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   2017| January-March  | Volume 29 | Issue 1  
    Online since June 12, 2017

 
 
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HISTORY OF MEDICINE
Medicine in ancient Egypt
Nevine Abd El-Gawad Ali Hasan
January-March 2017, 29(1):33-34
DOI:10.4103/ejim.ejim_23_17  
  1,186 243 -
ORIGINAL ARTICLES
Prevalence and profile of pulmonary fungal pathogens among HIV-infected patients attending University of Maiduguri Teaching Hospital, Nigeria
Muhammad Talle, Ibrahim M Hamidu, Idris-Abdullahi Nasir, Abubakar Mursal, Kalama B Dikwa, Mustapha Jelili, Peter O Musa
January-March 2017, 29(1):11-15
DOI:10.4103/ejim.ejim_5_17  
Background Fungal infections in lungs are being diagnosed with increasing frequency. This is related to the increased immunocompromised status and hygienic factors among patients. In view of this, the present study sought to isolate, identify, and determine the prevalence of pathogenic fungi in HIV-infected patients attending the University of Maiduguri Teaching Hospital, Nigeria. Materials and methods Between 5 April 2016 and 27 August 2016, three consecutive sputum samples in the early morning were collected from individual participants. The samples were inoculated onto Petri dishes containing sabouraud dextrose agar in triplicates for isolation. The fungal isolates were identified using standard mycological stains and reagents. Self-administered questionnaires and participants’ hospital cards were used to assess demographic and clinical variables, respectively. Results The prevalence of pulmonary fungal infection among the patients was at 68%. Of the infected patients, male patients accounted for 59.8%, whereas female patients accounted for 40.1%. However, there was no significant association between the prevalence of pulmonary fungal infection and sex of subjects (P=0.630). Candida albicans [24 (23.5%)] accounted for the highest proportion of the fungal isolates, followed by Aspergillus spp. [19 (18.6%)], with the least being Torulopsis dattila [one (0.9%)], Torulopsis glabrata, [one (0.9%)], and Microsporum canis [one (0.9%)]. Subjects with ages between 31 and 35 years that the highest prevalence of pulmonary fungal infections, 28 (27.5%), whereas those between 56 and 60 years, had the least prevalence, 1 (20.0%). Among the 102 participants coinfected with HIV/tuberculosis (TB), 92 (90.2%) had fungal coinfections, representing a relatively higher prevalence compared with those without TB, 10 (20.8%). There was statistical association between the prevalence of pulmonary fungal infections and TB status and age of patients (P<0.05). Conclusion Findings from this study revealed a high prevalence of pulmonary fungi in HIV/TB coinfected patients, with C. albicans being the leading causal fungi responsible for symptoms of pulmonary diseases.
  1,200 197 -
Approach to transgender individuals
Nilufer O Kutbay, Banu S Yurekli, Emine K Baykan, Nazli B Ozbaran, Hayriye Elbi, Fusun Saygili
January-March 2017, 29(1):1-4
DOI:10.4103/1110-7782.207782  
Background Trans-sexualism is the desire to be a member of the opposite sex during normal somatic sexual development. In this study, we would like to share our endocrinological approach and general clinical features of the patients with gender identity disorder. Patients and methods General and clinical features of 63 patients who were referred to Endocrinology Department between October 2012 and March 2014 were investigated retrospectively. In the beginning of the therapy, and later periodically, the patients were physically examined and their basal hormones and biochemical data were evaluated. Results Forty-eight (76.2%) patients constituted the female-to-male (FtM) group, and 15 (23.8%) patients constituted the male-to-female (MtF) group. The mean age was 25.0±4.6 in the FtM group and 24.9±5.9 in the MtF group. In the FtM group, 28 patients used testosterone preparations as cross-sex hormone, whereas 20 did not. Five (10.4%) patients had already used this preparation before they applied to us. Seven patients underwent mastectomy and four underwent oophorectomy. Penile prosthesis was implanted in one patient with reconstructive surgery. In the MtF group, nine patients used estradiol preparation. In the MtF group, three patients underwent breast implant surgery. Reconstructive surgery or orchiectomy was not performed. Conclusion The cross-sex hormone therapy provides the development of secondary sex characteristics and must also be given as a replacement therapy after gonadectomy.
  1,083 150 -
Correlation between Helicobacter pylori infection and reflux esophagitis: still an ongoing debate
Mohamed Saeed Hussein Gomaa, Maha Mosaad Mosaad
January-March 2017, 29(1):24-29
DOI:10.4103/ejim.ejim_9_17  
Context The vast majority of pathologies in the oesophagus, stomach and duodenum are related to either H. pylori infection or gastro-oesophageal reflux disease (GERD). Both conditions affect a large proportion of the population and they may occur either independently or concomitantly. The question of whether the two conditions are mutually exclusive, synergistic, or simply independent is an issue that was raised several years ago and is a matter of ongoing debate. Aim We aimed to determine the correlation between gastric Helicobacter colonization and grossly and histologically proven reflux esophagitis. Settings and design This work was designed as a descriptive cross-sectional study. Patients and methods The study was conducted on 50 patients, five women and 45 men, aged 19–79 years (mean: 35.3 years). The inclusion criterion was having a history of symptoms suggestive of GERD. The cases were chosen from among outpatients and inpatients undergoing diagnostic endoscopic study at the endoscopy unit. The main presenting complaints were GERD symptoms, dyspepsia and postprandial epigastric pain. All cases were subjected to thorough history taking regarding the details and nature of the presenting complaint, special habits including caffeine consumption, smoking, and intake of medications such as antacids and H2 blockers, complete physical examination and upper endoscopy. Detailed description of upper endoscopic examination was reported, including the grade of esophagitis according to Savary–Miller classification. Three groups of biopsies were taken from each case: the first set from the lower end of the oesophagus and the two other sets from the gastric antrum. The oesophageal biopsies and one set of gastric biopsies were examined histologically after being processed. The second gastric biopsy set was used for direct detection of H. pylori using the rapid urease test (Campylobacter-like organism test). The rapid urease test offers a sensitivity of 80–99% and a specificity of 92–100% in untreated patients when compared with histology as the gold standard in the diagnosis of H. pylori infection. Statistical analysis Data were statistically described in terms of frequencies (number of cases) and percentages and compared using the χ2-test. The exact test was used when the expected frequency was less than 5. Results On using the rapid urease enzyme test there were 44 (88%) positive cases and six (12%) negative cases for H. pylori. By direct histopathologic examination there were 32 (64%) positive cases and 18 (36%) negative cases for H. pylori. There was no statistically significant correlation between gastric colonization with H. pylori and reflux esophagitis diagnosed grossly and histopathologically. Conclusion The study showed no statistically significant correlation between H. pylori infection and the presence of reflux esophagitis.
  1,079 115 -
Effect of vitamin K1 supplementation on matrix Gla protein level and vascular calcification in hemodialysis patients
Ahmed Alla Eldin Ahmed Saad, Eglal Mohammed Kenawy, Ahmed Mohammed Elashakr, Hesham Hamdy Amin, Ahmed Abo Elfatoh Eldali, Waleed Saber Mohammed
January-March 2017, 29(1):5-10
DOI:10.4103/1110-7782.207779  
Background Matrix Gla protein (MGP) is a potent calcification inhibitor of the arterial wall. Its activity depends on vitamin K-dependent γ-carboxyglutamate. Aim We aimed to investigate the effect of vitamin K1 on MGP levels after 3 months’ supplementation and the relationship between MGP level and vascular calcification. Patients and methods A prospective case–control pilot study was conducted over a period of 3 months. The study included 57 long-term hemodialysis patients in stable conditions who were divided into two groups and were compared with 27 healthy age-matched controls. Group I consisted of 28 hemodialysis patients who received vitamin K1 at 10 mg three times per week for a successive period of 3 months. Group II consisted of 29 hemodialysis patients who did not receive vitamin K. Group III consisted of 27 healthy participants as controls. The serum level of MGP was measured by radioimmunoassay; in addition, hemoglobin%, parathyroid hormone, calcium, phosphorus, sodium, potassium, alkaline phosphatase, total cholesterol, triglyceride, and carotid intima–media thickness were also measured. Plain radiograph of the abdomen in lateral view was acquired to determine the abdominal aortic calcification score at the start of the study, which was reassessed after 3 months in groups I and II. Results We found a significant increase in blood pressure, body mass index (BMI) with elevation in the serum level of MGP in patient groups than control from the start. A significant elevation in MGP level was observed in group I accompanied by a decrease in serum cholesterol level, compared with group II. We did not find any significant change in carotid intima–media thickness or abdominal aortic calcification score in either group after 3 months. There was no significant correlation between elevated MGP level and vascular calcification either. No significant difference was found in other parameters. Conclusion Vitamin K supplementation may be essential for End Stage Kidney Disease (ESKD) patients on hemodialysis. Vitamin K can increase the level of MGP and decrease cholesterol level, but its beneficial effect on the vascular bed needs a long-term study.
  977 145 -
Clinical evaluation of acute kidney injury in Al-Zahraa University Hospital, Cairo, Egypt
Lamyaa I Ahmed, Hayam H Mansour, Amal Hussen, Mohammed S Zaki, Ragaa R Mohammed, Aalaa T Goda
January-March 2017, 29(1):16-23
DOI:10.4103/ejim.ejim_3_17  
Background Acute kidney injury (AKI) is a very common problem. Early detection of injury with initiation of appropriate supportive care remains the mainstay of therapy. Aim The aim of the present study was to evaluate the incidence, etiology, prognosis, treatment, and outcome of AKI. Patients and methods This was a prospective, observational study of 212 patients (137 men and 75 women) who were admitted in all departments of Al-Zahraa University Hospital with AKI during the period from October 2014 to October 2015. Their ages ranged from 22 to 85 years. We included adults aged more than 18 years who presented with AKI, and we excluded patients on regular dialysis. Serum creatinine, sodium, potassium, urea, calcium, phosphorus and uric acid, complete blood count, pelviabdominal ultrasound, and daily measurement of urine output (UOP) were done. AKI patients were classified according to the RIFLE and Acute Kidney Injury Network staging. Result According to the RIFLE criteria, the number of risk, injury, failure, loss, and end-stage renal disease patients were 55 (25.9%), 62 (29.24%), 33 (15.56%), 38 (17.92%), and 24 (11.32%), respectively. According to the Acute Kidney Injury Network staging system, the number of stages I, II, and III patients were 61 (28.7%), 50 (23.5%), and 101 (47.6%), respectively. The length of hospital stay was significantly associated with severity of AKI. The main cause of AKI was dehydration in 82 (38.7%) patients and sepsis in 71 (33.5%). Oliguric patients were 147 (69.34%) and nonoliguric were 65 (30.66%). Moreover, prognosis of patients was complete recovery in 95 (44.81%), partial recovery in 81 (38.21%), and no recovery in 36 (16.98%). Conclusion AKI was more common among patients in ICU than those in any other department. Dehydration and sepsis were its leading causes.
  783 113 -
OBITUARY
Dr el Sawy Mahmoud Habib
Amal F Radwan
January-March 2017, 29(1):35-36
DOI:10.4103/ejim.ejim_16_17  
  763 79 -
CASE REPORT
Diabetes mellitus and congenital proximal femur hypoplasia: is there a link or association
Mervat Essam, Ahmed Yamani
January-March 2017, 29(1):30-32
DOI:10.4103/ejim.ejim_12_17  
We present a case of congenital short femur with scleredema Diabeticorum (SD) in a patient with diabetic neuropathy with unusual skin lesion distribution. Gait symptoms progressively worsened. The atypical distribution of the skin lesions is quite unusual. This case express rare complications of diabetes mellitus, the maternal diabetes which had disrupted in part the development of skeletal system of the offspring who in turn developed a rare dermatologic complications i.e. scleredema Diabeticorum (SD). This case will leave inedible memory for every diabetologist not to miss the skeletal and dermatologic manifestations of DM. The combination of this congenital proximal femoral hypoplasia with complicating diabetes make the question if there is a link with similar genetic predilection or just an association.
  621 73 -
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