bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment protocol for patients with acquired apraxia of speech
Authors: Aboras Yehia Amin , Ashmawy Ghada Abdelhady , Elmaghraby Reham Mohamed , Gommaa Sabah Saeed
Published: September 2023

Background

Apraxia of speech can be defined as an articulation disorder that results from impairment of the capacity to order the positioning of speech musculature and the sequencing of muscle movements for volitional production of phonemes and sequences of phonemes.

Objective

The aim of this study was to adapt the Apraxia Battery for Adults II (ABA II) test to suit the Egyptian culture in order to apply this test for assessing Egyptian apraxic patients for proper management of this ailment.

Subjects and methods

This study was conducted on two groups: the first group consisted of 56 adult patients with expressive aphasia and/or dysarthria, who were evaluated with ABA II to detect any apraxic elements. The second group consisted of 100 healthy adults who served as the control group and were evaluated by ABA II to yield cutoff scores. Test reliability was assessed by internal consistency reliability using reliability coefficientα(Cronbach’sα). Test validity was measured on the basis of content validity, concurrent validity, and group differentiation.

Results

Reliability of the ABA II test was proved to be high, on the basis of the high values of coefficientαobtained for all test items (0.746–0.937), denoting an intercorrelation between test items. Validity of the ABA II was proven by three methods: content validity, concurrent validity (correlation matrix between different items of the test was determined and there was a strong correlation between the test items), and group differentiation (comparison of the test results between apraxic patients, nonapraxic patients, and controls was done and statistically significant differences were found between the scores of all test items among these groups.) The test was proven to be sensitive and specific.

Conclusion

The results were highly significant and were capable of discriminating between normal subjects and apraxic patients.
Erratum: Comparison between pitch discrimination in normal children, children with hearing aids, and children with cochlear implant
Authors: Ahmed Rania E.
Published: September 2023

In the article titled “Comparison between pitch discrimination in normal children, children with hearing aids, and children with cochlear implant”, published on pages 332–336, Issue 4, Volume 34 of Journal - The Egyptian Journal of Otolaryngology, the list of authors and affiliations is incorrectly written as “Rania E. Ahmed - Audio Vestibular Unit, Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt”. The correct list of authors and their affiliations should read as;

“Samir Ibrahim Asal - Assistant Professor of Audiology, Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Ossama Ahmed Sobhy - Professor of Audiology, Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Nesrine Hazem Hamouda - Lecturer in Phoniatrics, Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Rania Ebraheem Ahmed - Audio Vestibular Unit, Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt”.
Prevalence and predictors of chronic obstructive pulmonary disease among high-risk Egyptians
Authors: Said Azza F. , Ewis Ashraf A. , Omran Ahmad A. , Magdy Mohamed E. , Saleeb Micheal F.
Published: September 2023

Background

Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. COPD prevalence, morbidity, and mortality vary across countries and across different groups within countries. In Egypt, COPD is a rising significant health problem; however, information on its prevalence, morbidity, and mortality is still lacking.

Aim of the study

The first aim was to detect the prevalence of COPD among high-risk Egyptians Global using Initiative for Chronic Obstructive Lung Disease (GOLD) and FEV1/FVC < lower limit of normal (LLN) definitions. The second goal was to identify the factors predictive for diagnosis of COPD.

Patients and methods

This study included 363 randomly selected individuals with a high risk for COPD; 176 were smokers (group I), 107 were construction and brick manufacturer workers (group II), and 80 were women exposed to biomass fuel (group III). All individuals filled out a respiratory questionnaire, were clinically examined, and subjected to spirometric evaluation.

Results

The prevalence of COPD among high-risk individuals was 9.6 and 17.4% on the basis of GOLD and LLN, respectively. The sensitivity and specificity of prebronchodilator values of FEV1/FVC < LLN were 94.3 and 90.8%, respectively, for the diagnosis of COPD. However, our findings support that the postbronchodilator LLN definition is superior in ruling out the presence of COPD, as it has a good negative test specificity of 99.7%. Chest wheezes were the only symptom that was an independent predictor of COPD (odds ratio 4.80, 95% confidence interval 1.57–14.74, P = 0.02). Increasing age, smoking, and mean pack-years were also factors predictive for COPD.

Conclusion

The prevalence of COPD among high-risk individuals in Egypt was estimated to be about 10% as per GOLD. Prebronchodilator LLN is a reliable method for the diagnosis of COPD and it yields comparable results to the GOLD criteria. The main predictors for COPD diagnosis are old age, smoking history, and presence of chest wheezes.
Pulmonary involvement in juvenile-onset systemic lupus erythematosus patients asymptomatic for respiratory disease
Authors: Lotfy Hala M. , Halawa Eman F. , El Baz Mohamed
Published: September 2023

Objective

The aim of this study was to investigate the presence and frequency of abnormalities in subclinical pulmonary function tests (PFTs) in a group of Egyptian children with juvenile-onset systemic lupus erythematosus (jSLE) asymptomatic for respiratory manifestations.

Patients and methods

The study enrolled 20 children with jSLE followed up at the Pediatric Rheumatology Clinic, Cairo University. For all patients, pulmonary function testing was performed including measurement of lung volumes and lung flows using spirometry. Lung diffusion testing was performed using the transfer factor of the lung for carbon monoxide (DLCO) utilizing the single-breath method. Findings were correlated with clinical manifestations and lupus disease activity, and assessed using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores.

Results

NAmong our study group, musculoskeletal, mucocutaneous, hematologic, renal, and neurological manifestations were the most frequent lupus manifestations throughout the course of disease, occurring in 85, 80, 65, 45, and 35% of the patients, respectively. The mean SLEDAI score was 21.3 ± 9.515. Overall, 95% our patients had at least one PFT abnormality within a mean of 4.9 ± 1.94 years after disease onset. Diffusion defect was the most frequent defect detected in 14 (70%) patients, restrictive pathology was found in seven (35%) patients, obstructive pathology was found in six (30%) patients, and mixed restrictive and obstructive pathology in one (5%) patient. In terms of the correlation between PFTs and the SLEDAI, DLCO was correlated positively (r = 0.37, P = 0.05) to a high SLEDAI, that is, a diffusion defect was significantly evident in patients with high disease activity even without symptoms.

Conclusion

Occult pulmonary disease as shown by a PFT occurs frequently in our group of Egyptian patients with childhood-onset systemic lupus erythematosus.
Study of sleep quality among patients admitted to the respiratory intensive care unit
Authors: Magdy Doaa M. , Metwally Ahmed , Makhlouf Hoda A.
Published: September 2023

Background

Several factors may cause sleep disruption among critically ill patients. Determination of these factors that interfere with patients’ quality of sleep is very important in the treatment process to ensure normal sleep process.

Objective

The aim was to assess the quality of sleep among critically ill patients admitted to the respiratory intensive care unit (RICU) and identify the risk factors.

Materials and methods

This observational study was carried out on all patients who were admitted to the RICU. Patients’ age, gender, duration of ICU stay, cause of admission, and scores for the severity of illness on admission including Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment were done. A Freedman questionnaire was determined twice: at the RICU and at home to evaluate sleep quality and the contributing factors.

Results

One hundred patients were enrolled in this study. The mean ICU stay was 5.41±2.03 days; 82% of them were admitted for the first time to the RICU. The mean score of sleep quality of patients at the RICU was 4.38±1.83, which was significantly reduced compared with the mean score at home post-admission 8.30±1.09 (P<0.001). Noise (7.60 ±1.40) was the main sleep disruptive factor in the RICU; hospital staff conversations (7.77±1.38) and medical staff pagers and phones (7.42±1.53) were the maximum noises. Frequent use of light is the second influential factor for sleep disruption (6.82±1.31), followed by nursing interventions and blood sampling.

Conclusion

Due to the poor sleep quality during hospitalization and due to the presence of a wide range of sleep disturbing factors such as noise, light, and nursing activities, nursing education, using eye shields, and ear plugs might reduce environmental noise and improve sleep quality.
Study of addiction in newly diagnosed patients with pulmonary tuberculosis in Abbasia Chest Hospital
Authors: Saeed Adel M. , Raafat Riham H. , Elbaz Eman M.
Published: September 2023

Background

Drug abuse is an important factor in the epidemiology of tuberculosis (TB) in developing and developed countries, and there is a triple relationship between pulmonary TB, HIV, and drug users.

Aim

The aim of this work was to study the relation between addiction and newly diagnosed patients with pulmonary TB from Abbasia Chest Hospital’s outpatient clinic or admitted to the departments or ICU during the 8 months from August 2015 to April 2016.

Patients and methods

This prospective study was conducted on 100 addict male patients who were diagnosed as having new cases of pulmonary TB (positive sputum for ZN stain) at Chest Departments and respiratory ICU in Abbasia Chest Hospital during the 8 months from August 2015 to April 2016 to detect the relation between addiction and TB by full history, laboratory investigations, and chest radiography.

Results

Most of the cases were taking a combination of drugs and more of cannabis, except for dead cases, where intravenous heroin was the top drug abused with longer duration of addiction. Cavitary and infiltrative patterns were present in more than half of the cases, with being more infiltrative among dead cases, with grade III severity in the chest radiography taking the upper hand. A minority of the cases had pleural effusion, pneumothorax and lung abscess.

Conclusion

Drug abusers are at high risk of TB infection and disease, and intravenous drug abuse is considered an important factor in HIV-associated TB.

Recommendations

Drug addiction is a major public health problem that needs to be studied from different aspects.
Unilateral lung agenesis: a case report and literature review
Authors: Tyagi Rahul , Chowdhary G. S.
Published: September 2023

Pulmonary agenesis is an extremely rare malformation of lung with an estimated prevalence of only 34 per million live births. It is even more uncommon in females and on the right side. We report a case of this rare entity.
Diagnostic yield of fiber optic bronchoscopy in alveolar and/or ground glass opacification in chest computed tomographic scan
Authors: Youssef Hoda A. A. , Khattab Hany M. , Shaban Marwa M. , Mohamed Sabah A. , Mostafa Khaled M.
Published: September 2023

Background and objective

Transbronchial lung biopsy (TBLB) can be obtained using forceps and usually represents the centrilobular regions. Therefore, disorders that are centered around terminal and respiratory bronchioles or distributed along the lymphatic routes can be diagnosed. This study investigated the diagnostic yield of flexible bronchoscopy in patients with ground-glass opacity (GGO) or alveolar filling for histopathological diagnosis and found out its complications.

Patients and methods

Twenty-six patients with predominant GGO or alveolar opacity in the chest computed tomographic (CT) scan were submitted for TBLB for histopathological confirmation. Patients with respiratory failure, heart failure, coagulopathy, or pathognomonic CT patterns were excluded. All patients were subjected to full history taking, chest CT scan, and TBLB with histopathological examination of the specimens.

Results

The diagnostic yield of TBLB was 73.1%. Histopathological diagnoses included hypersensitivity pneumonitis (23.1%), sarcoidosis (19.2%), adenocarcinoma (11.5%), small cell lung cancer (7.7%), alveolar proteinosis (3.8%), alveolar hemorrhage (3.8%), organizing pneumonia (3.8%), and chronic nonspecific inflammation (26.9%). There was no significant correlation between age, sex, smoking, and histopathological diagnoses. Regarding the predominant CT finding, 15 (57.7%) patients had GGO, whereas 11 (42.3%) patients had alveolar filling with significant (P=0.008) positive correlation between the CT predominant pattern and histopathological diagnoses. There was a positive significant correlation between lymph node enlargement in CT and histopathological diagnosis (P=0.029). Complications from TBLB included the pneumothorax (15.4%) and bleeding (7.7%).

Conclusions

TBLB seems to be a useful and safe procedure. It is of a high diagnostic value. Therefore, it could be considered a routine diagnostic procedure before thoracoscopic or open lung biopsy.
Percutaneous tracheostomy, making it easier
Authors: Almansoury Ahmad , Ali Sayed , Said Hany
Published: September 2023

Objective

Open and percutaneous tracheotomy (PT) lead to many perioperative complications. To minimize the complication and to save time and cost, certain assistive tools can be used like fiberoptic bronchoscope, ultrasound guidance and others.

Aim

The aim was to compare the three procedures, blind PT, fiberoptic bronchoscopy-guided PT and open tracheostomy, regarding ease of the technique, infection rate, bleeding, and complications of the procedure.

Design

A retrospective comparative trial was conducted.

Setting

ICU at Dar El Shefa Hospital and respiratory ICU, Ain Shams University Hospital, were the locations for study conduction. Patients and methods All patients required prolonged mechanical ventilation during period between August 2012 and August 2014.

They were assigned into three groups: group I underwent open tracheostomy and included 16 patients, group II underwent blind PT and included 15 patients, and group III underwent fiberoptic-guided PT and included 12 patients.

Results

A total of 43 patients underwent tracheostomy during the study period. There was a statistically significant difference between the studied groups regarding neck circumference and intubation period before tracheostomy. Regarding hemodynamics, there is no statistically significant difference regarding mean heart rate, mean arterial pressure and FiO2, pH, PaO2, PCaO2, PaO2/FiO2 and oxygen saturation SPO2 before and after each procedure. Regarding complications after procedure, it shows that blind group had higher percentage of patients with no complications (86.7%) followed by fiberoptic group (75%) and open tracheostomy group (50%). It was noticed that the lowest mean of duration of the procedure was found in the blind group (15.7±5.3), followed by fiberoptic group (17.8±3.2) and lastly the open tracheostomy group (25.7±6.3).

Conclusion

This study showed that PT had fewer complications than open tracheostomy, saved operating room resources as well as was more cost effective.
Medication adherence and treatment satisfaction in some Egyptian patients with chronic obstructive pulmonary disease and bronchial asthma
Authors: Galal Iman H. , Mohammad Yasser M. , Nada Abeer A. , Mohran Yosra E.
Published: September 2023

Background

The degree of effectiveness in the management of asthma and chronic obstructive pulmonary disease (COPD) entails proper treatment adherence and satisfaction. In this study, medication adherence and treatment satisfaction were assessed among some Egyptian patients with asthma and COPD.

Materials and methods

Consecutive asthma and COPD patients were recruited from the outpatient clinic or inpatients admitted to the Chest Department at Ain Shams University Hospital, Abbassia, and Qena Chest Hospitals. Self-reported medication adherence and treatment satisfaction were tested using the Arabic versions of the eight-item Morisky Medication Adherence Scale and Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), respectively.

Results

Totally, 474 asthmatic patients (mean: 34.41 years, 61.2% male and 38.8% female) and 509 COPD patients (mean: 60.39 years, 91.7% male and 8.3% female) were included. According to eight-item Morisky Medication Adherence Scale, mean adherence was 4.55±2.01 and 3.88 ±1.63 in asthma and COPD, respectively, with no significant difference. In asthma and COPD, low adherence was found in 71.7 and 79.4%, medium adherence in 19.8 and 13.6%, and high adherence in 8.4 and 7.1%, respectively. There was a significant difference in all domains of TSQM between asthma and COPD, with more effectiveness, convenience, and global satisfaction but less side effects among asthma patients compared with COPD. There was a significant correlation in asthmatic patients between adherence and all domains of TSQM, whereas in COPD only side effects and convenience correlated significantly with adherence. In COPD, adherence was better in male smokers, with low smoking index, living in urban areas, having severe small airway obstruction, and treated by pulmonologists. In asthma, adherence was mainly affected by treatment satisfaction.

Conclusion

Most of the asthma and COPD patients were nonadherent to their medications. Asthma patients were more satisfied with treatment compared with COPD patients.
What does pulmonary–renal syndrome stand for?
Authors: Farag Taghreed S. , Farag Abeer S.
Published: September 2023

Pulmonary–renal disorder (PRS) is an emergency situation described by a rapidly progressive course without an early intervention. It is appropriate time to review this disorder, this is may be attributable to frequent patients’ attendance to pulmonologist with both vague pulmonary and/or renal symptoms with disproportionate lack of information concerning consequent care. In addition, the outcome data for PRS still confined to little studies with limited follow-up. An updated working knowledge of PRS including the disease pathogenesis, complications as well as quickly advancing field focused on current new immunomodulatory therapies which offer life-saving options for refractory disease. An often-multi-disciplinary team is required for management. Early rapid identification relies upon a high index of clinical suspicious, carful medical evaluation, accessible laboratory investigations, imaging study, histopathology, with exclusion of differential diagnosis. An accurate diagnosis, exclusion of infection, close monitoring of the patient as well as timely initiation of aggressive therapy are crucial for the patient’s outcome. The mortality rate of PRS, reach up to 25–50 % [1].
Clinical phenotype as a predictor of outcome in mechanically ventilated chronic obstructive pulmonary disease patients
Authors: Mohamed Elgazzar Alaa Eldin Metwally
Published: September 2023

Background

The outcome in patients with chronic obstructive pulmonary disease (COPD) who need mechanical ventilation (MV) is altered by several factors such as severity of the disease, severity of acute exacerbation, advanced age, the cause of exacerbation, and development of complications.

Aim

This study aimed to assess the outcome of clinical phenotypes of MV COPD patients who were admitted to the respiratory ICU in 2014 and the influencing factors.

Patients and methods

This prospective study included 106 MV COPD patients. All patients underwent a thorough medical history, routine and specific investigations including: chest radiography, high-resolution computed tomography, serum immunoglobulin E, total and differential leukocytic count, serial arterial blood gases immediately before intubation, during MV and just before weaning.

Results

There were many predictors of bad outcome with statistical significance such as: older age (62.94±12.5 vs. 57.81±12.6 years), higher temperature on admission (37.48 ±0.67 vs. 37.20±0.42°C), higher serum of HCO3 on admission (42.5±4.5 vs. 38.9±7.8 mEq/l), longer duration of MV (12.05±4.4 vs. 4.8±1.84 days), higher last year number of exacerbations (1.94±0.9 vs. 1.47±0.6 times), with shorter duration from last exacerbation (40.4±1.2 vs. 50.5±2.04 days), dyspnea as the main presenting symptom, past history of MV, occurrence of complications during MV, emphysema phenotype (52.7 vs. 22.8%).

Conclusion

Past history of MV, emphysema phenotype, duration of MV, higher last year number of exacerbations, and shorter duration since the last exacerbation are reliable predictors of poor outcome and mortality in MV COPD patients with acute on top of chronic respiratory failure.
Study of pleurodesis using ethanolamine oleate through ultrasound-guided pigtail
Authors: Saeed Adel M. , Ali Tamer M. , Gomaa Ashraf A. , Kamel Mohamed N.
Published: September 2023

Background

Malignant pleural effusion (MPE) is a common and serious condition that is associated with poor quality of life, morbidity and mortality.

Aim

Study of pleurodesis using ethanolamine oleate (ETH) through ultrasound-guided pigtail to evaluate the efficacy and complications of ETH and pigtail.

Design

Thirty-three patients with MPE were included and were subjected to history taking, clinical examination, chest radiographs (on admission, every day before pleurodesis to ensure complete lung expansion and to exclude pneumothorax, every day after pleurodesis till the removal of the catheter and on follow-up – 2 months after pleurodesis – to check for reaccumulation of pleural effusion), chest sonography, pleural tapping, chest computed tomography scan (in some patients), pleural biopsy using Abram’s needle or through ultrasonography (in some cases), lymph node biopsy (in some cases) and spirometry before and 2 months after pleurodesis. Patients were subjected to pigtail catheter insertion using chest sonography. When the amount of effusion became less than 100 ml/day and when the chest radiography shows complete lung expansion and there is no evidence of bronchopleural fistula, pleurodesis with ETH was done. Then after 12 h, the pigtail was connected to a drainage device. Follow-up radiographs were done every day till the removal of the catheter. When the amount of the effusion became less than 100 ml/day, the catheter was removed. Assessment of the response was made after 2 months of pleurodesis, before death that may occur to the patient within 3 to 12 months after diagnosis. Despite the progress in cancer treatment, the management of MPE remains palliative, with median survival ranging from 3 to 12 months.

Results

Complete response was 81.8% of studied cases, while no/partial response was 18.2%. Pleurodesis complications were fever (21.1%), chest pain (33.3%), nausea (24.2%), vomiting (12.1%) and hypotension (6.1%). Pigtail complications were pigtail obstruction (3.03%), chest pain (3.03%) and obstruction and pain (12.12%) of the studied cases. There was a decrease in FVC% and FEV1% 2 months after pleurodesis. However, no significant difference as regards actual (measured) FEV1/FVC% before and 2 months after pleurodesis in all cases. Whereas, complete response was 81.8% by CXR and chest ultrasound.

Conclusion

ETH injection through pigtail was safe and effective in pleurodesis of MPE.
Validity of three scoring systems in assessing the severity and outcome in Al-Abbassia Chest Hospital Respiratory Intensive Care Unit patients
Authors: El-Naggar Taher Abd El-Hamid , Raafat Riham H. , Mohamed Safaa A.
Published: September 2023

Background

ICU scoring systems allowed an assessment of the severity of disease and death prediction. As ICU populations, investigations and management were changed, scoring systems should be updated.

Aim

The aim of this study was to evaluate three scoring systems in predicting outcome in Al-Abbassia Chest Hospital Respiratory ICU patients in 6 months.

Patients and methods

It was conducted on newly admitted cases in Al-Abbassia Respiratory ICU from July 2016 till January 2017. All patients were evaluated on admission and after 48 h by Acute Physiology and Chronic Health Evaluation IV (APACHE IV), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiology Score II (SAPS II).

Results

APACHE IV and SAPS II scores were significantly higher between dead than alive patients on admission and after 48 h, but were not able to predict death in ICU. SOFA score was insignificantly higher on admission and after 48 h between nonsurvivors. None of the three scores could predict the length of stay in ICU.

Conclusion

APACHE IV and SAPS II scores were better than SOFA score as they were significantly higher between nonsurvivors but not to the extent to predict mortality or length of stay.
Investigation of association of biomarkers of iron metabolism and insulin resistance in Egyptian patients with impaired glucose metabolism and type 2 diabetes
Authors: ElEbrashy Ibrahim N. , Shaker Olfat , Abdelgalil Sarah I. , Yousief Elham M.
Published: September 2023

Introduction

Type 2 diabetes is an expanding overall medical issue. A large portion of the enthusiasm for the job of supplements in diabetes is fixated on macronutrients, yet a micronutrient, iron, is additionally closely connected with diabetes.

Aim

To study biomarkers of iron metabolism, including serum ferritin, transferrin saturation, iron, and insulin resistance, in diabetic and prediabetes patients.

Patients and methods

This is a cross-sectional study directed on a cohort of 50 patients, comprising 25 patients with impaired glucose tolerance and 25 patients recently discovered to have type 2 diabetes mellitus (T2DM), as well as 20 healthy controls of matched age and both sexes. All patients enrolled in the study were subjected to full history taking, full examination, laboratory investigations including iron, total iron-binding capacity, ferritin, insulin, lipid profile, fasting blood glucose, 2-h postprandial glucose, urea, creatinine, complete blood count, alanine aminotransferase, and aspartate aminotransferase.

Results

We found that patients with T2DM have significant higher body weight and BMI than prediabetes patients and controls, and also statistically significant difference in serum iron between the studied groups, but no statistical significance in serum ferritin between the studied groups. In addition, we found a positive correlation of serum iron and insulin resistance in T2DM, a significant positive correlation of serum ferritin with low-density lipoprotein and negative correlation with high-density lipoprotein in T2DM, positive correlation of ferritin with cholesterol and triglycerides in impaired glucose tolerance group. Moreover, transferrin saturation was negatively correlated with glycated hemoglobin, BMI, and total iron-binding capacity and is positively correlated with iron and creatinine and hemoglobin among the studied groups.

Conclusion

The distinguished relationship of several markers of iron metabolism with hyperglycemia and insulin resistance recommends that iron stores add to the pathogenesis of IGM and T2DM.
Serum copeptin as a diagnostic and prognostic biomarker of coronary artery disease among patients with type 2 diabetes mellitus
Authors: Rashad Nearmeen M. , Ezzat Tamer M. , Allam Reem M. , Ashour Wesam M. R. , Ali Ayman E. , Soliman Mohamad H.
Published: September 2023

Background

Diabetes is one of the major risk factors for coronary artery disease (CAD); hormones implicated in cardiac diseases may play a role in diabetes development. Increased activities of the arginine-vasopressin (AVP) system were shown to be associated with type 2 diabetes mellitus (T2DM). The aim of this study was to estimate the values of serum copeptin as a predictive biomarker of CAD and to assess the correlation between copeptin and cardiometabolic risk factors in patients with T2DM.

Patients and methods

The case–control study included 110 patients with T2DM and 80 age-matched and sex-matched control group. All the participants were subjected to B-mode ultrasonography of both common carotid arteries to measure carotid intima-media thickness (mm), echocardiography, and coronary arteriography. Serum copeptin levels were measured with a new sandwich immunoassay by using a human copeptin enzyme-linked immunosorbent assay kit.

Results

Patients with T2DM had significantly higher serum copeptin levels (7.64±1.98 pmol/l) compared with control groups (4.64±1.11 pmol/l). Serum copeptin levels were significantly higher in patients with CAD (8.64±2.55 pmol/l) compared with patients without CAD (6.36±0.86 pmol/l). Interestingly, copeptin was positively correlated with cardiometabolic risks. The area under the curve of serum copeptin levels in differentiating patient with T2DM from control was 0.768 (P<0.001) and differentiating patient with CAD from the nonischemic group was 0.818 (P<0.001).

Conclusion

The higher serum level of copeptin in patients with T2DM especially in the patient with CAD is strongly correlated with cardiometabolic risk factors.
Urinary cyclophilin A in Egyptian patients with type 2 diabetes and diabetic nephropathy: correlation with urine albumin/creatinine ratio
Authors: Saif Aasem , Elsayed Eman , Shaker Amr , Ramzy Tarek , Zaghlol Basma , Mousa Shrook
Published: September 2023

Introduction

Albuminuria is commonly used to predict the onset and to follow the progression of diabetic nephropathy (DN), but it lacks both sensitivity and specificity in early stages.

Aim

We assessed urinary cyclophilin A (CypA) as a biomarker for the diagnosis of DN in Egyptian patients with type 2 diabetes.

Patients and methods

The study was conducted on 150 Egyptian participants aged 30–65 years; 125 (58 male individuals and 67 female individuals) patients with type 2 diabetes mellitus (diabetes duration>5 years) in different stages of DN and 25 age-matched and sex-matched healthy control participants comprised the study cohort. Estimated glomerular filtration rate and urine albumin/creatinine ratio (ACR) were assessed in all participants. Urinary CypA was measured in the morning specimen.

Results

Urinary CypA was significantly higher in patients with stage 2 DN, as compared with stage 1 patients (P=0.02) and the control group (P=0.017), with no significant change in urine ACR between stages 1 and 2 (P=0.809). Urinary CypA also showed a steady rise in DN stages 3, 4 and 5 (P<0.001). Urinary CypA had strong positive correlations with creatinine and urine ACR and a strong negative correlation with estimated glomerular filtration rate in patients with DN (P<0.001 for all).

Conclusion

We suggest that urinary CypA is a good biomarker for early detection of DN in patients with type 2 diabetes. It starts to rise before urine ACR. It also correlates well with the progression of DN. A larger study is needed to confirm its superiority over urine ACR in the early stages of DN.
Efficacy and disposal of drugs after the expiry date
Authors: Sarla Gurmeet S.
Published: September 2023

Every drug manufacturer is legally bound to display the date of expiry on all pharmaceutical products. Excluding certain medicines such as nitroglycerin, insulin, epinephrine, and tetracycline, most medicines stored under reasonable conditions retain at least 70–80% of their original potency for at least 1–2 years after the expiration date, even after the container has been opened. The drug is likely to lose some potency after the expiration date, but it is not clear how much potency is lost over a certain period of time past expiration dates. Placing medication in a cool place, such as a refrigerator, will help it remain potent for many years. Even though both the American Medical Association and the Food and Drug Administration do not recommend the dosing of expired pharmaceuticals at this time, discussion of the issue is warranted in order to understand the potential behind some expired drugs. This review article studies the financial implications and reason for stock piling of unused and expired pharmaceuticals, health hazards, common and ideal ways of disposal of unused and expiry medications and the way forward.
Fecal B-cell-activating factor as a new noninvasive marker in the evaluation of ulcerative colitis Egyptian patients: a comparative cross-sectional study
Authors: Hussein Hany A. , Mohamed Rasha S.
Published: September 2023

Background and aim

Diagnosis of ulcerative colitis (UC) is suspected clinically and confirmed through endoscopic biopsy. It can be followed-up and assessed by noninvasive biomarkers such as fecal calprotectin. Recently, B-cell-activating factor (BAFF) has been proposed to be a regulator of B-cell and T-cell immune responses and to be associated with inflammatory processes in autoimmunity. The aim of our study was to clarify the role of fecal BAFF as a simple predictor for disease activity and severity in patients with UC.

Patients and methods

Fifty Egyptian patients with UC were divided into two groups: group I including 40 patients with active UC (newly diagnosed) and group II including 10 patients with inactive UC (previously diagnosed); disease activity was assessed according to the Mayo activity scoring index; fecal BAFF and fecal calprotectin were measured for all patients using enzyme-linked immunosorbent assay.

Results

Significantly higher levels of Fecal BAFF and fecal calprotectin were found among patients with active UC, as compared with inactive UC patients. Fecal BAFF more than or equal to 50 μg/g had 97.5% sensitivity and 100% specificity in predicting disease activity in comparison with fecal calprotectin, which had a sensitivity and specificity of 90% at a cut off value more than or equal to 47 μg/g. In predicting disease severity, fecal BAFF more than or equal to 340 μg/g had a sensitivity of 95% and specificity of 100%, while fecal calprotectin more than or equal to 170 μg/g had a sensitivity of 80% and specificity of 95%.

Conclusion

Fecal BAFF is more sensitive and specific in predicting UC activity and severity than fecal calprotectin.
Albumin-corrected serum calcium and serum parathyroid hormone-related polypeptide determined by enzyme-linked immunosorbent assay in cirrhotic patients with hepatocellular carcinoma – a pilot study
Authors: Fouda Ragai M. F. R. , Sheir Rania E. , Selim Nora M. , Hammad Ahmed A.
Published: September 2023

Context

Parathyroid hormone-related peptide (PTHrP) is produced by many malignant tumors. It is responsible for most cases of hypercalcemia in patients with malignancy. Few published studies shed light on the relation between serum calcium levels and serum PTHrP levels in cirrhotic patients with hepatocellular carcinoma (HCC).

Aim

The aim of the current work was to evaluate serum PTHrP in cirrhotic patients with HCC and a possible correlation between serum PTHrP levels and albumin-corrected serum calcium levels in these patients.

Patients and methods

This is a cross-sectional study. The study included 35 cirrhotic patients with HCC (diagnosed depending upon α-fetoprotein and abdominal imaging studies). Data about their serum albumin and albumin-corrected serum calcium levels were collected. Sera of the studied patients were collected for determination of PTHrP levels by enzyme-linked immunosorbent assay (ELISA). Numerical data were summarized in the form of mean±SD. Strength of association between variables was tested using Pearson correlation coefficient.

Results

Approximately 8.6% of studied patients were hypercalcemic, and no statistically significant positive correlation was detected between serum PTHrP determined by ELISA and albumin-corrected serum calcium in these patients.

Conclusion

Approximately 8.6% of studied cirrhotic patients with HCC were hypercalcemic. NO statistically significant positive correlation was detected between serum PTHrP determined by ELISA and albumin-corrected serum calcium in these patients. Studies involving a larger number of patients could clarify the exact role of PTHrP in the development of hypercalcemia in cirrhotic patients with HCC.
Frequency of malignant biliary strictures in Upper Egypt: a pilot study
Authors: Mohamed Adnan A. , Ali Ahmed M. , Shehata Mahmoud R. , Elsewify Wael A. , Maklad Salah
Published: September 2023

Background and aim

Biliary strictures are challenging clinical condition for gastroenterologists, radiologists, and surgical specialists. We aimed to find out the frequency of malignant biliary strictures in our institutions.

Patients and methods

This prospective study included 44 patients with biliary strictures who had undergone endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) in Aswan and Assiut University Hospitals.

Results

Thirty two patients (72.7%) had malignant strictures where distal stricture was the most frequent (68.8%) followed by hilar (25%) then mid and long segment strictures (3.1% each).

Conclusion

The vast majority of indeterminate biliary strictures are malignant (72.7%), so all indeterminate bile duct strictures in patients with obstructive jaundice should be considered malignant unless a benign etiology is definitively identifiable.
The incidence of type 2 diabetes in patients with bronchial asthma
Authors: Al-Jarhi Ula M. , Mostafa Amira I. , Alnaggar Alshaimaa R. L. R.
Published: September 2023

Background

The effect of bronchial asthma on development of new-onset type 2 diabetes has not been studied.

Aim

The aim was to study the association of bronchial asthma and its severity with the incidence of type 2 diabetes after 5 years in patients without diabetes at the disease onset.

Patients and methods

A total of 200 consecutive patients with a physician diagnosis of bronchial asthma (120 not known to be diabetic and 80 known to have diabetes) presenting to the outpatient chest clinic in Kasr Alainy Hospital were included. Fasting blood glucose, 2h 75 g oral glucose tolerance test, glycated hemoglobin, and lipid profile were done. Spirometry, blood pressure, BMI, and other risk factors of diabetes were sought.

Results

Of the 120 nondiabetic patients, 30 patients met at least one criterion of prediabetes and 90 patients met at least one criterion of diabetes. Multivariable regression model demonstrated that forced vital capacity (FVC)%, maximal expiratory flow 75%, and inhaled bronchodilators are independent risk factors for elevated glycated hemoglobin, independent of inhaled or oral corticosteroids, family history, blood pressure, BMI, high-density lipoprotein, and triglycerides. Logistic multivariable regression model demonstrated that FVC% and forced expiratory volume in the first second % are independent risk factors for development of new-onset type 2 diabetes (hazard ratio for FVC%: 1.1589, 95% confidence interval: 1.0684–1.2571, P=0.0004; hazard ratio for forced expiratory volume in the first second %: 0.8754, 95% confidence interval: 0.8155–0.9396, P=0.0002).

Conclusion

The incidence of diabetes and prediabetes in patients with bronchial asthma who are not known to have diabetes at disease onset is 75 and 25%, respectively. Poor pulmonary function tests were independently associated with new-onset diabetes in such patients. This association is linked to the severity of asthma and not related to treatment.
Value of right ventricular dimensions’ swings on weaning from mechanical ventilation
Authors: Ahamed Soheir Mostafa Kasem , Maghrapy Muhammad Hossam El-Din Hassan , Shehata Khaled Mohamed Ali , Sadek Samiaa Hamdy , Tawfek Samir El-Hadidy
Published: September 2023

Background

Cardiac dysfunction is a common cause of weaning failure. Previous studies focused on the role of LV diastolic dysfunction in the occurrence of weaning failure, and there are no more studies yet interested in RV dysfunction.

Herein we evaluate cardiac changes using tissue Doppler echocardiography in critically ill patients during the weaning process and to compare between left and right ventricular functions as a predictor of weaning failure from mechanical ventilation.

Methods

We recruited 40 mechanically ventilated patients admitted to our ICU in this cross-sectional study. Echocardiography was performed during baseline ventilator settings and during spontaneous breathing trial (SBT) to assess changes in cardiac dimensions and functions. of left and right ventricular contractility and relaxation in this subset of patients.

Results

Among 40 patients included, there was a significant increase in cardiac dimensions during SBT. There was a statistically significant decrease in LV EF with (P=0.000) during SBT. Also, there was a statistically significant decrease in RV systolic function during SBT. There was a significant increase in the E/E′ ratio of lateral mitral annulus due to the evolution of impaired LV relaxation and diastolic dysfunction (P=0.008). Moreover, the development of right ventricular diastolic dysfunction presented by E/E′ ratio of tricuspid annulus, (P value=0.03).

Conclusions

RV dysfunction, as detected by systolic wave velocity of anterior tricuspid annulus (S′) by Doppler tissue imaging during SBT, also has good sensitivity and specificity in weaning failure prediction from mechanical ventilation.
Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios as noninvasive predictors for renal involvement in systemic lupus erythematosus in health clinics
Authors: Soliman Mona M. , Makarem Yasmine S. , El Wafaa Ahmed A. , Khairallah Marwa K. A.
Published: September 2023

Objective

Renal injury is a prevalent complication related to lupus erythematosus and its occurrence is linked with bad alarms. Yet, a noninvasive procedure to predict renal impairment in health clinics has not been settled. Consequently, the authors postulated that platelet-to-lymphocyte (PLR) ratio and neutrophil-to-lymphocyte ratio (NLR) might be used as valid noninvasive indicators for kidney impairment.

Participants and methods

In this cross-sectional research, 270 participants were enrolled into the research after exclusion of 70 patients; the included patients were classified into four groups: 80 patients with lupus nephritis (LN) diagnosed by renal biopsy, 12 active lupus patients without renal involvement, 28 lupus patients on remission, and 80 healthy participants as controls. The authors evaluated levels of PLR and NLR in addition to other renal and lupus markers.

Results

The results have shown that PLR and NLR had significantly higher levels in active lupus patients as in biopsy-proven LN in comparison to inactive systemic lupus erythematosus and control groups. NLR was positively correlated with serum creatinine in patients with LN; however, they did not show significant association with other predictors of renal diseases. The study demonstrated that PLR and NLR had significant association to advanced classes of LN. Furthermore, the receiver-operating characteristic curve showed a higher sensitivity of PLR in early detection of kidney function impairment in LN patients (88.9%) while NLR showed more specificity (87.5%).

Conclusion

PLR and NLR could act as noninvasive markers for detection of renal involvement in lupus patients in health clinics as for the prediction of renal pathological class.
Noninvasive prediction of hepatitis C-associated hepatocellular carcinoma using circulating apolipoproteins
Authors: El Garem Hasan , Esmat Gamal , Salama Rabab , Fouad Hanan , Sabry Dina , Mostafa Yomna , Omran Dalia , Omar Heba
Published: September 2023

Background and aims

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. We investigated the potential usefulness of circulating apolipoproteins (Apo-A1 and Apo-A4) in HCC screening and diagnosis.

Patients and methods

We included 60 adult patients with hepatitis C virus-related chronic liver disease including HCC, in addition to 20 healthy controls. Patients were stratified into three equal groups, with 20 patients each: chronic hepatitis C, posthepatitis C cirrhosis (liver cirrhosis), and HCC. All patients and controls underwent full clinical assessment, laboratory investigations, and evaluation of candidate apolipoproteins by enzyme-linked immunoassay.

Results

Significantly higher Apo-A1 and Apo-A4 levels were detected in patients with HCC than in those with liver cirrhosis (P<0.001). Receiver operator characteristic curve showed that for HCC diagnosis, a cutoff of 78.6 mg/dl for Apo-A1 yielded 90% sensitivity and 100% specificity and a cutoff of 16.5 mg/dl for Apo-A4 yielded 85% sensitivity and 80% specificity. Furthermore, within HCC group, Apo-A1 was significantly higher in patients with small HCC (>2 cm) than those with large tumors (P=0.01). Lower Apo-A1 level correlated significantly with pylethrombosis (P=0.007).

Conclusion

Apo-A1 and Apo-A4 are novel biomarkers for HCC screening and diagnosis, with a special discriminative ability for Apo-A1 for those with small tumors and those with pylethrombosis.
Study of serum sclerostin levels and its role in vascular calcification in patients with chronic kidney disease
Authors: Elarbagy Ahmed R. , Yassein Yassein S. , Emara Mahmoud M. , Sonbol Ahmed A. , Elzorkany Khaled M. A. , El Deen Amera A. Sharaf
Published: September 2023

Objective

The aim of this work was to study serum sclerostin levels in patients with chronic kidney disease (CKD) not on dialysis and those on regular hemodialysis and its role in vascular calcification.

Background

CKD, whether starting hemodialysis (HD) or not, is associated with an increase in the risk for vascular calcification, which can only be partially explained by known classical risk factors. Sclerostin is an osteocyte-derived inhibitor of the Wnt pathway and has been shown to play a key role in vascular calcification in patients with CKD.

Patients and methods

This cross-sectional study was carried out on 80 patients with CKD attending Menoufia University Hospital. Patients were classified into 40 patients with CKD who were not on HD (group I) and 40 patients with CKD on regular HD more than 6 months (group II), who were compared with 15 controls (group III). Abdominal aortic calcification (AAC) was assessed using lateral lumbar radiography. Echocardiography was used to assess aortic valve calcification (AVC) calcification. Patient’s basic clinical and biochemical data were recorded. Serum sclerostin level was measured using commercially available enzyme-linked immunosorbent assay kits.

Results

Sclerostin levels among the patients with CKD on HD (116.8±0.103.69 Pmol/l) was significantly higher than that of CKD predialysis group (28.63±0.36.26 Pmol/l), which in turn was statistically higher than control group (6.6±0.2.9 Pmol) (P=0.000). AAC was observed in 16 (40%) patients in CKD predialysis group, whereas in CKD on HD group, 26 (65%) patients had AAC. AVC was observed in 14 (35%) patients in CKD predialysis group, whereas in CKD on HD group, 21 (52.5%) patients had AVC. Using binary regression analysis, sclerostin was identified as an independent predictor for the presence of AAC (OR: 1.017;P=0.000) and AVC (OR: 1.013;P=0.001) in patients with CKD.

Conclusion

Patients with CKD (predialysis and on HD) exhibit an increase in sclerostin levels. Sclerostin expansion correlated positively with vascular and valvular calcification. Sclerostin is an independent risk factor for heart valve calcification and AAC in patients with CKD.