bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of tuberculosis in smear predator pulmonary TB in Fayoum Chest Hospital
Authors: Al Essawy Assem F. , Ahmed Randa I. , Raheem Fadwa A. E. , Bakri Heba M.
Published: September 2023

Background

Tuberculosis (TB) is one of the causes of health problem in millions of people annually, and in 2015, it was one of the top 10 reasons of doom worldwide, ranking above HIV/AIDS as one of the important causes of death owing to an intended disease.

A negative smear result in pulmonary TB is believed to be a widespread clinical problem, so early detection of smear-negative pulmonary tuberculosis (SNPTB) is important for TB control and restriction of number of deaths, and it is tricky in these patients.

Aims

To detect TB in SNPTB in Fayoum Chest Hospital

Design

This was a retrospective study.

Setting

Fayoum Chest Hospital and Fayoum University Hospital in Egypt were used for conducting the study between 2015 and 2017.

Patients and methods

Fifty patients suspected to have pulmonary TB and had negative sputum smear results were included in the study.

For each patient, full history was taken, and clinical body checkup was done. Then, plain posteroanterior chest radiograph was done. Tuberculin test, direct sputum examination, and other diagnostic methods used for detection such as GeneXpert, bronchoscopy, bronchoalveolar lavage (BAL), transbronchial lung biopsy, Löwenstein–Jensen culture, QuantiFERON, or even open lung biopsy were recorded.

Statistical analysis

Coding of the data was done then entered with SPSS (Statistical Package for the Social Sciences) version number 18 windows 7 after that data were summarized using mean, standard deviation, median, minimum and maximum in the quantitative data with using frequency (count) & relative frequency (percentage) for categorization of data.

Results

It was found that 42% of patients were diagnosed by GeneXpert and 46% were diagnosed by BAL during bronchoscopy, whereas 68% of patients had positive ‘Löwenstein–Jensen culture’ result.

Conclusion

The GeneXpert MTB/RIF assay is an important test for quick diagnosis of acid-fast bacilli SNPTB.

Flexible fiberoptic bronchoscopy is a beneficial tool in the diagnosis of pulmonary TB in patients whose sputum smear is negative.

Clinical implications are as follows: in patients with SNPTB, microbiological samples should be obtained (through sputum, BAL, or induced sputum), and then radiological investigation should be performed. Thereafter, antituberculous treatment should be started following the diagnosis, with follow-up of the case.

Rapid detection and proper treatment of pulmonary TB, even in smear negative patients, can eliminate spread of the infection to others and may decrease the severity of the disease.
Pressure support ventilation mode versus pressure support ventilation+T-piece trial as a weaning modality in mechanically ventilated patients with chronic obstructive pulmonary disease
Authors: Azouz Ahmed M. , El-Sokary Rafat T. , El-Latif Hassan A. , Ahmed Ghada
Published: September 2023

Background

Pressure support ventilation (PSV) mode and T-piece trial were used in weaning of mechanically ventilated (MV) patients with chronic obstructive pulmonary disease (COPD). Thus, the objective of study is to assess the value of adding T-piece trial to PSV mode in weaning off patients with COPD.

Patients and methods

A total of 80 MV patients with COPD admitted to respiratory ICU were divided into two groups: group I included 40 patients who were weaned off by PSV mode and group II included 40 patients who were weaned off by PSV mode and T-piece trial.

Results

The mean age of patients was 62 years. Overall, 73.8% were males and 73.75% were smokers. There were no significant differences between both groups regarding age, sex, BMI, smoking status, Acute Physiology and Chronic Health Evaluation score, exacerbation frequency, and hospital admission. Moreover, there was no significant differences between both groups regarding vital capacity, negative inspiratory force, rapid shallow breathing index, partial arterial oxygen pressure, partial arterial carbon dioxide pressure, and arterial oxygen saturation at the end of PSV mode in both groups. A significant decline in partial arterial oxygen pressure and arterial oxygen saturation and increase in partial arterial carbon dioxide pressure were observed in group II patients after adding T-piece trial. A total of 34 (85%) patients were successfully extubated in group I, whereas 33 (82.5%) patients were successfully extubated in group II. Period of MV, duration of weaning, ICU stay, and mortality were significantly higher in group II patients.

Conclusion

T-piece trial after PSV mode has no role in weaning; moreover, it causes more complications and leads to longer duration of weaning.
Detection of chronic obstructive pulmonary disease among shisha smokers in the Fayoum Governorate
Authors: El Essawy Assem F. , Elhefny Radwa A. , Ahmed Randa I. , Fouad Samar A.
Published: September 2023

Background

Shisha smoking is a common practice among the population in Arabic countries.

Shisha smoking has a negative effect on lung function; it is probably one of the causes for chronic obstructive pulmonary disease (COPD).

Objective

Detection of COPD among Shisha Smokers in the Fayoum Governorate.

Design

Prospective study.

Setting

Fayoum University Hospital in Egypt between 2016 and 2017.

Patients and methods

Of the 300 participants, 200 were shisha smokers for more than 20 years or their age above 40 years and 100 of them were nonsmoker volunteers. History of smoking was taken from the patients with recording of the COPD assessment score and then general and local examination was done followed by flow volume loop and finally by a chest radiography (posteroanterior view).

Statistical analysis: case–control study

Coding of the data was done and then entered with SPSS (statistical package for the social sciences) version number 24. After that data was summarized using mean, SD, median, minimum and maximum in the quantitative data with using frequency (count) and relative frequency (percentage) for categorization of data.

Results

Out of the 300 male patients included in this study 51% has obstructive airway disease and 19% had restrictive airway disease.

The mean age was 56.20±10.98 years. Number of hagars smoked by the COPD patients were 10.82±9.88 hagars per day with a duration of smoking of 24.87±12.36 years.

Conclusion

Shisha smoking increases the risk of COPD and this risk increases with the increase in the duration of smoking and number of hagar smoked was the conclusion of the study.
Workplace pulmonary tuberculosis case detection in Mansoura City and neighborhood villages
Authors: Hadidy Samah S. El , El-Bestar Sohair F. , Kamel Emily A. , Shalabi Nesrein M.
Published: September 2023

Context

Tuberculosis (TB) represents a high burden in workplaces. Aims Therefore, the aim of this study was to detect pulmonary TB cases in the workplace and assess the associated risk factors. Settings and design This cross section study was carried out from January 2011 to December 2013. This study included 253 participants recruited from Mansoura City and neighborhood villages Dakahlia Governorate. The catchment areas and occupational categories were determined according to a 1-year retrospective study reviewing hospital records.

Participants and methods

All participants were subjected to the following: (a) assessment of sociodemographic data, occupational data, and risk factors for TB. (b) Clinical examination. (c) Screening by chest radiography, the tuberculin skin test, and sputum Ziehl–Neelsen stain. (d) Assessment of knowledge of TB. Data were analyzed using statistical package for the social sciences, version 15. Qualitative data were presented as number and percentage. Comparison between groups was carried out using the χ2-test.

Results

Most participants were younger than 35 years of age, men, smokers, married, and with low educational and monthly income. Silica-related occupations were the most common. History of Bacillus Calmette–Guérin vaccination was not found among TB participants and was found in only 8.9% of non-TB participants. The majority of participants reported 8 working hours with no use of protective tools. The TB participants had significantly lower knowledge scores than nontuberculous participants. A total of 136 out of 148 participants had a positive tuberculin skin test. Chest radiography indicated an abnormality in six out of 253 participants and five of these were positive for sputum Ziehl–Neelsen.

Conclusion

TB screening in workplaces is mandatory because it can identify asymptomatic cases with active TB. A poor knowledge score may be considered a risk factor for TB infection in the workplace.
Impact of a designed educational program on elderly patients undergoing flexible bronchoscopy
Authors: Hasan Ali A. , Ali Anwar M. , Sharkawy Soad A. , Abozeid Hanan A. , Labieb Martha M.
Published: September 2023

Background

Bronchoscopy is a frequently required procedure in the elderly due to the high prevalence of pulmonary diseases. Bronchoscopy is associated with fears, stress, and anxiety.

Aim

To evaluate the impact of an educational program on patient knowledge, anxiety level, difficulties, duration, and complications of bronchoscopy procedure in elderly patients.

Patient and methods

One hundred and fifty patients aged 60 years and older candidates for bronchoscopy were included. The patients were randomly divided into two equal groups: 75 patients received educational guideline (study group); 75 patients did not receive educational guideline (control group). Patient knowledge about bronchoscopy and anxiety level were assessed. The esigned educational program was applied to the study group on the day before the procedure. It included brochures with simple and brief instructions and pictures about bronchoscopy in Arabic language. It also includes the structure of the respiratory system, definition, indications and complications of bronchoscopy, patient preparation before, during and after the procedure, and patient’s precautions that should be taken during and after bronchoscopy.

Results

There were insufficient knowledge and high anxiety scale about bronchoscopy. Knowledge score significantly increased and anxiety scale significantly decreased after providing the patients with educational program (P<0.001 for each). There was significant reduction in the duration of bronchoscopy procedure and the amount of anaesthesia used in the study than in the control group (P<0.001). Difficulties and discomfort were significantly lower in the study group.

Conclusion

Besides improving knowledge and reducing anxiety score, implementing the designed educational program increases tolerability, easiness and decrease problems related to bronchoscopy.
Neighbours affect each other; pulmonary affection after cardiac surgery
Authors: Elkolaly Reham M. , Sabry Mohab , Abo-Elnasr Mohamed , Arafat Amr
Published: September 2023

Introduction

Lungs and heart are in close relation all the time; they affect each other. Pulmonary complications due to cardiac surgeries may alter the surgery outcome and patient survival.

Aim

The aim of this study was to report the most frequent respiratory complications after cardiac surgeries.

Materials and methods

The study included 22 patients (group 1) who underwent coronary artery bypass grafting and 56 patients (group 2) who underwent valve replacement surgery. Preoperative and postoperative investigations such as chest radiology, spirometric lung functions and PaO2/FiO2 were performed. Pleural effusion, pneumothorax, acute respiratory distress syndrome, pneumonia, atelectasis, wound infection or sternal dehiscence were reported.

Results

Pleural effusion, pneumothorax, acute respiratory distress syndrome, pneumonia, atelectasis, and sternal wound infection in group 1 were found among 81.81, 4.55, 9.10, 31.82, 86.36 and 18.18% of the included patients, respectively, whereas in group 2 they were found among 33.93, 0, 0, 35.71, 64.29 and 10.71%, respectively.

Conclusion

Complications after cardiac surgeries are common and precautions must be taken to decrease them and to improve outcome.
Unilateral lung hyperlucency in an adult: an unusual cause
Authors: Kodan Parul , Das Abanti , Vyas Surabhi , Ray Animesh , Sharma Surinder K.
Published: September 2023

We report a case of young adult with unilateral lung hyperlucency. His radiological features were suggestive of Swyer–James syndrome. The condition is uncommon in adults. We report this rare case with discussion on clinical presentation, diagnosis, and management of Swyer–James syndrome. The report also throws light on various other causes of unilateral lung hyperlucency and its approach.
The association between the serum total cortisol as an adrenal response biomarker and severe community-acquired pneumonia
Authors: Khalil Magdy M. , Maher Maram M. , Abd Al-Kader Maryam A. , Kamal Eman S.
Published: September 2023

Introduction

The serum total cortisol is a biomarker to adrenal response in stressful conditions including infection. This study aims to estimate the serum total cortisol level in severe community-acquired pneumonia (CAP) and to study its relation to the severity of illness.

Patients and methods

The study included 50 patients, who with severe CAP were admitted to the ICU of National Institute of Chest Diseases (Embaba), and 20 healthy adults as the control. Ethical approval done by ASU ethical approval team as the paper was taken from masters thesis. The severity of CAP was estimated using pneumonia severity index (PSI) and CURB65 scores. The two groups were subjected to the estimation of serum total cortisol level (8 a.m.) by electrochemiluminescence immunoassay.

Results

Serum total cortisol level significantly increased in the patient group than in the control group (20.356±11.198 and 15.070±1.384 μg/dl, respectively). Serum total cortisol level was positively correlated with PSI but not with CURB65 score.

Conclusion

Severe CAP is associated with increased serum total cortisol level compared to normal. Serum total cortisol level was positively correlated with the disease severity as estimated by PSI.
The utility of integrating basic echocardiography in routine respiratory intensive care practice
Authors: Khalil Magdy M. , El-Shahid Ghada S. , Galal Iman H. E. , El-Maraghy Ashraf A. , Mahmoud Hanan H. I.
Published: September 2023

Objective

The aim of this study was to evaluate the impact of integrating basic echocardiography in routine assessment of patients admitted to the respiratory intensive care unit and to assess its effect on the outcome of those patients.

Patients and methods

This prospective cross-sectional study was performed upon 300 patients admitted to the respiratory intensive care unit between January 2015 and December 2015 at Abbasia Chest Hospital. Baseline bedside scanning of patients on admission by portable echo machine for basic echocardiography was reviewed by an experienced cardiologist in all cases as gold standard. Basic echocardiography was done to assess the pericardium, left and right ventricular size and function, valvular lesions, and inferior vena cava. Limited compression ultrasonography was done to detect lower limb deep venous thrombosis (DVT).

Results

Basic echocardiography showed that 91/300 (30.3%) patients had normal echocardiogram, whereas 209/300 (69.7%) patients had cardiac abnormalities. Basic echocardiography added unsuspected serious conditions to the diagnosis in 33 (11%) patients; five patients with massive pericardial effusion, 22 patients who required inotropics due to dilated cardiomyopathy in 11 patients and ischemic cardiomyopathy in 11 patients, five patients with DVT, and one patient with aortic aneurysm. In addition to this, basic echocardiography confirmed suspected massive pulmonary embolism in seven patients and DVT in 13 patients. Basic echo was able to read the whole finding data as compared to standard echo, with mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93, 97, 97, 98, and 98%, respectively, except for probable incompetent and probable normal tricuspid valve; the standard echo had the upper hand (P<0.0001).

Conclusion

Basic echocardiography in critically ill patients can readily provide adequate information to get a successful diagnosis and management, especially in life-threatening conditions that can be missed at the primary assessment.
Role of chest ultrasonography in assessment of diaphragmatic mobility in chronic obstructive pulmonary disease patients on pulmonary rehabilitation program
Authors: Saeed Adel M. , El-Azeim Nermine Abd , Gomaa Ashraf A. , Yousef Yahia R.
Published: September 2023

Background

Chronic obstructive pulmonary disease (COPD) affects all skeletal muscles including the diaphragm as an extra pulmonary complication. Diaphragmatic mobility improves by pulmonary rehabilitation (PR). Chest ultrasound can be used in assessment of diaphragmatic mobility.

Aim

Evaluation of chest ultrasound as a simple, noninvasive tool in assessment of diaphragmatic mobility in COPD patients undergoing PR and its correlation with maximal inspiratory pressure (Pi MAX), 6-min walk test (6MWT) and clinical chronic obstructive pulmonary disease questionnaire (CCQ).

Patients and methods

This study was conducted upon 30 COPD male patients aged 54.50±8.81 years old. All patients were recruited in to a PR program including 16 sessions over 8 weeks. The program included upper limb exercise, lower limb exercise and inspiratory muscle training. Baseline spirometry, Pi MAX, modified medical research council (mMRC) dyspnea scale, CCQ, 6MWT and sonographic assessment of diaphragmatic excursion and thickness were done. Follow-up sonographic evaluation of the diaphragm, CCQ and mMRC every 2 weeks were done. Re-evaluation after the program by the same baseline parameters was done.

Results

There was statistically significant improvement in diaphragmatic excursion and thickness after PR program as evidenced by chest ultrasound. There was also significant functional improvement evidenced by 6MWT and Pi MAX. Also, there was significant improvement in mMRC and CCQ, but PR did not significantly affect spirometric parameters as forced expiratory volume in first second (FEV1)%, FEV1 value in liter or FEV1/forced vital capacity.

Conclusion

Chest ultrasound is a beneficial tool in diaphragmatic assessment in COPD patients undergoing PR.
Broncial stump aspergillosis, an unusual cause of hemoptysis, and review of the literature
Authors: Maskey Dipesh , Agrawal Ritesh
Published: September 2023

Aspergillus species are ubiquitous dimorphic molds found in an environment. of the 250 species, few of them are pathogenic to human and can cause various lung involvements, tracheobronchial being one of the variant. Bronchial stumps and anastomosis are prone for fungal infection and can present with cough, hemoptysis, central airway obstruction and bronchopleural fistula with its highest incidence in patients with lung transplantation. Its occurrence in other types of lung surgery is very rare and 20 cases have been described in English medical literature till date since first published in 1969. We present a case of recurrent hemoptysis caused by bronchial stump aspergillosis, first reporting from India, and systematically analyze the literature for all the reported cases of bronchial stump and anastomosis aspergillosis in patients with lung surgery other than transplantation.
The role of sclerostin in knee osteoarthritis and its relation to disease progression
Authors: Eldin Amina B. , Mohamed Elham S. , EL Zahraa Hassan Fatma
Published: September 2023

Background

Osteoarthritis (OA) is a common joint disease especially in aging population and is characterized by progressive degeneration of articular cartilage, osteophyte formation, and subsequent joint space narrowing. Sclerostin, a protein product of the SOST gene, secreted mainly by osteocytes causes inhibition of Wnt/ β-catenin signaling pathway and bone morphogenetic protein, therefore may affect bone formation and bone remodeling in OA.

Aim

The aim was to assess serum sclerostin level in patients with knee osteoarthritis (KOA) and its relation to disease severity.

Patients and methods

A total of 80 participants (50 KOA patients and 30 healthy controls) were recruited in the present study. Sclerostin level in plasma was assessed using an enzyme-linked immunosorbent assay. OA grading was performed using the Kellgren–Lawrence classification. Assessment of physical disability was done by Western Ontario and McMaster universities Arthritis index score and health assessment questionnaire score.

Results

Plasma sclerostin levels were significantly lower in patients with OA than in healthy controls (P<0.001). Moreover, serum sclerostin level demonstrated a significant inverse correlation with the physical disability score (r=−0.506, P<0.01), age (r=−0.295, P<0.01), disease duration (P<0.05), and radiographic severity of KOA (P<0.001). By univariate regression analysis, sclerostin was one of the strong negative predictors for severity of OA.

Conclusion

Sclerostin was significantly lower in OA plasma samples when compared with healthy controls. Serum sclerostin level was inversely associated with the physical disability and radiographic severity of KOA. Therefore, sclerostin may be used as a biochemical marker for reflecting disease severity in primary KOA.
The role of interleukin-19 in diabetic nephropathy
Authors: Elhefnawy Khaled A. , Salah Ahmed M. , Elsaid Hanaa H.
Published: September 2023

Background

Proinflammatory cytokines play an important role in the establishment of arteriolosclerosis and kidney injury. Inflammatory cytokines are involved in the development of microvascular diabetic complications, including diabetic nephropathy (DN). Interleukin-19 (IL-19) has vital functions in many inflammatory processes and also can induce the angiogenesis of endothelial cells.

Objective

To investigate the role of IL-19 in the development of DN.

Patients and methods

A total of 112 participants were included and classified into four main groups: group I was the control group, which included 28 age-matched and sex-matched persons; group II included 28 patients with type 2 diabetes without nephropathy (normoalbuminuria); group III included 28 patients with type 2 diabetes with nephropathy (microalbuminuria); and group IV included 28 patient with type 2 diabetes with nephropathy (macroalbuminuria). All participants were subjected to complete blood count, complete urine analysis, fasting and random blood glucose, glycosylated hemoglobin (HbA1c), serum creatinine and urea, urinary albumin excretion rate (UAE), albumin-creatinine ratio (ACR), lipid profile, and serum IL-19 level assays.

Results

C-reactive protein (CRP) and serum IL-19 levels were significantly higher in diabetic patients compared with controls. IL-19 levels were significantly positively correlated with serum creatinine, ACR, UAE, HbA1c, and CRP. Multivariable logistic regression analysis showed that IL-19 levels were independently associated with patients with DN.

Conclusion

IL-19 levels were elevated in patients with DN and were positively correlated with ACR, UAE, HbA1c, and CRP. IL-19 may play an important role that contributes to the progression of DN.
Thyroid dysfunction in obese adults in relation to nonalcoholic fatty liver disease
Authors: Abdel-Moez Fatema Abu Bakr , Mohamed Ghada A. , Abbas Wael A. , Abozaid Mohamed A. A. , Mohammed Shymaa
Published: September 2023

Background

Hormones of the thyroid gland play an important role in the regulation of various metabolic processes. Disturbances in thyroid hormone concentrations may lead to hyperlipidemia and obesity, thus contributing to nonalcoholic fatty liver disease (NAFLD).

Aim

To evaluate thyroid dysfunction and determine its possible relationship to NAFLD in obese adults.

Patients and methods

Our cross-sectional study recruited 100 obese patients, who were subjected to full medical history, physical examination, abdominal ultrasonography, and routine laboratory tests in addition to liver function and thyroid function tests. NAFLD was recognized on the basis of ultrasonographic findings, and in the absence of other causes of liver disease.

Results

The patients were divided into two groups: group 1 (65 patients) with NAFLD and group 2 (35 patients) without NAFLD. Out of 100 patients recruited into the study, the most common thyroid dysfunction was overt hypothyroidism (22%), followed by (9%) subclinical hypothyroidism. Twenty-six (40%) patients with NAFLD were found to have thyroid dysfunction, of them eight (12.3%) NAFLD patients had subclinical hypothyroidism, and 18 (27.7%) NAFLD patients had overt hypothyroidism. Although prevalence of thyroid dysfunction (whether overt hypothyroidism or subclinical hypothyroidism) was 22 and 9%, respectively, among patients with obesity, there was nonsignificant positive correlation between BMI and thyroid-stimulating hormone (r=0.051 and P=0.612). Multivariate regression analysis showed that fatty liver, obesity index, and dyslipedemia were predictors of thyroid dysfunction in obese patients.

Conclusion

Thyroid hypofunction is common in obese patients with NAFLD, which has implications for screening for hypothyroidism in patients with NAFLD and for the administration of appropriate therapy for hypothyroidism.
Ultrasonographic abnormalities of wrist and metacarpophalangeal joints in a cohort of Egyptian patients with systemic lupus erythematosus
Authors: Shedid Noha H. , Hafez Eman A. , Akram Safa A. , Sakr Hossam M. , Mohamed Elham S.
Published: September 2023

Background

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by chronic inflammation and autoantibodies, affecting different organs. Musculoskeletal manifestations are one of the most common manifestations in SLE, usually nonerosive and nondeforming. Musculoskeletal ultrasonography (US) can detect synovial inflammation and structural damage lesions.

Aim

The aim was to detect ultrasound abnormalities of the wrist and metacarpophalangeal (MCP) joints in a cohort of Egyptian patients with SLE and their relation to disease activity.

Patients and methods

A total of 80 female patients with SLE and 10 age-matched apparently healthy controls were enrolled. Clinical examination and laboratory investigations were done for all patients. US examinations of both wrists and second to fifth MCP joints were done for all participants. Patients were divided according to clinical and US assessments.

Results

US detected synovitis of MCPs and/or wrist in 63.75% patients compared with 10% of healthy control (P<0.01). Synovitis was identified in most of the patients with SLE who had hand arthralgia when compared with patients without (P<0.01). Conversely, 18.3% of patients had wrist joints tenderness on physical examination with no sonographic abnormalities. Systemic Lupus Erythematosus Disease Activity Index score and dsDNA antibodies were associated with the presence of synovitis.

Conclusion

US is a valuable tool for assessment of joints in patients with SLE. It helps in detection of inflammation when compared with clinical examination and monitoring disease activity.
Noninvasive parameters for assessment of esophageal varices
Authors: Elatty Ehab A. A. , Elshayeb Elsayed I. , Badr Mohammed H. , Mousa Waleed A. E. , El Mansory Mohammed F.
Published: September 2023

Objective

This study aims to assess esophageal varices (EV) by noninvasive parameters in patients with liver cirrhosis.

Background

The current guidelines recommend the screening of all cirrhotic patients by endoscopy for EV, but repeated endoscopic examinations are unpleasant for patients and have a high cost impact and burden on endoscopic units. Therefore, there is a particular need for noninvasive predictors of EV.

Patients and methods

A total of 120 cirrhotic patients were enrolled in this study and were divided into three groups: 40 cirrhotic patients with EV and a history of upper gastrointestinal bleeding, 40 cirrhotic patients with EV without a history of upper gastrointestinal bleeding, and 40 cirrhotic patients without EV. All patients in the study were subjected to an assessment of history, clinical examination, routine laboratory investigation, abdominal ultrasound, and upper gastrointestinal endoscopy.

Results

Serum albumin at cut-off less than 3.65 g/dl, platelet count at cut-off less than 99 000/mm3, platelet count/spleen diameter ratio (PC/SD) at cut-off less than 919.6, aspartate aminotransferase-to-platelet ratio index at cut-off greater than 1.14, spleen longitudinal diameter at cut-off more than 140.5 mm, portal vein diameter at cut-off more than 15.2 mm, and prothrombin time at cut-off more than 15.1s are significant in the prediction of EV. North Italian Endoscopy Club Index at cut-off more than 25.4, platelet count at cut-off less than 74 000/mm3, and PC/SD at cut-off 851.6 are significant in the prediction of variceal bleeding risk.

Conclusion

Serum albumin, platelet count, PC/SD ratio, aspartate aminotransferase-to-platelet ratio index, spleen longitudinal diameter, portal vein diameter, prothrombin time, and Child score can provide information that can help in the prediction of the presence of EVs in patients with liver cirrhosis. North Italian Endoscopy Club Index, platelet count, and PC/SD ratio can provide information that can help in the prediction of variceal bleeding risk in patients with liver cirrhosis.
Prevalence of undiagnosed thyroid dysfunction in correlation with Helicobacter pylori infection: cross-talk between Hashimoto’s thyroiditis and Helicobacter pylori
Authors: Rashad Nearmeen M. , Gomaa Ahmed F.
Published: September 2023

Background

Worldwide, the prevalence of thyroid dysfunction is increasing and it is one of the leading endocrine disorders. The objective of the present study was to assess the prevalence of undiagnosed thyroid dysfunction and its association with Helicobacter pylori (HP) infection and to clarify the association between HP and Hashimoto’s thyroiditis.

Patients and methods

A cross-sectional study was conducted among 300 unrelated patients; 187 patients had normal thyroid function and 113 patients had thyroid dysfunction. The patients were stratified into one of the following five groups based on the reference of the normal thyroid function test; thyroid-stimulating hormone and free thyroxine were used as the screening tests to diagnose thyroid dysfunction. HP antigen in the stool and antibodies against cytotoxin-associated gene A (cag-A), anti-thyroid peroxidase (anti-TPO) antibodies, and anti-thyroglobulin (anti-TG) antibodies were measured.

Results

Our results show that the prevalence of thyroid dysfunction was found in 37.6% of the studied population. The most frequent dysfunction was subclinical hypothyroidism (44.4%), followed by overt hypothyroidism (20.6%). Interestingly, the prevalence was higher in association with HP infection diagnosed by HP antigen and cag-A antibodies. There was statistically significant positive correlation between HP antigen and anti-TPO as well as anti-TG. Regarding cag-A. There were statistically significant positive correlations between antibodies against cag-A and anti-TG as well as anti-TPO. Interestingly, stepwise linear regression analysis showed that serum thyroid-stimulating hormone levels were independently correlated with free thyroxine, HP.

Conclusion

The higher prevalence of thyroid dysfunction as observed in the current study was associated with Hashimoto’s thyroiditis. Further future multicenter studies with a bigger sample size are needed to validate our findings.
Role of different direct-acting antiviral drugs on hepatitis C virus-associated mixed cryoglobulinemia in Egyptian patients
Authors: Elshazly Tarek A. , Elrabat Amr M. , Ali Sahar A. M. , Diasty Muhammed , El-Desoky Mohamed
Published: September 2023

Background

Several extrahepatic manifestations have been reported and mixed cryoglobulinemia is a clonal disorder of B cells which is strongly associated with hepatitis C virus (HCV).

New regimens of direct-acting antiviral agents (DAAs) have recently been approved for the treatment of genotype 4 HCV which offer improved results of sustained virologic response (SVR) in the treatment-naive and previously treated patients.

Aim

To assess the prevalence of cryoglobulinemia for evaluating the efficacy of DAA therapy on it.

Patients and methods

Patients received one of the following regimens: sofosbuvir, daclatasvir±ribavirin, or sofosbuvir plus ledipasvir±ribavirin follow-up for 24 weeks after treatment.

Results

A total of 132 patients were involved in our study: 65 men and 67 women. Cryocrit-positive patients clinically presented with clinical manifestations in 32 (53.3%) patients out of the 60 patients. After 12 weeks of DAAs treatment, there was a significant reduction in cryoprecipitate level and rheumatoid factor (RF) level with improvement of glomerular filtration rate, basal C4, and clinical improvement of purpura, Raynaud’s phenomenon, and this was the same when 38 patients continued treatment for 24 weeks. However, comparing 12 and 24-week therapy showed significant improved difference in cryoprecipitate level but improved glomerular filtration rate, basal C4, and decreased level of RF, proteinuria, purpura, and peripheral neuropathy although it did not reach statistical significance

Conclusion

Cryocrit-positive patients were old age, cirrhotics with long duration of HCV. There is significant improvement of both laboratory and clinical parameters of cryoglobulinemia after SVR12 and more significant after SVR24. There is no significant difference in using different DDA regimen with or without ribavirin on the SVR at either 12 or 24 weeks. So, we advise basal laboratory and clinical parameters of mixed cryoglobulinemia before designing treatment regimens of HCV patients in Egypt.
Factors affecting readmitted patients with acute exacerbation of bronchiectasis
Authors: Alduihi Fatima Alhamed , Khoury Abdallah
Published: September 2023

Background

Bronchiectasis is an important cause of morbidity and mortality all over the world. Determining the frequency of actual occurrence is particularly misleading and difficult to determine, especially in patients with multiple respiratory disorders, because it can be a result of any primary pulmonary disease. The objective of this study was to evaluate the effect of readmission with acute exacerbation of bronchiectasis (AEB) on the admissions later on, need of long-term O2 and mechanical ventilation, and mortality.

Patients and methods

This is an observational cohort and prospective study. It was conducted on patients admitted with AEB who achieved modified O’Donnell criteria, and their high-resolution computed tomography showed bronchiectasis on admission at Aleppo University Hospital between September 2017 and January 2019. They were divided into three groups by age. Patients with bronchial asthma, chronic obstructive pulmonary disease, and cystic fibrosis were excluded.

Results

The study included 90 patients (57 males and 33 females) with a mean age of 52.93 ±20.437 years. AEB showed a peak of incidence in the age group 41–65 years. Dyspnea is the most common symptom in exacerbations (88.23%) followed by hemoptysis (80.88%). Wheezing had the least frequency on admission (60.29%). Median survival age was 14±0.214 months. We collected information on 136 exacerbations in 90 patients. A total of 31 (34.44%) patients had at least one readmission and 19 (21%) patients died within 12 months of admission to the hospital. Age, smoking, and need of long-term O2 were statistically significant between the two groups of study (P=0.013, <0.0001, and 0.04, respectively). Sex, radiological changes, mortality, and mechanical ventilation have no significance.

Conclusion

AEB is a common reason for hospitalization, and it correlates with age, smoking, readmission, and need of long-term O2 treatment.
Delirium: a common preventable medical disorder in elderly patients
Authors: Hemeda Afaf
Published: September 2023

Delirium is one of commonest unmet medical emergencies in clinical practice however, its role in increasing mortality, hospital admission and institutional placement in very obvious. In addition, a link was found between delirium and development of dementia based on the finding that significant number of delirious patients developed persistent cognitive impairment thereafter. Several factors can lead to delirium or aggravate it and consequently primary care physician should be aware by these factors keeping in mind that delirium is still a treatable condition if identified and managed appropriately and urgently.
Multiplicity of hereditary thrombophilic factors inherited from both parents results in child catastrophe
Authors: Hemeda Afaf
Published: September 2023

Here we present a rare case of hereditary thrombophilia due to transfer of multiple hereditary thrombophilic factors from father and mother with lethal outcome.
Evaluation of the Sabadell noninvasive hepatitis C-related cirrhosis early detection index and right lobe diameter to albumin ratio in the prediction of presence of varices in Egyptian cirrhotic patients
Authors: Kamal Ghada M. , Zaghloul Amr M. , El Aref Rania
Published: September 2023

Introduction

Portal hypertension in cirrhosis results from progressive fibrotic remodeling of the liver, which increases the resistance to hepatic sinusoidal blood flow. Increased portal venous pressure causes esophageal and gastric varices, which contribute substantially to cirrhosis-related morbidity and mortality. The gold standard in the diagnosis of varices is esophagogastroduodenoscopy, but identification of noninvasive predictors of esophageal varices (OVs) will allow upper gastrointestinal tract endoscopy to be carried out only in a selected group of patients. Different noninvasive parameters including clinical, laboratory, and sonographic predictors are an alternative approach to perform selective screening endoscopy only in patients at high risk.

Objective

Our objective is to evaluate whether the noninvasive hepatitis C-related cirrhosis early detection (NIHCED) score and the right lobe diameter to albumin ratio can predict the presence of OVs in a group of Egyptian cirrhotic patients.

Patients and methods

Seventy-five patients with liver cirrhosis were enrolled in the study depending on the clinical evidence of stigmata of chronic liver disease (e.g. jaundice, ascites, palmar erythema, spider naevi, etc.) and ultrasonographic features of liver cirrhosis (e.g. coarse echo texture, shrunken liver, etc.).

Results

According to the esophagogastroduodenoscopy results, the patients were categorized into two groups: those with OVs (47 patients, 63%) and those without OVs (28 patients, 37%).

Receiver operating characteristic curve analysis of the NIHCED score was applied to both groups with a cutoff score of more than 45. The estimation cohort study had a sensitivity of 70%, specificity of 78%, and diagnostic accuracy of 74% with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval, 0.66–0.86).

Receiver operating characteristic curve analysis of the right lobe diameter to albumin ratio was applied to both groups with a cutoff score of more than 2.80. The estimation cohort study had a sensitivity of 80%, specificity of 53%, and diagnostic accuracy of 67% with an area under the receiver operating characteristic curve of 0.67 (95% confidence interval, 0.55–0.77).

Conclusion

The NIHCED score and right lobe diameter to albumin ratio are simple noninvasive predictors of the presence of varices in Egyptian patients with liver cirrhosis.
Prognostic value of serum autotaxin in liver cirrhosis and prediction of hepatocellular carcinoma
Authors: Ahmed Nagwa Ramadan , EL-Mazny Ahmed Nabil , Hassan Sarah Ahmed , Rashed Laila Ahmed
Published: September 2023

Background

Autotaxin is a lysophospholipase D related to liver fibrosis; its clinical role in liver cirrhosis is still unknown or limited. In this study we investigate the relation of autotaxin serum levels and prognosis of liver disease and/or prediction of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) patients.

Patients and methods

This observational, prospective case–control study included 180 participants, 60 patients with HCV-related liver cirrhosis, 60 HCV noncirrhotic patients, and 60 healthy controls. They were enrolled from inpatients and clinics of a tertiary-care hospital. Baseline characteristics, serum autotaxin, Child–Turcotte–Pugh and model of end-stage liver disease scores were determined. Abdominal ultrasound and upper gastrointestinal endoscopy were done at the beginning of the study. Cirrhotic patients were prospectively followed up for 6 months.

Results

Patients with liver cirrhosis had the highest level of autotaxin (106±24 μg/ml) compared with noncirrhotic HCV patients (81.9±21 μg/ml) and healthy controls (42.5±11 μg/ml) using one-way analysis of variance test (P=0.000). Spearman’s correlation analysis showed no significant correlation between autotaxin and Child–Turcotte–Pugh score (r=0.02; P<0.70), and model of end-stage liver disease score (r=0.15; P<0.41). At 6 months of follow-up, patients who developed HCC or encephalopathy had significantly higher baseline autotaxin level (141±55 μg/ml; P=0.02, 117±56.6 μg/ml; P=0.000), respectively, than patients who did not (102±34, 90.7±40 μg/ml). Cutoff values of autotaxin for the prediction of HCC and encephalopathy were 95 and 92μg/ml, respectively, with 91 and 92% sensitivity.

Conclusion

Autotaxin is a sensitive predictor for the development of HCC and encephalopathy in HCV-related cirrhotic patients. However, it was not related to disease severity.
Extracellular vesicles and systemic lupus erythromatosus
Authors: Omran Rasha N. , El Shebini Emad M. , Zahran Enas S. , Shoeib Sabry A.
Published: September 2023

Introduction

Extracellular vesicles (EV) have emerged as important ‘nanoshuttles’ of information between cells, carrying proteins, genetic information, and bioactive lipids to modify the phenotype and function of recipient cells. EVs are potential regulators in autoimmune disorders, playing a determinant role in the appearance and maintenance of inflammation.

Objective

This study aimed to carry out an up-to-date review of the EVs and their relationship with systemic lupus erythromatosus.

Data sources

Medline databases (PubMed, Medscape, ScienceDirect, EMF-Portal) and all materials available in the Internet till 2018.

Study selection

This search yielded 275 articles. The articles were studied to perform an up-to-date review of the extracellular vesicles and their relationship with systemic lupus erythromatosus.

Data extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was obtained, the eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Data synthesis

Comparisons were made by a structured review, with the results tabulated.

Conclusion

We can safely conclude that EVs play an important role in the complex pathogenesis and management of systemic lupus erythematosus.
Current characteristics of chronic hepatitis B in Egypt
Authors: Elsabaawy Maha M. , Elsherefy Mohammed E. , Sakr Haitham E. , Elsabaawy Dalia , Elshazly Helmy , Elezaawy Hossam , Al Azab Gasser I. , Eltahawy Mahmoud
Published: September 2023

Background and aim

In the era of hepatitis C virus eradication, Egypt had to pay attention to the two million infected with chronic hepatitis B. This study aimed to observe the current characteristics of chronic hepatitis B virus (HBV) infection in Egypt.

Patients and methods

This cross-sectional study was conducted on 183 patients with chronic HBV infection. The demographic, epidemiologic, clinical, laboratory, and treatment data were collected from patient registries.

Results

Positive hepatitis B e-antigen (HBeAg) cases represented 18.04%. They were younger (31.09±8.542–38.22±10.6 years) (P<0.05), with higher alanine aminotransferase (84.91±67.855–53.75±55.575 U/l) (P<0.05) and viral loads (3.58×108±16.49×108–1.74×106±10.1×106 IU/ml) (P<0.05), particularly in chronic active carrier states. Unsafe hygienic procedures (sharing toothbrushes and razors) were the main infective routes (73.7%). Coinfection with hepatitis C virus was documented in 14.7%, along with 16.3% with schistosomal infestation. HBV and hepatitis D virus coinfection was reported in 8.9% of the studied cohort. Radiologically, liver cirrhosis was detected in 44% of cases, with associated splenomegaly in 20.7%. Histologically, 40.2% were found to have significant pathology (A2, F2>2). Thirty (16.3%) cases were outside international guidelines of treatment, only for follow-up. Overall, 70.5% were subjected to lamidine therapy, with unfair responses mainly detected in the HBeAg-positive group (71.4%), who responded marvelously to interferon finite regimens. HBeAg-positive status and schistosomiasis were found to be associated with poor response to oral antivirals by multivariate analysis (P<0.05).

Conclusion

More classified governmental censorship efforts, notably on private organizations, along with awareness levitation are promptly mandated. Additionally, the poor response to oral antivirals in HBeAg-positive patients signifies sticking to interferon as a first-line treatment option.
Achieving euthyroidism in hypothyroid patients using levothyroxine improves depressivity and impaired daily life scores using ThyPRO questionnaire
Authors: Elsherbiny Tamer M.
Published: September 2023

Background

Levothyroxine is the recommended treatment to achieve euthyroidism in hypothyroid patients. Achieving euthyroidism was found to improve quality of life in some studies but failed to do so in other studies. Thyroid patient reported outcomes (ThyPRO) is a thyroid-specific health-related quality of life measure. This study aims to assess patient-reported outcomes in levothyroxine-treated hypothyroid patients using ThyPRO.

Patients and methods

The study included 194 patients, divided into two groups: group 1 included 141 hypothyroid patients with benign thyroid disease treated with l-thyroxine, stable in euthyroidism for at least 6 months, and group 2 included 53 patients with euthyroid benign thyroid disease. All patients completed a professionally translated, carefully revised version of the ThyPRO questionnaire into Arabic language. All patients had their Thyroid stimulating hormone (TSH) measured at inclusion. Anti-thyroperoxidase and/or anti-thyroglobulin antibodies were recorded for each patient where available.

Results

There were no significant differences between the two studied groups regarding age, sex, and TSH. Anti-thyroperoxidase antibodies were significantly higher in treatment group versus group 2, but anti-thyroglobulin antibodies did not differ among the two studied groups. Group 1, l-thyroxine treatment group, showed significantly lower scores in the goiter symptoms, depressivity, impaired daily life, and hyperthyroid symptom scales compared with group 2. No significant differences were found regarding the remaining symptom scales.

Conclusion

Hypothyroid patients of different etiologies rendered euthyroid for at least 6 months compared with euthyroid patients with benign thyroid disease have significantly better depression, goiter, impaired daily life scores using a thyroid-specific questionnaire, the ThyPRO, compared with euthyroid benign thyroid disease.