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   2016| January-April  | Volume 2 | Issue 1  
    Online since June 22, 2016

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Quality of medical care provided to type 2 diabetic patients attending Alexandria Main University Hospital, Egypt
Azza A Esmail, Heba M.T. Elweshahi, Dalia Abd Elmotey
January-April 2016, 2(1):1-6
Background Diabetes mellitus is a major contributor to morbidity and mortality worldwide. A marked variability in the application of preventive and therapeutic strategies was documented. Good quality of care is associated with lower burden of complications. Study objectives The present study was conducted to assess the quality of medical care provided to type 2 diabetic patients attending the internal medicine outpatient clinic in Alexandria Main University Hospital. Patients and methods A cross-sectional survey was conducted on 490 type 2 diabetic patients. Patients were interviewed using a structured questionnaire containing data on personal and sociodemographic characteristics as well as their self-care practices. Records of interviewed patients for a set of performance measures for diabetes care during the last year were reviewed. Weight, height, and blood pressure were measured and a series of laboratory investigations were carried out in order to assess the outcome of diabetes care. Results The study included 490 diabetic patients, of whom 281 (57.3%) were male patients. Their mean age was 53.62 ± 10.72 years. The duration of diabetes among the studied patients ranged from 1 to 22 years, with a mean of 9.54 ± 4.78 years. Nearly one-third of them were not compliant with antidiabetic treatment; 44.1% were current smokers and 82% of them had never practiced physical exercise before. In the previous 3 months, glycosylated hemoglobin was ordered for only 60.8% of the studied patients. In the last year, foot and fundus examinations were carried out for nearly two-third of the studied patients (68.2 and 64.5%, respectively). Moreover, only 12.5, 26.1, and 38.5% of patients were investigated for microalbuminuria, serum creatinine, and blood lipids, respectively. Uncontrolled hyperglycemic state was diagnosed in a vast majority of cases (99.2%). Moreover, 78.6% were obese and 82% had hypertriglyceredemia. Conclusion Intermediate outcome measures – namely, poor glycemic control and high prevalence of obesity and hypercholesterolemia – denote suboptimal medical care and/or poor compliance of patients with self-care management practices. In order to improve quality of care of type 2 diabetes aiming at reducing the incidence of complications, improving outcome, and improving the quality of life of patients, multilevel intervention plan should be carried out.
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Assessment of the association of the adiponectin gene single-nucleotide polymorphism 45T/G with type 2 diabetes mellitus in Egyptian diabetic patients
Said A Ooda, Mervat F El-Belbesy, Nargues M Hassanein, Ola H Elgaddar, Hassan M Bachlah
January-April 2016, 2(1):23-30
Background Type 2 diabetes mellitus (T2DM) is a common multifactorial genetic disease. Adiponectin is a hormone produced solely by adipocytes and is a regulator of glucose and energy homeostasis. A number of genes and polymorphisms have been reproducibly associated with T2DM in a variety of studies. The gene ADIPOQ, encoding adiponectin, was found to be the main locus contributing to variations in adiponectin serum levels. Objective The aim of the work was to investigate the association between single-nucleotide polymorphism in exon 2 (45T/G) of the adiponectin gene with serum adiponectin level, and the occurrence of T2DM, which could allow proper management and genetic counseling for the high-risk carrier. Patients and methods The study included 40 patients with T2DM and 40 normal individuals with no family history of diabetes mellitus. BMI, serum fasting and postprandial glucose, lipid profile, fasting insulin, and adiponectin were measured. Molecular study for adiponectin 45T/G gene polymorphism was carried out. Results There was no statistically significant difference found when either genotype or allele frequencies were compared between the two groups. Conclusion Single-nucleotide polymorphism 45T/G of adiponectin gene was not associated with T2DM.
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Serum chemerin levels and chemerin rs17173608 genotypes in the susceptibility of diabetic nephropathy in Egyptian diabetic patients
Yomna Khaled, Laila Rashed
January-April 2016, 2(1):18-22
Background Chemerin, a newly discovered adipokine, highly expressed in obese and insulin resistant patients may provide a link between chronic inflammation and metabolic syndrome. Aim Was to evaluate serum chemerin levels in diabetic nephropathy patients and to evaluate the susceptibility between rs17173608 chemerin gene polymorphism and diabetic nephropathy risk in Egyptian patients. Materials and methods Study was conducted on 105 patients having type 2 diabetes and twenty adult healthy matched controls. Patients were divided into three groups according to urinary albumin excretion (UAE), macroalbuminuric (UAE<300mg/24h), microalbuminurua (30<UAE< 300mg/24h) and normoalbuminuric (UAE<30mg/24h).Serum chemerin levels were measured to all patients and controls by enzyme linked immunosorbent assay.Tetra-amplification refractory mutation system-PCR was performed to detect gene polymorphism. Results Serum chemerin level was significantly elevated in diabetic patients compared to controls. There is significant increase in serum chemerin levels among diabetic subgroups, significantly higher in diabetic patients with macroalbuminuria than in patients with microalbuminuria (P < 0.001) and normoalbuminuria (P = 0.0001). Also it shows highly significant elevation in diabetics with microalbuminuria than in normoalbuminuria (P = 0.0001).Our findings showed a significant association between GT genotypes (OR: 2.95,95% CI = 1.06 to 8.1; P = 0.03 and diabetic patients with macroalbuminuria. In the dominant effect of the G allele (comparison between TG+GG and TT), TG+ GG genotypes were associated with the risk of diabetic macroalbuminuria (OR: 2.8, 95%CI = 1.08to 7.5; P = 0.03). The G allele is dominant and increased the risk of diabetic macroalbuminuria as compared to the T allele (OR = 2.8, 95% CI = 1.01to7.1, P = 0.03). Conclusion Elevated serum chemerin could be marker of diabetic nephropathy and chemerin gene rs17173608 polymorphism is associated with susceptibility of diabetic nephropathy.
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Evaluation of inflammatory markers in relation to serum level of adiponectin in obese asthmatic patients
N Assad Samir, M Khalil Yehia, E Bondok Maha, N Younan Doreen, Y Ibrahim Eiman
January-April 2016, 2(1):31-35
Context Obesity and asthma are major public health problems affecting large numbers of population across the world. Obesity induces some physiological and metabolic changes, which are associated with the development of asthma. Inflammation in adipose tissue could lead to airway inflammation causing asthma in the setting of obesity. Aim The aim of this study was to compare the serum level of adiponectin and inflammatory markers [tumor necrosis factor α and C-reactive protein (CRP)] in obese asthmatic patients versus nonobese asthmatic patients compared with a third control group of healthy individuals of the same age and sex. Settings and design The study included two patient groups, and a third one served as a control group. The study was carried out in the Pulmonology and Internal Medicine Departments and Outpatient Clinics in Alexandria Main University Hospital. Materials and methods Anthropometric measurements (BMI, waist circumference, and waist to hip ratio) were obtained. Serum adiponectin, tumor necrosis factor α, and CRP levels were measured. Routine laboratory investigations, lipid profile, and blood glucose tests were performed in all studied groups. Results The mean serum level of CRP was more elevated in the obese patients in comparison with the control group (P = 0.002) and was also elevated in the normal weight asthmatic patients in comparison with the control group (P < 0.001). The mean adiponectin serum level was significantly lower in obese asthmatic patients than in normal weight asthmatic patients, and significantly lower in nonobese asthmatic patients in comparison with controls (P < 0.001 for each). Conclusion Prevention of obesity may be the most beneficial therapy for the obesity–asthma phenotype, and modulating adiponectin may open a unique and innovative approach toward managing asthma.
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Serum allograft inflammatory factor-1 concentration in type 2 diabetes mellitus and its relation to the pathogenesis and progression of diabetic nephropathy
Yahia Zakareya, Fatma El-Zahraa S Bukhary, Elham A Mohamad, Khaled M Othman, Osama Abdel Shakoor
January-April 2016, 2(1):7-17
Objective Inflammatory mechanisms may play a pivotal role in diabetic nephropathy (DN). Allograft inflammatory factor-1 (AIF-1), a marker of activated macrophage, may have a role in the progression of DN. Aim The aim of the present study was to examine the relationship between serum AIF-1 concentration and parameters of DN. Patients and methods A total of 80 type 2 diabetes patients and 20 healthy volunteers (control group) were included in the present study. Patients with renal dysfunction or inflammatory conditions were excluded. Clinical and laboratory tests for patients and controls were carried out. The patients' group was classified according to the Urinary Albumin Excretion (UAE) level into the following: group IA (normoalbuminuria group), which included 30 patients with UAE less than 30 mg/g of creatinine (mg/g Cr); group IIA (microalbuminuria group), which comprised 25 patients with UAE from 30 to 300 mg/g Cr; and group IIIA (macroalbuminuria group), which included 25 patients with UAE greater than 300 mg/g Cr. All patients were subjected to further classification according to estimated glomerular filtration rate (eGFR) into the following: group IB, which included 31 patients with eGFR less than or equal to 60 ml/min/1.73 m2; and group IIB, which included 49 patients with eGFR greater than 60 ml/min/1.73 m2. Results AIF-1 was significantly raised in all patients compared with controls (P = 0.001), and in both group IIA and group IIIA than in group IA (P = 0.001). AIF-1 had significant positive correlation with age, diabetes duration, UAE, log urinary albumin creatinine (A/C) ratio, urea, creatinine, and Fasting Blood Sugar (FBS) (P < 0.001). AIF-1 concentration was inversely correlated with eGFR. Serum AIF-1 was significantly raised in group IB (112.35 ± 26.8) compared with group IIB (83.41 ± 26.23) (P < 0.001). Serum AIF-1 was significantly raised in both groups of simple and proliferative diabetic retinopathy than in the group of nondiabetic retinopathy (P = 0.001). Conclusion AIF-1 was significantly raised in type 2 diabetic patients and in those with DN and retinopathy, which may raise a possibility of their pathogenesis as an inflammatory process.
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Evaluation of coronary artery calcification using multislice computed tomography in patients on dialysis: association with fetuin-A and osteoprotegerin
Sherif Aziz Zaki, Osama Hassan Shehata, Akram A Deghedi, Shehab Mohamed Sami, Rehab H.M. Mersal
January-April 2016, 2(1):46-54
Introduction Cardiovascular disease is the leading cause of mortality in patients with end-stage renal disease (ESRD) and is attributed to a combination of traditional and nontraditional risk factors. In recent years, there has been an increasing recognition of a very high prevalence of cardiovascular calcification in the ESRD population, including patients receiving hemodialysis (HD) and peritoneal dialysis. The mechanism is multifactorial, including structural and functional abnormalities in the large vessels, disorders in calcium (Ca2+) and phosphate (P) metabolism, vascular smooth muscle cells changes, and regulatory markers such as fetuin-A and osteoprotegerin (OPG). Aim of the work The aim of the present study was to determine the utility of multislice computed tomography (MSCT) for the assessment of coronary artery calcifications (CACs) and to identify the potential risks for CAC, including calcification regulating proteins such as fetuin-A and OPG, among patients with ESRD on maintenance dialysis (HD and peritoneal dialysis). Patients and methods This study included 70 patients who were divided into four groups: 20 patients on continuous ambulatory peritoneal dialysis (CAPD), 10 patients with ESRD stage 4 and 5, 30 patients on HD (subdivided into three subgroups according to the duration of HD: for 1–5 years, for 5–10 years, and for more than 10 years), and 10 healthy controls. They were subjected to complete history-taking, thorough clinical examination, investigations including serum level of fetuin-A, serum level of OPG by using the enzyme-linked immunosorbent assay technique, as well as MSCT imaging using 128-detector scanners for the quantification of CAC (calcium scoring) by using the Agatston method. Results There was a significant decrease in the serum level of fetuin-A in patients on HD compared with patients on CAPD, as well as in healthy controls. Moreover, there was a significant increase in the serum level of OPG in patients on HD compared with its level in CAPD patients as well as in healthy controls. The calcium scoring was significantly high in the HD group of patients (group IIa) (P = 0.032), with a low calcium score in CAPD patients group (group I) (P = 0.036) compared with healthy controls in group IV. CAC scoring was correlated positively and significantly with serum level of OPG in the total samples (r = 0.345* and P = 0.0270). On the other hand, it was negatively and significantly correlated with the serum level of fetuin-A in the total samples (r = −0.411* and P = 0.002). Conclusion Fetuin-A and OPG can be early and important markers of vascular calcifications in patients on dialysis; in addition, calcium scoring using MSCT provides a noninvasive method of assessment of the vascular calcification in these patients. Vascular calcification is more evident in patients on HD than in patients treated using CAPD; this can help in the selection of the modality of treatment of patients with ESRD, as well as early detection and prevention of cardiovascular (CVS) diseases in patients with ESRD treated with dialysis either HD or CAPD.
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The role of serum angiopoietin-2 as a biomarker in sepsis induced acute kidney injury
Mohamed M Abdelkader, Amal R Mansour, Heba S Elshaer, Amr K Hussien
January-April 2016, 2(1):55-60
Background Acute kidney injury (AKI) is a major complication of sepsis in ICU patients. The overall incidence of AKI in ICU patients ranges from 20 to 50% with lower incidence seen in elective surgical patients and higher incidence in sepsis patients. AKI represents a significant risk factor for mortality and can be associated with mortality greater than 50%. The aim of this study was to investigate the role of angiopoietin-2 as a biomarker in sepsis induced AKI. Patients and methods The study was conducted on 60 participants (20 patients with septic AKI, 20 patients with sepsis only without AKI and 20 healthy volunteers as the control group). Serum angiopoietin-2 levels were assessed by the ELISA technique. Clinical, biochemical, and therapeutic data were collected. Results High levels of serum angiopoietin-2 were detected in patients with septic AKI. These levels were significantly higher in relation to septic patients with no AKI and the control group. There was a statistically significant positive correlation between serum angiopoietin-2 level in the septic AKI group and serum creatinine, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and there was a statistically significant negative correlation between serum angiopoietin-2 level in the septic AKI group and the estimated glomerular filtration rate. Conclusion Serum angiopoietin-2 levels were significantly positive in patients with septic AKI. Serum angiopoietin-2 may be used as a biomarker in sepsis induced AKI.
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Study of the relationship between colorectal cancer and vit D defficiency
Mohamed H El Gayar, Khaled M Makboul, Laila M Hindawy, Amr M Saleh
January-April 2016, 2(1):61-66
Background Colorectal cancer is currently the third most common cancer in both men and women. The high prevalence of vitamin D deficiency, combined with the discovery of increased risk for certain types of cancer in those who are deficient, suggests that vitamin D deficiency may play a role in the development and progression of colon, breast, ovarian, and prostate cancers. Many studies suggest a possible relationship between sufficient vitamin D status and lower risk for cancer. Aim of the work The aim of this study was to determine vitamin D status in a sample of Egyptian patients with cancer of the colon. Study design We conducted a case–control study on 40 participants, 20 cases of colon cancer and 20 healthy adults matched for age. The cases were recruited from the general surgery wards and outpatient clinics at Ain Shams University Hospital, before surgical intervention or receiving oncological treatment. All participants were subjected to full medical history taking and thorough clinical examination. Fasting blood samples were drawn in the morning for evaluating haemoglobin, total Ca, phosphorus, Mg++, alkaline phosphatase, alanine transaminase, aspartate transaminase, carcinoembryonic antigen, and 25 hydroxyvitamin D. For the patients, chest radiography, pelvic and abdominal ultrasound, and colonoscopy and biopsy were performed. Results Egyptian patients with cancer of the colon showed a statistically significantly lower serum concentration of vitamin D (6.4 ± 3.912 ng/dl) compared with healthy controls (14.4 ± 9.838) (P = 0.002). There was a highly significant difference between the two groups as regards alkaline phosphatase, with a mean of 381.500 ± 73.721 in patients with cancer of the colon and a mean of 194.300 ± 88.838 in healthy controls (P < 0.001). Conclusion Vitamin D is lower in Egyptian patients with colorectal cancer, which may point to the possible protective role of vitamin D against cancer colon.
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Assessment of the nutritional status and serum leptin level of hepatitis C virus-infected Egyptian patients with and without schistosomal hepatic periportal fibrosis
Said A Ooda, Mostafa A Mohamed, Maher A Nabi, Wael M Lotfy, Basem A Alhabet
January-April 2016, 2(1):36-45
Background Schistosomiasis has been a major public health problem in Egypt. Moreover, Egypt has been widely regarded as having the highest recorded prevalence of hepatitis C virus (HCV) in the world. Malnutrition is prevalent in all forms of liver disease. Objective The aim of the work was to assess the nutritional status of HCV-infected patients with and without schistosomal hepatic periportal fibrosis. Patients and methods This study was carried out on 93 men. A total sample size of 93 patients was taken. The patients were divided into three groups of 31 each: group I included 31 patients having HCV; group II included 31 patients having mixed schistosomal hepatic periportal fibrosis and HCV; and group III included 31 healthy controls. Serum leptin was measured. Abdominal ultrasonography was performed to all participants to detect the degree of fibrosis according to the WHO scoring system. Nutritional assessment was carried out using anthropometric measurements. Body fat content was measured using bioelectrical impedance analysis. Results This study showed that the fat content was higher in group I than in group II and was higher in controls than in patients. Serum leptin level was significantly higher in group II than in group I. Conclusion Affection with HCV and/or schistosomal hepatic periportal fibrosis affects the nutritional status of the individuals affected, with more pronounced nutritional derangement in patients with both diseases.
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