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  Most popular articles (Since January 27, 2014)

 
 
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ORIGINAL ARTICLE
Primary bile reflux gastritis versus Helicobacter pylori gastritis: a comparative study
Enaase A.M.E Barakat, Neven F Abbas, Nashwa Y El-Kholi
January-March 2018, 30(1):23-27
DOI:10.4103/ejim.ejim_42_17  
Background Bile reflux gastritis (BRG) is a common disorder, with few data on its pathophysiology and clinical course, whereas Helicobacter pylori is the well-known, commonest cause of chronic gastritis. Aim The aim of this study was to compare between BRG and H. pylori-related gastritis, as regards demographic data, comorbid conditions, and pattern of upper gastrointestinal involvement. Patients and methods It included 130 patients with endoscopic features of gastritis, subdivided into three groups: group A with BRG (56 patients); group B with H. pylori gastritis (58 patients); group C with gastritis in the presence of both H. pylori and bile reflux (16 patients). Statistical analysis was made to compare between the three groups as regards demographic data, history, and examination findings including endoscopic findings. Results BRG is more common among younger age (21–30 years) and elderly patients (71–80 years), whereas H. pylori gastritis is more common in patients in the middle age group (31–60 years), the female/male ratio was 1.5 : 1 in patients with BRG, 1 : 1 in H. pylori gastritis. Nausea was the commonest symptom in patients with BRG (69.6%), whereas epigastric pain/discomfort was the commonest symptom (77.6%) in H. pylori gastritis. Diabetes was found to be more common in patients with H. pylori gastritis (29.3%) followed by BRG (26.8%), whereas obesity was more common in patients with BRG (76.8%) followed by H. pylori gastritis (65.5%). Endoscopy showed antral gastritis in cases with BRG (57.1%), pangastritis in H. pylori and mixed etiology gastritis (60.3 and 68.8%, respectively), reflux esophagitis in both BRG and H. pylori gastritis (41.1 and 44.8%, respectively), higher than mixed etiology gastritis (25%). Endoscopic Barrett’s mucosa was diagnosed in 10.7% of cases with BRG and 12.1% of cases with H. pylori gastritis. Duodenitis, duodenal erosions, or ulcerations were more common in cases with mixed etiology gastritis (62.5%), than in H. pylori gastritis (24.1%), followed by BRG (14.3%). Conclusion BRG is a common, underdiagnosed condition, with distinct clinical and endoscopic features from H. pylori gastritis.
  9,480 264 -
REVIEW ARTICLE
Acute aluminium phosphide poisoning, what is new?
Yatendra Singh, Subhash C Joshi, Vivekanand Satyawali, Abhisek Gupta
July-September 2014, 26(3):99-103
DOI:10.4103/1110-7782.145298  
Aluminium phosphide (AlP) is a cheap solid fumigant and a highly toxic pesticide that is commonly used for grain preservation. AlP has currently generated interest with increasing number of cases in the past four decades because of its increased use for agricultural and nonagricultural purposes, and also its easy availability in the markets has led to its increased misuse to commit suicide. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. The poison affects all systems, shock, cardiac arrhythmias with varied ECG changes and gastrointestinal features being the most prominent. Diagnosis is made on the basis of clinical suspicion, a positive silver nitrate paper test to phosphine, and gastric aspirate and viscera biochemistry. Treatment includes early gastric lavage with potassium permanganate or a combination of coconut oil and sodium bicarbonate, administration of charcoal and palliative care. Specific therapy includes intravenous magnesium sulphate and oral coconut oil. Unfortunately, the lack of a specific antidote results in very high mortality and the key to treatment lies in rapid decontamination and institution of resuscitative measures. This article aims to identify the salient features and mechanism of AlP poisoning along with its management strategies and prognostic variables.
  8,782 622 5
Food allergy ( the invisible hoe)
Fardous Soliman
March 2013, 25(1):1-9
DOI:10.7123/01.EJIM.0000426470.14786.32   
  7,551 470 -
The secret of neuroscience boom: Are there secret human experiments in Latin América?
David Salinas Flores
January-March 2016, 28(1):1-4
DOI:10.4103/1110-7782.182942  
About 6 years ago there sparked a phenomenon in science called the neuroscientific boom. Neurologists underpin this phenomenon to cost reduction techniques such as electroencephalograms and to improved noninvasive technology such as functional MRI. But the human brain, the most complex organ in the universe, has not yet been fully investigated with the existing noninvasive technologies. Thus, there is a suspicion that the real reason for this boom is a secret, forced, and illicit human experimentation in Latin America. Physicians should investigate, be alert, and report these potential unethical human experiments to prevent any further damage to the public health of the citizens of Latin societies.
  5,258 323 2
The management of constipation-related functional gastrointestinal disorder (constipation-predominant irritable bowel syndrome)
Amal F Radwan, Nagwa R Ahmed, Eman A Sultan
October-December 2015, 27(4):127-132
DOI:10.4103/1110-7782.174926  
The terminology constipation-related functional gastrointestinal disorders was applied to embrace two conditions - constipation-predominant irritable bowel syndrome (IBS-C) and chronic constipation - because of the similarity in the etiology between the two conditions. The cardinal symptoms of IBS-C are abdominal pain or discomfort associated with constipation. The current symptom-based Rome III criteria are used to confirm the diagnosis. Many patients with IBS-C initially treat their symptoms with lifestyle modifications and exclusion diets, together with treatment of symptoms such as constipation by using fiber supplements, over-the-counter laxatives, or probiotics. Less commonly, the patients may also undergo various forms of psychotherapy. Despite these therapeutic modalities, many IBS patients are disappointed with their symptomatic response. There are several drugs that are being proposed for its treatment in the future, one of which is linaclotide, a 14-amino acid synthetic peptide that improves stool frequency and consistency and intestinal transit. Four-week treatment with Bifidobacterium lactis showed superior results when compared with placebo in decreasing the abdominal distention and improving orocecal and colonic transit.
  2,043 3,536 -
Thyroxine mimetics
Randa F Salam
October-December 2013, 25(4):171-176
DOI:10.4103/1110-7782.124969  
Thyroid hormones influence heart rate, serum lipids, metabolic rate, body weight, and multiple aspects of lipid, carbohydrate, protein, and mineral metabolism. Although increased thyroid hormone levels can improve serum lipid profiles and reduce fat, these positive effects are counterbalanced by the harmful effects on the heart, muscle, and bone. Thus, attempts to use thyroid hormones for cholesterol-lowering and weight loss purposes have so far been limited. However, over the past decade, thyroid hormone analogs that are capable of uncoupling the beneficial effects from the deleterious effects have been developed. Such drugs could serve as powerful new tools to address two of the largest medical problems, namely atherosclerosis and obesity. Aggressive reduction in LDL-cholesterol by the use of statins is a cornerstone of preventive cardiovascular risk, but additional therapies to prevent atherosclerosis and its clinical sequelae are still needed. Thyromimetics selective for the liver or the thyroid hormone receptor isoform β1 constitute a novel approach to treat dyslipidemia. In preclinical studies, selective thyromimetics were clearly shown to reduce plasma cholesterol and protect from atherosclerosis through the upregulation of hepatic LDL receptor and promotion of the so-called reverse cholesterol transport. Notably, there is the first evidence from on-going clinical trials that selective thyromimetics may reduce plasma cholesterol in humans also. Most importantly, thyromimetics has a synergistic action when used in combination with 3-hydroxy-3-methylglutaryl CoA reductase inhibitors. Animal data have further suggested that thyromimetics might be useful in the treatment of obesity, hepatic steatosis, and atherosclerosis.
  2,117 3,301 -
Liver transplantation for nontransplant physicians
Amany AbdelMaqsod Sholkamy
October-December 2014, 26(4):139-144
DOI:10.4103/1110-7782.148105  
Many of the nontransplant physicians who manage hepatic patients (internists and hepatologists) keep asking about liver transplantation. The purpose of this article is to highlight important topics a nontransplant colleague may require in his practice. There are many topics in this respect; however, three most important topics need to be highlighted; those are; the time of referral to transplantation, the indications and contraindications and the metabolic issues regarding a transplanted patient. Still, there are no clear guidelines for the management of many of the metabolic issues regarding liver transplanted patients. And this why, collaborative efforts of transplant and nontransplant physicians are needed to conduct multicenter, long term randomized controlled trials and proper follow up programs.
  1,648 3,570 -
Sarcopenia and the syndrome of frailty
Ajay Kumar Gupta, Siddhartha Mishra
October-December 2016, 28(4):133-139
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.
  1,894 3,305 -
ORIGINAL ARTICLES
The impact of obesity on walking and physical performance
Manal K Youssef
April-June 2014, 26(2):40-44
DOI:10.4103/1110-7782.139519  
Background Obesity-induced limitations of the cardiopulmonary and the metabolic systems, resulting in exertional dyspnea, contribute to the limitations in the functional capacity frequently observed in obese individuals. In addition, the sedentary lifestyle often adopted by these individuals further compounds and contributes to impaired exercise tolerance. Aim of the study The current study was conducted to detect the effect of lifestyle modification in the form of weight reduction by diet and aerobic exercise on walking and physical performance. Patients and methods Twenty obese participants were included in this study. Their ages ranged from 25 to 43 years. All participants were evaluated before the first session of physical therapy program and at the end of the program after 2 months of exercise and a low-caloric diet of 25 kcal/kg actual weight/day through physical evaluation, which included anthropometric measurements, BMI, inspiratory capacity, and a physical performance test, which includes four tests (15-m rapid walking test, a timed up-and-go test, and stair climbing and stair descending tests). Results Analysis of data revealed significant improvement in the parameters assessed as follows: weight decreased from 81.3 ± 8.5 to 68.00 ± 4.50 kg (P ≤ 0.001); BMI decreased from 29.8 ± 2.0 to 24.1 ± 2.0 kg/m 2 (P ≤ 0.001); waist circumference decreased from 120.3 ± 14.4 to 112.3 ± 9.6 cm (P = 0.053); hip circumference decreased from 121.3 ± 6.1 to 112.6 ± 11.4 cm (P = 0.009); inspiratory capacity increased from 14.4 ± 2.7 to 21.0 ± 2.3 s (P ≤ 0.001); time of 15 m walk decreased from 21.2 ± 1.7 to 15.5 ± 2.1 s; timed up-and-go test decreased from 24.1 ± 2.8 to 15.3 ± 2.3 s; stair climbing time decreased from 45.3 ± 6.5 to 34.2 ± 2.6 s; stair descending time decreased from 36.2 ± 2.3 to 27.2 ± 2.1 s. Hence, the total physical performance increased from 31.9 ± 10.3 to 23.0 ± 8.5 s (P ≤ 0.001) and consequently improved the quality of life. Conclusion Lifestyle modification in the form of a low-caloric diet accompanied by exercise has a positive effect on physical performance and consequently on the quality of life.
  4,355 320 -
CME
MCQ Questions and answers

September 2013, 25(3):164-0
DOI:10.7123/01.EJIM.0000433329.92031.29   
  1,397 3,226 -
ORIGINAL ARTICLES
Diagnosis of spontaneous bacterial peritonitis
Naglaa A El-Gendy, Naglaa A Tawfeek, Rayyh A Saleh, Enas E Radwan, Eman E Ahmad, Rehab A Mohammed
April-June 2014, 26(2):53-59
DOI:10.4103/1110-7782.139525  
Background Spontaneous infection of ascites is a severe complication of ascites and must be actively searched for. Many studies have been carried out on inflammatory markers and their levels in serum and ascitic fluid such as complement 3 (C3), complement 4 (C4), high-sensitive C-reactive protein (CRP), and procalcitonin, and have identified their role in the diagnosis of spontaneous bacterial peritonitis (SBP). The aim of our study was to measure and compare the serum and ascitic fluid levels of procalcitonin, high-sensitive CRP, C3, and C4 in patients with SBP and patients without SBP. Patients and methods This case-control study was carried out on 10 patients with cirrhotic ascites who were admitted with SBP and 20 patients with cirrhotic ascites with no existing evidence of SBP. Serum and ascitic fluid levels of C3, C4, high-sensitive CRP, and procalcitonin were determined using the enzyme-linked immunosorbent assay method. Results The mean ± SD of the serum levels of C3, C4, high-sensitive CRP, and procalcitonin were 3.38 ± 2.12, 0.36 ± 0.25, 18.76 ± 6.37, and 136.79 ± 58.14, respectively, in group I, whereas their levels in group II were 2.04 ± 1.98, 0.36 ± 0.29, 16.80 ± 5.97, and 147.78 ± 58.65, respectively. The mean ± SD of their ascitic fluid levels were 0.21 ± 0.14, 1.84 ± 1.69, 1.96 ± 1.15, and 162.43 ± 82.51, whereas their levels in group II were 0.46 ± 1.01, 2.07 ± 1.93, 2.98 ± 5.90, and 180.51 ± 93.70, respectively. Surprisingly, all these results were statistically insignificant. However, an ascetic fluid polymorph nuclear leukocyte count higher than 200/mm 3 has sensitivity, specificity, positive predictive value, and negative predictive value of 100% in the diagnosis of SBP. Conclusion An ascitic polymorph nuclear leukocyte count higher than 200/ml was the accurate marker for the diagnosis of SBP.
  3,883 334 -
EDITORIALS
An assurance letter to the pilgrims ( novel coronavirus 2012)
Amal F Radwan
December 2012, 24(3):59-60
DOI:10.7123/01.EJIM.0000422599.24526.40   
  755 3,274 -
ORIGINAL ARTICLES
Liver ultrasound scanning in the detection of hepatic steatosis and fibrosis in NASH patients
Mona Hegazy, Abeer Mostafa
August 2012, 24(2):27-31
DOI:10.7123/01.EJIM.0000419544.37462.5f   
Background

Nonalcoholic fatty liver disease (NAFLD) has become the most prevalent cause of liver disease in western countries. The development of nonalcoholic steatohepatitis (NASH) and fibrosis identifies the risk group with an increased incidence of liver-related deaths.

Aim

The aim of the present study is to investigate how accurately liver ultrasound (US) can contribute toward the prediction of the severity of liver damage in NAFLD, and to determine whether it may be an easily available, inexpensive, noninterventional, widely used screening method.

Methods

Fifty-four obese patients with variable degrees of BMI were recruited in the present study. Assessment of full medical history, anthropometric measurements, biochemical studies, abdominal US, liver biopsy for histological examination, and determination of the NAFLD activity score (NAS) score were carried out on all patients to identify NASH patients . Liver steatosis was evaluated using liver US, and graded according to a semiquantitative scale from 1 to 4. Liver histological examination was carried out to identify patients with NASH, borderline NASH, or non-NASH according to the NAS score.

Results

According to the NAS score, patients were divided into non-NASH patients (eight patients), borderline NASH patients (24 patients), NASH patients (20 patients), and patients with NASH and fibrosis (two patients). Alanine aminotransferase and γ-glutamyl transpeptidase were significantly higher in NASH patients. Correlating the grading of hepatic steatosis by liver US and NAS score, grade 1 was found in 37.5% of patients with non-NASH, 33.3% of patients with borderline NASH, and only in 5% of patients with NASH, whereas grade 4 steatosis was found in 20% of NASH patients and 4.2% of patients with borderline NASH; none of the non-NASH patients were diagnosed with grade 4 hepatic steatosis. The sensitivity of liver US in detecting grades of steatosis in liver biopsy was 61% in grade 1, 25% in grade 2, and 75% in grade 3. There was a direct correlation between grading of steatosis in the histological examination and the presence of NASH, P less than 0.000.

Conclusion

Liver US is not only sensitive in the detection of hepatic steatosis, but also in the prediction of the presence of NASH; therefore, it can be used as a simple, noninvasive, low-cost method for the screening of NAFLD and for the early identification of patients in need of aggressive intervention.

  3,444 289 -
Some risk factors of gallstone formation after laparoscopic sleeve gastrectomy and the role of ezetimibe versus ursodeoxycholic acid in its prevention
Alaa Elgamal, Ahmad Tarek Fawzy
April-June 2014, 26(2):75-79
DOI:10.4103/1110-7782.139548  
Aims Obese patients are at increased risk for gallstones during rapid weight loss and after laparoscopic sleeve gastrectomy. The aims of this study were to evaluate the prophylactic effect of ursodeoxycholic acid and ezetimibe for prevention of gallstone formation after sleeve gastrectomy and to identify some risk factors. Settings and design This was a prospective randomized study conducted at Al Rashid Hospital, Kuwait. Patients and methods A total of 215 obese patients were included. Preoperative assessment was performed, including history, examination, obesity evaluation (body weight, BMI, waist circumference), full laboratory work, gastroscopy, and abdominal ultrasonography. After laparoscopic sleeve gastrectomy, patients were divided randomly into: group 1 (control), group 2 (ursodeoxycholic acid), and group 3 (ezetimibe). Patients were scheduled for 3-, 6-, and 12-month visits for assessment of % excess weight loss and abdominal ultrasonography. Results A significant reduction in gallstone formation was found in the ezetimibe group (5.5%) compared with the control group (17.6%). A statistically significant increase in % excess weight loss was observed in patients with gallstones (38.5%) versus patients without gallstones (28.2%). Percentage of gallstone formation during first 6 months postoperatively was double that during the next 6 months in both the control and treatment groups. Conclusion Risk of gallstone formation during the first 6 months after laparoscopic sleeve gastrectomy was double that during the second 6 months. Ezetimibe is effective in reducing relative risk by 70% and ursodeoxycholic acid by 50% versus control; hence, we recommend usage of one of these medications for 1 year postoperatively. Furthermore, we recommend more work on combining both medications together.
  3,069 320 1
The impact of large-volume paracentesis on renal haemodynamics in cirrhotic patients with ascites
Tary Abdel-Hamid Salman, Hassan EL-Sayed Zaghla, Khaled Mohammad Attallah, Omkolthoum Mohammad El-Haddad, Enas Mohammad Korayem, Ashraf Abbass Basuni, Hossam El-Din Mahmoud El-Ezzawy
October-December 2014, 26(4):170-175
DOI:10.4103/1110-7782.148164  
Background and aim Ascites in liver cirrhosis is associated with a poor prognosis and impairment of the quality of life and may be complicated by hepatorenal syndrome. Renal functions and haemodynamic changes after large-volume paracentesis (LVP) in cirrhotic patients with tense ascites were evaluated. Patients and methods A total of 50 cirrhotic patients with tense ascites were divided into two groups: group I 25 patients without renal impairment and group II 25 patients with renal impairment (type II hepatorenal syndrome). Results In groups I and II, the serum creatinine decreased significantly 24 h after LVP (P < 0.05 and 0.01, respectively). The glomerular filtration rate and the urine output increased significantly 24 h after LVP (P < 0.05, P < 0.01 and P < 0.01, P < 0.05, respectively, in groups I and II). The renal artery resistive index (RI) was significantly higher in group II compared with group I (P < 0.01). LVP caused a significant increase in the cardiac output, the stroke volume and the cardiac index (P < 0.01) and a significant decrease in the RI in both groups (P < 0.01). There was significant correlation between serum and ascetic fluid electrolyte levels in all patients. Conclusion LVP causes a significant reduction of heart rate and mean arterial pressure, serum creatinine, blood urea nitrogen and RI with a significant glomerular filtration rate increase, but had no effect on the plasma renin activity.
  3,108 227 -
Seminal parameters before and during combined antiviral (pegylated interferon α-2a and ribavirin) treatment in chronic hepatitis C virus patients in upper Egypt
Hussein M Ghanem, Nashaat N Ismaeel, Alaa F Haseeb, Waleed M Nabawy, Mohamed Rehan, Hala Shreen
July-September 2014, 26(3):104-109
DOI:10.4103/1110-7782.145302  
Background Some reports suggest that chronic hepatitis C virus (HCV) infection and its combined antiviral therapy could alter seminal parameters, and so chronic HCV infection may influence male fertility. Aim The aim of this study was to evaluate seminal parameters before and during combined antiviral (pegylated interferon α-2a+ribavirin) treatment in chronic HCV patients. Because of the possible teratogenic effect of ribavirin, contraception is mandatory during therapy. This study was conducted on 40 male chronic HCV patients (PCR based), age 20-58 years: 30 patients were given combined therapy (group 1) and 10 were not given treatment (group 2); 10 normal controls were included (group 3). The seminal fluid (volume, concentration, motility, and morphology) was analyzed. Parameters were determined at the beginning, and in group 1, they were reassessed after 12 weeks of therapy. Results Semen abnormalities were common at baseline with further impairment during antiviral therapy in group 1: oligoasthenoteratozoospermia was detected in 15 patients, asthenozoospermia in six, and athenoteratozoospermia in six (sperm density: BL, 59.2 ± 40.7 × 106/ml; week 12, 26.7 ± 22.4 × 106/ml; progressive motility: BL, 44.5 ± 15.2%; week 12, 31.2 ± 12.5%). The proportion of sperm without motility reached its peak after 12 weeks of therapy. The percentage of abnormal forms was BL 14 ± 0.04% and week 12 16.8 ± 5.2%, with further increase during therapy. In group 2, oligoasthenoteratozoospermia was present in three patients, asthenozoospermia in three, and athenoteratozoospermia in two. The density was 46.7 ± 32.4 × 106/ml, and the progressive motility 40 ± 10.7%. The percentage of abnormal forms was 13.5 ± 1.6%. In group 3, there was no oligoasthenoteratozoospermia, one patient had asthenozoospermia, and one had athenoteratozoospermia. The density was 95.2 ± 28.7 × 106/ml, and the progressive motility 57.2 ± 18.2%. The percentage of abnormal forms was 9.5 ± 2.8%. Conclusion Semen abnormalities were common in chronic HCV patients, with further impairment during combined antiviral therapy.
  3,034 240 -
REVIEW ARTICLE
Celiac disease
Dina I Shehab
June 2013, 25(2):53-62
DOI:10.7123/01.EJIM.0000429397.19027.b6   
Purpose of review

The aim of this review was to summarize recent advances in celiac disease (CD) published between 2006 and 2012.

Recent findings

CD affects ∼1% of most populations but remains largely unrecognized. During the past year, research has shown that the prevalence of CD has increased dramatically and not merely because of increased detection. Moreover, undiagnosed CD may be associated with increased mortality. Significant progress has been made in understanding how gliadin peptides can cross the intestinal border and access the immune system. New deamidated gliadin peptide antibodies have better diagnostic accuracy over other tests. The inclusion of duodenal bulb biopsy specimens may increase the rate of CD detection. Finally, refractory CD, although rare, is associated with a poor prognosis. The use of novel highly efficient exogenous prolyl endoproteases enzymes may help patients deal with occasional lapses in their diet or may protect highly sensitive individuals from inadvertent presence of gluten in food products. Nevertheless, the efficiency of this approach still needs precise assessment.

Conclusion

Mortality rates among patients with untreated CD increase two-fold every year as they age (gastrointestinal malignancies) and most can be prevented/reversed with early diagnosis and initiation of a gluten-free diet. CD is a global health problem that requires a multidisciplinary and increasingly cooperative multinational research effort.

  2,969 278 -
CASE REPORTS
Spontaneous lung pneumatocele in an adult with community-acquired pneumonia
Jyoti Bajpai, Surya Kant, Ajay Kumar Verma, Darshan Kumar Bajaj
July-September 2017, 29(3):141-143
DOI:10.4103/ejim.ejim_6_17  
Pulmonary pneumatoceles are thin-walled, air-filled cystic lesions occurring in lung parenchyma. They occur as a sequelae to bacterial infections of the lung, especially bronchopneumonia. They are commonly seen in infants and children. In this article, we report a rare case of pneumatoceles in a 40-year-old adult following staphylococcal community-acquired pneumonia.
  2,729 167 -
ORIGINAL ARTICLES
Impact of hepcidin, interleukin 6, and other inflammatory markers with respect to erythropoietin on anemia in chronic hemodialysis patients
Ihab A. Ibrahim, Usama M. Mohamad, Hatem A. Darweesh, Amal M. Rashad
January-March 2014, 26(1):6-14
DOI:10.4103/1110-7782.132882  
Background/objective Hepcidin is a peptide hormone produced by the liver and appears to be the master regulator of iron homeostasis. This peptide is upregulated in inflammatory conditions, including uremia. Hepcidin functions to regulate (inhibit) iron transport across the gut mucosa, thereby preventing excess iron absorption and maintaining normal iron levels within the body. In this study, we aimed to investigate hepcidin levels and their relationship with the parameters of iron status, inflammation, anemia therapy, and parameters of dialysis efficiency in hemodialysis patients. Patients and methods Plasma hepcidin-25, inflammatory markers (high-sensitivity C-reactive protein and interleukin 6), and peripheral iron indices (serum iron, total iron-binding capacity, transferrin saturation and serum ferritin) were measured before hemodialysis in 40 end-stage renal disease (ESRD) patients treated with regular hemodialysis in a single dialysis unit as well as in 20 healthy individuals matched for age and sex serving as the control group. Results Plasma levels of hepcidin-25 were significantly higher in hemodialysis patients compared with controls. In a simple correlation analysis, plasma hepcidin levels were positively correlated with ferritin, transferrin saturation, CRP, and interleukin 6; however, it was negatively correlated with hemoglobin, dose of epoitin-α, and dose of iron. Conclusion Serum hepcidin levels were associated with iron status and inflammation in maintenance hemodialysis patients, and the high hepcidin serum levels, found in hemodialysis (HD) patients, are dependent on the magnitude of the inflammatory process and on recombinant human erythropoietin doses. Hepcidin and its regulatory pathways are potential therapeutic targets, which could lead to effective treatment of anemia in chronic hemodialysis.
  2,505 376 2
Zinc level and obesity
Doaa S.E. Zaky, Eman A Sultan, Mahmoud F Salim, Rana S Dawod
October-December 2013, 25(4):209-212
DOI:10.4103/1110-7782.124985  
Background Obesity is a chronic condition that is associated with disturbances in the metabolism of zinc. Therefore, the aim of this study was to investigate the relationship between serum zinc level and different clinical and biochemical parameters in obese individuals. Patients and methods Twenty-four individuals with BMI more than 30 kg/m 2 and 14 healthy controls (BMI < 24 kg/m 2 ) were assessed for BMI and waist circumference using anthropometric measurements. Colorimetric tests were carried out for the determination of zinc in serum. Results In this study, BMI and waist circumference were higher in the obese group than in the control group (P < 0.05). The mean serum zinc levels were 92 ± 31.1 and 101 ± 70 μg/dl in the obese group and control group (P > 0.05), respectively. There was a significant negative correlation between the serum zinc level and BMI, waist circumference and low-density lipoprotein (P < 0.05). Conclusion Plasma zinc concentration in obese individuals showed an inverse relationship with the waist circumference and BMI as well as serum low-density lipoprotein-cholesterol and correlated positively with high-density lipoprotein.
  2,492 289 1
REVIEW ARTICLE
Nicotinic acid: a lipid-lowering agent with unrealized potential
Samar H. Aboulsoud
January-March 2014, 26(1):1-5
DOI:10.4103/1110-7782.132881  
Nicotinic acid is a well-known treatment for dyslipidemia in adults. This review article explored not only the role of nicotinic acid in dyslipidemia but also its role in hypertension and as a cardioprotective agent. Adverse effects in association with nicotinic acid use are described with a focus on flushing, the major reason for the discontinuation of nicotinic acid therapy. The role of nicotinic acid receptor in mediating its metabolic and vascular effects is also reviewed.
  2,509 256 -
EDITORIALS
Ankylosing spondylitis: a multidisciplinary approach
Medhat El Shafei
December 2012, 24(3):61-62
DOI:10.7123/01.EJIM.0000422805.46488.8a   
  745 1,936 -
ORIGINAL ARTICLE
Ascitic calprotectin as a diagnostic marker for spontaneous bacterial peritonitis in hepatitis C virus cirrhotic Egyptian patients
Ahmed A Heikl, Mahmoud M El-Nokeety, Eman Roshdy, Abeer Mohey
January-March 2018, 30(1):1-7
DOI:10.4103/ejim.ejim_41_17  
Background The gold standard for the diagnosis of spontaneous bacterial peritonitis (SBP) is a polymorphonuclear leukocyte (PMNL) count of 250/mm3or more. Accurate and early diagnosis of SBP is important to decrease the mortality and complications in patients with cirrhosis. Aims The aim of this study was to evaluate the accuracy of ascitic fluid calprotectin as a diagnostic marker for the detection of SBP. Patients and methods Seventy Egyptian patients with liver cirrhosis and ascites were enrolled; these patients were divided into two groups: 50 patients with SBP and 20 patients with no SBP on the basis of an elevated ascitic PMNL count of 250 cells/mm3 or more. Ascitic samples were examined for PMNL count, culture, chemistry, and calprotectin concentrations in all patients. Results Calprotectin levels in ascitic fluid were correlated significantly with PMNLs and significantly higher in patients with SBP than non-SBP (P<0.001), with the best cutoff value for the detection of SBP of 783 ng/ml with a sensitivity, a specificity, a positive predictive value and negative predictive value, and an accuracy of 90, 100, 100, 80, and 92.9%, respectively. Conclusion Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of SBP and considered a surrogate marker for PMNL.
  2,416 265 -
REVIEW ARTICLE
Gout
Hanan Abdel Rehim
April-June 2014, 26(2):35-39
DOI:10.4103/1110-7782.139514  
Gout is a crystal deposition disease caused by raised levels of uric acid in the blood (hyperuricaemia) with persistence of hyperuricemia at levels higher than a serum saturation of 6.8 mg/dl leads to formation of monosodium urate (MSU) crystals and their deposition in joints and other tissues. However, only a minority of individuals with elevated serum uric acid (sUA) levels ever develop gout, emphasizing the importance of other factors in determining crystal formation including Genetics, Gender, age, Diet and alcohol intake, Obesity, some medications and medical conditions a correct diagnosis of gout is essential for the appropriate management, in 2011 the European League Against Rheumatism (EULAR) published an updated evidence based recommendations for diagnosis of gout. Although gout is well understood condition and good therapeutic options are available, it tends to be poorly managed, so The 2012 The American College of Rheumatology (ACR) guidelines for Management of Gout were designed to emphasize safety and quality of therapy and to reflect best practice. New approaches to urate lowering have led to mechanism-based therapies such as: non-purine, selective inhibitor of xanthine oxidase, URAT-1 inhibitors and a recombinant chimeric mammalian uricase. Three IL-1β antagonists - anakinra, rilonacept and canakinumab are being evaluated as an emerging therapies for gout.
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ORIGINAL ARTICLES
The association between the melatonin receptor 1B gene polymorphism rs10830963 and glucose levels in type 2 diabetes
Tarek S Heshmat, Heba Sh Kareem, Noha Kh M Khalil, Olfat G Shaker
October-December 2014, 26(4):145-150
DOI:10.4103/1110-7782.148120  
Introduction Melatonin is a pineal hormone under the control of the biological clock, which is located in the hypothalamus and regulated by light exposure. Melatonin receptors have been found throughout the body in many tissues including pancreatic islet cells, reflecting the widespread effects of melatonin on physiological functions such as energy metabolism and the regulation of body weight. Several lines of evidence suggest that melatonin may play a role in glucose metabolism. Aim of the work To investigate the association between diabetes mellitus (T2D) and the variants rs10830963 in the melatonin receptor 1B gene (MTNR1B) locus in a sample of the Egyptian population. Patients and method This was a case-control study conducted in the internal medicine department at El-Kasr El-Aini Hospital, Cairo University. It included 30 diabetic individuals (type 2) compared with 20 healthy individuals. All individuals included in the study were subjected to a detailed history taking, complete physical examination, body composition evaluation, and laboratory testing including blood picture, blood urea nitrogen, creatinine, lipid profile, and genotyping of melatonin receptor B1. Diabetic individuals were subtyped into three groups: (a) Diabetic patients without complications. (b) Diabetic patients with microvascular complications. (c) Diabetic patients with macrovascular complications. Results Statistical analysis revealed a significant positive correlation between the MTNR1B polymorphism rs10830963 and glucose levels in type 2 diabetes. Conclusion The study confirmed that individuals having the MTNR1B gene polymorphism are at a greater risk of developing type 2 diabetes and having higher blood glucose levels and are more prone to be dyslipidemic than others who have no polymorphism.
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