bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors predicting pulmonary hypertension in idiopathic pulmonary fibrosis patients
Authors: Sadek Samiaa H. , Kasem Soheir M.
Published: September 2023

Context

Pulmonary hypertension (PH) is a common complication of idiopathic pulmonary fibrosis (IPF) and an important pathophysiologic mechanism of exercise intolerance and poor quality of life in these patients.

Aims

The aims of this study were to assess predictors of PH in IPF from both resting pulmonary function test (PFT) and cardiopulmonary exercise testing (CPET) parameters and to establish cut-off values from resting PFT and CPET parameters for the prediction of PH.

Settings and design

This was a randomized, double-blind, and prospective study.

Patients and methods

Thirty-five patients with stable IPF were assessed in terms of resting pulmonary functions, arterial blood gases (ABG), echocardiography, and incremental CPET. Patients were classified into a PH group and a non-pulmonary-hypertension group.

Statistical analysis

Both groups were compared in terms of resting PFT and CPET parameters. A receiver operating characteristic curve was constructed to establish cut-off values for the prediction of PH.

Results

PH was observed in 13 (37.14%) patients. There were no significant differences between both groups in age and sex. forced vital capacity (FVC)%, forced expiratory volume in one second (FEV1)%, inspiratory capacity, resting and exercise partial arterial oxygen tension (PaO2) and arterial oxygen saturation (SaO2), and oxygen consumption (VO2%) were significantly reduced in the PH group, whereas the dyspnea score, resting and exercise PaCO2, respiratory frequency, and minute ventilation were significantly increased in the PH group. The receiver operating characteristic curve showed that resting SaO2 of 92.9% or less and exercise SaO2 of 87% or less had sensitivity of 84.6, and 100%, and specificity of 90.9 and 81.8%, respectively.

Conclusion

Marked deterioration in resting PFT, exercise parameters, and SaO2 can predict PH in IPF patients.
The diagnostic utility of pleural fluid viscosity in lymphocytic pleural effusion
Authors: Labiba Sayed , Dwidar Ibraheem , Riad Eman , Hasan Basma B.
Published: September 2023

Context

The first step in the diagnostic work up of pleural effusion is the distinction between transudative and exudative pleural effusions (TPEs and EPEs). This discrimination is based on some biochemical tests that are relatively costly and time consuming. Lymphocyte-predominant EPE is the result of many diseases with malignancy, tuberculosis being the most common among them.

Aims

The aim of this study was to assess the role of pleural fluid viscosity in the differentiation between exudates and transudates and to identify the cause of pleural effusion.

Patients and methods

The study comprised 10 patients with TPE and 48 patients with EPE: 18 of them had tuberculous (TB) effusion, 25 patients had malignant pleural effusion (MPE) (patients with MPE included 10 with lung cancer and 15 with other known or unknown cancers) and five patients had connective tissue disease (CTD)-associated effusion. Pleural fluid protein, albumin, lactic dehydrogenase, and viscosity were measured in all patients.

Results

Pleural fluid viscosity was higher in patients with EPE with a highly significant difference (P < 0.01), and a cutoff value of 1.01 cP could distinguish between TPE and EPE with a sensitivity of 97.7%, a specificity of 93.9%, a positive predictive value of 97.5%, and a negative predictive value of 92.5%. It also showed significant positive correlation with protein, albumin, and lactic dehydrogenase. It was also higher in TB effusion than in MPE, with a highly significant difference (P < 0.01), and in CTD-associated effusion with a significant difference (P < 0.05). At a cutoff value of 1.5 cP, pleural fluid viscosity could discriminate between TB effusion and MPE with a sensitivity of 67%, a specificity of 84%, a positive predictive value of 75%, and a negative predictive value of 77%. There was also a nonsignificant difference between MPE secondary to lung cancer versus other known or unknown primary cancer (P > 0.05).

Conclusion

Pleural fluid viscosity can reliably differentiate between TPE and EPE. It can also help in the discrimination between TB effusion and MPE with moderate sensitivity and high specificity.
Ultrasound-assisted medical thoracoscopy
Authors: Shoukri Amr
Published: September 2023

Introduction

Medical thoracoscopy is an important tool for the diagnosis and management of several pleural diseases. The presence of fibrous pleural adhesions may prevent medical thoracoscopy to access the pleural space properly, which may lower the diagnostic yield of the procedure and may also increase the risk for associated complications. The role of on-table chest ultrasound (US) before medical thoracoscopy is investigated in this study.

Aim of the study

The aim of this study was to evaluate the utility of on-table chest US before medical thoracoscopy and its ability to locate a safe point of entry, its impact on the facility of the procedure, and the risk for complications.

Patients and methods

Forty patients who underwent medical thoracoscopy for investigation of undiagnosed pleural effusion were included in this study. They were randomized into two groups. In group I, chest US was performed on table immediately before medical thoracoscopy and in group II, no chest US was performed.

Results

Computed tomography chest detected pleural adhesions in one patient (5%) in group I and in two patients (10%) in group II, whereas medical thoracoscopy detected five patients (25%) in group II and six patients (30%) in group I. Chest US was able to detect all cases with pleural adhesions in group I. Four patients (20%) in group II needed extra procedures to access the pleural cavity due to unsuccessful primary point of entry, and two (10%) had complications in the form of bleeding. All patients in group I had successful access to the pleural cavity with no needed extra procedures and no complications. The mean duration of the procedure in group I was 42 ± 5.4 versus 50 ± 10.4 min in group II.

Conclusion

Chest US performed before medical thoracoscopy can facilitate the procedure; it reduces the unsuccessful attempts to access the pleural cavity, minimizes the risk for complications, and reduces the duration of the procedure.
Extrapulmonary tuberculosis situation in El-Behira Governorate, Egypt
Authors: Hibah Nabil A. Abdelghaffar
Published: September 2023

Aim

There have been little published data about extrapulmonary tuberculosis (EPTB) situation in Egypt. The aim was to throw some light over EPTB patterns in Egypt regarding demographics, sites of affection, and treatment outcome.

Methods

This work was a retrospective, descriptive analysis of EPTB cases, carried out at El-Behira Chest Hospital and 14 related dispensaries. All available data about registered EPTB cases from January 1996 to December 2010 (15 years duration) were collected including demographic data, site of EPTB, previous treatment history, treatment category, and treatment outcome. A descriptive analysis of the data was performed using the SPSS statistical program. Data were described in absolute numbers and percentages. Statistical significance was set at P value less than 0.05.

Results

EPTB [n = 2119 (21%) of all diagnosed tuberculosis] occurred more in age groups between 15 and 29 and 30 and 44 years [n = 965 (45.5%) and n = 572 (27%), respectively] and in male patients [n = 1233 (58%)] than in female patients [n = 886 (42%)]. Pleural [n = 1341 (63.3%)], bone [n = 157 (7.5%)], and renal [n = 34 (1.6%)] tuberculosis were more common in male patients [n = 856 (64%), n = 99 (63%), n = 22 (64.5%), respectively], whereas lymph node [n = 427 (20%)] and genital [n = 70 (3.3%)] tuberculosis were more common in female patients [n = 240 (56.5%), n = 42 (60%), respectively]. Regarding treatment outcomes, successful treatment was obtained in 1725 cases (81.5%), treatment failure in 13 cases (0.5%), defaulting in 179 cases (8.5%), death in 77 cases (3.5%), and transfer-out in 125 cases (6%). Number of cases diagnosed declined through the years of study and was the highest in winter months, peaking in March.

Conclusion

EPTB is a burden of reproductive age groups (15–44 years), with pleura being the commonest site of the disease that occurred more in male patients and age groups 15–44 years, followed by lymph nodes that occurred more in female patients and age group below 15 years. Successful treatment outcome was obtained in 81.5% of EPTB cases.
Incidence of tuberculosis before and after DOTS (direct observed therapy short course strategy) implementation in El-Behira Governorate, Egypt
Authors: Alwani Ali K. , Al-Aarag Abdelsadek H. , Omar Magdy M. , Hibah Nabil A. Abdelghaffar
Published: September 2023

Aim

The aim of this work was to study the incidence of tuberculosis (TB) in El-Behira Governorate before and after application of DOTS (direct observed therapy short course strategy) to evaluate the National Tuberculosis Control Program in El-Behira Governorate as a representative part of Egypt.

Patients and methods

This work was a retrospective, descriptive, analytical study of the TB situation before and after DOTS, carried out at Chest Hospital, El-Behira Governorate, Egypt, and related dispensaries. All available data on registered TB cases from January 1996 until December 2010 (15-year duration) were collected, including demographic data, diagnosis of disease, sputum smear results, previous treatment history, and treatment outcome. A descriptive analysis of the data was performed using the SPSS statistical program. Data were described in absolute numbers and percentages. Statistical significance was set at P values less than 0.05.

Results

The incidence of TB (n = 10 035) was higher in age groups 15–29 and 30–45 years [n = 3829 (38.2%) and n = 2827 (28.1%), respectively], and in male patients [n = 6511 (64.8%)] compared with female patients [n = 3524 (35.2%)]. Pulmonary cases (78.8%) were more than extrapulmonary cases (21.2%). There was improvement in cure rate, treatment completion rate, treatment success rate, number of retreatment cases, and default rate after DOTS application (46–61.1, 16.1–18.6, 62.1–79.7, 29.1–12.4, and 20.4–6.8%, respectively).

Conclusion

TB is a burden of the productive age group of 15–45 years, with a higher incidence in men than in women, and DOTS is an effective tool for controlling TB in El-Behira Governorate. The implementation of this tool has led to significant increase in treatment success and decrease in default and failure rates.
Behçet’s disease: case reports
Authors: Agmy Gamal M.
Published: September 2023

Behcet diseases is not only orogenital ulcerations but also it can have many systemic manifestations. In this article we presented 3 cases of Behcet disease associated with pulmonary artery aneurysms affecting the large branches. Pulmonary artery aneurysms are common and serious vascular complication of Behcet disease.These are usully large and accompanied with intramural thrombi and multiple pulmonary infarctions with a common presentation of haemoptysis. A detailed discussion of pulmonary manifesttions of Behcet disease was demonstrated.
Assessment of the prevalence of depression in chronic obstructive pulmonary disease patients
Authors: Eissa Sherif A. , Essawy Tarek S. , Almahdy Mohammad A. , Mohammed Shaymaa A. , El-Hamady Mohammed M.
Published: September 2023

Background

Depression often occurs in patients with chronic obstructive pulmonary disease (COPD). In stable COPD, the prevalence of clinical depression ranges between 10 and 42%. The risk of depression is higher in patients with severe COPD, compared with control participants, reaching up to 62%, in oxygen-dependent patients.

Aim

The aim of this work was to study the prevalence of depression in COPD patients.

Patients and methods

The present study was carried out on 100 male COPD patients and 10 female COPD patients admitted to Mansoura Chest Hospital and the chest department of Benha University Hospital during the period from 2014 to 2016. All participants were submitted to Beck’s depression Inventory questionnaire.

Results

The degree of depression assessed by Beck’s score increased significantly with the degree of COPD, use of long-term oxygen therapy, and low BMI.

Conclusion

The prevalence and severity of depression increase with increasing severity of COPD.
Role of transthoracic ultrasound in differentiation of the causes of pleural thickening
Authors: Kamel Khaled M. , El-Hinnawy Yasmine H.
Published: September 2023

Objectives

Pleural thickening is defined as the increase in thickness of the pleura of more than 3mm and can be caused by a wide range of diseases, either nonmalignant or malignant. Thoracic ultrasound has high sensitivity in assessing the pleura.

Aim

The aim of this study was to assess the role of thoracic ultrasound in differentiation of the causes of pleural thickening.

Design

A prospective study included 48 patients selected from the inpatient Chest Department, Kasr Al-Ainy Hospital, from January 2016 till October 2017. Patients diagnosed as having pleural thickening underwent thoracic ultrasound as well as ultrasound-guided pleural biopsy by Tru-cut needle. Descriptive data were obtained including age and sex of the patients. Thoracic ultrasound was done for the side of pleural thickening. The distribution of pleural thickness, either localized or diffuse; the surface; invasion of chest wall or diaphragm; the echogenicity and vascularity; and the presence of pleural effusion and its pattern were determined. The patients were classified into two main groups: nonmalignant (subclassified as tuberculous and nonspecific infection) and malignant cases (subclassified as mesothelioma and metastatic cases).

Results

There was a statistically significant relation between the distribution either localized, diffuse, unilateral, or bilateral; the surface of the thickness; invasion of chest wall or diaphragm; the echogenicity; vascularity of the pleural thickness; and the presence of pleural effusion and its pattern on one hand and the diagnosis of pleural thickening on the other hand. There was insignificant statistical difference between pleural mesothelioma and pleural metastatic cases, and also there was insignificant statistical difference between tuberculous and nonspecific infection cases.

Conclusion

The transthoracic ultrasound had a very good predilection for the diagnosis of pleural thickening etiology whether malignant or nonmalignant.
The effect of triggering type on post-triggering pressure variations during pressure support ventilation: a simplified surrogate for dyssynchrony
Authors: Al-Najjar Maher M. H. , Fahmy Tamer S. , Al-Shafee Mohamed A. , Al-Atroush Hatem
Published: September 2023

Context

Several studies comparing flow and pressure triggering using invasive and noninvasive techniques have mostly focused on the trigger phase and favored flow triggering. Recently, there have been advancements in the technology of pressure triggering to improve its performance.

Aims

We sought to evaluate the effect of triggering type in old and new ventilators on patient’s synchrony in the post-trigger phase using variations in airway pressures with the set inspiratory pressure as a surrogate for dyssynchrony.

Patients and methods

Using three different ventilator types, 32 patients on pressure support ventilation were set on the two triggering types (at the same equivalent levels), each for 1 h, with all other ventilatory setting kept constant. At the end of the hour on each trigger mode, the measured peak pressure and its difference with the set inspiratory pressure [delta pressure (ΔP)], the mean airway pressure, and different ventilatory parameters and arterial blood gases were assessed.

Results

Pressure triggering resulted in a significantly higher peak pressure, ΔP, and lower dynamic compliance at any equivalent sensitivity and pressure support regardless of the level (<0.05). Moreover, at higher sensitivity levels (3 cmH2O and l/min), flow triggering produced higher mean airway pressures and oxygenation (<0.05). However, there was no significant difference as regards tidal volume, minute volume, frequency, rapid shallow breathing index, or PCO2.

Conclusion

Despite advances in pressure-triggering technology, flow triggering results in less pressure variation and better patient’s synchrony during pressure support ventilation; in this respect, ΔP and dynamic compliance are simple noninvasive measures for dyssynchrony.
Prevalence, causes, and clinical implications of pleural effusion in pulmonary ICU and correlation with patient outcomes
Authors: Farrag Mohamed , Masry Ahmed El , Shoukri Amr M. , ElSayed Mona
Published: September 2023

Introduction

Pleural effusion is common in medical ICU (MICU) patients, and it may develop owing to different causes and may affect patients outcomes.

Objective

The aim of this work was to study the prevalence and causes of pleural effusion in MICU and its effect on patient outcomes.

Patients and methods

A total of 90 patients admitted to MICU in Abbaseia Chest Hospital were included in the present study. The patients initially had pleural effusion or effusion developed during their ICU stay.

Results

Overall, 66 patients were males and 24 were females, and their mean age was 51.5±18.6 years. The prevalence rate of pleural effusion in our MICU during 1-year period was 12.7%. Pleural effusion was found to be exudates in 77.7% of cases and transudates in 22.3%. Uncomplicated parapneumonic effusion was the most common cause (36.7%), followed by heart failure (17.8%). The cause of pleural effusion did not significantly affect the patient outcome or duration of ICU stay. No significant reduction in duration of ICU stay or ICU mortality was seen in patients who received therapeutic aspiration or tube drainage compared with patients who received no specific management for effusion.

Conclusion

The commonest cause of pleural effusion in MICU is parapneumonic effusion, and chest ultrasonography is the best method of fluid detection. Different methods of management do not significantly affect patient outcomes.
Evaluation of the role of video - assisted thoracoscopic surgery in management of empyema
Authors: Farrag Mohammed Ali , Al Bawab Hatem Yazed , Mohamed Abd ELfattah Nevine Mohamed , Abd ElFattah Eman Badawy , Khalil Mahmoud Mohsen Mahmoud
Published: September 2023

Background

Video-assisted thoracoscopic surgery (VATS) is effective for fibropurulent thoracic empyema and less invasive, and it may be important as a bridge between minimally invasive and conventional open thoracic surgical management.

Aim

The aim of this study was to determine the optimal treatment of parapneumonic effusion in the fibrinopurulent stage comparing blind thoracostomy versus VATS with regard to efficacy, duration of hospitalization and intercostal tube (ICT) insertion, and need for further surgery or not.

Patients and methods

This study was a prospective comparative randomized study conducted on 60 patients with confirmed parapneumonic effusion where they were classified into two groups. The blind thoracostomy group: 30 patients underwent blind thoracostomy and the VATS group: 30 patients underwent VATS.

Results

The incidence of clinical improvement was more in the VATS group when compared to the blind thoracostomy group. The hospital outcome in the VATS group was much better than in the blind group, where in the VATS group, the postoperative length of hospital stay was around 4.8 days and the time of ICT removal was after 5 days from insertion, whereas in the blind group, the length of hospital stay was around 9.7 days and the time of ICT removal was after about 6 days of insertion. The incidence of postoperative complications was higher in the blind group than in the VATS group.

Conclusion

VATS provides more accurate staging for parapneumonic effusion, an excellent surgical view for a complicated empyema cavity, thus making it possible to perform a sufficient evacuation of all empyema membranes.
Magnetic resonance spectroscopy in evaluating cerebral metabolite imbalance in chronic obstructive pulmonary disease
Authors: El-Shinnawy Olfat M. , Khedr Eman M. , Metwally Mohamed M. , Thabiet Hassan Alaa EL-din , Shaddad Ahmad M. , Soliman Radwa Kamel
Published: September 2023

Rationale

Magnetic resonance spectroscopy (MRS) is a powerful research tool and has been proved to provide additional clinically relevant information for several diseases such as brain tumors, metabolic disorders, and systemic diseases.

Aim

The aims of this study were to evaluate cerebral metabolic imbalance in chronic obstructive pulmonary disease (COPD) and to correlate the abnormalities with spirometric and gasometric parameters.

Patients and methods

In a case–control study, eight COPD patients and eight age-matched and sex-matched healthy control individuals were compared. 1H-MRS was performed using 1.5-T MRI/MRS scanner. Using 1H-MRS single-voxel technique, N-acetyl aspartate/choline (NAA/Cho), choline/ creatine (Cho/Cr), and N-acetyl aspartate/creatine (NAA/Cr) ratios were estimated and compared in both groups.

Results

There were significant differences regarding the distribution of neurotransmitters in the temporal lobe only between COPD and control groups; there were significant positive correlations between the NAA/Cho ratio at the thalamus with both partial pressure of arterial carbon dioxide and base excess or base deficit. However, there was a significant positive correlation between the Cho/Cr ratio at the thalamus and forced vital capacity (l), and a significant positive correlation between the NAA/Cr ratio at the thalamus andBMI, and a negative correlation between the NAA/Cr ratio at the thalamus and partial pressure of arterial oxygen. There was a significant negative correlation between theNAA/Cr ratio at the temporal lobe and partial pressure of arterial carbon dioxide.

Conclusion

MRS provided an insight to study the neurochemical changes that occur in COPD patients. Chronic hypoxemia and hypercapnia seem to play a key role in the pathophysiology of neurochemical changes in COPD.
Psychological assessment of patients with bronchial asthma: focus on some predictors of abnormalities
Authors: Esmaeel Hend M. , Aly Hanan Y.
Published: September 2023

Background

Bronchial asthma is a common chronic respiratory illness. Psychiatric comorbidity is a neglected zone in the care and management of such important physical disorders as bronchial asthma.

Objective

The present study targeted a population sample of out-patient asthmatics, aiming at detailed psychocognitive evaluation. Predictors of depression, anxiety, and cognitive impairment were searched for by detailed assessment of patient sociodemographic and disease-related criteria.

Patients and methods

A total of 50 patients with confirmed asthma diagnosis were recruited and subjected to detailed respiratory and psychiatric evaluation using Mini-Mental State Examination, Beck Depression Inventory-II, and Taylor manifest anxiety scale tests.

Results

Mild, moderate, and severe depression were diagnosed in 26, 28, and 14% of patients, respectively, whereas mild, moderate, and severe anxiety were revealed in 32, 34, and 20%, respectively. Overall, 54% of the patients showed cognitive impairment. Asthmatic female patients were more common to have depression (P=0.022). The present analysis showed that predictors of cognitive impairment were older age, increasing frequency of hospital admission for asthma in the past year, improper adherence to treatment, and uncontrolled asthma. Meanwhile better education level proved to be protective from abnormal cognitive function.

Conclusion

There was high prevalence of depression, anxiety, and cognitive dysfunction among asthmatic patients in Sohag University. Improving patient education, patient adherence to treatment, and asthma level control may lessen the chance of cognitive abnormality.
Spontaneous pneumothorax: time to depart from the ‘chest tube underwater seal’?
Authors: Hassan Maged , Shaarawy Hany
Published: September 2023

Initial management of spontaneous pneumothorax has traditionally been inserting a chest tube and attaching it to an underwater seal and hospitalizing the patient. New options have emerged that allow management to be on an outpatient basis without the need for hospitalization. These options are needle aspiration (similar to aspiration of effusion) or attaching the chest tube to a one-way valve. So, is chaining a patient with spontaneous pneumothorax to their hospital bed because of the heavy jar attached to the chest tube the most prudent way of management? This review attempts to answer this question.
Noninvasive positive pressure ventilation in acute hypercapnic respiratory failure
Authors: Hussein Khaled
Published: September 2023

NPPV is well established in the management of acute on chronic hypercapnic respiratory failure secondary to acute exacerbation of COPD (AECOPD), obesity hypoventilation syndrome, and restrictive thoracic disorders. Because of its design, success depends largely on patient cooperation and acceptance. The most commonly used interfaces in acute hypercapnic respiratory failure are oronasal masks. During noninvasive ventilation patients respiratory system is maintained throughout the whole respiratory cycle at a constant pressure higher than the atmospheric pressure, usually termed the positive end-expiratory pressure (PEEP). Pressure support ventilation (PSV), is the most famous mode of partial ventilatory support that during spontaneous inspiratory efforts imposes a set level of positive pressure in a patient with intact respiratory drive. Bilevel positive airway pressure (BiPAP) include PSV during inspiration and EPAP during expiration. The highest pressure reached during inspiration is called inspiratory positive airway pressure (IPAP) which equal PSV + EPAP.
Bronchial asthma: clinical phenotypes and endotypes and their relation with glucocorticoids circadian rhythm and parasympathetic activity
Authors: Zedan Magdy M. , Moneim El-Ziny Magdy Abd El , Shabaan Abd Elazeez Atallah , Mosaad Youssef M. , Laimon Wafaa Nabil
Published: September 2023

Introduction

Asthma is a heterogeneous disease and presents in different clinical patterns ‘phenotypes’ as a result of diverse pathobiological background ‘endotypes’.

Objectives

Theaim of this studywas to study serum interleukin-13 (IL-13) levels and the frequency of (IL-13) +1923C/Tgene polymorphism in Egyptian children with asthma and to study glucocorticoids circadian rhythm in nocturnal asthma.

Patients and methods

The frequency of (IL-13) +1923C/Tgene polymorphism genotypes was determined in 114 asthmatic Egyptian children and compared with a matched group of 152 healthy controls using PCR. Serum IL-13 and cortisol a.m. and p.m. concentrations in serum were assessed using enzyme linked immunosorbent assay.

Results

Serum IL-13 was found to be significantly higher in asthmatic patients when compared with the control group (P<0.0001). In the asthmatic group, forced expiratory volume in 1 s showed a significant negative correlation with serum IL-13 (ρ=−0.2,P=0.03), whereas peripheral blood eosinophilic % showed a significant positive correlation with serum IL-13 (ρ=0.18,P=0.05). No statistically significant differences were found between asthmatic patients and controls in IL-13 C1923T genotype frequency. A significantly lower serum cortisol pm was found in asthmatic patients with nocturnal symptoms when compared with those without nocturnal symptoms (P<0.0001).

Conclusion

Serum IL-13 is significantly higher in asthmatic patients when compared with controls. (IL-13) +1923C/Tgene polymorphism is not a risk factor for development of asthma in Egyptian children. Nocturnal symptoms in some asthmatic patients can be partly attributed to lower serum cortisol level at night.
The expression level of microRNA-122 in patients with type 2 diabetes mellitus in correlation with risk and severity of coronary artery disease
Authors: Rashad Nearmeen M. , Ezzat Tamer M. , Allam Reem M. , Soliman Mohamad H. , Yousef Mohammed S.
Published: September 2023

Background

Type 2 diabetes mellitus (T2DM) has reached epidemic proportions worldwide. Coronary artery disease (CAD) is one of the most important causes of mortality worldwide. MicroRNAs (miRNAs) modulate gene expression and is involved in the pathogenesis of T2DM and CAD. The objective of the current study was to explore the expression pattern of miR-122 in T2DM with or without CAD. Moreover, we aimed to evaluate the association between miR-122 and risk and severity of CAD in T2DM.

Participants and methods

This cross-sectional controlled study enrolled 130 patients with T2DM and 110 control group. The enrolled diabetic patients were classified into two groups: seventy patients without CAD and 60 patients without CAD. All patients were investigated using a 12-lead standard ECG, echocardiography, and coronary arteriography. The serum MiR-122 expression profile was measured using quantitative real-time (qRT) PCR.

Results

miRNA-122 expression levels were significantly higher in T2DM, in particular patients with T2DM with CAD, compared with the control group. Interestingly, miRNA-122 expression levels were positively correlated with cardiometabolic risks and severity of coronary occlusion. Linear regression analysis test showed that miRNA-122 were independently correlated with high-density lipoprotein, ejection fraction, and uric acid. The power of miRNA-122 expression level to diagnose T2DM among studied participants was evaluated using receiver operating characteristic. The area under curve was 0.997 (95% confidence interval=0.993–1.00), with sensitivity of 96.9% and specificity of 99%, and regarding the power for differentiating patients with T2DM with CAD from patients with T2DM without CAD, the area under curve was 0.832 (95% confidence interval=0.763–0.902), with sensitivity of 93.3% and specificity of 96.86%.

Conclusion

The miRNA-122 expression levels were higher in the T2DM group compared with controls, in particular patients with CAD. The higher levels of miR-122 expression were strongly correlated with cardiometabolic risk factors and severity of coronary occlusion. Therefore, miR-122 expression levels seem to be a noninvasive biomarker for CAD.
Association of serum adropin with risk and severity of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus
Authors: Rashad Nearmeen M. , Sabry Hanan M. , Afifi Samir A. , Fathy Maha A.
Published: September 2023

Background

Diabetic peripheral neuropathy (DPN) is the major microvascular complication of type 2 diabetes mellitus (T2DM). Adropin is a peptide hormone that has essential roles in metabolic homeostasis and the pathogenesis of T2DM and its complications. This study was designed to estimate serum adropin levels in patients with T2DM in correlation with risk factors of DPN. The authors also aimed to investigate the association between serum adropin level and clinical and electrophysiological tests of DPN.

Patients and methods

This case–control study enrolled 100 patients with T2DM (40 diabetic cases without DPN and 60 diabetic cases with DPN) and 50 controls. All participants were subjected to a complete neurological examination. The motor and sensory conduction velocities of the median nerve, ulnar nerve, and common peroneal nerve were measured. The severity of DPN was assessed by Toronto clinical scoring system (TCSS). Serum adropin levels were assessed using an enzyme-linked immunosorbent assay.

Results

Our results revealed decreased circulating serum adropin levels in patients with T2DM (3.5±1.2), especially diabetic patients with DPN (3.1±1.07), compared with controls (6.1±0.89). There is a negative correlation between serum adropin level and TCSS as well as electrophysiological tests: motor nerve conduction velocity of median and ulnar nerve, sensory nerve conduction velocity of median and ulnar nerve, compound muscle action potential amplitude (median and ulnar nerve), and sensory nerve action potential amplitude (median, ulnar, and perception threshold nerve) (P<0.001*).

Conclusion

Diabetic patients with DPN had lower values of serum adropin than diabetic patients without DPN, and serum adropin levels were negatively correlated with metabolic risk factors, TCSS, as well as electrophysiological tests of DPN.
Trimester-specific thyroid hormone changes in normal pregnant Egyptian women
Authors: Mousa Shrook , El-Sawy Shereen S. , Abdelraouf Maged , Farouk Dina , Rashed Laila , Saif Aasem
Published: September 2023

Introduction

The range of normal thyroid functions during pregnancy differs between ethnic groups. Establishment of trimester- and assay-specific reference intervals for every population is recommended.

Aim

Assessement of the changes in thyroid function tests across the different trimesters in normal pregnant Egyptian females.

Subjects and methods

The study included 150 normal pregnant Egyptian females, recruited from Cairo university hospital antenatal care clinic, with 100 age-matched non-pregnant females, as a control group. Serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured in the three trimesters of pregnancy for every patient. Thyroid peroxidase antibodies (TPO Abs) were also assessed.

Our study showed that TSH reference ranges, using the 2.5th and the 97th percentiles, were 0.6–4.3, 0.9–3.7 and 1.0–4.2 mIU/ml for the first, second and third trimesters respectively. The median TSH concentration (50th percentile) was lower in the first trimester (2.1 mIU/ml) in comparison with the second and third trimesters of (2.6 and 2.9 mIU/ml respectively). FT4 reference ranges, using 2.5th to 97th percentile, were 0.9–2 and 0.7–1.4 and 0.6–1.2 ng/dl for the first, second and third trimesters respectively. The median FT4 concentration was higher in the first trimester (1.5 ng/dl) in comparison with the second and third trimesters of (1.1 and 1.0 ng/dl respectively). The percentage of positive TPO Ab was higher in pregnant women than that of age matched non-pregnant ladies (15.3 vs 2%, P<0.001).

Conclusion

Our study established trimester-specific changes in thyroid hormone reference ranges in normal pregnant Egyptian females. A larger population-based study would help to confirm those ranges.
Study of the effect of metformin therapy on thyroid function in type 2 diabetic patients
Authors: Abdelmoez Fatema A. , Mohamed Ghada A. , Eldine Dina M. S.
Published: September 2023

Background

Metformin, the most widely used antidiabetic drug, is considered as the cornerstone of type 2 diabetes treatments. Surprisingly, a few years ago, it has been reported that serum thyroid-stimulating hormone (TSH) level in hypothyroid patients decreased in response to metformin therapy and increased again when metformin was discontinued. This study was performed at the Diabetic Outpatient Clinic and Internal Medicine Department at Assiut University Hospital during the period between January and June 2017.

Aim

The study aimed to assess the effect of metformin treatment on TSH in type 2 diabetic patients with or without thyroid dysfunction.

Results

A total of 100 patients, with type 2 diabetes mellitus, were enrolled in the study. The patients were divided into two groups: group I included 50 patients on metformin therapy and group II included 50 patients without metformin therapy. Their age was equal to or more than 40 years; their duration of diabetic treatment was equal to or more than 5 years.

Conclusion

In conclusion, there were significant relationships between TSH levels and metformin therapy, obesity, macroangiopathy, and hyperlipidemia, as the treatment with metformin caused suppression of TSH to subnormal levels without any change in free T4 or frees T3 in diabetic patients.
Vascular endothelial growth factor in systemic lupus erythematosus in correlations with disease activity and nailfold capillaroscopic changes
Authors: Hamza Sherin M. H. , Khalil Nermeen S. , Hamoda Rasha M. , El-Asfahani Marwa A.
Published: September 2023

Background

Angiogenesis plays a role in the pathogenesis of systemic lupus erythematosus (SLE). Both serum vascular endothelial growth factor (VEGF) and capillaroscopic abnormalities may reflect intensity of microcirculatory changes in the course of SLE.

Aims

To quantify serum VEGF level and its correlation with microvascular changes, assessed by nailfold capillaroscopy (NFC), and possible relationship with SLE activity.

Patients and methods

A total of 90 patients with SLE were subjected to detailed medical history and clinical examination and assessment of disease activity using the SLE Disease Activity Index score and organ damage using Systemic Lupus International Collaborating Clinics/ American College of Rheumatology damage index. Laboratory investigations were done including autoantibodies [anti-nuclear antibody, anti-DNA, anti-cardiolipin (immunoglobulin G and immunoglobulin M), and lupus anticoagulant]. VEGF serum level was measured using enzyme-linked immunosorbent assay. NFC examination was done for recognition of NFC abnormalities.

Results

Serum VEGF level was elevated in the entire study group (mean of 831±572 ng/l), with a statistically highly significant correlation with Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index and SLE Disease Activity Index score of disease activity (r=0.349,P=0.001, andr=0.897,P<0.001, respectively), together with a significant positive correlation with the presence of nephritis (P=0.002), positive anti-double-stranded DNA (P≤0.001), and consumed C3 and C4 (P≤0.001), which are laboratory markers indicating lupus activity. Moreover, a higher serum VEGF level was associated with severe NFC changes with a statistically highly significant positive correlation with the capillary width (r=0.561,P<0.001), capillary length (r=0.411,P<0.001), and mean capillary density (r=0.308,P=0.003).

Conclusion

Increased serum VEGF level and progression of NFC score had been directly related to lupus activity and internal organ involvement, especially nephritis.
Procalcitonin as a marker of diabetic foot ulcer infection
Authors: El-Kafrawy Nabil A. , Shaaban Mohammed A. , Korany Mohammed A. , Sonbol Ahmed A. , Ata Moustafa B.
Published: September 2023

Background

Procalcitonin (PCT), an amino acid protein precursor of calcitonin hormone released by thyroid C cells or other body cells, can be used as a marker for diagnosing infection. PCT has a suggestive role in diagnosing diabetic foot infection alone or in combination with other markers of infection.

Objective

The aim was to clarify the effectiveness of PCT as a marker for diagnosing of infection in Egyptian patients with diabetic foot ulcer (DFU) in comparison with other inflammatory markers such as C-reactive protein, white blood cell count, and erythrocyte sedimentation rate.

Patients and methods

This cross-sectional study was carried out at Menoufia University Hospitals, from the period of January 2018 to December 2018. In total, 90 patients were classified into three groups; each group contained 30 patients: group I served as diabetic control without foot ulcers, group II patients had noninfected DFU, and group III patients had infected diabetic foot ulcer (IDFU). Diagnosis of IDFU relied on Infectious Diseases Society of America-International Working Group on the Diabetic Foot classification of diabetic foot infection.

Results

Serum PCT levels were elevated in DFU groups, with significantly higher in infected more than noninfected DFU. In addition, PCT levels were significantly higher in patients with IDFU compared with traditional markers such as C-reactive protein, erythrocyte sedimentation rate, and white blood cell counts.

Conclusion

Based on our results, we conclude that PCT has a valuable role in diagnosing infection in DFUs.
Effect of iron therapy on red cell indices and hemoglobin subtypes on patients with beta-thalassemia trait who developed iron-deficiency anemia: a tertiary center experience
Authors: Moeen Sawsan M. , Thabet Ahmad F. , Thabet Marwa M.
Published: September 2023

Background

The combination of beta-thalassemia trait (BTT) and iron-deficiency anemia (IDA) is an interesting common issue in our country. However, treatment of this condition is challenging.

Objectives

This prospective observational study was designed to evaluate the effect of oral iron therapy on red cell indices, iron status, and hemoglobin A2levels in patients with BTT who developed IDA.

Patients and methods

A total of 50 patients with BTT who developed IDA were included. A complete blood count, iron status, and follow-up hemoglobin electrophoresis by high-performance liquid chromatography were done. The patients with BTT received oral iron therapy of 60mg elemental iron three times/day for a period of 5 months, and the investigations were repeated after 3 and 5 months of treatment.

Results

There was a statistically significant increase in hemoglobin level (P<0.001 each), mean corpuscular volume (P<0.001 each), mean corpuscular hemoglobin (P=0.004 andP<0.001, respectively), mean corpuscular hemoglobin concentration (P=0.007 andP=0.001, respectively), serum iron (P<0.001 each), serum ferritin (P<0.001 each), and hemoglobin A2levels (P=0.001 andP=0.005, respectively), whereas significant decrease in the total iron-binding capacity (P=0.001, andP=0.005, respectively) after the third and fifth month of oral iron therapy.

Conclusion

It is important to suspect, recognize, and correct IDA in patients with BTT and to repeat hemoglobin electrophoresis after iron therapy.
Detection of fundic varices obturation by endoscopic ultrasound versus multidetector computed tomography
Authors: Elrabat Amr , El-Gamal Salah , Kashwaa Mohammad M. , El-Rakhawy Mohamed M.
Published: September 2023

Background

Gastroesophageal varices (GVs) present in 50% of patients with liver cirrhosis. GVs bleed at a rate of 5–15%, and the 6-week mortality after hemorrhage is 20%. GVs are treated with a tissue adhesive, cyanoacrylate, where repeated sessions are performed 2–4 weeks until obliteration, and eradication is achieved with 2–4 injections using 1–2 ml/ session. Endoscopic ultrasonography (EUS) was found superior to endoscopy in detecting gastric varices. Gastric varices obturation can be detected using CD-EUS to assess blood flow in variceal lumen after cyanoacrylate injection. Multidetector computed tomography (MDCT) is an acceptable imaging modality for abdominal vascular system and assessment of endoscopic therapy of fundal varices. To our knowledge, there is no study for detecting GV obturation yet. The aim of this study to compare between EUS and MDCT in detecting obturation of GV and comparing EUS and upper endoscopy in detection of GV obturation.

Patients and methods

A total of 22 patients with liver cirrhosis presented with acute GV bleeding for the first time, which was confirmed and managed by upper endoscopy, being carried out in the first 12h after admission. Then the patients were subjected to monthly gastric varices injection of cyanoacrylate until they appeared to be obturated by upper endoscopy using blunt end of injection catheter sheath to palpate varices. After that EUS and CT were done for evaluation of GV, in addition to perigastric and paragastric collaterals.

Results

EUS is superior to CT in detecting GV obliteration, with a high significant difference (P=0.04), whereas EUS and upper endoscopy have similar results in detecting the obliteration of GV (P=0.68). There was a statistically significant association between splenic size and GV obliteration (P=0.002) and a significant negative correlation between size of paragastric collaterals and GV obturation.

Conclusion

EUS is superior to CT in detecting the obliteration of GV.
Thyroid dysfunction in Egyptian patients with hepatitis C virus: prevalence and possible triggering
Authors: Fayed Ahmed , Soliman Ahmed , Naguib Mervat , Ali Hala M. , Elhaddad Hemmat
Published: September 2023

Background

The contribution of chronic hepatitis C virus (HCV) infection per se in thyroid autoimmunity and dysfunction remains controversial. We investigate the prevalence of thyroid disorders and the possible association between thyroid dysfunction and different factors in a cohort of HCV-untreated patients.

Patients and methods

A total 1050 patients with untreated HCV infection were enrolled in this study. Thyroid function tests, antiperoxidase (TPO-Ab), antithyroglobulin, thyroid ultrasound, real-time PCR to assess HCV RNA viral load, and fibroscan to determine degree of hepatic fibrosis were done.

Results

Thyroid dysfunction was found in 17.1% of patients: 11.5% hypothyroidism and 5.6% hyperthyroidism. Subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism were detected in 8.6, 2.8, 3.3, and 2.3% of patients, respectively. Thyroid ultrasound showed abnormality in 10.2% of patients. TPO-Ab and antithyroglobulin were positive in 5.1 and 6.4% of patients, respectively. TPO-Ab was more frequently positive in hyperthyroid patients compared with euthyroid (P<0.001) and hypothyroid (P<0.001) patients. Positive TPO-Ab was only significantly associated with thyroid state (P<0.001) and duration of HCV infection (P=0.02).

Conclusion

The prevalence of thyroid dysfunction is 17.1% among patients with HCV infection. Furthermore, thyroid disorder is related mainly to thyroid autoimmunity independent of age, sex, or level of viremia.
Serum osteocalcin level in end-stage renal disease patients on maintenance hemodialysis after parathyroidectomy in relation to parathyroid hormone level
Authors: Ellakany Soheir A. , Hashaad Doaa I. , Merghany Alyaa F.
Published: September 2023

Background

Parathyroidectomy (PTX) is an effective treatment for refractory hyperparathyroidism in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). However, adynamic bone disease, a possible complication, is associated with persistent bone pain and increased fracture risk. Osteocalcin (OC) is a bone formation marker, produced by osteoblasts, stimulated by parathyroid hormone and active vitamin D, associated with overall survival. Late changes in its level after PTX need to be evaluated.

Aim

The aim of this study was to determine serum OC and its relation to intact parathyroid hormone (iPTH) in patients on MHD with and without a history of PTX.

Patients and methods

This case–control study was conducted on 50 patients with ESRD on MHD, subdivided into two groups (group I and group II), according to the history of PTX. Patients having diabetic mellitus or autoimmune disease were excluded. Patients were inquired about manifestations of bone disease. Serum concentrations of ionized total calcium, magnesium, phosphorus, alkaline phosphatase (ALP), iPTH, and OC (by ELISA) were determined. Serum OC concentration was also measured in the samples of 20 healthy participants (group III) to evaluate its reference value.

Results

Bone fracture was present in nine patients with or without PTX, with no significant difference from the other patients, as regards the studied parameters. Patients with ESRD on MHD had a significantly higher serum OC level than controls (P<0.001). Serum OC in patients who underwent PTX, and with adynamic bone disease (iPTH<150 pg/ml) (group IA), was significantly lower than that in the corresponding subgroup without PTX (group 2A) (P=0.001); similarly, the two subgroups were different, as regards serum ALP (P<0.001) and serum iPTH (P<0.001). There were significant positive correlations between serum OC and total ALP and iPTH in the total patient sample (P<0.001 and <0.001, respectively).

Conclusion

Adynamic bone disease after PTX in patients on MHD in comparison with those who have not undergone PTX is associated with a lower level of bone formation marker OC.