASH, borderline NASH, or non-NASH according to the NAS score.

Results

According to the NAS score, patients were divided into non-NASH patients (eight patients), borderline NASH patients (24 patients), NASH patients (20 patients), and patients with NASH and fibrosis (two patients). Alanine aminotransferase and γ-glutamyl transpeptidase were significantly higher in NASH patients. Correlating the grading of hepatic steatosis by liver US and NAS score, grade 1 was found in 37.5% of patients with non-NASH, 33.3% of patients with borderline NASH, and only in 5% of patients with NASH, whereas grade 4 steatosis was found in 20% of NASH patients and 4.2% of patients with borderline NASH; none of the non-NASH patients were diagnosed with grade 4 hepatic steatosis. The sensitivity of liver US in detecting grades of steatosis in liver biopsy was 61% in grade 1, 25% in grade 2, and 75% in grade 3. There was a direct correlation between grading of steatosis in the histological examination and the presence of NASH, P less than 0.000.

Conclusion

Liver US is not only sensitive in the detection of hepatic steatosis, but also in the prediction of the presence of NASH; therefore, it can be used as a simple, noninvasive, low-cost method for the screening of NAFLD and for the early identification of patients in need of aggressive intervention.

  1,647 193 -
EDITORIALS
An assurance letter to the pilgrims ( novel coronavirus 2012)
Amal F Radwan
December 2012, 24(3):59-60
DOI:10.7123/01.EJIM.0000422599.24526.40   
  331 1,506 -
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.
  1,660 156 1
REVIEW ARTICLE
Nicotinic acid: a lipid-lowering agent with unrealized potential
Samar H. Aboulsoud
January-March 2014, 26(1):1-5
DOI:10.4103/1110-7782.132881  
Nicotinic acid is a well-known treatment for dyslipidemia in adults. This review article explored not only the role of nicotinic acid in dyslipidemia but also its role in hypertension and as a cardioprotective agent. Adverse effects in association with nicotinic acid use are described with a focus on flushing, the major reason for the discontinuation of nicotinic acid therapy. The role of nicotinic acid receptor in mediating its metabolic and vascular effects is also reviewed.
  1,518 177 -
ORIGINAL ARTICLES
Influence of admission blood glucose and hemoglobin A1c on outcome of acute myocardial infarction
Hanan E. Zaghla, Mahmoud A. Elbadry, Alaa M. Ashour, Mohamed M. Abdelfatah
January-March 2014, 26(1):21-26
DOI:10.4103/1110-7782.132895  
Introduction Patients either with or without a prior history of diabetes mellitus may present with hyperglycemia during acute myocardial infarction (AMI); it is uncertain whether hyperglycemia upon admission, irrespective of the diagnosis of diabetes, remains an independent predictor of in-hospital morbidity and mortality. Aim of the study We aimed in this study to assess the impact of admission blood glucose level on the hospital course and outcome in patients presenting with AMI in ICU. Patients and methods We included 50 patients with AMI divided into two groups: group I included 30 patients with admission blood glucose level less than 180 mg/dl and group II included 20 patients with admission blood glucose level 180 mg/dl or more. Group I was subdivided into group IA including 16 patients with HbA1c less than 6% and group IB including 14 patients with HbA1c of 6% or more. All patients were subjected to complete history taking and complete clinical examination; 12-lead ECG was performed for every patient and routine laboratory investigations including cardiac enzymes, admission blood glucose level, and HbA1c were estimated at the time of admission of the patients. Results There was significant correlation between admission blood glucose level and history of diabetes mellitus and history of smoking (P = 0.000 and 0.008, respectively). There was also significant correlation between admission blood glucose level and complications of myocardial infarction including sinus tachycardia, arrhythmia, and ICU length of stay (P = 0.008, 0.002, and 0.000, respectively). However, HbA1c level was not found to be correlated with any of the previous parameters. Conclusion We concluded that elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with AMIs. However, the prognostic value of diabetic control (i.e. hemoglobin A1c levels) in patients with AMI is still undefined.
  1,349 202 -
REVIEW ARTICLE
Gout
Hanan Abdel Rehim
April-June 2014, 26(2):35-39
DOI:10.4103/1110-7782.139514  
Gout is a crystal deposition disease caused by raised levels of uric acid in the blood (hyperuricaemia) with persistence of hyperuricemia at levels higher than a serum saturation of 6.8 mg/dl leads to formation of monosodium urate (MSU) crystals and their deposition in joints and other tissues. However, only a minority of individuals with elevated serum uric acid (sUA) levels ever develop gout, emphasizing the importance of other factors in determining crystal formation including Genetics, Gender, age, Diet and alcohol intake, Obesity, some medications and medical conditions a correct diagnosis of gout is essential for the appropriate management, in 2011 the European League Against Rheumatism (EULAR) published an updated evidence based recommendations for diagnosis of gout. Although gout is well understood condition and good therapeutic options are available, it tends to be poorly managed, so The 2012 The American College of Rheumatology (ACR) guidelines for Management of Gout were designed to emphasize safety and quality of therapy and to reflect best practice. New approaches to urate lowering have led to mechanism-based therapies such as: non-purine, selective inhibitor of xanthine oxidase, URAT-1 inhibitors and a recombinant chimeric mammalian uricase. Three IL-1β antagonists - anakinra, rilonacept and canakinumab are being evaluated as an emerging therapies for gout.
  1,320 230 -
CASE REPORTS
Reversible myelopathy: An uncommon accompaniment of hypothyroidism
Nimisha Jain, Ramesh Aggarwal, Sachin Kumar Jain, Nitin Garg, Aadhaar Dhooria, Kajal Prasad
April-June 2014, 26(2):86-87
DOI:10.4103/1110-7782.139561  
Atypical neurological presentations of hypothyroidism include myelopathy which has been seldom reported as presenting feature in patients. This case was one of those atypical presentations of hypothyroidism in which patient presented with neurological complication viz myelopathy which was timely diagnosed and treated. The symptoms including neurological findings reversed with thyroxin replacement. The case highlights the varied and vivid manifestations of hypothyroidism which treating physicians should be aware of while treating patients.
  1,347 125 -
ORIGINAL ARTICLES
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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Colonic mucosal changes in Egyptian patients with liver cirrhosis and portal hypertension
Zakaria A Salama, Ahmad N Hassan, Samar K Darweesh
October-December 2013, 25(4):196-201
DOI:10.4103/1110-7782.124981  
Background and aims In patients with liver cirrhosis and portal hypertension (PHT), portal hypertensive colopathy (PHC) is thought to be an important cause of lower gastrointestinal bleeding. This study aimed at evaluating the prevalence and clinical significance of colonic mucosal changes in Egyptian patients with liver cirrhosis and PHT. Patients and methods A prospective study was conducted on 35 patients with liver cirrhosis and PHT (proved by upper endoscopy and/or abdominal ultrasonography). They were evaluated using full colonoscopy to detect changes in colonic mucosa and using gastroscopy to detect the presence of both gastroesophageal varices and portal hypertensive gastropathy. Results Colonic lesions were found in 27 patients (77.1%), including haemorrhoids in 20 patients (57.1%), diffuse hyperaemic mucosa in 16 patients (45.7%), angiodysplastic lesions in 12 patients (34.3%) and rectal varices in five patients (14.3%). Bleeding per rectum was detected in seven patients (20%), and it significantly correlated with the presence of haemorrhoids (P = 0.02). The prevalence of PHC and the presence of haemorrhoids increased with the worsening Child-Pugh class (P = 0.01 and 0.02, respectively). Conclusion The prevalence of PHC and haemorrhoids increases with the progression of liver disease and worsening of the Child-Pugh grading in cirrhotic patients. However, haemorrhoids, rectal varices, hyperaemia and colonic angiodysplasia are not affected by the presence of portal hypertensive gastropathy.
  1,249 137 -
Outcome of critically ill hyperglycemic stroke patients admitted to the intensive care unit
Kamel Abdelaziz Mohamed, Ahmad Saad
October-December 2013, 25(4):185-190
DOI:10.4103/1110-7782.124979  
Introduction It has been suggested that admission hyperglycemia is a marker of extensive brain damage. Despite these observations, studies that have examined the relationship between glucose levels and the outcome after stroke in diabetic and nondiabetic patients have reported conflicting results. Aim We evaluated data on stroke patients admitted to the intensive care department to estimate the influence of hyperglycemia on the short-term mortality in both diabetic and nondiabetic patients. Patients and methods A total of 100 consecutive adult patients with stroke admitted to the ICU were studied over a period of 28 months. The patients were followed up for 28 days until discharge from the hospital or until death, whichever occurred first. The patients were divided into three broad groups, on the basis of fasting blood glucose or random sugar and HbA1c to rule out undetected diabetes patients. Results There were no significant differences in the stroke subtype or the baseline stroke severity between diabetic (group 3) and hyperglycemic (group 2) patients. Also, there was no significant association between the stroke severity and the glycosylated hemoglobin level in group 2 and group 3 (r = 0.26, P = 0.4; r = 0.19, P = 0.31; respectively). With regard to an excellent outcome of stroke, which was measured by the modified Rankin scale (0-1), there was no significant difference between group 2 and group 3. The unadjusted risk ratio was 1.85 (95% confidence interval 0.52-4.41) for group 2, whereas it was 1.25 (95% confidence interval 0.7 6-4.3) in group 3. Nondiabetic patients with hyperglycemia had a 1.6 times higher relative risk of in-hospital 28-day mortality than diabetic patients. There were four nonsurvivors (11%) out of 36 patients in the control nondiabetic (group 1), whereas eight (26%) of 31 patients died in group 2, which was statistically significant when compared with group 1 (P = 0.02). However, six nonsurvivors (18%) of 33 in group 3 when compared with group 2 was statistically significant (P = 0.04). Conclusion Our current study showed that nondiabetic patients with hyperglycemia had a 1.6 times higher relative risk of in-hospital 28-day mortality than diabetic patients. Stress hyperglycemia predicts an increased risk of in-hospital mortality after ischemic stroke; thus, we should not underestimate the potential harm, as patients with the highest admission glucose levels would have most likely been treated earlier and more aggressively.
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