2024-03-29T13:25:24Z
https://ejhm.journals.ekb.eg/?_action=export&rf=summon&issue=14648
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Enhanced Peripheral Blood T lymphocyte Apoptosis in Pulmonary Tuberculosis: Correlation with Disease Severity as Reflected by Mycobacterial Load
Amal Abd El Nabi
Ayoub
Effat Moustafa
Hassan
Azza Hassan
El Salakawy
Amany M.
Tawfeik
Background: Pulmonary tuberculosis (TB) is one of the major causes of illness and mortality worldwide. Control of TB requires coordinated efforts of both innate and adaptive immune systems. Apoptosis is a genetically regulated physiological process that when dysregulated can contribute to the pathogenesis of various diseases including TB. Objectives: The frequency of apoptotic T cells among peripheral blood mononuclear cells in patients with active pulmonary TB was studied and correlated with results of sputum bacterial load that reflects disease severity. Patients and methods: The study included 28 newly diagnosed tuberculin positive patients under anti-TB chemotherapy, classified into 3 groups according to sputum smear grading for AFB. In addition, 11 age matched apparently healthy individuals were included as a control group. PBMCs were stained for flowcytometric analysis using the TUNEL method. Results: Increased frequency of apoptotic T cells was observed in 71.4% of patients compared to controls. Patients with higher smear grades (grades 2+ and 3+) showed increased frequency of apoptosis compared to those with low smear grade (1+). Conclusion: Increased apoptosis may explain the T cell depletion/sustained low T cell responses observed in patients with active pulmonary TB. Its strong association with bacterial load make it a possible in vitro readout of pathogen burden that can be used for fast tracking the response to treatment. Targeting molecules involved in apoptosis may be an approach for an adjunctive anti-TB therapy that rescues T lymphocytes protective activity especially for infections caused by MDR and XDR MTB strains.
Blood T lymphocyte
apoptosis
pulmonary tuberculosis
Mycobacterial
2020
07
01
754
759
https://ejhm.journals.ekb.eg/article_97055_260203a79a80dab28d0d20452095c557.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Assessment of Intelligence Quotient in School-Aged Children Who Are Breastfed Versus Artificial-Fed
Hisham Samy
Abdel-Hameed
Ehab M.
Rasheed
Shimaa Adel Ali
Yousef
Background: Food can affect the brain throughout the entire life cycle. Cognition refers to the mental processes involved in the acquisition of knowledge and the integration of these processes into responses such as the intelligence quotient (IQ). Objective: The purpose of this study was to compare intelligence quotient of children aged 6-10 years who were breastfed in their post-natal life versus those who were not exposed to breastfeeding. Patients and methods: A case control study was conducted on 56 children in Zagazig University Children Hospital, during the period from October 2018 to March 2019. They were divided into two groups. Group I: 28 healthy children who were exclusively breastfed. Group II: 28 healthy children who were artificially-fed. All cases were subjected to: A constructed questionnaire assessing breastfeeding practices during the first two years as well as the current health status over the past years and current and past behavioral disorders. Clinical examination was done. Dietary assessment was done to assess current feeding and food intake practices. Special test; Wechsler and Primary Scale of Intelligence was done for all participants to assess the cognitive functions. Results: This study showed that, higher IQ in the breastfed group as compared to the artificially-fed group. Conclusion: Cognitive function of the child is increased with the increased duration of exclusive breastfeeding up to six months of age. The education of the mother positively influenced the IQ among children who were exclusively breastfed for 6 months but not the other groups.
Intelligence Quotient
Breastfed versus
Artificial fed
2020
07
01
760
765
https://ejhm.journals.ekb.eg/article_97057_4b5d3832ec23a2968f5063bc490ee39a.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Vitamin D Receptor Polymorphisms in Children with Chronic Immune Thrombocytopenic Purpura
Mervat Abd-Allah
Hesham
Laila Metwaly
Sherif
Aml Fawzy
Abd-Elmaaguid
Shehab Mohamed Nageeb Mohamed
Saad
Background: Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by autoantibodymediated-enhanced platelet destruction. Chronic ITP was defined as thrombocytopenia persisting for more than 12 months. Previous studies have found that vitamin D receptor (VDR) polymorphisms are associated with the incidence and severity of certain autoimmune diseases. Objective: This study aimed to detect the frequency and role of VDR gene polymorphisms on pathogenesis of chronic ITP in children. Patients and methods: A case control study that was conducted at Hematology Unit of Pediatric, Medical Biochemistry and Molecular Biology Departments at Zagazig University Hospital during a period from November 2017 until November 2018. The study was conducted on 40 participants divided into two groups: case group including 20 children with chronic ITP (8males and 12 females) and control group including 20 age- and sexmatched healthy children (6males and 14females). Results: This study showed that the patients’ group had a lower serum vitamin D level than the control group with a statistical significant difference (24.2 ± 9.64 ng/ml and 33.75 ± 11.1 ng/ml respectively). There was also a highly significant difference between chronic ITP cases and control regarding distribution of SNP of VDR gene (Cdx2) where GG was founded in 65% of ITP cases versus 35% in control. Also, AA was founded in 30 % of control versus 5% of cases. Conclusion: Vitamin D receptor gene (Cdx2) polymorphism was found to be associated with higher incidence of chronic childhood immune thrombocytopenic purpura. Also chronic ITP in children was found to be associated with lower level of serum vitamin D.
ITP
Vitamin D
association
2020
07
01
767
772
https://ejhm.journals.ekb.eg/article_97060_d6ad334a093edba8a2227852177c8265.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Investigation of the Association Between Imaging and Pathological Characteristics of HCC
Mansour Mohamed
Kabbash
Hussein Ali
Mostafa
Stephen
Wigmore
Sherif Elprince
Sayed
Abdelrahman Mohamed Kamel
Amin
Background: Hepatocellular carcinoma (HCC) is the most typical primary viscus malignancy and also the second leading reason behind cancer-related death worldwide. Objectives: To study the association between the tomography and pathological options of HCC for getting an honest designation on the lesions of HCC for getting the best treatment and prognosis of these lesions. Patients and Methods: Study of the imaging criteria of HCC which includes the arterial enhancement and venous washout in both CT and MRI within a background of cirrhosis, and it’s a possible association with the vascular density and microvascular invasion seen in the biopsy. We enrolled consecutive cirrhotic patients with HCC liver resection in 2 years (from January 2018 till December 2019). Results: Our results on the number of lesions cleared that, the number of lesions ranged from 1 in number that observed in 68 (66.02 %) and 2 that observed in 11 (10.68 %), followed by 3, 4, and 5 lesions that observed in 1 (0.97 %) of the examined patients. The higher incidences of the lesions observed in middle hepatic vein 55 (53.40 %) right lobe of the liver 16 (15.54 %) , seg 2/3 10 (9.71 %), right liver 5 (4.86 %), left liver 5 (4.86 %) and in left lateral liver 4 (3.88 %). Conclusion: The association between the Imaging and pathological features of HCC including microvascular invasion and density which is very important for getting an honest designation on the lesions of HCC and for getting the best treatment and prognosis of these lesions.
HCC
CT
MRI
T2WI
HBP
DWI
2020
07
01
773
781
https://ejhm.journals.ekb.eg/article_97063_4c2908ad9252ffde956f6b4f33e4a7bc.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Phosphate Disturbance in Critically Ill Children in Zagazig University Pediatric Intensive Care Unit
Tarek Abd El-Rahman
Atiyyah
Sahar Abd Elraouf
ElShaarawy
Aml Said
Al- Shal
Asmaa Mohammed Hussein
Mohammed
Background: Phosphorus is very important for normal cellular structure (cell membrane and nucleic acids). Phosphorus has an important role in the cell metabolism, ATP production, and homeostasis. Objectives: The aim of the work was to determine the prevalence and some of risk factors of hypophosphatemia in sick children, and to evaluate the prognostic effect of serum phosphorous level on the outcome in terms of morbidity and mortality in critically ill children during their stay in the pediatric intensive care unit. Patients and methods: This prospective cohort study included a total of 50 critically ill children, attending at Department of Biochemistry and Pediatric Intensive Care Unit (PICU), Department of Pediatrics, Zagazig University Hospitals. This study was conducted between April 2017 to August 2018. Patients age ranged from 2 months to 129 months and according to serum phosphorus level cases were classified into those with hypophosphatemia and others with normal phosphate level. The severity of illness was determined by using SOFA score. Results: Revealed that there was statistically significant decrease in phosphorus level at day 1 and day 3 between hypophosphatemia and normal phosphate level groups. The prevalence of hypophosphatemia was 46% at first day of admission and 70% at third day of admission. Significant increase of PTH and total bilirubin in hypophosphatemia group, and significant decrease of calcium in hypophosphatemia group compared to normophosphatemia group. The cases were followed and compared regarding; morbidity (need for mechanical ventilation, and length of PICU stay), degree of organ failure (SOFA score) and their outcome (discharge from PICU or death). Conclusion: It could be concluded that hypophosphatemia is considered a common co-morbidity in critically ill children in PICU. Hypophosphatemia more prevalent in those with respiratory problems, and higher SOFA score.
Hypophosphatemia
SOFA score
PICU
PTH
2020
07
01
782
788
https://ejhm.journals.ekb.eg/article_97065_5b275cdf8add80ca24420b93df69b2cc.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Serum Level of Heart Type Fatty Acid Binding Protein Before and after Treatment of Congestive Heart Failure in Children
Hanaa Abdel Fattah
Mohamed
Eman Mahmoud
El-Moghazy
Somia Hassan
Abdallah
Alshaimaa Mohamed Hassan
Ali
Background: Heart failure (HF) in children is a clinical and pathophysiological syndrome that results from ventricular dysfunction, volume or pressure overload, either alone or in combination. This study aimed to estimate serum level of H-FABP before and after treatment of congestive heart failure, and correlate its level with severity of the disease. Patients and methods: The study was cohort control study. It included 30 infants and children; their ages ranged from two months to four years with heart failure diagnosed clinically and were admitted to Cardiology Unit of Pediatric Department, at Zagazig University Hospitals during the period from November 2017 to April 2018. They were divided into four groups, first group aged (2-12 month), second group (13-24 m), third group (25-36 m) and fourth group (37-48 m). Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum heart type fatty acid binding protein (H-FABP) level (estimated on patient admission and 1 week after treatment) was determined by quantitative sandwich enzyme linked immunosorbent assay (ELISA) technique. Results: There was a significant difference in the serum level of H-FABP in our patients before treatment (2.156 ± 1.156 ng/ml) compared with after treatment (0.882 ± 0.716 ng/ml). There was a significant positive correlation between serum H-FABP level and Ross classification. Conclusion: H-FABP may be used as diagnostic and prognostic predictor of adverse outcome in children with heart failure.
Heart failure (HF)
Heart-type fatty acid-binding protein (H-FABP)
Serum level
2020
07
01
793
797
https://ejhm.journals.ekb.eg/article_97935_2fe46f3857eeeb2fbe3a0e586628632b.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Two Sofosbuvir Containing Regimens in Egyptian Hepatitis C Related Compensated Liver Cirrhosis: Impact on Clinical Outcome and Liver Stiffness
Nahed A
Makhlouf
Youssef M
Swifee
Mohamed M
Darwish
Nasr K.
Khalil
Amal A.
Mahmoud
Ahmed
Medhat
Rasha O
Refaie
Zainab G
Mahran
Background/Aim: The current study aimed to evaluate the impact of sustained virological response (SVR) after two sofosbuvir (SOF) containing regimens on the clinical outcomes, non invasive markers of hepatic fibrosis and liver stiffness. Patients and Methods: The study included 200 patients with compensated HCV cirrhosis. Group 1: received SOF and Ribavirin (RBV) for 6 months, Group 2: received SOF, Daclatsvir (DAC) and RBV for 3 months. Hepatitis C Virus Ribonucleic Acid (HCV RNA) by Polymerase Chain Reaction (PCR) was done at baseline, end of treatment (EOT), SVR12, SVR48. Model for end stage liver disease (MELD) score was calculated, the aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) scores were done. FibroScan was done at baseline and SVR48. Results: SVR12 occured in 75% and 96% in group 1 and 2, respectively. There was improvement in both of APRI and FIB-4 scores at EOT in the two groups, and maintained to SVR48. A significant improvement in mean liver stiffness (LS) occurred at SVR48 compared to baseline in the study groups. Improvement in LS was observed more in group 2. There was a significant decrease in the mean value of MELD score in group 2 and non-significant decrease in group 1 at SVR48 in comparison to pre-treatment mean value. Conclusion: SOF/DAC/RBV was effective treatment regimen in compensated liver cirrhosis. This regimen resulted in significant improvement in MELD score, and liver stiffness at SVR48.
Sofosbuvir
daclatsvir
Cirrhosis
Outcome
MELD
LS
2020
07
01
798
802
https://ejhm.journals.ekb.eg/article_97938_3e9aa0e4e9ab74ecff6858632a7735b5.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Cognitive impairment in asthmatic Children in Pediatric Department, Zagazig University Hospitals
Mahmoud Abdel-Hameed
Mahmoud
Mohamed Sanad
Naguib
Osama Mohamed
Gado
Ahmed Hosny
Mohamed
Background: Asthma is a heterogenous disease, usually characterized by chronic airway inflammation. The variable expression of asthma symptoms has prompted the shift from the concept that asthma is a single disease to the new concept of asthma as a syndrome. Objectives: this study aimed to evaluate and assess cognitive impairment of children with asthma. Subjects and methods: This was a descriptive cross-sectional study of children with asthma that has been approved from Institutional Review Board (IRB). Assuming that the total number of bronchial asthma patients attending to Pediatric Outpatient Clinic Pulmonology Unit, Pediatric Department, Zagazig University Hospital. Results: With 290 asthmatic children in 6 months and prevalence of low Wechsler Intelligence Scale for Children Third Edition (WISC-R) score was 88%, at CI 95%. So, the total sample size was 104 patients (male 58.7% and female 41.3%) calculated by EPI-INFO 7. There was a statistically significant difference between severity of asthma and IQ (verbal, performance and full IQ).i.e., with increasing severity of asthma there was significant decrease in IQ. Conclusion: Cognitive impairment in affected children is related to asthma severity. Asthmatic children have lower cognitive abilities as regarding general intelligence. Children with chronic asthmatic chest troubles represent a population at possible high risk for cognitive and psychological maladjustment.
Asthma
cognitive impairment
Pediatric
2020
07
01
803
808
https://ejhm.journals.ekb.eg/article_98911_e2afb330bd25fb833d0d746215c8bd63.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Intestinal Fatty-Acid-Binding Protein in Neonatal Necrotizing Enterocolitis
Ehab A.
Al-banna
Hadeel M.
Abd El-Rehman
Lamiaa M. M.
Kamel
Ahmed E. M.
Ahmed
Background: Necrotizing enterocolitis (NEC) is the most common gastrointestinal (GI) medical and surgical emergency occurring in neonates. It is an acute inflammatory disease with a multifactorial etiology; the condition is characterized by variable damage to the intestinal tract ranging from mucosal injury to full- thickness necrosis and perforation. Objective: Our work aimed to detect the role of I-FABP in plasma in early diagnosis of NEC and prediction of severity of NEC among neonates at neonatal intensive care units, children's hospital, Zagazig University. Patients and Methods: About 160 preterm neonates aging less than 35 weeks and weighing less than 2500 gm were included in this study to evaluate which of them will develop NEC, after follow up 24 of them developed NEC and still alive until the last samples were obtained from them. These neonates were diagnosed and classified according to Later Modified Bell's Staging for NEC. Results: I-FABP level was highly increased in more complicated cases. We can predict NEC by the cut of value of IFABP ≥3.2 ng\ml with sensitivity 95.8%, specificity 95.8% at 1st 24 hours, and at diagnosis by ≥9.2 ng\ml with sensitivity 95.8%, specificity100%, and accuracy 0.99%. Conclusion: Serum IFABP can serve as a serological biomarker for early diagnosis of NEC for premature neonates with high accuracy and can predict the severity of the disease.
biomarker
Necrotizing enterocolitis
intestinal
necrosis
Preterm Neonates and I-FABP
2020
07
01
809
814
https://ejhm.journals.ekb.eg/article_98912_b43394b82a59e09b6b1ae550183dd313.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Serum 25-Hydroxyvitamin D in Patients with Juvenile Idiopathic Arthritis
Mohamed
Almalky
Mervat
Hesham
Ayman
Marei
Mogeep El-Rahman
Ibrahim
Background: Vitamin D has been implicated in the pathogenesis of a lot of autoimmune diseases. While the roles of vitamin D in rheumatic arthritis in adult have been investigated, less is known about the role of vitamin D in juvenile idiopathic arthritis (JIA). Objectives: Evaluation of the level of serum 25(OH) vitamin D in patients with juvenile idiopathic arthritis and its relationship to the disease activity. Methods: This was a case-control study included 36 children who were divided into two equal groups of matched age and sex. The first group (case group) consisted of 18 patients with JIA. The second group (control group) consisted of 18 healthy children. 25(OH) vitamin D level is measured in both groups and its relation to disease manifestations and disease activity using JADAS 27 score was determined. Results: The mean value of vitamin D serum level was significantly lower in patients than in healthy control. There was a negative correlation between vitamin D level and both disease activity and number of joints affected among the studied patients. Conclusion: Serum vitamin D levels were reduced in children with JIA. In addition, there was a significant negative correlation between serum vitamin D levels and both the number of affected joints and the disease activity as measured by JADAS 27 score.
Juvenile idiopathic arthritis
Vitamin D
25 hydroxy vitamin D
JADAS 27 score
2020
07
01
815
819
https://ejhm.journals.ekb.eg/article_98913_667eee3fa11387634edee0dcf12c1bd4.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Serum Soluble Glycoprotein VI (sGPVI) to Predict the 28th Day In-Hospital Mortality in Adult Patients with Sepsis
Sabry Abd Allah
Shoeib
Ayman Fathy
Abd ElHalim
Mohamad Ahmad
Abd ElHafez
Ashraf Abd ElRaof
Dawod
Essam Ali
Abd ElMohsen
Sameh Abo ElNasr Abd ElSalam
ElBaz
Background: Sepsis is a complicated syndrome resulting from the inappropriate expression of host factors in response to infection and is a major cause of death in patients that are hospitalized in emergency departments and in critical care units. Objective: The purpose of the present study was to identify the role of serum soluble glycoprotein VI (sGPVI) in predicting the 28th day in-hospital mortality in adult patients with sepsis. Patients and methods: This observational prospective cohort study included a total of 90 adult patients aged ≥18 years old with clinically suspected sepsis, recruited from Medical Intensive Care Units of Menoufia University Hospital and Kafr El-Sheikh general hospital. The included subjects were diagnosed using quick SOFA score and according to survival at the 28th day, they were divided into two groups; Group A (survivors) consisted of 69 patients (76.7%) and Group B (non survivors) consisted of 21 patients (23.3%). Results: As regard clinico-laboratory data (qSOFA, sGPVI, SGOT, respiratory rate, ESR, WBCs) and complications (hospital stay), they are significantly increased (P value < 0.001) in non-survivor studied patients in comparison with survivor ones. Concerning platelet count, it is significantly reduced (P value < 0.001) in non-survivor studied patients in comparison with survivor ones. As regard clinico-laboratory data (qSOFA, SGOT, respiratory rate, ESR and WBCs) and complications (hospital stay), they are positively correlated with sGPVI with a statistically significant difference in non-survivor studied patients. Concerning platelet count, it is negatively correlated with sGPVI with a statistically significant difference in non-survivor studied patients. Conclusion: It could be concluded that glycoprotein VI is a valuable prognostic predictor during sepsis being more reliable than other widely used indicators and severity scores, such as qSOFA, WBCs, platelet count and CRP.
Sepsis
sGPVI
qSOFA
CRP
2020
07
01
820
826
https://ejhm.journals.ekb.eg/article_98915_eac449f41b867d8c752535f6c03e99f7.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
The Influence of the MDR1 C3435T Polymorphism on Methotrexate Responsiveness in Rheumatoid Arthritis Patients
Shahira Fathy
El Fedawy
Abeer
Shehab
Rania A.
Abo-Shady
Samah A.
El-Bakry
Dina
Ragab
Sara
Salem
Nermeen
Samy
Background: Methotrexate (MTX) is most widely used for the treatment of rheumatoid arthritis (RA). However, different clinical responses have been observed in patients treated with MTX. Objective: The aim of the work was to determine the influence of the MDR1 C3435T polymorphism on Methotrexate responsiveness in RA patients. Patients and Methods: A cross sectional study included 90 RA patients. Demographics, clinical features, medication history, and the disease activity score (DAS28) were carefully recorded. Genotypes of the C3435T polymorphism were determined by real time polymerase chain reaction for all patients. According to disease activity score, patients were classified into 2 groups: group (1): MTX responders (DAS28 score ≤3.2) and group (2): MTX non-responders (DAS28 score >3.2). Results: Of the 90 RA patients, 80 were females (88.9%) and 10 were males (11.1%). No statistically significant difference was found in genotype or allele frequencies between MTX responders and non-responders groups. However, patients who had C allele were 1.65 times more likely to be non-responder to MTX treatment when compared to those who had the T allele. The most common MTX adverse effects reported were Gastrointestinal upset in 31.1% followed by undesirable hair loss in 11.1%. The probability of having GIT adverse effects was observed to be higher among the cases with (CT) genotype than the other genotypes but without statistical significance. Conclusion: It could be concluded that no significant association could be detected between MDR1 gene C3435T polymorphism and responsiveness to methotrexate in the studied rheumatoid arthritis patients.
Rheumatoid Arthritis
MDR1 C3435T SNP
MTX sensitivity
2020
07
01
857
864
https://ejhm.journals.ekb.eg/article_98917_47fb9bcc3996fa4e516dbd6660625de8.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Thyroid Dysfunction and Critical Illness in Intensive Care Unit Patients of Aswan University Hospital
Marwa Ahmed Abdelhameid
Ahmed
Mohammad Alyamany
Kobiesy
Mohamed Zein EL-Dein
Hafez
Asmaa Osama
Bakr
Background: Thyroid hormones play an essential role in human metabolism. Critical illness is often associated with alterations in thyroid hormone concentrations in patients with no previous intrinsic thyroid disease. Objective: This study was conducted to evaluate frequency of thyroid dysfunction in Intensive Care Unit patients of Aswan University Hospital and to correlate between thyroid dysfunction and susceptibility for mechanical ventilation. Patients and methods: This was a cross-sectional non randomized study was conducted at Internal Medicine Intensive Care Units and Surgical Intensive Care Unit of Aswan University Hospital on 200 patients who were eligible to inclusion/exclusion criteria of the study. Thyroid function test of TSH, FT3 and FT4 levels were investigated for all patients and were compared and correlated with the clinical data of those patients. Results: Thyroid function abnormalities are common in critically ill patients who didn’t have abnormal thyroid functions before and more common in female patients than males. There was a correlation between abnormal thyroid functions in critically ill patients and their mortality and more in sick euthyroid syndrome patients. There was no relation between abnormal thyroid functions in critically ill patients and their increased susceptibility for mechanical ventilation. Conclusions: Thyroid function abnormalities are common in ICU patients, reflecting the prognosis and affect the clinical outcome for those patients.
THYROID
critical
illness
ICU
2020
07
01
835
844
https://ejhm.journals.ekb.eg/article_100198_eb31e329dc3b1245c44cfc4f48e31157.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Kidney Injury Molecule 1 in Children with Heart Failure
Sahar Abd Elraouf
Elsharawy
Laila Raslan
Abd Elaziz
Naglaa Ali
Khalifa
Hamdy Ahmed Mohammed
Mohey El-Din
Background: Kidney injury molecule-1 (KIM-1) is a novel biomarker that was initially identified and evaluated in patients with acute kidney injury. It predominantly indicates tubular injury and is an earlier and more sensitive indicator of acute kidney injury than plasma creatinine. Objective: To evaluate the role of KIM-1 as an early marker of renal dysfunction in children with heart failure and to assess whether KIM-1 concentration is related to heart failure severity and cardiac function. Patients and Methods: This case-control study was carried out at the Cardiology Unit, Outpatient Cardiology Clinic, and Clinical Pathology Unit, Zagazig University Hospitals during the period from November 2018 to May 2019 included 93 children. Results: KIM-1 was higher in patients
with acute and chronic heart failure as compared with controls also it has positive correlations with LVEDD, LVESD, and serum creatinine, while it had a negative correlation with GFR. An optimal admission KIM-1 cut off at >588 ng/ml, with a sensitivity of 85.5%, a specificity of 83.9% for WRF prediction in HF, with an area under the curve (AUC= 0.948, P>0.001). While the sensitivity of GFR and serum creatinine was 67.7%, 72.6% respectively and the specificity was 71%, 90.3% respectively with an area under the curve of 0.773 and 0.875 respectively. Conclusions: KIM-1 can be considered as a sensitive diagnostic marker superior to both GFR and creatinine for early detection of impaired renal function in acute and chronic HF even before GFR is markedly reduced and even before serum creatinine is significantly affected.
Heart failure
Cardiorenal Syndrome
Renal dysfunction
2020
07
01
845
851
https://ejhm.journals.ekb.eg/article_100199_2c7b63f8d13514f80f3f6e2cea425fd5.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
The Value of Estimating Paraoxonase Activity in Nephrotic Children
Saad Ahmed
Mansour
Mayy Abd Alfattah
Neemat-Allah
Amal Saeed
El Shal
Shaymaa Sherif Abd El Aziz
Ibrahim
Background: Nephrotic syndrome (NS) is a series of symptoms caused by kidney damage. This involves protein in the urine, low levels of blood albumin, elevated blood lipids, and high levels of swelling. Objective: This study aimed to evaluate paraoxonase1 (PON1) activities in children with nephrotic syndrome before and after treatment and compare it with healthy control individuals. Patients and Methods: A case control study was carried out at Pediatric Nephrology Unit and Outpatient Nephrology Clinics of Children Hospital at Zagazig University over a period of fifteen months from August 2017 to November 2018, included 40 children classified into three groups; group1: included 20 child of newly diagnosed nephrotic syndrome children; Group 2: comprised same nephrotic patients of group 1 in remission stage after one month of daily divided dose of steroid; group 3 included 20 children apparently healthy and matched with the previous groups in age and sex (control group). Results: There was a high significant difference in the lipid profile among the three studied groups. There was a significant difference in serum PNO1 levels among three studied groups. There was a high significant decrease in serum PNO1 in group1 than control group. There was no significant difference in PNO1 serum levels between group 2 (remission) and control group. Conclusion: PON1 activity of newly diagnosed cases is significantly decreased antioxidant ability to prevent lipid oxidation. Hyperlipidemia with diminished antioxidant potential due to reduced PON1 collectively predisposes NS patients to the possibility of atherosclerosis.
Paraoxonase, Antioxidants, lipid profile
nephrotic syndrome
2020
07
01
852
856
https://ejhm.journals.ekb.eg/article_100200_d3bb610421c708c7a5091752fa7d0e5f.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Thyroid Dysfunction as a Mortality Predictor for ICU Patients
Marwa Ahmed Abdelhameid
Ahmed
Mohammad Alyamany
Kobiesy
Mohamed Zein EL-Dein
Hafez
Asmaa Osama
Bakr
Background: Patients suffering from critical illness admitted to the Intensive Care Unit (ICU) exhibit alterations in their thyroid hormone levels. These changes correlate with the outcome and mortality of critically ill patients treated in ICUs. Objective: Our study was conducted to determine thyroid dysfunction as a risk predictor for ICU patients. Patients and Methods: This is a prospective observational cross-sectional non-randomized hospital-based study. The study was performed at the Internal Medicine Intensive Care Units and Surgical Intensive Care Unit of Aswan University hospital at the duration between 1-6-2017 to 30-1-2019 for 200 patients. Results: Regarding TSH, 61.8% sensitivity, 37.1% specificity, 61.3% negative predictive value and 37.6% positive predictive value. Regarding the FT3, 63.2% sensitivity, 50.8% specificity, 69.2% negative predictive value and 44.0% positive predictive value. Regarding the FT4, 15.0 was the cut off value with 61.8% sensitivity, 50.0% specificity, 68.1% negative predictive value, and 43.1% positive predictive value. It showed 54.5% Accuracy & the area under the curve (AUC) was 0.601. From results, FT3 is the most sensitive thyroid function in predicting prognosis and mortality of critically ill patients in ICU. The increase in the APACHE II score could significantly predict the increased risk of mortality while a decrease in FT3 and FT4 could significantly increase the risk of mortality. Conclusions: FT3 was the strongest predictor of ICU mortality. Further, the combination of FT3 levels and APACHE-II scores provided for a higher probability for predicting mortality in ICU patients.
Thyroid dysfunction
MV
ICU
FT3
APACHE-II
2020
07
01
857
864
https://ejhm.journals.ekb.eg/article_100202_eb13c10d3349e20afbb33fb9f0419d5f.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Hearing Affection in High Risk Neonates
Abdel-Razek
El-sheikh
Ali
Abdel Hamied
Waleed Mohamed
Ibrahim
Marwa Mostafa Mohamed
El Shanawany
Background: Hearing impairment in children is a hidden disability. By the time, it is recognized usually at 2:3 years. The child’s speech and language ability will be irreversibly affected. Early detection of hearing impairment and timely intervention can give better consequences. Objectives: Identification of the most significant risk factors for hearing impairment in high risk neonates hospitalized at our Neonatal Intensive Care Unit (NICU) and to assess the sensitivity of hearing screening tests. Patients and methods: This study was carried out on newborns with risk factor of hearing loss admitted to NICU of Pediatric Department, Zagazig University Hospital from December 2017 to December 2018 using both transient evoked otoacoustic emissions (TEOAE) and Auditory Brainstem Response (ABR) tests in Audiology Unit, Zagazig University Hospital. Number of the studied neonates was 58 high risk neonates. Results: Of the criteria that studied neonates was chosen according to it, exposure to ototoxic medications was the most common risk factor (82.8%) followed by assisted ventilation > 5 days (77.6%), prematurity (62.1%), LBW (56.9%), septicemia (50%), perinatal asphyxia (13.8%). There were statistical significant relationship between auditory brainstem response and ototoxic medications in the studied neonates. Vancomycin and meropenem were significant risk factors of hearing loss. Conclusion: Prematurity, Low birth weight, Septicemia, Perinatal asphyxia and Administration of vancomycin and meropenem were significant risk factors of hearing impairment in our studied neonates by ABR test.
Hearing Affection
Neonates
ABR test
Vancomycin
Meropenem
2020
07
01
865
870
https://ejhm.journals.ekb.eg/article_100203_95515d9b29ddbdc2275562e71ed71c52.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis
Marwan N
Elgohary
Kamal
Amer
Mohamed AA
Bassiony
Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the development of MHE. MMSE and NCT A showed significantly good performance in diagnosis of MHE. Multiple regression analysis showed that high serum ammonia level (53-61) u/dl, large PSS (> 8 mm in diameter), MMSE score (22-26) and NCT A score (45-56) were the most significant risk factors for MHE. Conclusion: MHE is a major and prevalent manifestation in compensated liver cirrhosis patients. It is associated with significant decrease in work and driving abilities and quality of life. Its major risk factors are high serum ammonia, large PSS and high scores of MMSE and NCT A tests that have a good performance in MHE diagnosis.
Minimal hepatic encephalopathy
hepatitis C
Cirrhosis
Mini-Mental State Examination
porto-systemic shunt
number connection test A
2020
07
01
871
875
https://ejhm.journals.ekb.eg/article_100204_ffb0138985f96f447048596c65f90ee7.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Outcome of Minimally Invasive Locked Plate in Management of Proximal Tibial Fracture
Mohamed Abd Allah
El-Soufy
Amr Mohamed Ahmed
El-Adawy
Mohamed Khaled
Saleh
Abdel-Rahman Mansour
AlKoum
Background: Proximal tibia being a prime component of knee joint, which is vital for weight bearing and mobility. Because of its superficial location and vulnerable position, proximal tibia is frequently injured, more frequently in road traffic accidents (RTA). Open reduction and internal fixation with plate can result in extensive devitalization of soft tissue leading to wound healing problems. Minimally invasive plate osteosynthesis (MIPO) is a new technique which is becoming widely accepted for treatment of proximal tibial fractures. Objective: To evaluate functional and radiological outcome of fixation of proximal tibial fracture by minimal invasive plate osteosynthesis. Patients and methods: A prospective analysis of 12 patients with proximal tibial fracture. The right side was affected in 8 patients and left side in 4 patients, all of patients treated by MIPO technique by LCP. The patients were assed clinically by Rasmussen score post-operatively. Results: Functional evaluation was performed according to the criteria described by Rasmussen score. 7 cases (58.33%) had excellent result, 4 patients (33.33%) had good results and 1 patient (8.33%) had fair results. No patient had poor result. Conclusion: Minimally invasive plate osteosynthesis for proximal tibia fractures achieved good radiological and functional outcome. There was minimal soft tissue damage and minimal disruption of blood supply to fracture ends. The fractures treated with pure bridge plating and combined principle of compression and bridge plating healed rapidly by secondary fracture union
Proximal tibial
fracture
Minimally invasive plate osteosynthesis (MIPO)
2020
07
01
876
882
https://ejhm.journals.ekb.eg/article_100206_75462ab2c98ef1123a90df387b017e47.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Delayed Massive Lower Gastrointestinal Bleeding Secondary to Suprapubic Cystostomy, A Case Report of Very Rare Complication
Bashaeer Abdullh
Al Jalal
Introduction: Suprapubic cystostomy is a common procedure in urology. Bowel perforation is the most serious and rare complication. This report highlights the first published case of massive lower gastrointestinal bleeding as a complication secondary to suprapubic cystostomy. Case presentation: A sixty-seven-year-old patient with benign prostate hyperplasia had a suprapubic catheter inserted under spinal anesthesia, during concurrent cystoscopy. It was functioning well after insertion. Twelve days later, he developed massive hematochezia. On examination, he was hemodynamically stable. There was a demonstrable right lower abdominal tenderness and the digital rectal examination revealed dark red blood. The suprapubic cystostomy was draining clear urine without leakage. Investigations revealed a hemoglobin 6 g/dL and normal INR. Two units of packed red blood cells were given. A colonoscopy showed a normal colon with blood coming from above the ileocecal valve area. Upper endoscopy was normal. A red blood cell scan revealed active bleeding at the terminal ileum. A computerized tomography scan of the abdomen with IV contrast showed that the suprapubic catheter had passed into terminal ileum causing active bleeding. Exploratory laparotomy confirmed the presence of suprapubic catheter passing to the terminal ileum. The suprapubic catheter was removed, the unhealthy bowel resected, and anastomosis performed with no immediate post-operative complications. Conclusion: This case determines the importance of keeping careful watch for possible bowel injury after cystostomy and should be considered a rare complication and cause of lower gastrointestinal bleeding.
suprapubic cystostomy
Lower gastrointestinal bleeding
Rare complication
2020
07
01
883
884
https://ejhm.journals.ekb.eg/article_100205_6e68bf5801317ddb618424e185b3b924.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Association between Arginine 16 Polymorphism of B2 Adrenergic Receptor and Bronchial Asthma in Children
Khalid Mohamed
Salah
Heba Gamal
Anany
Nissreen El-Sayed
El-Badawy
Doaa Taha Ebrahim
Taha
Background: Asthma is one of the most prevalent health problems. The relationship between β2AR genotypes and response to β2AR agonist therapy is controversial. Some studies have found that the Arg-16 genotype is associated with reduced response to β2AR agonists, whereas others have found that the Gly-16 genotype is associated with reduced response. Objective: to detect gene polymorphism and to determine the association between gene polymorphism and bronchial asthma susceptibility as a risk factor, and to evaluate of the degree of severity of bronchial asthma among cases having a defect in studied gene and those without defect, and also to assess of drug response to β2 agonists concerning gene polymorphism. Methods: This study was carried out at Zagazig university hospitals. 100 Egyptian children with ages ranging from 5 to 12 years were enrolled. They were divided into 2 groups, the asthmatic group included 50 asthmatic children who were diagnosed according to GINA guidelines (2016), and a control group of 50 age and sex-matched healthy children. Results: Arg16Gly heterozygous represents 48%, Arg16 homozygous represents 38% and Gly16 homozygous represents 16% of asthmatic patients, while among the control group Arg16heterozygous represents 38%, homozygous represents 14% and 48% for Gly16 homozygous. There was no significant difference between Arg16Gly genotypes and asthma severity. Also, Arg 16 homozygous showed the best response to treatment with inhaled shortacting beta 2 agonists. Conclusion: there is an association between beta 2 adrenergic receptor polymorphism and the occurrence of bronchial asthma and also between this polymorphism and response to treatment. Also that the polymorphism at codon 16 of the β2 adrenergic receptor gene not a determinant of asthma severity in the Egyptian children.
2020
07
01
885
890
https://ejhm.journals.ekb.eg/article_103010_0b189c6e26703cd37d5cc1856328f34d.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Influence of Addition of Ondansetron or Ketorolac on Levobupivacaine in Bier Block for Upper Limb Surgeries
Hossam Eldeen AS
Faid
Enas M
Ashrey
Sahar Y
Osman
Background: Intravenous administration of a local anesthetic into a tourniquet occluded limb, continued to be in favor due to simplicity and reliability with rapid onset of the technique and decreased systemic toxicity.
Objectives:
Our study aimed to compare between the effects of adding ondansetron 8 mg or ketorolac 30 mg to levobupivacaine
0.125% for IVRA on duration of postoperative analgesia
Patients and methods: 60 adult patients of both sex who are matched with American Society of Anesthetists (ASA, I - II). Their ages ranged between 21–60 years old and scheduled for upper limb surgery under intravenous regional anesthesia (IVRA). Patients were randomly divided into three equal groups (20 patients each). Group (L): levobupivacaine (0.125%) + IV saline, (control group). Group (LO): levobupivacaine (0.125%) + IV ondansetron (8 mg/kg). Group (LK): levobupivacaine (0.125%) + IV ketorolac (30mg). All patients received levobupivacaine (0.125%) diluted with 0.9% normal saline to a total volume of 40 ml.
Results: Onset of sensory and motor block was rapid in ondansetron group than other groups. Duration of offset time of sensory and motor block was significantly prolonged in ketorolac group (p < 0.0001). Visual analog scale was significantly lower in ketorolac (p < 0.001) and ondansetron group than in control group. Duration of postoperative analgesia was longer in ketorolac group and ondansetron group than in control group (p < 0.001). Postoperative total analgesic consumption in 24h was significantly less in ketorolac group than in ondansetron group and control group (P < 0.002).
Conclusion: T
he results of the present study revealed that addition of ondansetron or ketorlac to levobupivacaine for
IVRA improved quality of anesthesia, reduced postoperative analgesic consumption with rapid onset of sensory block with ondansetron group than with ketorolac group. Moreover, the time to the first analgesic requirement after surgery
was prolonged with ketorolac group than with ondansetron group when compared to the control group.
Intravenous regional anesthesia
Levobupivacaine
Ondansetron
Ketorolac
2020
07
01
891
898
https://ejhm.journals.ekb.eg/article_103581_c233cbe68b0bdb6dbd4490fe9a52befa.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Albumin and Magnetic Resonance Imaging-Liver Volume to Identify Hepatitis C-related Cirrhosis and Esophageal Varices
Said Abd Elbaky Gad
Shams El Deen
Background: Liver cirrhosis is the 3rd leading cause of death globally, with increasing mortality rate worldwide portal hypertension is a frequent consequence in the progress of liver cirrhosis and plays a crucial role in the progression of the disease. One of the most serious complications of portal hypertension is the development of esophageal varices. Objective: To evaluate the changes in the liver lobes volume with that of albumin as non-invasive predictors of liver cirrhosis and esophageal varices. Patients and methods: One hundred cases are chosen and classified into four groups as 20 healthy as controls, 20 cases HCV without cirrhosis, 40 cases with cirrhosis but without varices, and 20 cirrhotic cases with varices. All participants undergo magnetic resonance imaging for liver lobes volume, biochemical analysis of serum albumin. All cirrhotic patients are exposed to upper gastro-intestinal endoscopy to differentiate cirrhotic with or without varices. Statistical analysis was done to determine the combination of liver lobes volume change together with albumin changes to predict the severity of cirrhosis and for esophageal varices. Results: RV, LMV, LLV, and albumin are significantly lower in cases of cirrhosis and LMV/albumin LLV/ALB, CV/Albumin shows a more significant difference in cirrhotics with varices. Conclusion: From the results of our study we conclude that MRI liver lobes volume and albumin are good predictors noninvasive markers of liver cirrhosis.
Liver cirrhosis
serum albumin
MRI
2020
07
01
899
906
https://ejhm.journals.ekb.eg/article_103582_1eb379fdec60e94eb881891758b77863.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Comparative Study between Bonfils Intubation Fiberscopy, Fiberoptic Bronchoscopy and Direct Laryngoscopy in Difficult Airway Patients
Noha Mohamed
Abdelwahab
Amira Abdelfattah
Shaaban
Ruqaya Mohamed
Elsayed
Amira Mohamed
Nassar
Background: Airway management has progressed since the first orotracheal intubation using a blind digital technique. The Macintosh laryngoscope has allowed tracheal intubation under direct vision. Objective: The present study was designed to compare the effect of fiberoptic intubation, bonfils intubation and direct laryngoscope on the hemodynamics, time taken for intubation, stress response hormones (glucose, cortisol and C-peptide) in difficult airway patients. Subjects and Methods: This Prospective, randomized, controlled study included a total of 90 adult patients aged 21-50 years with physical status (ASA) I or II of both sexes undergoing general anesthesia for elective surgical procedures. Patients were subjected to clinical examination and full investigations and assessment of the patients’ airway by El-Ganzori score. Patients were randomly allocated into three equal groups, 30 patients each: Group A: direct laryngoscope, Group B: fiberoptic bronchoscope and Group C: bonfils fiberoscope. Results: Fiberoptic has significant hemodynamic stability after one min of intubation than bonfils and direct laryngoscope. While bonfils has significant hemodynamic stability after five minute and ten minutes after intubation and had highly significant short time of intubation than fiberoptic and direct laryngoscope. As regard to number of attempts, most patients were successfully intubated on the first attempt in group B, while on the second attempt in groups A, and group C which was statistically non-significant between three groups. Conclusions: It could be concluded that bonfils has hemodynamic stability after five minute and ten minutes after intubation and also had the shortest time of intubation than fiberoptic and direct laryngoscope.
Fiberoptic bronchoscope
Bonfils
Direct laryngoscope
general anesthesia
Hemodynamic responses
2020
07
01
907
912
https://ejhm.journals.ekb.eg/article_103585_1c7b67ed4a5cfd3b2e2f45d505589bdd.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Value of Nailfold Capillaroscopy as A Screening Method for Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis
Rasha M.
Hammoda
Yasmin Abdelrazek
Ali
Nermeen
Samy
Background: Pulmonary arterial hypertension (PAH) represents one of the main clinical pictures of microvascular damage in systemic sclerosis (SSc). Objective: To assess the role of nailfold capillaroscopy (NFC) changes as a screening tool for the existence of PAH in patients with systemic sclerosis.
Patients and methods: Forty SSc patients were studied, included: 20 patients with PAH (diagnosed by transthoracic echocardiography and confirmed by right heart catheterization) and another 20 without PAH. History taking, clinical examination, and laboratory investigations including serological biomarkers (anti-centromere and anti-topoisomerase1 antibodies) have been recorded. NFC was performed for all patients according to the standard method.
Results: Scleroderma patients with PAH had significantly a longer disease duration (p=0.002) and higher frequencies of positive anticentromere and anti-topoisomerase 1 antibodies (p=0.011 and p=0.010 respectively). As regard NFC picture, SSc patients without PAH had significantly higher frequencies of early scleroderma pattern changes in 73.7% (p= 0.003), avascular area score 0 in 52.6% (p=0.014) and total NFC score 0 in 57.9% (p=0.022). In contrast, SSc patients with PAH showed higher frequencies of late scleroderma pattern changes in 50% (p=0.005) with lower capillary density (p <0.001), increased number of dilated mega-capillaries (p=0.049) together with more advanced avascular area of score 3 in 47.6% (p=0.007) and total NFC of score 3 in 45% (p=0.003). A significant negative correlation between mean pulmonary arterial pressure and capillary density (r=-0.57, p<0.001) was reported. Conclusion: Low capillary density together with wide avascular areas and more severe NFC scores have a clear association with the presence of PAH.
Systemic sclerosis
Pulmonary arterial hypertension
Nailfold capillaroscopy
2020
07
01
920
927
https://ejhm.journals.ekb.eg/article_103657_fedba724a16187c56da59447598f0430.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Pretreatment Renal Biopsy Findings as a Predictor of Post Treatment Renal Function in Patients with Hepatitis C Virus Associated Nephropathy: A Prospective Study
Marwa K.
Khairallah
Effat A. E.
Tony
Mohamed A.
Tohamy
Mahmoud
Essmat
Background: Renal histopathological patterns are established predictors of outcomes in many disorders. However, its role in predicting outcomes in hepatitis C virus (HCV)-associated nephropathy has not been elucidated yet. The preset study aimed to assess utility of biopsy in predicting post treatment renal functions in HCV-associated nephropathy patients. Patients and Methods: Prospective study included HCV 30 nephropathy-established patients, recruited from Nephrology Unit of Internal Medicine Department from September 2016 to September 2017. Ultrasound-guided, percutaneous, needle biopsy was utilized to obtain the renal samples. Results: Commonest form of HCV-associated glomerular disease was membranoproliferative (43.3%), followed by membranous glomerulonephritis (16.7%). Focal segmental glomerulosclerosis (FSGS), crescentic glomerulonephritis (CGN), and cryoglobulinemic were equally presented in 13.3% of the patients, each. Interstitial fibrosis was found in (73.3%), tubular atrophy in (70%), glomerular sclerosis in (46.7%), and arteriolosclerosis in (33.3%). Twelve weeks after new antiviral therapy, patients with moderate tubular atrophy exhibited statistically significant higher reductions in serum creatinine and urea levels than patients with severe form (-1.13 ±0.45 versus -0.71 ±0.56 mg/dL and -9.98 ± 1.67 versus -4.01±4.02 mg/dL, respectively; p =0.01). No significant difference between both groups was noted regarding 24-hours urinary protein and e-GFR. Patients with mild and moderate interstitial fibrosis and arteriolosclerosis exhibited statistically significant higher reductions in serum creatinine and urea levels. Tubular atrophy and Interstitial fibrosis significantly affect post treatment serum creatinine and urea (p <0.05). Conclusion: Pretreatment renal histopathology significantly influence post treatment renal functions in HCV nephropathy patients.
Hepatitis C Virus Glomerulopathies
Renal biopsy
Viral Response
Direct-acting antiviral
2020
07
01
928
935
https://ejhm.journals.ekb.eg/article_103658_f802d187bace758eb933de4ba6e4bac4.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Thyroid Autoantibodies in Egyptian Patients with Autoimmune Rheumatic Diseases: Relation to Disease Activity and Functional Impairment
Safaa Abd Elsalam
Hussein
Howaida Elsayed
Mansour
Mohammed Salah
Hussein
Ayat Sami Mohamed
Abdel Aziz
Nermeen Noshy
Aziz
Background: Autoantibodies against the thyroid seem to be more common in patients with rheumatic diseases than in the normal population. Their appearance may be linked to an associated autoimmune thyroid disease. Knowing the degree of association between rheumatic and thyroid diseases may help the clinician to make the correct decision. Objectives: The aim of the work was to estimate the prevalence of thyroid autoantibodies among patients with systemic autoimmune rheumatic diseases with or without thyroid disorders and its association with disease activity and functional impairment. Patients and Methods: The current study included 60 patients and 20 healthy controls. Patients were divided into three groups; systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and systemic sclerosis (SSc). Clinical and laboratory assessment were done to all patients including routine laboratory investigations and thyroid function tests (thyroid stimulating hormone [TSH], T3 and T4), and thyroid autoantibodies; anti- thyroglobulin (TgAb) and anti-thyroperoxidase (TPOAb). Results: SLE group had significant (P=0.018) lower age than other groups. Antithyroid antibodies and thyroid disorders were more common in SSc and SLE patients than RA patients and control subjects; however, no significant difference between studied groups. Presence of autoantibodies with and without thyroid disorders was not associated with the activity or functional indexes evaluated. Conclusion: The prevalence of thyroid autoantibodies in SLE and SSc patients was higher than in RA patients. No link could be established between the presence of thyroid autoantibodies and the results from any of the instruments used to measure inflammatory activity and functional impairment in these cases of rheumatic diseases.
Thyroid autoantibodies
Autoimmunity
Rheumatic disease
RA
SLE
SSc
2020
07
01
936
942
https://ejhm.journals.ekb.eg/article_103659_b64222d85dc3a6df8de4283d57634380.pdf
The Egyptian Journal of Hospital Medicine
1687-2002
1687-2002
2020
80
2
Prediction of Acute Kidney Injury in Critically-Ill Pediatric Patients Admitted to PICU: The Role of Serum Cystatin C And Serum Interleukin-18
Hams Ahmed
Attalla
Ali Mahmoud
Ahmed
Objectives: We conducted this study to assess the sensitivity and specificity of serum cystatin C (sCysC) and serum interleukin-18 (IL-18) in comparison with serum creatinine and serum urea for early detection of acute kidney injury (AKI) in critically-ill pediatric patients admitted to the pediatric intensive care unit (PICU). Methods: This was an observational case-control study enrolled 61 patients admitted in PICU divided into two groups (the case group 30 patients with proposed AKI and the control group 31 control individuals). After complete clinical evaluation, electrolyte profile, including Na and K besides the biomarkers assay of serum creatinine, urea, sCysC , and IL-18 were measured at the first day of admission and after three days. Results: Urea and creatinine were increased at admission in only three patients and two patients, respectively, while it dramatically increased in 25 patients in both urea and creatinine separately on the third day of admission. sCysC and sIL-18 showed a high diagnostic ability for detecting AKI at admission with AUCs of 0.877 and 0.819 respectively. Supportingnly, sCysC and IL-18 were significantly higher in AKI group compared to the control group. Conclusions: sCysC and serum IL-18 proved their accuracy in prediction of AKI in patients admitted to the PICU. Their diagnostic ability was superior to serum creatinine, serum urea, and even urinary IL-18 and CysC.
Serum Cystatin C
Serum Interleukin-18
Acute kidney injury
PICU
2020
07
01
943
950
https://ejhm.journals.ekb.eg/article_103660_b18ce0699c081c54a5072b3c6370f121.pdf