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   Table of Contents - Current issue
May-August 2017
Volume 23 | Issue 2
Page Nos. 67-123

Online since Wednesday, November 22, 2017

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Early diagnosis of infective endocarditis using a commercial multiplex PCR assay in Egypt Highly accessed article p. 67
Nevin G Al-Rachidi, Amany A El-Kholy, Mervat G Elanany, May S Soliman, Reem M Hassan, Dina M Bassiouny, Hussien H Rizk
Context Diagnosis of infective endocarditis (IE), particularly in blood culture-negative patients, has been a problem and requires further investigations. Aim This study was designed to evaluate the added value of a commercial multiplex PCR performed on blood in the early diagnosis of IE and compare its performance with conventional blood culture and serological testing, at a tertiary care center in Egypt. Settings and design Thirty-seven cases of diagnosed definite endocarditis were enrolled in the study. Patients and methods For each patient, blood culture was prepared and serum sample was obtained for serology testing for Brucella spp., Bartonella spp., Coxiella burnetii antibodies, and Aspergillus galactomannan antigen. Patients were selected for commercial Seegene multiplex PCR (sepsis screening) when their blood culture remained negative after 24 h incubation. Statistical analysis Sensitivity, specificity, positive predictive value, negative predictive value, and κ-test were used in statistical analysis for agreement. Results Thirty-seven cases were diagnosed as having definite IE. Causative organisms were detected using blood cultures in 18.9% (7/37) of cases after 24 h of incubation. Blood culture remained negative in 81% (30/37) of cases until the end of 21 days of incubation. One case showed positive result in serological testing for Aspergillus galactomannan Ag, whereas serological tests for Bartonella spp., C. burnetii, and Brucella spp. were negative in all cases. Multiplex PCR (sepsis screening) showed positive results in 51.3% (19/37) of definite IE cases. Conclusion The added value of multiplex PCR to conventional blood culture and the serological testing decreased the percentage of unidentified cases of IE from 81 to 48.7% in the selected study group.
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Value of H-TERT and CD10 in differentiating endometrial carcinoma from atypical endometrial hyperplasia: an immunohistochemical study p. 73
Maha E Salama, Ahmed N Eesa, Ahmed A Soliman
Context The histopathological differentiation between atypical endometrial hyperplasia and well-differentiated conventional endometrial carcinoma is sometimes tricky, particularly in endometrial dilatation and curettage specimens, to the extent that a differentiating marker is sought. Aim This study was devoted to evaluate the immunohistochemical expression of CD10 and human telomerase reverse transcriptase (H-TERT) in atypical endometrial hyperplasia and endometrial carcinoma to determine their role in differentiating both lesions. Patients and methods Thirty paraffin blocks of endometrial biopsy distributed as 15 cases of atypical endometrial hyperplasia and 15 cases of conventional endometrial carcinoma were studied immunohistochemically using antibodies against CD10 and H-TERT. Data were represented as mean, SD, and percentage. The Fisher exact test was used to compare immunoexpression between atypical endometrial hyperplasia and endometrial carcinoma. The Mann–Whitney U-test and the Kruskal–Wallis test were used to compare between the two marker expressions in both lesions. The one-way analysis of variance test was used to determine whether the difference was significant. A P-value of less than 0.05 was considered significant. Results A statistically significant difference was observed between CD10 and H-TERT expression in both lesions, but only H-TERT significantly correlated with international federation of gynecology and obstetrics (FIGO) tumor grades in endometrial carcinoma cases. Although H-TERT labeling index upregulates with CD10 weaker expression, the relation between the two markers was not significant. Conclusion Both CD10 and H-TERT may be involved in the progression from the atypical endometrial hyperplasia to endometrial carcinoma as well as to differentiate between the two lesions. However, only H-TERT may be associated with the prognosis of endometrial carcinoma.
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The value of urine neutrophil gelatinase-associated lipocalin in the prediction of septic acute kidney injury, dialysis need, and mortality in a cohort of Eegyptian sepsis patients p. 80
Mohamed Momtaz A Elaziz, Ahmed A Fahmy, Dina Hisham
Aim The aim of this study was to assess the role of urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL) in the early diagnosis of septic acute kidney injury (AKI) in critically ill Egyptian adults. Patients and Methods The studied patients were categorized into three groups: sepsis–non-AKI; sepsis–AKI; and nonsepsis–non-AKI. Urine samples were collected daily for 5 days from the sepsis patients. For the sepsis–non-AKI patients urine NGAL levels were measured from samples taken on the admission day and on day 5. In the sepsis–AKI patients, urine NGAL levels were measured from samples taken on the admission day, from samples collected 24 h before the onset of AKI, and from those taken on the day of AKI onset. For nonsepsis–non-AKI patients, urine NGAL levels were measured from samples taken on the admission day only. Results Totally, 172 patients were studied: 61 in the sepsis–non-AKI group; 82 in the sepsis–AKI group; and 29 in the nonsepsis–non-AKI group. Urine NGAL was significantly higher in sepsis patients than in nonsepsis patients (14.8±4.2 and 5.5±2.6 ng/ml, respectively; P<0.001). In sepsis patients who developed AKI, urine NGAL preceded the rise in serum creatinine, and at its cutoff level of 33.1 ng/ml it predicted AKI with an area under the curve of 0.96, sensitivity of 99%, and specificity of 85%; at its cutoff level of 48.7 ng/ml, it predicted the need for dialysis with an area under the curve of 0.81, sensitivity of 84%, and specificity of 73%. Urine NGAL could not predict mortality among sepsis patients. Conclusion Urine NGAL predicted AKI well in critically ill septic patients and predicted their need for dialysis.
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Can diffusion-weighted MRI predict the histological grade of urinary bladder carcinoma? p. 86
Nadine Barsoum, Mohamed Talaat, Samira Saraya
Aim The aim of this study was to prospectively evaluate the ability of diffusion-weighted (DW) MRI in determining the T-stage of bladder cancer and to measure the correlation between the apparent diffusion coefficient and the histologic grade. Patients and methods Totally, 50 patients with suspected bladder cancer underwent MRI. These patients presented with gross (macroscopic) hematuria or had urinary bladder mass detected on ultrasound and/or computed tomography examinations. Human ethics committee approval for this study was obtained from the institutional review board of the hospital where these cases were treated. Two of 50 patients were excluded from the study because of technical difficulties or failure of data acquisition. All 48 patients underwent transurethral cystoscopic biopsy after imaging. Their MRI were read by two different radiologists who were blinded to the results of each other to minimize the bias. Results As regards the detection of urinary bladder carcinoma, DW-MRI showed an overall sensitivity of 100%, specificity of 75%, positive predictive value of 98%, negative predictive value of 100%, and accuracy of 98%. The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using T2 images alone and combined use of T2 and diffusion-weighted images (DWIs) were 97, 64, and 88% and 100, 86, and 96%, respectively. The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using postcontrast MRI alone and combined use of postcontrast MRI and DW images were 96, 71, and 91% and 100, 100, and 100%, respectively. In addition, we concluded that there is an inverse relationship between the mean apparent diffusion coefficient values and the histological grade of the tumor. Conclusion DW-MRI is a safe and confident method in the detection and local staging of urinary bladder carcinoma. In addition, DWIs may predict the histological grade of the tumor. Hence, DWI may be added to routine imaging protocols of urinary bladder tumors.
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Assessment of synovitis in rheumatoid arthritis by enhanced magnetic resonance imaging (OMERACT RAMRIS score) and power Doppler ultrasound: a comparative study p. 96
Manar H Abdel Sattar, Hend H Alsherbini
Background and objectives Disease activity in rheumatoid arthritis (RA) joints is conventionally assessed clinically in combination with the measurement of levels of biochemical surrogate markers. Plain radiography shows only late signs of preceding disease activity. Newer imaging modalities such as contrast-enhanced MRI and power Doppler ultrasonography (PDUS) may offer improved monitoring. The aim of the study was to compare the role of PDUS with enhanced MRI in the assessment and scoring of synovitis of the wrist and hand joints in RA patients. Patients and methods Fifty patients (39 female patients and 11 male patients) with RA were subjected to a PDUS study and enhanced MRI examination of the clinically dominant wrist and hand joints. The mean age of the patients was 45.3 years and mean disease duration was 6.2 years. Power Doppler score of synovitis was correlated and compared with MRI OMERACT score. Results PDUS detected increased vascularity within 30 (60%) wrist joints denoting active synovitis and MRI detected synovial enhancement within 38 (76%) wrist joints denoting active synovitis; both scoring systems agreed in the assessment of synovitis degree in 20 wrist joints. PDUS missed detection of synovitis in nine joints detected by MRI, seven of them estimated by MRI to be of mild activity (grade 1). PDUS detected synovial activity (increased vascularity) in metacarpophalangeal (MCP) joints of 21 patients, whereas MRI detected synovial activity (synovial enhancement) in MCP joints of nine patients. Both modalities agreed in eight patients as regards the total synovial activity score. Statistical analysis of these results showed a statistically significant correlation (P<0.001) and good agreement between the two modalities in the assessment of synovial activity in the wrist and MCP joints. Comparison of ultrasonography and MRI yielded a κ value of 0.482 and 0.376, respectively. Conclusion Our results showed that both modalities are comparable and closely related in the assessment of synovial inflammatory process of the hand and wrist joints in RA patients.
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Seroprevalence of Toxoplasma gondii among pregnant Saudi woman in Arar, Northern Borders Province, Saudi Arabia p. 104
Fadi I.B. Alanazi, Taha M.M. Hassan, Wafa M.F. Alanazi
Background Toxoplasmosis, a worldwide disease, is considered one of the main problems challenging developed and developing countries. Congenital toxoplasmosis is caused by intrauterine infection with Toxoplasma gondii. Particularly, if the infection occurs in the first trimester of pregnancy it may cause serious complications, resulting from vertical transmission to an embryo, such as microcephaly, hydrocephalus, and blindness. This study aimed to investigate the seroprevalence of T. gondii among pregnant Saudi women in Arar, Northern Borders Province, Saudi Arabia. Patients and methods A total of 340 participants enrolled for prenatal care at the Arar Maternity and Pediatric Hospital in Arar over a 1-year period between January 2015 and January 2016 were included. Two techniques were used to detect the presence of T. gondii-specific antibodies in their sera: an indirect hemagglutination assay followed by a specific enzyme-linked immunosorbent assay. Results In general, the data showed that there was a positive correlation (P<0.05) between women aged between 20 and 30 years and toxoplasmosis infection. Of the 340 samples tested using an indirect hemagglutination assay, 285 samples were negative and 55 (6.2%) samples were positive at dilutions between 1 : 64 and 1 : 2048. For the specific enzyme-linked immunosorbent assay, from 340 tested samples, two were seropositive at 0.6% with T. gondii immunoglobulin M and 55 samples were seropositive at 13.5% with anti-T. gondii immunoglobulin G. Conclusion Screening measures can be taken to decrease the risk for infection during pregnancy and prevent severe illness in newborn infants. Therefore, many cases of congenital toxoplasmosis can be prevented.
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Role of thymic ultrasonography in the diagnostic workup of infants with protein–energy malnutrition p. 109
Mona El-Kalioubie, Wessam Abd El-Rahman El-Zayat, Mariam Raafat
Purpose The aim of this study was to report the significance of quantitative thymic gland analysis using ultrasonography (US) in the diagnostic workup of infants with protein–energy malnutrition (PEM) to assess thymic index and correlate it with anthropometric and peripheral blood lymphocyte subset measurements. Patients and methods US assessment of thymic size was carried out prospectively in 36 infants with PEM, compared with 16 control infants. Correlation with anthropometric measurements and peripheral total leukocytic count as well as peripheral CD4/CD8 T-lymphocytes ratio was made. Results Significant thymic atrophy and reduced anthropometric measurements were found in all patients. Leukopenia and significantly lower CD4/CD8 ratio were also found. A positive weak correlation was noted between the thymic index and the CD4/CD8 ratio in PEM infants (r=0.4695; P=0.004). A weak negative correlation was found between the thymic index and the CD4/CD8 ratio in controls (r=0.0813; P=0.76). Conclusion An easy, rapid, and especially noninvasive method such as US provides a suitable quantitative method to assess the thymus gland. In infants with PEM, thymic atrophy is associated with changes in the peripheral lymphocyte subsets with detrimental sequelae on the immune system, justifying the use of US for indirect evaluation of the immunocompetence level in malnourished children.
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Prognostic value of hepatocyte growth factor in dialysis patients with heart failure p. 115
Elham Sobhy, Mervat Gaber ElAnany, Magy Abadir, Ahmed Elebiary, Mervat M Naguib
Objective The aim of this study was to evaluate hepatocyte growth factor (HGF) as a predictor of short-term mortality in patients with chronic renal failure (CRF) and congestive heart failure (CHF) and study its relation to heart failure severity. Design The work was designed as a prospective case–control study. Patients and methods The study included 52 CRF patients with heart failure: 41 patients were on regular dialysis (group 1) and 11 patients were on conservative treatment (group 2). They were compared with 11 CHF patients with normal renal function (group 3), 10 CRF patients on regular dialysis and normal cardiac function (group 4), and 15 healthy controls (group 5). Initial baseline characteristics, New York Heart Association Classification of Heart Failure, serum HGF, and cardiac functions by echocardiography were determined. All groups were prospectively followed up for 6 months in order to determine mortality. Results The mean HGF level in group 1 (1.3±0.96 ng/ml), group 2 (0.65±0.25 ng/ml), group 3 (1.34±0.61 ng/ml), and group 4 (1.67±0.89 ng/ml) was significantly higher than the level in the control group (0.25±0.24 ng/ml) (P<0.0001). Post-hoc test showed a nonsignificant difference in HGF concentration between group 1 and other groups. Patients with a moderate degree of CHF in group 1 had significantly higher HGF than those with a mild degree (1.7±1 vs. 0.78±0.6 ng/ml) (P=0.002). In group 1, bivariate correlation analysis showed a positive correlation of HGF and left atrium diameter (r=0.34, P=0.03) and a negative correlation with ejection fraction (r=−0.45, P=0.0003). No statistically significant difference was found in HGF levels between patients who survived (1.27±0.94 ng/ml) and those who did not survive (1.26±0.75 ng/ml) in group 1 (P=0.9). Conclusion In this study, serum HGF was found to be a good marker of severity of heart failure in CRF patients undergoing dialysis. However, it was not associated with mortality.
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Uncommon pathology of thyroid, myeloid sarcoma: a case report p. 121
P Kumar Mandal, Anindya Adhikari, Kumar Praveen, Samrat Dutta
Myeloid sarcoma (MS) of the thyroid in a patient suffering from chronic myeloid leukemia (CML) is very rare. Herein, we report a case of MS of the thyroid in a 50-year-old woman who was a diagnosed as a case of CML but discontinued treatment for the last 1 year despite satisfactory initial response to chemotherapy. She came with weakness, fever, and painful swelling of the thyroid for the last 1 month. Present hematological examination diagnosed CML in blast crisis phase. Ultrasonography revealed multiple nodules along with calcification in the right lobe of the thyroid. Guided fine needle aspiration from thyroid nodule disclosed MS of the thyroid. Our report is not only rare but also stresses the need for regular chemotherapy, discontinuity or irregularity of which calls upon such complication.
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