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Table of Contents
October-December 2016
Volume 28 | Issue 4
Page Nos. -
Online since Wednesday, March 29, 2017
Accessed 21,920 times.
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REVIEW ARTICLE
Sarcopenia and the syndrome of frailty
p. 133
Ajay Kumar Gupta, Siddhartha Mishra
DOI
:10.4103/1110-7782.203297
Sarcopenia is the process of loss of body mass, specifically the musculoskeletal tissue, with age, which ultimately leads to a syndrome of clinical entity poorly defined as frailty. It is probably as old as humanity itself. Functionally, frailty is described as a syndrome characterized by a progressive decrease in the body's reserve and declining resistance to stressors, possibly because of declining capacity of multiple physiologic systems resulting in higher vulnerability morbidity and mortality. Ayurveda also mentions morbidity occurring with advancing age and various options for its management. Elixirs are recommended in Ayurveda, popularly called ‘rasayana’, for recovery from the symptoms of frailty. Worldwide, because of the wide demographic profile, the process of ageing exerts its effects on geriatric populations at different ages. Europeans were the first to paraphrase the word frailty for the ageing process. With better medical care and nutrition, a substantial subset of populations survives longer than 60 years or longer worldwide. The most relevant aspect of the recognition of syndrome of frailty is that the process is, to some extent, reversible, provided that adequate attention is paid and a timely intervention is performed for the needy subset of population, which is likely to improve the quality of life markedly, besides resulting in an increased life span.
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ORIGINAL ARTICLES
Serum angiopoietin-2 as a noninvasive diagnostic marker of stages of liver fibrosis in chronic hepatitis C patients
p. 140
Mohamed M Makhlouf, Mahmoud A Osman, Shereen A.B. Saleh, Wael A Yousry, Mohamed L Soliman, Wahid H Doss, Fayrouz S Wahba
DOI
:10.4103/1110-7782.203293
Background
The process of fibrogenesis is associated with the development of disease-specific markers. The management of chronic hepatitis C (CHC) depends on the staging of liver fibrosis. Use of noninvasive methods is preferable in diagnosis and follow-up.
Objective
The aim of this study is to evaluate serum angiopoietin-2 (Ang-2) as a noninvasive marker in the diagnosis of different stages of liver fibrosis in CHC patients.
Materials and methods
A total of 90 individuals were included. They were divided into a patient group (75 patients) and a control group (15 normal individuals). Serum Ang-2 was measured using enzyme-linked immunosorbent assay. Pretreatment liver biopsy was performed for the patients. The METAVIR score was used in the staging of liver fibrosis. A comparison of Ang-2 was performed between patients and controls, and between different stages of liver fibrosis. A receiver operating characteristic curve analysis was carried out to determine the best cutoff values of Ang-2 in the differentiation of different stages of fibrosis.
Results
Ang-2 serum levels were significantly higher in advanced stages of liver fibrosis. The cutoff points 869.3, 2226, and 7205 pg/ml were the best for differentiating fibrosis stages >F1; >F2; and >F3, respectively. Ang-2, international normalized ratio, α-fetoprotein, and albumin were found to be independent predictors of liver fibrosis using univariate analysis.
Conclusion
Ang-2 correlated significantly with liver fibrosis stage. It can aid noninvasive differentiation between different stages of liver fibrosis in patients with CHC.
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Diabetogenic effect of hepatitis C virus and insulin resistance among chronic hepatitis C patients
p. 149
Mohamed Sayed Hassan, Yousra Hamed Mourad, Mohammad Ahmad Elghobary
DOI
:10.4103/1110-7782.203294
Context
Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. In addition to established liver injury, type 2 diabetes mellitus is one of the most important extrahepatic metabolic disorders that are attributed to HCV infection.
Aim
The aim of this study was to investigate the impact of HCV infection in insulin resistance (IR).
Patients and methods
Our study included 100 patients with HCV who were divided into two groups according to the presence and absence of diabetes and 25 diabetic patients who served as a control group. They were subjected to full medical history and examination and laboratory investigations including high-sensitivity C-reactive protein (CRP), serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), fasting insulin, and fasting glucose.
Results
Our study showed increased IR among diabetic HCV-infected patients (group I) with a mean level of homeostasis model assessment of IR of 3.02, 1.457, and 1.064 in groups I, II, and III, respectively. There was also an increased level of proinflammatory cytokines (CRP, TNF-α, and IL-6) in this group, with mean levels of high-sensitivity CRP of 9.448, 7.7062, and 5.8229 mg/dl in groups I, II, and III, respectively. The mean level of IL-6 in group I was 215.63 pg/ml, in group II it was 167.62 pg/ml, and in group III it was 173.72 pg/ml. The mean level of TNF-α was 626.12, 618, and 422.76 pg/ml in groups I, II, and III, respectively, suggesting the role of proinflammatory cytokines in the pathogenesis of IR in chronic HCV.
Conclusion
HCV infection is associated with an increased level of proinflammatory cytokines that play a crucial role in the pathogenesis of IR in chronic HCV.
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Assessment of severity of bronchial asthma by studying new markers: transforming growth factor-β1 and chitinase-3-like-1
p. 155
Abdelwahab M Lotfy, Farag Khalil, Hendawy Zidan, Mahmoud Hadad, Mahmoud A Elsayed, Mohammad M Al-Sayyad, Nagwa A.E. Mohamed, Essam Abouelyazed
DOI
:10.4103/1110-7782.203295
Aim
The aim of this work was to look for non-invasive biomarkers that may enable us to assess asthma severity, as a surrogate for the invasive bronchial mucosa biopsy, by studying TGF-β1 and YKL-40.
Objectives
TGF-β1 is used as biomarkers in the pathogenesis, prediction and follow up of asthma severity. YKL-40 has a role in airway inflammation; this relation suggests that YKL-40 and TGF-β1 can be used as biomarkers in the pathogenesis, prediction and follow-up of asthma severity.
Background
Defective extracellular matrix (ECM) turnover characterizes airway remodeling. Transforming Growth Factor Beta-1 (TGF-β1) stimulate airway remodeling through activation of gene transcription via binding to specific subfamilies of cell trans-membrane receptors.
Methods
The work was done on a 60 subject aged between 20–40 years with equal sex. Classified into three groups; 20 patients with mild asthma, 20 patients with severe asthma and 20 normal subjects were taken as controls. For all subjects chest X-ray, pulmonary functions tests, allergy skin prick test, eosinophilic count, total IgE, YKL-40 and TGF-β1 in serum were performed.
Results
The results showed that serum TGF-β1 and serum YKL-40 between the three groups were highly significantly different (
P
<0.01) between the three groups in asthmatic patients compared with control group.
Conclusions
These variations were correlated positively with the severity of the disease indicating that their increased serum levels may be a biological characteristic of the disease exacerbation with a sentinel role in asthma.
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Study of graft survival rates of renal transplants in Cairo University Hospitals
p. 162
Mohamed G Saadi, Sahier O El-Khashab, Rabab M.A. Mahmoud
DOI
:10.4103/1110-7782.203296
Background
Many factors and events can complicate the outcome of renal transplantation and can eventually lead to progressive renal dysfunction and graft failure. We aimed in this study to identify the risk factors for the entire course after transplantation, and then to analyze the relative impact of these risk factors on short-term and long-term graft survival in our patients.
Patients and methods
This analytical retrospective study was conducted at the King Fahd Unit, the Faculty of Medicine, Cairo University, on 104 patients for the study of 1-year graft survival, though 43 patients were followed-up for 3 years for the study of 3-year graft survival. Serum creatinine was used to evaluate the renal function; graft dysfunction was defined as serum creatinine more than 2.5 mg/dl. Survival analysis was carried out by using the Kaplan–Meier survival curve estimation. To predict the value of graft survival after 5 years, regression analysis was used.
Results
In our study, the overall graft survival rates were 88.6 and 76.7% at 1 and 3 years, respectively. The corresponding overall patient survival rates were 89.4 and 79.1% at the first and third years after transplant. Our study showed that among the long list of predictors for graft outcome variables, factors that had a significant impact on outcome by Kaplan–Meier analysis included donor’s age, primary immunosuppression, and serum creatinine 1 month after transplant. There was a greater rate of graft dysfunction with the presence of hypertension and hepatitis C virus but these results did not reach statistically significant values.
Conclusion
Old donor’s age, primary immunosuppression, and serum creatinine 1 month after transplant are the most effective factors on graft survival in kidney transplantation. Whatever the cause, graft dysfunction should be treated early and aggressively.
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CASE REPORTS
Spontaneous hemothorax: primary pleural epithelioid angiosarcoma
p. 170
Amit Panjwani, Iqbal Singh, Nagendra Parvataneni, Phulkumari Talukdar
DOI
:10.4103/1110-7782.203298
Spontaneous hemothorax is a rare condition seen in coagulation and vascular disorders. Uncommonly, malignant neoplasms may cause spontaneous hemothorax. Primary pleural epithelioid angiosarcomas (excluding the cases with pleuropulmonary or chest wall involvement) are extremely rare pleural tumors, which may be mistaken for mesothelioma or adenocarcinoma, and only 19 cases (one of them from India) have been reported in the English literature, to date. It commonly occurs in older men, has a nonspecific clinicoradiological presentation, and carries a poor prognosis with no survivors beyond a year of establishing the diagnosis. We report a case of primary pleural epithelioid angiosarcoma presenting as a life-threatening spontaneous hemothorax. We also present a brief literature review on pleural angiosarcoma.
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Pleural effusion resembling a lung tumor: phantom tumor of the lung
p. 174
Soorih Shaikh, Sarwan Shaikh
DOI
:10.4103/1110-7782.203292
78-years- old female known case of Congestive Heart failure, with ejection fraction of 55% on recent echocardiograph, presented with complains of Shortness of breath, Cough and sputum without fever. She had stopped taking medications recently and examination showed patient in fluid overload. Conventional postero-anterior Chest radiograph revealed a mass like opacity in lower zone of the right lung while Lateral view radiograph showed cigar shaped opacity due to pleural effusion in oblique fissure of the right lung. Patient was given diuretics on the basis of clinical and radiographic findings and the rounded opacity disappeared on repeat radiograph. Thus the diagnosis of Phantom tumor of lung was made. It is therefore suggested to get a lateral chest radiograph and give a trial of diuretics in such cases before going for other investigations or surgical procedures.
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