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  Citation statistics : Table of Contents
   2016| April-June  | Volume 29 | Issue 2  
    Online since October 18, 2016

 
 
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ORIGINAL ARTICLES
Study of prevalence of end-stage renal disease in Assiut governorate, upper Egypt
Ahmed R El-Arbagy, Yassin S Yassin, Boules N Boshra
April-June 2016, 29(2):222-227
DOI:10.4103/1110-2098.192441  
Objective: The aim of this work is to assess the prevalence rate, etiology, and risk factors for end-stage renal disease (ESRD) in Assiut governorate, Egypt, during the year 2014. Background: ESRD is one of the main health problems in Assiut governorate. Currently, hemodialysis represents the main mode of treatment of ESRD in Assiut governorate, Egypt. The epidemiology of ESRD in Assiut has never been examined before 2014. Assiut is located in upper Egypt. The total area of Assiut is 13 720 km2, and the province has a population of 4 263 719 million individuals. Patients and methods: Patients with ESRD from the entire Assiut governorate were interviewed and questionnaires were filled out by the investigators. The questionnaire included personal and sociodemographic data, history of relevant diseases, dialysis frequency, investigations performed, and other data investigating the causes. Results: All patients (n= 1559) with chronic renal failure surviving on renal replacement therapy, definitely those on hemodialysis in Assiut governorate during 2014, were distributed in 14 units of hemodialysis across all 10 Assiut districts. These units were governmental. Only 1109 (71%) patients in 13 hemodialysis units agreed to participate in this study (729 men, 65.7%) and 380 (34.3%) women. The prevalence of ESRD in Assiut governorate is 366 per million populations (pmp) of the population. The etiology of ESRD was unknown in 25% of cases, whereas hypertension was responsible in 21.4% of cases, obstructive uropathy in 11% of cases, chronic glomerulonephritis in 8% of cases, analgesic nephropathy in 3% of cases, chronic pyelonephritis in 8.9% of cases, diabetic nephropathy in 14.9% of cases, toxemia of pregnancy in 2% of cases, and polycystic kidney disease in 0.7% of cases. Conclusion: The prevalence rate of ESRD in Assiut governorate during the year 2014 was 366 pmp. Unknown etiology and hypertension are the major known causes of ESRD. A unifying system of an electronic data registry should be established in each governorate to constitute the national Egyptian data registry.
  2 2,658 339
Her-2 neu status in gastric carcinoma in Egyptian patients: The epidemiology and the response to chemotherapy
Tarek A Abdelwahab Hashem, Mohamed A El-Fotouh, A Ehab, Hala S El Rebey, Mahmoud A Satar, Hany S Attallah
April-June 2016, 29(2):449-453
DOI:10.4103/1110-2098.192437  
Background: Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer-related death worldwide, affecting one million people per year. Currently, gastric cancer is still the seventh most common cause of cancer-related death in the USA, and the prognosis of advanced gastric cancer remains poor. Objectives: The aim of this study was to assess the frequency of Her-2 overexpression and amplification in Egyptian patients with gastric/gastroesophageal adenocarcinoma, in correlation with tumor histology, grade, size, and location (cardia vs. noncardia). Patients and methods: This study included 39 eligible patients with pathologically proven gastric/gastroesophageal carcinoma presented to Menoufia University Oncology Hospital, Alexandria Military Hospital, from January 2012 until the end of June 2013. Results: It was found that the mean age was 55.3 years. There was slightly higher incidence in the male population (51.3%). All of them had tumors of diffuse histopathological type. Stage at presentation was as follows: localized, one (2.6%); locally advanced, 20 (51.3%); and metastatic, 18 (46.2%). Her-2 was found to be overexpressed in four out of 39 patients (10.3%). Her-2-negative patients had a significantly longer overall survival (9 months in Her-2 negative-patients vs. 4 months in Her-2-positive patients) (P= 0.01). Progression-free survival (PFS) was significantly prolonged in Her-2-negative patients. Her-2-negative patients had a PFS of 8 months, versus only 4 months in Her-2-positive patients (P= 0.01). Median survival and PFS in locally advanced disease were significantly affected by the Her-2 status (P= 0.02). Neither median survival (P= 0.8) nor PFS (P= 0.5) was affected in metastatic disease. Conclusion: Her-2 is a prognostic factor in a small cohort of Egyptian patients with gastric/gastroesophageal carcinoma.
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Assessment of right ventricular function in patients with first inferior myocardial infarction: strain imaging study
Ahmed A Reda, Mohamed F El-Noamany, Naglaa F Ahmed, Hesham M Saad Tayel
April-June 2016, 29(2):418-422
DOI:10.4103/1110-2098.192438  
Objective: The aim of the study was to assess strain and strain rate (SR) properties of the right ventricle (RV) in patients with RV myocardial infarction (MI). Background: Quantitative assessment of RV function is still challenging due to its complex anatomy and thin wall structure, and therefore is not incorporated into daily clinical practice. Two-dimensional strain and SR analyses are novel Doppler-independent techniques to obtain these measurements of myocardial movement and deformation. These methods have been frequently used to assess left ventricular function; however, they have yet rarely been used to examine RV function, despite RV function is an important prognostic factor in patients with acute first inferior MI. Patients and methods: A total of 40 patients with acute inferior MI were included in this study; 20 patients had ECG signs of inferior MI without RV infarction (group II) and 20 patients had ECG signs of inferior MI with RV infarction (group III). In all, 20 age-matched and sex-matched healthy volunteers were included as a control group (group I), using two-dimensional speckle tracking measurements of RV free wall longitudinal strain and SR in the apical four-chamber. Results: A statistically highly significant difference was found among the three groups regarding the peak systolic longitudinal strain at apical, mid, and basal segments of RV free wall (P < 0.0001), and significant difference was found among the three groups regarding The peak systolic SR at basal and mid segments of RV free wall (P < 0.05). Conclusion: This study demonstrates that RV strain and SR were lower in patients with left ventricular inferior wall MI with RV infarction compared with those without RV infarction.
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PD-1 expression on peripheral CD8+ T cells closely correlated with hepatitis C virus viral load in chronic hepatitis C patients
Amr A Fathy, Khaled A Khalefa, Maha M El-Sabawy, Amal A El Sharnoby, Hossam A Galbt
April-June 2016, 29(2):383-388
DOI:10.4103/1110-2098.192444  
Objective: Our objective was to evaluate the relationship between the expression of PD-1 as an inhibitory novel marker on CD8+ T cells and hepatitis C virus (HCV) viral replication and disease progression in chronic HCV-infected Egyptian patients. Background: Tight correlation between host circulating CD8+ T-cell-mediated immune response and control of viral replication is a classic characteristic of long-term HCV infection. Patients and methods: This study included 28 chronic hepatitis C patients without cirrhosis (17 male and 11 female), 25 chronic hepatitis C patients with cirrhosis (14 male and 11 female), and 15 healthy controls (10 male and five female). Laboratory investigations such as complete blood picture, liver function tests, evaluation of hepatitis viral markers (HBsAg and anti-HCV Ab), and HCV RNA PCR were performed on all participants. The level of PD-1 on CD8+ T cells was assessed using flow cytometry. Results: The data revealed a higher percentage of PD-1 on CD8+ T cells in HCV-infected patients compared with healthy controls. Our results also indicated a significant correlation between PD-1/CD8 level and HCV viral load in the studied groups. Conclusion: Our results suggested that PD-1 level on peripheral CD8+ was highly correlated with HCV viral load in chronic HCV-infected patients, which made PD-1 a novel indicator to evaluate the impairment and dysfunction of host CD8+ T-cell immunity as well as HCV viral persistence.
  1 448 43
A study on how patients catch hepatitis C virus
Reda S Badr, Tarek E Korah, Ahmad R Tawfeek, Kamal A Mohamed
April-June 2016, 29(2):215-221
DOI:10.4103/1110-2098.192443  
Objective: The aim of this study was to evaluate the prevalence of hepatitis C virus (HCV) and its mode of transmission in Kafr El-Sheikh governorate. Background: The overall prevalence of antibody to HCV in the general population is around 15–20%. Knowledge of the risk factors and clinical outcome of hepatitis C will provide important information regarding treatment and public health guidelines. Patients and methods: Data were collected on patients exposed to risk factors for HCV transmission or have clinical manifestation of liver cell failure from among outpatients and inpatients at the Liver Institute, Kafr El-Sheikh governorate. Two hundred patients who were HCV positive and 60 patients who were HCV negative, determined according to the one-step test device by ACON Laboratories, were included as cases and controls, respectively. Patients recently exposed to sources of risk factors (at least 6 weeks) were excluded from the study. All the study participants were subjected to history taking and complete physical examination. Results: The study showed that 200 of the studied samples were seropositive (cases), and 60 were seronegative (control). With regard to the risk factors to which the patients were exposed, there were highly significant differences in patients than in controls in relation to blood transfusion, family history, antischistosomal drug (tartar emetic), and surgery. The most significant cause of HCV transmission was intrafamilial exposure [odds ratio (OR) = 8.522, 95% confidence interval (CI) 3.704–19.605], followed by antischistosomal drug injection (OR = 3.905, 95% CI 1.605–9.503) and blood transfusion (OR = 0.2, 95% CI 0.099–0.743). Conclusion: There are several modes of transmission. The most significant cause of HCV transmission was intrafamilial exposure, followed by antischistosomal drug injection and blood transfusion. There should be focus on preventing HCV by reducing its transmission, particularly among those at risk of acquiring the virus. Screening of all family members of HCV-infected patients should be made mandatory.
  1 599 53
Serum leptin level as a marker of neonatal sepsis
Ghada M El-Mashad, Hanan M El-Sayed, Osama H Salem
April-June 2016, 29(2):252-258
DOI:10.4103/1110-2098.192427  
Objectives: For evaluation of serum leptin level in neonates with sepsis to aid early and accurate diagnosis and treatment. Background: Leptin is a polypeptide hormone that is mainly, but not exclusively, produced in adipose tissue and plays an important role in the innate immune defense. This study was designed to evaluate the level of serum leptin in cases of neonatal sepsis. Materials and methods: This study was carried out on 50 neonates divided into a case group (30 neonates with sepsis) and a control group (20 healthy neonates). All patients in the study were subjected to adequate assessment of history, full clinical examination, complete blood cell, C-reactive protein with titer, blood culture, and serum leptin assay by ELISA at the time of diagnosis and after recovery from sepsis. Results: The study showed that neonates who developed sepsis had significantly higher serum leptin levels than those of the control group and leptin levels were significantly higher in patients before antimicrobial therapy than after antimicrobial therapy. Also, there were no significant correlations between serum leptin and complete blood cell parameters or C-reactive protein, but there was a significant positive correlation with the sepsis score. A significantly higher level of serum leptin was found in patients with positive blood cultures compared with those with negative blood cultures, but there was no difference in the serum leptin level between survivors and nonsurvivors. The study showed that the best cut off value for serum leptin in the detection of sepsis was 2.75 ng/ml with a sensitivity of 75% and a specificity of 70%. Conclusion: Serum leptin plays a role in neonatal sepsis.
  1 573 103
LETTER TO THE EDITOR
Hydrops fetalis: our experience in a rural setting
Mahmood D Al-Mendalawi
April-June 2016, 29(2):468-468
DOI:10.4103/1110-2098.192407  
  - 311 37
ORIGINAL ARTICLE
Colonoscopic findings in children with lower gastrointestinal bleeding
Mohsen M Deeb, Rania S El-Zayat, Heba A. Abd Elghany Abo El-Khair
April-June 2016, 29(2):247-251
DOI:10.4103/1110-2098.192425  
Objective: The aim of our work was to assess the clinical manifestations and to determine the colonoscopic findings of children with lower gastrointestinal bleeding (LGIB) attending to hospital. Background: Colonoscopy is used for both diagnostic and therapeutic purposes in patients with lower gastrointestinal symptoms. LGIB in children has many different etiologies and is a serious problem that warrants careful diagnostic work-up. Patients and methods: This study was conducted on 75 patients (51 male and 24 female with age ranging from 3 to 12 years) presented with LGIB. We divided the patients into three age groups to find the relationship between the age and the causes of rectal bleeding in the studied patients. These groups were: group 1, which included patients from 3 to 6 years; group 2, which included patients from 6 to 9 years; and group 3, which included patients from 9 to 12 years. Results: Colon polyps were the most common colonoscopic finding among children (44%), followed by linear ulcerations and edema (25.3%), diffuse nonspecific inflammation (24%), and normal cases (6.6%). Juvenile polyps were the most common pathological finding among children. We found polyps common in patients between 3 and 6 years of age. Conclusion: Colonoscopy was performed for children with LGIB; we found that the most common causes of bleeding were polyps, ulcerative colitis, nonspecific colitis, and infectious colitis.
  - 544 66
The effect of hemodialysis-induced preload changes on the left ventricular function: a speckle-tracking echocardiographic study
Said S Ibrahim, Mahmoud A Koura, Ahmed A Emara, Mahmoud Kamel, Wagdy A.Abd El-Wahed
April-June 2016, 29(2):406-411
DOI:10.4103/1110-2098.192409  
Objective: This study aim to evaluate the effect of hemodialysis (HD)-induced preload changes on the left ventricular (LV) function in patients with chronic renal failure using LV imaging strain. Background: In dialysis patients, both cardiovascular and noncardiovascular mortality are significantly increased as compared with the general population. In particular, cardiovascular mortality contributes to 40% of all-cause mortality in patients on HD. Patients and methods: Twenty-six participants were enrolled in this study on maintenance HD three times per week for 3 h; they included 13 patients with hypertension, six with diabetes mellitus, and eight with ECG criteria of left ventricular hypertrophy. All participants underwent standard two-dimensional echocardiography and myocardial strain imaging. Results: There was a significant reduction of the stroke volume, the LV internal diameter in diastole, the LV internal diameter in systole, the LV posterior wall thickness in systole, the end-diastolic volume, the end-systolic volume, E wave, the E/A ratio, and finally the pulmonary artery systolic pressure after HD set (P < 0.05). In contrast, there were no significant changes in the interventricular septum in either diastole or systole, the LV posterior wall thickness in diastole, fractional shortening, A wave, the ejection fraction or left atrial dimensions (P > 0.05). Also, there was a significant reduction in the global longitudinal peak systolic strain in the long-axis view (GLPS_LAX) (−19.32 ± 4.30 to −16.58 ± 3.87), the global longitudinal peak systolic strain in the apical four-chamber view (GLPS_A4C) (−17.73 ± 4.76 to −15.98 ± 3.70), the global longitudinal peak systolic strain in the apical two-chamber view (GLPS_A2C) (−18.73 ± 4.22 to −16.79 ± 4.25), and the global longitudinal peak systolic strain average (GLPS_AVG) (−18.59 ± 3.96 to −16.45 ± 3.31) after HD set (P < 0.05). Conclusion: The preload reduction resulting from HD is associated with a reduction of the LV systolic function when assessed by the peak systolic longitudinal strain. This indicates preload dependence of the LV systolic function.
  - 625 99
ORIGINAL ARTICLES
Apical rotation in patients with ST-elevation myocardial infarction
Mahmoud A Soliman, Morad B Mena, Luther S Amen
April-June 2016, 29(2):412-417
DOI:10.4103/1110-2098.192439  
Objective: The aim of this study was to assess apical rotation in patients with anterior and inferior myocardial infarction (MI) by speckle-tracking echocardiography. Background: Left ventricular ejection fraction (LVEF) is the most widely used index of left ventricular (LV) systolic function. However, the development of wall-motion abnormalities after acute MI significantly decreases the accuracy of LVEF; further, calculation of LV volume by the biplane Simpson method is inaccurate, because it depends on geometric assumptions. Recently, two-dimensional speckle-tracking imaging has facilitated noninvasive measurement of LV strain and rotation. Patients and methods: The present study enrolled 54 patients with anterior or inferior MI, in addition to 20 healthy volunteers (matched for age and sex) as the control group. Basal and apical LV short-axis images were acquired for further off-line analysis. Using commercially available two-dimensional strain software, apical, basal rotation, and LV torsion were calculated. Results: Apical rotation was significantly reduced in the patient group compared with the control group (P < 0.001). Consequently, torsion degree (P < 0.001), torsion rate, and untwisting rate (P = 0.007) were significantly reduced. Conclusion: There was a significant correlation between ejection fraction and apex rotation (r = 0.466, P = 0.044), torsion degree (r = 0.499, P = 0.03), and untwisting rate (r = −0.543, P < 0.001). Correlation with basal rotation was nonsignificant, and thus measurement of apical rotation alone (rather than calculation of LV torsion) might provide a simple and accurate alternative for assessment of LV contractility. No difference was found between anterior and inferior MI as regards torsion (P = 0.870). Apical rotation and torsion were decreased in ST-elevation MI, and this was statistically significant in patients with LV dysfunction.
  - 518 80
A study on the effect of estrogen, progesterone, and their cutaneous receptors in the pathogenesis of melisma
Mohamed A Basha, Rania M Azmy, Mai M Farag
April-June 2016, 29(2):389-392
DOI:10.4103/1110-2098.192411  
Objective: The aim of the study was to assess the efficacy of estrogen, progesterone, and their cutaneous receptors in the pathogenesis of melasma. Materials and methods: From January 2013 to June 2013, 40 female patients with melasma and 20 age-matched and sex-matched healthy individuals as the control group were included. Estrogen and progesterone were measured using IMMULITE 2000. Results: Concerning the serum estrogen and progesterone levels, the patients showed a statistically significant increase in progesterone levels with a mean value of 3.65 ± 13.11 when compared with the controls with a mean value of 3.63 ± 2.64. Conclusion: Increase in serum progesterone supports the role of pregnancy in melasma.
  - 1,249 69
Evaluation of dapoxetine hydrochloride in treatment of primary premature ejaculation
Abdallah M Attia, Sherif M Abo-elmaaty
April-June 2016, 29(2):393-395
DOI:10.4103/1110-2098.192410  
Objective: The aim of the study was to evaluate the role of dapoxetine in treatment of primary premature ejaculation (PE). Background: PE is regarded as the most common male sexual disorder. To date, there is no accurate and objective diagnostic test or specific treatment for PE. Dapoxetine hydrochloride is recently developed for treatment of primary PE. It is a short-acting selective serotonin reuptake inhibitor. Although it was refused by the food and drug administration (FDA) in 2005, it is now available in many countries, including Egypt, for treatment of PE. Its efficacy and side effects are not fully studied and few studies exist in this regard with controversial results. Materials and methods: This was a double-blind, placebo-controlled, cross-over study. It included 24 patients with primary PE, selected according to the International Society of Sexual Medicine definition of primary PE with intravaginal ejaculatory latency time (IELT) less than 1 min. The patients received dapoxetine 60 mg and placebo for 6 weeks, each with 2 weeks in between as a washout period. The drug and placebo were received on demand 1–3 h before the sexual activity. Efficacy and tolerability were evaluated by IELT and Arabic index of premature ejaculation (AIPE) mean score changes, and the side effects were reported upon at baseline and at 1, 3, and 6 weeks. Results: Dapoxetine significantly increased IELT by first, third, and sixth week and the geometric mean by 5.15 ± 0.17 folds, and with dapoxetine (60 mg) the AIPE became normal in 88.9% of patients by the sixth week, whereas placebo failed to give any change. Conclusion: Dapoxetine is a promise drug for PE as on-demand treatment. Dapoxetine significantly improved the IELT and AIPE, and it is well tolerated.
  - 827 57
Caspase-3 expression in lichen planus
Alaa H Maraeea, Hala S El-Rebey, Eman A Zaky
April-June 2016, 29(2):396-405
DOI:10.4103/1110-2098.192428  
Objective: The aim of this study was to examine keratinocyte apoptosis and caspase-3 expression in lichen planus (LP). Background: Caspase-3 expression level in LP lesions is considered a reliable marker of apoptosis, which is frequently found in LP, but the pathways leading to apoptosis are unknown. Patients and methods: A total of 25 skin biopsy specimens from LP lesions were used and 17 healthy volunteers were used as controls. Histopathological examination of hematoxylin and eosin-stained sections of LP was carried out for the evaluation of histopathological parameters. The expression of caspase-3 was examined immunohistochemically. Results: There were highly significant differences between caspase-3 immunostaining in epidermal keratinocytes in normal skin and the lesional area of LP (P= 0.006). No statistically significant correlation was found between caspase-3 expression in keratinocytes of LP cases and the histopathological parameters studied. No statistically significant correlation was found between caspase-3 expression in dermal lymphocytes and the histopathological parameters studied. A significant relation was found between various intensities of caspase-3 expression in dermal lymphocytes and the age of the individuals (P= 0.03), where the younger age group showed a strong intensity, whereas in older individuals, the mild expression predominated, which may indicate more severe disease with more apoptosis in early-onset LP. Conclusion: Caspase-3 expression in epidermal keratinocytes and dermal lymphocytes may play a role in the pathogenesis of LP.
  - 446 58
Inducible clindamycin resistance among clinical isolates of Staphylococcus aureus
Amira A Kilany
April-June 2016, 29(2):228-233
DOI:10.4103/1110-2098.192418  
Objective: The aim of the study was to detect the presence of inducible clindamycin resistance among clinical isolates of Staphylococcus aureus. Background: The resistance to antimicrobial agents among staphylococci is an increasing problem. This has led to renewed interest in the usage of macrolide–lincosamide–streptogramin B (MLSB) antibiotics to treat S. aureus infections. The resistance to macrolide can be mediated by the msrA gene coding for efflux mechanism or by the erm gene encoding for enzymes that confer inducible or constitutive resistance to MLSB antibiotics. Materials and methods: Ninety staphylococcal isolates were collected and were tested for antibiotic susceptibility using the disk diffusion method. Inducible resistance to clindamycin in S. aureus was tested by using the double disk diffusion test as per CLSI guidelines. Results: Inducible MLSBresistance (EryRClinInd) was seen in 7/90 (7.7%) isolates, the constitutive phenotype of MLSBresistance (EryRClinR) was detected in 6/90 (6.6%) isolates, and the MSBphenotype (EryRClinS) was seen in 34 (37.7%) isolates. In these isolates, inducible clindamycin resistance was detected in 4.3% (3/70) of S. aureus and 20% (4/20) of coagulase-negative staphylococci. Conclusion: This study showed that the double disk diffusion test should be used as a mandatory method in routine disk diffusion testing to detect inducible clindamycin resistance in staphylococci for the optimum treatment of patients.
  - 678 95
Comparison between different lines of treatment of typhoid fever
Reda S Badra, Sabry A Shoeiba, Amira A El-Hendy, Asmaa M Mousa Nasr
April-June 2016, 29(2):234-239
DOI:10.4103/1110-2098.192405  
Objective: This study was conducted to evaluate the status in antimicrobial susceptibility patterns of Salmonella typhi obtained from blood culture in Shebin El-Kom Fever Hospital. Background: Enteric fever is a global health problem, and rapidly developing resistance to various drugs makes the situation more alarming. Drug sensitivity in S. enterica typhi and paratyphi A isolated from 60 blood culture-positive cases of enteric fever was tested to determine in-vitro susceptibility pattern of prevalent strains. Materials and methods: Strains isolated from 60 blood culture-positive cases of typhoid and paratyphoid fever over a period of 5 months were studied about their sensitivity patterns to chloramphenicol and ciprofloxacin, and were analyzed. Results: Our study revealed that there was a high sensitivity of S. enterica typhi and paratyphi A to chloramphenicol and ceftriaxone (100%) and resistance to ciprofloxacin (20%). Conclusion: These findings suggest changing patterns of antibiotic resistance in enteric fever with re-emergence of chloramphenicol sensitivity and ciprofloxacin resistance in Shebin El-Kom Fever Hospital, Egypt.
  - 1,128 154
Renal failure index and assessment of renal function in asphyxiated newborns
Maha A Tawfik, Ahmed T Mahmoud, Osama H Elnggar
April-June 2016, 29(2):240-246
DOI:10.4103/1110-2098.192449  
Objective: To assess the renal failure index (RFI) in asphyxiated neonates in relation to other clinical and laboratory findings among those with acute renal failure, whether prerenal or intrinsic renal failure. Background: Asphyxia is an important cause of morbidity and mortality among neonates. It leads to multiorgan dysfunction and redistribution of cardiac output to maintain cerebral, cardiac and adrenal perfusion while potentially compromising renal, gastrointestinal and skin perfusion. Thus, acute renal failure is recognized as a complication of birth asphyxia. Materials and Methods: This case–control study included 80 neonates divided into two groups: the patient group (40 babies with perinatal asphyxia) and the control group (40 normal babies). In all patients, hypoxic ischemic encephalopathy staging (Sarnat and Sarnat) was performed. Blood and urinary parameters for renal function were assessed in all newborns, and fractional excretion of sodium (FENa) and the RFI were also calculated. The results obtained were analyzed and compared within subgroups using the computer program statistical package for social science, version 16. Results: Acute renal failure was noted in 19 patients in the patient group (47.5%): 16 of them (40%) had prerenal failure and three had intrinsic renal failure (7.5%). FENa and the RFI were found to be the most useful in evaluating babies with renal failure, as these derived renal indices were more reliable than individual parameters. FENa and RFI increased with increasing hypoxic ischemic encephalopathy staging. Conclusion: Perinatal asphyxia is an important cause of neonatal acute renal failure, which is predominantly prerenal failure. FENa and RFI are useful parameters for assessing the renal function in these neonates and can be used to differentiate prerenal failure from intrinsic renal failure, and thus helps in proper management.
  - 985 61
A clinical study investigating the impact of adding silymarin to combined therapy (pegylated interferon+ribavirin) on hepatitis C virus viremia
Reda S Badr, Said S Khamis, Khalid El-zorkani, Ahmed M Shakwar
April-June 2016, 29(2):192-197
DOI:10.4103/1110-2098.192420  
Objectives: The aim of the study was to evaluate the impact of oral silymarin in hepatitis C virus (HCV) infection when added to conventional treatment [pegylated interferon (IFN)+ribavirin]. Background: Oral silymarin is widely used for the treatment of HCV as an additive to the conventional therapy but its efficacy is unclear. Participants and methods: Sixty consecutive HCV patients referred to our clinic for treatment were recruited. All patients were on combined 180 μg of IFN subcutaneous weekly injection and 800–1200 mg/day ribavirin orally. Patients were randomized into two groups each of 30 patients: the first group received silymarin 140 mg/day orally, whereas the other group did not. Patients had their liver enzymes [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] and complete blood count checked at baseline and at 12 weeks from the start of treatment. PCR was performed at 12 and 24 weeks from the start of treatment and at 24 weeks after treatment completion. Results: The mean age was 37.6 ± 7.9 years, and 23 (38%) patients were female. There was no significant difference between groups regarding their age, sex, AST, ALT, or complete blood count. Compared with patients who did not have silymarin, patients who had silymarin showed significantly lower ALT (29.5 ± 15.7 vs. 44.4 ± 30.4 U/l, P = 0.021), lower AST (26.6 ± 11.5 vs. 40 ± 31 U/l, P = 0.03), similar hemoglobin (11 ± 1.1 vs. 10.6 ± 0.9 g/dl, P = 0.1), higher platelets (170.1 ± 61.9 vs. 133.6 ± 43 × 103/mm3, P = 0.011), and a higher white cell count (3.6 ± 1.1 vs. 2.9 ± 0.8 × 103/mm3, P = 0.011). According to PCR, 24 (80%) patients who received silymarin showed an early virologic response at 12 weeks, whereas only 18 (60%) patients who did not receive silymarin showed early virologic response (P = 0.09). Twenty-four weeks after the completion of therapy, sustained virologic response occurred in all silymarin patients and in only 13 (43%) patients who did not have silymarin (P = 0.003). Conclusion: Silymarin may increase the antiviral response and adds a protective benefit against side effects of the conventional IFN/ribavirin therapy in HCV patients.
  - 632 107
Study of urinary neutrophil gelatinase-associated lipocalin as a predictor of acute kidney injury in postliver transplant recipients
Hassan Abdel-Hady, Said S Khamis, Mahmoud A Kora, Emad F Abdel-Halim, Wael M Abdel-Razek, Mohamed H Badr
April-June 2016, 29(2):198-208
DOI:10.4103/1110-2098.192432  
Objective: The aim of this work is to study the value of urinary neutrophil gelatinase-associated lipocalin (u-NGAL) as an early predictor for the occurrence of acute kidney injury (AKI) in patients undergoing liver transplantation (LT) in comparison with the SCr and RIFLE i (Risk, Injury, and Failure; and Loss; and End-stage kidney disease) classification. Background: Renal dysfunction is common after LT. The incidence of AKI complicating the post-transplant period varies between 48 and 94% and affects both short-term and long-term outcomes. Mortality in those requiring renal replacement therapy may be as high as 40% at 90 days, increasing to 54% at 1 year. Materials and methods: This study was carried on 30 hepatic patients who underwent LT in the National Liver Institute, Menoufiya University, Egypt, in the period from June 2012 to May 2014. Thorough assessment of history, clinical examination and preoperative routine investigations, and baseline renal functions including assessment of GFR by renal scan were performed. Operative data were collected during LT; patients were also assessed 5 days postoperatively for the occurrence of AKI by SCr, urine output and RIFLE classification, and u-NGAL. Results: Fourteen of 30 patients (46.7%) fulfilled the criteria of the RIFLE classification and had AKI; in these patients, there was a significant relation between the RIFLE classification and the cause of LT, preoperative platelet count, the use of basiliximab in the induction of immunosuppression, and day 1, day 2 u-NGAL. u-NGAL levels above the cut-off value of 1300 pg/ml at day 1 and 4440 pg/ml at day 2 are considered good predictors of AKI post-LT, with AUROC 0.77 and 0.77, respectively, with an acceptable accuracy of 66.7 and 73.3%, and high sensitivity and specificity for prediction of AKI post-LT, and correlate significantly with different preoperative and operative parameters. Conclusion: u-NGAL is a valuable marker for early detection of AKI in patients undergoing LT before an increase in SCr occurs. Levels above the cut-off value (1300 pg/ml) have a high sensitivity, specificity, and positive predictive value for AKI after LT.
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Retinopathy in type 2 diabetes mellitus patients with and without chronic hepatitis C virus infection
Nabil El-Kafrawy, Alaa Dawood, Seham Khodeer, Hany Khairy, Walaa Abd El-Elah Darwish
April-June 2016, 29(2):209-214
DOI:10.4103/1110-2098.192482  
Objective The aim of the study was to evaluate the effect of chronic hepatitis C virus (HCV) infection in the prevalence of diabetic retinopathy. Background Diabetes mellitus (DM) is associated with significant morbidity and mortality as a result of both microvascular and macrovascular complications. Type 2 diabetes mellitus (T2DM) and HCV infection are two major public health problems worldwide. Patients and methods In this study, we examined 70 patients with T2DM who were selected for this prospective study from the outpatient clinics of Internal Medicine and Ophthalmology Departments. Patients were classified into two groups: group I and group II: group I comprised 38 patients with T2DM without HCV infection. Group II comprised 32 patients with T2DM with positive HCV infection. All patients were subjected to detailed history taking, clinical examination, and laboratory investigations including complete blood picture, glycosylated hemoglobin (HbA1C) level, PCR test to prove the presence of HCV infection, prothrombin time, international normalized ratio, fibrinogen, platelet count and mean platelet volume, liver function tests including aspartate aminotransferase, alanine aminotransferase, serum albumin, and total serum bilirubin, and ophthalmoscopic examinations for diagnosis of diabetic retinopathy. Results Retinopathy was higher in T2DM patients: 27 (71.1%) patients were positive for retinopathy and 11 (28.9%) patients were negative, compared with chronic HCV-DM patients, among whom 13 (40.6%) were positive for retinopathy and 19 (59.4%) were negative. This difference is high enough to produce significant statistical difference (P = 0.014). Platelet count, fibrinogen concentration, and mean platelet volume were increased in diabetic retinopathy patients. International normalized ratio and prothrombin time levels were significantly higher in diabetic patients with chronic HCV infection than in diabetic patients without HCV infection. Conclusion Diabetic retinopathy was significantly higher in diabetic patients without chronic HCV infection than in diabetic patients with chronic HCV infection.
  - 529 78
Haematological parameters of newborns delivered vaginally versus caesarean section
Fady M El Gendy, Alif A Allam, Maha M Allam, Rania K Allam
April-June 2016, 29(2):259-264
DOI:10.4103/1110-2098.192429  
Objectives: This study aimed to evaluate the effect of mode of delivery on the haematological parameters of newborns (caesarean section against normal vaginal delivery). Background: Complete blood count (CBC) correlates highly with gestational age, birth weight, blood sampling site, crying, physical therapy, mode of delivery and other factors. Participants and methods: This study was carried out on 72 neonates. Group I included 31 neonates delivered vaginally. Group II included 41 neonates delivered by caesarean section. CBC was performed on these neonates from umbilical cord blood immediately after birth. Results: Haemoglobin, red blood cell count, haematocrit, platelet, total leucocyte count, neutrophils, eosinophils and basophils in full-term neonates delivered vaginally were significantly higher than those of neonates delivered by caesarean section. However, there was no significant difference in the mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width, lymphocytes and monocytes. There was a significant increase in haemoglobin, red blood cell count, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, red cell distribution width, platelets, total leucocyte count, neutrophils, eosinophils and lymphocytes in preterm neonates delivered vaginally than those delivered by caesarean section, whereas there was no significant difference in the mean corpuscular haemoglobin concentration, basophils and monocytes. Conclusion: Mode of delivery is one of the perinatal factors that affects neonatal CBC.
  - 1,057 125
Effect of omega-3 supplementation on lipid profile and inflammatory markers in children on chronic hemodialysis
Ali M Elshafie, Mohammed H Bahbah, Fathia M Elnemr, Ghada M Elmeshad, Mohamed A Mohamed Elsayed
April-June 2016, 29(2):265-268
DOI:10.4103/1110-2098.192431  
Objectives: The aim of this study was to evaluate the effect of omega-3 supplementation on the lipid profile and inflammatory markers in children on chronic hemodialysis. Background: Children with end-stage renal disease on hemodialysis are at a high risk of adverse cardiovascular events. Dyslipidemia is an important risk factor for cardiovascular morbidity and mortality in dialysis patients, Patients who are on hemodialysis have elevated serum levels of inflammatory markers. There is a growing interest in the application of omega-3 fatty acids in the prevention of cardiovascular disorders in dialysis patients. Omega-3 fatty acids have been postulated to reduce proinflammatory response, confer antithrombotic properties, improve lipid levels (particularly triglycerides), and improve endothelial function. Materials and methods: This clinical trial was conducted in 23 children with end-stage renal disease undergoing dialysis in the pediatric hemodialysis unit of Menoufia University Hospitals. The patients received 1 g omega 3 per day for 3 months. Blood samples were obtained from the patients studied before and at the end of the study for hemoglobin, ferritin, triglyceride, total cholesterol, LDL-c and HDL-c, and high specific-C-reactive protein measurement, and the differences were analyzed. Results: Of 23 patients, 12 were males and 11 were females, mean age 14.52 (8–18) years. There were statistically highly significant differences between the level of triglycerides before (148.86 ± 44.41 mg/dl), and after supplementation with omega-3 fatty acid (135.17 ± 45.99 mg/dl) (P<0.001). The differences found in hemoglobin, parathyroid hormone, ferritin, C-reactive protein, LDL-c, and HDL-c before and after supplementation with omega-3 fatty acid were not statistically significant (P> 0.05). Conclusion: The use of omega 3 led to a significant decrease in serum levels of triglycerides in children on hemodialysis, and its use may be recommended in such patients.
  - 647 64
Evaluation of iron-deficiency anemia in infancy
Fahima M Hassan, Fady M El-Gendy, Hassan S Badra, Samar M Kamal Eldin, Dina M.M Elsayyad
April-June 2016, 29(2):269-274
DOI:10.4103/1110-2098.192412  
Objective: The aim of this study was to evaluate iron-deficiency anemia (IDA) in infancy in relation to different patterns of feeding (exclusive breast milk, exclusive cow's milk, and milk fortified with iron). Background: Iron is a component of several metalloproteins and plays a crucial role in vital biochemical activities, such as oxygen sensing and transport, electron transfer, and catalysis. The biological functions of iron are based on its chemical properties. Decreased hemoglobin level and decreased serum ferritin level aid the identification of IDA in infants. Patients and methods: This study included 147 infants with different patterns of feeding (exclusive breast fed, exclusive cow's milk fed, and iron-fortified formula). The studied groups were subjected to a full detailed assessment of history, thorough clinical examination, anthropometric measurements, complete blood count, and determination of serum iron, serum ferritin, and total iron-binding capacity. Results: In our study, the results showed that 84 (57.1%) infants of the total group studied (147 infants) were found to have IDA. According to sex, IDA among girls was 51.2%, which is higher than that found among boys (48.8%). IDA was much higher in cow's milk-fed infants 24 (96%) than exclusively breast milk-fed infants 47 (66.2%), and less in infants receiving mixed feeding with a fortified formula, 13 (25.5%), respectively. Conclusion: Our study found that infants aged 6–24 months represent one of the highest risk groups to develop IDA (57.1%) of the total study. The risk factors for IDA include consumption of cow's milk during the first year, delaying the introduction of solid foods, and lack of fortification of food with iron after 6 months of age.
  - 577 74
Correlation between clinical examination and ultrasound of liver and spleen span in normal children between 12 and 18 years
Ali M EL Shafie, Fathia M Elnemr, Alif A Allam, Moatseem Bedin Allah F Elemy
April-June 2016, 29(2):275-279
DOI:10.4103/1110-2098.192417  
Objectives: The aim of the study was to determine liver and spleen span in normal Egyptian school children of 12–18 years of age in El-Gharbiah governorate using the ultrasonographic method. Background: A sound measurement of the liver and spleen size in children of different age groups is necessary to help the pediatrician exclude hepatomegaly and splenomegaly. Patients and methods: This study included 300 healthy Egyptian school children from El-Gharbiah governorate — Kotour district. The age of the children ranged from 12 to 18 years (156 boys and 144 girls). The children were divided into six groups (12 up to 13 years, 13 up to 14 years, 14 up to 15 years, 15 up to 16 years, 16 up to 17 years, and 17 up to 18 years). The age, weight, and height were assessed, and the BMI was calculated. The clinical liver span was estimated by percussion and palpation and compared with ultrasonography; in addition, the spleen size was obtained by ultrasound (US). Results: Normal liver and spleen length and range were obtained sonographically. There was strong positive correlation between clinical liver span and age, weight, height, BMI, and US liver longitudinal at midclavicular line and at midline diameters. In addition, there was strong positive correlation between US liver at midclavicular line and age, weight, height, BMI, US liver longitudinal at midline, and US spleen diameters (P<0.001). Conclusion: The study provides the normal values of clinical liver span and ultrasonography of liver and spleen size in healthy children from 12 to 18 years of age.
  - 1,195 62
Carotid intima–media thickness in children with end-stage renal disease on hemodialysis
Ali M Elshafie, Mohammed H Bahbah, Fathia M Elnemr, Seham M Ragab, Zein A Saber Omar
April-June 2016, 29(2):280-284
DOI:10.4103/1110-2098.192440  
Objectives: The aim of this study was to study carotid artery intima–media thickness (CIMT) in children with end-stage renal disease who are undergoing hemodialysis. Background: Cardiovascular morbidity and mortality are common in patients with end-stage renal disease. Patients and methods: The study involved 60 children divided into three groups: 20 children had chronic kidney disease on conservative therapy (group I) (predialysis), 20 children were undergoing hemodialysis (group II), and 20 children constituting the control group (group III). All participants were subjected to detailed history taking and clinical examination. Laboratory investigations included evaluation of complete blood picture, serum creatinine, blood urea, calcium (Ca), phosphorus (PO4), uric acid, C-reactive protein, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, total bilirubin, and albumin. The glomerular filtration rate was calculated from serum creatinine using the Schwartz formula. All participants underwent measurements of CIMT by means of ultrasonography. Results: There was a significant increase in CIMT in group I and group II when each group was compared with group III. CIMT had a significant positive correlation with systolic and diastolic blood pressure, C-reactive protein, serum urea, creatinine, parathyroid hormone, total bilirubin level, and total cholesterol levels. CIMT had a significant negative correlation with BMI, hemoglobin level, hematocrit, estimated glomerular filtration rate, serum calcium, albumin, and high-density lipoprotein levels. Conclusion: Chronic kidney disease is associated with increased CIMT. This suggests that even in young children uremia and/or metabolic alterations have a profound impact on the arterial structure and function leading to cardiovascular morbidity and mortality.
  - 499 54
Transarterial ethanol ablation of hepatocellular carcinoma with lipiodol–ethanol mixture
Adel M El Wakeel, Mohammed S El Warraky, Tarek F Abd Ella, May S El Safty
April-June 2016, 29(2):285-290
DOI:10.4103/1110-2098.192426  
Objective: The aim of the study was to determine the safety and effectiveness of transarterial embolization ablation (TEA) of hepatocellular carcinoma (HCC) with a lipiodol–ethanol mixture. Background: TEA is a new treatment strategy for HCC, and some researchers have reported its effectiveness in HCC. Patients and methods: This study was a prospective cohort study conducted at the National Liver Institute and Faculty of Medicine, Menoufia University, and included 40 patients having unresectable HCCs. At 3 and 6 months after TEA, triphasic computed tomography was performed, and tumor responses were assessed using a modified version of Response Evaluation Criteria in Solid Tumor (mRECIST). Results: Every case was treated. At 3 and 6 months after embolization, contrast computed tomography showed no enhancing lesions. a-Fetoprotein levels were significantly reduced (12.18 ± 15.67) at 6 months after treatment. The partial and complete responses of tumors were 12.5 and 87.5%, respectively, 6 months after treatment. The overall survival rate was 90%. Conclusion: TEA is an effective therapy for patients with unresectable HCC.
  - 506 61
Multidetector computed tomography in the detection of hepatocellular carcinomas meeting the Milan criteria before liver transplantation
Elsayed E Elsayed, Enas M Koryem, Sarah A Mohammed
April-June 2016, 29(2):291-296
DOI:10.4103/1110-2098.192448  
Objective: The purpose of this study was to assess the diagnostic performance of multidetector computed tomography (MDCT) in the detection of hepatocellular carcinoma (HCC) in cirrhotic patients who are recommended for liver transplantation according to the Milan criteria. Background: Liver transplantation has been considered to be the only causal treatment for patients with liver cirrhosis and HCC because of its theoretical advantage of eliminating both the tumor and liver disease. However, because of the shortage of donor organs, it is strongly recommended that liver transplantations be performed on cirrhotic patients with HCCs only when the patients meet the predetermined criteria. Imaging is thus decisive in the inclusion or exclusion of patients from transplantation lists. Patients and methods: This study included 35 patients (29 male and six female) with ages ranging from 39 to 60 years presented to the Transplantation Unit of the National Liver Institute, Menoufia University, during the period between May 2013 and December 2014. Potential recipients with focal lesion on their ultrasound underwent triphasic computed tomography. After liver transplantation, the imaging findings were correlated with histopathological findings in the explanted livers on a patient-by-patient and a lesion-by-lesion basis. Results Histopathologic examination revealed 46 HCCs in 31 of 35 patients, whereas MDCT revealed 42 HCCs in 30 of 35 patients. A patient-by-patient analysis showed that the sensitivity of MDCT in the detection of HCC was 90.3%, its specificity was 50%, and its accuracy was 85.7%. Conclusion: MDCT has reasonable sensitivity and high diagnostic accuracy in the detection of HCC in cirrhotic patients indicated for liver transplantation according to the Milan criteria.
  - 377 35
Role of multidetector computed tomography without contrast enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi
Alaa Mohamed Mohamed El Mahdy, El Sayed El Mekkawy El Sayed
April-June 2016, 29(2):297-302
DOI:10.4103/1110-2098.192414  
Objective: The aim of this study was to evaluate the role of nonenhancing computed tomography as a predictive factor for successful extracorporeal shock wave lithotripsy (ESWL) for urinary calculi to avoid the cost of ineffective ESWL. Background: Urolithiasis is a universal problem. Many methods of treatment of urolithiasis are described, among which is ESWLs. The outcome of ESWL is affected by several factors. Multidetector computed tomography (MDCT) can aid the localization of calculi and may provide accurate anatomical detail, providing valuable data such as stone size and stone density as predictors for ESWL success. Materials and methods: This study included 54 patients who presented with symptomatic renal colic and hematuria at the ESWL unit. ESWL was used as the primary treatment option for all patients. All patients were investigated by MDCT before and after ESWL treatment. Successful ESWL was defined when a patient had achieved complete clearance of the stone fragments or had small residual gravels of size less than 4 mm. ESWL failure was defined as no breakage of the stone after three sessions. Results: A high rate of ESWL success after a second session of ESWL was achieved in 26 cases (48.1%), followed by a first session in 15 cases (27.8%), with an overall success rate of 90.7% in 49 cases. Also, smaller size and density of urinary stones will increase the success rate of ESWL. Conclusion: MDCT can be used to provide valuable data on urinary stones to aid treatment decisions and predict the outcome of ESWL.
  - 799 118
The role of diffusion-weighted MRI in the evaluation and differentiation of space-occupying brain lesions
Amira I Baghdady, Mohamed A Maaly, Adel M El-wakeel, Waleed A Mousa
April-June 2016, 29(2):303-311
DOI:10.4103/1110-2098.192445  
Objectives: The aim of this study was to assess the role of diffusion-weighted MRI in the evaluation and differentiation of space-occupying brain lesions in patients whose conventional MRI (cMRI) examination revealed abnormal imaging features suggestive of space-occupying brain lesions. Diffusion-weighted imaging provides information about the physiological properties of the tumor that have been linked to cellularity, structural integrity, and necrotic transformation of brain or tumor tissue. MR diffusion imaging has become a powerful, multifaceted tool both for very basic clinical needs and for advanced, specialized diagnosis and treatment planning. Background: This study included 75 patients who presented with acute focal neurological deficit or with manifestations of space-occupying brain lesions. All of these patients were subjected to cMRI examination of the brain and to diffusion-weighted MRI. Postprocessing of apparent diffusion coefficient (ADC) maps was generated for all patients. Standard mean ADC values were calculated automatically and expressed in 10−S mm2/s. The cutoff value of 1 × 10−3 mm2/s was used to differentiate restricted areas from nonrestricted areas. Patients and methods: Among the 75 studied patients, the final diagnosis was intracranial neoplastic lesions (group A) in 46 patients (61.3%), non-neoplastic tumor-like lesions (group B) in 17 patients (22.6%), intracranial suppuration (group C) in seven patients (9.3%), and intracerebral hemorrhage (group D) in five patients (6.6%). Analysis of calculated ADC values using the t-test, the U-test, analysis of variance, and the c2-test revealed statistical difference of ADC values between high-grade/low-grade gliomas, abscesses, and intracranial necrotic neoplasms including glioblastoma multiforme, lymphoma/high-grade astrocytoma, medulloblastoma/ependymoma and pilocytic astrocytoma, and epidermoid/arachnoid cysts. Results On the basis of simplicity of the method and the results obtained, diffuse-weighted imaging should be used routinely as a valuable noninvasive tool besides cMRI, whenever available, to reach a definitive final diagnosis.
  - 2,112 245
Retinoblastoma protein interacting zinc finger 1 gene in hematological malignancies
Fathia I EL-Bassal, Khaled A Khalifa, Olfat M Hendy, Samar M Kamal
April-June 2016, 29(2):312-318
DOI:10.4103/1110-2098.192406  
Background: Several lines of evidence have shown that inactivation of tumor suppressor genes is closely associated with tumorigenesis in a wide variety of hematological malignancies. The role of downexpression of the RIZ1 gene in hematological malignancy has been reported in many studies, but its levels after receiving induction therapy in these patients have not been evaluated, which was the aim of this study. Objective: The current study aimed to find the relationship between expression of RIZ1 in cases of hematological malignancies before the start of induction therapy and at the end of induction therapy and its possible role as a risk factor in disease progression. Patients and methods: The study included two groups of patients: group I included 26 newly diagnosed patients with hematological malignancies before the start of induction therapy (day 0) and group II included 12 patients at the end of induction therapy (day 28). Group III included 10 individuals with another indication for bone marrow (BM) (such as peripheral blood unexplained cytopenia) who were age and sex matched with the patients and were enrolled in the study as a control group. The following investigations were performed for all the participants: complete blood count, BM sample for morphological examination, immunophenotyping, and cytogenetic analysis. The levels of RIZ1 gene expression were detected by real-time PCR (RT-qPCR) at diagnosis (day 0) and after induction therapy (day 28). Results: The mean levels of RIZ1 gene expression in day 0 patients were significantly lower than those of the control group, and at the end of induction therapy (on day 28), the level was significantly increased to reach close to that in the healthy controls. Furthermore, the levels of the RIZ1 gene were negatively correlated with the blast cell counts in peripheral blood and BM. Conclusion: We conclude that the RIZ1 gene is downexpressed in leukemic patients and its levels increased after induction therapy, indicating its possible role in disease pathogenesis. The relationship between its level and risk factors suggests its role in disease progression. A large-scale study is recommended for the use of the RIZ1 gene in the therapy of hematologic malignancies.
  - 399 36
CD19+CD5+ B-cell expansion and risk of pre-eclampsia
Rawhia H Eledel, Maha A Bassuoni, Wafaa M Radwan, Alaa Masoud, Sara M Eldeeb
April-June 2016, 29(2):319-323
DOI:10.4103/1110-2098.192433  
Background: Pre-eclampsia (PE) is a devastating pregnancy-associated disorder affecting 5–8% of pregnant women worldwide. It emerges as an autoimmune-driven disease. The autoantibodies against angiotensin type 1 receptor II have been proposed to account for PE symptoms. CD19(+)CD5(+) B-1a B cells constitute the main source of natural and polyreactive antibodies, which can be directed against own structures. Objectives: The aim of this study was to identify the B-cell subpopulation responsible for autoantibody production during PE and its correlation with b subunit of hCG levels. CD19+CD5+ B-cell percentages were measured using flow cytometry in 36 PE women in their third trimester (20 severe and 16 mild) and 15 age-matched normotensive pregnant women with normally developing pregnancies in their third trimester. Patients and methods: We observed significantly higher levels of frequency of CD19+/CD5+ B lymphocytes in the mild and severe PE groups compared with the levels observed in normotensive women with normally developing pregnancies in the third trimester (mild PE, 28.7 ± 14.3%, n = 16; severe PE, 29.9 ± 9.8%, n = 20; control, 11.3 ± 6.4%, n = 15; P < 0.01 and P < 0.001, respectively). However, comparison of the mild PE group with the severe PE group showed comparable levels of CD19+/CD5+ B cells (P > 0.05). Results: Correlation between the percentages of CD19+/CD5+ B lymphocytes and b hCG levels was not significant. Moreover, correlations between the percentages of CD19+/CD5+ B lymphocytes and other laboratory parameters were not significant. Conclusion: CD19+/CD5+ cells emerge as a novel PE marker. Their frequency does not seem to be regulated by the increased serum hCG levels. The detection and quantification of CD19+/CD5+ cells in maternal blood may open vast new therapeutic opportunities.
  - 532 48
Osteoprotegerin in type 2 diabetic patients with microalbuminuria
Gehan K El-Saeed, Said S Ahmed Khamis, Seham Khodeer, Rawaby A Atta
April-June 2016, 29(2):324-329
DOI:10.4103/1110-2098.192424  
Objectives: The aim or the study is to study the role of osteoprotegerin (OPG) in type 2 diabetic (T2DM) patients with microalbuminuria as an early marker of atherosclerosis. Background: OPG is a bone-related glycopeptide produced by vascular smooth muscle cells because of arterial damage. OPG is a glycoprotein that is part of the tumor necrosis factor receptor superfamily mainly involved in bone metabolism, but it is also found in various other tissues such as vascular smooth muscle cells. Participants and methods: The study included 80 individuals divided into three groups: group I included 20 T2DM patients without microalbuminuria, group II included 40 T2DM patients with microalbuminuria, and group III included 20 healthy individuals as controls. For all participants, the following were performed: assessment of history, clinical examination including BMI, systolic blood pressure, and diastolic blood pressure, and assessment of fasting blood glucose, glycated hemoglobin, lipid profile, serum creatinine and urea, microalbumin in urine, serum OPG, and carotid artery duplex for measurement of carotid intima media thickness (CIMT). Results: Group II had significantly higher values of fasting blood glucose, glycated hemoglobin, serum creatinine and urea, total cholesterol, triglycerides, LDL-cholesterol and CIMT compared with groups I and III. OPG levels were significantly higher in diabetics than in the controls; the highest level was observed in group II (10.49 ± 3.17), followed by group I (6.24 ± 1.10), and group III (3.66 ± 1.88). OPG levels were significantly correlated to CIMT, urea, creatinine, and lipid profile. Conclusion: OPG could be used as an early marker of atherosclerosis in patients with T2DM, especially those with microalbuminuria.
  - 501 57
Effect of apolipoprotein B-100 EcoRI polymorphism on serum lipids and insulin resistance in obese children
Belal A El Mohsen Montaser, Gehan K Sead, Emad F Haleim, Hanzada I Fattah, Waleid F Azeim
April-June 2016, 29(2):330-336
DOI:10.4103/1110-2098.192436  
Objective: The aim of this work was to evaluate the role of apolipoprotein B-100 (ApoB-100) Eco RI gene polymorphism on serum lipid parameters and BMI in obese children and its possible relationship with insulin resistance. This is the first study in Egypt to determine possible relationships of these parameters. Background: ApoB-100 is a large, amphipathic glycoprotein playing a central role in human lipoprotein metabolism and is required for very low-density lipoprotein production in the liver. ApoB-100 is also the ligand for low-density lipoprotein-receptor-mediated endocytosis of low-density lipoprotein particles. There are several known ApoB-100 polymorphisms that were proven to cause obesity, hyperlipidemia, and cardiovascular diseases. Three common polymorphisms were found, MspI, XbaI, and Eco RI (exon 26), which have been associated with variation in lipid levels. Materials and methods: BMI was calculated, fasting serum lipids were assayed by routine techniques on Synchron systems, serum fasting insulin was assayed by ELISA technique, HOMA-IR was calculated, DNA was extracted from whole blood, amplified, and then ApoB-100 Eco RI polymorphism was assayed using PCR-RFLP. Results: The results of this study revealed that there was a significant statistical difference in BMI, lipid profile, insulin, and insulin resistance between positive Eco RI and negative Eco RI polymorphisms, and hence there was a direct positive relationship between ApoB-100 Eco RI polymorphism and all studied parameters. Results were collected, tabulated, and statistically analyzed using the statistical package for the social sciences (SPSS, version 11). Two types of statistics were performed: the Mann–Whitney U-test and Pearson's correlation. Conclusion: This study revealed a great association between ApoB-100 Eco RI gene polymorphism and atherogenic hyperlipidemia and insulin resistance in obese pediatric patients.
  - 457 50
Evaluation of interleukin-6 and C-reactive protein in patients with breast cancer at Menoufia University Hospitals
Gehan K El Saeed, Dalia M Hosny Abou-elela, Mona T Ahmed El-Gendy
April-June 2016, 29(2):337-340
DOI:10.4103/1110-2098.192447  
Objectives: The aim of this study was to determine the serum level of interleukin-6 (IL-6) and C-reactive protein (CRP) in patients with breast cancer and to correlate them with the staging of the disease. Background: Breast cancer is a disease that continues to plague women. IL-6 and CRP are found to be elevated in various inflammatory and malignant diseases, and their levels are found to correlate with the extent of the disease. Patients and methods: A total of 39 female patients with breast cancer were identified for the study. Serum level of IL-6 was assessed with enzyme-linked immunosorbent assay, and CRP was measured by means of immunoturbidimetry. The patients were classified into six groups on the basis of the pathological Tumor-Node-Metastasis (TNM) system. Statistical analyses of the data were then processed. Results: Increase in cancer invasion and staging are generally associated with increase in preoperative serum IL-6 and CRP level. IL-6 and CRP level correlate with lymph node metastasis (P > 0.001) and distant metastasis (P > 0.001). Serum IL-6 and CRP level correlate with TNM staging (P > 0.001). Conclusion: The levels of IL-6 and CRP have a positive correlation with the TNM staging system of breast cancer. Hence, IL-6 and CRP could be used as parameters to assess the prognosis of breast cancer patients.
  - 467 45
Detection of circulating lamin B1 and glypican-3 for early diagnosis of hepatocellular carcinoma patients
Gehan K El-Saeid, Amira A Al-Hendy, Olfat M Hendy, Waleed M Fathy, Heba S Mohammed Ghanem
April-June 2016, 29(2):341-348
DOI:10.4103/1110-2098.192442  
Objective: To assess circulating lamin B1 (LMNB1) mRNA and glypican-3 cytotoxic T lymphocytes (CTLs) as markers for early detection of hepatocellular carcinoma (HCC). Background: HCC is the fifth most common form of cancer worldwide and the third most common cause of cancer-related deaths. HCC often occurs in the background of a cirrhotic liver. In recent years, surveillance strategies in patients at a higher risk of HCC have led to the diagnosis of the disease at much earlier stages. Patients in early stages have a much higher chance of curative response with different treatment options. Materials and methods: The study included 50 participates, of which 13 were patients with posthepatitis C liver cirrhosis (group I), 13 were patients with early stages of HCC (group IIa), 14 were patients with late stages of HCC (group IIb), and 10 were healthy volunteers with matched age and sex as a control group (group III). The patients were selected from the outpatient clinic and inpatient department of the National Liver Institute, Menoufiya University. LMNB1 mRNA was assessed by reverse transcription-PCR and glypican3 CTLs by flow cytometry and then we compared that with α±-feto protein. Results: Glypican3 CTLs can be used for early detection of HCC patients with 100% specificity and sensitivity. In addition, LMNB1 mRNA can be used in early detection of HCC with specificity and sensitivity 92 and 100%, respectively. Conclusion: Circulating LMNB1 mRNA and glypican3 CTLs can be used as markers for early detection of HCC patients.
  - 552 75
Biofilm formation by blood stream staphylococcal isolates from febrile neutropenic cancer patients
Amira A El-Hendi, Mohamed A Abo El-Fotouh, Abeer H El-Shalakany, Hadeel M Shalaby
April-June 2016, 29(2):349-353
DOI:10.4103/1110-2098.192435  
Objectives: The aim of this study was to define the main causative organisms of bacteremia in febrile neutropenic patients and to study the prevalence of biofilm forming capability of staphylococci in blood isolates of these patients. Background: Blood stream infections remain the main cause of morbidity and death in patients undergoing treatment for cancer. Researchers showed that the first step of staphylococcal infection is the attachment to surfaces of various materials and biofilm formation. Biofilms render the cells less accessible to the defense system of the host, thus impairing the action of antibiotics. Therefore, methods identifying strains with a capacity for biofilm formation are necessary to develop effective strategies for biofilm control and improve patient care. Patients and methods: The study included 185 participants divided into two groups; group I included 155 cancer patients and group II included 30 healthy participants as control. The participants were subjected to the following: medical history, blood cultures, antimicrobial susceptibilities of the staphylococcal isolates, Congo red agar (CRA) test, and microtiter plate (MTP) test. Results: Positive blood culture represented 33% of cases; of them, gram-positive bacteria represented 78.5% (40 cases staphylococci): 17 cases were of Staphylococcus aureus and 23 cases were of Staphylococcus epidermidis. Biofilm-positive strains of S. aureus were 4/17 (23.6%) when assessed with CRA and 6/17 (35.3%) when assessed with MTP. Biofilm-positive strains of S. epidermidis were 7/23 (30.4%) when assessed with CRA and 10/23 (43.5%) when assessed with MTP. Most strains that form biofilm were more resistant to most antibiotics compared with other strains. Conclusion: There is an association between biofilm production with persistent infection and antibiotic therapy failure. The MTP is the test of choice in detecting biofilm formation among staphylococci.
  - 420 44
Assessment of laminin level and its comparison with five liver fibrosis indices in chronic hepatitis B and C patients
Gehan K El-Saeid, Ahmed A El-Sharawy, Hossam E Tahaa, Waleed M Fathy, Isis S El-morsy Bedira
April-June 2016, 29(2):354-359
DOI:10.4103/1110-2098.192419  
Objective: The aim of the study was to assess the serum level of laminin in patients with chronic hepatitis B and C and conduct a comparative study with laminin and five liver fibrosis indices in chronic hepatitis B and C patients. Background: Liver fibrosis is the excessive accumulation of extracellular matrix proteins including collagen that occurs in most types of chronic liver diseases – for example, viral hepatitis. Over the last decade, several noninvasive markers for assessing the stage of hepatic fibrosis have been developed. Some have been well validated and are comparable to liver biopsy. Materials and methods: This study was carried out at the Clinical Pathology Department, Faculty of Medicine, and National Liver Institute, Menoufia University, from June 2012 to December 2013. The study included 34 patients with mild liver fibrosis and 28 patients with severe liver fibrosis, in addition to 20 unrelated healthy adults with matched age and sex who served as controls. Serum laminin concentration was estimated by enzyme-linked immunosorbent assay and five liver fibrosis indices were calculated. Results: Serum laminin concentrations could discriminate between patients with liver fibrosis and healthy individuals and between patients with severe fibrosis and those with mild fibrosis with high accuracy compared with other fibrosis markers like aspartate aminotransferase-to-platelet ratio index, FIB4, Fibro Q, AAR, and AP. Conclusion: There is a positive correlation between laminin levels and degree of liver fibrosis with high accuracy compared with other fibrosis markers like aspartate aminotransferase-to-platelet ratio index, FIB4, Fibro Q, AAR, and AP, although in combination they show higher efficacy.
  - 494 61
Collagen I and collagen III expression in fibrotic bone marrow
Amira M. F Shehata, Samia H Kandel, Samia H Rizk, Khalid A Khalifa, Ahmad S Fouad
April-June 2016, 29(2):360-366
DOI:10.4103/1110-2098.192403  
Objective: The aim of this study was to assess the expression of collagen I and III in fibrotic bone marrow (BM) in different pathologies. Background: A wide variety of benign conditions and malignant disorders are associated with BM fibrosis. BM fibrosis can be demonstrated by histochemical staining using silver impregnation or by trichrome stains. Immunohistochemical stains, especially anticollagen I and III, are also used for more accurate assessment of BM fibrosis. This study demonstrates the expression of collagen I and III in fibrotic marrow in different pathologies. No clinical data, prognosis , survival were mentioned in this study and so the impact was not investigated. Materials and methods: In this study 50 formalin-fixed paraffin-embedded BM biopsy samples were selected from archived cases at the Clinical Pathology Department, Cairo University. These 50 cases included seven cases with myeloproliferative neoplasms, 14 with lymphoproliferative disorders, three with acute leukemia, four with metastasis, and 22 with reactive BM changes. Cases were divided into two groups according to the Masson's trichrome staining pattern: the fibrotic group, which included 13 cases, and the nonfibrotic group, which included 37 cases. The included cases were subjected to reticulin and trichrome stains, in addition to assessment of collagen I and III expression by immunohistochemistry. Results: As regards collagen I and III staining grades, grade 4 was significantly higher in the fibrotic group, whereas grade 0 was significantly higher in the nonfibrotic group. Conclusion: Collagen I and III are markedly expressed in fibrotic marrow and marrow fibrosis; in particular, collagen fibrosis appears to be more evident in myeloproliferative neoplasms and in tumor metastasis to the BM.
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Evaluation of CD40 ligand in normal pregnancy and preeclampsia
Emad F Abd-Alhalim, Seham A Khodeer, Wael G El Damaty, Shereen M Abd-El Azeem Neweer
April-June 2016, 29(2):367-372
DOI:10.4103/1110-2098.192423  
Objective: This study was carried out to assess the presence of an inflammatory response during preeclampsia by demonstrating the presence of the CD40 ligand in preeclamptic pregnancies compared with normal pregnancies. Background: Preeclampsia is a multisystem disorder generally appearing after the 20th week of gestation. Worldwide, the incidence of preeclampsia is seen in 2–10% of pregnancies. WHO estimates the incidence of preeclampsia to be seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%). It is characterized by hypertension, proteinuria, vascular abnormalities, and often intrauterine growth retardation. The only effective treatment is delivery of the fetus and placenta. Participants and methods: Fifteen normal, apparently healthy nonpregnant women, 20 normal, apparently healthy pregnant women, and 68 pregnant women suffering from preeclampsia were included in this study. The serum concentration of sCD40 ligand was measured using ELISA. Statistical analysis was performed using Mann–Whitney U and ANOVA tests. Results: The serum concentration of soluble CD40L was significantly higher in women with preeclampsia than in normal pregnant women. In normal pregnancy the concentration of sCD40L was significantly lower than that in nonpregnant women. We conclude that the levels of inflammatory mediators are higher in women with preeclampsia than in normal pregnant women. In normal pregnancy the levels of these inflammatory mediators are lower than those seen in nonpregnant women. Conclusion: These results suggest that preeclampsia is associated with activation of the CD40–CD40L system. The activation of this system may contribute to the development or maintenance of the proinflammatory and prothrombic state found in preeclampsia.
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Contribution of the STAT4 gene single nucleotide polymorphism to systemic lupus erythematosus
Maha A El Bassuonia, Dalia F Mohamed, Wafaa M Radwana, Ahmed S Hasab El-Naby
April-June 2016, 29(2):373-378
DOI:10.4103/1110-2098.192430  
Objectives: We investigated the prevalence of the STAT4 G > C (rs7582694) polymorphism in patients with systemic lupus erythematosus (SLE) and controls in a sample of the Egyptian population. Background: STAT4 has been found to be a susceptible gene in the development of SLE in various populations. Participants and methods: The presence of the STAT4 G>C (rs7582694) polymorphism was determined by PCR-RFLP. Results: There was an insignificant difference between SLE patients and controls in their phenotypes (P> 0.05). Also, the distribution of the polymorphism among the SLE patients in terms of different symptoms and the anti-dsDNA titer showed an insignificant difference (P> 0.05). Conclusion: There is no association between the STAT4 G>C (rs7582694) polymorphism and susceptibility for SLE in the population of Egypt that may be different from other populations in geographic location, together with the racial and ethnic differences, and also environmental factors, with differences in lifestyle.
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Arginase-1 enzyme in B-cell non-Hodgkin lymphoma
Khaled A Ali, Maha A Al-Basuni, Mohamed A Alftooh, Wafaa M Radwan, Hanem M Badwy
April-June 2016, 29(2):379-382
DOI:10.4103/1110-2098.192422  
Objectives: Assessment of arginase-1 enzyme in B-cell non-Hodgkin lymphoma (NHL). Background: Arginase-1 enzyme is involved in the mechanism of immune suppression in NHL, which affects both the treatment outcome and the patient survival. Patients and methods: This study was carried out on 42 NHL patients attending the Oncology Department, Menoufia University Hospitals. Of the 42 NHL cases, 16 were relapsed or refractory (eight refractory: five cases relapsed within 1 year, two cases relapsed after 3 years, and one case after 4 years) and 26 were newly diagnosed cases. Follow-up for 24 months was carried out for the new cases. Sixteen of them achieved remission, two cases were relapsed (one case relapsed after 6 months and the other case relapsed after 9 months), whereas eight cases were lost to follow-up. Twenty age-matched and sex-matched individuals were selected as controls. A peripheral blood sample was drawn, and arginase-1 enzyme was analyzed by the enzyme-linked immunosorbent assay method. Results: The plasma level of arginase-1 enzyme was significantly increased in cases compared with controls. It was also increased in stages IV and III compared with stages I and II. Arginase-1 has the highest ratio in DLBCL compared with follicular lymphoma, which is higher than other indolent lymphomas. After patients were followed up for 2 years, the statistical data showed a highly significant difference in arginase-1 between patients with relapsed disease and patients with disease remission. Conclusion: The arginase-1 pathway is a main mechanism in the immune suppression in NHL as arginase-1 is increased in NHL patients. It is also increased in advanced stages of the disease and in a more aggressive pathology and in refractory and relapsed disease.
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Diagnostic impact of serum myoglobin and human heart-type fatty acid binding protein in patients with acute myocardial infarction
Said S Montaser, Walaa F Abd El-Aziz, Naglaa M Ghanayem, Mahmoud A Soliman, Emtiaz F Amin El-Lakwah
April-June 2016, 29(2):423-430
DOI:10.4103/1110-2098.192446  
Objective: The aim of the study was to assess the value of the serum concentrations of myoglobin and human heart-type fatty acid binding protein (H-FABP) in the early detection of acute myocardial infarction (AMI). Background: Myoglobin and H-FABP are useful as biochemical markers of muscle injury. We conducted this investigation to detect whether both markers and their ratio were useful in the early detection of AMI. Patients and methods: This study included 21 patients with AMI, 20 patients with skeletal muscle injury, and 10 normal healthy individuals. Their blood samples were obtained (within 6 h of onset of chest pain in AMI patients), and serum concentrations of creatinine, aspartate aminotransferase, H-FABP, myoglobin, cardiac troponin I, and creatine kinase-MB (CK-MB) were determined. Results: It was found that H-FABP has higher sensitivity and predictive accuracy compared with myoglobin in the early detection of AMI: the sensitivity of H-FABP was 95% and that of myoglobin was 81%, and the sensitivity of their ratio was 90%. H-FABP is a more sensitive marker, but in our study its specificity was 90%, which was lower than that of myoglobin (99%) for the detection of AMI within 6 h after the onset of chest pain. Also, our study showed that myoglobin and H-FABP were directly proportional to troponin and CK-MB, in which there is significant positive correlation. Conclusion: The diagnostic sensitivity of H-FABP is high, above that of myoglobin in patients presenting within 6 h of chest pain. H-FABP is a sensitive and specific marker for the early diagnosis of AMI. The lower specificity of H-FABP makes troponin and CK-MB superior for the diagnosis of AMI.
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Spectrum of pregnancy with heart diseases in Menoufia governorate
Mahmoud Ali Soliman, Alaa Masoud Abd El-Gayed, Amr Refaat Hamed Elgarf
April-June 2016, 29(2):431-436
DOI:10.4103/1110-2098.192434  
Objective: The aim of this study was to assess the spectrum of pregnancy with heart diseases in Menoufia governorate. Background: Heart diseases during pregnancy are the leading indirect cause of maternal death worldwide.Although the incidence of cardiac abnormalities during pregnancy has remained more or less unchanged, the relative contribution of the different causes of heart disease preceding or diagnosed during pregnancy varies with study population and study period. Patients and methods: This is a cross-sectional study of pregnant women with heart disease who underwent delivery between January 2012 and January 2013 at University Hospital and Shebin El Kom Teaching Hospital (Menoufia, Egypt). Maternal and fetal outcome and complications were evaluated for each patient. Results: The overall prevalence of pregnant women with heart disease was 9.3%. Hypertensive disorders during pregnancy were the most common cardiac disease diagnosed in our study (83%); native and prosthetic valvular heart diseases were present in 10 and 1.1%, respectively, whereas cardiomyopathy and congenital heart disease were present in 5.7 and 0.2%, respectively. The most prevalent maternal complication was bleeding (4.8%). Most women had spontaneous vaginal deliveries (57.4%), although 42.6% of women underwent cesarean sections. The most prevalent neonatal complications were premature birth (1.5%), babies requiring incubator support or on mechanical ventilation (7.8%), and fetal mortality (1.7%). Conclusion: Women of child-bearing age who are at risk for, or already have, cardiovascular disease should receive early counseling and treatment not only from their family physician but also from an interdisciplinary team comprising gynecologists, cardiologists, and, if necessary, cardiac surgeons.
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Extent of coronary atherosclerosis in diabetic and nondiabetic patients by multislice CT calcium scoring
Ahmed A Reda, Ahmed M Al Kersh, Mohamed M Al Sherif
April-June 2016, 29(2):437-442
DOI:10.4103/1110-2098.192450  
Objectives: The purpose of this study was to evaluate the differences in the extent of coronary atherosclerosis in patients with (type I and type II) diabetes as compared with patients without diabetes by multislice computed tomography calcium scoring and its effect on the patency of coronary arteries in patients referred for multislice computed tomography. Background: The calcium score is an important method for the assessment of coronary atherosclerosis. Participants and methods: This study was conducted on 90 patients: 30 of them with known type I diabetes mellitus (DM) (on insulin), 30 patients with type II DM (on oral treatment) and the other 30 participants without DM. Results: Results of the current study showed that the calcium score was significantly higher among patients with DM than among controls (P < 0.005). Results also showed that the mean number of affected vessels was significantly higher among the studied patients than among the controls (P < 0.001).The percentage of obstructive lesions was significantly higher among the studied patients than among controls (P < 0.026). The calcium score was significantly higher among diabetic patients with obstructive lesions in comparison with diabetic patients with nonobstructive lesions (P < 0.001). Conclusion: The calcium score is an accurate method for determining the presence and the extent of coronary atherosclerosis, especially in patients with DM. The calcium score was significantly higher among patients with DM than among controls. The mean number of affected vessels and the percentage of obstructive lesions was significantly higher among the studied patients than among controls. The calcium score was significantly higher among diabetic patients with obstructive lesions in comparison with diabetic patients with nonobstructive lesions.
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Metronomic capecitabine as maintenance in treatment of hepatocellular carcinoma after localized intervention
Tarek A Hashem, Mohamed A Shehata, Suzan A Elhassanin, Hagar A Alagizy, Rehab S Ahmed
April-June 2016, 29(2):443-448
DOI:10.4103/1110-2098.192408  
Background: Hepatocellular carcinoma (HCC) accounts for between 85 and 90% of primary liver cancer. Surgery is considered curative treatment; however, local ablative technique has a high rate of recurrence. Different attempts are being tried to decrease time of recurrence with less side effects and toxicities. Metronomic chemotherapy is an emerging method of treatment with less side effects and good tolerability. Objectives: The aim of the study was to evaluate the effect and toxicity of metronomic capecitabine in HCC patients after localized intervention. Material and methods: This study included 30 patients with HCC who have been treated with locoregional interference (tranarterial chemoembolization, radiofrequency, or both) and have got complete response (CR) or partial response (PR). The patients were selected from the clinical oncology department, faculty of medicine, Menoufyia University; they received capecitabine 1000 mg/day continuously. Patient characteristics, disease-free survival, time to progression, effect of primary localized intervention on the outcome, and toxicity were evaluated using univariate and multivariable analysis. Results: Most patients were men with mean age of 54 years and hepatitis C virus positive (73%). Median disease-free survival was 8 months for patients who had CR after localized interference. Median time to progression was 8 and 4.4 months for CR and PR patients, respectively, which was statistically significant (P = 0.001). No grade IV toxicity was found. Grade III toxicity was hepatic toxicity (hyperbilirubinemia) and was found in three patients (10%); renal toxicity (elevated creatinine and urea) was found in one patient (3.3%); and one patient stopped due to deterioration of general condition. The most common hematological toxicity was thrombocytopenia grade I (50%) of the studied group. Four patients stopped treatment due to persistent grade III toxicity and one stopped it due to deteriorated performance. Effect of the initial response to localized treatment or the type of this localized intervention on the end outcome was insignificant. Conclusion: Metronomic capecitabine has a modest antitumor efficacy on HCC patients in CR or PR after localized intervention. However, because of its low toxicity profile, it deserves further attention as a convenient, outpatient-based chemotherapy regimen. We recommend more randomized controlled trials and phase III trials with comparative arm in larger populations.
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Skin and soft tissue bacterial infections in cirrhotic patients with edema
Mohmed A Nouh, Mohamed A Basha, Gamal S El-Deeb, Basam M Masoud, Hend A Hammouda
April-June 2016, 29(2):454-459
DOI:10.4103/1110-2098.192421  
Objective: The aim of this study was to determine the type, risk factors, and the causative organism of bacterial skin infections in cirrhotic patients with edema. Background: Bacterial infections are often associated with significant morbidity and mortality in cirrhosis. The common practice of outdoor barefoot walking and the associated risk of trauma may predispose cirrhotic patients to skin infection. Patients and methods: This study was conducted on 150 patients, of whom 35 cirrhotic patients served as the control group. Data, including the type, the site, risk factors, and the culture results of the skin or soft tissue infection present, were collected. Results: A unique criterion of this study was that in all the study participants in the cirrhotic group the infection was due to posthepatitic cirrhosis (hepatitis C virus, hepatitis B virus, or combined infection). History or evidence of trauma, uncontrolled diabetes, massive lower-limb edema, and a high BMI are major risk factors for developing skin or soft tissue infection. Cellulitis represents the most common type of infection, affecting mainly the lower limbs. Gram-negative organisms are the causative organisms in cirrhotic patients (17%), mainly Escherichia coli in 13% of the cases. Conclusion: Gram-negative bacteria may cause bullous cellulitis in patients with cirrhosis. Trauma, diabetes mellitus, and massive lower-limb edema are major risk factors for skin and soft tissue infections in cirrhotic patients.
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Clinical study of some medico-legal aspects of cases with extremities trauma admitted to Menoufia University Hospital over 1 year (2011)
Samy M Badawy, Naira F Girgis, Ahmed K Al-Fiky, Hebaallah A Mabrok
April-June 2016, 29(2):460-463
DOI:10.4103/1110-2098.192415  
Objective: The aim of this study was to analyze the socio-demographic patterns of extremities trauma in cases admitted to Menoufia University Hospital during 2011, with evaluation of homicidal cases in relation to the instrument used, type of injury, and the associated complications. Background: Trauma to the extremities represents one of the most common injury patterns seen in emergency medical and surgical practice. Extremities injuries were more common in males in the age group 18 to <30 years. Blunt instruments were the causative agents of most assault and self-inflicted injuries. Materials and methods: In this study, patients with trauma to the extremities admitted to Menoufia University Hospital during 2011 were included. Clinical data, plain radiography and/or computed tomography, MRI, electromyography, and nerve conduction studies were assessed. Results: The total number of patients included was 1020. Most cases of the study were males in the age group 18 to <30 years. Assault was found to be the most common reason followed by accidents. Injuries were found to be more common in upper limbs than lower limbs, and they outnumbered lower limbs in the self-inflicted mode, whereas lower limbs were more common in the assault mode. A significant relationship was found between the causative instrument and circumstances of injury; accident injuries occurred most frequently because of heat. Most of assault and self-inflicted injuries were caused by blunt instruments. A significant relationship was found between the outcome and the circumstances of injury. Most of accident and assault injury patients developed complications, whereas most of the self-inflicted injury patients improved. Conclusion: Trauma can affect different parts of the body: head, chest, abdominal region, extremities, face, spinal cord, the genitourinary system, pelvis, and soft tissues. Limb injuries are a common problem among the physically active, and such injuries may result in diminished performance, reduced participation, and in the longer term loss of function, chronic joint disease, and disability. Limb injuries represent the commonest form of injury involved in road traffic accidents.
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Study of the role of ascitic fluid lactoferrin levels in the diagnosis of spontaneous bacterial peritonitis
Atef Abulseoud, Hossam Ibrahim, Abdallah Essa, Enas Essa, Ahmed Elmaaz
April-June 2016, 29(2):464-467
DOI:10.4103/1110-2098.192416  
Objectives: To study the role of ascitic fluid (AF) lactoferrin as a surrogate marker for the diagnosis of spontaneous bacterial peritonitis (SBP). Background: SBP is one of the most dangerous and life-threatening complications of liver cirrhosis and ascites. Its diagnosis is difficult, operator dependent, and time consuming. Materials and methods: This study was conducted on 60 patients with decompensated chronic liver disease and ascites admitted to the Tropical Medicine Department at Menoufia University Hospital. These patients were classified into two groups: group I (non-SBP group) and group II (SBP group). AF samples from both groups were examined for polymorphonuclear leukocyte cell count, AF culture, and lactoferrin levels. Results: The results showed a highly significant increase in AF lactoferrin in the SBP group and at a cut-off level of 255 ng/ml; the sensitivity and specificity of AF lactoferrin in the diagnosis of SBP were 100 and 88.9%, respectively. AF culture revealed the presence of organisms in 43.4% of patients in the SBP group; all organisms were gram negative. Conclusion: Our results support that AF lactoferrin could be used as a marker for screening and diagnosing SBP in patients with cirrhosis and ascites.
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REVIEW ARTICLES
β-Cell plasticity
Nabil A El-Kafrawy, Ahmed A Shoaib, Mohammed A Farahat
April-June 2016, 29(2):181-186
DOI:10.4103/1110-2098.192413  
Objective: The aim of this study was to present the current trends and methodologies in the preservation of the β-cell function by targeting the β-cell mass. Data sources: Medical text books and also the ScienceDirect database were searched from the start date of the database and a search was performed on January 2014 with no language restrictions. Data selection: The selected articles are systematic reviews and experimental studies that address the β-cell plasticity and the β-cell mass and plasticity. Data extraction: Extraction was performed according to the quality, validity, and originality of the selected reviews and studies that fulfilled the previous criteria; in addition, the main focus was on studies that presented the latest or the most updated findings on the prevention and treatment of the β-cell failure. Data synthesis: Each review and study were reviewed independently without intercomparisons. The layout was selected to present a wide range of data including the most recent findings on the subject. Recent findings: Most recent studies concluded that the successful management of the growing epidemic of type-2 diabetes involves stopping the progressive loss of the β-cell mass and/or function before diabetes develops. Conclusion: The main conclusion of the studies and reviews that were presented in the current research paper is that the preservation of a functional β-cell mass is the means to prevent diabetes. β-Cell plasticity is the ability of β-cells to adjust to the body's demand for insulin. Preservation of β-cell plasticity will preserve a functional β-cell mass. Once there is a functional β-cell mass diabetes cannot develop; in addition, a proper diet alone might be able to restore a good environment for the β-cell to function properly and preserve its mass, and many new strategies and approaches are being investigated for this purpose.
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Exosomes: clinical implications and therapeutic potentials
Ali Z Galal, Sabri A Shoieb, Mohammad A Abdel Hafez, Mohammed Al-Houseiny Ata
April-June 2016, 29(2):187-191
DOI:10.4103/1110-2098.192402  
The aim of this review was to assess the role of exosome microvesicles in medicine. Exosomes are spherical nanosized extracellular membrane vesicles that act as regulators of cell-to-cell communication and as immune modulators with immunosuppressive or immune-stimulating properties by delivering proteins or nucleic acid to recipient cells. Data were obtained from medical text books, medical journals, and all materials available on the internet from 2006 to 2014. We selected systematic reviews that addressed exosomes as well as studies that addressed the clinical implications and therapeutic potential of exosomes. A special search was conducted in Medline with the keywords in the title of papers; suitable studies were extracted, after assessing the quality and validity of the papers. Each study was reviewed independently. The obtained data were translated into the language understood by the researcher and have been arranged in topics throughout the article. Exosomes are believed to possess a powerful capacity to regulate cell survival/death, inflammation, and tumor metastasis, depending on their molecular content. The clinical application of exosomes as a drug delivery system for the treatment of autoimmune/inflammatory diseases and cancer is promising. Exosomes provide a novel minimally invasive approach to diagnosis, prognosis, and therapy.
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