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  Citation statistics : Table of Contents
   2015| January-March  | Volume 27 | Issue 1  
    Online since April 27, 2015

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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
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 2,256 327
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
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 2,322 280
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
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 1,771 188
Extracellular vesicles: fundamentals and clinical relevance
Wael Nassar, Mervat El-Ansary, Mostafa Abdel Aziz, Ehab El-Hakim
January-March 2015, 27(1):1-7
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.
  1 2,462 292
Pulmonary Langerhans cell histiocytosis causing spontaneous bilateral pneumothorax in a child
Anupam Patra, Sujit K Bhattacharyay, Arnab Maji, Abhijit Mandal
January-March 2015, 27(1):38-39
Bilateral pneumothorax is very rare in childhood. Moreover, if it is due to pulmonary involvement of Langerhans cell histiocytosis, it is even rarer in childhood. In our case, a nonsmoker 12-year-old boy presented with bilateral pneumothorax, whose high-resolution computed tomography scan was highly suggestive of pulmonary Langerhans cell histiocytosis. Excision biopsy of a clinically palpable cervical lymph node and histopathological examination and immunohistochemistry positivity for CD1a indicated a diagnosis of Langerhans cell histiocytosis. Clinicians should consider pulmonary Langerhans cell histiocytosis in differential diagnoses in dealing such a case.
  - 1,706 178
Esophageal squamous papilloma
Seham M Seif, Ahmed Y Altonbary, Wagdi F Elkashef
January-March 2015, 27(1):40-41
Squamous papilloma of the esophagus is a rare benign tumor with less than 200 cases reported in the literature. The etiology and pathogenesis appear to be related to an inflammatory-reparatory type, such as chronic gastroesophageal reflux, esophagitis, trauma, chemical irritants, and viruses. We present the case of a young female patient with esophageal squamous papilloma discovered accidently during screening upper gastrointestinal endoscopy.
  - 2,507 170
Pulmonary manifestations in a group of patients with Behçet's disease
Sherif M Naguib, Manal M El Menyawi, Mona I Nabih, Ihab Ismail
January-March 2015, 27(1):8-14
Background and aim Behçet's disease (BD) is a multisystem vasculitis and pulmonary involvement in BD is reported to indicate a poor prognosis and high mortality. We aimed to study the manifestations of pulmonary involvement in a group of patients with BD and to study the correlation of pulmonary involvement with other clinical manifestations. Patients and methods Our study included 15 patients with BD admitted to Cairo University Hospital, 14 men (93.3%) and one woman (6.7%), mean age 30.06 ± 9.8 years. All patients fulfilled the diagnostic criteria published by the International Study Group for Behçet's Disease in 1990. All patients were subjected to both plain chest radiography and a helical computed tomography study of the chest. Results Pulmonary manifestations were present in 11 patients, 10 men (90.9%) and one woman (9.1%). The main pulmonary and constitutional symptoms were as follows: dyspnea (81.8%), cough (63.6%), expectoration (36.4%), chest pain (54.5%), hemoptysis (36.4%), massive hemoptysis (9.1%), fever (36.4%), and weight loss (63.6%). In the 11 patients with pulmonary manifestations, analyses of both vascular and parenchymal lung lesions in helical computed tomography scan indicated the following: pulmonary artery aneurysm occurred in five patients (45.4%), pulmonary nodules in three patients (27.2%), pleural effusion in three patients (27.2%), pulmonary infarction in one patient (9.1%), and pneumonitis in one patient (9.1%). Pulmonary involvement was associated significantly with a positive pathergy test, erythema nodosum, and gastrointestinal manifestations. Conclusion A high frequency of pulmonary artery aneurysm was observed in our patients with pulmonary BD. Patients with pulmonary BD have higher frequencies of skin and gastrointestinal manifestations.
  - 2,099 219
The role of Helicobacter pylori in minimal hepatic encephalopathy
Seham S El-seid, Fatma A Attia, Mona Abd El-Raouf, Ghada S Abd Al-Azeem, Nagwa Abd EL-Ghaffar Mohammed, Heba Anwar
January-March 2015, 27(1):26-31
Background One of the causes of death in patients with liver cirrhosis is hepatic encephalopathy (HE). Hyperammonemia is the most important cause of HE. Aim The aim of this work was to determine the relation between the Helicobacter pylori infection and minimal hepatic encephalopathy (MHE) in cirrhotic patients and to assess the outcome after treatment of H. pylori. Patients and methods This study was carried out on 50 Egyptian cirrhotic patients. The patients were divided into two groups: group A1 (32 positive H. pylori) and group A2 (18 negative H. pylori). Both groups were compared with 20 (age and sex matched) healthy individuals (group B). Patients and controls were subjected to an assessment of history, clinical examination, upper gastrointestinal endoscopy with gastric biopsy for histopathological examination of H. pylori, abdominal ultrasound, neuropsychiatric assessment using the figure connection test (FCT), complete blood count, liver and kidney function tests, and determination of plasma ammonia level. Plasma ammonia level and FCT were measured before and after treatment of H. pylori among patients with positive H. pylori. Results Plasma ammonia levels and FCT were highly significantly increased in all cirrhotic patients (group A) compared with the controls (group B) (P < 0.01) and in the positive H. pylori patients (group A1) compared with the negative H. pylori patients (group A2) (P < 0.01) and in group A1 before treatment compared with after treatment (P < 0.01). Conclusions There is a highly significant association between H. pylori infection and MHE in cirrhotic patients. The treatment of H. pylori infection reduces the mean plasma ammonia levels and improves FCT results among the infected patients. Therefore, H. pylori infection is an effective treatable risk factor for the clinical management of MHE.
  - 1,760 229
Clinical, laboratory, and virological characteristics of patients with positive hepatitis B surface antigen in Upper Egypt
Khairy H Morsy, Mohamed AA Ghaliony, Tarek T.H. El Melegy
January-March 2015, 27(1):32-37
Aim The aim of the study was to determine the clinical, laboratory, and virological characteristics of patients with chronic HBV infection in Upper Egypt. Patients and methods This descriptive, cross-sectional study included 252 patients with positive hepatitis B surface antigen (HBsAg). It was conducted in the Tropical Medicine and Gastroenterology Department and Outpatient Clinic, Assiut University Hospital (Egypt), from May 2012 to May 2014. All patients underwent clinical evaluation, were administered a questionnaire about risk factors for transmission of HBV, underwent liver function tests, abdominal ultrasonographic examination, and complete blood count, evaluation of serological markers of HBV, and quantitative detection of HBV-DNA. Results Of the 252 patients included, 88.5% were male with a mean age of 35.4 years. Arthralgia was the most common complaint (15.5%) and hepatomegaly was the most common finding (8.3%). As regards imaging results (ultrasonographic) the following were found: normal liver in 83.3%, coarse liver in 11.9%, hepatomegaly in 7.5%, splenomegaly in 6.3%, and cirrhosis in 5.9%. As regards laboratory results normal alanine aminotransferase was found in 79.8%, normal aspartate aminotransferase in 85.7%, reduced serum albumin in 4.4%, and low platelet count in 9.9%. The majority of patients (91.7%) were hepatitis B envelope antigen negative; 65.9% of patients were positive for HBV on PCR. No significant differences were found between positive HBV-DNA status (by PCR) and negative HBV-DNA status as regards clinical, imaging, and laboratory characteristics of patients. Conclusion Most of the patients had normal liver on ultrasonographic examination and normal liver function tests. No significant difference was found between positive HBV-DNA status (by PCR) and negative HBV-DNA status as regards clinical, imaging, and laboratory characteristics of patients.
  - 1,741 181