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   Table of Contents - Current issue
Coverpage
January-April 2018
Volume 4 | Issue 1
Page Nos. 1-29

Online since Friday, July 27, 2018

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ORIGINAL ARTICLES  

Predictors of recurrent thyrotoxicosis in a cohort of Egyptian thyrotoxic patients treated with radioactive iodine p. 1
Alaa M Wafa, Hanan A Wahba, Hend A El-Hadaad, Amro Elhadidi, Hosam Halim
DOI:10.4103/ejode.ejode_5_18  
Background The use of radioactive iodine (RAI) in the treatment of thyrotoxicosis is increasing either in recurrent cases or as first-line therapy. RAI has the advantages of being relatively inexpensive, reliable, safe, easy to administer, and highly effective. Objective The purpose of this retrospective study is to assess the efficacy of RAI in the treatment of hyperthyroidism and to determine the different prognostic factors that affect the outcome. Patients and methods Our cohort include 60 patients with hyperthyroidism who were treated with RAI in the Nuclear Medicine Unit, Mansoura University Hospital and Internal Medicine Hospital during the period from 2009 to 2015 inclusive. Patients’ records were reviewed for the following data: age, gender, history of antithyroid medications (antithyroid drugs), size of the gland, cause of hyperthyroidism (Graves’ disease, and multiple and single functioning nodules), level of fT4, and dose of RAI. Results There was female predominance of hyperthyroidism with a female to male ratio of 4.5 : 1. Sixty percent of patients were less than or equal to 50 years and 71.7% received antithyroid medications. Thyroid gland was moderately or markedly enlarged in 55% of patients. A high level of fT4 (>4 ng/ml) was recorded in 56.7%. Graves’ disease was the most common pathological diagnosis. Most patients (68.3%) received a higher dose of RAI (≥10 mCi). After 6 months of RAI therapy; hypothyroidism was observed in 29 patients (48.3%) while 12 were euthyroid (20%). Hypothyroidism was higher in Graves’ disease than other causes of thyrotoxicosis (P=0.04), while patients who have previously received antithyroid medications were less likely to develop it (P=0.04). Response to RAI was significantly higher in those with a low level of fT4 (P=0.03), small size of the gland (P=0.02), and higher dose of RAI (P=0.02). Efficacy of RAI was not dependent on age (P=1) and gender (P=1). Conclusion Our results of this study of a cohort patient with thyrotoxicosis demonstrated that the size of the thyroid gland, the dose of RAI, use of antithyroid drugs, the cause of thyrotoxicosis, and the level of fT4 significantly affect the response to RAI, while the age and gender do not. So we should appreciate these factors when planning the treatment of such cases.
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Frequency of rheumatoid arthritis in patients with autoimmune thyroid disease: a case–control study p. 5
Hafez A Abd-Elhafeez, El-Sayed El-Meghawry, Sabry Al-Azhary, Khaled N Elfayoumy, Tarek Emran, Ahmad R Amin, Saad Alzokm
DOI:10.4103/ejode.ejode_1_18  
Introduction Hashimoto’s thyroiditis and Graves’ disease both constitute autoimmune thyroid diseases (AITD) that frequently coexist with other autoimmune disorders (AID). This study was conducted to evaluate the frequency of rheumatoid arthritis (RA) in patients diagnosed with AITD in relation to the general population. Patients and methods This was a cross-sectional case–control study, conducted on 103 patients with AITD of either Hashimoto’s thyroiditis or Graves’ disease with positive antithyroid peroxidase (TPOAb). A group 100 volunteers, matched for age and sex, with normal thyroid function and negative history of AID, were investigated for the prevalence of RA in the general population (control group). Participants in the study were tested for thyroid profile, rheumatoid factor (RF), erythrocyte sedimentation rate, and C-reactive protein. When appropriate, anticitrullinated peptide antibody was checked. Results Patients with AITD had a higher frequency of RA than the control (P=0.031). Thyroid profile showed no significant difference between patients with and without RA within the group of AITD. In that group, a positive correlation between titers of both RF and TPOAb was observed (r=0.474, P<0.001). The coexistence of RA with AITD was noticed to be associated with higher RF, C-reactive protein, and TPOAb titers as well as. the presence of type 2 diabetes mellitus, other AID and family history of RA. Conclusion RA is more prevalent in patients with AITD than the general population, and the underlying autoimmunity is likely to be the link. Our data highlight the importance of screening thyroid patients for RA especially if present with type 2 diabetes mellitus, another AID, or having a family history of RA.
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Insulin resistance and hepatitis C infection: a bidirectional relationship independent of diabetes and metabolic syndrome p. 11
El-Sayed El-Meghawry, Khaled N Elfayoumy, Mahmoud S Berengy, Tarek Emran
DOI:10.4103/ejode.ejode_3_18  
Introduction Hepatitis C virus (HCV) infection is known to be associated with insulin resistance (IR). The latter occurs early in the course of the disease and adversely affect it. The mechanism of this association seems to be different from that occurring in the metabolic syndrome. The aim of the study was to test this relationship in non-diabetic patients with early cirrhosis who are not fulfilling the criteria of metabolic syndrome. Patients and methods This cross-sectional study, included 100 patients with Child A cirrhosis induced by HCV. The patients were subjected to clinical, laboratory, ultrasonographic, and endoscopic evaluation. On the basis of homeostasis model assessment for insulin resistance (HOMA-IR) categorization, the patients were divided into two groups, with and without IR. Results A total of 63 patients had a higher HOMA-IR score, hence assigned as group 1, with significant elevation of liver enzymes, less albumin levels and more esophageal varices than in group 2. In a cohort of patients previously eradicated from the virus, HOMA-IR is lower than the non-treated patients. Conclusion Even in the absence of diabetes and metabolic syndrome, IR is evident in nearly two-thirds of patients having early HCV-induced cirrhosis. This link is associated with more inflammation of the liver and more drawbacks on the portal circulation. Sustained clearance of the virus improves insulin sensitivity.
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Assessing the effectiveness of an educational program for patients with gestational diabetes in Assiut University p. 17
Lobna F El Toony, Walaa A Khalifa, Osama M Ghazaly
DOI:10.4103/ejode.ejode_29_17  
Objective The aim was to evaluate the effectiveness of an individualized educational program in improving patient’s awareness, knowledge, and attitude and to assess its role in reducing the burden of gestational diabetes mellitus (GDM). Patients and methods A prospective study was conducted on women diagnosed to have GDM at 24–28 weeks of gestation according to The Diabetes In Pregnancy Study group India criteria 2015 (2 h blood glucose ≥140 mg/dl) between December 2015 and December 2016 who were enrolled into an individualized GDM educational program. A modified and shortened version of a validated questionnaire developed by Carolan and colleagues was tested before and after education to evaluate the feedback of education. Follow-up was every 2 weeks till labor to assess awareness together with both maternal and fetal outcomes. Results A total of 60 pregnant women diagnosed to have GDM were included. The questions that were answered correctly in the post-test by more than 50% of the participants fell into these categories: definition of GDM (100%), associated risk factors (75%), way of diagnosis (83.3%), management of GDM (71.7%), and postpartum follow-up (56.7%). As regards fetal and maternal outcome it was observed that both weight gain and glycemic control were better in the well-educated group versus other groups (P=0.02, 0.01, respectively). Conclusion Health education plays an important role in increasing patients awareness regarding the GDM risk and its proper management in order to reduce its complications both for the mother and the fetus.
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Chemerin is associated with diabetic retinopathy in type 2 diabetes p. 23
Mohamed R Halawa, Abeer A Abdullah, Nesma A Ibrahim, Ahmed M El-Sabawy
DOI:10.4103/ejode.ejode_26_17  
Background Chemerin is a novel adipokine, which is suggested to play a role in the development of type 2 diabetes mellitus (T2DM) and its chronic complications. Diabetic retinopathy (DR) is a common complication of diabetes, caused by diabetic microvascular lesions. Objective To investigate the relationship between serum chemerin level and DR in T2DM. Study design Eighty participants were enrolled in the study and were divided into three groups: group I included 40 patients with T2DM complicated with DR, and this group was further subdivided to proliferative diabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR); group II included 20 patients with T2DM not complicated with DR; and group III included 20 apparently healthy patients representing control group. Anthropometric and laboratory measurements including serum chemerin levels were assessed, and values were analyzed to compare the differences among the groups. Results Chemerin level was significantly higher in group I than that in both group II and group III (158.4±25.7 vs. 127.4±20.1 and 116.6±20.3 ng/dl, respectively; P<0.01). Moreover, chemerin level was significantly higher in the PDR group than that in NPDR group (167.7±28.4 vs. 152.2±22.2 ng/dl; P<0.05). Otherwise, no significant difference of chemerin level between group II and group III was found (P=0.135). Conclusion Serum chemerin levels were elevated in patients with T2DM with DR than those without DR and were elevated in patients with PDR than NPDR, suggesting that chemerin may be involved in the development of PDR.
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