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   Table of Contents - Current issue
Coverpage
January-April 2018
Volume 24 | Issue 1
Page Nos. 1-46

Online since Thursday, May 24, 2018

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ORIGINAL ARTICLES  

A study of serum suppression of tumorigenicity 2 level in critically ill children p. 1
Ahmed A Khattab, Muhammad S El-Mekkawy, Reem M El-Kholy, Heba M Abdel Samie
DOI:10.4103/kamj.kamj_41_17  
Background sST2 is a new biomarker that was predominantly studied in adults with heart failure but was not adequately investigated in other diseases or in children. Aim to evaluate the diagnostic and prognostic values of sST2 in critically ill children. Patients and methods A prospective observational study of 70 children admitted into Pediatric intensive care unit (PICU) and 20 healthy controls. sST2 was measured within 24 hours of admission. Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality 2 (PIM2) were calculated. Primary outcome was 30-day mortality. Results sST2 was significantly higher among critically ill children compared with controls (P<0.001). sST2 was significantly elevated among septic children compared with controls (P<0.001) and the area under receiver operating characteristic curve (AUC) for discriminating septic children from controls was excellent (AUC=0.958, P<0.001). However, no significant difference in sST2 level was noted between septic and non-septic children or between survivors and non-survivors. sST2 was not correlated with CRP, PRISM, PIM2, or other indicators of disease severity. Conclusion sST2 is an acute phase protein with potential value in sepsis diagnosis. However, sST2 is not useful for predicting disease severity and prognosis of critically ill children.
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Studying the correlation between transforming growth factor β1 and chitinase-3-like-1 in assessment of bronchial asthma severity p. 7
Farag Khalil, Nagwa Abd El-Ghaffar Mohamed, Essam Abo El-Yazed
DOI:10.4103/kamj.kamj_35_17  
Background Chronic inflammation and airway remodeling have important roles in asthma pathophysiology. Transforming growth factor β1 (TGF-β1) and YKL-40 play a very important role in the pathogenesis of asthma. Aim The aim of this work was to find noninvasive biomarkers that may enable us to assess asthma severity as a surrogate for invasive bronchial mucosa biopsy. Therefore, we studied the correlation between TGF-β1 and YKL-40 and asthma severity. Patients and method The work was done on 40 patients with asthma who were classified into two groups: 20 patients with mild asthma and 20 patients with severe but stable asthma. A third group of 20 normal participants was taken as control. Immunoglobulin E total, YKL-40, and TGF-β1 were determined in serum of all studied groups. Results The results showed highly significant increased serum TGF-β1 and serum YKL-40 in patients with asthma compared with control group, and they were positively correlated with disease severity. Conclusion We conclude that increased serum levels of TGF-β1 and YKL-40 may be a biological characteristic of asthma exacerbation.
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Urinary connective tissue growth factor level in relation to nephropathy and retinopathy in patients with type 2 diabetes p. 14
Mervat M Naguib, Laila A Rashed
DOI:10.4103/kamj.kamj_39_17  
Introduction Connective tissue growth factor (CTGF), a major promoter of fibrosis, has been linked to diabetic complications. The aim of this observational case–control study was to investigate urinary connective tissue growth factor (uCTGF) as a marker of diabetic nephropathy and diabetic retinopathy (DR) in a cohort of patients with type 2 diabetes mellitus (T2DM). Patients and methods The study included 60 patients with T2DM (group A: 20 patients with normoalbuminuria; group B: 20 patients with microalbuminuria, and group C: 20 patients with macroalbuminuria) and 20 age-matched and sex-matched healthy participants as controls. Thorough clinical evaluation and fundus examination were done to determine the presence of DR. Laboratory workup included glycated hemoglobin, serum creatinine level, estimated glomerular filtration rate (eGFR) using modification of diet in renal disease (MDRD) formula, urine albumin to creatinine ratio (UACR), and uCTGF measurements. Results uCTGF levels showed a stepwise increase in group A (116.2±33.4), group B (197.9±75.7), and group C (365.5±197.3) (P<0.001). In patients with T2DM, uCTGF showed significant positive correlation with UACR (r=0.731, P<0.001) and HA1c (r=0.230, P=0.038) but negative correlation with eGFR (r=−0.421, P<0.001). uCTGF was an independent predictor of eGFR (β coefficient=−0.042, P=0.017) and UACR (β coefficient=0.720; P<0.001). In contrast, patients with DR had no significantly different uCTGF level from patients without retinopathy (329.18±47.149 vs. 252.02±27.3, P=0.067). Conclusion In the present study, uCTGF was significantly associated with markers of nephropathy but not with retinopathy in patients with T2DM.
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Vitamin D status in patients with type-2 diabetes mellitus in Riyadh City, Saudi Arabia p. 19
Mysara M Mogahed
DOI:10.4103/kamj.kamj_30_17  
Background Type-2 diabetes mellitus (T2DM) is a progressive and chronic disease characterized by both β-cell dysfunction and increased insulin resistance. Vitamin D is a crucial factor in the development of T2DM because it is necessary for normal insulin secretion. Despite ample sunshine, vitamin D deficiency is common in the Middle East. Objective To report the vitamin D status and its impact on the people in Riyadh City, Saudi Arabia, with T2DM. Patients and methods The study was carried out on 100 patients of 31–79 years old with T2DM. According to their vitamin D status, they were classified into three groups: group 1 (deficient, vitamin D: <20 ng/ml), group 2 (insufficient, vitamin D: 20–30 ng/ml), and group 3 (normal, vitamin D: >30 ng/ml). All were subjected to history taking, clinical examination, and assessment of fasting blood samples of serum concentrations of 25-hydroxy vitamin D [s-25(OH)D], blood glucose, glycated hemoglobin, lipid profile, liver enzymes (alanine transaminase and aspartate transaminase), urea and creatinine. Results Inadequate vitamin D level was observed in 80% of the participants, with a mean s-25(OH)D of 18.3±10.9 ng/ml. S-25(OH)D correlated negatively with fasting blood sugar (FBS) (P=0.008), with cholesterol and low-density lipoprotein (P=0.012 and 0.003, respectively). The low vitamin D status was strongly associated with poor glycemic control (P=0.001) and in females (P=0.002). There was no significant association between s-25(OH)D level and different age groups. Conclusion There is an overwhelming prevalence of vitamin D deficiency in our sample of Saudi diabetic patients. Association of low vitamin D status with poor glycemic control and atherogenic lipid profile suggests a role of vitamin D in the control of T2DM and dyslipidemia and the importance of early detection of its deficiency and vitamin D supplementation.
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L-carnitine serum level in healthy and septic neonates p. 26
Dalia M El-Lahony, Hanan M El-Sayed, Mahmoud A El-Hawy, Nagwa T.Abou El-Naga
DOI:10.4103/kamj.kamj_9_18  
Objective The aim was to measure plasma l-carnitine concentration in healthy and septic neonates, and the relation between l-carnitine concentration and gestational age, birth weight, and presence of neonatal sepsis. Background Neonatal sepsis and endotoxemia result in impaired lipid metabolism and hepatic energy generation from fatty acid oxidation which could put those neonates at risk of l-carnitine deficiency. Materials and methods The study was carried out at the Menoufiya University Hospital over 1 year on 40 of healthy and septic neonates. All neonates were subjected to full history taking, clinical examination, and laboratory investigations included measurement of serum l-carnitine level, sepsis workup, and other laboratory investigations. Results Our study included 40 neonates, They were divided into four groups. Group 1: 10 healthy preterm neonates with a mean gestational age of between 33.50±1.18 weeks and mean birth weight of between 1.82±0.18 kg. Group 2: 10 healthy full-term neonates with a mean gestational age of between 38.80±1.03 weeks and mean birth weight of 2.98±0.23 kg. Group 3: 13 septic preterm neonates with a mean gestational age of between 33.46±1.13 weeks, and mean birth weight of 1.95±0.31 kg. Group 4: seven septic full-term neonates with a mean gestational age of between 38.57±1.27 weeks and mean birth weight of between 3.00±0.34 kg. Septic neonates groups (groups 3 and 4) have a low level of l-carnitine than healthy neonates groups (groups 1 2) and among septic groups the septic preterm neonates group (group 3) have a high level of l-carnitine than septic full-term neonates group (group 4). Also among healthy groups, the healthy preterm neonates group (group 1) have a high level of l-carnitine than healthy full-term neonates group (group 2). There was no correlation between l-carnitine and maternal age, gestational age, birth weight, and laboratory investigations in all groups. Conclusion There is a significant decrease of serum l-carnitine level in septic neonates, so they need assessment and supplementation. There is no correlation between serum level of l-carnitine and both gestational age and birth weight.
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The response to sedative doses of propofol and dexmedetomidine in a prenatal valproate autistic rat model p. 32
Soha A Elmorsy, Ghada F Soliman, Laila A Rashed, Hamed Elgendy
DOI:10.4103/kamj.kamj_37_17  
Introduction Autism is a challenging neurodevelopmental disorder. Previous clinical observations point to altered sedation requirements of autistic children. The current study aims to test this observation experimentally and to explore its possible mechanisms. Materials and methods Eight adult female Sprague Dawley rats were randomly divided into two groups of four each: four were injected with intraperitoneal sodium valproate on the gestational day 12.5 and four were injected with saline. On postnatal day, 28 delivered male rats were subjected to an open-field test to confirm autistic features. Then each rat was injected intraperitoneally with a single dose of propofol (50 mg/kg) or dexmedetomidine (0.2 mg/kg). Time to loss of righting reflex (LORR) and time to return of righting reflex were recorded, and on the next day, all rats were re-sedated and their electroencephalographies were recorded. Rats were killed, and hippocampal GABAA receptor gene expression and glutamate N-methyl-d-aspartate receptor gene expression were assessed. Results Autistic rats showed significantly longer time to LORR and significantly shorter time to return of righting reflex as compared with controls for both dexmedetomidine and propofol treatments (median time to LORR: 12.0 versus 5.0 for dexmedetomidine and 22.0 and 8.0 for propofol; P<0.05). Electroencephalograph showed a slow, high-amplitude wave pattern 2 min after LORR in control rats, whereas autistic ones showed a high-frequency low-amplitude awake pattern. Hippocampal GABAA receptor gene expression was significantly less in autistic rats, and N-methyl-d-aspartate receptor gene expression was significantly more. Conclusion The results of the current study confirm the clinical observations of increased anesthetic sedative requirements with autism and propose a mechanism for it.
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Immunohistochemical study of GATA-3 expression versus estrogen and progesterone receptor in invasive mammary carcinomas p. 40
Aya M Ismail, Sara E Khalifa, Eman M Saied, Maha M El-Tamamy
DOI:10.4103/kamj.kamj_31_17  
Background Estrogen receptor (ER)-positive and progesterone receptor (PR)-positive breast tumors are characterized by a gene expression profile exhibiting profound differences from that of ER and PR-negative tumors. GATA-3 gene expression is correlated with ER in breast cancer. Aim We aimed to evaluate immunohistochemically the expression of GATA-3 in invasive breast carcinoma, comparing this with ER and PR status and available clinicopathological features, and also to detect the association between GATA-3 and the included breast cancer molecular subtypes. Materials and methods Fifty invasive breast carcinomas were studied for immunohistochemical demonstration of GATA-3 in the tumor cells. Cases were classified into two equal groups: group 1, that is, ER and PR positive, and group 2, that is, ER and PR negative. Molecular subtyping was applied. Results GATA-3 expression was detected in 88% of cases of group 1 and 56% of cases of group 2, showing direct association with ER and PR (P=0.031) and also significant association with luminal-like breast tumors. In addition, GATA-3 showed an inverse association with Ki-67 (P=0.0269); however, GATA-3 failed to show significant association with any of the clinicopathological parameters. Conclusion GATA-3 is an important luminal marker showing strong association with ER and PR in breast cancers, suggesting being a promising new breast-specific immunomarker that could be used for detection of breast cancer origin in metastatic tumors.
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