bluuebunny/crossref_metadata_2025_split huggingface dataset:
25-Hydroxy-vitamin D3 level is a predictor to insulin resistance in patients with hepatitis C virus-induced liver cirrhosis
Authors: Zakaria Abir , Ramadan Nagwa , El-Sayed Naglaa , Zahra Amr 
Published: September 2023

Abstract
Background
There is an established relationship between liver disease and hepatogenous diabetes mellitus, and a growing evidence for the role of vitamin D deficiency in the pathogenesis of type 1 and type 2 diabetes mellitus. However, data on the impact of vitamin D serum level on insulin resistance among liver cirrhosis patients are lacking.

Objectives of the study
The primary objective of the current study was to investigate the relationship between vitamin D status and insulin resistance among hepatitis C virus (HCV)-induced liver cirrhosis patients using a homeostasis model for assessment of insulin resistance (HOMA-IR). The secondary objectives were to assess the association between deterioration of liver function on the one hand and insulin resistance and vitamin D deficiency on the other.

Participants and methods
Fifty patients with biopsy-proved HCV-induced liver cirrhosis were enrolled in this cross-sectional study. Routine clinical, laboratory, and imaging workout was performed to assess the degree of liver decompensation using the model of end-stage liver disease (MELD) score and the Child–Turcotte–Pugh Score (CTPS). Serum level of 25-hydroxy-vitamin D3 [25(OH)D3] was estimated. Fasting plasma glucose and fasting insulin were also measured to calculate HOMA-IR as an indicator of insulin resistance. Patients were subclassified according to serum 25(OH)D3 levels into tertiles, according to the MELD score into three groups, and according to CTPS into Child A, B, and C.

Results
A significant inverse correlation was found between serum 25(OH)D3 level and insulin resistance as assessed by HOMA-IR, whether using one-by-one correlation (r = −0.976, P =0.000) or using 25(OH)D3 tertiles’ correlation (r = −0.830, P =0.000). Linear multiple regression analysis determined low serum 25(OH)D3 level as an independent predictor for increase in HOMA-IR among HCV-induced liver cirrhosis patients. No significant association was identified between low serum 25(OH)D3 level and the severity of liver dysfunction as assessed by the MELD score or CTPS.

Conclusion
The present study showed that low serum 25(OH)D3 level was an independent predictor for insulin resistance among patients with HCV-induced liver cirrhosis.
The link between the fibroblast growth factor-23—klotho—vitamin D3 axis and the renin—angiotensin—aldosterone axis in the development and progression of obesity-related kidney disease
Authors: Nassar Wael F. , Mustafa Mustafa A. , Kamel Uomna , Hafez Mohammad H. , Saad Abdekbaser , Anan Mohammad , Temraz Mahmud , Hendi Yaser , Elokely Amir , Fouad Malaka 
Published: September 2023

Abstract
Introduction and aim of the work
Obesity is established as an important contributor of increased diabetes mellitus, hypertension and cardiovascular disease, all of which can promote chronic kidney disease (CKD). Recently, there is a growing appreciation that even in the absence of these risks, obesity itself significantly increases CKD and accelerates its progression. The aim of this work is to evaluate the link between Renin-Angiotensin-Aldosterone System (RAAS) and FGF23-Klotho-1,25D3 axis and their impact in obese and non-obese CKD patients.

Patients and methods
In a cross sectional randomized multi centers study, two hundred twenty six CKD patients stage III and IV (eGFR20–60 ml/min/m2) have enrolled in this study as follows: group I; 87 non diabetic CKD patients aged 20–40 years with body mass index (BMI) between 20–25 kgm/m2; group II; 130 non diabetic CKD patients aged 20–40 years with (BMI) >30 kgm/m2 and group III; 89 CKD patients aged >60 years. All patient have been tested for plasma leptinlevels, 1,25-dihydrocholicalciferole (1,25D3), plasmaparathormone (PTH) Serum calcium (Ca), serum phosphorus (PO4), and plasma FGF-23 , plasma renin activity (PRA), plasma angiotensinogen receptor 1 & 2 (AT1 & AT2) and plasma aldosterone (ALD) and pulse wave velocity (PWV).

Results
The eGFR was significantly reduced in the obese group II (eGFR = 37.7 ± 13.6) when compared with eGFR of the lean group I (eGFR = 49.3 ± 7.51) were P < 0.001, but not significant when compared with the old age group III (eGFR = 41.0 ± 13.47). The obese group II shows significant increase in the ALD/PRA ratio when compared with the lean group I and old age group III (43.23 ± 14.9) for group II vs 11.29 ± 4.1 for group I, P < 0.001 and 24.91 ± 12.1 for group III, P < 0.05 ). Regarding the FGF23-Klotho-vitD3 axis, its components of the obese group II (FGF23 259.55 ± 138.6 Ru/ml; PTH 77.63 ± X32.4 pg/ml; S.PO 4.74 ± 1.61 mg/dl) were significantly elevated when compared to the lean group I (FGF23 132.81 ± 126.1 Ru/ ml; PTH 59.18 ± 24.7 pg/ml; S.PO4 3.85 ± 0.92 mg/dl); the P values were <0.001, <0.01 and <0.05 respectively , while when compared with the old age group III (FGF23 179.33 ± 237.4 Ru/ml; PTH 70.94 ± 15.26 pg/ml; S.PO4 4.09 ± 0.42 mg/dl), values were of less significance. Plasma insulin levels were significantly high in the obese group II (insulin = 13.73 ± 2.38fg/l) than the lean group I (insulin = 5.59 ± 2.31 fg/l) and P < 0.001 and in group III p. insulin level was 10.7 ± 1.68 (P < 0.05).

Conclusion
Obesity per se is an independent risk factor in the development and progression of chronic kidney disease specially in young age patients.
Right ventricular dysfunction in patients with end-stage renal disease on regular hemodialysis
Authors: Momtaz Mohamed , Fishawy Hussein Al , Aljarhi Ula Mabid , Al-Ansi Rabei Z. , Megid Mohamed A. , Khaled Mahmoud 
Published: September 2023

Abstract
Background
Although there are considerable data on the changes in left ventricular function in hemodialysis (HD) patients, only a few studies on right ventricular (RV) function can be found in the literature. We investigated the changes in RV function in HD patients.

Methods
We examined 74 individuals grouped as follows: healthy controls (n = 24) and HD patients (n = 50). Echocardiography including tissue Doppler imaging (TDI) of the RV was performed in all patients.

Results
HD patients had significantly lower RV systolic indices than control participants in right ventricle fractional area change (normal 35–63%) (37.54 ± 9.86 vs. 43.5± 4.8%, P<0.001), tricuspid plane systolic excursion (normal 1.6–3 cm) (2.09 ± 0.49 vs. 2.61± 0.36 cm, P<0.001), STDIS′ wave (7.99± 1.37 vs. 9.66± 1.86 cm/s, P<0.001), and LTDIS′ wave (peak systolic velocity at lateral tricuspid annulus; normal: 10–19 cm/s) (11.86 ± 2.86 vs.16.04 ±3.60, P<0.001). HD patients had statistically significantly higher systolic pulmonary pressure (normal<35mmHg at rest) compared with those in the control group (32.75 ± 10.11 vs. 25.23± 3.99, P<0.001). There were no statistically significant correlations between systolic pulmonary pressure and RV dimensions or RV function indices.

Conclusion
Subclinical RV dysfunction – as estimated by RV function indices; tricuspid plane systolic excursion, right ventricle fractional area change, and LTDIS′ – is increased among HD patients. A high prevalence of pulmonary hypertension was found among HD patients and this was not associated significantly with RV or left ventricular dysfunction in these patients.
Visfatin and adiponectin as early markers of atherosclerosis in type 2 diabetes mellitus
Authors: Zakaria Ibtissam , Rizk Mary N. , Rakha Maha , Shehaby Amal 
Published: September 2023

Abstract
Introduction
As cardiovascular disease is the leading cause of mortality in type 2 diabetes mellitus, new markers for early detection and risk stratification of diabetic macroangiopathy and microangiopathy are highly desired. Adipocytokines were considered to lead to an increased risk of vascular complications in patients with type 2 diabetes by modulating vascular function and affecting the inflammatory process, thus enhancing atherosclerosis. Two of these were of particular interest, namely, visfatin and adiponectin.

Aim
The aim of this study was to evaluate serum visfatin, serum, and urinary adiponectin as early, sensitive surrogate markers of vascular atherosclerosis. We also correlated the levels of these markers to the degree of carotid intimal medial thickness (reflecting the atherosclerotic burden) in type 2 diabetic patients.

Results
Sixty diabetic patients were subdivided into two groups: group I (30 patients with carotid atherosclerosis as assessed by carotid Doppler) and group II (30 patients without carotid atherosclerosis). Twenty healthy volunteers participated as controls. Serum visfatin as well as serum and urinary adiponectin were assessed in all the study groups. We found significantly higher levels of serum visfatin among diabetics compared with the control group. Visfatin was also significantly higher in group I diabetics with atherosclerosis than those without (P<0.05). Similarly, urinary adiponectin was significantly higher in group I than in group II and in diabetics than in the control group. Serum adiponectin was higher in the control group than both the study groups. Using a regression model, visfatin proved to be the only significant predictor in the model (ß = 0.03, P<0.001). In fact, visfatin alone proved significant, explaining 63% of the variability in carotid intima-media thickness (P<0.001).

Conclusion
Serum visfatin is highly correlated with macrovascular complications in diabetic patients. Serum visfatin may emerge as a valuable and cheaper surrogate marker for the prediction of prevalent macrovascular complications in a type 2 diabetic population. It is a novel and easy-to-obtain method for the clinical assessment of vascular stress and cardiovascular disease risk in type 2 diabetes. Future prospective studies are needed to confirm our results.
Plasma long pentraxin 3 as a marker of endothelial dysfunction in early diabetic nephropathy
Authors: El Meligi Amr A. , Hamid Alaa M. Abdel , Aziz Manal A. , El Haddadd Hemmat E. , Ishak Marian F. , Yousief Elham M. 
Published: September 2023

Abstract
Objective
This study investigated the utility of measuring plasma long pentraxin 3 (PTX3) levels in the early detection of endothelial dysfunction compared with Von Willebrand factor (vWF) activity and flow-dependent arterial dilatation (well-known markers of endothelial dysfunction) in early diabetic nephropathy.

Materials and methods
A total of 50 Egyptian patients with type 2 diabetes and 20 healthy controls were recruited from the Diabetes, Endocrinology and Metabolism center, Faculty of Medicine, Cairo University. The diabetic patients were divided into two equal groups of comparable age and sex: group I consisted of patients with normal urinary albumin excretion and group II consisted of patients with microalbuminuria.

Results
In group II, the plasma PTX3 level was significantly higher (median value 2.3 ng/ml) and the mean flow-mediated dilatation (FMD; 0.433 ±0.059) was significantly lower when compared with the control group (PTX3 1.15 ng/ml, FMD 0.901 ± 0.04; P<00001) and with group I (PTX3 1.2 ng/ml, FMD 0.627± 0.05; P<0.0001). The vWF activity (median value) was significantly higher in the two diabetic groups compared with controls (20.2, 16.3 and 4% in group I, group II, and controls, respectively; P<0.0001), with no significant difference between the two diabetic groups. There was a significant positive correlation between PTX3 levels and vWF activity (P<0.001), diabetes duration, and concentration of fasting blood sugar, HbA1c, cholesterol, and triglyceride and a significant negative correlation between PTX3 levels and FMD (P<0.001) in all diabetic patients. In group II, there was a significant positive correlation between PTX3 levels and vWF activity (r= 0.603, P= 0.001).

Conclusion
PTX3 may represent a useful endothelial dysfunction marker in early diabetes nephropathy.
Electrophysiological differences in sensorineural hearing loss patients with and without problem-tinnitus
Authors: Said Eman A. 
Published: September 2023

EnAbstract
Objects
Problem-tinnitus refers to tinnitus that is sufficiently severe to produce a major disruption in the patient’s life; tinnitus of such severity involves a number of regions of the auditory system and other brain systems may also play an essential role. Auditory brainstem responses (ABR) and event-related potentials (ERP) were recorded from sensorineural hearing loss (SNHL) patients with problem-tinnitus and were then compared with responses from normal hearing and hearing loss tinnitus-free patients.

Aim
To study whether differences exist in ABR and/or ERP parameters in SNHL patients with and without problem-tinnitus when matched as closely as possible for hearing loss, age, and sex to investigate the mechanism responsible for tinnitus.

Materials and Methods
Ninety participants were included in this study. They were divided into two groups: the study group included 66 participants with bilateral symmetrical SNHL that did not exceed a moderate degree. The study group was divided into two subgroups: 36 patients had problem-tinnitus and 30 patients were tinnitus-free (SNHL, age, and sex matched). Participants in each of these subgroups were compared with each other and were also compared with 24 healthy individuals in the control group (age and sex matched with the study group). All participants were subjected to a basic audiological evaluation and electrophysiological tests (ABR and ERP).

Results
This work had shown a higher prevalence of ABR abnormalities in tinnitus patients in comparison with either the control group or the SNHL tinnitus-free group. Statistically significant differences were found in III–V and I–V interpeak latencies and in the VI amplitude ratio in problem-tinnitus female patients compared with tinnitus-free female patients. Meanwhile, in problem tinnitus male patients when compared with tinnitus-free male patients at III–V interpeak latencies and at VI amplitude ratio.
As regards the results of ERP in this work, an increase in latency and amplitude reduction were found. Statistically significant differences were observed regarding both the mean latency values of waves N1, P2, and P300 and the amplitude mean values of P2 and P300 when we compared the problem-tinnitus subgroup with either the tinnitus-free subgroup or the control group (both female and male patients.

Conclusion
A variety of ABR and ERP components are altered in tinnitus patients; this would indicate impairment in both the central auditory pathway and central auditory processing. Thus, it is suggested that this form of ABR, ERP testing could be considered as an objective measure to complement behavioral, audiologic, and other physiologic methods of assessing tinnitus, rather than a single definitive tinnitus measure in an attempt to supplement and thereby extend knowledge of the nature and origins of tinnitus. Furthermore, these results provide the basis for future neurofeedback-based tinnitus therapies aiming at maximizing the ability to shift attention away from the tinnitus.
Endoscopic-assisted laser therapy for extensive rhinoscleroma
Authors: Nassim Nassim Talaat 
Published: September 2023

EnAbstract
Background
Scleroma is a granuloma affecting mainly the nose, and may extend to affect the pharynx, the larynx, the lacrimal apparatus, and many soft tissue structures surrounding the nose. In Egypt, as in many other Eastern countries, scleroma is the most common nasal granuloma diagnosed clinically and pathologically. Although it mainly affects the anterior part of the nose, it is not uncommon to find cases with extensive lesions that extend to occupy the entire nasal cavity, and also to the sinuses and the orbit. Active rhinoscleroma is usually treated medically, and surgical intervention is carried out in the fibrotic stage.

Theory
The aim of this study was to determine the role of CO2 laser in the management of extensive active rhinoscleroma.

Materials and methods
This is a prospective study that included 24 patients with extensive rhinoscleroma in the active phase, that is, patients had almost complete nasal obstruction with mouth breathing. Patients were divided into two groups: group A (12 cases), who were managed only with medical treatment, and group B (12 cases), who were managed with CO2 laser debulking, concurrently with medical treatment.

Results
Patients were followed up clinically for nasal blockage and histologically to assess the activity of the disease; group B showed earlier relief of nasal obstruction and needed less medical treatment to reach the inactive stage.

Conclusion
CO2 laser debulking is a good option in treating extensive rhinoscleroma, even in the active stage, as it provides rapid relief of nasal blockage and decreases the time needed for medical treatment, reducing the possible side effects of antibiotics.
Comparing sound field audiometry and free field auditory steady state response in the verification of hearing aid fitting in adults
Authors: Selim Mona H. , Mourad Mostafa E. , El-Shennawy Amira M. , Elfouly Hedayet S. 
Published: September 2023

EnAbstractObjectivesThe aim of this work was to establish hearing aid (HA) functional gain measurements using free field (FF) auditory steady-state response (ASSR) and to compare and correlate sound field (SF) versus ASSR functional gain and unaided and aided hearing thresholds in order to assess the reliability of FF ASSR as an objective tool for the verification of HA fitting.Participants and methodsThis study was conducted on 20 HA user adults with a mean age of 57.09±14.79 years. For each patient, the following were administered: history taking, basic audiological evaluation including pure tone audiometry and immittancemetry, unaided and aided SF audiometry thresholds, and unaided and aided FF ASSR thresholds. The results obtained were then compared. In addition, correlation studies between all the obtained results were carried out.ResultsA highly significant difference was found at 500 Hz only between the SF hearing thresholds and the FF ASSR thresholds among the unaided patients at the four test frequencies (500–4000 Hz). Similarly, aided SF and FF ASSR hearing thresholds showed a statistically significant difference only at 500 Hz. The results of correlation coefficient showed that unaided SF and FF ASSR thresholds were positively significantly correlated at 2 and 4 kHz. In addition, aided SF and FF ASSR thresholds were positively significantly correlated at 1 and 2 kHz. Comparison between the functional gain obtained using both SF and FF ASSR tests showed that there was a highly significant difference only at 4000 Hz.ConclusionSF audiometry and FF ASSR unaided and aided thresholds showed very similar results and this indicates that ASSR may be a good alternative method for the measurement of hearing level in infants and children, for whom pure tone audiometry is not possible. FF ASSR appears to be a reliable procedure for the verification of HA fitting and can be used to assess functional gain in difficult-to-test populations and children. Future research on the effect of the electroacoustic characteristics of HAs on aided FF ASSR thresholds is recommended.
Tongue base suspension using a repose bone screw system in the treatment of obstructive sleep apnea
Authors: Sabry Ramez , Reda Ramez , Abdelmonem Mohamed Sherif A. 
Published: September 2023

EnAbstract
Objectives
The aim of this study was to evaluate the tongue base suspension suture technique using a repose bone screw system with respect to efficiency in relieving obstructive sleep apnea, safety, and postoperative morbidity.

Study design
This was a prospective study carried out on 10 patients with a complaint of moderate or severe obstructive sleep apnea because of retrolingual hypopharyngeal obstruction.

Methods
Demographic data were determined and preoperative investigations (flexible nasopharyngoscopy, polysomnography, and lateral cephalometry) were carried out; in addition, operative technique and postoperative assessment of patients’ complaints and postoperative data of polysomnography and lateral cephalometry were carried out.

Results
Improvement in the main complaints of patients, a significant reduction in the mean apnea hypopnea index in postoperative polysomnography, and an increase in the mean posterior airway space at the level of the tongue base in postoperative lateral cephalometry were recorded.

Conclusion
The tongue base suspension technique using a repose bone screw system is an easy and efficient procedure for the treatment of retrolingual obstruction, with minimal postoperative morbidity.
Audiovestibular manifestations in a radiologically confirmed enlarged vestibular aqueduct in congenital nonsyndromic sensorineural hearing loss in Egypt
Authors: Ghannoum Tarek , El-Minawi Sherif , Hosni Noha , Aly Aml , Nassef Amr 
Published: September 2023

EnAbstract
Background
Enlarged vestibular aqueduct (EVA), the most common radiological finding in children with sensorineural hearing loss, is associated with variable auditory and vestibular symptoms.

Aim of the work
The aim of this study was to determine vestibular findings in patients with EVA.

Patients and methods
Twenty patients diagnosed with sensorineural hearing loss and EVA were included in the study group and 20 healthy individuals matched for age and sex were included in the control group. Both groups were subjected to the following: complete history taking, general and neurological examination, full ENT examination, pure tone audiometry, tymanometry, high-resolution computed tomography, vestibular evoked myogenic potentials (VEMP), caloric test, and computerized dynamic posturography.

Results
EVA was bilateral in 14 patients and unilateral in six patients. The VEMP amplitude of wave p13–n23 was higher in ears with EVA and it correlated positively with its size. p13–n23 latencies did not differ significantly from the control group. The caloric test showed an absent response in four patients, unilateral weakness in six patients, and normal results in 10 patients. There was no statistically significant difference in the results of computerized dynamic posturography.

Conclusion
The results showed a larger VEMP amplitude, which is indicative of a third window lesion. Some patients showed abnormalities in the caloric test, which indicates a peripheral vestibular lesion. VEMP, caloric test, and computerized dynamic posturography testing were effective in the evaluation of patients with EVA.
Simultaneous bilateral myringoplasty as a single-stage operation
Authors: El-Ahl Magdy A. S. , Amer Hazem S. , El-Anwar Mohammad W. 
Published: September 2023

EnAbstract
Background
Myringoplasty is a common otologic procedure that results in successful closure of the perforation in most cases; however, the theoretical risk of iatrogenic sensorineural hearing loss during surgery has induced a reluctance among otosurgeons to perform bilateral myringoplasty.

Objectives
The aim of this study was to evaluate simultaneous bilateral myringoplasty as a single-stage operation.

Patients and methods
A prospective study was carried out between December 2009 and March 2012 on 30 patients (60 ears) with bilateral tympanic membrane perforations. Bilateral myringoplasty was performed in the same sitting using an underlay technique.

Results
Of the 60 ears operated upon, perforation closure was achieved in 56 (93.3%) ears and 51 (80%) ears gained hearing. No worsening of hearing was observed in any ear.

Conclusion
Simultaneous bilateral myringoplasty is safe and effective as a single-stage operation, with a high success rate.