bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Neutrophil to Lymphocyte Ratio in Risk Stratifying Patients with Unstable Angina and NSTEMI
Authors: Hinnawy Abeir Ramadan El , Abdul-Wahab Sameh Mosaad , Fekky Ehab Mohamed El , Ahmed El Abd Ali
Published: August 2023

Background

A well-known fact about acute myocardial infarction is its association with leukocytosis. The differential analysis of white blood cells gives additional benefit of assessing ACS severity by clinical outcomes. Obtaining peripheral leukocyte count is a cheap and widely available mode.

Aim of the Work

The aim of the study was to test the value of neutrophil to lymphocyte ratio in risk stratifying patients with acute coronary syndromes and its early outcomes.

Patients and Methods

A total of 100 patients with UAP and NSTEMI were prospectively evaluated at Ain Shams University Hospital (63% UAP and 37% NSTEMI).The patients were followed for clinical outcomes for 48 hours in-hospital and 1 month after discharge.

Results

The median (IQR) NLR was 8.4 (5.3 to 9.7) in NSTEMI group versus 1.8 (1.2 to 2.8) in unstable angina group, NLR > 3.9 had a sensitivity of 100%, specificity of 92% as a diagnostic value. All patients were divided into “low risk,” “intermediate risk” and “high risk” groups according to TIMI score. In unstable angina group, the quartiles of NLR in “low risk,” “intermediate risk” and “high risk” groups were 3.01 (2.01, 4.33), 3.39 (2.36, 5.10) and 5.49 (3.44, 9.65). In NSTEMI group, the quartiles of NLR in “low risk,” “intermediate risk” and “high risk” groups were 5.08 (3.07, 8.14), 5.17 (2.98, 9.05) and 6.49 (3.86, 11.68). Meaning that there is positive correlation, as NLR were found to be significantly higher in high risk groups.

Conclusion

Admission NLR is the strong and independent predictor of cardiovascular outcomes in patients with NSTEMI and UAP. Consequently, given the advantages of NLR, it may be the ideal marker for risk stratification in patients with NSTEMI and UAP. Despite the science of inflammatory biomarkers having been described decades ago, NLR appears to be enjoying a renaissance as a cost-effective biomarker with immediate clinical predictability and prognostication. The ease and rapidity of performing these tests make them an independent, simple, inexpensive and accurate early predictor of high-risk TIMI score patients in ACS.

Abbreviations

ACS: Acute coronary syndrome; AMI: Acute myocardial infarction; CAD: Coronary artery disease CK: Creatine kinase cTnI: Cardiac troponin I cTnT: Cardiac troponin T; EDTA: Ethylene-diamine-tetra-acetic acid; MI: Myocardial infarction; NLR: Neutrophil-to-lymphocyte ratio; NSTEMI: Non-ST-elevation myocardial infarction; SCD: Sudden cardiac death; STEMI: ST-elevation myocardial infarction; TLC: Total leucocyte count; UA: Unstable angina; UAP: Unstable angina pectoris; VF: Ventricular fibrillation; WBC: White blood cell count
Assessment of Extent of Myocardial Injury in Patients Undergoing Transvenous Implantation of Pacemaker Using Cardiac Troponin I (cTnI) as a Marker of Structural Heart Damage and It’s Relation to Different Sites of RV Implantation
Authors: Ramadan M , Effat E , Badran H , El Damanhoury H
Published: August 2023

Aim and objectives

The aim of the study is to assess the extent of myocardial injury in patients undergoing trans-venous implantation of pacemaker using cardiac troponin I (cTnI) as a marker of myocardial injury and it’s relation to different sites of RV pacing and number of screwing.

Patients and Methods

This study included 50 patients undergoing Trans-venous Implantation of single or dual chamber permanent pacemakers at Ain Shams University Hospitals during the period from February 2020 to August 2020, divided into 2 equal groups according to the site of RV lead implantation, 25 patients RV lead implanted in the Apex and 25 patients RV lead implanted in the Septum.

Results

All patients had rise in Troponin I after implantation of pacemaker indicating that there is significant relationship between trans-venous implantation of permanent pacemaker and incidence of myocardial injury. Comparing the RV septal pacing group to the RV apical pacing group, results showed that septal RV pacing caused more rise in cardiac troponin I after implantation than in apical pacing group indicating that there is a significant relationship between site of RV pacing and extent of myocardial injury being more in septal RV pacing than apical RV pacing. Furthermore, our study showed that regarding active fixation of RV lead into the myocardium, increasing number of trials of screwing the lead in different sites to achieve the best pacing threshold causes more rise in cardiac troponin I. So, there is a significant relationship between number of screwing and extent of myocardial injury.

Conclusion

We conclude that trans-venous implantation of permanent pacemakers is associated with an increased incidence of myocardial injury and septal RV pacing is associated with more extent of myocardial injury than apical RV pacing. Also, increasing number of trials of active fixation by screwing the RV leads into the myocardium is associated with more extent of myocardial injury.
Registry for the Safety and Success of Percutaneous Coronary Intervention of Chronic Total Occlusion in Ain Shams University Hospitals
Authors: Ayman Elbaz M , Sallam Walid , Rashid Tarek , Okasha Nireen
Published: August 2023

Aim and Objectives

The aim of this registry was to develop an electronic registry for all patients who had Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) at Ain Shams University Hospitals (ASUHs) over a period of eight months. To collect data on treatment strategies and the outcomes of the procedure and analyze it to determine the frequency of CTO PCI performed, examine the procedural strategies utilized, determine patients „comorbidities, risk factors, the predictors of in-hospital mortality and the outcomes regarding technical and procedural success during the hospital stay.

Patients and Methods

This study is an electronic Registry implementation study on all patients who had Coronary Angiography that shows viable CTO vessel and underwent CTO PCI at Ain shams University Hospitals during eight months of activity since the first of July 2020 till the end of February 2021.

Results

Our registry was conducted on 62 patients. overall procedural success was achieved in 57 lesions (91.9%). The rate of success among re-attempts following a previous failure was slightly lower and not significant (28.1%) (p = 0.573). An ante-grade approach was undertaken in 42 lesions (67.7%), while a retrograde approach was used in 20 lesions (32.2%); the switch of the initial approach strategy in the same procedure was observed in 4 cases (6.4%): in one case (1.6%), retrograde was switched with antegrade, while in the remaining 3 procedures (4.8%) antegrade was changed into the retrograde approach. Procedural success according to the approaches were (88.1%) for anterograde and (100%) for retrograde with no statically significant relation with (p < 0.108). In-hospital adverse event rates were very low (death 1.6% and stroke 1.6%). Potential disadvantages of these procedures, including a large amount of a contrast volume (median 400 ml) and long fluoroscopic time (median 55 min), were not associated with serious clinical sequelae (contrast induced nephropathy 3.2%).

Conclusion

Most CTO lesions can be safely and successfully treated with PCI. Invasiveness and potential risks of these strategies, which have been the greatest concerns of CTO treatment, may be acceptable in the majority of cases considering the actual incidences of related major adverse cardiac events and the procedural success rates. Such outcomes should become the standard of care that all centers undertaking CTO PCI should aspire to.
Evaluation of Efficiency and Reliability of Teledermatology
Authors: Abdel-Aal Sherine Mohamed El-Mustafa , Lotfy Rania Adel , El-Khateeb Ekramy Ahmed
Published: August 2023

Background

Teledermatology (TD) is one of the most rapidly evolving branches of telemedicine. It uses the information and communications technologies to diagnose, monitor, treat, prevent, research, and educate over a distance. It was demonstrated to be more efficient and cost effective in certain settings, such as travel times. It was reported to be reliable and diagnostically accurate for a variety of dermatologic complaints and was shown to reduce wait times, increase access, and improve patient satisfaction and quality of life.

Aim of the Work

to evaluate the efficiency of teledermatology as a patient-doctor communication channel, as well as its reliability to reach a proper diagnosis of variable skin disorders.

Patients and Methods

All patients took photos for their lesions and accompanied them with history in their own words, then the clinic dermatologist carried out history taking and face to face examination as well as taking professional photos. The images and history collected by the patients and the clinic dermatologist were assessed by 10 blinded dermatologists.

Results

of dermatologist presenting cases expectedly showed high percentages of history and photo appropriateness (89.3%, 93.4% respectively) hence high percentage of clue to diagnosis (94.3%). However 35.9% of the cases needed in person evaluation which is still acceptable percent and it could be attributed to the need of further assessment such as clinical, dermoscopic, histopathological examination. On the other hand, the cases presented by the patients were significantly less appropriate than those presented by the dermatologist as regards history and photo appropriateness (31.0%, 31.4% respectively) hence lower percentage of clue to diagnosis (59.1%). And 71.5% of the cases needed FTF consultations.

Conclusion

TD is a leading subspecialty of telemedicine that continues to evolve with advancements in telecommunications and smartphone technology. The evidence to date supports its accuracy, cost effectiveness and ability to facilitate dermatologic care. It should be considered as a valid alternative for face-to-face consultations. And in these days particularly when social distancing is important; TD must be considered as a critical tool to avoid virus transmission and to save both patients’ and physician’s lives. However FTF consultations will remain the gold standard method for diagnosis especilally in diseases which needs clinical, dermoscopic and histopathological examination.
Measurement of Serum Interleukin 24 Specific Immunoglobulin E in Chronic Spontaneous Urticaria and Atopic Dermatitis Patients
Authors: Attia Walaa Abdel Hakim , Elhusseiny Rania Mahmoud , Abdallah Mahmoud Mohamed Abdel Rahim
Published: August 2023

Background

Interleukin-24 is one of the IL-10 cytokine family, it exhibits several functions as autoimmune effect in many diseases of immune origin as chronic spontaneous urticaria. Therefore SP IL24 IgE has been extensively studied for its potential role in the pathogenesis of these diseases, and it hasn’t been studied in AD.

Aim of the Work

To evaluate the presence and percentage of serum IL24 specific IgE in chronic spontaneous urticaria and atopic dermatitis in relation to severity of the diseases.

Patients and Methods

This case control study were done on 20 AD patients, 20 CSU patients, and 20 apparently healthy matched aged and sex controls. Included subjects were subjected to full general and dermatological examination, calculation of AD score for patients using SCORAD and calculation of urticaria activity score seven (UAS7) for CSU patients. Autologous serum skin test and measurement of total serum IgE and IL24 specific IgE in all subjects were performed.

Results

Our results showed that: autologous skin testing revealed significantly higher positive ASST in CSU patients compared to AD patients and control subjects, ASST results were significantly prevalent in CSU female patients compared to males and significantly correlated with increased disease activity. In addition Specific IL24 IgE levels were significantly higher in AD and CSU patients compared to controls being highest in AD patients. Also, specific IL24 IgE discriminated AD and CSU patients from controls with sensitivity and specificity of 90%.

Conclusion

IL24 specific IgE can be considered as a common, specific, and functional auto-antigen of IgE antibodies in patients with CSU and AD.
A Retrospective Study of Management of Gastric Stenosis Post Laparoscopic Sleeve Gastrectomy, Our Institution Experience
Authors: Moustafa Alaa Abbas Sabry , Khalaaf Mohammed Ahmed , Moety Karim Fahmy Abdel , El Qader Matar Ahmed Abd
Published: August 2023

Background

Bariatric surgery is the only obesity treatment with long-term efficacy. Of the various surgical techniques available, laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular because of its good weight loss results, its ability to correct comorbidities associated with obesity, and its low post-operative complication rate. The early-onset complications of LSG (i.e., those that appear in the first three post- operative months) include gastric fistula (in 2.5 % of cases, according to a recent meta-analysis) and hemorrhage (in fewer than 5 % of cases). Stenosis is a less frequently described early-onset complication of LSG, with an incidence of 0.69 to 3.5%.

Objective

To evaluate different strategies of management of post LSG stenosis and the benefit affecting patient's morbidity and mortality and to describe the mechanism of stenosis and its treatment, suggest a standardized approach to management of post-LSG GS on this basis.

Patients and Methods

This study is a retrospective discreptive study which included patients underwent Laparoscopic sleeve gastrectomy (LSG) at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric centers under the supervision of the study modulatrors, Cairo, Egypt From September 2018 to September 2019 with six months of postoperative follow up till January 2020.

Results

In this study we have revised the data of one thousand patients performed laparoscopic sleeve gastrectomy in our bariatric surgery departement and showed a rate of stenosis of 1%, the mean age was 37.5, mean BMI was 47.9, 5 cases were treated by balloon dilatation, two of the were diagnose as stricture and the other three were diagnosed as twist, another two cases were managed by RYGB, and two cases were managed by MGB, finally one case was conservatively managed along with thiamine deficiency support.

Conclusion

Gastric stenosis is a rare but potentially life-threatening complication of LSG. Endoscopic treatment (balloon dilatation in particular) is effective, safe, and avoids the need for revisional surgery. If three attempts at dilatation fail, surgery is necessary. Nutritional support and vitamin supplementation are necessary in cases of poor oral feeding with recurrent vomiting.
Comparative Study between the Effect of the Ultrasound Dissector (the Harmonic) versus Monopolar and Bipolar Electrocautry in Reducing Seroma Formation Post-Conservative Breast Surgery
Authors: El-Anwar Ali Mohamed , Hamid Mohamed Abdel Sattar Abdel , Zaid Mohamed Hamdy , Abuelneel Ahmed Nabil Mohamed
Published: August 2023

Background

Breast cancer, according to national cancer institute, is the commonest cancer in women in Egypt, It represents 37% of all female cancers among Egyptian females cancers, seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery (monoplar and bipolar) in reducing seroma formation post conservative breast surgery.

Patients and Methods

This prospective randomized study was conducted on female patients with breast tumours at the General Surgery Department at Ain Shams University Hospitals starting from November 2020 to May 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained.

Results

Our study included 60 patients, in whom a conservative breast surgery and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 20) or monopolar electrocautery (n = 20) or bipolar electrocautery (n = 20). Our mean age was 45.47±9.14 years (19-60 years). 10/60 patients (16.6%) had positive family history of mammary cancer, 18/60 patients were diabetic (30%), 23/60 patients were hypertensive (38%), 10/60 patients received neoadjuvant chemotherapy (10%). The mean lesional size was 2.9 ±1.03 cm (1.5-6.2 cm).the mean safety margin was 2.23±0.37 (1.5-3 cm). Operation timing was longer in bipolar electrocautry being (91.90 ± 3.14 minute) than monopolar elctrocautery being (83.35± 3.41 minute), while in harmonic group operation timing being (51.65 ± 5.02 minute).in addition intraoprative blood loss was significant large amount in monopolar electrocautery 75.15 ± 3.12 ml, while in harmonic dissection compared with bipolar electrocautery mean intraoprative blood loss was no significant (52.00 ± 4.18 ml vs 55.80 ± 9.89 ml pvalue =0.055). moreover there was asignificant reduction in the mean time of drain removal (2.90 ± 0.64 day in harmonic dissector), while in bipolar electrocautery 4.95 ± 0.69 day and longest mean time in drain removed in monopolar electrocautery 6.85 ± 0.37 day). And the incidence of seroma formation after drain removal is significant in monopola relectrocautery 58.3%. p-value =0.040, while in harmonic dissection compared bipolar electrocautery incidence of seroma formation after drain removal (16.7% vs 25.0%), this mean that harmonic dissector is low incidence of seroma formation.

Conclusion

Harmonic dissection technique leads to significant decreases in intraoperative blood loss, operative time, mean time of drain removal and postoperative seroma in terms of shorter drain duration and better quality of life. Here, we recommend the use of the harmonic dissection technique in conservative breast surgery.
Stapled Cardioplasty in Management of Cardiac Achalasia
Authors: Salem Amir Hany Ali Elsayed , Fiky Khaled Abdallah El , Hefny Amr Mohamed Mahmoud El , Alsayed Mohammed Abdalmegeed , Elmoenem Ayman Hossam Eldeen Abd
Published: August 2023

Background

Cardioplasty is a new surgical solution for achalasia. It is done by cutting the lower oesophageal sphincter using an Endo GIA stapler and making side to side anastomosis between the lower oesophagus and the funds of the stomach.

Aim of the Work

To assess the outcome of Stapled Cardioplasty as regard improvement of the symptoms and incidence of complications.

Patients and Methods

This study was conducted at upper GIT surgery unite Faculty of Medicine, AinShams University, in the period from February 2021 till September 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained. This is a prospective pilot study was conducted to assess the outcome of stapled cardioplasty. Six patients were included, four patients underwent open cardioplasty and two patients underwent laparoscopic cardioplasty.

Results

The results of this study showed a remarkable effect of cardioplasty on improvement of the symptoms of achalasia. This means cardioplasty may be a promising new option for management of cardiac achalasia.

Conclusion

Cardioplasty can be recommended as a safe and appropriate option for patients with achalasia. Albeit with limited experience, the procedure seems to provide excellent symptomatic relief and avoids the need for another intervention. It may be used as substitute of Heller myotomy as the standard treatment for achalasia in the future.
Comparison between Size of OV, Fibroscan in Chronic Hepatitis C Patients before & after Treatment with DAAs
Authors: Elsawaby Ahmed Shawky , Ibrahim Wesam Ahmed , Saleh Shreen Abo Bakr , Hasaneen Ahmed Samir
Published: August 2023

Background

HCV infection is a global health issue and one of the major causes of chronic liver diseases, Egypt on the top of the countries with heavy HCV burden, HCV genotype 4 is the most common in Egypt and represents 92% of total infections.

Objective

To asses changes on the size of esophageal varices and liver stiffness after treatment of HCV with DAAs.

Patients and Methods

The study was carried out at Gastroenterology and hepatology Department, Ain-Shams Hospital and Kobry-Elkoba Military Hospital and included 60 patients with chronic infection of hepatitis c virus diagnosed by (HCV Ab by ELISA positive and HCV RNA by PCR positive) and was divided into 3 groups: Group I: 20 patients chronically infected with HCV received sofosbuvir (one 400 mg tablet taken once daily) & Ribavirin (weight –related dose, 75 kg or less: 400 mg orally in the morning and 600 mg in the evening, Greater than 75 g: 600 mg orally twice daily and decrease the dose in case of anaemia) for 6 months. Group II: 20 Patients chronically infected with HCV received sofosbuvir (one 400 mg tablet taken once daily) & simeprevir (one 150 mg tab taken once daily) for 3 months. Group III: 20 patients chronically infected with HCV received sofosbuvir (one 400 mg tablet taken once daily with or without food) & daclatasvir (one 60 mg tab taken once daily) for 3 months.

Results

In the study, patients achieved high rates of SVR 12 (98.3%) only one patient at group II relapsed after finishing the treatment and did not reach SVR12. In the study, there was decrease in fibroscan stages after treatment with different regmins of DAAs, but it was significant with group III (HCV patients who received sofosbuvir & daclatasvir for 3 months). In the study, There is significant improvement in liver enzymes (AST&ALT) and significant increase at platelet count after treatment in all the 3 groups, Also there was significant decrease in hemoglobin level in group I (SOF/RIB) in comparison to other groups. In the study, there was no significant change in OV grading in group I before and after treatment, and also in group II & III only one patient in each group had changes in OV grading after treatment from OV grade III to OV grade II.

Conclusion

High rates of SVR achieved after DAAs therapy associated with significant improvement of the liver function and fibrosis regression estimated by (LSM by fibroscan) but with no improvement of the degree of esophageal varices at least in short term follow up after therapy.
Study of Risk Factors in Patient with Persistant Elevation of Liver Enzymes after Treatment of Chronic HCV by Direct Acting Antiviral Drugs (DAADs)
Authors: Salem Amira , Hamdy Hisham , Gamil Ayman , Ghobashy Asmaa Abdelraouf
Published: August 2023

Background

Hepatitis C virus (HCV) infection is a major global health challenge; it is estimated that more than 80 million people are chronically infected worldwide, with 3- 4 million new infections and 350000 deaths occurring each year because of HCV- related complications. Egypt is the country with the highest HCV prevalence in the world.

Aim of the Work

The aim of this study is to determine risk factors that cause persistent elevation of liver enzymes in hepatitis c virus patients treated by direct acting antiviral drugs (dyslipidemia, high BMI, type2 diabte, NAFLD).

Patients and Methods

This retrospective cross sectional study was conducted on 128 Egyptian candidates achieved SVR after 12 weeks with elevated liver enzymes before treatment by (DAAds)

Results

In this study, we found that there were correlations between the elevated ALT levels and most metabolic risk factors. There were increase in TG, BMI, and decreased. HDL-c, which were components of metabolic syndrome, were associated with high ALT levels in patients. Metabolic syndrome (MS) components are highly prevalent in NAFLD lack of biochemical response was associated with a higher risk to develop liver related complications (decompensation and cancer), indicating that these patients should undergo further hepatological followup.

Conclusion

Further large-scale studies employing larger number of patients are needed to evaluate risk factors that cause persistent elevated liver enzymes after eradication of hepatitis c viral infection with DAAds.
Patatin-Like Phospholipase Domain Containing 3 (PNPLA3) as a Non-Invasive Marker in Diagnosis of NASH
Authors: Elmagid Nanees Ahmed Adel Abd , Riad George Safwat , Hashem Walaa Mohamed , Agwa Sara Hassan , Sabry Karim , Elgohary Shimaa Abdelraouf , Bawal Bino Andrea Ahmed
Published: August 2023

Background

Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of progressive liver disease characterized by increased hepatic triglyceride content (HTGC) in the absence of excess alcohol consumption. NAFLD includes simple steatosis, non-alcoholic steatohepatitis, fibrosis and ultimately cirrhosis, and is strongly associated with features of the metabolic syndrome (obesity, insulin resistance/type 2 diabetes mellitus and dyslipidemia).

Objective

To study the role of PNPLA3 as non-invasive biomarker in diagnosis of NASH.

Patients and Methods

Single Centre randomized case control clinical study This study was conducted for patients attended Bariatric surgery unit at Ain-Shams University Hospital. Literature review designed and data collection started in October 2019 up to March 2021. This study performed on 50 Egyptian patients, proven NAFLD by histology, patients were biopsied during a bariatric Surgery at Ain-Shams University Hospital after written consent were obtained, and 25 healthy control Subjects were selected randomly after meted the criteria.

Results

The G risk allele shows higher level of ALT and statistically significant (p < 0.028*) but not significant with AST (p < 0.243), significant with triglycerides (p < 0.013*), with total cholesterol (p < 0.010*) and BMI (p < 0.016*) independent of the others parameter compared to wild type C allele. To greater number of G risk allele more higher scoring of NAS score (p < 0.002*) and increasing likelihood of advance fibrosis stage (p < 0.046*). By dominant analysis 54.77% of the steatohepatitis patients carrying the risk allele G while steatosis group only 22.42% carrying the risk allele the risk G allele had 4.19 fold more risk of having sheatohepatitis (NASH) than the wild type C allele among the studied NAFLD patients group (odds ratio 4.19, CI 95% 1.762-9.962, p < 0.001*). Homozygous and heterozygous Risk allele GG, CG had 4.37 fold risk of developing NAFLD than the homozygous wild type CC (CI 1.491-12.826, p < 0.005*) and by dominant analysis the risk G allele had 3.45 fold more risk of having NAFLD than the wild type C allele (CI 1.408-8.474, P-value <0.003*) in Egyptian

Conclusion

We demonstrated for the first time risk of PNPLA3 rs738409 polymorphism in Egyptian, by dominant analysis the risk G allele had 3.45 fold more risk of having NAFLD than the wild type C allele in Egyptian, the risk G allele had 4.19 fold more risk of having sheatohepatitis (NASH) than the wild type C allele among the studied NAFLD patients group.
Relation of Growth Differentiation Factor 15 (GDF 15) to Early Diabetic Nephropathy
Authors: Seif Khaled Hussein Abou , Abouellail Hesham Atef , Said Tamer Wahid E L , Rezk Khaled Mohamed , Boktor Haron Akhnokh Haron
Published: August 2023

Background

Diabetic nephropathy (DN) is one of the leading causes of end-stage renal disease (ESRD) in developed countries and is becoming more prevalent globally due to the rise in the incidence of obesity and type 2 diabetes, DN is a progressive kidney disease caused by alterations in the glomerular capillary and tubular structure and function induced by the disturbed glucose homeostasis. Recent studies are conflicting regarding the sensitivity and the specificity of biomarkers currently used in practice for DN diagnosis (e.g., eGFR, albuminuria).

Aim of the Work

The aim of this work is to evaluate the relation of Growth Differentiation Factor 15 (GDF 15) to early Diabetic Nephropathy. For this purpose we study 90 adult diabetic patients classified into three groups: group (1); 35 patients with micro-albuminuria (UAE 30–299 mg/24 h), group (2); 35 patients with macro-albuminuria (UAE ≥ 300 mg/24 h), and group (3); 20 patients with norm-albuminuria (UAE <30 mg/24 h). It was found that there is no statistically significant difference between age and sex in the three studied groups, so patients in this study are matched in age and sex.

Patients and Methods

This cross-sectional comparative study involved 90 adult diabetic patients were selected from the patients attending the outpatient clinic of the Nephrology Department in Hurghada General Hospital. The study was performed at the period from January 2018 to January 2019.

Results

As regard the type of diabetes in our study there was statistically insignificant difference between microalbuminuric and macroalbuminuric groups in this study as regard type 1 and type 2 diabetes. Our data revealed that there is a statistically insignificant difference between the three studied groups as regard duration of diabetes, The study also showed that there was statistically insignificant difference between the two studied groups (1 & 2) as regard hypertension, while they were statistically significant compared to controls, This study showed that GDF-15 was markedly elevated in group 1 & 2 compared to control. There was statistically very highly significant difference between the two studied groups (1 & 2) and control group (3), while there is a statistically significant difference between group 1 and group 2.

Conclusion

In conclusion, the GDF-15 levels at the time of diagnosis have a significant negative correlation with the initial renal function and a significant positive correlation with a higher risk of disease progression in DN. Our result suggested that high GDF-15 reflects early renal injury and a mild degree of proteinuria in DN. GDF-15 is independent prediction to proteinuria level.
Anti-Ficolin-2 Antibody: Could It Be a Predictor of Proliferative Lupus Nephritis in Lupus Patients?
Authors: Kamal Sylvia Talaat , Farres Mohamed Nazmy , Ibrahim Rehab Ali , Ibrahim Ibrahim Sami , Ahmed Fatma Abdelrahman
Published: August 2023

Background

Nephritis is a challenging domain of systemic lupus erythematosus (SLE). There is a growing need for identification of a non-invasive marker for diagnosing and monitoring nephritis.

Objective

To explore the relevance of using anti-ficolin-2 antibody (Anti-FCN2) as a biomarker for detecting lupus nephritis (LN), and its relation to renal biopsy histopathology and disease activity.

Patients and Methods

Sixty SLE patients were compared to 30 apparently healthy individuals. Thirty of the patients were LN patients (documented by a recent renal biopsy). Full history, examination and laboratory investigations were done. Activity was assessed by SLE disease activity index (SLEDAI) score, and Anti-FCN2 titer was measured by enzyme-linked immunosorbent assay technique (ELISA).

Results

Forty-four of our SLE patients were in disease activity by SLEDAI score. Anti-FCN2 titer was significantly higher among SLE patients compared to control group (p value <0.001). It was also higher among patients with high disease activity compared to those with low disease activity and cutoff value was at 37 ng/ml (p value is < 0.001). AntiFCN2 titer was significantly higher among patients with LN compared to those without LN (p value is < 0.001) with best cutoff value at 72.50 ng/ml. Regarding LN patients, it was significantly higher among patients with proliferative changes than LN patients with non-proliferative changes (p value is 0.05) with best cutoff value at 155 ng/ml.

Conclusion

Anti-FCN2 shows promising results as a biomarker for lupus disease activity, especially regarding LN and proliferative changes. Further longitudinal studies on larger samples are needed to confirm.
Urinary Podocalyxin Is an Early Marker for Podocyte Injury in Patients with Diabetic Nephropathy as well as Other Glomerular Disease
Authors: Ibrahim Khaled Mahfouz Abdel Naim , Ahmed Yasser Suleiman , Salman Manal Ibrahim Mohammed , Bashary Walid Ahmed , Hussein Hussein Sayed
Published: August 2023

Aims/Objective

Nephropathy, a major complication of diabetes, is the leading cause of end-stage renal disease. Recent studies have demonstrated that podocyte injury is involved in the onset of and progression to renal insufficiency. Here, we describe a novel, highly sensitive ELISA for detecting urinary podocalyxin, a glycoconjugate on the podocyte apical surface that indicates podocyte injury, particularly in the early phase of diabetic nephropathy.

Methods

Urine samples from patients with glomerular diseases (n = 40) and diabetic nephropathy (DN) (n = 40) subdivided into 2 groups (DN with macroalbuminuria (n = 20) and DN with microalbuminuria (n = 20)) were used to quantify urinary podocalyxin by ELISA. Urine samples were obtained from 20 healthy controls for whom laboratory data were within normal values. Podocalyxin was detected in urine by ELISA.

Results

urinary podocalyxin.detective range was 0.156-10 ng/mL, Levels of urinary podocalyxin were elevated in patients with various glomerular diseases and patients with diabetic nephropathy. level of urine podocalyxin was significantly positively correlated regarding LDL cholesterol and urine protein in all patients group, patients with glomerular diseases and patients with DN, while urine podocalyxin was significantly positively correlated regarding diastolic BP, HbA1c in all patients group but neither in patients with glomerular diseases nor patients with DN, while urine podocalyxin was significantly positively correlated regarding CRP in all patients group but in patients with DN it was significantly negatively correlated.while it was not significantly correlated in patients with glomerular diseases. No significant correlation between urine podocalyxin and pathology in renal biopsy.

Conclusions/interpretation

the level of urinary podocalyxin could provide information of earlier glomerular impairment in patients with Glomerular diseases and diabetic nephropathy and can be used as earlier marker for Glomerular diseases and diabetic nephropathy like microlbuminuria.
The Effect of Sodium Bicarbonate Supplementation on Serum Alpha Klotho in Chronic Kidney Disease Patients Stage 3b to 4
Authors: Shinnawy Howayda Abdel Hameed El , Khedr Lina Essam , Abdel-Samea Marwa Shaaban , Ibrahim Mahmoud Rabie
Published: August 2023

Background

Growing evidence suggests that the FGF–Klotho endocrine system also has a crucial role in the pathophysiology of ageing-related disorders, including diabetes, cancer, arteriosclerosis and chronic kidney disease.

Aim of the Work

The present study aimed to ascertain the potential significance of oral sodium bicarbonate supplementation on soluble α-Klotho serum levels in chronic kidney disease (stage 3b:4) according to CKD-EPI formula.

Patients and Methods

This was an uncontrolled clinical trial conducted on Inward and OPC patients at El-Demerdash Internal Medicine Hospital. The baseline values of plasma α-klotho were measured in 45 patients having CKD with an estimated glomerular filtration rate (eGFR) of (15:44) mL/min/1.73 m2 (according to CKD-EPI formula) with follow up plasma α-klotho after 3 months of taking sodium bicarbonate tabs orally 0.5 g/12 hrs.

Results

In our study, 14 (Fourteen) patients with Hypertension, 13 (Thirteen) patients Diabetes, 6 (Six) patients Glomerulus's nephritis, 6 (Six) patients Repeated urinary tract infection, 4 (Four) patient Recurrent stones, 4 (Four) patient Polycystic kidney and 2 (Two) patient Systemic lupus. The Klotho (pg/mL) Before ranged from 296.7 to 976.5 with mean 596.30 ± 202.89 and the Klotho (pg/mL) After ranged from 327.4 to 988.6 with mean 696.16 ± 185.32. The Hco3 before ranged from 17.6 to 22.5 with mean 19.74 ± 1.43 and the Hco3 After ranged from 15 to 28.3 with mean 23.63 ± 3.23. The current study showed that there was non statically significant correlation Between Klotho (pg/mL) and SPB, DPB, Pulse, Temperature, Respiratory rate. The present study showed that there was non statically significant correlation Between Klotho (pg/mL) and Platelets, Urea, Creat, U. creatinine, U. albumin, A/C Ratio, E-GFR, Na, K, Ca, Po4. There was Non statically significant correlation Between Klotho (pg/mL) and Hco3 Before, and there was statically significant Positive correlation Between Klotho (pg/mL)After and Hco3 After.

Conclusion

There was highly significant difference found between before and after sodium bicarbonate supplementation in terms of Klotho and Hco3 in chronic kidney disease patients stage 3b to 4.
Study of Procalcitonin Level in Obese Prevalent Hemodialysis Patients and Its Relation to Hemodialysis Adequacy
Authors: El-Wakeel Mahmoud Talaat Mahmoud , Saeed Saeed Abdelwahab , Abdelwahab Khaled Gouda , Mohamed Ahmed Yehia
Published: August 2023

Introduction

In hemodialysis (HD) patients procalcitonin considered as an early predictor of acute infection. It represents a new and potential marker of inflammation and may correlate with dialysis adequacy. This makes procalcitonin a potential biomarker for obesity-related low-grade inflammation.

Objective

To assess procalcitonin level in obese prevalent hemodialysis patients and its relation to hemodialysis adequacy

Methods

A cross sectional study was conducted on 90 patients divided into 3 groups, 40 obese (BMI ≥ 30 Kg/m2) ESRD patients on regular hemodialysis at dialysis unit of El-Sahel Teaching Hospital (group A), 40 non obese (BMI < 25 Kg/m2) ESRD patients on regular hemodialysis (group B) and 10 healthy individuals with BMI < 25 Kg/m2 as a control group (group C).All patients were subjected to detailed history taking and general examination. All patients were laboratory investigated for CBC, serum urea, creatinine, CRP, Urea reduction ratio (URR), equilibrated Kt/v. All controls were subjected to written informed consent, full history and examination and CRP level. Procalcitonin level was done by ELISA technique for all patients and control.

Results

In our study, we found that there was a higher level of procalcitonin (PCT) in obese hemodialysis patient than non-obese. We also found that there was no correlation between PCT and hemodialysis adequacy in our study population.

Conclusion

Our study showed that procalcitonin is a potential biomarker for obesity-related low-grade inflammation. But not related to hemodialysis adequacy.
Study of Neutrophil–Lymphocyte Ratio, Interleukin-6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF-α) in Type 2 Diabetes with Diabetic Nephropathy
Authors: Sabry Inas Mohamed , Mahdy Maram Mohamed Maher , Elhalawany Salah Hussien Aly , Ahmed Marwa Mohamed Ali
Published: August 2023

Background

Diabetic kidney disease is defined by characteristic structural and functional changes. The predominant structural changes include mesangial expansion, glomerular basement membrane thickening, podocyte injury, and, ultimately, glomerular sclerosis. The major clinical manifestations of diabetic nephropathy are albuminuria, hematuria (less often), and, in many patients, progressive chronic kidney disease, which can be slowed with optimal therapy.

Objective

to assess the Neutrophil-lymphocyte Ratio, Interleukin- 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in Type 2 Diabetes with Diabetic Nephropathy.

Patients and Methods

In Our study We collect 90 subjects with their ages ranging from 35-70, selected from Internal Medicine and Endocrinology outpatient clinics and the inpatient department at Ain Shams University Hospitals.

Results

As regards NLR, there were statistically significant and direct correlations between NLR and IL6, TNF, serum BUN, serum creatinine and albumin to creatinine ratio, while significant and indirect correlation with EGFR. As regards IL6, there were statistically significant and direct correlations between IL6 and TNF, serum BUN, serum creatinine and albumin to creatinine ratio, while significant and indirect correlation with BMI and EGFR. As regards TNF, there were statistically significant and direct correlations between TNF and serum BUN and albumin to creatinine ratio. There is no statistical difference between the studied groups as regard sex, age, BMI, SBP, DBP.

Conclusion

The current study could find that NLR, IL-6 and TNF-α were significantly associated with albuminuria in Type 2 Diabetic patients with DN and that they can be used as evident biomarkers in assessing the progression of deteriorating renal function and different stages of renal disease in patients with DN.
Clinical Significance of Immature Neutrophils in Relation to Disease Activity in Psoriatic Arthritis Patients
Authors: Darwish Rofida Mostafa , Kamel Abd El bar Nadia Salah , Elwy Mohamed Ali , Saber Nayera Zaghloul
Published: August 2023

Background

Psoriatic arthritis (PsA) is a complex type of progressive inflammatory arthritis associated with psoriasis. Prevalence of PsA has been reported 5.8–40.9% among patients suffering from psoriasis. A recent meta-analysis indicated that there is no gender predilection in patients with PsA. It shares genetic and clinical features with other forms of spondyloarthritis and affects different structures of the musculoskeletal system in addition to the skin and the nail. Neutrophils are crucial responders of the innate immune response, but the role played by neutrophils in psoriasis has not been well characterized. This thesis discussed the current understanding of the role and potential mechanisms of immature neutrophils in psoriatic arthritis.

Objective

To study the relation between immature neutrophils in blood and disease activity in psoriatic arthritis patients.

Methods

This randomized control trial, done on 50 PsA patients from Physical medicine, Rheumatology and Rehabilitation and Dermatology outpatient clinics of Ain Shams University hospital, included by CASPAR criteria, subjected to full medical history taking and thorough clinical examination with calculation of SPARCC, ASDAS and PASI scores.laboratory evaluation include CBC with differential white blood cell count for Immature Neutrophils percentage, ESR, CRP and Rheumatoid factor.CBC was compared with 20 age and sex matched healthy controls.

Results

The Immature Neutrophils mean ± SD(%) was found to be 5.99±1.57 in patients and was statistically significantly higher in them than in controls 2.25±1.16(P < 0.037) and it was statistically significantly correlated with disease activity according to ASDAS score, SPARCC, PASI score, ESR, CRP, RBCS, WBCS, Platelets, Enthesitis, Dactylitis, skin and nail affection.

Conclusion

This study highlighted the role of immature neutrophils as a novel biomarker for disease activity in psoriatic arthritis.
Accuracy of Different Intraocular Lens Calculation Formulas in Patients with High Axial Myopia
Authors: Moustafa Dina M , Gaafar Ayman A , Wahba Sherine S , Wessam Moataz M
Published: August 2023

Background

The two main problems encountered in calculation of intra ocular lens power are the measurement of the proper axial length (AL), and the lack of accuracy of the available formulas that calculate the power of the intra ocular lens in cases of eyes with high axial length.

Aim of the Work

To compare the accuracy of intraocular lens (IOL) calculation formulae (Holladay I, Haigis, SRK/T, Hoffer Q, Holladay II, and Barrett Universal II) in the prediction of postoperative refraction for eyes with AL 26.0 mm or more.

Patients and Methods

A prospective study was carried on forty-seven eyes of forty-seven patients. All the patients were managed at Ain Shams University Hospitals in cooperation with a specialized centre between April 2019 and March 2020.

Results

Mean absolute error (MAE) was calculated for each formula showed that the least MAE is for Barrett Universal II formula. SRK/T formula is the 2nd lower MAE followed by Haigis formula and the last is Holladay II formula. The scatter plots between AL and absolute error from each of the six calculations formulae was done and showed that Barrett universal II has negative correlation with AL. As for SRK/T and Haigis formulae there is a linear correlation. Numerical Predictive Error showed that SRK/T formula had the lowest mean numerical error followed by Haigis formula then Barrett Universal II and last came Holladay II formula.

Conclusion

for high axial myopic eyes, the Barrett Universal II formula is the best in this group of patients and provide the lowest mean absolute error, highest percentage of eyes within ≤ ± 0.50 D and the lowest risk of refractive surprise compared to other IOL power calculation formulae. Then comes Haigis and SRK/T formulae which performed similarly and provide a good predictable outcome then at last came Holladay II formula.
Anatomical and Functional Evaluation of RNFL Parameters and Choroidal Thickness Changes in Patients with Chronic Renal Failure Undergoing Hemodialysis Using Spectral-Domain Optical Coherence Tomography and Visual Field
Authors: Salman Abdelrahman Gaber , Rashed Hazem Omar , Ramadan Heba Ramadan Abdel Qader
Published: August 2023

Background

There is a structural analogy between the glomerular vascular network and the choroidal circulation. With hemodialysis (HD), lots of alterations occur in patients' homeostasis and metabolic parameters. These alterations affect the eye and may cause neuro-ophthalmologic complications.

Aim

To evaluate anatomical and functional changes of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), and changes in subfoveal choroidal thickness (SFCT) in patients with chronic renal failure (CRF) on HD.

Methods

This case control study was carried on 20 eyes of 20 CRF patients (HD group) and 20 eyes of 20 healthy individuals. 10 of the HD group were non-diabetic (NDM subgroup) and 10 were diabetic (DM subgroup). For all eyes, the thickness of peripapillary RNFL, GCL, and SFCT were measured by optical coherence tomography (OCT) (RS-3000; NIDEK, Japan) and visual field (VF) analysis using Humphrey field analyzer (Carl Zeiss, USA).

Results

A statistically significant decrease in peripapillary RNFL thickness in HD group when compared to the control group in most analyses, but did not amount to statistical significance in the temporal quadrant and in 5 of the studied clock hour sectors. There was also a statistically significant decrease in the macular GCL thickness of HD group when compared to the control group in both hemifields, and in all of the 8 subfields. The results of the SFCT reported in HD group were also significantly less than that reported in the control group. Analysis of results from VF demonstrated a highly significant depression in both MD and PSD of the HD group when compared to the control group. The difference between the NDM and DM subgroups was not significant in any of the studied parameters.

Conclusion

Our results demonstrate highly significant retinal and choroidal changes in CRF patients on HD. Thus, we recommend that CRF patients undergo regular ocular examination by OCT to prevent early ocular damage.