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   Table of Contents - Current issue
April-June 2019
Volume 31 | Issue 2
Page Nos. 107-246

Online since Friday, June 28, 2019

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Association of serum Sestrin-2 level with insulin resistance, metabolic syndrome, and diabetic nephropathy in patients with type 2 diabetes Highly accessed article p. 107
Hazem M EL-Ashmawy, Azza M Ahmed
Background The aim of the study was to evaluate the relationship between serum Sestrin2, Insulin resistance (IR), metabolic syndrome (MetS), and diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Patients and methods The study group consisted of 155 patients with T2DM who were recruited and evaluated for DN. IR was evaluated by the homeostasis model assessment-insulin resistance (HOMA-IR). Sestrin2 levels were determined by enzyme-linked immunosorbent assay. Results Serum Sestrin2 levels showed significant positive correlations with tumor necrosis factor-α (r=0.247, P=0.018), triglycerides (r=0.178, P=0.021), total cholesterol (r=0.33, P=0.007), fasting c-peptide (r=0.164, P=0.035), and systolic blood pressure (r=0.171, P=0.041). A significant negative correlation was found between Sestrin2 levels and serum adiponectin (r=0.247, P=0.018). Also, Sestrin2 levels were positively correlated HOMA-IR (r=0.188, P=0.026). There was a progressive significant increase of mean HOMA-IR through Sestrin2 tertiles (P=0.001). A significant increase of mean serum Sestrin2 levels was found in relation to the presence of DN or MetS. Conclusion Serum Sestrin2 levels are significantly associated with IR, MetS, and DN in patients with T2DM.
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Assessment of some inflammatory markers and lipid profile as risk factors for atherosclerosis in subclinical hypothyroid patients p. 115
Khaled A El-Hefnawy, Hanaa Hosni Elsaid
Background Subclinical hypothyroidism (SCH) is associated with dyslipidemia and low grade inflammation leading to atherosclerosis. Atherosclerosis shows an association with inflammatory markers, which with dyslipidemia may accelerate the atherogenesis, in SCH. Objective The objective of this study was to investigate some inflammatory markers and lipid profile as risk factors for atherosclerosis in SCH. Patients and methods An overall 100 participants were included and classified into two groups: control group I included 20 healthy volunteer, patient group II included 80 SCH patients and was subdivided into group ΙΙa (26 male patients) and group ΙΙb (54 female patients). All patients were submitted to the following investigations: complete blood picture, liver function tests, renal function tests, Lipid profile, calculated risk ratio I and II and specific laboratory Investigations [thyroid-stimulating hormone (TSH), free thyroxine, free tri-iodothyronine, C-reactive protein (CRP), serum interleukin (IL)-6 and serum IL-10 assays]. Results There were statistically high significant differences between the control group and the SCH group as regards serum triglycerides, cholesterol, low-density lipoprotein, risk ratio I and II, TSH, IL-6, IL-10 and CRP (P<0.001). Statistically significant higher levels of CRP, serum IL-6 and IL-10 were observed in SCH patients than in controls. TSH had a positive correlation in SCH patients with all studied parameters including all lipid parameters, CRP, IL-6 and IL-10 and was negative only to free tri-iodothyronine and free thyroxine, whereas IL-6 and IL-10 correlated also with all parameters except age. Conclusion SCH is associated with increased levels of inflammatory markers and dyslipidemia, which are indicators for atherosclerosis, and are good predictors of cardiovascular morbidity.
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Evaluation of microRNA-192 in patients with diabetic nephropathy p. 122
Gamal Saadi, Amr El Meligi, Mervat El-Ansary, Alkhateeb Alkemary, Ghada Ahmed
Background Diabetic nephropathy (DN) is the leading cause of kidney failure. The role of microRNAs (miRs) which are endogenous RNA oligonucleotides that regulate gene expression in DN is not yet clearly established. This study was designed to evaluate the blood level of miR-192 and its relation to disease severity in patients with type 2 diabetes mellitus with and without DN evidenced by the presence of albuminuria. Materials and methods The study included 60 patients (37 women and 23 men) with type 2 diabetes mellitus and 20 healthy control participants. All were subjected to thorough history taking, clinical evaluation and measurement of glycosylated hemoglobin, creatinine and urinary albumin/creatinine ratio. miR-192 was quantified in blood using reverse transcription TaqMan microRNA assay. Results The study showed that the miR-192 levels were significantly higher in patients with lower estimated glomerular filtration rate and higher albumin/creatinine ratio. Conclusion These findings may help to find a new marker for early detection of DN and this could be used in the future as a novel therapeutic target for the treatment of DN.
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Maternal thyroid status and its relation to ferritin and vitamin B12 in Saudi pregnant women p. 129
Mysara Mohamad Mogahed, Eman El Sayed Amer, Mona Ahmed El-Awady
Background Thyroid dysfunction is a worldwide phenomenon in women, and the prevalence increases during pregnancy, with hypothyroidism being the most common. In most developing countries, nutritional deficiencies of nearly all essential nutrients, including iron, vitamin B12, and folic acid, are common in pregnant women. Thyroid disorders and nutritional deficiencies especially of iron and vitamin B12 cause a number of maternofetal complications. Objectives To assess thyroid status in pregnant Saudi women and explore its relation to ferritin and vitamin B12. Patients and methods This was a cross-sectional study conducted at antenatal clinics of the Northern Area Armed Forces Hospital, KSA, enrolling 254 Saudi women: 180 pregnant [classified according to gestational age into group A (first trimester) and group B (second trimester)], and 74 age-matched healthy nonpregnant women, as control group (group C). After a detailed obstetrical and medical history, and clinical assessment, participants were subjected to laboratory investigations in the form of thyroid function by measuring thyroid-stimulating hormone (TSH) and free thyroxin, hemoglobin (HB), serum ferritin, and vitamin B12 levels. Results TSH level was lower in pregnant than nonpregnant women. Subclinical hypothyroidism (35.5%) was the most common thyroid disorder followed by overt hypothyroidism (10%) and hypothyroxinemia (2.2%) in pregnant women. HB and vitamin B12 levels were significantly lower in first and second trimesters of pregnancy when compared with controls (P=0.001). Serum free thyroxin correlated positively with HB and ferritin, whereas TSH correlated negatively with HB and ferritin. Conclusion High prevalence of hypothyroidism in pregnant females and its association with iron and vitamin B12 deficiencies highlight the urgent need for thyroid status to be detected and to evaluate nutritional deficiencies in such group, so as to start early treatment promptly and to prevent the adverse effects of the disorder to both mother and fetus to achieve normal pregnancy outcome.
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Prolonged QTc interval in adults with diabetic ketoacidosis: is it only electrolyte disturbance? p. 136
Osama A Khalil, Ghada M Samir, Ayman M.E.M Sadek
Context Cardiac arrhythmia in diabetic ketoacidosis (DKA) is a well-known complication that is usually a result of electrolyte imbalance. Another frequently missed cause of arrhythmia is the QT interval prolongation, which is not always attributed to electrolytes disturbance. Aim We aimed to explore the frequency of QTc interval prolongation among patients with DKA in the medical ICU, the association with serum electrolytes and pH, and the implication on the outcome. Patients and methods We carried out a cross-sectional cohort study on patients with DKA admitted to medical ICU. We had worked on 72 patients with DKA by performing the routine investigation including ECG follow-up during the hospital stay. Maximum QT interval in all measured leads (QTmax) and heart rate-corrected QTmax (QTmaxc) were calculated in milliseconds according to Bazett’s formula. We used SPSS, version 20.0, with the following statistical tests: Shapiro–Walk, Student’s t, Pearson’s correlation, logistic regression, receiver operating characteristic curve analysis, and relative risk. Results The frequency of QTmaxc interval prolongation without electrolyte imbalance was seen in 46 (63.9%) patients. pH revealed to be the most significant independent risk factor for QTmaxc interval prolongation (odds ratio=8.39, 95% confidence interval: 1.67–18.06) with a cutoff value less than 7.03, with sensitivity of 56% and specificity of 44%. QTmaxc prolongation carried a relative risk of ∼1.7-fold for mortality in patients with DKA. Conclusion Acidosis carries an independent risk for QTmaxc interval prolongation in the absence of electrolytes abnormalities, with related poor ICU outcome in patients with DKA.
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Effect of walking and aerobic exercise on physical performance and depression in cases of type 2 diabetes mellitus p. 142
Manal K Youssef
Aim Investigate the effect of walking and aerobic exercise on physical performance and depression symptoms in patient with type 2 diabetes mellitus (T2DM). Patients and methods Forty patients with T2DM were divided into two groups. Group 1 was treated by walking 30 min three times per week. Group 2 was treated by aerobic exercise for 30 min for 3 months. Physical performance and depression were measured pretreatment and posttreatment. Results Walking improved BMI by 4.2%, waist circumference by 1.22%, blood glucose by 6.82%, timed up and go test by 24.34%, static balance by 74.63%, 6 min walk by 14.91%, muscle power by 15.97%, muscle endurance by 71.42%, 2 min stair climbing by 52.63%, squat test by 73.63%, and hospital scale of anxiety and depression by 46.79%. Aerobic exercise improves by BMI 5.47%, waist circumference by 3.95%, blood glucose by 17.21%, time up and go test by 29.2%, static balance by 118.58%, 6 min walk 8.57%, muscle power by 31.93%, muscle endurance by 81.63%, 2 min stair climbing by 49.19%, squat test by 81.3%, and hospital scale of anxiety and depression by 50%. Conclusion Both walking and aerobic exercise improve physical performance and depression scale in T2DM.
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Prevalence of diabetic kidney disease in patients with type 2 diabetes mellitus p. 149
Khaled A Elhefnawy, Ahmed Maher Elsayed
Introduction The increased prevalence of diabetes has led to an increase in its vascular complications such as coronary heart disease, stroke, diabetic nephropathy (DN), and end-stage renal disease. The growing epidemic of type 2 diabetes led to increased incidence of DN. DN is characterized by proteinuria. Objective The aim of the study was to estimate the prevalence of diabetic kidney disease in patients with type 2 diabetes mellitus. Patients an methods This study included 151 patients with type 2 diabetes mellitus. After fulfilling the inclusion and exclusion criteria, all patients were submitted to these investigations: complete blood count, fasting blood glucose, and glycosylated hemoglobin, blood urea, serum creatinine, serum uric acid, calculation of estimated glomerular filtration rate using modification of diet in renal disease equation, lipid profile, serum albumin, urine analysis, and urinary albumin creatinine ratio. Results Of the patients, 60.3% have normoalbuminuria, 31.8% have microalbuminuria, and 7.9% have macroalbuminuria. Regarding glomerular filtration rate grades, 25.8% of the patients are of G1, 31.8% G2, 16.6% G3a, 16.6% G3b, 6.6% G4, and 2.6% are of G5. There is a significant increase in grading in patients with macroalbuminuria; also, most normoalbuminuric patients are G1 and G2. Of the studied patients, 53.6% are at low risk of chronic kidney disease progression, 9.9% are at moderate risk, and 36.4% are at high risk. Conclusion The prevalence of DN is increasing, partly due to the growing epidemic of type 2 diabetes so we have to detect it as early as possible to apply the proper measures to prevent or delay its progression.
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Salivary α2-macroglobulin as a marker for glycemic control in patients with type 2 diabetes mellitus p. 155
Ayman Abd-Elrahman Mohamed Nsr-Allah, Saad El-Osh, Azza M Ahmed, Sara Hazem
Introduction Panic from needle and the cost can discourage some diabetic patients from monitoring their blood glucose levels in a regular manner, so there is a critical need to find a new cost-effective, painless, and sensitive glucose-detection method. Many studies have found that α2-macroglobulin (A2MG) concentrations are increased in the blood of both type 1 and type 2 diabetic patients. Aim The aim of the article is to study the salivary A2MG value as a marker for glycemic control in patients with type 2 diabetes mellitus (DM). Patients and methods A total of 60 patients were included and divided into three groups. Group 1 included patients with type 2 DM with glycosylated hemoglobin (HbA1c) levels more than or equal to 7% (inadequate glycemic control). Group 2 included patients with type 2 DM with HbA1c levels less than 7% (adequate glycemic control). Group 3 included healthy persons (control group). All patients were subjected to the following: thorough history taking, full physical examination, and laboratory investigations, including fasting blood glucose, cholesterol, triglycerides, HbA1c, and salivary A2MG. Results There were statistical significant relations between salivary A2MG and both BMI and duration of diabetes (P<0.05) in type 2 uncontrolled diabetes group but not in controlled group (P>0.05). There were statistically significant positive correlations between levels of salivary A2MG and HbA1c, cholesterol, triglycerides, fasting blood sugar, duration of DM, BMI, and age. The best cutoff value of salivary A2MG as a predictor of bad glycemic control, in relation to HbA1c, was more than or equal to 645 ng/ml, with area under the receiver operating characteristic curve of 0.92, sensitivity of 91.7%, specificity of 90%, and P value of less than 0.001. Conclusion and recommendation With the advantages of rapid, accessible, sensitive, cost-effective, and noninvasive method, salivary A2MG is a promising biological marker for glycemic control in patients with type 2 DM.
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The relationship between vitamin D level and thyroid antibodies in primary hypothyroidism p. 164
Salwa S Hosny, Maram M.M Aboromia, Nesma A Ibrahim, Doaa K Abd El Halim
Background Vitamin D deficiency is a global health problem. Its deficiency has been reported to be associated with different autoimmune diseases. The aim of this study was to evaluate the relationship between vitamin D level and thyroid antibodies in primary hypothyroidism. Patients and methods A total number of 90 individuals were enrolled in this study. They were divided into the following groups: group I included 60 naïve patients with hypothyroidism representing the case group, and this group was further subdivided into 30 patients with autoimmune thyroid disease (AITD) and 30 patients without autoimmune thyroid disease. Group ІІ included 30 apparently healthy participants matched for age and sex representing a control group. All participants underwent a detailed clinical examination and laboratory tests including, 25 (OH) vitamin D, thyroid function tests (thyroid-stimulating hormone, free triiodothyronine, and free thyroxine), and thyroid autoantibodies assessment, including anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies. Results Serum levels of 25 (OH) vitamin D recorded a highly significant difference between the studied groups (13.08±3.58 ng/ml in group I vs. 20.67±13.33 ng/ml in group II; P<0.01). Moreover, there was a highly significant difference between patients with AITD and patients without AITD (12.6±5.5 ng/ml vs. 14.5±7.3 ng/ml, respectively; P<0.01), and vitamin D deficiency was more frequent in patients with AITD (43.3%), rather than 23.3% in patients without AITD. There was a significant negative correlation between serum 25 (OH) vitamin D and thyroid-stimulating hormone, anti-thyroid peroxidase antibodies, and anti-thyroglobulin (r=−0.459, −0.582, and −0.324, respectively; P<0.05), whereas a significant positive correlation between serum 25 (OH) vitamin D and both of free triiodothyronine and free thyroxine (r=0.368 and 0.598, respectively; P<0.05). Conclusion Vitamin D deficiency is associated with AITD, and further studies are needed to determine its role in management of primary hypothyroidism.
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Risk factors of hematological malignancies in Upper Egypt: a case–control study p. 171
Safinaz Hussein, Doaa Mohamed, Rania Hafez
Background The definite etiologies of hematological malignancies (HMs) are still unknown. Objective The aim of our study was to identify the distribution of HMs and its subtypes as well as to determine their risk factors in Assiut Governorate, Upper Egypt. Patients and methods This case–control study included 1137 patients diagnosed with different HMs (leukemia, lymphoma, myelodysplastic syndromes, and multiple myeloma) and normal healthy controls from January 2014 to December 2017. Data were collected using interviewed administered questionnaire, and clinical and biochemical assessment. Logistic regression analysis was conducted to identify the predictors of HMs and their subtypes. Results Leukemia was the most common presented HM (75%), nearly half of leukemic cases were acute myeloid leukemia, while non-Hodgkin’s represented the majority of patients with lymphoma. Increasing age and diabetes mellitus were significantly associated with all HMs. Except for multiple myeloma, hepatitis C virus and obesity had significantly higher odds ratio for HMs and their subtypes. Exposure to agricultural chemicals was a risk factor for lymphoma and myelodysplastic syndromes while exposure to electromagnetic field was a significant risk factor for leukemia. Conclusion and recommendations This is the first study evaluating the different risk factors and distribution of HMs in Upper Egypt. Studies with a more detailed evaluation of the role of the possible risk factors in the occurrence of blood cancers in Egypt are recommended.
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Pretransplant assessment of cyclosporine level as a predictor of cyclosporine dose requirements after kidney transplantation p. 178
Sahier O El-Khashab, Amin R Soliman, Rabab M Ahmed, Samar Amin
Introduction and aims Pretransplant administration of cyclosporine (CsA) may reduce post-transplant maintenance dose and consequently CsA inhibitor nephrotoxicity and helps in achieving the desired target C2 levels earlier. The optimum dose or timing of administration of CsA induction dose is still debatable. Patients and methods We compared three different protocols for pretransplant administration of CsA aiming to reach a target C2 therapeutic level of greater than 800 ng/ml on the third day post-transplant. Sixty kidney transplant recipients from Cairo University hospitals were divided into: group 1 (n=20) who received a single CsA induction dose of 2 mg/kg 12 h pretransplant; group 2 (n=20) who received four CsA consecutive doses of 4 mg/kg 48 h pre-transplant; and group 3 (n=20) who received four CsA consecutive doses of 2 mg/kg 48 h pretransplant. Results The desired therapeutic level in the earlier post-transplantation period was achieved in 65% in group 1, 100% in groups 2 and 3). In group 2 a lower dose was needed to maintain C2 within the therapeutic range during the first year post-transplantation (P<0.01). Furthermore, a lower number of cases were complicated by CsA nephrotoxicity in group 2 in comparison to groups 1 and 3 (25, 0, 5% in group 1, 2, 3, respectively, P<0.039). A higher longer dose of CsA pretransplant associated with early withdrawal of CsA had a better effect on graft function than lower or shorter induction doses with late withdrawal as evidenced by lower serum creatinine levels all through the follow-up period in group 2 compared with group 3. Conclusion Forty-eight-hour pretransplant induction with CsA at a dose of 4 mg/kg with early dose reduction post-transplant was associated with lower CsA maintenance and a better 1-year graft function.
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Cystatin and glomerular filtration rate equations in old renal transplant donors p. 185
Ahmed Y Ali, Sahier O Elkhashab
Introduction Early detection of renal dysfunction in live kidney donors is important and needs easy reliable tools. The aim of the study is to evaluate the cystatin level and cystatin-based equation in assessment of renal function in old healthy kidney donors. Participants and methods A total of 27 living kidney donors were selected in the study, where serum creatinine and cystatin C were measured. Measured glomerular filtration rate (GFR) was done by DTPA renal scintigraphy, and it was estimated by the following equations: Cockroft–Gault, Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration-based creatinine, cystatin, and creatinine–cystatin formulae. Results A total of 27 kidney donors comprised 12 (44.4%) males and 15 (55.6%) females. The mean±SD age was 61±0.14 years, and mean±SD age at the time of donation was 56.9±1.7 years. The mean of cystatin level was 1.28±0.44. Serum cystatin was negatively correlated with measured filtration rate by renal scintigraphy and estimating GFR by cystatin and creatinine–cystatin formulae. The performance of Cockroft–Gault equation was better, with the highest sensitivity (70%). Serum cystatin and cystatin-based equation had higher specificity (70%) at criterion of 1.4 and 48, respectively. Area under the curve was 0.204 and 0.839, respectively, and significance level was 0.002 and 0.009, respectively. Conclusion Serum cystatin and cystatin-based formulae could outperform as surrogate tools to monitor the renal function and estimating GFR in healthy older kidney donors. Chronic Kidney Disease Epidemiology Collaboration-based cystatin has better specificity, whereas Cockroft–Gault equation has better sensitivity with the best accuracy.
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Electrocardiographic and echocardiographic changes in nonalcoholic fatty liver disease p. 191
Ahmed S Elsawaby, Rawia A Al-Fiky, Azza E Mohamed, Hossam El Din A Mahmoud, Shereen A Saleh, Haitham G Mohammed, Iman F Montasser, Mohammed H Abdelbary
Context Interactions between the heart and the liver have been described. The presence and severity of nonalcoholic fatty liver disease (NAFLD) was found to be associated with increased QTc interval and subclinical cardiac abnormalities. Aim The aim of this study was to evaluate the ECG and echocardiographic changes in patients with NAFLD and their correlation with disease severity. Patients and methods This study was conducted in Ain Shams University, Ain Shams Specialized, and Helwan University Hospitals in the period from May 2015 till May 2018. It was conducted on 50 patients with NAFLD and 50 controls. Clinical, laboratory, and ultrasonographic examinations were done for all included patients together with liver biopsies. ECG and echocardiography were also performed. Independent Student’s t-test, χ2-test, Fisher’s exact test, and Pearson’s correlation coefficient were used. Data were presented as mean±SD and number and percentage. Results Longer corrected QT was found in the NAFLD group in comparison with controls (406.6±26.8 and 380.0±24.5 ms, respectively). Significant correlation between QTc and liver size, grade of steatosis, and NAFLD activity score was found. Overall, 16 and 8% of patients with NAFLD had diastolic and valvular dysfunctions, respectively. Conclusion NAFLD is associated with significant QTc prolongation and structural heart changes, with significant correlation between QTc and disease severity.
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Assessment of the role of interleukin 17A and interleukin 17F in chronic hepatitis C virus infection in Egyptian patients p. 199
Ahmed F Gomaa, Mohammed O Wahba, Raghda Abd El Lateif Hafez, Omar Mohamed Eldaly, Shahenda Gamal Badran
Background/purpose of the study Chronic hepatitis C virus (HCV) infection is considered one of the major health problems. About 170 million patients were infected with HCV worldwide. Till few years, Egypt was considered the highest HCV prevalent country worldwide, with predominant genotype number 4. The host immunity plays a major role in HCV infection with evolving data confirming the role of T-helper 17 cells in the formation of chronic HCV infection. The aim of our work was to determine the role of interleukins 17A (IL17A), 17F (IL17F) in the formation of chronic hepatitis C infection. Patients and methods We classify the patients into two groups: the first group included 51 chronic HCV patients who did not take antiviral therapy (the study group) and the second group included 51 healthy blood donors (as a control group). The levels of IL17A and IL17F in the serum of both groups were measured using the sandwich enzyme-linked immunosorbent assay method. Results The serum values of IL17A were higher in patients with chronic HCV than the other group with the mean values being 52.9±32.6 pg/ml in the patient group and 17.1±10.4 pg/ml in the control group. IL17F was slightly higher in the HCV patient group than the control group, but it was statistically insignificant. Moreover, there were significant positive correlations between IL17A and alanine aminotransferase, viral load, and degree of liver fibrosis. Conclusion Patients with chronic HCV infections had a higher serum level of IL17A than the normal persons and it is positively correlated with alanine aminotransferase, viral load, and degree of liver fibrosis. This suggests its pivotal role in the formation of chronic HCV infection; so, it can be used as a new marker for disease progression due to its positive correlation with the severity of liver injury.
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Pretransplantation α-fetoprotein level as a predictor of hepatocellular carcinoma recurrence after adult living donor liver transplantation within milan criteria in egyptian patients p. 203
Magdy Galal, Mohamed Bahaa, Wesam A Ibrahim, Ahmed I Elshafie, Christine R Sedrak
Background and aim of the work Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third most common cause of mortality in patients with cancer. HCC represents one of cirrhosis complications. The aim of this study was to assess pretransplantation α-fetoprotein (AFP) level as a predictor for HCC recurrence after living donor liver transplantation (LDLT). Patients and methods This is a cross-sectional retrospective study for patients with HCC who underwent LDLT and within Milan criteria. Preoperative assessment was performed to assess etiology, operability, and AFP. Locoregional therapy was performed preoperatively as a bridge therapy or for downstaging in patients beyond the Milan criteria. Postoperative abdominal ultrasound and AFP measurement have been performed for HCC recurrence surveillance, as routine investigations. If there is a suspicious lesion of HCC recurrence, triphasic computed tomographic scan is performed and biopsy may be performed. Results Data of 75 patients with HCC who underwent LDLT were analyzed retrospectively. Seventy-three patients were infected with hepatitis C virus; two of them were previously infected with hepatitis B virus, one patient with hepatitis B virus infection, and one patient had hepatitis C virus/hepatitis B virus coinfection. AFP may predict HCC recurrence after LDLT (area under the curve=0.806) at cutoff value of more than 66 ng/ml, with 60% sensitivity, 94.3% specificity, 42.9% positive predictive value, and 97.1% negative predictive value. Conclusion Preoperative serum AFP level may predict post-transplant HCC recurrence. It may be used in combination with other factors to create a prognostic model that may predict HCC recurrence after liver transplantation.
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Serum and ascitic procalcitonin as a marker for early diagnosis of spontaneous bacterial peritonitis p. 208
Elsayed I Elshayeb, Mohamed H Badr, Eman M. Abdu Elgayed, Amira S Nor El-dean
Background and aim of the work Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with decompensated cirrhosis. SBP is an inflammation of the peritoneum by micro-organisms such as gram-negative bacilli. Early diagnosis of SBP is essential which may be a challenge for clinicians owing to lack of symptoms in early stage of SBP. The aim of this study is to evaluate procalcitonin (PCT) level in the serum and ascitic fluid of patients with cirrhosis for early diagnosis of SBP. Patients and methods This study was carried out on 45 patients with decompensated liver cirrhosis. They were classified into two groups: group 1 included 15 patients free of SBP and group 2 with SBP based on ascetic polymprphnuclear leucocytes (PNLs) more than 250/3 mm and ascitic fluid culture. Evaluation of C-reactive protein, ascetic fluid polymorphs count, and serum and ascetic PCT levels was done for all patients. Results No significant difference between SBP group and non-SBP group regarding ascetic PCT level, with P value more than 0.05. Serum PCT in patients with SBP shows high statistically significant difference, with P value less than 0.005, in comparison with patients without SBP. Conclusion Serum PCT is a good predictor marker for early diagnosis of SBP in patients with decompensated cirrhosis.
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Serum microRNA 143 as a potential biomarker for the diagnosis of hepatitis C virus-related hepatocellular carcinoma p. 214
Ahmed M El-Gohary, Ahmed E Zeid, Mohamed E Ibrahim, Fatma I Dewedar, Essam A Elzoheiry
Background Hepatocellular carcinoma (HCC) is the fifth most frequently diagnosed cancer worldwide. Early recognition of the onset of HCC would help to select more effective therapies for patients leading to a better prognosis and life span. So, the development of effective markers for the diagnosis of HCC could have an impact on HCC-related cancer mortality. MicroRNAs (miRNAs) are reported as a group of small noncoding RNAs that can function as endogenous RNA interference to regulate the expression of targeted genes. Aim To study serum miR-143 expression level in patients with hepatitis C virus (HCV)-related HCC. Patients and methods The present study was conducted on 60 participants classified into group A: 30 patients with HCV-related cirrhosis with HCC; group B: 15 patients with HCV-related cirrhosis without HCC; and group C: healthy participants as control. Expression of miR-143 in the serum of all participants was obtained in all groups. Total serum RNA was extracted with small RNA enrichment followed by reverse transcription real-time PCR. Expression of miR-143 in the serum of all participants was obtained using the comparative cycle threshold method (2–ΔΔCT) after normalization for the expression of Syn-cel-miR-39 mi script miRNA mimic as control. MiR-143 expression levels were then compared in different groups. Results The mean serum miR-143 levels were significantly higher in cirrhotic patients without and with HCC than in healthy participants (1.69±0.64, 13.0±6.23 vs. 0.56±0.29, P˂0.001, respectively) and in patients with HCC than in patients without HCC (P<0.001). The mean serum miR-143 levels were significantly higher in cirrhotic patients with HCC Barcelona Clinic Liver Cancer stage D than stage B (19.91±2.40, 13.41±1.80, P˂0.001, respectively) and in stage B compared with stage A (13.41±1.80, 5.68±1.86, P<0.001, respectively). Conclusion The significantly higher serum level of miR-143 in cirrhotic patients with HCC compared with those without and to normal participants may suggest its role in hepatocarcinogenesis and may have a value as a potential biomarker for early diagnosis of HCV- related HCC.
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Predictors of adequate percutaneous liver biopsy specimens: a single-center experience p. 222
Shahad M Alharbi, Asma D Zaidan, Ahmed A Aljuffri, Ghassan A Sukkar, Hatem Q Almaghrabi
Background Percutaneous liver biopsy is one of the widely accepted procedures to find any disorder, infection, and disease. Understanding the correlation between biopsy factors and adequacy rate will improvize efficacy and safety of biopsy. Objectives This study was carried out to find the effect of needle size on the adequacy rate of biopsy and also to establish the association of factors such as BMI, cumulative length, and the number of cores to adequacy rate of biopsy. Materials and methods This retrospective review study was carried out at King Abdul-Aziz Medical City, MNGHA, Jeddah, Saudi Arabia. The data were acquired on adult patients who underwent percutaneous liver biopsy for 2010–2016 time periods. The data were analyzed by using the statistical package for social sciences, version 23. Results No significant difference was observed in the adequacy rate of biopsy among samples of different needles (P=0.998). Similarly, BMI and guidance did not significantly (P=0.860 and 0.873) affect the adequacy rate. However, the number of cores (P<0.001) and cumulative length (P<0.001) had a significant effect on adequacy rate. Finally, only cumulative length (2.4 cm) was significantly correlated (P<0.05) to the adequacy rate of Percutaneous liver biopsy (PLB). Conclusion The adequacy rate significantly depends on cumulative length and the number of cores. However, further studies are required to establish a conclusive relationship between factors and adequacy rate.
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Bone marrow findings in rheumatoid arthritis patients with peripheral cytopenias p. 226
Mohamed A Abd El Hafez, Mohamed Helwa, Zeinab A.A Kasemy
Objective The aim was to study bone marrow (BM) cellularity, morphological characteristics, and types of cellular infiltrates in rheumatoid arthritis (RA) patients associated with peripheral cytopenias. Background RA is a systemic, autoimmune disease leading to joint destruction. BM is an important compartment in RA, where there are autoreactive lymphocytes, abnormal production of cytokines, and abnormal BM microenvironment, which may affect the integrity of the BM and accordingly may require specific modalities in treatment. Patients and methods In the current study, we examined 60 RA patients with cytopenias (defined according to WHO as hemoglobin level below 12 g/dl (woman), 13 g/dl (man), platelet count below 150×109/l, absolute neutrophil count below 1.8×109/l, and lymphocytes below 1.0×109/l. The diagnosis of RA was made according to the American College of Rheumatology (2010) criteria. All patients were subjected to thorough history taking, physical examination, imaging studies including abdominal ultrasound, and chest radiography and laboratory investigations including routine investigations, blood film, antinuclear antibody, antidouble stranded DNA antibody, rheumatoid factor, anticyclic citrullinated peptide (anti-CCP) antibody, and BM aspiration and biopsy. Flow cytometry immunophenotyping was performed to detect lymphocytic infiltration in the BM and its subtypes. Results The patients were predominantly women (91.7%); 40 (66.6%) patients had normocellular BM, 16 (26.6%) patients had hypercellular and four (6.6%) patients had hypocellular BM. Dysmyelopoiesis was present in five (8.3%) patients; dyserythropoietic and megaloblastoid changes were present in 26 (43.3%) patients whereas dysmegakaryopoiesis was present in six (10%) patients. BM eosinophils mean±SD was 2.95±1.51%. BM plasma cell mean±SD was 4.0±2.35. BM lymphocytes mean±SD was 15.65±6.75% and was predominantly T-lymphocytes (mean±SD: 61.63±8.69%). BM-activated (CD25+) T-lymphocytes mean±SD was 23.8±11.5. Higher BM lymphocytes, T-cells, and plasma cell percentages were statistically associated with increased frequencies of positive anti-CCP, neutropenia, thrombocytopenia, and arthritis and were positively correlated to inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, and ferritin).The percentage of activated (CD25+) BM T-lymphocytes was higher in RA patients with either positive C-reactive protein, positive anti-CCP, elevated ferritin, or pancytopenia. There was no significant relation between lymphocytic infiltration (either B-lymphocyte or T-lymphocyte) and type of BM cellularity. Conclusion Lymphocytic infiltration, especially T-lymphocytes is closely related to the activity markers in RA and to the type and degree of cytopenia in RA patients.
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Effect of interleukin-1β gene polymorphisms on clinicopathological features and disease activity of systemic lupus erythematosus p. 235
Nearmeen M Rashad, Manar H Soliman, Amal S El-Shal, Dina Said, Ghada M Samir
Background Systemic lupus erythematosus (SLE) is responsible for severe disability and represents a major cause of chronic illness. Interleukin (IL)1β is a proinflammatory cytokine. We aimed to explore the possible associations of IL1β-511C/T (rs16944) and IL1β +3954C/T (rs1143634) gene polymorphisms with SLE, and to detect whether these polymorphisms are associated with disease activity of SLE. Moreover, we aimed to clarify the effect of these polymorphisms on clinical and biochemical parameters of SLE. Patients and methods Polymorphisms of IL1β-511 and IL1β +3954 genes were assessed in a case-control study comprising 110 patients with SLE and 90 controls. Disease activities were assessed by systemic lupus erythematosus disease activity index (SLEDAI). Serum IL-1β was estimated using an enzyme-linked immune sorbent assay. Genetic variants were genotyped using PCR-restriction fragment length polymorphism. Results Our results revealed higher values of IL1β in patients with SLE. In addition, there was a significant positive correlation between IL-1β serum level and SLEDAI score. The CT genotype distribution was significantly higher in patients with SLE than controls. Regarding IL1β +3954 gene polymorphisms, our results showed nonsignificant difference between control and SLE groups. In an attempt to estimate the diagnostic power of serum IL1β serum in differentiating patients with SLE from the control group, we found that the sensitivity was 94.5%, and the specificity was 99%. In conclusion, the CT genotype distribution of IL1β-511 was significantly higher in patients with SLE than controls. However, there was a nonsignificant difference regarding IL1β +3954 gene mutation.
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Pulmonary function test in upper airway obstruction: a simple yet effective diagnostic test p. 243
Amit Panjwani, Jaini Lodha
Upper airway obstruction (UAO) is a dangerous condition that is associated with significant mortality. It is easily diagnosed when its presentation is acute, but subacute or chronic presentation may pose a diagnostic dilemma resulting in disastrous consequences. Clinical evaluation may provide subtle clues towards its presence, whereas pulmonary function test can provide useful information to confirm the presence and site of UAO. Relevant radiological and endoscopic investigation may then be carried out to identify the exact etiology and institute appropriate therapy. We present a case of chronic UAO that was detected with the help of pulmonary function test and confirmed with computed tomography and endoscopy. The etiology was found to be related to fibrosis of the larynx resulting in the immobility of the vocal cords secondary to radiotherapy given to the patient 7 years ago. This is an unusual presentation, as most of the radiotherapy-related fibrosis in the head and neck region present within a few months of the exposure to radiation.
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