bluuebunny/crossref_metadata_2025 huggingface dataset:
Impulse oscillometry to differentiate between chronic obstructive pulmonary disease and bronchial asthma
Authors: Ahmed Mona M. , Kader Maryam A. A. , Mohammed Esraa M.
Published: September 2023

Background

The impulse oscillation system (IOS) yields useful clinical data that predominantly include functional assessment of peripheral airways more than that available from commonly used spirometry. The aim of this study was to differentiate between chronic obstructive pulmonary disease (COPD) and bronchial asthma using IOS.

Patients and methods

This study was carried out on 40 patients; 20 patients were diagnosed with bronchial asthma and the remaining 20 patients had a clinical diagnosis of COPD. All patients underwent baseline IOS and spirometry, and then after 15 min of inhalation of 400 μg salbutamol, spirometry was repeated in all patients.

Results

A highly statistically significant difference was found between asthma patients and COPD patients in R20, whereas no statistically significant difference was found between the two studied groups in R5, X5. There was a statistically significant difference between asthma patients and COPD patients in resistance; 75% of asthmatic patients had increased total airway resistance, mainly proximal, 20% had increased total airway resistance, mainly peripheral, and 5% had normal airway resistance, whereas all COPD patients had increased total airway resistance, mainly peripheral. No significant correlation was found between IOS parameters and spirometric parameters in COPD or asthmatic patients, but in both groups, there was a significant correlation between forced expiratory volume 1 (FEV1) and R5, X5.

Conclusion

IOS provides useful clinical information that prominently includes functional assessment of small, peripheral airway behavior beyond that available from commonly used pulmonary function tests. IOS also aids differentiation between COPD and bronchial asthma. COPD patients had increased airway resistance, mainly in the peripheral airways, whereas asthmatic patients had increased airway resistance, mainly in the proximal airways. R20 is the best IOS parameter to differentiate between these two diseases.
Assessment of ventilator-induced diaphragmatic dysfunction in patients with chronic obstructive pulmonary disease using transthoracic ultrasonography
Authors: Farghaly Shereen , Hasan Ali A. , Makhlouf Hoda A.
Published: September 2023

Background

Mechanical ventilation (MV) can cause progressive thinning of diaphragm muscle and hence progressive decrease in diaphragmatic function. We aimed to assess the rate at which diaphragm thickness (tdi) changed during MV and its effect on weaning outcome using transthoracic ultrasound (TUS) evaluation in patients with chronic obstructive pulmonary disease (COPD).

Patients and methods

Thirty mechanically ventilated patients with COPD were enrolled in this cohort study. Baseline tdi was recorded within 24 h of MV after stoppage of sedation using TUS. The subsequent measurements were recorded on the third, fifth, and seventh day of MV and at the time of initiation of weaning.

Results

There was a significant decrease in tdi at end expiration and at end inspiration by approximately 27.2 and 17% at third day of MV, respectively, and 35.5 and 18.5% at fifth day of MV, respectively, compared with baseline parameters. In the 10 patients who were still on ventilator till the seventh day, tdi were significantly lower compared with baseline recordings. Percentage of decrease of tdi at end inspiration from baseline recordings was significantly higher in patients with difficult weaning than in those with simple weaning. The optimum cutoff value of % of decline of tdi at end inspiration associated with difficult weaning was at least 10.6% giving 88.9% sensitivity and 83.3% specificity.

Conclusion

MV is associated with gradual diaphragmatic atrophy which can be detected by TUS and could predict weaning outcome in mechanically ventilated patients with COPD.
Effect of inspiratory muscle training on weaning from mechanical ventilation in acute respiratory failure
Authors: Ewis Ahmed M.
Published: September 2023

Objective

This study aimed to evaluate the effect of inspiratory muscle training (IMT) on weaning time and success.

Patients and methods

This is a prospective, randomized clinical study conducted in an ICU. A total of 15 patients were trained by inspiratory muscle exercise twice per day and 15 patients did not go under training (control group). Training was conducted through tuning the ventilator sensitivity based on the patients’ maximal inspiratory pressure (MIP). The experimental group received IMT starting with an initial load of 30% of their MIP measured immediately after changing patients to pressure support mode of mechanical ventilation (MV) and increased up to 40% as tolerated by the patient. Training was conducted for 5 min, two sessions per day. In addition, these patients received usual care of MV patients. Sputum culture assessment for aerobic organisms was done immediately after intubation.

Results

This is a prospective randomized control study that collected data on 30 patients with acute respiratory failure. Patients were randomly arranged into two groups (control and experimental). The mean MIP before initiation of weaning in both group was 16cm H2O. There is a significant difference in the final mean MIP between the experimental group (23.27 cm H2O) and the control group (17.40 cm H2O). There is also significant shortening in the weaning time in the experimental group and less frequent likelihood of reintubation, which was recorded in two cases of control group.

Conclusion

The IMT during MV may assist in early weaning off MV among patients with acute respiratory failure, and also it improves the weaning success rate, with less frequent likelihood of reintubation.
Bile carcinoembryonic cell adhesion molecule 6 as a potential diagnostic tool for malignant biliary stenotic lesions
Authors: Mahdy Mohamed Abd-Elhakim , Wahid Lobna Abdel , Abd-Elkader Alaa S. , Hassan Ramy A. , Ahmed Hanan M.
Published: September 2023

Aim

Validate the biliary carcinoembryonic antigen-related cell adhesion molecule 6 in differentiating malignant from benign biliary lesions.

Background

The nature of biliary stenosis needs to be diagnosed early and accurately to give the patient the best chance of therapy. Imaging techniques still lack the high accuracy for this purpose. Different biomarkers were postulated to increase the diagnostic accuracy, and of them, carcinoembryonic cell adhesion molecule 6 (CEAM6) in bile was investigated in this study.

Patients and methods

Forty-four patients with biliary stenosis were enrolled in this prospective study in Assiut University Hospital from 2017 to 2019. CEAM6 concentration in bile and serum was measured using human carcinoembryonic antigen-related cell adhesion molecule 6 ELISA kit from SinoGeneClon Biotech Co. Ltd, and CA19-9 concentration in serum was assessed by the ELISA kit for CA19-9 from USCN Life Science Inc.

Results

The area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of bile CEAM6 for diagnosis of stricture type among the study population were 0.841, 83, 74, 77, 82, and 78.5%, respectively, at a cut-off value of 6.15 ng/ml. Multivariate analysis showed age, CEAM6, CA19-9, and alkaline phosphatase as good predictors of malignancy.

Conclusion

CEAM6 in bile could be a good diagnostic tool to detect the nature of biliary stenosis.
Serum visfatin level in prediabetics and its relation to left ventricular function
Authors: Abdel-Hassib Mohammed , Hassabo Abdelhaleem A. , Elashmawy Hossam , Mansour Mostafa I. S.
Published: September 2023

Introduction

Visfatin is a molecule of clinical relevance, released mainly from visceral fat (hence it named as such) and could be a promising biomarker with diagnostic and prognostic significance in metabolic syndrome. Very little is known about visfatin and its relation with prediabetes.

Objective

The present study was conducted to demonstrate the relationship between serum visfatin level and prediabetes and its relation to left ventricular function.

Patients and methods

We studied 60 prediabetic patients recently diagnosed according to ADA criteria 2014 and classified into two groups according to the BMI. They were compared with 30 healthy matched controls. All groups underwent complete history taking, general examination, laboratory investigations (including homeostasis model assessment-insulin resistance and serum visfatin level), and two-dimensional transthoracic echo Doppler study at baseline and 8 months thereafter only for the patient groups.

Results

This study showed that there is a positive correlation between serum visfatin level and prediabetes and left ventricular function.

Conclusion

Serum visfatin is an early and strong predictor of prediabetes and left ventricular dysfunction.
Peripheral blood neutrophils and upregulated surface expression of interleukin-17 and CD177 in patients with bronchial asthma: an association with fungal allergy
Authors: Ahmed Eman E. , Sabry Mohamed K. , Elbadie Hazem E. Abd , Melek Nermine A. Elnour
Published: September 2023

Background

Asthma is a prevalent debilitating airway disease, with a tremendous effect worldwide. Fungi and their spores are identified as major culprits in allergic asthma (AA) etiology. Peripheral blood neutrophils and interleukin 17 (IL-17), which are considered crucial players in both bronchial asthma and host defense mechanisms against fungi, increase concomitantly; moreover, certain subsets of neutrophils express and even release IL-17.

Objectives

In this study, we sought to determine the peripheral frequency of certain neutrophil subpopulations, expressing both CD177 and IL-17, among AA patients, particularly those with fungal allergy.

Methods

This observational study comprised 40 patients with AA (age range 19–60 years) and 20 age-matched and sex-matched healthy controls (age range 20–55 years). All patients had positive allergy skin prick test results, and accordingly, they were further subdivided into two groups (18 reactive to fungal allergens and 22 to other aeroallergens). The frequency of IL-17+CD177+ neutrophils in the peripheral blood was assessed by flow cytometry in all studied participants.

Results

The authors observed significantly increased frequency of circulating IL-17+CD177+ neutrophils among AA patients (especially mild to moderate cases) compared with healthy controls (43.3±13.9 vs 15.3±4.8). On the contrary, and surprisingly, patients with fungal allergy and those without did not show any difference with respect to this neutrophil subpopulation (44.6±14.4 vs 42.2±13.7).

Conclusion

Despite limited sample size, we reported elevated IL-17+CD177+ neutrophil proportion in all AA, regardless of fungal aeroallergenicity. This observation points to a role played by this neutrophil subpopulation in asthma pathophysiology, especially the allergic phenotype, and hopefully offer a new therapeutic approach in asthma management.
Serum retinol-binding protein 4 and the risk of ischemic stroke in Egyptian patients with hypothyroidism
Authors: Rashad Nearmeen M. , Sabry Hanan M. , Afifi Samir A. , Fathy Maha A. , El-Helaly Amira M. , Mohamed Haitham E.
Published: September 2023

Objective

Ischemic stroke (IS) is one of the major causes of disability and death worldwide. Effective prevention remains the best approach to reduce the burden of stroke. Adipokines can serve as a key messenger to central energy homeostasis and metabolic homeostasis. Retinol-binding protein 4 (RBP4), a retinol transporter, is elevated in insulin resistance. Controversy exists regarding the role of RBP4 in thyroid diseases. The objective of this study was to evaluate serum RBP4 in patients with hypothyroidism and to assess the association of serum RBP4 with susceptibility of IS.

Patients and methods

This case–control study included 50 healthy individuals as a control group and 90 patients with hypothyroidism, who were stratified into two subgroups: patients with IS and patients without IS. All participants were subjected to history taking and clinical, laboratory, and radiological evaluation.

Results

Serum RBP4 levels were significantly higher in hypothyroid patient, especially patients with IS, compared with the nonstroke group. Interestingly, serum RBP4 level was positively correlated with vascular and metabolic risk factors. Moreover, diastolic and systolic blood pressures, triglyceride, free T3, as well as thyroid-stimulating hormone, were independently correlated with serum RBP4 by linear regression analysis test. The diagnostic power of serum RBP4 level in differentiating hypothyroidism from controls was revealed at the cutoff value of 12.25, with area under the curve of 0.909 (95% confidence interval: 0.861–0.957). However, the diagnostic power of serum RBP4 level in differentiating hypothyroid patient with IS from those without stroke was revealed at the cutoff values of 11.4, with area under the curve of 0.822 (95% confidence interval: 0.737–0.906). In conclusion, the higher levels of serum RBP4 in hypothyroidism, especially in patients with IS, were associated with metabolic and glucose abnormalities, and thus, it could be used as a promising predictive biomarker of IS in hypothyroidism.
Association of serum visfatin and its mRNA expression levels with cognitive function and idiopathic intracranial hypertension in obese Egyptian women
Authors: Rashad Nearmeen M. , Sabry Hanan M. , Fouad Amira A. , Afifi Samir A. , Fathy Maha A. , El-Helaly Amira M.
Published: September 2023

Background

An epidemic of obesity has spread across the globe. Obesity has numerous comorbidities, including airway disease, insulin resistance, type 2 diabetes, cardiovascular disease, atherosclerosis, degenerative neurological disease, cognitive dysfunction, and cancer. Inflammatory cytokine is suggested to play a role in obesity and its complications. The current study aimed to estimate the expression and serum visfatin concentrations in obese Egyptian women. Moreover, we aimed to evaluate the possible association of visfatin gene expression and its serum levels with idiopathic intracranial hypertension (IIH) and cognitive dysfunction

Participants and methods

This cross-sectional study enrolled 60 obese women and 40 lean healthy women as controls. Obese women were classified according to grades of obesity into three groups. All participants underwent full clinical, neurological, and psychiatric examination. IIH group included patients with intracranial pressure greater than 25 cm H2O (opening pressure measured during lumber puncture in lateral decubitus position). Cognitive function was evaluated by using Montreal Cognitive Assessment scale (MoCA), Arabic version. Estimation of visfatin expression levels was determined by real-time PCR, and serum visfatin concentrations were measured using enzyme-linked immunosorbent assay.

Results

Our results revealed that obese women had higher values of visfatin expression (1.44±0.29) and serum levels (124.1±) compared with lean women (1.01±0.3 and 46.1±33.8, respectively). The visfatin expression and serum levels were significantly positively correlated with obesity indices, metabolic risks, MoCA, cerebrospinal fluid opening pressure, and cognitive dysfunction. Linear regression test showed that BMI, cerebrospinal fluid opening pressure, and MoCA were the main predictors of both serum and expression levels of visfatin in obese women. The receiver operating characteristic curve analysis revealed that the power of serum visfatin levels was higher than visfatin expression in differentiating obese women from lean ones.

Conclusion

There was a strong independent association between both higher visfatin expression and serum levels and obesity indices, metabolic risks, IIH, and cognitive dysfunction in obese Egyptian women.
Updated ACR Thyroid Imaging Reporting and Data Systems in risk stratification of thyroid nodules: 1-year experience at a Tertiary Care Hospital in Al-Qassim
Authors: Ewid Mohammed , Naguib Mervat , Alamer Ali , El Saka Hala , Alduraibi Sharifa , AlGoblan Abdullah , Ahmed Elzaki
Published: September 2023

Background

Thyroid imaging reporting and data system (TI-RADS) is assessment of risk stratification of thyroid nodules, using a score. A novel ACR (American College of Radiology) TI-RADS has been recently suggested by American College of Radiology. But, the utility of ACR TI-RADS in risk stratification for thyroid lesion needs further evaluation.

Aim

Of this study was to evaluate ACR TI-RADS classification in discriminating benign and from other thyroid lesions as detected by fine needle aspiration cytology (FNAC).

Methods

This retrospective study included all patients referred to our institute for FNAC of a thyroid nodule over 1 year. Thyroid nodules were categorized according to the 2017 ACR TI-RADS. Ultimately, efficacy of ACR TI-RADS in differentiating benign from non-benign nodules was assessed using ROC curve, cross-tabulation, and Chisquare tests. According to the results of FNAC, nodules were classified into 2 groups; benign lesions (Bethesda II) and malignant lesions (Bethesda IV, V).

Results

The percentages of Bethesda IV and V lesions defined in our ACR-TIRADS were as follows: ACR TI-RADS 1, 2 (0%), ACR TI-RADS 3 (4%), ACR TI-RADS 4 (6.6%), and ACR TI-RADS 5 (22.6%). ROC curve analysis for ACR TI-RADS to differentiate benign from non-benign pathology showed (AUC 0.60, 95% CI: 0.505–0.713). ACR TI-RADS had sensitivity, specificity, positive predictive value and negative predictive value 75%, 62.35 %, 15.7%, 96.3% respectively.

Conclusion

Differentiation between benign and malignant thyroid lesion can be suggested from the ultrasound based ACR TI-RADS system. FNAC might be deferred in patients having ACR TI-RADS 1 and 2.
Role of endoscopic colonic stent insertion in patients with colonic obstructing malignancy: a single-center study
Authors: Marie Mohammad S. , Behairy Gad M.
Published: September 2023

Background

Left-sided colonic malignant lesions have the potential of acute bowel obstruction. Emergency surgery with stoma construction is considered the standard of management. Insertion of colonic stent to allow bowel decompression, primary resection, and re-anastomosis, avoiding the need of colostomy formation, can be an alternative. We describe our experience with the use of colonic stent in left-sided malignant obstruction as a step to relieve the obstruction before definitive surgical intervention.

Patients and methods

A total of 30 patients with left-sided colonic malignant obstruction were included; 15 patients were offered colonic self-expandable metal stent insertion, and the other fifteen patients were offered emergent surgery.

Results

Of the 15 patients, 10 (66.6%) had successful stent insertion (technical and clinical). We failed to insert stent in four (26%) patients, and one (6.6%) patient had colonic perforation. All patients with successful colonic stent insertion underwent one-step resection and primary anastomosis.

Conclusion

Colonic stent for left-sided colonic malignant obstruction represents a valuable procedure for one-step resection and primary anastomosis without the need for colostomy.
Serum osteoprotegerin as an early marker of chronic kidney disease in hypertensive patients
Authors: Elhefnawy Khaled A. , Mohamed Ezzat M. , Abou Yousef Athar M. , Fikry Abeer A. , Allam Hala M.
Published: September 2023

Background

Serum osteoprotegerin (OPG) is a marker of cardiovascular disease. The deterioration of renal function in diabetic patients could be predicted by OPG concentrations, and it was suggested that OPG could be used as a risk marker for chronic kidney disease (CKD) in patients with hypertension.

Objective

The aim was to investigate the role of serum OPG as an early marker of CKD in hypertensive patients.

Patients and methods

A total of 144 hypertensive patients were included and classified into two main groups: group I, which included 72 hypertensive patients without CKD [estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2], and group II, which included 72 hypertensive patients with CKD (eGFR<60 ml/min/1.73 m2). All participants of the study were subjected to detail clinical examination and investigations including complete blood count, fasting and random blood glucose, glycosylated hemoglobin, urine analysis, serum creatinine, liver function tests, eGFR, and serum OPG assays.

Results

Serum OPG levels were significantly higher in hypertensive group with CKD than in hypertensive group without CKD. A significant positive correlation was found between OPG and diastolic blood pressure, duration of hypertension, serum creatinine, and albumin creatinine ratio, whereas there is a negative correlation between OPG and both weight and eGFR. The best cutoff value of serum OPG in prediction of CKD among hypertensive patients is greater than 1.9 ng/ml with sensitivity of 100% and specificity of 100%.

Conclusion

Serum OPG can serve as an early marker for CKD in hypertensive patients.
Assessment of serum and urinary levels of neutrophil gelatinase-associated lipocalin in correlation with albuminuria in nondiabetic obese patients
Authors: Rashad Nearmeen M. , Said Nora M. , Emad George , Gomaa Ahmed F. , Kadry Heba M.
Published: September 2023

Background

Obesity, a new pandemic, is associated with an increased risk of death and morbidity. Obesity-related glomerulopathy is an increasing cause of end-stage renal disease. Neutrophil gelatinase-associated lipocalin (NGAL) is a neutrophil-expressed inflammatory protein that is increased in different diseases. The objective of the current study was to evaluate the predictive performance of serum and urinary NGAL in obese patients and to clarify its possible relationship with different stages of albuminuria in nondiabetic patients.

Patients and methods

This cross-sectional study was conducted on 55 obese patients and 40 healthy individuals as a control group. The enrolled patients were divided into three groups according to the level of albuminuria. Serum and urinary NGAL (ng/ml) were measured by enzyme-linked immunosorbent assay kits.

Results

Serum and urinary NGAL levels were significantly higher in obese (354.44±121.2 and 213.22±10.8, respectively) compared with healthy controls (44.21±11.2 and 13.9±6.3, respectively; P<0.001). Moreover, there were higher significant values of serum NGAL in patients with macroalbuminuria (488.65±44.53) and microalbuminuria (264.33±25.53) compared with patients with normoalbuminuria (122.48±4.53, P<0.001) and higher significant values of urinary NGAL in patients with macroalbuminuria (363.84±32.53) and microalbuminuria (112.19±26.53) compared with patients with normoalbuminuria (32.17±10.53, P<0.001). Serum and urinary NGAL levels were statistically significant predictors of albuminuria among obese patients. In addition, our results observed that BMI, waist/hip ratio, urinary albumin, estimated glomerular filtration rate, and urinary albumin-creatinine ratio were independently correlated with serum NGAL, whereas BMI, waist/hip ratio, and urinary albumin were the only variables that were independently correlated with urinary NGAL.

Conclusion

The higher levels of serum and urinary NGAL in obese patients compared with healthy group were strongly correlated with urinary albumin-creatinine ratio and cardiometabolic risk factors.
Oxidative stress and risk of polycystic ovarian syndrome in women with epilepsy: implications of malondialdehyde and superoxide dismutase serum levels on female fertility
Authors: Rashad Nearmeen M. , Ashour Waleed M. Reda , Allam Reem M. , Saraya Yasser S. , Emad George
Published: September 2023

Background

Epilepsy is a common neurologic disease and has important implications for women’s fertility, as approximately half of the epileptic women have reproductive disorders. Oxidative stress is a key contributor in the pathogenesis of polycystic ovary syndrome (PCOS) and epilepsy. We aimed to investigate the role of malondialdehyde (MDA) and superoxide dismutase (SOD) serum levels as predictors of PCOS in women with epilepsy (WWE) and to evaluate the possible relationship between oxidative stress and epilepsy characteristics as well as clinicomorphological features of PCOS.

Patients and methods

A cross-sectional study enrolled 130 WWE. They were classified to two subgroups; women with PCOS (n=50) and women without PCOS (n=80) according to Rotterdam criteria. Metabolic markers and markers of PCOS were measured. Serum MDA and SOD concentrations were estimated by enzyme-linked immunosorbent assay.

Results

Our results revealed higher levels of MDA and SOD in WWE, in particular, women with PCOS. Moreover, serum MDA and SOD levels were significantly positively correlated with PCOS phenotypes. Linear regression test revealed that Low-density lipoprotein cholesterol (LDL) and luteinizing hormone (LH) were the main predictors of serum MDA levels in PCOS, whereas BMI and LH were the main predictors of serum SOD levels. Regarding antiepileptic medication, there were significantly higher levels of MDA and SOD in patients treated with valproic acid compared with the ones treated with carbamazepine.

Conclusion

The high levels of MDA and SOD among WWE, in particular, women with PCOS, were positively correlated with obesity indices and PCOS phenotypes. Thus, we recommended avoid using valproic acid in women during childbearing period.
Effect of direct-acting antivirals on elastographic measures in patients with chronic hepatitis C virus infection
Authors: Sakr Mohamed M. , El-Agrody Ahmed I. , Farrag Hesham A.
Published: September 2023

Background

Hepatitis C virus (HCV) infection is a worldwide health problem. Liver fibrosis has been a major topic of research for decades. However, recent data have shown the occurrence of fibrosis fall in a wide spectrum of chronic liver diseases.

Aim

We aimed to evaluate the changes in transient elastography (TE) values of different direct-acting antivirals regimens in HCV chronic liver disease patients.

Settings and design

This observational analytic study was carried out at the Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Participants and methods

100 Egyptian chronic hepatitis C patients were recruited into this study. All participants were included according to the inclusion criteria approved by the national committee in Egypt for control of viral hepatitis. They were subjected to a thorough assessment of history and clinical examination, routine investigations, ECG, radiological examination, and TE 2 weeks before treatment initiation, at the end of the course, and 6 months after treatment.

Results

There was a significant improvement in liver stiffness (LS) values in cirrhotic patients, but they still had cirrhosis, with lower LS values than pretreatment values. This study reported a significant decrease 12 weeks after the end of treatment for LS measurements and validated fibrosis scores such as FIB-4 and APRI. Patients with F4 grade fibrosis showed a significant improvement in the score, and the percentage decreased from 56% before treatment to 42 and 38% after sustained virological response 1 and sustained virological response 2, respectively.

Conclusion

Direct-acting antivirals based treatment results in a significant improvement in hepatic fibrosis measures, indicated by TE as well as noninvasive fibrosis scores such as fibrosis score (FIB-4) and APRI.
Assessment of fibroblast growth factor 23 in relation to peripheral arterial disease in type 2 diabetes mellitus
Authors: Halawa Mohamed R. , Abdalah Abeer A. , Eid Yara M. , Nasr Merhan S. , Mostafa Bassem M. , Ahmed Nesma H.
Published: September 2023

Background

Peripheral arterial disease (PAD) is a major vascular complication and the leading cause of amputation in people with diabetes. Fibroblast growth factor 23 (FGF-23) is a recently discovered 30-kD secreted hormone glycoprotein that plays a role in the complex and tightly regulated mechanisms of mineral metabolism. Increase in serum FGF-23 concentration was an independent predictor of coronary artery diseases in patients with mild chronic kidney disease and of mortality in patients undergoing hemodialysis. Recently, FGF-23 has been found to be associated with total body atherosclerosis and vascular dysfunction.

Objective

To evaluate the relation between FGF-23 and PAD in patients having type 2 diabetes with normal kidney function.

Patients and methods

A case-control study was conducted on 120 diabetic patients, where 60 patients having type 2 diabetes with PAD were compared with 60 patients having type 2 diabetes without PAD. All patients were subjected to full history taking, thorough clinical examination, ankle-brachial index assessment, and laboratory measurement of glycated hemoglobin%, estimated glomerular filtration rate, microalbuminuria, lipid profile, serum ionized calcium and phosphorous, and serum FGF-23.

Results

Significantly higher serum FGF-23 was found in diabetic patients with PAD compared with diabetic patients without PAD. Logistic regression analysis showed that duration of diabetes, triglycerides level, phosphorous level, glycated hemoglobin, and FGF-23 were independent predictors for PAD.

Conclusion

FGF-23 level was higher in type 2 diabetic patients with PAD, which highlights a possible implication of FGF-23 in the pathogenesis of PAD in type 2 diabetes.
Value of endoscopic ultrasound in prediction of dysplasia in ulcerative colitis
Authors: Elrabat Amr M. , Ibraheem Neveen F. , Maher Maha M. , Abozeid Fatma A. , Abelrahman Maha A.
Published: September 2023

Background

Ulcerative colitis (UC) is one of the most common forms of chronic inflammatory bowel disease. Its diagnosis is based on history, clinical, radiological, laboratory, endoscopic, and histological examinations. Endoscopic ultrasound (EUS) is a highly accurate diagnostic endoscopic and radiological modality for assessing of rectal pathology. However, EUS data remain scarce for patients with UC. The aim of this study was to assess the correlation between EUS indices and clinical, endoscopic, and histological scores of inflammation in UC and to evaluate the usefulness of EUS in assessing the activity and dysplasia of UC.

Patients and methods

A total of 57 patients with UC were cross-sectionally evaluated based on clinical (Truelove score), laboratory [complete blood count (CBC), c reactive protein (CRP), erythrocte sedementaion rate (ESR), and fecal calprotectin], and endoscopic (Mayo score) parameters. The patients were divided into three groups: mild UC, moderate UC, and severe UC. They were subjected to EUS at 10, 20, and 30cm from the anal verge to assess the correlation between severity of UC and histopathological examination results.

Results

Total wall thickness (TWT) at 10cm from the anal verge was positively and highly significantly correlated to histopathological severity in comparison with 20 and 30 cm from anal verge (P=0.001). TWT at 10 cm by EUS was a significant predictor of the histopathological severity of UC (P=0.007). For TWT of the colon at 10 cm from the anal verge, significant discrimination (P=0.02) between severe UC and mild to moderate UC could be achieved by utilizing a cutoff of 3.5 mm with sensitivity of 60.5% and specificity of 85.7%. In addition, highly significant (P=0.006) discrimination of mucosal dysplasia in UC could be achieved using TWT cutoff of 5.05mm at 10cm from the anus with sensitivity of 75% and specificity of 94.3%.

Conclusion

For EUS at 10cm from the anal verge, TWT cutoff of 3.5mm can assess histopathological severity of UC, and TWT cutoff of 5.05 mm can predict dysplasia in UC.
The significance of bariatric surgery in Egyptian patients with metabolic syndrome: a multicenter study
Authors: Bassiony Mohamed A. A. , Mohamed Mohamed S. , Elgohary Marwan N. , Nawar Abdelrahman M. H. , Abdelrahman Emad M. , Elshoura Ahmed A.
Published: September 2023

Background

Obesity and metabolic syndrome (MS) are global health concerns, with high rates of cardiovascular morbidity and mortality. The current guidelines recommend lifestyle modifications as the best initial treatment for obesity and MS. However, lifestyle interventions have modest effects and high 1-year failure rates. Bariatric surgery offers more weight loss with sustained effect in the long term.

Aim

The aim was to assess the effect of bariatric surgery on MS and all its components and to detect the probable risk factors for persistent MS after bariatric surgery in Egyptian patients.

Patients and methods

This prospective multicenter study included 250 obese patients who underwent bariatric surgery and completed 1 year of postoperative follow-up. The patients were evaluated preoperatively and at 1, 6, and 12 months postoperatively for presence of MS and its components according to criteria of the third report of National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III).

Results and discussion

After 1 year of follow-up, the percentages of patients who had MS, obesity, type 2 diabetes mellitus, hypertension, hypertriglyceridemia, and low high-density lipoprotein-cholesterol were significantly decreased from 92, 100, 84, 50, 74, and 50% to 17, 2, 8, 17, 42, and 25%, respectively. Smoking, family history of obesity, and less percentage of excess weight loss were the most important risk factors for persistence of MS after bariatric surgery.
Occult hepatitis C virus infection among Egyptian hemodialysis patients and its potential effect on anemia management
Authors: Abdelsalam Mostafa , Tawfik Mona M. , Habib Alaa , Abdel-Razik Ahmed , Anber Nahla , Zaki Maysaa , Marie Mohammad S.
Published: September 2023

Background

Hepatitis C virus (HCV) infection is still a main health problem in hemodialysis (HD) patients. The prevalence of occult hepatitis C infection (OCI) in HD patients may be underestimated, and its possible influence on anemia management has not been studied. We aimed to determine the existence of OCI in Egyptian HD patients as well as its possible effect on anemia management.

Patients and methods

This cross-sectional multicenter study included 98 HCV-negative HD patients (negative for both anti-HCV antibody and HCV-RNA), 43 anti-HCV-positive HD patients, and 10 volunteer people matched for age and sex as a healthy control group. Serology test for anti-HCV antibody, reverse-transcription PCR for HCV-RNA (both serum and peripheral mononuclear cell (PMNC)), complete blood count (CBC), liver transaminases, serum iron, serum ferritin, and high-sensitivity C-reactive protein (hsCRP) were done. The average erythropoiesis-stimulating agent (ESA) doses were calculated over 6 months, and ESA resistance index was calculated. The frequency of packed red blood corpuscle (RBC) transfusion for each patient was recorded.

Results

Our HD patients had significant higher levels of serum ferritin (P=0.011), higher serum alanine aminotransferase and aspartate aminotransferase (P=0.002 and 0.006, respectively), higher hsCRP (P<0.0001), and significant lower level of hemoglobin (P<0.0001) compared with the healthy control group. The prevalence of OCI was 8.16% (8 of 98 patients). OCI patients had significant longer dialysis duration, higher transaminases, higher hsCRP, higher serum ferritin, and higher frequency of packed RBCs transfusion (P<0.0001), whereas mean hemoglobin levels and ESA resistance index showed insignificant differences compared with HCV-negative HD patients. Using logistic regression analysis, frequency of packed RBC transfusion and aspartate aminotransferase were the only independent predictors for OCI (P=0.012 and 0.049, respectively), and by multivariate analysis, no significant predictors were found to be associated with anemia in patients with OCI.

Conclusion

The prevalence of OCI in our study was 8.16%. OCI had no effect on anemia managements.
Gastroduodenal pathology in the light of Helicobacter pylori genotype in Egyptian patients
Authors: Azzam Eman , Ali Ezzat , Ahmed Shwikar , Talha Ahmed
Published: September 2023

Context

Infection with Helicobacter pylori is associated with gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric cancer, and mucosa-associated lymphoid tissue lymphoma.

Aim

The aim of this study was to detect the nature of gastroduodenal pathology in the light of the genotype of the associated H. pylori organism.

Materials and methods

The study was conducted on 100 patients with upper gastrointestinal tract symptoms; infection with H. pylori was detected by stool antigen test. Moreover, 20 asymptomatic patients, infected with H. pylori, were included in the study as controls.

Upper gastrointestinal tract endoscopy was performed in all participants to take biopsies to diagnose the disease microscopically and to determine H. pylori virulence factors [cytotoxin-associated protein A (CagA) and VacA] by PCR.

Results

Patients infected by H. pylori organisms having CagA-positive genes (41 patients) developed gastritis in 53.7%, peptic ulcer disease (PUD) in 36.6%, and gastric malignancy in 9.8%. Patients infected with organisms that have VacA s1 in addition to CagA genes (19 patients) were found to have gastritis in 21.1%, PUD in 63.2%, and gastric malignancy in 15.8%. However, patients infected with H. pylori organism that have VacAs2 in addition to CagA genes (34 patients) developed gastritis in 79.4%, PUD in 20.6%, and no malignancy.

Discussion

The presence of VacA s1 gene in addition to CagA significantly increases the virulence of the organism toward development of PUD and gastric malignancy. The presence of VacA s2 gene significantly decreases the virulence of CagA gene to develop PUD and prevent completely its carcinogenicity.
Congenital nasal stenosis: a report of two cases
Authors: El-Wany Samy , El-Hennawi Diaa M. , Ahmed Mohamed R. , Abou-Halawa Ashraf S. , Madian Yasser T. , Ibrahim Ibrahim H.
Published: September 2023

The human neonate is an obligate nasal breather for a variable period of time after birth. Congenital nasal airway anomalies are potentially dangerous if they are not immediately recognized at birth and if appropriate intervention is not instituted. Here, we report two clinical cases of congenital nasal stenosis seen in the Suez Canal University Hospital in Ismailia in 2016. Approval from our institutional ethics committee and consent from parents of the patients to publish the cases and their photos were obtained. Level of Evidence: 3b.
Evaluation of hearing outcome of tympanoplasty using cartilage graft versus temporalis fascia graft
Authors: El-Sheikh Mohamed M.
Published: September 2023

Background

Various materials such as fascia, perichondrium, and cartilage have been used for the reconstruction of the tympanic membrane in middle ear surgery. Owing to its stiffness, cartilage is resistant to resorption and retraction.

Patients and Methods

This study comprised a randomized, controlled trial conducted to analyze the audiological gain when using cartilage grafts in type 1 tympanoplasty compared with temporalis fascia grafts on 60 patients suffering from chronic otitis media after successful tympanoplasty. The follow-up period was at least 6 months. All patients were subjected to audiological evaluation before and at least 6 months postoperatively.

Results

There was a significant reduction in mean air-bone gap (ABG) in both groups, whereas in group A (fascial graft) the mean preoperative ABG was 25±10.2 dB and the mean postoperative ABG was 13.5±7.3 dB, whereas in group B (cartilage graft) the mean preoperative ABG was 30.6±8.6 dB and the mean postoperative ABG was 15.9±8.7 dB, analyzing the effectiveness of both surgical techniques showed that both were equally effective in reducing ABG from preintervention to postintervention with no statistical significance among both groups (P=0.212).

Conclusion

Patients who had cartilage grafts showed similar hearing outcomes to those who had fascial grafts after a successful tympanoplasty procedure.
Role of vitamin D in chronic rhinosinusitis: a systematic review and meta-analysis study
Authors: Al-Ebiary Hassan A. , Shafik Amr G. , Hassan Mohammed A. , Taha Mohammed S. , El-Naggar Yahya M.
Published: September 2023

Background

Chronic rhinosinusitis (CRS) is one of the most common diseases with no specific long-term treatment. CRS can present in two phenotypes: chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP). Vitamin D (VD) is considered to have an immunomodulatory role, especially in allergic diseases. Recent studies have found that patients with CRS have VD level lower than normal, especially patients with CRSwNP.

Aim

The aim of this study was to systematically evaluate and find out whether there is a relationship between serum VD level and CRS and its phenotypes.

Materials and methods

Using Medline database, we conducted a systematic search to find all related articles published up to 31 August 2016 using the keywords Vitamin D, allergic rhinitis, CRSwNP, and CRSsNP and applying certain inclusion and exclusion criteria.

Results

Six articles were included with a total number of participants of 309 with serum VD level. Four comparisons were made. The first comparison showed no statistically significant difference in VD level between the CRSsNP and the control group. The second comparison showed a statistically significantly lower VD level in the CRSwNP group than in the control group. The third comparison showed a statistically significantly lower VD level in the CRSwNP than in the CRSsNP group. The last comparison showed no statistically significant difference in VD level between CRS with or without nasal polyps and controls.

Conclusion

VD level was significantly low in patients with CRSwNP, which might have a causative relationship. However, there was no relation between VD level and CRSsNP.
An algorithm for management of nasal caudal septal deformities
Authors: Younes Ahmed , El-Dsowkey Rasha , Ragab Sameh M. , Romaih Hosam E. , Elsheikh Mohamed N.
Published: September 2023

Introduction

Caudal end septal deformities are common deformities. Trauma is a main cause of these deformities. there is lack of an algorithm for choosing the suitable technique for the type of deformity. The aim of this retrospective study was to put an algorithm for approaching different caudal end deformities.

Patients and methods

Retrospective review of 136 patients underwent surgical correction for caudal end deformities. Data collection included functional breathing outcomes and drawbacks of different techniques as postop caudal end sublaxation and firm nasal tip sensation.

Results

Patients were divided into 4 groups (according to the technique by which the caudal end of nasal septum was managed) as following: Group A: 90 patients who had undergone surgeries with swinging door or modified swinging door techniques with fixation to anterior nasal spine technique, Group B: 26 patients who had undergone surgery with tongue in groove technique, Group C: 10 patients who had undergone surgery with caudal end splinting using septal bone, Group D: 10 patients who had undergone surgery with septal extension graft with tongue in groove technique.

Conclusion

An algorithm was obtained to help in deciding a methodology for correcting the caudal end deformities according to preoperative patient data.
The sensitivity of the ce-chirp auditory brainstem response in estimating hearing thresholds in different audiometric configurations
Authors: El Kousht Moustafa , El Minawy Mohamed S. , El Dessouky Tarek M. , Koura Rabab A. , Essam Mona
Published: September 2023

Background

CE-Chirp is a new broadband stimulus that permits the energy from the stimulus to reach the whole regions of the cochlea at approximately the same time.

Aim

Comparison of auditory brainstem response (ABR) thresholds obtained by using click stimulus, broadband CE-Chirp and 500 Hz, 1, 2, and 4 kHz narrow band CE-Chirp stimuli to those obtained by behavioral hearing thresholds in adults with normal hearing and with varying configurations of sensorineural hearing loss (SNHL).

Patients and Methods

Ten adult patients with normal-hearing thresholds, whose age ranged from 19 to 50 years, with a mean age of 30.4±9.1 years constituted a control group (group 1). Thirty adult patients with different configurations of SNHL constituted group 2, whose age ranged from 18 to 65 years, with a mean age of 32.5±9.8 years. All cases and controls were subjected to pure-tone audiometry, click, CE-Chirp and four narrow band CE-Chirp (at 500, 1000, 2000, and 4000 Hz) evoked ABRs.

Results

ABR thresholds to chirps have a relationship closer to behavioral hearing thresholds than ABR thresholds to clicks in individuals with normal-hearing thresholds and SNHL. Wave V mean latencies at threshold in response to click stimuli were earlier than those obtained using CE-Chirp in both groups. Wave V mean amplitudes at threshold with CE-Chirp were significantly larger than those with click in both groups. Wave V amplitude increased and latency decreased as the stimulus frequency increased in both groups.

Conclusion

There are evidences to suggest that ABR recording in response to CE-Chirps provide an efficient tool for estimating hearing thresholds in normal-hearing thresholds and individuals suffering from SNHL in comparison to click stimuli. The use of CE-Chirp had the potential to provide high sensitivity and accuracy for frequency-specific thresholds estimation in young children and difficult to test adults.
Impact of mastoidectomy on tympanoplasty for recurrent suppurative otitis media
Authors: Kadah Sayed Mohammed Said , Mokhemar Sayed Mohammed , Ibrahim Hoda. Ali , Ibrahim Hanem Elsayed
Published: September 2023

Background

There are still many questions about the pathogenesis of chronic suppurative otitis media (CSOM) and consequently about the optimal management medical or surgical interventions. Many otolaryngologists continue to routinely perform mastoidectomy with tympanoplasty, arguing that surgical aeration of the mastoid will improve outcomes by providing a reservoir of air that can buffer pressure changes in the middle ear according to Boyle’s law.

Patients and methods

During the period from December 2013 to October 2017, the mean age was ranging from 20 to 50 years; 25 (62.5%) patients were females, whereas 15 (37.5%) patients were male who were attending the Otorhinolaryngology Department, Al Zahraa University Hospital, with recurrent suppurative otitis media refractory to medical treatment. The 20 patients selected for this study were randomly assigned to undergo tympanoplasty with cortical mastoidectomy (n=20) and tympanoplasty alone (n=20).

Results

The factors that may influence surgery success rates are age, perforation location and size, Eustachian tube conditions, status of the middle-ear mucosa, the type of graft used, and surgeon experience. The primary argument in favor of mastoidectomy has been an improvement in the middle ear and mastoid environment through clearance of the diseased mucosa and through the ventilatory mechanisms of an open mastoid system, as a buffer to the changes in pressure within the middle ear.

Conclusion

There was no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated perforations. Mastoidectomies were generally performed with a worst disease, as suggested by the presence of extensive inflammation, or a sclerotic middle ear or mastoid.