bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome and Prognostic Factors of Class V Membranous Nephropathy (Pure and Mixed Form) in a Cohort of Egyptian Patients with Systemic Lupus Erythematosus
Authors: Attia Allah Duaa Farghaly , Hosny Hamza Sherin Mohamed , Khalil Nermeen Samy , Mohamed Mansour Mohamed Maher
Published: November 2024

Background

Renal disease is a frequent and severe cause of morbidity in systemic lupus erythematosus (SLE). Lupus membranous nephropathy (LMN), which is an uncommon subtype of lupus nephritis, is usually associated with nephrotic syndrome and can have a variable course; some patients maintain stable kidney function or show a slow progression, while others can have renal flares and transformation to more severe proliferative forms eventually leading to ESRD or to life-threatening extrarenal complications, including thrombotic events, cardiovascular disease (CVD), or infections. In many cases, a combination of membranous and proliferative lesions may be seen in renal biopsies.

Objective

To study the clinical presentation, course, outcome and prognostic factors of class V membranous nephropathy (pure and mixed) in a cohort of Egyptian patients with SLE.

Methods

This was an observational study which was conducted on ninety six (96) adult Egyptian patients diagnosed with LMN recruited from the outpatient clinic and inpatient department of rheumatology, at Ain Shams university hospitals, during a period of 12 months.

Results

In this study, the univariate logistic regression analysis shows that (low level of WBCs, low level of hemoglobin, high level creatinne, high level of urine, Protein / Cr ratio, low level of Creatinine clearance) were found significantly associated with poor outcome in patients with mixed type. Also, the multivariate logistic regression analysis shows that the most important factors associated with poor outcome in patients with mixed type was found WBCs level ≤3. WBC of urine analysis>10, that ESR >28, partial remission and SLEDAI score >13 were found significantly associated with poor outcome among patients with pure MLN. Also, the multivariate logistic regression analysis shows that the most important factor associated with poor outcome in patients with pure type was found partial remission.

Conclusion

The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes and longer follow up to reassess our findings.
COVID-19 and DKA of Type 2 Diabetes, Impact and Outcome
Authors: Abd Albaky Mohamed Rania Al Sayed , Ali Hendawy Laila Mahmoud , Mohamed Abd Al Hady Saleh Amr Mahmoud , Mahmoud Farghaly Eman Elsayed
Published: November 2024

Background

Recent evidence suggests a potential link between COVID-19 infection and the development of insulin dependence in individuals with diabetes, particularly through direct damage to pancreatic insulin-producing beta-cells mediated by the virus's affinity for ACE2 receptors. This association bears similarities to the role of other viruses like enteroviruses and mumps in causing fulminant ketoacidosis. While it is feasible that the insulin dependence seen in diabetic ketoacidosis (DKA) during COVID-19 arises from SARS-CoV-2-induced beta cell dysfunction, stronger evidence supports an alternate pathway involving indirect factors like systemic hypoxia, sepsis, inflammatory responses, and cytokine storms resulting from the infection.

Aim of the Work

This study aimed to assess the risk factors and outcomes related to DKA in COVID-19-infected patients with type 2 diabetes.

Patients and Methods

The research analyzed data from 70 patients, comprising 35 with DKA and 35 without DKA, focusing on variables such as age, sex, comorbidities, laboratory results, and clinical symptoms. The mean age was found to be significantly higher in the DKA group, aligning with previous studies that linked older age to increased DKA susceptibility during COVID-19. Sex distribution did not show significant differences between the DKA and non-DKA groups.

Results

Notably, patients with DKA displayed longer diabetes duration and significantly higher hemoglobin A1c levels, suggesting a potential role of poor glucose control in precipitating DKA during COVID-19 infection. Furthermore, DKA patients exhibited more severe acid-base disturbances and electrolyte imbalances compared to their non-DKA counterparts. These imbalances, along with respiratory and cardiovascular symptoms, characterized the clinical presentation of DKA during COVID-19.

Conclusion

Ultimately, the mortality rate was found to be markedly higher among DKA patients than among non-DKA patients. These findings emphasize the importance of recognizing the complex interplay between COVID-19 infection, diabetes, and DKA, especially in older individuals with longer diabetes duration and poor glycemic control. This study provides valuable insights into the risk factors and clinical outcomes associated with DKA in COVID-19-infected patients with type 2 diabetes, contributing to our understanding of the multifaceted relationship between these medical conditions. Further research is needed to elucidate the underlying mechanisms and optimize management strategies for this vulnerable patient population.
Correlation of Magnesium Levels and Retinopathy in Patients with Type 2 Diabetes Mellitus
Authors: Ahmed Iman Zaky , Bekhet Meram Mohamed , Elsamkary Mahmoud Ahmed , Girgis Bishay Caroline Adel , Mohammed Bahaa Mahmoud , Mohamed Ahmed Eman Mahmoud
Published: November 2024

Background

Diabetes mellitus is a set of metabolic diseases characterized by chronic hyperglycemia as a consequence of lack in insulin action, secretion, or both. All of which lead to long-term damage and dysfunction of different organs predominantly the eyes, kidneys, nerves, heart, and blood vessels. Diabetic retinopathy (DR) is a chronic inflammatory neurovascular complication linked to DM, and it is known to be the leading cause of preventable blindness, affecting more than 415 million people worldwide. Recent studies showed that Magnesium deficiency has been correlated to type 2 diabetes mellitus and diabetic retinopathy (DR).

Objective

To investigate the correlation of magnesium levels and retinopathy in patients with type 2 diabetes mellitus and magnesium status in type 2 diabetes mellitus in comparison to healthy population.

Methods

The study was a case-control study conducted on 180 cases attending diabetes outpatient clinic at Ain Shams university hospital: 38 males, 62 females divided into 3 groups, Group Ι: 60 type 2 diabetic patient without diabetic retinopathy, Group ΙΙ: 60 type 2 diabetic patients with diabetic retinopathy & Group ΙΙΙ: 60 cases as a control group of non-diabetic patients.

Results

In our study results, serum magnesium (Mg) levels remarkably lower in type 2 diabetes patients (groups Ι & ΙΙ) compared to controls (group ΙΙΙ). On comparing groups I & II serum Mg levels were significantly lower in group II (type 2 diabetes patients with diabetic retinopathy) compared to group I (type 2 diabetes patients without diabetic retinopathy). This study showed that serum Mg levels had a (PPV) Positive predictive value for diabetic retinopathy 80 % when their levels are ≤ 1.5 mg/dl, with sensitivity 46.67% and specificity 88.33% (this means that serum Mg levels can predict diabetic retinopathy among patients with type 2 diabetes mellitus when their levels are below or equal 1.5 mg/dl). In a multivariate analysis magnesium is considered an independent risk factor for diabetic retinopathy in type 2 diabetes mellitus after adjustment of Age, SBP, cholesterol and eGFR.

Conclusion

Magnesium level is lower among patients with type 2 diabetes compared to normal population. Magnesium is considered an independent risk factor for diabetic retinopathy in type 2 diabetes mellitus. Magnesium level ≤ 1.5 mg/dl has a PPV for DR with sensitivity 46.67% and specificity 88.33%.
The Effectiveness of Potassium-Competitive Acid Blocker in Eradication of Helicopacter Pylori in Comparison with Proton Pump Inhibtor
Authors: Faheem Ghaly Sameh Mohamed , Sabry Manal Sabry Mohamed , Aziz George Tari Magdy , Mogahed Esraa Ali El-Desoky
Published: November 2024

Background

Helicobacter pylori (H. pylori) disease is becoming a debilitating and chronic infection as it invades the gastric mucosa and causes gastritis. Chronic inflammation caused by H. pylori in the gastric mucosa can lead to atrophic gastritis, gastroduodenal ulcer, mucosa-associated lymphoid tissue (MALT) lymphoma, gastric adenocarcinoma, and even idiopathic thrombocytopenic purpura. These conditions can be prevented and treated by H. pylori eradication.

Aim of the Work

To assess the efficacy including symptoms improvement and cure rate, in addition to evaluation of the adverse events of vonoprazan triple therapy in treatment of H. pylori.

Patients and Methods

The study participants consisted of 72 adults that visited Outpatient clinics at Ain Shams University hospital, Egypt, with various dyspeptic cases with symptoms like upper abdominal pain, bloating, nausea, or early satiety. All the study participants underwent upper endoscopy to enable appropriate disease diagnosis.

Results

There is no significant difference between the two groups regarding age, sex, height, weight, and BMI. Also, there is no significant difference between the two groups regarding neither comorbidities nor routine laboratory parameters, positive antigen was lower among group B (61.1%) compared to group A (69.4%) but without statistically significant difference, and there is no significant difference between the two groups regarding side effects.

Conclusion

Based on these findings, it can be concluded that the P-CAB-based triple therapy demonstrated comparable efficacy to the standard PPI-based triple therapy for H. pylori eradication. These results suggest that P-CAB, with its stronger acid inhibitory effect, can be considered as an effective alternative treatment as a part of triple therapy for H. pylori infection.
Plateletcrit and Mean Platelet Volume in the Evaluation of Liver Cirrhosis and Nonalcoholic Fatty Liver Disease in Egyptian Patients
Authors: Gadallah Abdel-Naser Abdel-Atty , Elshayeb Elsayed Ibrahim , Shaheen Ghada Ahmed Abdel-Fattah , Montaser Belal Abd El-Mohsen
Published: November 2024

Background

Chronic liver disease secondary to liver cirrhosis from non alcoholic fatty liver disease is a leading cause of morbidity and mortality and a major public health problem in Egypt. Mean platelet volume (MPV) is a marker that reflects platelet activation and function. MPV values were increased in patients with nonalcoholic fatty liver disease, intrahepatic cholestasis of pregnancy, chronic hepatitis, and liver cirrhosis. Recently, MPV and MPV/platelet count ratio were proposed as markers for the diagnosis of HCC in patients with chronic liver disease.

Objective

To identify noninvasive, easy, and cheap markers for diagnosis and staging of NAFLD and cirrhotic patients without the need for liver biopsy.

Patients and Methods

A case control study conducted on 133 patients with liver cirrhosis and non-alcoholic fatty liver patients in hepatology outpatient clinics, inpatient ward, and intensive care unit at Menoufia University hospital, during a period time from April 2022 to May 2023.

Results

RBCs and HGB were significantly increased in control group (4.95±0.56, 11.97±1.56) than NAFLD (4.58±0.70, 11.11±1.94) and Cirrhosis (4.11±0.75, 10.89±2.02), respectively. While, PCT was significant increase in Cirrhosis (0.31±0.15) group than NAFLD (0.23±0.12) and control (0.14±0.06). MPV was significantly increased in NAFLD (10.75±2.18) than control (9.46±1.72) and cirrhosis (8.61±0.58), (P < 0.05). However, there were no significant differences among studied groups according to WBCs, Platelets and PDW (P > 0.05)

Conclusion

A current survey revealed that PLT indices can be treated as potential prognostic markers in liver cancer (LC) and NAFLD patients, correlating significantly with biochemical markers of liver fibrosis. According to our observations, PCT in LC and MPV in NAFLD turned out to be the most powerful markers. The study results showed an increase in MPV in patients with NAFLD. Rise in MPV in NAFLD can suggest the need for early evaluation and appropriate treatment by clinicians.
Association between Serum Beclin 1 Level and Cardiac Valvular Calcification in Hemodialysis Patients
Authors: Hebah Hayam Ahmed , Kamel Ali Morsi Hadeer Moamen , Bastawy Islam Mahmoud , Ahmed Fatma Abdelrahman
Published: November 2024

Introduction

Cardiovascular calcification is a prevalent condition at all stages of chronic kidney disease (CKD). Autophagy is a natural cellular phenomenon that is considered to have a great ability to modulate pathology of cardiac diseases such as cardiac arrhythmias, atherosclerosis, heart failure and especially cardiac valvular and vascular calcifications. Beclin- 1, a highly conserved eukaryotic protein, has a major regulatory role in autophagy. It is a component of the phosphatidylinositol-3-kinase (PI3K) complex. Recent studies showed that autophagy effect of beclin 1 might play a protective role in CKD vascular calcification. Autophagy is expected to become a new therapeutic target for CKD vascular calcification.

Methods

This study enrolled 102 hemodialysis patients divided into 2 equal groups according to echo results. All the participants were subjected to serum Beclin 1 and transthoracic echocardiography. Patients with acute kidney injury, active malignancy and diabetics were excluded.

Results

There was statistically significant difference between the two groups regarding serum Beclin 1, all parameters of lipid profile, ischemic heart disease, serum albumin, and total calcium. the echocardiography findings regarding aortic valve calcification in group 1 showed that the majority of cases exhibited mild calcification (60.78%), there was a significant relation between beclin 1 and both of IHD (p = 0.011), and ECHO findings Aortic valve calcification (p˂0.001). (lower level of beclin was associated with severe valvular calcification). The best cutoff value of beclim 1 was ≤ 35.5 ng/ml, with the best sensitivity (98%) and specificity (92%).

Conclusion

The serum beclin 1 level assessment could be used as a tool for the prediction of cardiac valvular calcification in hemodialysis patients.
Evaluation of Vitro Score (Von Willebrand Factor Antigen/Thrombocyte Ratio) as a New Marker for Presence of Esophageal Varices due to Clinically Significant Portal Hypertension (CSPH) in Liver Cirrhosis
Authors: Muhammad Hala Saleh , Karmoty Khaled El , Hamdy Hesham , Shaarawy Salah
Published: November 2024

Background

Bleeding due to esophageal varices is one of the causes of high mortality in cirrhotic patients. Esophageal varices occurs with the presence of clinically significant portal hypertension that is more than 10 mmHg. The most diagnostic method for clinically significant portal hypertension is the measurement of HVPG and the most diagnostic to detect esophageal varices is UGIE, both of which are invasive procedures and costly.

Aim of the Work

to evaluqate the vitro score as a non-invasive marker for presence of esophageal varices in clinically significant portal hypertension.

Patients and Methods

The study was carried out on 60 Egyptian patients. These were divided into two groups (varices and no varices) based on the findings of UGIE. For all participant in this study, full clinical assessment by history and physical examination was done in addition to laboratory hematological and biochemical assessment and detection of varices was done by UGIE, We also assessed serum vWF antigen in all study participant.

Results

In this study, we found the VITRO score was higher in patients with esophageal varices. We found that the VITRO score ranged from 0.78 to 1.92 in patients with varices with median (IQR) 1.22(1.03-1.32); and from 0.08 to 0.82 in patients with no cirrhosis with median(IQR) 0.23 (0.15-0.4), being statistically significant higher in patients with varices with p-value= 0. There was no significant correlation between VITRO score and (age, WBCs, HB, BUN, Creat, Na, K, Total and direct bilirubin, AST, ALT, AFP and MELD score). The results showed sensitivity 93.75% and specificity 100% for VITRO score as a marker for detection of esophageal varices, with cut-off point > 0.82

Conclusion

VITRO score is a promising non-invasive marker for detection of esophageal varices.
Cardio-Metabolic Index as a Novel Predictor for Metabolic Associated Fatty Liver Disease (MAFLD) In Egyptian Patients
Authors: Khalil Sultan Hanan Sedki , Abd Elmageed Khaled Hamdy , Allam Ahmed Samir , Abd Elhady Abeer Abd Elraof
Published: November 2024

Background

Metabolic associated fatty liver disease (MAFLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is a new definition of liver disease associated with known metabolic dysfunction and is the most common chronic liver disease worldwide.

Aim of the Work

to investigate the association between the cardiometabolic index (CMI) with risk of metabolism-associated fatty liver disease (MAFLD).

Patients and Methods

a cross-sectional study. It included 50 patients. It was conducted in Ain Shams University Internal Medicine department for six months from June 2023 to December 2023.

Results

the study revealed that a wide age group ranging from 22 to 70 years, (mean age of 49.86±12.91 years). There was male to female ratio 1:1, mean of BMI [wt/ (ht)∧2] was 34.17±5.28, WHtR was 0.59±0.09, DM was 22 (44.0%) and HTN was 22 (44.0%). Association between CMI and different parameters was done and resulted in no statistically significant association between CMI and sex, obesity. While it showed statistically significant association between CMI and age groups, higher score of steatosis, higher score of fibrosis, and enlarged liver size. Correlation between CMI with different parameters in patients, using Pearson's correlation coefficient (r) was done and resulted in; statistically significant positive correlation between CMI with age (years), HTN, TG, steatosis score, fibrosis score and size liver, with p-value (p < 0.05). While, there was a statistically significant negative correlation between Cardio-metabolic Index with WHtR and HDL, with p-value (p < 0.05). As for the rest have insignificant correlation, with p-value (p > 0.05). ROC curve analysis proved good discriminating power of the (Cardio-metabolic Index) between positive liver and negative liver for Fibrosis where Area under the ROC curve (AUC) = 0.86 with SE 0.163 (95% Confidence interval 0.72 – 0.94. Z statistic= 6.332, p < 0.001. Cutoff point >5.5 with sensitivity= 87.2% and specificity=81.8.

Conclusion

The cardiometabolic index (CMI), a recently developed index reflecting visceral adipose tissue (VAT) distribution and dysfunction consisting of anthropometric and biochemical indicators, including waist-to-height ratio (WHtR) and triglyceride to high- density lipoprotein cholesterol ratio (TG/HDL-C), which can be easily obtained during a health examination.
The Relation of Residual Kidney Function to Post-Dialysis Fatigue
Authors: Abdelaziz Haitham Ezzat , Abdelmobdy Ashraf Hassan , Metwally Mohammed Hend Mahmoud
Published: November 2024

Background

End-stage kidney disease (ESKD) poses intricate challenges in its management, often requiring long-term dialysis or kidney transplantation to sustain metabolic balance and fluid- electrolyte equilibrium. Despite these treatments, ESKD patients frequently experience debilitating symptoms, such as fatigue. Fatigue's prevalence is substantial in both dialysis and non-dialysis ESKD patients, impacting their daily lives and overall well-being. Residual kidney function (RKF) after dialysis initiation plays a pivotal role in influencing various health outcomes.

Aim of the Work

To estimate post-dialysis fatigue in chronic haemodialysis patients and its relation to residual kidney function and other associated variables.

Patients and Methods

The study included 70 Patients with ESKD who underwent regular HD and they were divided into 2 groups; group A (Included 35 patients who had residual kidney function) and group B (Included 35 patients who did not have residual kidney function).

Results

Fatigue was widespread, as indicated by FAS scores ranging from 16 to 37. Most patients experienced fatigue, with 67.1% reporting fatigue and 15.7% extreme fatigue. Although there was no significant correlation between FAS scores and RKF, RKF's role was evident in parameters like urea post-hemodialysis, influencing patient outcomes.

Conclusion

In conclusion, the complex interaction involving RKF and the exhaustion experienced after dialysis calls for a more profound exploration. This research brings into focus the elaborate correlation between RKF and fatigue, underscoring the diverse aspects of symptomatology in ESKD. Additional inquiries are merited to gain a more comprehensive comprehension of the variables influencing fatigue and to formulate precise interventions aimed at enhancing the quality of life for individuals with ESKD.
Serum Calprotectin as an Inflammatory Marker in a Cohort of Egyptian Patients with Psoriatic Arthritis and its Correlation with Disease Activity and Radiological Findings
Authors: Farouk Hanan Mohamed , Habeeb Reem Abd El-Monem , Badr Fatma Mohamed , Hamada Magdeldin Naghim Ibrahim , ElSherbiny Dalia AbdelHamid
Published: November 2024

Background

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis and is found in about 20 to 30% of psoriatic patients. The use of inflammatory markers can be disappointing in PsA, since they are elevated in only half of the patients with PsA., in this study we assessed serum calprotectin as a marker of inflammation in psoriatic arthritis and correlated it to disease activity and radiological findings.

Objective

To measure serum calprotectin level in psoriatic arthritis patients and to assess its association with disease activity score and radiological findings using musculoskeletal ultrasound.

Methods

This was a Case-Control Study Rheumatology inpatient departments and outpatient clinics at Ain Shams University Hospitals. This study was conducted on 50 patients with psoriatic arthritis according to the classification criteria for psoriatic arthritis (CASPAR) criteria and 30 Normal subjects with no past medical history and with no family history of psoriasis.

Results

Patients serum calprotectin level had statistically significant higher value in comparison to the control group P-Value < 0.001., and with cutoff point 106.36 ng/ml with sensitivity 98% and specificity of 86.6 %, There was highly statistically significant relation between the level of serum calprotectin and synovial hypertrophy in small hand joints P-Value=0.004 and it can predict synovial hypertrophy in hands by joint ultrasound at the level of 258.9 ng/ml with sensitivity and specificity of 71%, 83% respectively There was also a with statistically significant relation nail bed affection in ultrasound P-Value=0.034. Multiple regression analysis was done in psoriatic arthritis patients and it was found that serum calprotectin was the most predictive for the presence of psoriatic arthritis in comparison to ESR and CRP.

Conclusion

in psoriatic arthritis patients, serum calprotectin level is significantly higher and is correlated to radiographic and nail changes. Further studies are required to define a specific cutoff serum level for diagnosis.
Doppler Ultrasonography on Small Joints of Hands and Feet to Assess Subclinical Affection in Patients with Psoriasis
Authors: Mohamed Maha Shokry , Mohamed Dalia Fayez , Abdelaziz Amina Badr Eldin , El-Azizi Noran Osama Ahmed , Mohamed Elham Shabaan , Ali Hussein Safaa AbdelSalam
Published: November 2024

Background

Psoriasis, a systemic inflammatory disease, often manifests as plaque psoriasis, affecting 80-90% of patients. Psoriatic arthritis (PsA) diagnosis relies on CASPAR criteria, with ultrasound, especially power Doppler, proving valuable in assessing severity and treatment response. PsA causes deformity, dysfunction, and significantly impairs patients' quality of life.

Aim of the Work

To asses subclinical affection of peripheral joints in psoriatic patients without symptoms of arthropathy.

Patients and Methods

A cross-sectional study conducted at Ain Shams University Hospital involved 70 psoriasis patients recruited from dermatology clinics. The study, adhering to ethical standards, utilized comprehensive methods, including medical history, clinical examinations, routine laboratory tests, and musculoskeletal ultrasound with power Doppler. The cross-sectional design allowed assessment of various aspects of psoriasis and its associated conditions.

Results

This cross-sectional study of 70 psoriatic patients revealed that musculoskeletal involvement was more prevalent in females (57.7%) and those with a BMI >24 (kg/m2). Higher PASI scores (>5) correlated with increased risk. Treatment with topical steroids and methotrexate showed positive associations. In multivariate analysis, female gender and PASI score >5 remained significant predictors of musculoskeletal affection in psoriatic patients (p < 0.05).

Conclusion

The study underscores the significance of evaluating musculoskeletal issues in psoriatic patients. Female gender, higher BMI, smoking, and elevated PASI scores were linked to musculoskeletal involvement. Treatment with topical steroids and methotrexate correlated with such issues. Female gender and higher PASI scores were independent predictors of musculoskeletal concerns.
Assessment of Vitamin D Level in Patients with Acute Coronary Syndrome in CCU Patients
Authors: Shoukry Nihad Shoeib , Abdelsalam Mona Mohamed , Abdelsalam Ahmed Mohamed , Ali Hanan Mahmoud , Aoud Mahmoud Said
Published: November 2024

Background

Vitamin D is a steroid hormone that plays a crucial role in mineral homeostasis and bone metabolism. Recent studies have revealed its diverse role in the immune system, vascular and myocardial cells. Vitamin D deficiency and insufficiency are frequently observed in children and adolescents worldwide, particularly in the Middle East. Cardiovascular disease (CVD) is a leading cause of mortality, and ischemic heart disease (IHD) is a major contributor to the global disease burden. The current study aimed to assess the role of vitamin D in IHD patients.

Aim of the Work

Assessment of vitamin D level in patients with acute coronary syndrome.

Patients and Methods

A cross-sectional study was conducted on 90 male patients aged between 40- 60 years old. Patients were divided into two groups based on the presence of diabetes mellitus (DM). Group A comprised of 45 diabetic patients, and Group B included 45 non-diabetic patients. The patients were further divided into four groups based on the presence of acute coronary syndrome (ACS). Group 1 comprised of 23 patients with acute ST-elevation myocardial infarction (STEMI), Group 2 included 22 patients with non-ST elevation acute myocardial infarction (NSTEMI), Group 3 had 23 patients with unstable angina, and Group 4 consisted of 22 patients with stable angina. All patients included in the study provided informed written consent.

Results

The study found that vitamin D insufficiency was prevalent in all ACS and stable angina groups, with the highest vitamin D level observed in Group 4 (stable angina), followed by Group 3 (unstable angina), Group 1 (STEMI), and Group 2 (NSTEMI). A negative correlation was observed between serum vitamin D level and cardiac enzymes CK-MB and troponin. A significant negative correlation was found between serum vitamin D level and age, BMI, and glycemic profile of the studied patients.

Conclusion

In conclusion, the study suggests that vitamin D deficiency and insufficiency are common among Egyptian patients with acute coronary syndrome (ACS) and stable angina, which may increase the risk of developing coronary artery disease (CAD), especially NSTEMI and STEMI. Therefore, vitamin D should be considered as an atypical risk factor for CAD. The incidence of IHD can be controlled by controlling its risk factors such as BMI, age, uncontrolled diabetes, hypertension, and dyslipidemia, which are also associated with low vitamin D levels.
Relationship between Serum Zinc Level and Retinopathy in Type 1 Diabetic Patients
Authors: Eid Yara Mohamed , Ibrahim Wessam Ahmed , Abushady Manal Mohammed , Aly Elhalawany Salah Hussein , Hakim Akhnokh Mary Fayez
Published: November 2024

Background

Diabetes mellitus is one of the common chronic metabolic diseases associated with various micro- and macro-vascular complications. Diabetic retinopathy (DR) is a microvascular disorder with various grades which leads to visual problems or even blindness. Nearly all patients with type 1 diabetes and more than 60% of those with type 2 have some degree of retinopathy after 20 years. Zinc is one of the micro-nutrients abundant in the human body and possess an important role in various metabolic reactions. Previous studies reported that decreased serum zinc levels was associated with certain diabetic microvascular complications. Zinc depletion has a major impact on the pathogenesis of diabetic complications. However, the correlation between zinc level and diabetic retinopathy needed more studies and especially in type 1diabetic patients which has not been studied at all.

AIM/ Objectives

Assess the correlation between serum zinc and diabetic retinopathy in type 1 diabetic patient.

Subjects and Methods

This observational study was conducted on 60 subjects with their ages ranging from 18-60, selected from diabetes outpatient clinics of Ain Shams University Hospitals for 7 months in a period from June 2022 to January 2023; 40 patients and 20 non diabetic as control divided into three groups: 20 Patients with Type 1 diabetes without diabetic retinopathy, 20 Patients with Type 1 diabetes with diabetic retinopathy and 20 apparently healthy individuals. All patients included in the study will be screened for diabetic retinopathy using fundus photography camera. Photos were assessed and graded by an expert ophthalmologist. Assessment of zinc level by automated chemistry analyzer will be done.

Results

The study shows that there was statistically significant negative correlation found between zinc level and duration of diabetes, HbA1c, LDL, TC, FPS, 2PP and serum creatinine level in all diabetic type 1 group. And in groups of patients with and without retinopathy. There was no statistically significant difference found between control group and DM type1 with and without retinopathy group regarding zinc level although there was numerical differences.

Conclusion

Positive relationship between decreased zinc level and diabetic retinopathy suggesting the contribution of this factors in the pathogenesis of DR through acting in a same pathway Further studies using larger numbers of patients are recommended to get benefit of giving zinc supplements to these patients
Role of Serum IGFBP-7 for Diagnosis of Cardiomyopathy in Diabetic Patients vs Healthy Individuals
Authors: El-Shayeb Mohammed Abdelrahman , Ahmed Hoda Mohammed Al-Sayed , Zeyada Omneya Mohamed , Awad Mohammed Rashad , Mahmoud Nassar Mennatullah Nabil Shafik
Published: November 2024

Background

Among the general adult population, it has been estimated that the prevalence of heart failure in diabetic patients ranges from 19% to 26%.

Aim of the Work

This study aims to assess the role of the serum level of IGFBP-7 as a potential biomarker for diagnosis of Diabetic Cardiomyopathy and cardiac fibrosis.

Patients and Methods

Our study was a case control study, conducted on 75 patients of matched age and sex attending Diabetes, Internal Medicine and Cardiology outpatient clinics at Ain Shams university hospital during the period from March 2023 to July 2023. 25 were medically free individuals and they made the control group. As regards the cases group it was divided into further 2 groups where 25 were diabetic patients with normal echo and the remaining 25 patients were diabetic patients with cardiomyopathy.

Results

Our study strongly supports that IGFBP-7 as a biomarker is sensitive enough to detect diabetic cardiomyopathy. BMI was highly significant when compared between diabetic cardiomyopathy and normal Echo and diabetic cardiomyopathy and control group. Linking the correlation between IGFBP-7 and metabolic syndrome. In our study HbA1c was found non-significant between diabetic cardiomyopathy and diabetic normal Echo. Raising the suspicion of correlation between glycemic control and development of Heart Failure. In this study, certain lab parameters such as serum Cr and lipid profile were associated with positive statistical significance in patients with diabetic cardiomyopathy linking the association of diabetic cardiomyopathy with other chronic illnesses such as chronic kidney disease and atherosclerotic diseases.

Conclusion

Our study focused on IGFBP-7 levels to detect the diabetes-induced changes in cardiac structure and function existing at the early stage of DCM, and progression of DCM from subclinical diastolic dysfunction to overt HF. With specificity 100% and sensitivity 68% between diabetic cardiomyopathy and diabetic normal echo. Moreover; with sensitivity 100% and specificity 84% between diabetic normal echo and controls.
Thrombophilia Gene Screen Most Incriminated Factor in Portal Vein Thrombosis in Chronic Liver Disease Patients before Liver Transplantation with Protein C & S Deficiency
Authors: Makhlouf Mohammed Marey , Abd El Aal Amr Ahmad , Abdelrahman Ghada , Raafat Khaled Mohammed , Elsayed Eldemnawy Mennatullah Yasser Elsayed
Published: November 2024

Background

Portal vein thrombosis whether due to inherited or acquired thrombophilia is a major problem prior to liver transplantation & during surgery & post- operative requiruiring prompt diagnosis & management & thrombophilia gene screen is important to identify any inherited cause for thrombophilia as a cause for portal vein thrombosis prior or during or post-surgery or as a cause of any venous thromboembolism in liver transplantation candidate to start proper anti-coagulation when needed.

Aim of the Work

The aim of this study was to determine which factor in thrombophilia gene screen most incriminated in causing portal vein thrombosis in cirrhotic patients prior to liver transplantation.

Patients and Methods

This retrospective study included 40 chronic liver disease patient prior to liver transplantation with protein c &s deficiency,& divided into two groups where group (A) 20 patients have PVT, protein c&s deficiency & mutation in thrombophilia gene screen. And a control group (B) of 20 patients haven’t PVT & have protein c&s deficiency.& patients were collected from Ain Shams University Hospitals.

Results

The results of this study showed that there’s no factor in thrombophilia gene screen shown to be more incriminated in portal vein thrombosis prior to liver transplantation than the other.

Conclusion

It’s not settled yet which factor in thrombophilia gene screen most incriminated in portal vein thrombosis or venous thromboembolism in general, where inherited factors are considered to be low risk factors for thrombosis, yet further studies are needed with larger sample size to determine which factor is most incriminated in portal vein thrombosis prior to liver transplantation.
Study of Leaky Gut syndrome and its Correlation to Hashimoto’s Thyroid Disease with Respect to Antibodies Titre
Authors: Halawa Mohamed Reda , Ahmed Iman Zaky , Eid Yara Mohamed , Youssef Ashour Zeinab Ahmed , Anwar Maha Ahmed , Nesim Mina Michael
Published: November 2024

Background

Hashimoto's thyroiditis (HT) is the most common autoimmune disease worldwide, characterized by chronic inflammation and circulating auto antibodies against thyroid peroxidase and thyroglobulin. Alterations in the gut microbiota are associated with autoimmune diseases development. There is increasing evidence that gut microbiota is an important environmental factor directly or indirectly influencing the progression of thyroid diseases and that thyroid diseases can exacerbate disturbances in the microbiota

Objective

To evaluate serum zonulin levels and stool lactobacillus acidophilus growth as markers of leaky gut syndrome in patients with Hashimoto's thyroiditis.

Methods

This was a case control study that was conducted on 80 Egyptian subjects age (20 – 60 years old) & were divided into 60 patients with Hashimoto's thyroiditis and 20 control, the patient group was further divided into 3 equal groups according to the thyroid functions state (Euthyroid, sub clinical hypothyroid and overt hypothyroidism), evaluation of serum zonulin and stool lactobacillus acidophilus growth and correlation with TPO antibody titer was done.

Results

Our study showed statistically significant increase in serum zonulin level which was positively correlated to TPO level in Hashimoto's thyroiditis patients implicating a possible presence of leaky gut syndrome, this was present in the hypothyroid group significantly than the Euthyroid Hashimoto's group, as it was also associated with lactobacillus acidophilus stool culture positivity which may reflect a bacterial dysbiosis.

Conclusion

This data may reflect the interaction between the gut microbiota and possible leaky gut syndrome association with Hashimoto’s thyroiditis. However, whether this data is a result from Hashimoto's disease or a cause, this need a further evaluation.
Endoscopic versus Histopathological Diagnosis of Pan-gastritis in Patients with Chronic Gastric Dyspepsia
Authors: Abdelghany Mohamed Mohamed , Elsaid Kadry , Elkhadr Enas , Galal Salah Shaarawy
Published: November 2024

Background

One of the most prevalent, severe, and sneaky chronic disorders in people is chronic gastritis. Numerous hundreds of millions of individuals worldwide may have chronic gastritis in one way or another, according to estimates that more than half of the world's population has this disease to some degree or extent. Despite the clear role of gastritis in the etiology of common peptic ulcers and stomach malignancies, the relevance of chronic gastritis as a dangerous disease is vastly overestimated in clinical practice.

Aim of the Work

to compare the endoscopic diagnosis and histopathologic diagnosis of pan gastritis in patients presented with chronic gastric dyspepsia.

Patients and Methods

This study is a Randomized study conducted at Gastroenterology Medicine outpatient clinic and endoscopy unit in Air Force General Hospital and Benha teaching hospital included 100 patients presented by dyspepsia for more than 8 weeks

Results

In this study we demonstrated that RBCs ranged from 3.8 to 5.9 x1012/L with a mean ± SD of 4.86 ± 0.64 x1012/L. WBCs ranged from 4 to 9.5 x109/L with a mean ± SD of 6.62 ± 1.55 x109/L. Platelets ranged from 120 to 348 x103/µL with a mean ± SD of 224.71 ± 63.94 x103/µL. Hb ranged from 9.5 to 14.5 g/dL with a mean ± SD of 11.83 ± 1.55 g/dL. ALT ranged from 5.9 to 45 U/L with a mean ± SD of 24.34 ± 11.46 U/L. AST ranged from 10.7 to 49 U/L with a mean ± SD of 29.28 ± 10.33 U/L. Urea ranged from 6.5 to 44.7 mg/dL with a mean ± SD of 24.77 ± 10.39 mg/dL. Creatinine ranged from 0.2 to 2.1 mg/dL with a mean ± SD of 1.1 ± 0.6 mg/dL. In this study we illustrated that regarding endoscopic results, 25 (25%) patients were normal, 56 (56%) had gastritis and 19 (19%) had other lesions. regarding patients with gastritis, 7 (12.5%) of them had atrophy, 8 (14.29%) had mucosal nodularity, 24 (42.86%) had edema and 17 (30.36%) had erythema while the location of gastritis varied as 41 (73.21%) patients had pan-gastritis, 9 (16.07%) had antrum predominant gastritis and 6 (10.71%) had corpus predominant gastritis. regarding patients with other lesions, 7 (36.84%) of them had esophagitis, 9 (47.37%) had duodenal ulcer and 3 (15.79%) had hiatal hernia. In this study we illustrated that there was a statistically significant difference among endoscopic and histopathological findings of the studied patients (P value <0.001).

Conclusion

Pan-gastritis is a common finding in early dyspeptic patients and endoscopy has high sensitivity in diagnosis of pangastritis and normal endoscopic appearance did not rule it out, and the histopathology was still the gold standard method.
Role of Soluble Transferrin Receptor and Transferrin Receptor-Ferritin Index to Detect Iron Deficiency Anemia in Regular Hemodialysis Patients
Authors: Abd Elmageed Khaled Hamdy , Allam Ahmed Samir , Abdo Samy Mahmoud , Elshony Mustafa Salah Mustafa
Published: November 2024

Introduction

Several iron indicators can be used to detect iron deficiency anaemia (IDA) where confounding comorbidities occurred such as patients with regular hemodialysis.

Aim of the Study

to determine the diagnostic value of sTfR and TfR-F and to combine these two markers in detecting IDA in HD anemic patients.

Patients and Methods

This is observational prospective case–control study carried on 30 cases &30 controls. IDA was diagnosed based on TS < 20% and ferritin level < 200 ng/L and functional iron deficiency when TS < 20% and ferritin > 200 ng/L. TfR-F index calculated as sTfR/log ferritin. All participants were subjected to full clinical examination& routine laboratory investigations (CBC, RBCs indices, iron profile, serum electrolytes blood urea and creatinine) specific investigations (Serum sTfR was measured with ELISA technique)

Results

There is statistically significant difference between the two groups as regard sTfR. There were strong significant correlations between TfR-F index and T.SAT, CRP, TIBC and sTfR. In Univariate correlation regression, there were strong significant positive correlations between TfR-F index and T.SAT, CRP, TIBC and sTfR. In Multivariate correlation regression, there were strong significant positive correlations between TfR-F index and T.SAT, CRP, TIBC and sTfR. Sensitivity of sTfR and TfR-F index was 83.5% and 85% respectively. Specificity of sTfR and TfR-F index was 70.1% and 75% respectively.

Conclusion

When sTfR and the TfR-F index used in combination to detect IDA, we found that sensitivity of sTfR and TfR-F index was 83.5% and 85% respectively. Specificity of sTfR and TfR- F index was 70.1% and 75% respectively.
Impaired Intestinal Barrier Function in Immune Thrombocytopenic Purpura Patients Measured by Serum Zonulin
Authors: Nour Melek Nermine Abd-El , Kamal Tanagho Sylvia Talaat , Mehriz Ali Salem Lamyaa Elsayed , Mettias Tacla Nermine Moheb , El-Mekawey Mohamed Nada Ragab
Published: November 2024

Background

Besides its involvement in the digestion and resorption of nutrients, one task of the intestine is to act as a barrier regulating the passage of antigens and macromolecules from the environment into the organism. This barrier is to a major extent formed by the intestinal epithelia and its lateral tight junctions whichclose off the paracellular interstices. The tight junctions consist of transmembrane barrier proteins such as occludin and claudins, which are bound via proteins of the intracellular cytoskeleton with actin and microtubular structures. The function of the intestinal barrier (IB) can be modulated by a variety of stimuli. These include nutrients such as gluten, toxins or bacteria or their respective metabolic products ab- sorbed with the nutrition which induce a raised secretion of zonulin through the cells of the lamina propria.

Objective

To evaluate serum Zonulin level, as a marker of increased intestinal permeability, in ITP patient compared to healthy subjects.

Methods

This Study was conducted between October 2022 and June 2023 on 60 patients diagnosed with ITP divided in to 2 sub-groups 30 patients on steroid therapy for a duration longer than 3 months and 30 steroid naïve patients togetherwith 30 apparently healthy individuals as a control group. Patients were recruitedfrom Hematology department and outpatient clinic, Ain Shams University Hospitals.

Results

There was highly statistically significant difference between chronic patients and newly diagnosed patients regarding PLT and Serum Zonulin p < 0.001. There was highly statistically significant difference between recently diagnosed patients and healthy controls regarding PLT p < 0.001, there was statistically significant difference regarding ALT and Serum Zonulin, (p value were 0.03 and 0.01) respectively. There was a statistically significant correlation among all study participants between Serum Zonulin and Creatinine, p value = .004. There was no statistically significant correlation among all study participants between Serum Zonulin and TLC, HB, PLT and ALT, (p value were 0.736, 0.227, 070 and 0.619) respectively. There was highly statistically significant correlation between serum zonulin level and PLT in chronic patients, p value <0.001.

Conclusion

There was highly statistically significant difference between three study groups regarding PLT and Serum Zonulin. There was a statistically significant correlation among all study participants between Serum Zonulin and Creatinine. There was highly statistically significant correlation between serum zonulin level and PLT in chronic patients.
Study of Ascetic Fluid Lactoferrin and Calprotectin as a Novel Diagnostic Markers in Cirrhotic Patients with Spontaneous Bacterial Peritonitis
Authors: Yousef Mohamed Gamal , Mohamed Sayed Khalid Abd-Elhamid , Abd-Elsadik Abo-Halima Ahmed Samir , Hassan Aly Omar Aly
Published: November 2024

Background

Spontaneous bacterial peritonitis (SBP) is a critical infection in patients with liver cirrhosis and ascites, necessitating early diagnosis for effective intervention. The standard diagnostic criterion for SBP is an ascitic fluid polymorphonuclear leukocyte (PMN) count of ≥ 250 cells/mm³. This study explored alternative diagnostic markers for SBP, including high sensitivity C-reactive protein (hsCRP), serum procalcitonin, urinary lipocalin, ascitic lactoferrin, homocysteine, and fecal or ascitic calprotectin.

Aim of the Work

The aim of this study is to evaluate the diagnostic accuracy of both ascitic fluid calprotectin and lactoferrin in detecting SBP in cirrhotic patients.

Patients and Methods

The research was conducted at the Hepatology and Gastroenterology Department at Ain Shams University in Egypt from September 2022 to May 2023. Patient data, including demographics, clinical symptoms, laboratory results, and ascitic fluid markers (calprotectin and lactoferrin), were collected and analyzed to assess their diagnostic accuracy for SBP in cirrhotic patients.

Results

Among the studied population, bleeding, abdominal pain, and fever were significantly more frequent in patients with SBP than those without SBP. Patients with SBP exhibited higher levels of leucocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST), and lower levels of albumin compared to those without SBP. Ascitic fluid parameters, including PMN, calprotectin, and lactoferrin, were significantly higher in patients with SBP. These biomarkers also showed a positive correlation with liver disease severity and were positively correlated with white blood cell count, ESR, and CRP, while calprotectin showed a negative correlation with albumin. At a cut-off point of > 221, ascitic fluid calprotectin demonstrated a sensitivity of 92% and specificity of 96% for predicting SBP, while ascitic fluid lactoferrin, at a cut-off point of > 64.5, had a sensitivity of 92% and specificity of 80% for SBP prediction.

Conclusion

Both ascitic fluid calprotectin and lactoferrin were significantly elevated in cirrhotic patients with SBP compared to those without SBP. These findings suggest that ascitic fluid calprotectin and lactoferrin can serve as valuable diagnostic tests for screening and diagnosing SBP in patients with liver cirrhosis. Early detection of SBP is crucial for timely intervention and improved patient outcomes.