Medicine

Cardiac outcomes after successful kidney transplantation Ahmed Hassan, Hala I Mohamed, Yasser A Hendy, Hala M Allam, Mohamed K Mohamed Journal of Medicine in Scientific Research 2018 1(4):219-226 Aim The aim of this study was to investigate the effects of renal transplantation on cardiac function and morphology in patients with ESRD on regular hemodialysis at the post-transplant period. Background End stage renal disease (ESRD) is considered an overall general health issue related to increased morbidity & mortality. The mortality rate among cases with ESRD who have been experiencing dialysis has been approximately seven times higher than for comparable cases in the general population and has been to a great extent related to cardiovascular causes. Cardiac diseases have been common in cases with chronic kidney disease (CKD). About 75% of cases with CKD who begin dialysis have left ventricular hypertrophy, left ventricle dilatation or diminished left ventricle functional shortening; these cardiac anomalies keep on progressing during the first year of hemodialysis. Besides these changes, impairment of diastolic function has been also expected in these cases. For example, Left ventricular hypertrophy has been a very common pathological condition in cases with ESRD and considered as an independent risk variable for death and cardiac disease. Generally, many risk variables including uremic toxins, fluid retention & chronic volume over-load, anemia, hypoalbuminemia, hyperparathyroidism, arterio-venous fistula and pressure over-load were involved in the pathogenesis for Left Ventricular Hypertrophy in cases with ESRD. Renal transplantation is a well-established treatment for ESRD, allowing most patients to return to a satisfactory quality of life. It is the most acceptable treatment modality for the patients with ESRD, which improves some complications of renal failure such as chronic uremia and volume overload. Methods This cross sectional study was done on 40 kidney transplant recipients enrolled from the patients in the NIUN according to the inclusion and exclusion criteria. We compared echocardiographic findings and some cardiac risk factors after transplantation with those done before transplantation. Results There was highly significant reduction with respect to serum creatinine, blood urea, phosphorus. Comparison of echocardiographic findings between the pre-transplant period and post-transplant period. Ejection fraction (EF) was significantly increased at the post-transplant period while left ventricular systolic dimension (LVSD), left ventricular diastolic dimension (LVDD), and LVH showed a significant decrease after transplantation. Conclusions We have found that cardiac parameters showed significant improvement after transplantation as well as cardiac risk factors including anemia, hyperparathyroidism and volume & pressure overload.

Hepatic encephalopathy in patients with diabetes mellitus El-Saied Shaheen, Helmy M Elshazly, Noha Abd Allah Journal of Medicine in Scientific Research 2018 1(4):227-230 Background and aim of the work Hepatic encephalopathy (HE) is a complex frequent neuropsychiatric manifestation of chronic and acute liver disease with disturbance of psychomotor, intellectual, cognitive, behavioral, and fine motor function of varying severity. Diabetes mellitus (DM) exacerbates progression of hepatic fibrosis. Recently, a meta-analysis study concluded that type 2 DM was associated with relative 1.5-fold increased risk for clinically defined Alzheimer disease and 2.5 for vascular dementia compared with nondiabetic individuals; furthermore, one recent prospective study showed that elevated blood glucose in the absence of DM increased the risk of dementia. Given the high prevalence of DM in the liver cirrhosis population, a better understanding of the effect of DM offers significant opportunities to improve patient outcome. Aim of the work To determine the relationship between duration of DM and blood sugar level and increase risk of the occurrence of HE in patients with liver cirrhosis. Patients and methods This study was carried out on 100 patients with cirrhosis with DM admitted between July 2017 and July 2018 in Internal Medicine Department, Shebin Elkom Teaching Hospital, Menoufia, Egypt. They were categorized into two groups according to the presence or absence of HE. Group 1 included 50 cirrhotic diabetic patients with HE and group 2 included 50 cirrhotic diabetic patients without HE. All patients in the study were subjected to a thorough physical examination; laboratory investigations, including complete blood picture, liver function tests, hepatitis B virus surface antigen, hepatitis C virus antibody, renal function tests, serum ammonia level, fasting and postprandial blood sugar, and glycated hemoglobin; tests to detect the presence of autonomic neuropathy (tilt-table test and diurnal variation of blood pressure measurement); and abdominal ultrasonography. Results The present study found a significant increase in fasting and postprandial blood glucose, glycated hemoglobin, and duration of DM in group 1 versus group 2. Positive tilt-table test and positive posture hypotension were highly significant in group 1 versus group 2. Conclusion Patients with cirrhosis with long-standing and uncontrolled DM are more likely to developed HE. Autonomic neuropathy, which may complicate patients with cirrhosis with long-standing uncontrolled diabetes, may play a role in the pathogenesis of HE in these patients.

Nonalcoholic fatty liver disease and outcomes in patients with acute coronary syndrome El-Saied Shaheen Journal of Medicine in Scientific Research 2018 1(4):231-233 Background According to the results of longitudinal cohort study, patients with nonalcoholic fatty liver disease (NAFLD) were found to have a higher mortality owing to coronary heart disease than the liver cirrhosis. Patients with NAFLD may also have a higher prevalence of subclinical atherosclerosis independent of established cardiovascular risk factor. Patients and methods This study was performed at Shebin El-Kom Teaching Hospital from January 2018 to March 2018. All consecutive patients with nonfatal acute coronary syndrome (ACS) admitted were included in this study. Patients with excessive alcohol consumption, patients with established cirrhosis, and patients with identified risk factors for liver disease were excluded from study. All patients underwent ultrasound scan of liver. Results There were 118 participants with ACS. The number of patients with NAFLD was 55 (46.6%) and patients without NAFLD was 63 (53.4%). The number of male patients with NAFLD was 31 (56.4%) versus 40 (63.5%) in patients without NAFLD. There was a significant increase in total Global Registry of Acute Coronary Events score in patients with NAFLD versus patients without NAFLD and also patients with NAFLD showed significant increased high and intermediate risk of death during the hospital stay versus patients without NAFLD. Conclusion Patients with NAFLD and ACS require aggressive treatment of CAD and higher predicted mortality.

Anti-cyclic citrullinated peptide antibodies in ulcerative colitis with and without joint involvement Tarek A Fouad, El Saied E Shabaan, Mohamed A Safy, Aisha El-Shimy, Hala I Mohamed, Wael Gomah Journal of Medicine in Scientific Research 2018 1(4):234-238 Background Joint affection is the most common extraintestinal manifestation of ulcerative colitis (UC). Despite the high specificity of anti-cyclic citrullinated peptide (CCP) antibodies for rheumatoid arthritis, their role in UC remains unclear. Aim The aims of this study were to assess the prevalence of anti-CCP antibodies in patients with UC and to investigate any association with joint affection. Patients and methods A total of 60 patients with UC were studied. Demographic data were collected, careful history was taken, and clinical examination including rheumatologic examination was done. A blood sample was collected for assessment of anti-CCP and other laboratory tests. Colonoscopy was done for assessment of severity and extension of UC. Results Joint affection was found in 28.33% of patients. Anti-CCP antibody was positive in 8.33% of patients. There were no statistically significant differences between patients with positive and negative anti-CCP antibody regarding joint affection or UC activity or extension. Conclusion The prevalence of anti-CCP antibodies in patients with UC was 8.33%, but there was no association between the presence of these antibodies and the joint affection or disease activity or extension.

Effects of iron-deficiency anemia on auditory function in school-aged children Gehan M S. Abd El-Salam, Eman Soliman Abd El-Gaffar, Hala M Abd El-Samad Journal of Medicine in Scientific Research 2018 1(4):239-244 Introduction Iron is important for proper myelination of spinal cord and white matter of cerebellar folds in brain and is a cofactor for a number of enzymes involved in neurotransmitter synthesis. Auditory brainstem evoked response (ABR) represents the progressive activation of different levels of the auditory pathway from the acoustic nerve (wave I) to the lateral lemniscuses (wave V). Otoacoustic emissions (OAEs) are sounds measured in the external ear canal that reflect movement of the outer hair cells in the cochlea. Patients and methods A total of 40 children, of both sexes, with age ranging from 6–12 years old, were selected for this study after a thorough clinical assessment to exclude any other pathological disorder other than anemia. They are compared with a control group that consisted of 20 normal children of the same age. After laboratory investigations, all children were examined by ABR and transient-evoked OAEs. The study group children were classified according to ABR results into study group 1, comprising anemic children with abnormal ABR results and study group 2, comprising anemic children with normal ABR results. Results ABR showed that absolute peak latencies of waves I, III, and V and interpeak latencies were prolonged; moreover, ABR waves I and V showed reduced amplitude in study group 1 than control group, and the difference is statistically significant. In contrast, there was no statistically significant difference between study group 2 and control group regarding ABR results. Transient-evoked OAEs results showed no statistically significant difference between anemic children and control group. Conclusion This study added to the evidences that iron-deficiency anemia is a risk factor for auditory function impairment. Further studies for the effect of timing, duration, and severity of iron deficiency on auditory functions are needed. Well-designed large-scale studies are needed to address the iron-deficiency anemia in health planning programs to put plans for control and prevention especially in developing countries.

The relationship between presbycusis and vestibular activity Gehan M S. Abd El-Salam Journal of Medicine in Scientific Research 2018 1(4):245-249 Introduction Presbycusis or age-related sensorineural hearing loss (SNHL) is a complex disorder that results in a slow deterioration in auditory function. A considerably high number of these patients with presbycusis or age-related SNHL also experience dizziness and related vestibular symptoms. Although auditory and vestibular systems are distinct, they work just alike. So, there is a great relation among their functions. Once one is stimulated, the other experiences changes as well. Participants and methods This study comprised 40 adult patients (50–75 years) without any vestibular symptoms or diagnosed vestibular diseases. Audiological status was measured with auditory brainstem response (ABR). The vestibular system was assessed using videonystagmography test battery, sensory organization test, and vestibular evoked myogenic potential (VEMP). ‘Get up and go’ test was used as a quick screening tool for detecting balance problems. Patients were divided into two groups: a study group (patients with SNHL) and a control group (patients without SNHL). ABR and VEMP results of the groups were calculated and compared. Results Absolute peak latencies of ABR waves I, III, and V were prolonged in the study group than the control group (P < 0.0001). VEMP results showed that P13 and N23 latencies were prolonged in the study group when compared with the control group (P < 0.0001). Conclusion Thorough full examination of the vestibular system, in conjunction with auditory functions in elderly persons, is recommended. This may help to discover their subclinical vestibular problem and guide physicians to design a suitable treatment plan that helps in decreasing risk of falls for aged persons.

Effect of pulsed electromagnetic field on menstrual distress in primary dysmenorrhic women Ahmed H Abd El Aziz, Engy M El Nahas, Hesham M Kamal Journal of Medicine in Scientific Research 2018 1(4):250-254 Background Primary dysmenorrhea is a common menstrual cramp that is recurrent and is not owing to other diseases and is a common cause of stay at home and school or work. Purpose The purpose of this study was to investigate the effect of pulsed electromagnetic field (PEMF) on menstrual distress in primary dysmenorrheic women. Patients and methods A total of 40 women having primary dysmenorrhea were selected from Physical Therapy Department in Al Mataria Teaching Hospital in Cairo. Their ages ranged from 20 to 30 years. They were divided randomly into two groups equal in number: group A (study group), treated with the PEMF, three times/week for 3 months, with each session lasted for 30 min, in addition to medical treatment, and group B (control group, which received medical treatment only (NSAIDs). Menstrual distress questionnaire and visual analog scale were used for assessment of menstrual distress and pain before treatment and after treatment for both groups A and B. Results The results showed that there is a significant improvement in menstrual distress and pain scores in both groups A and B after treatment, in favor of group A. Conclusion It was concluded that PEMF is effective in improving dysmenorrheic pain and menstrual distress score.

Prevalence of allergic disorders of respiratory system in children in Shebin Elkom Khaled ElKelany, Salama ElShenawy, Ezzat Rizk, Mohamed F Al Soda Journal of Medicine in Scientific Research 2018 1(4):255-260 Introduction Allergic rhinitis is a global health problem that causes significant illness and disability worldwide. Interactions between the lower and the upper airways are well known and have been studied since 1990. More than 80% of asthmatics have rhinitis, and 10–40% of patients with rhinitis have asthma. Indoor and outdoor allergens, as well as occupational agents, cause rhinitis and other allergic diseases. Aim A trial was done to determine or distinguish the causative agents, either one or multiple agents, in allergic patients. We hope this will help us in the management of allergic patients by avoiding this causative agent(s) if possible. Patients and methods A total of 97 individuals were recruited from the outpatient clinics of Shebin Elkom teaching hospital. Results Pigeon and pollens showed the highest prevalence at 56.7%, whereas wheat showed the least incidence at 5.15%. As for ingestant, the cacao showed the highest incidence at 16.49%, and the least one was strawberry at 5.15%. Conclusion The importance of our research that If we recognize the causative allergen that triggers the allergic disorder, we can try to avoid it and protect the patient from the hazards of an allergic disorder.

Screening and identification of red blood cell alloantibodies among hemodialysis patients in National Institute of Urology and Nephrology Aisha M A. Elshimy, Tarek A Fouad, Ahmed Hasan Journal of Medicine in Scientific Research 2018 1(4):261-265 Background It is well known that alloimmunization to red blood cell antigens resulting from the genetic disparities between the donor and the recipient is one of the risks of blood transfusion. Alloimmunization can result in clinical hemolysis and difficulty in cross-matching blood. The risk of alloimmunization is higher in patients who have received multiple blood transfusions such as renal failure patients on dialysis who receive blood transfusions. The antibody-screening test (2–3 cells panel) used to detect unexpected antibodies is not a mandatory pretransfusion testing in our blood bank of National Institute of Urology and Nephrology (NIUN), and is performed routinely in limited blood centers. Aim This study was conducted to screen and identify different types of red cell alloantibodies and the factors influencing the development of alloantibodies among patients on dialysis in NIUN. Patients and methods This study was conducted in the blood bank of NIUN, Egypt. A total of 192 patients (102 males and 90 women) who were diagnosed to have chronic renal failure, on regular hemodialysis for at least 1 year, their age more than 20 years, anemic (hemoglobin <8 g/dl), and with a previous history of blood transfusion for at least once were selected for the study. All patients’ sera were subjected to the following tests: antibody screening, patients’ sera were tested against three panels of commercially prepared group O cells and antibody identification, positive patients’ sera by a screening test, and retested against commercial panels of 11 cells. Results Red cell alloantibodies were detected in 10 (5.2%) patients (two men and eight women). The prevalence of alloantibodies detected in patients with positive results were anti-E (2.1%), anti-K (1.6%), antibodies of unknown specificity (1.6%), and antibody against high-incidence antigen (0.5%). There was a significant difference between sex and the number of blood units transfused with alloimmunization (P = 0.048 and 0.037, respectively). Conclusion The prevalence of alloimmunization among chronic renal failure patients on dialysis was 5.2%. The most common alloantibodies were anti-E (the Rhesus system) (2.1%) and anti-K (the Kell system) (1.6%) and the risk of alloimmunization is known to be influenced by the recipient sex (more in females) as well as the number of blood units transfused. So, antibody screening and identification tests are recommended as a routine pretransfusion testing protocol at least for the patients who are at higher risk of alloimmunization and require long-term transfusion dependence, which will definitely add significant value in blood safety.

Association of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels with diabetic foot ulcer in Egyptians with type 2 diabetes mellitus Ghada H Sayed, Ghada A Omar, Ayat I Ghanem, Naglaa F Mohamed, Mourad I El-Kholy Journal of Medicine in Scientific Research 2018 1(4):266-270 Background The imbalance between matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) may play an important role in impaired healing of diabetic foot ulcer. Aim of the work This study was designed to investigate the association of MMP-9 and TIMP-1 levels in diabetic foot ulcer among Egyptian patients with type 2 diabetes mellitus attending the outpatient clinic of National institute of diabetes and endocrinology. Patients and methods This study was conducted on a total number of 90 participants comprising three groups: group I included 35 type 2 diabetic patients without foot ulcer. Group II included 35 type 2 diabetic patients having various degrees of foot ulcer complications. Group III included 20 apparently healthy participants (as controls). In addition to the routine clinical and laboratory investigations, MMP-9 and TIMP-1 were measured. All patients were randomly taken from the outpatient clinic of National institute of diabetes and endocrinology. Results The study results showed that the higher levels of plasma MMP-9 and the lower levels of TIMP-1 were associated with patients with diabetic foot ulcer. Conclusion The measurement of plasma MMP-9 and TIMP-1 in type 2 diabetic patients may help us to know the patients at most risk to develop diabetic foot ulcer.