• Users Online: 99
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Reader Login
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2012| August  | Volume 24 | Issue 2  
    Online since July 16, 2014

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
ORIGINAL ARTICLES
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.

  3,150 274 -
Cardiovascular changes in dipper and nondipper hypertension in perimenopausal women ( time-dependent effects of antihypertensives)
Wael Ragheb Refaie, Ehsan Refaie, Nagy Abd El Hady, Salah Tantawy, Ahmad Elewa
August 2012, 24(2):37-42
DOI:10.7123/01.EJIM.0000419545.12615.3e   
Background

The lack of a decrease in nocturnal blood pressure to up to 10% of the daytime measure is termed as nondipper (ND) hypertension. It is a cardiovascular (CV) risk factor with increased CV morbidity and accelerated target organ damage especially in women. The beneficial effect of restoring the ND state by administering antihypertensives (chronotherapy) at bedtime rather than on awakening is still debated.

Objectives

The aim of this study was to determine the extent of ND hypertension and the magnitude of CV morbidities among perimenopausal women in comparison with an identical dipper group. The study also intended to determine the administration time-dependent effect on the ND state.

Study design

The study included a cross-sectional part and a prospective randomized part.

Patients and methods

One hundred and thirty perimenopausal women who were not known to be hypertensive, with an office blood pressure repeatedly exceeding 140/90 mmHg were included. After obtaining informed consents, complete history was taken and clinical examination was carried out. The included patients underwent 12-lead ECG and echocardiography, and the carotid intima–media thickness was measured. Besides the routine urine and blood analysis, analyses to obtain levels of lipids, HbA1-c, serum thyroid stimulating hormone, coagulation factors (factor VIII, fibrinogen), urinary albumin excretion, and C reactive protein were also carried out. Ambulatory blood pressure of all patients on a nonworking day was monitored. The studied patients were classified as dippers and NDs. The ND patients were randomly assigned to treatment with angiotensin receptor blockers (ARBs). Half of the ND patients received their dosage at bedtime and the others received the same dosage on awakening for 6 months, after which the ambulatory blood pressure was remeasured.

Results

ND hypertension was detected in 61.5% of patients, its occurrence being significantly higher among women with hot flashes, those with postural hypotension, obese women, and among women with elevated HbA1-c, fibrinogen, cholesterol, C reactive protein and urinary albumin excretion levels. There was significant prolongation of the QTc interval and QT dispersion with a significant increase in the interventricular septal dimension and carotid artery intima-media thickness in the ND group. Disappearance of the ND phenomenon occurred in 80% of patients receiving therapy with ARBs at bedtime.

Conclusion

ND hypertension is common among perimenopausal women, especially those with hot flashes, postural hypotension, and higher BMIs and HbA1-c levels, and is associated with many CV risk factors. Chronotherapy with ARBs at bedtime is more efficient in restoring the circadian rhythm of blood pressure compared with that on awakening.

  1,136 100 -
Mean platelet volume as a risk factor in pregnant diabetic women
Sayed M. Abel-Rahman, Essam S. Badawy, Ahmad A. Amer, Dalal Fekry
August 2012, 24(2):32-36
DOI:10.7123/01.EJIM.0000419581.67334.75   
Background

Diabetes is an established risk factor for cardiovascular disease (CVD); therefore, the subset of women with gestational diabetes mellitus (GDM) who develop type 2 diabetes mellitus is at an increased risk for developing CVD in the future.

Objectives

To assess the platelet count and mean platelet volume (MPV) of pregnant women with GDM and gestational impaired glucose tolerance (GIGT) to determine whether GDM and GIGT are risk factors for future development of CVD.

Patients and methods

A 50 g oral glucose load (OGL) was administered to all participants (400 pregnant women), and routine hematologic parameters and MPV were studied at 24–28 gestational weeks using a Beckman/Coulter MAXM Hematology Analyzer. When a plasma glucose level of at least 140 mg/dl was measured after administering OGL, a 100 g 3-h oral glucose tolerance test was performed. Of these women, 296 (74%) had normal oral glucose tolerance, 48 (12%) had GIGT, and 65 (14%) had GDM. The mean platelet counts were higher in the normal OGL group than in the GIGT group, and higher in the GIGT group than in the GDM group, with no statistically significant differences among the three groups. However, MPV was significantly higher in the GDM group than in the normal glucose level group (P<0.05). Also, women with high MPV values had lower platelet counts.

Results

A significant difference was observed for MPV values between the GDM and normal OGL groups.

Conclusion

Presence of a high MPV in cases of GDM could indicate an increased risk for current and future thrombotic complications.

  845 111 -
Evaluating the role of the hepatitis C virus in the pathogenesis of Hodgkin’s lymphoma in Egyptian patients
Aml S. Nasr, Nehad M. Tawfik, Engy M.A. Aziz, Dalia Roushdy
August 2012, 24(2):43-46
DOI:10.7123/01.EJIM.0000419546.28308.26   
Background

Hepatitis C is an infection caused by a virus that attacks the liver and leads to inflammation. Several studies from Europe have reported a high prevalence of hepatitis C virus (HCV) infection in patients with non-Hodgkin’s lymphoma. It has been suggested that HCV plays a role in the pathogenesis of B-cell non-Hodgkin’s lymphoma (B-NHL). The aim of our study was to determine the prevalence of HCV infection in patients with B-NHL in the Egyptian population and to compare it with apparently healthy volunteers (as a control group).

Patients and methods

The current study was carried out on 50 patients diagnosed with B-NHL (as a patient group) as well as 35 healthy individuals (as a control group). HCV status was evaluated by the detection of anti-HCV antibodies using the enzyme-linked immunosorbent assay (ELISA) technique as well as the detection of HCV RNA by a reverse transcription PCR (RT-PCR).

Results

In terms of the results of anti-HCV antibodies by ELISA, 26 of 50 patients (52%) were positive in patients with B-NHL compared with 10 of 35 cases (28.6%) in the control group (P=0.0541). HCV RNA detection by RT-PCR was positive in 30 of 50 patients (60%) with B-cell lymphoma compared with 15 of 35 patients (42.9%) in the control group (P=0.1823).

Conclusion

In conclusion, the results of our study show that there is a higher incidence of HCV infection in B-NHL patients compared with apparently healthy individuals. This supports the suspected role of HCV in the pathogenesis and etiology of B-NHL.

  672 66 -
Dissection of the aorta, a rare combination of coarctation, a bicuspid aortic valve, and hypertension in a young patient
Abdulrahman Aldousari, Amir Masud, Mohsin Mahmood
August 2012, 24(2):54-56
DOI:10.7123/01.EJIM.0000419548.11504.22   

Aortic dissection is an uncommon but very lethal disease. Majority of cases are found in elderly patients with a history of hypertension. Young patients usually have other risk factors such as vasculitis, Marfan syndrome, unrecognized coarctation of the aorta, and a bicuspid aortic valve. We present a case of a young patient who presented with epigastric pain mimicking peptic ulcer disease that was later on proved to be type B dissection of the aorta. The patient had a unique combination of hypertension, a bicuspid aortic valve, and postductal coarctation.

  556 78 -
Molecular diagnosis of human metapneumovirus
Essam S. Badawy, Sayed Mohamed Abdel Rahman, Mervat Shafik Yousef, Sayed Z. Bukhary
August 2012, 24(2):47-50
DOI:10.7123/01.EJIM.0000419582.44849.67   
Background

The recent discovery of human metapneumovirus (hMPV) as a major respiratory pathogen has been made possible by means of reverse transcriptase-PCR (RT-PCR). Studies published so far have been mostly conducted using the molecular approach.

Objective

The objective of the present study was to clarify the epidemiological and clinical features of hMPV using molecular biological techniques for its diagnosis.

Patients and methods

A total of 189 patients with suspected viral respiratory tract infections were included and their respiratory specimens were analyzed for the presence of hMPV using a Seeplex respiratory virus detection kit. Detection techniques that were applied included virus identification by transcriptase-PCR (TC-PCR), direct fluorescent antibody staining, and the rapid culture technique known as shell vial amplification using monoclonal antibodies (mAbs) of nasal wash or aspirate fluid. The epidemiological and clinical data were analyzed and the latter were represented as percentages where applicable.

Results

The study determined the presence of respiratory viruses in 61 (32.3%) of the 189 respiratory samples and showed the presence of hMPV in eight (13.1%) of the 61 samples. hMPV showed variable seasonal activity. Six patients (75%) positive for hMPV had pre-existing serious disorders. Using the shell vial cultures with mAbs, we found that non-Hodgkin lymphoma patients with the related isolated virus showed a plaque of infected cells with small syncytial formations, whereas the other seven patients showed single infected cells. The RT-PCR results of all samples from hMPV-positive patients were correlated with the results of direct fluorescent antibody staining or shell vial cultures using mAbs.

Conclusion

hMPV is a significant pathogen in immunocompromised patients with a risk for high morbidity and mortality. A combination of diagnostic workups may be useful for confirming the detection of hMPV.

  484 79 -
Comparison between body mass index and percentage of body fat as measured by bioelectrical impedance in Egyptians
Dalia R AbdelRahman, Hoda Maamoun, Amin R Soliman
August 2012, 24(2):51-53
DOI:10.7123/01.EJIM.0000419547.69277.30   
Background

During the past decade, the number of Egyptians showing overweight and obesity as measured in terms of BMI (kg/m2) has been documented through different surveys. This increase in adiposity has been associated with metabolic syndromes in Egyptians and with higher fasting insulin concentrations. The purpose of this study was to assess the relationship between BMI and percentage body fat (PBF) in Egyptians and to determine whether this relationship differs between men and women.

Methods

We conducted a cohort study including 152 healthy participants; body fat composition was calculated using the BMI equation and bioelectrical impedance (BEI).

Results

The predicted PBF values based on BMI values between 15 and 50 for women and 18 and 50 for men were analysed, which showed that the trend of predicted PBF values differs in accordance with BMI:

at BMI at least 30, men tended to have higher PBF compared with women;

at BMI at least 35, women tended to have higher PBF compared with men.

Conclusion

The present study has investigated the relationship between PBF and BMI in Egyptians. The results show a significant difference in PBF on the basis of BMI and sex. There are some potential explanations for this difference, including sedentary lifestyles and possible genetic makeup. Similar observations with regard to the mediation of BMI on PBF according to sex have been reported previously. It is important to emphasize that the PBF values obtained in this study using BMI are estimates determined on the basis of the samples and that significant differences were found only among women.

  460 72 -
QUESTIONS
Questions from an exam

August 2012, 24(2):57-57
DOI:10.7123/01.EJIM.0000419644.51860.01   
  427 44 -
Feedback