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   2012| April  | Volume 24 | Issue 1  
    Online since July 16, 2014

 
 
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ORIGINAL ARTICLES
Sympathetic skin response test in essential hypertensive patients
Ann Abdel Kader, Ayatollah Farouk, Shereen Fathy, Amani Nawito, Khalid Taher
April 2012, 24(1):12-16
DOI:10.7123/01.EJIM.0000415589.84978.e8   
Background

Essential hypertension is the most prevalent type of hypertension, affecting 90–95% of hypertensive patients. Although no direct cause has been identified, there are many factors such as overactivity of the sympathetic nervous system.

Objectives

To study the predictive value of the sympathetic skin response (SSR) test to determine the role of sympathetic overactivity in essential hypertensive patients.

Methods

The study was carried out on 30 essential hypertensive patients and 15 normal controls who were similar in terms of age and sex. Thorough history taking, neurological and cardiological examination, and the neurophysiological technique (SSR) test were performed in both the groups.

Results

Three patients were found to have an upper limb latency less than 1.2 ms, which was faster than the fastest upper limb SSR in the controls, and two patients were found to have a lower limb latency less than 1.9 ms, which was faster than the fastest lower limb SSR in the controls. However, there was no statistically significant difference between the patient and the control groups in terms of the mean SSR latencies and amplitudes in the upper and lower limbs.

Conclusion

Although SSR has a low diagnostic value in patients with essential hypertension, it might be a good diagnostic test particularly in the presence of signs and symptoms of sympathetic overactivity such as tachycardia and sweating.

  436 43 -
EDITORIAL
Advances in the management of type 2 diabetes mellitus
Nariman Moustafa
April 2012, 24(1):1-3
DOI:10.7123/01.EJIM.0000418015.54092.98   
  381 44 -
CASE REPORT
Atypical presentation of primary hypoparathyroidism
Afaf Hemeda, Aml Fouad
April 2012, 24(1):24-25
DOI:10.7123/01.EJIM.0000418012.50897.22   
  345 42 -
ORIGINAL ARTICLES
Study of diabetes mellitus among patients with hepatitis C virus
Mona Abdel Raouf, Zeinab A. Yousry, Olfat M. Hindy, Somayh S. Eissa, Dalia S. Soliman
April 2012, 24(1):17-23
DOI:10.7123/01.EJIM.0000415588.62804.fc   
Introduction

Hepatitis C virus (HCV) infection and type 2 diabetes are two common disorders with high impact on health worldwide. There is growing evidence to support the concept that HCV is associated with type 2 diabetes.

Purpose

This work aimed to study the clinical phenotype of type 2 diabetes in HCV patients.

Patients and methods

Our study was conducted upon 100 nonobese, noncirrhotic hepatitis C positive patients who were classified into two groups according to homeostatic model assessment (HOMA) test for insulin resistance (HOMA IR). This study also included 15 nonobese type 2 diabetic patients negative for HCV and hepatitis B virus infection classified as control groups. We excluded alcoholics and drug addicts and patients with conditions that affect blood glucose such as endocrine diseases associated with disordered glucose metabolism and use of drugs. All participants were subjected to full history taking and complete clinical examination including BMI and the following investigations: complete blood count, fasting blood sugar, 2 h postprandial blood sugar, glycosylated hemoglobin, fasting insulin level, cholesterol level, HDL, LDL, triglyceride, serum urea, creatinine, complete urine analysis, liver function tests: total bilirubin, alkaline phosphatase, albumin, prothrombin time, INR, SGOT, SGPT, quantitative PCR for determination of HCV-RNA, surface antigen (HbsAg), abdominal ultrasonography, liver biopsy when needed and possible for HCV patients, and ECG.

Results

In this study, we found that the prevalence of type 2 diabetes in group I is 24%. HCV can independently contribute to IR with viral genotypes 1 or 4. We noticed significant positive correlation between fasting insulin and HOMA IR in hepatitis C +ve patients. IR in HCV-infected patients is high irrespective of the degree of liver injury even before a minimal fibrosis is present. Both IR and diabetes can adversely affect the course of chronic hepatitis C, leading to enhanced steatosis and liver fibrosis, and even increase the risk of hepatocellular carcinoma. A significant correlation between HOMA IR and steatosis, a significant positive correlation between fasting insulin and steatosis and a negative correlation between steatosis and BMI in HCV patients was found. No correlation was found between HOMA IR and the viral load (quantitative HCV RNA).

Conclusion

We can concluded that diabetic HCV patients had intermediate clinical phenotype lower BMI and LDL than control and development of type 2 diabetes mellitus in HCV patients was significantly higher in nontreated patients than treated patients. Antiviral therapy and clearance of HCV improves IR, β-cell function, the blood glucose abnormalities.

  308 77 -
Study of thrombopoietin levels in some Egyptian patients with chronic liver diseases secondary to the hepatitis C virus
Enayat O. Ezzat, Somayh E. Suliman, Samiha Abo El-Yazeed, Fatma M. Ahmad, Sahar K. Said
April 2012, 24(1):5-11
DOI:10.7123/01.EJIM.0000415596.67959.9c   
Introduction

The hepatitis C virus (HCV) is a leading cause of chronic liver disease (CLD), cirrhosis, and hepatocellular carcinoma, as well as the most common indication for liver transplantation in many countries.

Purpose

This work was carried out to study of thrombopoietin (TPO) level in Egyptian patients with chronic hepatitis C and liver cirrhosis with HCV.

Patients and methods

This work was conducted on 40 patients proved to have chronic liver disease due to chronic HCV infection by positive HCV antibody by enzyme-linked immunosorbent assay, PCR for HCV RNA, abdominal ultrasonography, and histopathological examination. Twenty of these patients had chronic active hepatitis C (CAH) and the other 20 patietns had liver cirrhosis. Fifteen apparently healthy individuals (negative for HCV antibody) were included in a control group. None of the patients had received interferon therapy. Patients with other causes of CLD, chronic renal disease, diabetes, endocrinal hematological, and other debilitating diseases were excluded. All the patients studied were subjected to the following: complete medical history, full clinical examination, laboratory investigations including complete blood picture, liver function tests, fasting blood sugar, 2 h postprandial, HCV antibody and PCR for RNA of HCV; serum TPO level, abdominal ultrasonography, and liver biopsy for histopathological examination.

Results

Our results showed a highly significant reduction in the platelet count in patients with CAH (192.55±41.02) and cirrhotic patients (159.800±86.189) in comparison with (322.67±38.12) the control group (P<0.01). There was nonsignificant increase in TPO in patients with CAH (115.93±71.66) and a significant decrease in TPO in cirrhotic patients (77.504±64.576) in comparison with (107.98±52.53) the control group. In the cirrhotic patients, there was a significant positive correlation between TPO and platelet count, whereas there was no correlation between TPO level and liver enzymes (alanine aminotransferase and aspartate aminotransferase) in all patients. In addition, a significant decrease in TPO was found in cirrhotic patients in comparison with CAH patients.

Conclusion

Serum TPO level was elevated in patients with chronic viral C hepatitis as a compensatory response to the reduction of platelet count with still functionally active liver cells, but as the disease progress to cirrhosis which also is associated with thrombocytopenia, TPO production is impaired, with failure to compensate the low platelet count aggravating thrombocytopenia.

  297 53 -
REVIEW ARTICLE
Digital electroencephalography and long-term video electroencephalography
Ayat Allah Farouk
April 2012, 24(1):4-4
DOI:10.7123/01.EJIM.0000415590.13433.52   

EEG is the name commonly used for electroencephalography. EEG is an important test for diagnosing epilepsy. Conventional EEG has relatively low sensitivity in epilepsy, ranging between 25-56%. The combination of wake and sleep records gives a yield of 80% in patients with clinically confirmed epilepsy. Video-EEG is most helpful in determining whether seizures with unusual features are actually epilepsy.

  246 45 -
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