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   2014| July-September  | Volume 26 | Issue 3  
    Online since November 24, 2014

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Acute aluminium phosphide poisoning, what is new?
Yatendra Singh, Subhash C Joshi, Vivekanand Satyawali, Abhisek Gupta
July-September 2014, 26(3):99-103
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.
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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
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.
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Functional and structural abnormalities of the skin microcirculation in hemodialysis patients
Maggie S El-Nahid, Ali M El-Ashmaoui
July-September 2014, 26(3):116-123
Background The changes that occur at the level of the skin microvessels reflect changes at other microvessels including the cardiac microvessels. Several disease states seem to alter skin microvascular function and structure such as diabetes, hypertension, and hypercholesterolemia. Many of these disease states are frequently encountered in hemodialysis (Hdx) patients. The process of Hdx itself is also associated with vascular abnormalities. It was thus the aim of our study to examine the structure and function of skin microcirculation in Hdx patients. Materials and methods Sixty patients were examined: 20 patients on regular Hdx, younger than 60 years old, with no diabetes, hypertension, or hypercholesterolemia, 20 patients on regular hemodialysis with coexisting hypertension (Htn-Hdx), and 20 young healthy volunteers. The skin microcirculation was assessed using the laser Doppler fluxmetry and the capillaroscope. Results Results showed significant differences in the laser Doppler fluxmetry measurements between the Hdx group and the Htn-Hdx group compared with the control group, with no significant differences in the capillaroscope study. Conclusion The study of skin microcirculation in Hdx patients indicated the presence of functional abnormalities without significant structural changes.
  2,128 178 1
The effect of exercise on insulin resistance in obese women with polycystic ovary syndrome
Heba S Kareem, Noha KM Khalil, Nagwa MH Badr, Fayez El-Shamy
July-September 2014, 26(3):110-115
Introduction The link of polycystic ovary syndrome (PCOS) with insulin resistance was subsequently established by clinical studies characterizing the profound insulin resistance in obese and lean PCOS patients. Aim The aim of this study was to compare the effect of aerobic exercise using an ergonomic treadmill on insulin resistance, body weight, and waist circumference in obese diabetic and nondiabetic women with polycystic ovary. Patients and methods Sixty obese women with PCOS, their age ranging from 30 to 40 years, participated in this study. All study participants were recruited from the Gynecology Outpatient Clinic of Kasr Al Aini Hospital. They were assigned into two equal groups: Group A (study group) included 30 obese diabetic women. Group B (control group) included 30 nondiabetic obese women.All patients received a controlled diet program and an aerobic exercise program (each exercise training session included continuous aerobic exercises on a treadmill for 30 min performed three times per week for 24 weeks under the supervision of physicians of the Faculty of Physical Therapy) and were on metformin drug (850 mg every 12 h).Fasting blood glucose, insulin resistance, and waist circumference were measured at the beginning of the study and after the study for both groups. Results Statistical analysis revealed a significant improvement in insulin resistance and waist circumference in both groups after the aerobic exercise training program. Conclusion Regular aerobic exercises improve insulin resistance, abdominal fat distribution, and body weight in obese diabetic and nondiabetic women with polycystic ovary, and they are advised to perform regular aerobic exercises.
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Painful leg in a diabetic patient: an unusual cause (pyomyositis)
Sanjay Bhat, Kalyan Dutt, Khalid Javid Bhat
July-September 2014, 26(3):136-138
Pyomyositis, a rare condition can involve perfectly healthy individuals but is generally a disease of immunocompromised like diabetic patients. Probably, the result of transient bacteraemia characteristically involve muscles of lower limbs. Clinically to begin with, can mimic other non-infective musculoskeletal disease which often result in the delay of diagnosis.
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Vaspin in type 2 diabetes in relation to atherosclerosis
Nehal H El-Said, Noha A Sedik, Nagwa A Mohamed
July-September 2014, 26(3):130-135
Background Vaspin is a novel adipocytokine with insulin-sensitizing effects. However, it is not known whether a correlation exists between human vaspin serum levels and markers of insulin sensitivity and glucose or lipid metabolism. Aim of the work To determine whether there is an association between serum vaspin levels (a novel adipocytokine with insulin-sensitizing effects), type 2 diabetes mellitus (T2D) and atherosclerosis. Patients and methods The study included 40 patients with T2D divided into 20 without hypertension (group 1), 20 with hypertension (group 2) and 15 age-matched and sex-matched healthy control participants (group 3). The serum vaspin level was determined by enzyme-linked immunosorbent assay. Its level was compared between both diabetic patients and controls, and between diabetic patients without hypertension and those with hypertension. All participants were subjected to an imaging procedure in the form of carotid Doppler to measure the intima - media thickness as an early marker of atherosclerosis. Results The serum vaspin level was significantly higher in diabetic patients compared with control participants. There was significant increase in the left carotid intima-media thickness in diabetic patients with hypertension and without hypertension compared with control participants. There was a significant positive correlation between the serum vaspin level and the BMI in diabetic patients with hypertension, a significant negative correlation between the serum vaspin level and the duration of diabetes and a significant negative correlation between the serum vaspin level and HDL in diabetic patients without hypertension. Conclusion There was a significantly high level of serum vaspin in T2D patients. Serum vaspin was shown to be significantly lower in T2D patients with a longer duration of illness. An increased carotid intima-media thickness in diabetic patients was not related to the vaspin level, denoting an underlying combining factor for atherosclerosis in diabetic patients other than vaspin.
  1,749 179 1
Wonderful drug for walking pneumonia: oseltamivir
Faheem Arshad, Suhail Mantoo, Umar H Khan
July-September 2014, 26(3):97-98
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Role played by T-helper 2 in resetting the cytokine balance in allergic patients
Mohamed Y Attia, Howida M Saber
July-September 2014, 26(3):124-129
Background Bronchial asthma is an allergic disorder characterized by excessive hyperactive nature of the airways, which depends on many cytokines such as interleukin-4 (IL-4) and IL-5 that are responsible for the allergic inflammatory response. One of the strategies in the management of bronchial asthma is the induction of synthesis of IL-10; it has an inhibitory effect on the synthesis of the T-helper-2 (Th2) cytokines. Th2 cells play a triggering role in the activation/recruitment of immunoglobulin E antibody-producing B cells, mast cells, and eosinophil cells. To assess regulatory changes in the immune system, in patients with allergy and asthma, we studied the cytokine profile in serum in comparison with normal healthy controls. The study was carried out in Allergy and Immunology Unit, Ain Shams University Hospitals. A total of 170 patients with various allergies and asthmatic conditions were studied, for cytokines in the serum by enzyme-linked immunosorbent assay using kits from Immune Technology, and analyzed to identify the triggering factors or main contributors toward allergy and asthma. Our study showed increase in the levels of IL-4, IL-5, and IL-6 in all groups, which was nonsignificant. However, the levels of IL-10, IL-13, and tumor necrosis factor-α were highly significantly increased. Besides, we found correlation of granulocyte macrophage colony-stimulating factor with IL-10. Significant positive correlation with different cytokines was observed. Most of these patients showed increase in immunoglobulin E levels. This study gives a better understanding of how cytokines are the mediators of balance of Th1 and Th2 immune responses and how immunoglobulin E synthesis is controlled by cytokines. Further studies will eventually lead to improved treatment strategies in the clinical management of immunoglobulin E-mediated allergy.
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