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   2015| July-September  | Volume 27 | Issue 3  
    Online since September 15, 2015

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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
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.
  2,968 199 -
Aluminium phosphide induced acute kidney injury
Quaiser Saif, Ruhi Khan, Aparna Sharma
July-September 2015, 27(3):115-117
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.
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Significance of hepatocyte growth factor concentrations in serum of patients with liver cirrhosis and patients with hepatocellular carcinoma
Heba S El Deen, Hemmat E El Haddad
July-September 2015, 27(3):92-102
Objective Egypt has the highest prevalence of chronic hepatitis C virus (HCV) infection worldwide with the development of cirrhosis and hepatocellular carcinoma (HCC). The hepatocyte growth factor (HGF)-cMET axis promotes cell survival, proliferation, migration, and invasion. This study aimed to evaluate the role of serum HGF as a noninvasive biomarker in the diagnosis of liver cirrhosis and HCC. Patients and methods This study included 80 individuals. They were divided into three groups: group 1 included 20 healthy volunteers as a control group, group 2 included 30 patients with liver cirrhosis, and group 3 included 30 patients with HCC. Results HGF was highly significantly elevated in the HCC group (median 3709 pg/ml) and the cirrhotic group (median 2843.5 pg/ml) compared with the control group (median 913 pg/ml). α-Fetoprotein (AFP) was highly significantly elevated in the HCC group (median 128.5 ng/ml) than both the cirrhotic (median 4.9 ng/ml) and the control (median 3.15 ng/ml) group. Results of aspartate aminotransferase/alanine aminotransferase, APRI, fibroindex, and model 3 in the cirrhotic group were highly significantly different from those in the control group. We found a positive significant correlation between HGF and AFP for all the participants studied. There were direct correlations between HGF and aspartate aminotransferase/platelet ratio index (APRI), fibroindex, and model 3. The sensitivity and specificity of HGF for selective detection of the HCC group over the non-HCC group (HCV group and healthy control group) were 93.3 and 46%, respectively, at a cut-off value of 1415 pg/ml, whereas that of AFP were 100 and 92%, respectively, at a cut-off value of 10 ng/ml, and area under the curve of HGF and AFP were 0.787 and 0.999, respectively. The sensitivity and specificity of both AFP and HGF together were 100 and 66%, respectively, at the same cut-off values. The odds ratio of occurrence of HCC in patients with elevated HGF levels was 11.926 and 95% confidence interval 2.56-55.55. Conclusion We conclude from this study that both HGF and AFP can be used as noninvasive biomarkers for early detection of HCC in HCV cirrhotic patients, especially if their values match the cut-off levels detected in our study.
  1,750 210 -
Outcome of hemodialysis in elderly diabetic patients: a single-center experience
Hatem Darwish, Ahmed Fathi
July-September 2015, 27(3):87-91
Background The optimal renal replacement therapy for elderly patients is unclear, and literature is evolving in this regard. For elderly individuals who progress to CKD5, hemodialysis is often a valuable treatment option. Although hemodialysis is a life-sustaining therapy and extends life, it may also create, increase, or prolong suffering in selected subgroups of geriatric patients. In our current study we focused on elderly diabetic patients above 65 years, as they constitute the more vulnerable subgroup, having multiple comorbid conditions. The primary objective was to study the patient's survival and the association with different comorbidities. Patients and methods We conducted a retrospective analysis of 48 type 2 diabetic patients aged above 65 years. We reviewed their survival data and comorbid conditions - namely, vascular, cognitive, and autonomy. Results and conclusion The mortality rate was 7.5% per year with significant association with prior cerebrovascular accident, cognitive impairment, and lost autonomy.
  1,673 183 -
Adenocarcinoma of the lung masquerading as miliary mottling: A rare presentation
Deepak K Prajapat, Arjun Khanna, Deepak Talwar
July-September 2015, 27(3):118-120
Bronchogenic carcinoma usually presents as a mass lesion associated with variable degrees of lung collapse and associated effusion. Although primaries from other sites such as thyroid, choriocarcinoma, and sarcomas may present as miliary mottling, bronchogenic carcinoma presenting this way is uncommon. We present here the case of a 62-year-old housewife, who presented with bilateral miliary shadows on chest radiography and was treated for pulmonary tuberculosis on the basis of history and radiological findings. As the disease advanced, the diagnosis of primary adenocarcinoma of the lung was made.
  1,514 170 -
Dissemination of tuberculosis after biopsy of primary tubercular prostate: a case report
Onkar Jha, Vidya Nair, Deepak Talwar
July-September 2015, 27(3):123-126
Only 15-20% of extrapulmonary tuberculosis (TB) has been attributed to TB of the urogenital system and often results from haematogenous spread from an active site of infection. Isolated involvement of prostate by TB is relatively less common. The incidence of primary prostatic TB is unknown and in its truest sense is a very rare entity. Here, we report the case of a patient with primary prostatic TB who was misdiagnosed as nonspecific granulomatous inflammation on transrectal ultrasound-guided biopsy of the prostate, who later presented to our centre after 4 months with disseminated TB. The rarity of the case prompted us to report this case.
  1,544 130 -
Treating double-digit hyponatremia: walking a tight rope
Manjunath Kulkarni, Prashanth Kadri, Raghavendra Bakki Sannegowda, Maria Bethsaida, Nikhil D'Souza
July-September 2015, 27(3):121-122
We report the case of a diabetic patient who presented with severe hyponatremia (serum sodium concentration of 88 mEq/l) caused by hypovolemia and thiazide diuretic use. His serum sodium levels were gradually corrected using a combination of isotonic and hypotonic fluids based on urine output and rate of rise in sodium levels. The patient had complete recovery without any evidence of osmotic demyelination.
  1,446 131 -
Study of the LMNA 1908 C/T gene polymorphism in type 2 diabetic Egyptians with vascular complications
Heba Mostafa, Manal Eldeeb, Ahmed Hamdy, Rasha M Abdel Samie, Badawy El-Kholy, Nahla Fawzy, Ahmed Eltaweel, Nahed M Ibrahim
July-September 2015, 27(3):103-107
Aims/introduction Vascular complications are the main cause of morbidity and mortality in type 2 diabetic patients. Genetic susceptibility is associated with the evolution of diabetic complications. One such gene is the lamin A and C gene located on chromosome 1q21, a susceptibility locus for type 2 diabetes mellitus, and encodes nuclear lamins A and C. The LMNA 1908 C/T polymorphism has been reported to be associated with dyslipidemia, metabolic syndrome, and obesity, suggesting that this polymorphism increases the risk of atherosclerosis and vascular disease. The present study aims to elucidate the association between the LMNA 1908 C/T single nucleotide polymorphism and the prevalence of vascular complications in a sample of type 2 diabetic Egyptian patients. Materials and methods Genomic DNA from 47 type 2 diabetic patients with vascular complications and 20 control participants was analyzed for the LMNA 1908 C/T polymorphism using PCR-RFLP. Results Carriers of the LMNA 1908 T-allele showed a significantly higher prevalence in patients with diabetic nephropathy than carriers of the C-allele (P < 0.05). Multiple regression analysis showed that the LMNA 1908 T-allele tended to be independent risk factor for diabetic nephropathy (P = 0.012, odds ratio = 5.460). Conclusion The findings of this study suggest that the LMNA 1908 C/T single nucleotide polymorphism is associated with the development of diabetic nephropathy in Egyptian type 2 diabetic patients.
  1,335 158 -