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   2012| December  | Volume 24 | Issue 3  
    Online since July 16, 2014

 
 
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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   
  1,423 4,042 -
Ankylosing spondylitis: a multidisciplinary approach
Medhat El Shafei
December 2012, 24(3):61-62
DOI:10.7123/01.EJIM.0000422805.46488.8a   
  1,237 2,433 -
ORIGINAL ARTICLES
Correlations of folic acid, vitamin B12, homocysteine, and thrombopoietin to platelet count in HCV infection
Somayh S. Eissa, Olfat M. Hendy, Fatma Younis, Aziza K. Omar Samy, Ayat R. Abdallah, Laila A. Ahmed
December 2012, 24(3):83-92
DOI:10.7123/01.EJIM.0000422603.17424.31   
Introduction

The platelet count is known to decrease in proportion to the advancement of the stage of liver disease in chronic hepatitis C (CHC) viral infection. The platelet count is currently used as an index for fibrosis staging. The pathophysiology of thrombocytopenia (TCP) in patients with hepatitis C virus (HCV) infection is not completely understood.

Purpose

This work aimed to study the correlations of folic acid (FA), vitamin B12 (Vit B12), homocysteine (Hcy), and thrombopoietin to the platelet count in HCV infection.

Patients and methods

Sixty-seven patients (51 men and 16 women) with HCV infection were included in this study. All patients were sero-negative for hepatitis B viral markers. In addition, 20 healthy volunteers, matched for sex and age, were included as a control group. All patients and control individuals were subjected to the following: assessment of medical history, thorough clinical examination, and laboratory investigations including the following: complete blood cell counts, viral hepatitis markers, liver and renal function tests, HCV-RNA by quantitative PCR, serum folate, Vit B12, thrombopoietin, and plasma Hcy. Abdominal ultrasonography and ultrasound-guided liver biopsy for histopathologic examinations were carried out for the patients. Patients were divided into two groups of 36 patients with CHC and 31 patients with cirrhosis with HCV liver cirrhosis (LC).

Results

The results indicated a significant decrease in the platelet count in CHC and LC patients compared with the healthy control group. There was a highly significant decrease in the FA level in CHC and LC patients compared with the control group; also, a significant decrease in the platelet count was found in LC patients compared with CHC patients. Hcy was significantly increased in CHC and LC patients. There was a nonsignificant decrease in Vit B12 in CHC patients, whereas it was significantly increased in LC patients. There was a nonsignificant decrease in thrombopoietin in CHC patients compared with the control group, whereas in LC patients, there was a highly significant decrease. There was a highly significant positive correlation between the platelet count and FA, but an insignificant correlation between the platelet count and Hcy, Vit B12, thrombopoietin, and viral load.

Conclusion

This study concluded that TCP in HCV-related chronic liver diseases is multifactorial and decreased FA is involved in its pathogenesis as an independent risk factor. Increased Hcy may cause TCP through platelet activation and endothelial dysfunction.

  1,917 164 -
The importance of using ultrasonography in knee osteoarthritis
Gaafar Ragab, Mohamed A El-Ghobary, Rasmia M. El Gohary
December 2012, 24(3):93-96
DOI:10.7123/01.EJIM.0000422604.53524.16   
Background

Radiographic features of osteoarthritis (OA) do not correlate with its symptoms at the individual patient level; thus, conventional radiography has limitations. Ultrasonography plays an important role in the diagnosis of musculoskeletal disorders. It reveals soft-tissue abnormalities such as pes anserine bursitis, Baker’s cyst, effusion, synovial hypertrophy, meniscal tear, and collateral ligament injury.

Aim of work

The aim of this study was to detect changes in the knee that cannot be visualized using conventional radiography and to better understand and manage unexplained pain in OA.

Results

There was a discrepancy between the results obtained by clinical examination and those by ultrasonography. Knee effusion was found in 21 knees (70%); synovial hypertrophy was found in three knees (10%), of them two showed Baker’s cyst and marked effusion; Baker’s cyst was found in eight knees (27%); and pes anserine bursitis was found in one knee. Results that could not be found by clinical examination were: cartilage degeneration in 27 knees (90%) and meniscal degeneration in 26 (86%). Meniscal degeneration and synovial hypertrophy were correlated significantly with advanced cartilage degeneration (P<0.001).

Conclusion

Ultrasonography can be used for diagnosing soft-tissue lesions, for grading the severity of OA, and for guiding and monitoring therapy.

  1,698 256 -
TNF-related apoptosis-inducing ligand levels in rheumatoid arthritis, osteoarthritis, and spondyloarthritis
Mustafa Abdelaziz Mustafa, Uomna K. Mohamed, Assem Bastawisy
December 2012, 24(3):72-78
DOI:10.7123/01.EJIM.0000422601.29845.af   
Introduction

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a tumor necrosis factor (TNF) family member capable of inducing apoptosis in many cell types. Data suggest that TRAIL/TRAIL receptor expression profiles on T cells might be important in rheumatoid arthritis (RA) pathogenesis.

Objectives

To characterize the role of TNF-related apoptosis-inducing ligand (TRAIL) in rheumatoid arthritis (RA) and to explore whether TRAIL investigated in serum and synovial fluid were associated with clinical, laboratory, and radiological variables of RA disease activity and severity.

Methods

Circulating levels of TRAIL were measured by ELISA in serum samples obtained from 50 patients with RA (during activity and quiescence), 20 patients with osteoarthritis, 15 patients with spondyloarthritis, and 50 normal healthy individuals serving as controls.

Results

The median serum TRAIL concentrations were increasingly higher across the following groups: healthy controls (185 pg/ml), and RA patients with active disease (1625 pg/ml; P=0.0001 vs. controls) and inactive disease (1750 pg/ml; P=0.0001 vs. controls) (inactive vs. active RA; P=0.07). It is noteworthy that RA patients had significant higher median TRAIL concentrations as compared with osteoarthritis patients whether during activity or during quiescence. However, the median levels of TRAIL were statistically comparable in RA and spondyloarthritis patients. The median and mean±SD synovial fluid TRAIL concentrations were 2100 and 1765.8±752 pg/ml, respectively. The levels of TRAIL in synovial fluid from the patients were higher than those in sera from both the patients and the healthy individuals. TRAIL concentrations in paired sera and synovial fluid samples could be related to each other. Serum and synovial concentrations of TRAIL were correlated positively with the total number of joints with active arthritis and with the overall articular severity score. Patients with Larsen index and total radiographic score of at least 1 had significantly higher serum TRAIL levels than patients with indices and scores 1 or less.

Conclusion

Upregulated expression of TRAIL might be somewhat useful for the evaluation of RA disease activity and progression, although its increment is not disease specific.

  1,472 235 -
Correlation of serum angiogenin level with various vascular complications in type 2 diabetic patients
Nagwa F. Ahmed, Somayh S. Eissa, Abeer A. Ali, Mona N. Ali, Amal A. Morsy, Sahar M. Ismail, Heba R. Ahmed
December 2012, 24(3):63-71
DOI:10.7123/01.EJIM.0000422600.48719.a3   
Introduction

Premature development of microvascular and macrovascular disease is the most frequent complication of diabetes. It is responsible for diabetic retinopathy, nephropathy, and neuropathy. Moreover, diabetes leads to reduced collateralization in ischemic tissues, which causes a three- to four-fold increase in cardiac mortality in diabetic individuals compared with nondiabetic individuals.

The pathophysiological mechanisms responsible for impaired angiogenic activity in diabetes remain unknown. The role of angiogenin in the physiological revascularization process has not been clarified.

Purpose

This work was carried out to determine the serum angiogenin level in type 2 diabetic patients and to determine its correlation with various microangiopathies, cardiovascular complications, and the duration in type 2 diabetic patients.

Patients and methods

This work was carried out on 88 individuals, 68 type 2 diabetic patients and 20 apparently healthy controls. All individuals were subjected to the following assessments: medical history taking; clinical examination including measurement of BMI; estimation of levels of fasting blood sugar, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea, low-density lipoprotein, and creatinine; determination of the albumin/creatinine ratio and complete lipid profile (total cholesterol, triglyceride, high-density lipoproteins); serum angiogenin estimation by enzyme linked immunosorbent assay; fundus examination; ECG and transthoracic echocardiography; and abdominal ultrasonography.

Results

Our results indicated a significant decrease in the serum angiogenin level in diabetic patients compared with the control group; an insignificantly low serum angiogenin level in diabetic patients with retinopathy and nephropathy compared with those without retinopathy and nephropathy, respectively; a significant decrease in the serum angiogenin level in patients with coronary artery disease (CAD) compared with diabetic patients without CAD; an insignificant inverse correlation of angiogenin with fasting blood sugar, duration of diabetes mellitus with urea, and creatinine with albumin/creatinine ratio; and an insignificant proportional correlation of angiogenin with ejection fraction in diabetic patients with complications of retinopathy, nephropathy, and CAD in each group separately.

Conclusion

This work concluded that the serum angiogenin level is lower in type 2 diabetic patients compared with the control group and it decreases with prolonged duration of diabetes, especially in uncontrolled patients and patients with microangiopathic and cardiovascular complications.

As angiogenin is one of most powerful angiogenic factors, we recommend further studies to evaluate the diagnostic, prognostic, and therapeutic value of angiogenin in various microangiopathic and cardiovascular complications of type 2 diabetes.

  1,096 444 -
CASE REPORTS
Double-chambered left ventricle
Islam F.H. Ali, Khalid Y Tohamy, Mousa Akbar
December 2012, 24(3):105-107
DOI:10.7123/01.EJIM.0000422606.65378.27   

We describe a rare congenital anomaly in a 39-year-old woman who was referred for a preoperative echocardiographic assessment in February 2012. A double-chambered left ventricle was suspected on transthoracic echocardiography and was confirmed by transesophageal echocardiography.

  1,370 161 -
ORIGINAL ARTICLES
Nonendoscopic predictors of large esophageal varices
Ahmed A ElNaggar, Mohamed S Gomaa, May M Fawzy
December 2012, 24(3):97-99
DOI:10.7123/01.EJIM.0000422605.92412.30   
Background

There is a particular need for noninvasive predictors of esophageal varices (EV) that might help reduce medical, social, and economic costs. Our study aimed at studying the noninvasive predictors of EV.

Patients and methods

A total of 100 live cirrhotic patients with compensated liver functions were subjected to full clinical, laboratory, and imaging investigations.

Results

A total of 55% of the studied groups showed EV; 39% showed high-grade EV (grades III, IV, and V). Platelet count and platelet count/splenic diameter ratio have the highest accuracy and specificity for predicting EV, whereas platelet count/splenic diameter ratio has the highest predictive accuracy for the presence of large EV.

Conclusion

The platelet count/splenic diameter ratio can predict the presence of EV and large-sized EV.

  1,253 136 -
Noninvasive evaluation of hepatic fibrosis in patients with hepatitis C using elastography
Hussein Okasha, Mohamed Naguib Abdalla, Nagwa Ramadan, Waleed El-Nabwey
December 2012, 24(3):79-82
DOI:10.7123/01.EJIM.0000422602.51592.c4   
Background

Evaluation of the static elastography as a noninvasive method for predicting liver fibrosis in patients with hepatitis C virus as an alternative modality for liver biopsy.

Materials and methods

A group of 35 patients with chronic hepatitis C virus were subjected to biological tests, abdominal ultrasonographic examination, liver biopsy with a histopathological estimation of score of activity and fibrosis, and liver stiffness measurement by means of elastography of the left lobe of the liver.

Results

Our study showed that there is a significant association between the elastography score and the grade of fibrosis (P=0.001). A significant positive relationship was found between the activity stage and the elastography score (r=0.625 and P=0.01). Elastography has been shown to have a reasonably high sensitivity, specificity, and diagnostic accuracy 100, 48.27, and 57.14% and 87.5, 96.3, and 94.29% for fibrosis grades 0, 1, 2 and 5, 6, respectively. No statistically significant relationship was found between the diameter of the anterior abdominal wall and the accuracy of elastography. However, 63.6% of those with bright liver texture had an incorrect elastography score, whereas 42.9% of those with a normal liver texture had the correct elastography score, and this association was statistically significant (P=0.039).

Conclusion

Transient elastography indicates whether the liver is normal or cirrhotic; however, it has a low accuracy in the assessment of moderate stages of fibrosis (stages II, III, and IV). Bright liver affects the accuracy of elastography in assessing the degree of fibrosis, whereas anterior abdominal wall diameter does not.

  1,258 114 -
Dynamic posturography findings among patients with liver cirrhosis in Egypt
Wael M. Aref, Noha A. Hosni, Mohamed Naguib, Mohamed El-Basel
December 2012, 24(3):100-104
DOI:10.7123/01.EJIM.0000422797.51953.a7   
Background

Liver cirrhosis is a condition that destroys the normal function of the liver, leading to hepatic encephalopathy, which is associated with impairment in postural control and disturbance in balance.

Aim of the study

The aim of this study was to detect the disturbances in balance and postural control because of hepatic encephalopathy as a result of liver cirrhosis using dynamic posturography.

Participants and methods

Individuals were divided into two groups: 45 patients with liver cirrhosis and 45 controls. Both groups underwent dynamic posturography to evaluate balance control, number connection test-type A, line tracing test, and serum ammonia (NH3) level to assess encephalopathy.

Results

Dynamic posturography findings were significantly weaker in patients with liver cirrhosis than in the controls. They were also weaker in patients with high NH3 than in patients with low NH3. There were significant negative correlations between dynamic posturography findings and number connection test-type A, line tracing test, and NH3 levels.

Conclusion

Hepatic encephalopathy because if liver cirrhosis affects balance control and the degree of affection is related to the degree of encephalopathy.

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QUESTIONS
Questions from exam

December 2012, 24(3):113-113
DOI:10.7123/01.EJIM.0000422608.49116.ca   
  917 82 -
CASE REPORTS
Floating right heart thrombus and massive pulmonary embolism
Khalid Y Tohamy, Islam Ali, Mousa Faris, Mousa Akbar
December 2012, 24(3):108-112
DOI:10.7123/01.EJIM.0000422607.07704.63   

Right heart thrombi are a severe form of venous thromboembolic disease and justify diagnosis and treatment in emergency. Free-floating right heart thrombi are a rare phenomenon, generally diagnosed when echocardiography is performed in patients with suspected or proven pulmonary embolism, and have a dismal prognosis if not diagnosed and treated in a timely manner. In our case which presented and treated in December 2010, thrombolytic therapy was the treatment of choice, although other treatment options are available, including anticoagulation and embolectomy.

  864 103 -
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