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   Table of Contents - Current issue
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January-April 2017
Volume 23 | Issue 1
Page Nos. 1-65

Online since Monday, May 29, 2017

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ORIGINAL ARTICLES  

Relation between resistivity and pulsatility indices of renal and intrarenal arteries and degree of albuminuria in type 2 diabetic patients Highly accessed article p. 1
Yasser M Abdelhamid, Marie W Fawzy, Randa F Abd Al-Salam, Yousra M Gouda, Mona M Salem
DOI:10.4103/1687-4625.207195  
Introduction Macrovascular complications are well known in diabetes mellitus and diabetic nephropathy. This work aimed to study the relation between resistivity index (RI) and pulsatility index (PI) of the main renal and intrarenal arteries and the degree of albuminuria in diabetic patients. Patients and methods The study included 60 type 2 diabetic patients with more than 5-year duration of diabetes. There were 14 male and 46 female patients. They were divided into three groups: group I included patients with no albuminuria [albumin/creatinine ratio (ACR) in first voiding morning urine sample <30 mg/g creatinine]; group II included patients with microalbuminuria (ACR: 30–300 mg/g creatinine), and group III included patients with macroalbuminuria (ACR: ≥300 mg/g creatinine). Patients with fever, urinary tract infection, uncontrolled blood pressure, congestive heart failure, critically ill patients, or patients having other renal disease were excluded. All patients were subjected to measurement of ACR in the first voiding morning urine sample, serum creatinine, estimated glomerular filtration rate using Cockroft–Gault formula, and HbA1C. RI and PI of main renal and intrarenal arteries were measured on both sides using duplex Doppler ultrasonography Results RI and PI of renal and intrarenal arteries were found to be significantly higher in group III than in group II and group I, with group II patients having higher values compared with group I (P < 0.001 for all). ACR was found to be positively correlated with RI and PI of all studied renal and intrarenal arteries (P < 0.001 for all). Conclusion In type 2 diabetes mellitus, RI and PI of renal arteries on duplex Doppler ultrasonography examination are related directly to the degree of albuminuria, which could serve as an indicator to the degree of resistance in renal arteries.
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Vitamin D deficiency in critically ill children p. 6
Nora El Said Badawi, Hebat Allah Fadel Algebaly, Riham El Sayed, Eman Sayed Abu Zeid
DOI:10.4103/1687-4625.207191  
Context Vitamin D is needed for the proper function of different organs of the body. A few studies have assessed vitamin D status in critically ill children and reported the prevalence of vitamin D deficiency (VDD) in the range of 30–71%. Aim The objectives of this study were to assess the prevalence of VDD in a pediatric ICU (PICU) patients and to determine whether there is any relationship between VDD and illness severity, mortality, or length of PICU stay. Design and settings We carried out a cross-sectional study of serum 25(OH)-vitamin D levels, measured during the first day of admission to a 10-bedded medical PICU at the Children’s Cairo University. Materials and methods We analyzed demographic data, pediatric risk of mortality III, and pediatric logistic organ dysfunction between normal and VDD groups in the PICU. Results The prevalence of VDD was 44% and that of severe VDD was 34% in critically ill Egyptian children at the onset of critical illness. The median level of vitamin D in the whole group was 59 nmol/l and in deficient group it was 17 nmol/l. Infants had higher median vitamin D levels than those above 1 year of age, but with no statistical difference. VDD patients had higher pediatric logistic organ dysfunction (12 vs. 10; P=0.001) and lower platelet counts (240 vs. 331; P=0.021). Pediatric risk of mortality III, inotropes, sepsis, ventilation, duration of PICU stay, and mortality were not related to VDD. Conclusion VDD is highly prevalent in critically ill children and is observed to be associated with organ dysfunction on admission.
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Observational study of metabolic syndrome among renal transplant recipients in Kasr Al-Aini School of Medicine: a single-center study p. 12
Osama Mohammady Mohammed, Ahmed Abdalla Aly, Dawlat Abdel-Hamid Belal, Karim Magdy Soliman
DOI:10.4103/1687-4625.207189  
Introduction The metabolic syndrome (MS) is a constellation of clinical abnormalities related to insulin resistance and inflammation. The syndrome is now recognized as a risk factor for diabetes and cardiovascular disease in the general population. Recent studies suggest that MS is common after kidney transplantation, also possibly being predictive of allograft loss and poor allograft function. Objectives We studied the prevalence of MS in Egyptian kidney transplant recipients (from Kasr Al-Aini School of Medicine) and its correlation with C-reactive protein (CRP), serum uric acid (UA), alkaline phosphatase (ALP), different immunosuppressive intakes, and hepatitis C virus (HCV) in these patients. Patients and methods The present cross-sectional study was conducted in 2012 on 100 renal transplant recipients, 68 male (68%) and 32 female (32%), with stable kidney function (serum creatinine=1.5±1 mg/dl) in King Fahd Unit, Cairo University. All clinical and laboratory data were recorded, including serum creatinine, UA, cholesterol, triglyceride (TGL), low-density lipoprotein, high-density lipoprotein (HDL), ALP, CRP, and HCV Abs. The presence of MS was determined using NCEP-ATP III criteria, with BMI used in place of waist circumference. Results Patients were divided into two groups – MS (group 1): 26 patients, 12 female (46.2%) and 14 male (53.8%), with a mean age of 34.46±9.69 years; and non-MS (group 2): 74 patients, 20 female (27%) and 54 male (73%), with a mean age of 27±8.33 years. There was a highly significant correlation (P≤0.001) between CRP and MS, BMI and diabetes mellitus, whereas the correlation between CRP and hypertension, ALP, HCV Abs, alanine aminotransferase (ALT), TGLs level, and HDL was insignificant. Conclusion Metabolic syndrome is prevalent in post-renal transplant patients. Serum CRP concentration correlates positively with metabolic syndrome in kidney transplantation patients. The age, weight, BMI, systolic and diastolic BP, serum triglycerides, ALT of MS group were significantly higher than in non-MS group. The duration of hypertension in the MS cases was significantly longer than in non-MS cases.
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Lung ultrasound and bioimpedance in assessment of volume status of hemodialysis patients p. 18
Ghada Youssef, Bahaa Zayed, Mohammed Momtaz, Amin Roshdy, Mohamed Shaaban
DOI:10.4103/1687-4625.207188  
Background Assessment of volume status is crucial in patients with chronic renal failure who are maintained on regular hemodialysis. Aim of the work The aim of the study was to evaluate the effectiveness of lung ultrasound in detecting changes in volume status in chronic hemodialysis patients and compare it with the gold standard bioimpedance technique. Patients and methods Forty chronic renal failure patients on regular hemodialysis (three times per week) since at least 6 months were subjected to full history taking and physical examination, full anthropometric measurements, routine laboratory studies, and conventional transthoracic echocardiography. Lung comet score was assessed in both lungs using lung ultrasound, and total body water (TBW) and TBW% were assessed using bioelectrical impedance. The last two investigations were carried out both before and after a midweek dialysis session. Results Most of the patients were male (57.5%) and hypertensive (75%). The mean age was 49.40±16.06 years. The mean lung comet score before and after dialysis was 20.1±15.8 and 14.6±11.8, respectively (P<0.001) and the mean TBW was 37.2±9.1 and 35.8±8.5 l, respectively (P=0.002). Before dialysis, the lung comet score showed significant correlation with TBW% (P=0.01), left ventricular end-diastolic (P=0.02) and end-systolic (P<0.001) dimensions and significant negative correlation with left ventricular ejection fraction (P=0.003). After dialysis, the lung comet score showed only significant negative correlation with left ventricular ejection fraction (P<0.001). There was no significant correlation between change in lung comet score (before and after dialysis) and change in TBW% (P=0.93). Conclusion Bioimpedance and ultrasound lung comet score may provide different but complementary information. Whereas bioimpedance may be more specific to hydration state, lung ultrasound may indicate cardiac condition coexisting with overhydration. It also gives an idea about the hydration state and the effect of dialysis.
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Simvastatin ameliorates vascular endothelial growth factor overexpression in a rat model of diabetic retinopathy: a histological and immunohistochemical study p. 24
Eman M Sadek, Lamiaa I Abd-El Fattah, Zeinab M El Maadawi, Manal A Abd-El Mohsen
DOI:10.4103/1687-4625.207186  
Background and objectives Diabetic retinopathy (DR) is one of the main causes of vision loss. Treatment options during its early stages are not available. This study was designed to evaluate the potential protective effects of simvastatin on experimentally induced DR, with special emphasis on its possible modulatory effect on vascular endothelial growth factor (VEGF). Materials and methods Thirty adult male albino rats were divided equally into three groups: group І (the control group), group II (the diabetic group), and group III (diabetic/simvastatin-treated group). Diabetes was induced by intraperitoneal injection of streptozotocin at a dose of 50 mg/kg/rat in 20 adult male albino rats. Simvastatin was administered orally as 20 mg/kg/rat 48 h after streptozotocin injection. Blood glucose levels and body weight were measured. Retinal specimens were processed for hematoxylin and eosin staining and VEGF immunohistochemistry. Morphometric analysis included measurement of retinal thickness and area percentage of VEGF. All results were statistically analyzed using the Student t-test and analysis of variance test. Results The untreated group showed histological features of DR and increased VEGF immunoreactivity compared with controls. The simvastatin-treated group showed improved features of DR and decreased VEGF immunoreactivity. Conclusion These results suggest that simvastatin has protective effects against DR by eliminating VEGF overexpression and might be considered a promising therapeutic agent for it.
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Anti-Cryptosporidium efficacy of Olea europaea and Actinidia deliciosa in a neonatal mouse model p. 32
Mona M Khater, Shaimaa H El-Sayed, Hebat-Allah S Yousof, Soheir S Mahmoud, Nadia El-Dib, Ayman A El-Badry
DOI:10.4103/1687-4625.207190  
Background Cryptosporidiosis is caused by an opportunistic protozoan parasite Cryptosporidium. It may be life-threatening in immunocompromised individuals, children and the elderly. To date, no specific therapy has been proven to be effective against Cryptosporidium, which necessitates exploring for new therapeutics. This study evaluated the anti-Cryptosporidium therapeutic potential of two natural medicinal plants − Olea europaea (olive leaf extract) and Actinidia deliciosa (kiwi fruit pulp extract) − in four different groups of experimentally infected neonatal mice. Materials and methods Anti-Cryptosporidium efficacies of tested extracts were evaluated in four groups of age-matched neonatal Swiss albino mice parasitologically by detection of Cryptosporidium parvum oocysts and copro-DNA, using microscopy and nested PCR assay, as well as histopathological examination of their small intestines. Results and conclusion There was a 100% reduction in Cryptosporidium oocyst excretion in stool and copro-DNA of O. europaea-treated infected mice after 2 weeks of drug administration, whereas there was persistence of oocysts in the stool of A. deliciosa-treated mice until scarification. Obtained results make O. europaea a promising natural therapeutic for cryptosporidiosis, a scientific case that calls for further clinical trials to replicate this model in human individuals.
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Corneal hysteresis values in normal Egyptian population p. 38
Alaa A Ali
DOI:10.4103/1687-4625.207196  
Introduction Knowledge of the cornea's biomechanical properties is important for a wide variety of applications within ophthalmology. Corneal biomechanical variations are known to affect the accuracy of intraocular pressure measurements and may be used to identify early corneal disease and may assist in predicting refractive outcomes following corneal refractive surgery. It has also been suggested that corneal biomechanical properties may reflect globe biomechanics, and thus give an indication of the susceptibility of developing glaucomatous damage. Aim of the work The purpose of this study was to explore the relationships between Ocular Response Analyzer-generated corneal biomechanical characteristics and age in a sample of Egyptian population. Materials and methods Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured in 195 Egyptians of different age groups. Results The mean CH value was 10.25 ± 0.12 mmHg (range, 6.5–14.4), and the mean CRF was 10.25 ± 0.15 mmHg (range, 4.9–14.2). The CH value was lower in older eyes, and the difference between the youngest age group (19–40 years) and the oldest age group (40–71 years) was statistically significant (t-test = 0.01). The mean CH in the youngest age group was 11.1 ± 0.14, and that in the oldest age group was 9.8 ± 0.21. The mean CRF in the youngest age group was 10.9 ± 0.18, and that in the oldest age group was 10.1 ± 0.19. Conclusion This study of corneal biomechanics in normal Egyptian eyes describes the interactions between age and Ocular Response Analyzer metrics. The study reveals that age is significantly associated with CH and CRF. This may help in diagnosis and treatment.
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Can vitamin E protect the pancreas against ethanol-induced alterations in adult male albino rats? A histomorphometric and immunohistochemical study p. 43
Ayman A El-Enein Rizk, Shereen Abdel Fattah, Mohamed El Sebaie
DOI:10.4103/kamj.kamj_6_17  
Background Ethanol has a destructive effect on the pancreas by inducing oxidative damage on pancreatic cells. This injurious effect could be ameliorated by the administration of vitamin E. Aim The aim of the study was to investigate the possible protective role of vitamin E on ethanol-induced alterations in the pancreas in adult male albino rats and also the effect of ethanol withdrawal. Materials and methods Forty adult male albino rats were divided into four equal groups (10 rats each): group I (control group), group II (ethanol-treated group), group III (ethanol and vitamin E-treated group), and group IV (recovery group). At the end of the experiment, the rats were sacrificed by cervical dislocation and their pancreas were excised and prepared for light microscopic and histochemical study. Detection of interleukin (IL)-1B and IL-6 by real-time PCR and proliferating cell nuclear antigen immunoexpression in the pancreatic tissue was carried out. Results Group II showed loss of acinar tissue, distorted degenerated pancreatic acini, dilated distorted interlobular ducts, distorted islets of Langerhans, and dilatation and congestion of the blood vessels. Interlobular inflammatory cellular infiltration was also detected. There was an increased collagen fiber deposition and diminution of the proliferating stem cells. There was a marked increase in IL-1B and IL-6 levels. Group III showed an obvious improvement in the structure of the pancreas. The recovery group showed improvement in the structure of the pancreas and minimal collagen deposition. Conclusion Vitamin E could protect the pancreas against ethanol-induced alteration in adult male albino rats.
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Cord blood lipid profile in relation to anthropometric measures of newborns p. 54
Nermin Ramy, Mostafa Zakaria, Mona El Kafoury, Manar Kamal
DOI:10.4103/kamj.kamj_5_17  
Background Elevated serum lipid is a contributing factor in cardiac diseases. Exposure to stress in utero may affect lipid metabolism and anthropometric measures at birth. Objective The aim of the study was to assess cord blood lipid profile of newborns and its possible effect on newborn body measurements. Patients and methods This prospective cross-sectional study was conducted on 100 newborns. They were divided into three groups: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) groups. Maternal data were recorded, and BMI was calculated. Cord blood lipids, namely, total cholesterol, triglycerides (TGL), low-density lipoproteins (LDL), and high-density lipoproteins, were assessed. Results Mean levels of TGL and LDL were significantly higher in the SGA group compared with the AGA group, and significantly higher in the AGA group compared with the LGA group, whereas mean total cholesterol levels were significantly higher in the SGA group, with no difference between AGA and LGA groups. There was a strong negative correlation between TGL and each of birth weight, abdominal circumference, and ponderal index. The same was reported for LDL. Furthermore, maternal BMI did not affect neonatal lipids. Conclusion Variation in lipid profile at birth can affect anthropometric measures of the newborn.
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CASE REPORTS Top

A rare case of bilateral trigeminal palsy presenting as a complication of Sjogren syndrome p. 59
Ali Ilyas, Wasim T Malik, Anam Abrar, Faleha Zafar
DOI:10.4103/kamj.kamj_57_16  
Sjogren syndrome is a chronic disorder affecting the exocrine glands of the body, mostly lacrimal and salivary glands, resulting in sicca symptoms. Diagnosis is aided by the presence of anti-Ro and anti-La antibodies and gland biopsy showing lymphocytic infiltration. Bilateral loss of facial sensation in Sjogren syndrome (SS) has not been reported before, although unilateral trigeminal palsy as a presentation of SS has been reported in literature. A 25-year-old lady presented in the neurology clinic with complete facial numbness and vision loss for 1 month. The vision worsened, leading to complete blindness. She had dry mouth and dry eyes for the past 3 months. She was diagnosed with SS using American–European consensus Sjogren criteria. Electrophysiological blink reflex testing confirmed complete trigeminal nerve palsy. SS was treated with prednisolone, 1 mg/kg/day, with a poor response. Symptomatic treatment was given for sicca symptoms, which improved significantly. Corneal transplantation was done for visual loss, but limited improvement was seen.
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Adult-onset Still’s disease and dermatomyositis, is there a relation? p. 63
Doaa Atef, Asmaa Sabbah, Shaimaa I El-Jaafary, Noha T AboKrysha
DOI:10.4103/1687-4625.207187  
Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. We report a 22-year-old female patient, admitted to our department with fever, rash, large joint pains, and mild proximal weakness of both upper and lower limbs. With further evaluation of the patient and exclusion of infections, hematological malignancies, and connective tissue disorders, AOSD diagnosis was established with strikingly elevated serum ferritin level. This patient is the daughter of a patient who was diagnosed as having dermatomyositis in our department 2 years earlier. The mother was re-evaluated, and AOSD could not be excluded through the normal serum ferritin level.
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