Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.368093
A. Abdelhai, Amir Abd-elhameed, Ahmed Barakat, M. Esawy, May M. Sami, A. Gad, Ahmed Ibrahim
Background: Although antiviral properties of vitamin D are recognized, the influence of parental Vit D supplementation on COVID-19 disease has not been determined. Objective: The aim of study was to evaluate impact of prompt treatment of Vit D deficiency on COVID-19 patients. Patients and Methods: A randomized controlled experiment was carried out on 250 COVID-19 patients. Patients were categorized into two cohorts: one cohort received daily intramuscular injection of 200,000 IU cholecalciferol for four consecutive days, while other cohort received daily oral dose of 10,000 IU cholecalciferol. The latter group functioned as control group. Before and after therapy, serum 25(OH)D level, inflammatory markers and electrolytes were measured, besides, clinical follow-up. Results: In Vit D group, the 25(OH)D levels considerably increased after 7 days compared to initial levels (32.48 ±9.64 Vs 13.77 ±6.51 ng/mL, respectively). All Vit D deficient patients have transitioned to sufficient status. Levels of markers (ESR 50.99±17.56 mm/hr, CRP 30.75 ±24 mg/L, and ferritin 392.05 ±139.17 ng/mL) decreased after seven days (29.74±8.97 mm/hr, 10.52 ±13 mg/L, and 94.59 ±27.14 ng/mL, respectively). A substantial clinical improvement occurred in Vit D group compared to their initial condition. Also Vit D deficiency was found to significantly increase risk of COVID-19 mortality by factor of 15.375 [AOR = 15.375, 95% CI: 1.898-124.52, p=0.01]. Conclusion: A daily intramuscular injection of 200,000 IU cholecalciferol for four consecutive days has been proven to significantly enhance clinico-labarotaory parameters in COVID-19 patients. Considering higher Vit D supplementation as a potential treatment for COVID-19 is a viable option.
背景：虽然维生素 D 的抗病毒特性已得到认可，但父母补充维生素 D 对 COVID-19 疾病的影响尚未确定。研究目的研究旨在评估及时治疗维生素 D 缺乏症对 COVID-19 患者的影响。患者和方法：对 250 名 COVID-19 患者进行了随机对照实验。患者被分为两组：一组连续四天每天肌肉注射 20 万国际单位的胆钙化醇，另一组每天口服 1 万国际单位的胆钙化醇。后一组为对照组。治疗前后，除临床随访外，还测量了血清 25（OH）D 水平、炎症指标和电解质。结果显示维生素 D 组的 25（OH）D 水平在 7 天后明显高于初始水平（分别为 32.48 ±9.64 Vs 13.77 ±6.51 ng/mL）。所有维生素 D 缺乏的患者都已过渡到充足状态。标记物水平（血沉 50.99±17.56 mm/hr、CRP 30.75 ±24 mg/L 和铁蛋白 392.05 ±139.17 ng/mL）在七天后有所下降（分别为 29.74±8.97 mm/hr、10.52 ±13 mg/L 和 94.59 ±27.14 ng/mL）。与初始状况相比，维生素 D 组的临床症状有了显著改善。此外，研究还发现，缺乏维生素 D 会使 COVID-19 死亡风险显著增加 15.375 倍[AOR = 15.375，95% CI：1.898-124.52，p=0.01]。结论事实证明，连续四天每天肌肉注射 200,000 IU 胆钙化醇可显著提高 COVID-19 患者的临床-实验室指标。将补充更多的维生素 D 作为治疗 COVID-19 的潜在方法是一个可行的选择。
{"title":"Impact of Rapid Correction of Vitamin D Deficiency on Patients with COVID-19 Disease: A Randomized-Controlled Trial","authors":"A. Abdelhai, Amir Abd-elhameed, Ahmed Barakat, M. Esawy, May M. Sami, A. Gad, Ahmed Ibrahim","doi":"10.21608/ejhm.2024.368093","DOIUrl":"https://doi.org/10.21608/ejhm.2024.368093","url":null,"abstract":"Background: Although antiviral properties of vitamin D are recognized, the influence of parental Vit D supplementation on COVID-19 disease has not been determined. Objective: The aim of study was to evaluate impact of prompt treatment of Vit D deficiency on COVID-19 patients. Patients and Methods: A randomized controlled experiment was carried out on 250 COVID-19 patients. Patients were categorized into two cohorts: one cohort received daily intramuscular injection of 200,000 IU cholecalciferol for four consecutive days, while other cohort received daily oral dose of 10,000 IU cholecalciferol. The latter group functioned as control group. Before and after therapy, serum 25(OH)D level, inflammatory markers and electrolytes were measured, besides, clinical follow-up. Results: In Vit D group, the 25(OH)D levels considerably increased after 7 days compared to initial levels (32.48 ±9.64 Vs 13.77 ±6.51 ng/mL, respectively). All Vit D deficient patients have transitioned to sufficient status. Levels of markers (ESR 50.99±17.56 mm/hr, CRP 30.75 ±24 mg/L, and ferritin 392.05 ±139.17 ng/mL) decreased after seven days (29.74±8.97 mm/hr, 10.52 ±13 mg/L, and 94.59 ±27.14 ng/mL, respectively). A substantial clinical improvement occurred in Vit D group compared to their initial condition. Also Vit D deficiency was found to significantly increase risk of COVID-19 mortality by factor of 15.375 [AOR = 15.375, 95% CI: 1.898-124.52, p=0.01]. Conclusion: A daily intramuscular injection of 200,000 IU cholecalciferol for four consecutive days has been proven to significantly enhance clinico-labarotaory parameters in COVID-19 patients. Considering higher Vit D supplementation as a potential treatment for COVID-19 is a viable option.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363593
H. A. Hamza, Nasser Kamal, Abd El-Aal, Eman Abbas, Ibrahim Eledel, Mahy Nabil, Mahmoud Egiz
Background: A recently discovered measurement called transverse cerebellar diameter (TCD) is used to estimate a fetus's gestational age (GA). When determining GA, the measurement of TCD is incredibly accurate, especially when the last menstrual period (LMP) date is uncertain. Objective: This study aimed to assess the diagnostic accuracy of fetal TCD as independent parameter in diagnosis of intrauterine growth restriction (IUGR). Patients and methods: This prospective observatory study was conducted in Obstetrics and Gynecology Department, Menoufia University Hospital and Berket El-Sabaa Central Hospital through the period from November 2022 to February 2024. 200 pregnant women attended to Antenatal Care Outpatient Clinic for follow up with a mean age of 26.43 ± 6.115 years old, singleton pregnancy, GA more than 13 weeks and clinically suspected intra uterine fetal growth restriction (FGR) were enrolled. Results: The study included individuals with a mean parity of 1.47 ± 1.5, a mean BMI of 26.32 ± 5.028 kg/m 2 , and 19% of patients were obese. There was a highly statistically significant lower mean value of GA by TCD in IUGR was 27.18 ± 7.454 compared to Non-IUGR that was 34.95 ± 3.502 (p<0.001). Conclusion: TCD is a critical measure for identifying IUGR and appropriately measuring GA. This is especially crucial for patients who arrived at the hospital without any medical records or prior prenatal care visits, particularly those from low-income families. These individuals frequently do not recall their LMP or estimated date of delivery (EDD), making it difficult for clinicians to precisely determine the GA of the fetus, especially in situations of IUGR.
{"title":"Diagnostic Accuracy of Fetal Transverse Cerebellar Diameter as Independent Parameter in Diagnosis of Intrauterine Growth Restriction","authors":"H. A. Hamza, Nasser Kamal, Abd El-Aal, Eman Abbas, Ibrahim Eledel, Mahy Nabil, Mahmoud Egiz","doi":"10.21608/ejhm.2024.363593","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363593","url":null,"abstract":"Background: A recently discovered measurement called transverse cerebellar diameter (TCD) is used to estimate a fetus's gestational age (GA). When determining GA, the measurement of TCD is incredibly accurate, especially when the last menstrual period (LMP) date is uncertain. Objective: This study aimed to assess the diagnostic accuracy of fetal TCD as independent parameter in diagnosis of intrauterine growth restriction (IUGR). Patients and methods: This prospective observatory study was conducted in Obstetrics and Gynecology Department, Menoufia University Hospital and Berket El-Sabaa Central Hospital through the period from November 2022 to February 2024. 200 pregnant women attended to Antenatal Care Outpatient Clinic for follow up with a mean age of 26.43 ± 6.115 years old, singleton pregnancy, GA more than 13 weeks and clinically suspected intra uterine fetal growth restriction (FGR) were enrolled. Results: The study included individuals with a mean parity of 1.47 ± 1.5, a mean BMI of 26.32 ± 5.028 kg/m 2 , and 19% of patients were obese. There was a highly statistically significant lower mean value of GA by TCD in IUGR was 27.18 ± 7.454 compared to Non-IUGR that was 34.95 ± 3.502 (p<0.001). Conclusion: TCD is a critical measure for identifying IUGR and appropriately measuring GA. This is especially crucial for patients who arrived at the hospital without any medical records or prior prenatal care visits, particularly those from low-income families. These individuals frequently do not recall their LMP or estimated date of delivery (EDD), making it difficult for clinicians to precisely determine the GA of the fetus, especially in situations of IUGR.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"68 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363740
Reem Raouf, El Sayed, El Adawy, Y. Elbalawy, Mohamed Shawki Abdelsalam, Dina S. Abd
Background: One of the most common musculoskeletal conditions that impair quality of life and cause functional impairment is chronic mechanical low back pain (CMLBP). Objective: The purpose of this study was to assess the gastrocnemius electro-myographic activity when compared to healthy controls in patients with CMLBP. Patients and Methods: Fifty-two male and female participants were invited to participate in this study, divided as the following: group (A) (Study group) involved 26 participants with chronic mechanical low back pain, and group (B) (Control group) involved 26 age-matched healthy volunteers. Results: There were no significant differences between study group (A) and control group (B) in the electro-myographic activity of gastrocnemius muscle (amplitude and frequency). In addition, there were no significant correlations between gastrocnemius muscle activity and pain intensity measured via visual analogue scale (VAS), static balance measured via single leg stance test and dynamic balance measured via Y balance test. Conclusion: Electro-myographic activity of gastrocnemius muscle seems to be not affected in chronic mechanical low back pain patients.
{"title":"Assessment of Gastrocnemius Muscle Activity in Patients with Chronic Mechanical Low Back Pain","authors":"Reem Raouf, El Sayed, El Adawy, Y. Elbalawy, Mohamed Shawki Abdelsalam, Dina S. Abd","doi":"10.21608/ejhm.2024.363740","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363740","url":null,"abstract":"Background: One of the most common musculoskeletal conditions that impair quality of life and cause functional impairment is chronic mechanical low back pain (CMLBP). Objective: The purpose of this study was to assess the gastrocnemius electro-myographic activity when compared to healthy controls in patients with CMLBP. Patients and Methods: Fifty-two male and female participants were invited to participate in this study, divided as the following: group (A) (Study group) involved 26 participants with chronic mechanical low back pain, and group (B) (Control group) involved 26 age-matched healthy volunteers. Results: There were no significant differences between study group (A) and control group (B) in the electro-myographic activity of gastrocnemius muscle (amplitude and frequency). In addition, there were no significant correlations between gastrocnemius muscle activity and pain intensity measured via visual analogue scale (VAS), static balance measured via single leg stance test and dynamic balance measured via Y balance test. Conclusion: Electro-myographic activity of gastrocnemius muscle seems to be not affected in chronic mechanical low back pain patients.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"111 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141714240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.368095
Afaf H. Rashwan, Sayed Abass, Sayed Amal, A. El, Fatah Abd, El Hamed, Amal Abd, El Fatah, Abd El Hamed
Background: Diabetic health literacy, encompassing knowledge, motivation, and the ability to access, understand, evaluate, and apply healthcare information, is a crucial non-clinical factor in diabetes management. Objective: To evaluate the health literacy levels in diabetic patients and its impact on retinal health, including a complete epidemiological profile of the participants. Subjects and Methods: This observational descriptive cross-sectional study included 500 Egyptian diabetic patients attending the Ophthalmology outpatient clinic at Al-Azhar University Hospitals from November 2022 to September 2023. Participants underwent a comprehensive evaluation including a specially designed questionnaire based on the European Health Literacy Survey (HLS-EU), thorough medical history, complete ophthalmological examination, fundus photography, and laboratory tests as needed. Results: There was a statistically significant correlation between health literacy levels and education, BMI, treatment compliance, and the presence of retinopathy (p<0.05). Among the patients, 320 (64%) had no retinopathy. The percentage of patients with adequate health literacy (excellent and sufficient) was 44.6%, while 55.4% had inadequate health literacy (problematic and inadequate). In patients with diabetic retinopathy, only 22.8% had adequate health literacy. For those with severe diabetic retinopathy, the percentage dropped to 9.2%. Among patients without diabetic retinopathy, 57% had adequate health literacy, whereas 43% had inadequate levels. Conclusion: Health literacy is significantly associated with diabetic retinopathy, treatment compliance, BMI, and education
{"title":"Health Literacy Level of Patients with Diabetic Retinopathy: An Observational Descriptive Cross Sectional Study","authors":"Afaf H. Rashwan, Sayed Abass, Sayed Amal, A. El, Fatah Abd, El Hamed, Amal Abd, El Fatah, Abd El Hamed","doi":"10.21608/ejhm.2024.368095","DOIUrl":"https://doi.org/10.21608/ejhm.2024.368095","url":null,"abstract":"Background: Diabetic health literacy, encompassing knowledge, motivation, and the ability to access, understand, evaluate, and apply healthcare information, is a crucial non-clinical factor in diabetes management. Objective: To evaluate the health literacy levels in diabetic patients and its impact on retinal health, including a complete epidemiological profile of the participants. Subjects and Methods: This observational descriptive cross-sectional study included 500 Egyptian diabetic patients attending the Ophthalmology outpatient clinic at Al-Azhar University Hospitals from November 2022 to September 2023. Participants underwent a comprehensive evaluation including a specially designed questionnaire based on the European Health Literacy Survey (HLS-EU), thorough medical history, complete ophthalmological examination, fundus photography, and laboratory tests as needed. Results: There was a statistically significant correlation between health literacy levels and education, BMI, treatment compliance, and the presence of retinopathy (p<0.05). Among the patients, 320 (64%) had no retinopathy. The percentage of patients with adequate health literacy (excellent and sufficient) was 44.6%, while 55.4% had inadequate health literacy (problematic and inadequate). In patients with diabetic retinopathy, only 22.8% had adequate health literacy. For those with severe diabetic retinopathy, the percentage dropped to 9.2%. Among patients without diabetic retinopathy, 57% had adequate health literacy, whereas 43% had inadequate levels. Conclusion: Health literacy is significantly associated with diabetic retinopathy, treatment compliance, BMI, and education","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"15 s2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363704
Ibrahim Omar, Ibrahim Badr, Esraa Ahmed, Mohamed Ramadan, Maha Mosaad
Background: The local application of stains or dyes during endoscopy is referred to as "chromoendoscopy" in an attempt to improve tissue identification, distinction, and diagnosis. Objectives: To judge the value of chromohysteroscopy in identifying endometrial abnormalities that are too subtle for standard hysteroscopy to detect. The histopathology from routine endometrial sampling and chromohysteroscopy was compared. Methodology: This interventional prospective study included 49 women with abnormal uterine bleeding. First of all, a 4 mm diameter hysteroscope was used to perform a diagnostic hysteroscopy. Between the 20 th and 25 th day of their menstrual cycle, patients were booked for blind endometrial sampling and chromohysteroscopy directed biopsies. Results: Focal staining had higher sensitivity, specificity and accuracy 65.5%, 95% and 77.6% respectively, for detection of endometrial pathologies compared with diffuse staining. Focal dark pattern was significantly associated with, submucous myoma, endometrial hyperplasia, necrotic mass, endometritis, simple and complex endometrial hyperplasia with atypia and endometrial carcinoma. Conclusion: The diagnostic precision of traditional hysteroscopy is enhanced with chromohysteroscopy. In cases of Abnormal Uterine Bleeding (AUB), it is a useful, affordable diagnostic for identifying endometrial diseases.
{"title":"Evaluating the Role of Chromohysteroscopy in Evaluation of Endometrial Pathology as a Cause of Abnormal Uterine Bleeding","authors":"Ibrahim Omar, Ibrahim Badr, Esraa Ahmed, Mohamed Ramadan, Maha Mosaad","doi":"10.21608/ejhm.2024.363704","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363704","url":null,"abstract":"Background: The local application of stains or dyes during endoscopy is referred to as \"chromoendoscopy\" in an attempt to improve tissue identification, distinction, and diagnosis. Objectives: To judge the value of chromohysteroscopy in identifying endometrial abnormalities that are too subtle for standard hysteroscopy to detect. The histopathology from routine endometrial sampling and chromohysteroscopy was compared. Methodology: This interventional prospective study included 49 women with abnormal uterine bleeding. First of all, a 4 mm diameter hysteroscope was used to perform a diagnostic hysteroscopy. Between the 20 th and 25 th day of their menstrual cycle, patients were booked for blind endometrial sampling and chromohysteroscopy directed biopsies. Results: Focal staining had higher sensitivity, specificity and accuracy 65.5%, 95% and 77.6% respectively, for detection of endometrial pathologies compared with diffuse staining. Focal dark pattern was significantly associated with, submucous myoma, endometrial hyperplasia, necrotic mass, endometritis, simple and complex endometrial hyperplasia with atypia and endometrial carcinoma. Conclusion: The diagnostic precision of traditional hysteroscopy is enhanced with chromohysteroscopy. In cases of Abnormal Uterine Bleeding (AUB), it is a useful, affordable diagnostic for identifying endometrial diseases.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"49 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141689665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.366548
H. El-Banna, Aya El Shintenawy, Wessam Salah, Ramy Atlam, Esraa Elshintenawy, Amira Mohammad El
Background: In cases with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), attention should be given to the risk of cardiovascular diseases, which are responsible for an excess burden of morbidity & mortality. In cases with RA and SLE, the cardiovascular system (CVS) should be evaluated for early detection of subclinical cardiovascular affection. Objective: To assess serum interleukin-21 level and IL-21 genetic polymorphism association with the CVS risk in cases with RA and SLE. Patients and methods: Seventy patients with RA, seventy patients with SLE and seventy matched controls were included in the study. Measurements of serum IL-21 levels were conducted by using ELISA procedure, and polymerase chain reaction (RT-PCR) was used to determine the genotypes. Cardiovascular assessment was done by: electrocardiography, transthoracic echocardiography, evaluation of carotid atherosclerosis by intima media thickness (IMT) of the carotid artery and evaluation of endothelial function by flow mediated dilation (ED-FMD) of the brachial artery. Results: Serum interleukin-21 level was significantly higher in cases compared to healthy controls (HC), with significant elevation in clinically active patients. A significant relationship between serum IL-21 level with activity score, ejection fraction, intima media thickness, cholesterol, low density lipoprotein (LDL) and flow mediated dilatation was found. Patients with rs6822844 GT and TT haplotypes showed higher frequency of subclinical cardiovascular abnormalities in RA (p=0.0002, 0.01) and in SLE (p=0.001, 0.025) patients’ groups respectively. Conclusion: IL-21 may be a potential biomarker of cardiovascular risk in RA and SLE, and could be used as a possible target for new therapeutic agents. IL-21 polymorphism was significantly accompanied by inherited predisposition to RA and SLE and their associated cardiovascular morbidity.
{"title":"Association between Interleukin-21 Serum Level and IL-21 Genetic Polymorphism with the Cardiovascular Morbidity Risk in Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients","authors":"H. El-Banna, Aya El Shintenawy, Wessam Salah, Ramy Atlam, Esraa Elshintenawy, Amira Mohammad El","doi":"10.21608/ejhm.2024.366548","DOIUrl":"https://doi.org/10.21608/ejhm.2024.366548","url":null,"abstract":"Background: In cases with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), attention should be given to the risk of cardiovascular diseases, which are responsible for an excess burden of morbidity & mortality. In cases with RA and SLE, the cardiovascular system (CVS) should be evaluated for early detection of subclinical cardiovascular affection. Objective: To assess serum interleukin-21 level and IL-21 genetic polymorphism association with the CVS risk in cases with RA and SLE. Patients and methods: Seventy patients with RA, seventy patients with SLE and seventy matched controls were included in the study. Measurements of serum IL-21 levels were conducted by using ELISA procedure, and polymerase chain reaction (RT-PCR) was used to determine the genotypes. Cardiovascular assessment was done by: electrocardiography, transthoracic echocardiography, evaluation of carotid atherosclerosis by intima media thickness (IMT) of the carotid artery and evaluation of endothelial function by flow mediated dilation (ED-FMD) of the brachial artery. Results: Serum interleukin-21 level was significantly higher in cases compared to healthy controls (HC), with significant elevation in clinically active patients. A significant relationship between serum IL-21 level with activity score, ejection fraction, intima media thickness, cholesterol, low density lipoprotein (LDL) and flow mediated dilatation was found. Patients with rs6822844 GT and TT haplotypes showed higher frequency of subclinical cardiovascular abnormalities in RA (p=0.0002, 0.01) and in SLE (p=0.001, 0.025) patients’ groups respectively. Conclusion: IL-21 may be a potential biomarker of cardiovascular risk in RA and SLE, and could be used as a possible target for new therapeutic agents. IL-21 polymorphism was significantly accompanied by inherited predisposition to RA and SLE and their associated cardiovascular morbidity.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"287 9‐10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363590
Mohamed A. Shaban, Abdallah Nosair, Eman Salah, Eldin Elsakaan, Ahmed Sultan, Mohamed Shehata, Hisham M. Elbatanony
Background: Acute aortic dissection is a critical medical condition that has a significant risk of death and morbidity. The Bentall procedure has become the accepted standard for treating aortic root pathology. The newer trend is to perform the aortic valve-sparing operations to prevent various risks related to prosthetic valves. Objective: This study primarily aimed at assessment of the early and short-term results of adopting aortic valve re-implantation technique (Tirone David) addressing DeBakey Type 1 aortic dissection including cardiac function assessment, major cardiac problems, clinical status, quality of life and mortality over 1-year follow-up. Patients and Methods: This retrospective study included 49 patients with acute aortic dissection DeBakeytype 1 associated with severe aortic incompetence (AI), intramural hematoma involving the ascending aorta and/or penetrating atherosclerotic ulcer in the ascending aorta. They were operated upon using aortic valve re-implantation technique (Tirone David). Results: The mean age was 54.15±13.77 years. Mortality was 0% intraoperatively, 5(10.20%) operative mortality, no late mortality and the overall 1-year survival rate was 44(89.80%). The overall hospital complications rate was13 (26.53%). At 1-year follow-up, there were statistically significant improvements in left ventricular ejection fraction per cent (LVEF%), left ventricular end-diastolic diameter (LVEDD)(p<0.001), left ventricular end-systolic diameter (LVESD) (p<0.001) and AI degree. LVEF improved from 52.54±9.16% preoperatively to 55.67±8.35% (p=0.015). AI degree improved from severe AI in 100% of cases to no or trivial AI in 28(63.63%) patients, mild AI in 15(34.09%) patients, moderate AI in 1(2.27%) patient and no patients with severe AI (p<0.001). There were no complications in the form of aortic valve (AV) failure. Conclusion: The procedure of preservation of the patient’s native aortic valve through re-implantation technique (Tirone David operation), when appropriate, is recommended as it allows better left ventricular performance and avoiding the development of valve-related complications (endocarditis, thromboembolic complications and life-long anticoagulation).
{"title":"Early and Short-term Outcomes of Adopting Aortic Valve Re-Implantation Technique Addressing DeBakey Type 1 Aortic Dissection","authors":"Mohamed A. Shaban, Abdallah Nosair, Eman Salah, Eldin Elsakaan, Ahmed Sultan, Mohamed Shehata, Hisham M. Elbatanony","doi":"10.21608/ejhm.2024.363590","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363590","url":null,"abstract":"Background: Acute aortic dissection is a critical medical condition that has a significant risk of death and morbidity. The Bentall procedure has become the accepted standard for treating aortic root pathology. The newer trend is to perform the aortic valve-sparing operations to prevent various risks related to prosthetic valves. Objective: This study primarily aimed at assessment of the early and short-term results of adopting aortic valve re-implantation technique (Tirone David) addressing DeBakey Type 1 aortic dissection including cardiac function assessment, major cardiac problems, clinical status, quality of life and mortality over 1-year follow-up. Patients and Methods: This retrospective study included 49 patients with acute aortic dissection DeBakeytype 1 associated with severe aortic incompetence (AI), intramural hematoma involving the ascending aorta and/or penetrating atherosclerotic ulcer in the ascending aorta. They were operated upon using aortic valve re-implantation technique (Tirone David). Results: The mean age was 54.15±13.77 years. Mortality was 0% intraoperatively, 5(10.20%) operative mortality, no late mortality and the overall 1-year survival rate was 44(89.80%). The overall hospital complications rate was13 (26.53%). At 1-year follow-up, there were statistically significant improvements in left ventricular ejection fraction per cent (LVEF%), left ventricular end-diastolic diameter (LVEDD)(p<0.001), left ventricular end-systolic diameter (LVESD) (p<0.001) and AI degree. LVEF improved from 52.54±9.16% preoperatively to 55.67±8.35% (p=0.015). AI degree improved from severe AI in 100% of cases to no or trivial AI in 28(63.63%) patients, mild AI in 15(34.09%) patients, moderate AI in 1(2.27%) patient and no patients with severe AI (p<0.001). There were no complications in the form of aortic valve (AV) failure. Conclusion: The procedure of preservation of the patient’s native aortic valve through re-implantation technique (Tirone David operation), when appropriate, is recommended as it allows better left ventricular performance and avoiding the development of valve-related complications (endocarditis, thromboembolic complications and life-long anticoagulation).","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"426 1‐2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.368094
Khaled Ahmed, El-Banna, Fawzy Abd, El-Fattah El-Messallamy, Jehan Saeed, Abdo Soliman, Nermin Saad Ghanim, Ahmed Atef, Zaki El-naggar, Ahmed Sallam Soliman, Noha Usama Khalil
Background: Diabetes patients are more likely to experience foot infections, which are extremely morbid and raise the possibility of lower limb amputation. The clinical symptoms and indications of local inflammation are used to diagnose diabetic foot infections (DFI). Objective: This study aimed to evaluate procalcitonin/Lactate ratio as a diagnostic marker for osteomyelitis and soft tissue infection in diabetic foot ulcers. Patients and methods: This case-control study was carried out on 112 diabetic patients attending to Diabetic Foot Outpatient Clinic, Zagazig University. Patients were divided into 4 groups: Group (1) included patients with T2DM without foot complications, group (2) patients with non-infected diabetic foot ulcer (NIDFU), group (3) that included infected diabetic foot without osteomyelitis and group (4) Infected diabetic foot with osteomyelitis. Full clinical examination, routine and metabolic investigations were done. Procalcitonin, lactic acid level and procalcitonin/lactate ratio were measured for all subjects. In addition, MRI on bone of infected diabetic foot groups was done. Results: A statistically significant increase in serum procalcitonin, lactic acid level and procalcitonin/lactate ratio were found in infected diabetic foot with osteomyelitis than those without osteomyelitis and those of diabetic foot ulcer without infection and those without foot complications. Also, there was significant increase in those without osteomyelitis than in those of diabetic foot ulcer without infection and those without foot complications. Elevated WBCs, T. cholesterol and serum triglyceride were independent predictors of elevated procalcitonin (PCT)/lactate ratio. Procalcitonin/lactate ratio at cut-off value of ≥ 0.31 could be a marker for early detection of infected diabetic foot ulcers without osteomyelitis with 95.9 % sensitivity and 92.4% specificity. Also, cut-off value of ≥ 2.3 could be a marker for early detection of osteomyelitis in infected diabetic foot ulcers patients with.85.6% sensitivity and 77.4% specificity Conclusion: Procalcitonin/ lactate ratio, which is easy faster and cheaper than MRI could be a good marker for early detection of osteomyelitis in infected diabetic foot ulcer patients with high sensitivity and specificity and a dependable sign for acute DFI.
{"title":"Procalcitonin/Lactate Ratio as a Diagnostic Marker for Osteomyelitis in Patients with Diabetic Foot Ulcers","authors":"Khaled Ahmed, El-Banna, Fawzy Abd, El-Fattah El-Messallamy, Jehan Saeed, Abdo Soliman, Nermin Saad Ghanim, Ahmed Atef, Zaki El-naggar, Ahmed Sallam Soliman, Noha Usama Khalil","doi":"10.21608/ejhm.2024.368094","DOIUrl":"https://doi.org/10.21608/ejhm.2024.368094","url":null,"abstract":"Background: Diabetes patients are more likely to experience foot infections, which are extremely morbid and raise the possibility of lower limb amputation. The clinical symptoms and indications of local inflammation are used to diagnose diabetic foot infections (DFI). Objective: This study aimed to evaluate procalcitonin/Lactate ratio as a diagnostic marker for osteomyelitis and soft tissue infection in diabetic foot ulcers. Patients and methods: This case-control study was carried out on 112 diabetic patients attending to Diabetic Foot Outpatient Clinic, Zagazig University. Patients were divided into 4 groups: Group (1) included patients with T2DM without foot complications, group (2) patients with non-infected diabetic foot ulcer (NIDFU), group (3) that included infected diabetic foot without osteomyelitis and group (4) Infected diabetic foot with osteomyelitis. Full clinical examination, routine and metabolic investigations were done. Procalcitonin, lactic acid level and procalcitonin/lactate ratio were measured for all subjects. In addition, MRI on bone of infected diabetic foot groups was done. Results: A statistically significant increase in serum procalcitonin, lactic acid level and procalcitonin/lactate ratio were found in infected diabetic foot with osteomyelitis than those without osteomyelitis and those of diabetic foot ulcer without infection and those without foot complications. Also, there was significant increase in those without osteomyelitis than in those of diabetic foot ulcer without infection and those without foot complications. Elevated WBCs, T. cholesterol and serum triglyceride were independent predictors of elevated procalcitonin (PCT)/lactate ratio. Procalcitonin/lactate ratio at cut-off value of ≥ 0.31 could be a marker for early detection of infected diabetic foot ulcers without osteomyelitis with 95.9 % sensitivity and 92.4% specificity. Also, cut-off value of ≥ 2.3 could be a marker for early detection of osteomyelitis in infected diabetic foot ulcers patients with.85.6% sensitivity and 77.4% specificity Conclusion: Procalcitonin/ lactate ratio, which is easy faster and cheaper than MRI could be a good marker for early detection of osteomyelitis in infected diabetic foot ulcer patients with high sensitivity and specificity and a dependable sign for acute DFI.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"68 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.366542
Aml Ibrahiem Sayed, A. Abo, El Sood, Mohamed Amin, Rasha Mahmoud Ahmed, B. Moussa, Gouda Mohamed El, Labban
Introduction: In order to prevent unnecessary deaths and severe morbidity in these patients, it is crucial to evaluate the hemodynamic status of polytrauma patients as well as to screen for continued bleeding and evaluate the effectiveness of resuscitation. Aim of this study: To assess inferior vena cava (IVC) /aortic index importance in assessment of intravascular volume status and in prediction of early blood transfusion in trauma patients. Patients and methods: This study was conducted as a prospective cohort study. The major blunt trauma patients were divided into two groups. Patients group had signs of shock such as decreased blood pressure<90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate >100 b/m, cold clammy skin, capillary refill >2 sec Control group: had normal blood pressure (≥90/60 mmHg) and normal heart rate, no other signs of shock. Results: There were 31 patients (51.7%) required blood transfusion after 24-hour. The mean 24-hour blood transfusion was 1556.3 ± 1081.9. IVC/aortic index 0 at presentation in case group, mean ± SD was 0.60 ± 0.12, while in control group mean ± SD was 0.98 ± 0.08 (p-value < 0.001). IVC/aortic index 1 in case group, mean ± SD was 0.70 ± 0.12, while in control group mean ± SD was 0.94 ± 0.09 (p-value < 0.001). Conclusion: The IVC/aorta diameter index can be used as a parameter for detecting volume status and early blood transfusion in polytrauma patients.
{"title":"Evaluation of the Role of Inferior Vena Cava/Aortic Index Sonography in Assessment of Intravascular Volume Status in Resuscitation of Major Blunt Trauma Patients in Emergency Department","authors":"Aml Ibrahiem Sayed, A. Abo, El Sood, Mohamed Amin, Rasha Mahmoud Ahmed, B. Moussa, Gouda Mohamed El, Labban","doi":"10.21608/ejhm.2024.366542","DOIUrl":"https://doi.org/10.21608/ejhm.2024.366542","url":null,"abstract":"Introduction: In order to prevent unnecessary deaths and severe morbidity in these patients, it is crucial to evaluate the hemodynamic status of polytrauma patients as well as to screen for continued bleeding and evaluate the effectiveness of resuscitation. Aim of this study: To assess inferior vena cava (IVC) /aortic index importance in assessment of intravascular volume status and in prediction of early blood transfusion in trauma patients. Patients and methods: This study was conducted as a prospective cohort study. The major blunt trauma patients were divided into two groups. Patients group had signs of shock such as decreased blood pressure<90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate >100 b/m, cold clammy skin, capillary refill >2 sec Control group: had normal blood pressure (≥90/60 mmHg) and normal heart rate, no other signs of shock. Results: There were 31 patients (51.7%) required blood transfusion after 24-hour. The mean 24-hour blood transfusion was 1556.3 ± 1081.9. IVC/aortic index 0 at presentation in case group, mean ± SD was 0.60 ± 0.12, while in control group mean ± SD was 0.98 ± 0.08 (p-value < 0.001). IVC/aortic index 1 in case group, mean ± SD was 0.70 ± 0.12, while in control group mean ± SD was 0.94 ± 0.09 (p-value < 0.001). Conclusion: The IVC/aorta diameter index can be used as a parameter for detecting volume status and early blood transfusion in polytrauma patients.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363739
Hassan Abd-elhady Ahmed, A. Elarbagy, M. M. Emara, Y. Yassein, Nesreen Gamal, Eldin Elhelbawy, Omnia Mahmoud Zidan
Background : Patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) are at increased risk of atherosclerosis and cardiovascular event. Paraoxonase 1 has atheroprotective effects through its role in lipid peroxidation. Objectives: This study aimed to check serum paraoxonase 1 level and gene polymorphism (PON 1-Q192R) as an atherosclerotic marker in CKD patients in Menoufia University Hospitals, Egypt. Patients and methods: This case-control study included 65 patients with CKD attending Menoufia University Hospitals. Patients were classified into 2 groups: 30 patients on conservative therapy (Group II) and 35 ESRD patients on regular hemodialysis (HD) more than 6 months (Group III). Thirty healthy age-and gender-matched individuals were evaluated as control group (group I). Complete blood count, lipid profile, blood urea, serum creatinine, C-reactive protein, serum homocysteine and PON1 lactonase activity (human serum paraoxonase 1) were measured using commercially available enzyme-linked immunosorbent assay kits and genetic study (PON 1-Q192R) was determined by Real time polymerase chain reaction (PCR). Carotid intima media thickness (CIMT) was measured through ultrasonographic examination of carotid arteries. Results: CIMT was significantly higher in CKD patients than in control group. Serum PON 1 was significantly lower in ESRD patients on HD than in CKD patients predialysis, which in turn was significantly lower than in healthy control subject. There was statistical significant negative correlation between CIMT and PON 1 level. There was statistically significant difference between patients and control as regards paraoxonase gene polymorphism. Genotype QQ and Q allele were common in CKD & ESRD patients than in control. Conclusion: Serum paraoxonase 1 level may be a potential biomarker of atherosclerosis in CKD patients.
{"title":"Serum Paraoxonase 1 and Gene Polymorphism (PON- Q192R) as an Atherosclerotic Marker in Chronic Kidney Disease Patients in Menoufia University Hospitals- Egypt","authors":"Hassan Abd-elhady Ahmed, A. Elarbagy, M. M. Emara, Y. Yassein, Nesreen Gamal, Eldin Elhelbawy, Omnia Mahmoud Zidan","doi":"10.21608/ejhm.2024.363739","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363739","url":null,"abstract":"Background : Patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) are at increased risk of atherosclerosis and cardiovascular event. Paraoxonase 1 has atheroprotective effects through its role in lipid peroxidation. Objectives: This study aimed to check serum paraoxonase 1 level and gene polymorphism (PON 1-Q192R) as an atherosclerotic marker in CKD patients in Menoufia University Hospitals, Egypt. Patients and methods: This case-control study included 65 patients with CKD attending Menoufia University Hospitals. Patients were classified into 2 groups: 30 patients on conservative therapy (Group II) and 35 ESRD patients on regular hemodialysis (HD) more than 6 months (Group III). Thirty healthy age-and gender-matched individuals were evaluated as control group (group I). Complete blood count, lipid profile, blood urea, serum creatinine, C-reactive protein, serum homocysteine and PON1 lactonase activity (human serum paraoxonase 1) were measured using commercially available enzyme-linked immunosorbent assay kits and genetic study (PON 1-Q192R) was determined by Real time polymerase chain reaction (PCR). Carotid intima media thickness (CIMT) was measured through ultrasonographic examination of carotid arteries. Results: CIMT was significantly higher in CKD patients than in control group. Serum PON 1 was significantly lower in ESRD patients on HD than in CKD patients predialysis, which in turn was significantly lower than in healthy control subject. There was statistical significant negative correlation between CIMT and PON 1 level. There was statistically significant difference between patients and control as regards paraoxonase gene polymorphism. Genotype QQ and Q allele were common in CKD & ESRD patients than in control. Conclusion: Serum paraoxonase 1 level may be a potential biomarker of atherosclerosis in CKD patients.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"56 S22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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