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Hayam Mansour

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Papers by Hayam Mansour

Role of Endoscopic Ultrasound-Fine Needle Aspiration in Management of Submucosal Lesions (SMLs) of GIT and Significant Predictors of Malignancy of GIST Lesions

The Egyptian Journal of Hospital Medicine, 2020

Background: Submucosal lesion is a mass or bulge covered by normal-appearing mucosa identified du... more Background: Submucosal lesion is a mass or bulge covered by normal-appearing mucosa identified during standard endoscopy. Endoscopic Ultrasound (EUS) allows precise differentiation of the individual layers of the gastrointestinal (GI) tract. Endoscopic Ultrasound-Fine Needle Aspiration (EUS-FNA) permits safe and accurate sampling of submucosal lesions (SMLs) for further histopathology. Gastrointestinal stromal tumors are the commonest mesenchymal neoplasms of the GI tract. They should be stratified by malignant potential according to tumor size, location, and mitotic count. Objectives: The aim of work was to evaluate the role of endoscopic ultrasound with EUS-FNA in management of submucosal gastrointestinal lesions, with special concern about gastrointestinal stromal tumors (GISTs) lesions and the criteria highly associated with malignant nature. Patients and methods: This multi-center prospective study included a total of 150 patients with gastrointestinal submucosal lesions, conducted to evaluate EUS and EUS-FNA as diagnostic tools of submucosal lesions, including 68 GIST lesions. All patients underwent conventional endoscopy, EUS-FNA and histopathological examination of the samples obtained in Theodor Bilharz Research Institute, Cairo University Hospital and Kobry El Qubba Military Hospital from 2015 to 2017. Results: There were 150 patients with submucosal GI lesions, including 93(62%) males and 57(38%) females, with the mean age of 52±11.9 years. Presentations included dyspepsia 73(48.7%), asymptomatic SMLs 31(20.7%). The lesions were mainly gastric 102(68%). Final diagnoses were GIST 68 (45.3%), lipoma 11(7.3%), leiomyoma 9(6%) and extramural lesions 7(4.7%). There were 68 patients with GIST lesions, including 43(63.2%) males and 25(36.8%) females, with the mean age of 54±10.3 years. Presentations included dyspepsia 41(63.2%), asymptomatic SMLs 16(23.5%). The lesions were mainly gastric 57(83.8%). Sensitivity and specificity were 88.6% and 100% of EUS-FNA as diagnostic tools for GIST lesions respectively. (PPV) and (NPV) were 100% and 82.8% respectively. Conclusion: It could be concluded that EUS and EUS-FNA were highly significant methods in diagnosis of GIST lesions in relation to final histopathology.

The Plasma Level of miRNA-133a as a Novel Biomarker for Prediction of Left Ventricular Hypertrophy and Dysfunction in Hemodialysis Patients

American Journal of Biochemistry, 2017

Background: Patients with end stage renal disease (ESRD) exhibit high cardiovascular risk related... more Background: Patients with end stage renal disease (ESRD) exhibit high cardiovascular risk related to high incidence of cardiac hypertrophy, cardiomyopathy, heart failure, and coronary artery disease. Early identification of ESRD patients with heightened cardiovascular risk is crucial for further prognosis and tailored therapy. MicroRNAs (miRNAs) have emerged as new biomarkers for additional clinical assessment and to increase the ability for classification of vulnerable ESRD patients with cardiovascular risk. Aim of this work was to measure the circulating levels of miRNA-133a in ESRD patients on regular hemodialysis (HD) compared to healthy persons and to detect the correlation between miRNA-133a levels with left ventricular mass and function. Patients and methods: The present study included 30-ESRD patients on regular HD who were allocated from the nephrology unit, internal medicine department, Alzahraa university hospital. They were compared to 15 age matched apparently healthy volunteers as a control group. Comprehensive conventional echo Doppler and tissue Doppler imaging were performed for both control group and patients immediately after dialysis including assessment of left ventricular (LV) function, LV mass and LV mass index (LVMI) to detect left ventricular hypertrophy (LVH). Patients were classified according to Echo into group I: patients with LVH, group II: patients without LVH. Serum level of high sensitive troponin-T (hs Tr-T) measured by electrochemiluminescence assay and plasma miRNA-133a levels were measured by real time PCR for all patients and control group. Results: The average levels of plasma miRNA-133a were significantly decreased in LVH-HD group compared to non-LVH HD group and healthy controls. The plasma levels of miRNA-133a were negatively correlated with LVMI (r=-0.773, p<0.0001) and LV diastolic function (r=-0.433, p<0.05). A positive correlation was found between miRNA-133a and LVEF-biplane (r=0.613, p<0.0001). We found positive correlation between hsTr-T with LVMI (r=0.574, p<0.0001) while hs Tr-T was negatively correlated with LVEF-biplane (r=-0.434, p<0.05). Conclusion: The levels of miRNA-133a are markedly decreased in HD patients with LVH compared to those without LVH and to control group. The down-regulation of miRNA-133a was associated with more prominent cardiac hypertrophy and more sever LV diastolic dysfunction and significant impairment of LV systolic function. We hypothesize that plasma level of miRNA-133a can be used as a novel biomarker for predicting cardiac hypertrophy and left ventricular dysfunction in HD patients.

FP142ASYMMETRIC Dimethyl Arginine and Cell Free Total Dnaas Diagnostic Markers in Preeclampsia

Nephrology Dialysis Transplantation, 2018

METHODS: B cells (CD19þ) and their subsets innate B1a (CD19þ CD5þ), naive (CD19þ CD27À) , memory ... more METHODS: B cells (CD19þ) and their subsets innate B1a (CD19þ CD5þ), naive (CD19þ CD27À) , memory (CD19þ CD27þ), CD19þ BAFFþ and CD19þ IgMþ, as well as the expression of CD45, a regulator of T-and B-cell antigen receptor signalling on lymphocytes were quantified using flow cytometry in the peripheral blood of 21 pre-dialysis patients, and results were compared to age-matched healthy control group. Exclusion criteria were age <18 or>75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months. Furthermore, CRP, C3, C4, IgG, IgA, and IgM levels were also evaluated. RESULTS: Mean age of the patients (n¼21, M/F 12/9) was 62.46 12.5 years. ESRD patients had reduced lymphocyte count (15796711l/L vs. 22766482l/L, p¼0.005) compared to controls. Likewise, whereas the percentages of B cell subsets were not particularly affected, the absolute number of almost all subsets was significantly smaller in ESRD patients

Hrombin Activatable Fibrinolysis Inhibitor (TAFI) Relationship with Insulin Resistance and Other Risk Factors of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus (DM)

4 Abstract: Type 2 Diabetes Mellitus (DM), is a global public health crisis that threatens the ec... more 4 Abstract: Type 2 Diabetes Mellitus (DM), is a global public health crisis that threatens the economies of all nations, particularly developing countries. Diabetes affects at least 285 million people worldwide and the number is expected to reach 438 million by the year 2030. Egypt is an African country with a population (82 million). By the 2025, Egypt is expected to be among the top ten countries that have the highest prevalence rates of diabetes in the world, notably type 2 DM. Cardiovascular complications are the main cause of mortality in patients with diabetes. Premature atherosclerosis, increased platelet reactivity and activation of coagulation factors with associated hypo fibrinolysis all contribute to increased cardiovascular risk in this population. In fact, type 2 DM is considered the most frequent acquired thrombophilic state. Under physiological conditions, fibrinolytic system is responsible for the lysis of fibrin clot, thus maintaining the blood fluidity. Recently, a...

Clinical evaluation of acute kidney injury in Al-Zahraa University Hospital, Cairo, Egypt

The Egyptian Journal of Internal Medicine, 2017

Background Acute kidney injury (AKI) is a very common problem. Early detection of injury with ini... more Background Acute kidney injury (AKI) is a very common problem. Early detection of injury with initiation of appropriate supportive care remains the mainstay of therapy. Aim The aim of the present study was to evaluate the incidence, etiology, prognosis, treatment, and outcome of AKI. Patients and methods This was a prospective, observational study of 212 patients (137 men and 75 women) who were admitted in all departments of Al-Zahraa University Hospital with AKI during the period from October 2014 to October 2015. Their ages ranged from 22 to 85 years. We included adults aged more than 18 years who presented with AKI, and we excluded patients on regular dialysis. Serum creatinine, sodium, potassium, urea, calcium, phosphorus and uric acid, complete blood count, pelviabdominal ultrasound, and daily measurement of urine output (UOP) were done. AKI patients were classified according to the RIFLE and Acute Kidney Injury Network staging. Result According to the RIFLE criteria, the number of risk, injury, failure, loss, and end-stage renal disease patients were 55 (25.9%), 62 (29.24%), 33 (15.56%), 38 (17.92%), and 24 (11.32%), respectively. According to the Acute Kidney Injury Network staging system, the number of stages I, II, and III patients were 61 (28.7%), 50 (23.5%), and 101 (47.6%), respectively. The length of hospital stay was significantly associated with severity of AKI. The main cause of AKI was dehydration in 82 (38.7%) patients and sepsis in 71 (33.5%). Oliguric patients were 147 (69.34%) and nonoliguric were 65 (30.66%). Moreover, prognosis of patients was complete recovery in 95 (44.81%), partial recovery in 81 (38.21%), and no recovery in 36 (16.98%). Conclusion AKI was more common among patients in ICU than those in any other department. Dehydration and sepsis were its leading causes.

Salivary changes in type 2 diabetic patients

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2017

Objective: this study was conducted to determine the effect of type 2 diabetes mellitus on saliva... more Objective: this study was conducted to determine the effect of type 2 diabetes mellitus on salivary secretion of glucose, amylase and immunoglobulin A levels and also to fined out if saliva could be used as anon invasive method to monitor glycaemic control in type 2 diabbetes. This study was conducted on 40 human subjectes, , They were 20 males and 20 females, their ages ranged from 35 years to 64 years ,and they were divided into two groups, the first one is the patient group which contains 20 diabetic paient. (10 males and 10 females ,aged between 38 years to 64 years). the second one is the control group which contains 20 healthy adult (10 males and 10 females ,aged between 35 years to 60 years) they were age and sex matched. .All studied group were subjected to clinical and laboratory investigation which includes post prandial blood glucose ,HA1C, salivary glucose , salivary amylase, and salivary immunoglobulin A. Results: there was a highly significant increase in the level of post prandial blood glucose , HBA1C; Salivary glucose, Salivary amylase & Salivary immunoglobulin A in diabetic group compared with control group and There was a significant positive correlation between post prandial blood glucose and salivary glucose in diabetic group. Conclusions: These results suggest that diabetes influences the composition of saliva and that saliva can be used as less painful ,non invasive biomarker for monitoring the blood glucose concentration in the patients with diabetes mellitus.

Relationship between vitamin D receptor gene polymorphism FokI and fetuin A as marker of vascular calcification in Egyptian hemodialysis patients

International Journal of Medical Arts, 2020

Background: Vascular calcification is a common complication in end-stage renal disease patients a... more Background: Vascular calcification is a common complication in end-stage renal disease patients and the leading cause of morbidity and mortality. Aim of the work: The current work aimed to evaluate the possible relationship between vitamin D receptor gene polymorphism FokI with fetuin-A and intact parathormone hormone in Egyptian hemodialysis patients. Patient and Methods: This study is a cross-sectional study including 50 hemodialysis patients attending the hemodialysis unit in Al-Zahra University Hospital and 30 apparently healthy persons as a control group. For all studied subjects, a detailed history was taken, physical examination, carotid intima-media thickness by carotid duplex, echocardiography, Laboratory investigations included serum levels of calcium, phosphorus, iPTH, fetuin, and genotype frequency by PCR Results: There was a highly significant increase in carotid intimal media thickness in the patient group Vs. control group & a highly significant decrease in serum Fetuin-A in the patient's group Vs. control group. There was a significant difference in the genotype distribution of FokI polymorphism among patients and control. There were significant negative relationships between FF genotype and iPTH and a highly significant negative correlation between serum fetuin-A and iPTH in the patient group. Conclusion: Vitamin D receptor gene FokI polymorphism FF genotyping is more frequent in hemodialysis patients who have higher iPTH and lower fetuin-A levels, which could identify the high-risk group susceptible to vascular calcification in hemodialysis patients. Further studies are needed.

Serum vaspin: as a predictor of ischemic heart disease in Egyptian hemodialysis patients

The Egyptian Journal of Internal Medicine, 2018

Vaspin is a compensatory adipokine with anti-inflammatory properties that can improve insulin sen... more Vaspin is a compensatory adipokine with anti-inflammatory properties that can improve insulin sensitivity and plays a cardioprotective role. The aim of this study was to evaluate the level of vaspin in patients with end-stage renal disease on hemodialysis (HD) and to determine whether it has any relation to the presence of ischemic heart disease (IHD) in these patients. The study was carried out on 45 HD patients who were divided into 15 patients with risk factors of developing IHD (group I) and 30 patients (group II) proved to have IHD by echocardiography and ECG compared with 20 healthy individuals (group III). We found that the mean±SD of serum vaspin was significantly lower in HD patients with IHD (0.57±0.27) ng/ml compared with the control group (0.74±0.20) ng/ml and there was a negative correlation between serum vaspin and serum creatinine in group I and group II. Also, an receiver operating characteristics study for patients with IHD (group II) yielded a vaspin cut-off value of 0.410 ng/ml with a sensitivity of 40%, a specificity of 100%, a positive predictive value of 100%, and an negative predictive value of 53%, whereas the cut-off value for serum vaspin was 0.485 ng/ ml in patients at risk of developing IHD, with a sensitivity of 100%, a specificity of 85%, a positive predictive value of 83%, and an negative predictive value of 100%. Lower vaspin level is associated independently with IHD in HD patients and can be used as a predictor of IHD in patients with end-stage renal disease.

Assessment of Vascular Calcification in Egyptian Patients with Chronic Kidney Disease

5 Abstract: Vascular calcification is common in chronic kidney disease (CKD) and associated with ... more 5 Abstract: Vascular calcification is common in chronic kidney disease (CKD) and associated with increased morbidity and mortality. This calcification starts to develop in the early stages of chronic kidney disease and is present in over 50% of patients at the time of dialysis commencement. The aim of this study is to assess the degree of calcifications that may involve the main arteries (carotid, aorta) in Egyptian patients with chronic kidney disease and whether there is significant correlation between the age, Parathormone hormone (PTH), serum calcium, serum phosphorus, Ca x Ph product, cholesterol and triglycerides and these calcifications. The study was conducted on 81 individuals classified into three groups: 41 patients with stage 5 chronic kidney disease on regular hemodialysis for at least one year (group A), 30 CKD patients in predialysis period (group B) and 10 persons of normal individuals as control group (group C). All patients and control were subjected to full medica...

SP394ROLE of TLR 2 & Il 6, IL18 in the Pathogenesis of Egyptian Prediaysis Stage 3 & 4 CKD Patients

Nephrology Dialysis Transplantation, 2018

Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by ... more Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by the world today with new cases being added at an alarming rate. Controlling traditional risk factors has not been effective in bringing down the incidence of the disease. CKD is associated with inflammation, morbidity, poor quality of life, decreased life-expectancy and death. Chronic inflammation is associated with complications and comorbidities frequently seen in CKD. Toll-like receptors (TLRs) are members of innate immune receptors that regulate inflammatory and immune responses and stimulate both immune and nonimmune cells to express inflammatory cytokines and chemokines. Objective: To evaluate the potential role of TLR-2 and proinflammatory cytokines in the pathogenesis of stage 3-4 CKD which could be used to pave the way for prophylactic or therapeutic procedures. Subjects and methods: This study was carried out on 20 patients with stage 3-4 CKD and 10 age and sex matched controls. The percentage of CD14 + monocytes expressing TLR-2 and mean florescence intensity (MFI) of TLR-2 on CD14 + monocytes were detected by flowcytometry, while the serum levels of interleukin-6 (IL-6) and IL-18 were measured by enzyme linked immunosorbent assay (ELISA). Results: There was insignificant difference between the percentage of CD14 + monocytes expressing TLR-2 in both patients and control groups(p > 0.05), while there was a highly significant increase in MFI of TLR-2 on CD14 + monocytes, serum IL-6 and serum IL-18 levels in stage 3-4 CKD patients when compared to controls (p ≤ 0.01). There was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum creatinine level (p≤ 0.05, r=0.538) and a highly significant positive correlation between IL-6 serum level and serum creatinine level in patients group (p ≤ 0.01, r= 0.672). Also there was a highly significant negative correlation between MFI of TLR-2 on CD14 + monocyte and estimated glomerular filtration rate (eGFR) (p ≤ 0.01, r=-0.667), and a significant negative correlation between IL-6 and eGFR in patients group (p ≤ 0.05, r=-0.516). Finally, there was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum IL-6 level in patients group (p≤ 0.05 , r = 0.473), while the correlation between serum IL-18 level and serum creatinine level, eGFR, MFI of TLR-2 on CD14 + monocyte and serum IL-6 level in patients group was insignificant (p> 0.05, r =0.168,-0.196,-0.057,-0.010 respectively). Conclusions: This study demonstrated that the expression of TLR-2 on CD14 + monocytes was up regulated in stage 3-4 CKD patients and was associated with inflammatory response as assessed by increased serum levels of IL-6 and IL-18. These findings indicated that TLR-2, IL-6 and IL-18 played a significant role in pathogenesis of CKD.

Detection Of Angiotensin Converting Enzyme Gene Polymorphism In Egyptian Patients With Diabetic Nephropathy

Introduction and aim of the study: Approximately 10 - 40% of diabetic patients develop diabetic n... more Introduction and aim of the study: Approximately 10 - 40% of diabetic patients develop diabetic nephropathy. The pathogenesis of this drastic complication is not clearly understood; but available data suggest that multiple factors contribute to this complication. Several publications suggested that genetic predisposition played a role in development of diabetic nephropathy which clusters within families in both type I and type II diabetes mellitus. The present study was performed to evaluate the association between angiotensin converting-enzyme gene (ACE) insertion (I)/ deletion (D) polymorphism and diabetic nephropathy, this could lead to better understanding of different phenotypes observed in diabetes and would determine whether a patient is genetically predisposed to such complication or not. Methods: The study was conducted on 40 patients with diabetic nephropathy (group I) and 30 diabetic patients without nephropathy (group II).Both groups were subjected to full history includ...

Asymmetric Dimethyl Arginine and Cell Free Total DNA as Diagnostic Markers in Preeclampsia

Clinical Medicine and Diagnostics, 2017

This study was conducted to evaluate the predictive value of cell-free total DNA (cfDNA), asymmet... more This study was conducted to evaluate the predictive value of cell-free total DNA (cfDNA), asymmetric dimethyl arginine (ADMA) and compare between them in early diagnosis of preeclampsia (PE). This study was carried on twenty-five females with multiple pregnancies and had preeclampsia (preeclampsia group); they were admitted to obstetrics & gynecology department and followed by nephrologist or seen in nephrology & gynecology outpatient clinics of Al-Zahra University Hospital. Preeclampsia was diagnosed by the increased blood pressure ≥140 mm Hg systolic and ≥90 mm Hg diastolic measured on two occasions at least four hours apart accompanied by proteinuria—urinary excretion of more than 0.3g protein in a 24hr specimen. The control group consisted of age-matched twenty healthy pregnant women who had no medical problems, were normotensive throughout pregnancy and had neither proteinuria nor hyperuricemia (control group). All studied groups were subjected to full medical history, clinical...

Fetuin a as an Early Marker of Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus

Background: Fetuin-A is a liver-derived plasma protein, mediates the formation and stabilization ... more Background: Fetuin-A is a liver-derived plasma protein, mediates the formation and stabilization of calciprotein particles formation, ensures mineral solubilization, thus preventing pathological calcification, also it promotes insulin resistance. Objective: To study the role of fetuin A as a marker for early diabetic nephropathy in type 2 diabetes mellitus. Subjects and Methods: Cross sectional study including 30 diabetic patients without microalbuminuria (group I), 30 diabetic patients with microalbuminuria (Group II) and age and sex matched 30 healthy subjects served as a control group. All patients and control subjects were thoroughly examined clinically. Fasting and post prandial blood sugar, HbA1c, renal function tests, lipid profile, creatinine clearance, albumin/creatinine ratio and serum fetuin A by ELISA were investigated. Results: Serum Fetuin A increased in diabetic nephropathy patients without microabuminuria compared to those with microabuminuria. Significant negative c...

Role of TLR-2, IL-6 and IL-18 in the Pathogenesis of Egyptian Predialysis CKD Patients

Background:Chronic Kidney Disease (CKD) is one of the most important health challenges faced by t... more Background:Chronic Kidney Disease (CKD) is one of the most important health challenges faced by the world today with new cases being added at an alarming rate. Controlling traditional risk factors has not been effective in bringing down the incidence of the disease. CKD is associated with inflammation, morbidity, poor quality of life, decreased life-expectancy and death. Chronic inflammation is associated with complications and comorbidities frequently seen in CKD. Toll-like receptors (TLRs) are members of innate immune receptors that regulate inflammatory and immune responses and stimulate both immune and nonimmune cells to express inflammatory cytokines and chemokines. Objective:To evaluate the potential role of TLR-2 and proinflammatory cytokines in the pathogenesis of stage 3-4 CKD which could be used to pave the way for prophylactic or therapeutic procedures. Subjects and methods:This study was carried out on 20 patients with stage 3-4 CKD and 10age and sex matched controls. Th...

Serum magnesium level in maintenance hemodialysis and cardiovascular calcification

The Scientific Journal of Al-Azhar Medical Faculty, Girls

Background Patients with chronic kidney disease have a high prevalence of vascular calcification,... more Background Patients with chronic kidney disease have a high prevalence of vascular calcification, and cardiovascular disease is the leading cause of death. Magnesium (Mg) is a natural calcium antagonist and many studies have shown that low circulating levels of Mg are associated with vascular calcification. Aim of the work The aim of the study was to assess the relationship between serum Mg levels and vascular calcification in chronic hemodialysis (HD) patients. Patients and methods A cross-sectional study conducted on 60 patients with end-stage renal disease on regular HD in Al-Zahraa University Hospital (group I) compared with 30 healthy controls (group II), from June to December 2017. Patients with evidence of infection, chronic diarrhea, ileostomy, and those receiving Mg-based phosphate binders were excluded from the study. All studied groups were submitted to clinical examination, renal function, lipid profile, serum albumen, calcium, phosphorus, intact parathyroid hormone, Mg, carotid duplex, echocardiography, ECG, and lateral view plain abdominal radiograph. Results There were highly significant differences regarding Mg and carotid intimal medial thickness (CIMT) in group I compared with group II: 1.51±0.28, 0.89±0.30 and 2.47±0.18, 0.45±0.08 respectively, P<0.001. Echocardiographic findings showed calcified mitral and aortic valves in 12 (20%) patients and calcified abdominal aorta by abdominal X-ray radiograph in 20 (33.33%) patients. There were highly significant negative correlation between serum Mg and CIMT and abdominal aortic calcification in group I. Conclusion The patients on maintenance HD have lower serum Mg levels. It was associated with increased CIMT and vascular calcification if compared with healthy group and concomitant use of proton pump inhibitors may aggravate this hypomagnesemia. So serum Mg level in maintenance HD patients could be a potential biomarker for cardiovascular calcifications.

Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Relationship with Insulin Resistance and Other Risk Factors of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus (DM) 1Emad A. Nafie, 2Nagwa Abd El-Ghaffar Mohammad, 3Gamila S.M. EL-Saeed, 1Amany M. Abdallah, 1Hayam H. Mansour, 1Gh...

World Journal of Medical Sciences

Cutaneous Manifestations in Egyptian Patients with Chronic Renal Failure on Regular Hemodialysis

Background. Hemodialysis patients experience frequent and various cutaneous manifestations of oft... more Background. Hemodialysis patients experience frequent and various cutaneous manifestations of often hypothetical pathogenesis. Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Objective. To evaluate the prevalence and nature of cutaneous lesions, associated with CRF patients on hemodialysis in Egyptian patients. Patients and methods. One hundred patients with CRF on regular hemodialysis from nephrology units were examined for cutaneous changes. Specific investigations like skin biopsy, culture and sensitivity for bacterial infections, potassium hydroxide mount and fungal culture were done when indicated. Results. All patients included in this study had at least one cutaneous manifestation attributable to CRF. The most prevalent findings was pruritus (55%), followed by xerosis (54%), hyperpigmentation (54%) and pallor (45%). Other cutaneous manifestations were wrinkles (40%), fungal infections (33%), ecchymosis (27%), dermatitis (23%), yellow face (22%)...

Semaphorin 5A, Anti-Nucleosome Antibodies and Ferritin: Disease Activity Markers in Patients with Systemic Lupus Erythematosus

Journal of Clinical & Cellular Immunology

Background: Systemic Lupus Erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder ... more Background: Systemic Lupus Erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder characterized by dysfunction of T and B lymphocytes. Although the prognosis of SLE has improved in the past few decades, the absence of biomarkers for residual activity in various organs and the early detection of disease flares hamper further management. Conventional serologic markers of SLE, such as anti-dsDNA and complement levels, are not ideal, as they are not sufficiently sensitive and specific for the diagnosis of the disease and monitoring of disease activity. Thus, novel biomarkers for SLE activity have to be developed. Semaphorin 5A (Sema 5A), antinuclosome antibody (Anu A) and ferritin may fall into this category of novel bio markers. Objective: To evaluate the role of serum Sema 5A, Anu A and ferritin in detection of SLE activity. Methods: The present study included 40 patients with SLE divided according to Systemic Lupus Erythematous Disease Activity Index (SLEDAI) into two groups: 20 active SLE and 20 inactive SLE patients. They were compared with 20, sex and age matched healthy individuals for control. Levels of Sema 5A, Anu A were measured by Enzyme-Linked Immunosorbent Assay (ELISA) and serum ferritin levels were measured by Electrochemiluminescence immunoassay (ECLIA). Results: There was highly significant increase in Sema 5A, Anu A and ferritin levels inactive when compared within active SLE patients and control subjects (P=0.000 and P=0.000 and P=0.000 respectively). There was a significant increase in ferritin level in inactive SLE patients when compared with control subjects (P=0.045) with no significant difference regarding Sema 5A, Anu A (P3=0.089 and 0.225 respectively). There were positive correlations between Sema 5A, Anu A, ferritin and each of SLEDAI, and CRP. Positive correlation also found between Sema 5A and each of Anu A and ferritin and between AnuA and ferritin. Negative correlation was found between Sema 5A and C3 and between Anu A, ferritin and C4. Significant relation was found between Sema 5A, Anu A, ferritin and each of ANA and anti-dsDNA in active SLE patients. Area under the curve (AUC) for ferritin, Sema 5A and Anu A were (0.861, 1.0 and 1.0 respectively). Conclusion: Our study showed that the serum proteins semaphorin 5A, antinuclosome antibodies and ferritin may be useful markers in monitoring disease activity in patients with SLE. Regarding area under the curve (AUC), these serum protein markers result in even better sensitivity and specificity profiles in picking up early relapse of SLE.

SP138Egyptian Experience of Ombitasvir/Paritaprevir/Ritonavir plus Ribavirin in Treatment of Chronic Hepatitis C Patients with End Stage Renal Disease on Regular Hemodialysis

Nephrology Dialysis Transplantation

Role of TLR-2, IL-6 and IL-18 in the Pathogenesis of Egyptian Predialysis CKD Patients

Clinical Medicine and Diagnostics, 2014

Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by ... more Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by the world today with new cases being added at an alarming rate. Controlling traditional risk factors has not been effective in bringing down the incidence of the disease. CKD is associated with inflammation, morbidity, poor quality of life, decreased life-expectancy and death. Chronic inflammation is associated with complications and comorbidities frequently seen in CKD. Toll-like receptors (TLRs) are members of innate immune receptors that regulate inflammatory and immune responses and stimulate both immune and nonimmune cells to express inflammatory cytokines and chemokines. Objective: To evaluate the potential role of TLR-2 and proinflammatory cytokines in the pathogenesis of stage 3-4 CKD which could be used to pave the way for prophylactic or therapeutic procedures. Subjects and methods: This study was carried out on 20 patients with stage 3-4 CKD and 10 age and sex matched controls. The percentage of CD14 + monocytes expressing TLR-2 and mean florescence intensity (MFI) of TLR-2 on CD14 + monocytes were detected by flowcytometry, while the serum levels of interleukin-6 (IL-6) and IL-18 were measured by enzyme linked immunosorbent assay (ELISA). Results: There was insignificant difference between the percentage of CD14 + monocytes expressing TLR-2 in both patients and control groups(p > 0.05), while there was a highly significant increase in MFI of TLR-2 on CD14 + monocytes, serum IL-6 and serum IL-18 levels in stage 3-4 CKD patients when compared to controls (p ≤ 0.01). There was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum creatinine level (p≤ 0.05, r=0.538) and a highly significant positive correlation between IL-6 serum level and serum creatinine level in patients group (p ≤ 0.01, r= 0.672). Also there was a highly significant negative correlation between MFI of TLR-2 on CD14 + monocyte and estimated glomerular filtration rate (eGFR) (p ≤ 0.01, r=-0.667), and a significant negative correlation between IL-6 and eGFR in patients group (p ≤ 0.05, r=-0.516). Finally, there was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum IL-6 level in patients group (p≤ 0.05 , r = 0.473), while the correlation between serum IL-18 level and serum creatinine level, eGFR, MFI of TLR-2 on CD14 + monocyte and serum IL-6 level in patients group was insignificant (p> 0.05, r =0.168,-0.196,-0.057,-0.010 respectively). Conclusions: This study demonstrated that the expression of TLR-2 on CD14 + monocytes was up regulated in stage 3-4 CKD patients and was associated with inflammatory response as assessed by increased serum levels of IL-6 and IL-18. These findings indicated that TLR-2, IL-6 and IL-18 played a significant role in pathogenesis of CKD.

Role of Endoscopic Ultrasound-Fine Needle Aspiration in Management of Submucosal Lesions (SMLs) of GIT and Significant Predictors of Malignancy of GIST Lesions

The Egyptian Journal of Hospital Medicine, 2020

Background: Submucosal lesion is a mass or bulge covered by normal-appearing mucosa identified du... more Background: Submucosal lesion is a mass or bulge covered by normal-appearing mucosa identified during standard endoscopy. Endoscopic Ultrasound (EUS) allows precise differentiation of the individual layers of the gastrointestinal (GI) tract. Endoscopic Ultrasound-Fine Needle Aspiration (EUS-FNA) permits safe and accurate sampling of submucosal lesions (SMLs) for further histopathology. Gastrointestinal stromal tumors are the commonest mesenchymal neoplasms of the GI tract. They should be stratified by malignant potential according to tumor size, location, and mitotic count. Objectives: The aim of work was to evaluate the role of endoscopic ultrasound with EUS-FNA in management of submucosal gastrointestinal lesions, with special concern about gastrointestinal stromal tumors (GISTs) lesions and the criteria highly associated with malignant nature. Patients and methods: This multi-center prospective study included a total of 150 patients with gastrointestinal submucosal lesions, conducted to evaluate EUS and EUS-FNA as diagnostic tools of submucosal lesions, including 68 GIST lesions. All patients underwent conventional endoscopy, EUS-FNA and histopathological examination of the samples obtained in Theodor Bilharz Research Institute, Cairo University Hospital and Kobry El Qubba Military Hospital from 2015 to 2017. Results: There were 150 patients with submucosal GI lesions, including 93(62%) males and 57(38%) females, with the mean age of 52±11.9 years. Presentations included dyspepsia 73(48.7%), asymptomatic SMLs 31(20.7%). The lesions were mainly gastric 102(68%). Final diagnoses were GIST 68 (45.3%), lipoma 11(7.3%), leiomyoma 9(6%) and extramural lesions 7(4.7%). There were 68 patients with GIST lesions, including 43(63.2%) males and 25(36.8%) females, with the mean age of 54±10.3 years. Presentations included dyspepsia 41(63.2%), asymptomatic SMLs 16(23.5%). The lesions were mainly gastric 57(83.8%). Sensitivity and specificity were 88.6% and 100% of EUS-FNA as diagnostic tools for GIST lesions respectively. (PPV) and (NPV) were 100% and 82.8% respectively. Conclusion: It could be concluded that EUS and EUS-FNA were highly significant methods in diagnosis of GIST lesions in relation to final histopathology.

The Plasma Level of miRNA-133a as a Novel Biomarker for Prediction of Left Ventricular Hypertrophy and Dysfunction in Hemodialysis Patients

American Journal of Biochemistry, 2017

Background: Patients with end stage renal disease (ESRD) exhibit high cardiovascular risk related... more Background: Patients with end stage renal disease (ESRD) exhibit high cardiovascular risk related to high incidence of cardiac hypertrophy, cardiomyopathy, heart failure, and coronary artery disease. Early identification of ESRD patients with heightened cardiovascular risk is crucial for further prognosis and tailored therapy. MicroRNAs (miRNAs) have emerged as new biomarkers for additional clinical assessment and to increase the ability for classification of vulnerable ESRD patients with cardiovascular risk. Aim of this work was to measure the circulating levels of miRNA-133a in ESRD patients on regular hemodialysis (HD) compared to healthy persons and to detect the correlation between miRNA-133a levels with left ventricular mass and function. Patients and methods: The present study included 30-ESRD patients on regular HD who were allocated from the nephrology unit, internal medicine department, Alzahraa university hospital. They were compared to 15 age matched apparently healthy volunteers as a control group. Comprehensive conventional echo Doppler and tissue Doppler imaging were performed for both control group and patients immediately after dialysis including assessment of left ventricular (LV) function, LV mass and LV mass index (LVMI) to detect left ventricular hypertrophy (LVH). Patients were classified according to Echo into group I: patients with LVH, group II: patients without LVH. Serum level of high sensitive troponin-T (hs Tr-T) measured by electrochemiluminescence assay and plasma miRNA-133a levels were measured by real time PCR for all patients and control group. Results: The average levels of plasma miRNA-133a were significantly decreased in LVH-HD group compared to non-LVH HD group and healthy controls. The plasma levels of miRNA-133a were negatively correlated with LVMI (r=-0.773, p<0.0001) and LV diastolic function (r=-0.433, p<0.05). A positive correlation was found between miRNA-133a and LVEF-biplane (r=0.613, p<0.0001). We found positive correlation between hsTr-T with LVMI (r=0.574, p<0.0001) while hs Tr-T was negatively correlated with LVEF-biplane (r=-0.434, p<0.05). Conclusion: The levels of miRNA-133a are markedly decreased in HD patients with LVH compared to those without LVH and to control group. The down-regulation of miRNA-133a was associated with more prominent cardiac hypertrophy and more sever LV diastolic dysfunction and significant impairment of LV systolic function. We hypothesize that plasma level of miRNA-133a can be used as a novel biomarker for predicting cardiac hypertrophy and left ventricular dysfunction in HD patients.

FP142ASYMMETRIC Dimethyl Arginine and Cell Free Total Dnaas Diagnostic Markers in Preeclampsia

Nephrology Dialysis Transplantation, 2018

METHODS: B cells (CD19þ) and their subsets innate B1a (CD19þ CD5þ), naive (CD19þ CD27À) , memory ... more METHODS: B cells (CD19þ) and their subsets innate B1a (CD19þ CD5þ), naive (CD19þ CD27À) , memory (CD19þ CD27þ), CD19þ BAFFþ and CD19þ IgMþ, as well as the expression of CD45, a regulator of T-and B-cell antigen receptor signalling on lymphocytes were quantified using flow cytometry in the peripheral blood of 21 pre-dialysis patients, and results were compared to age-matched healthy control group. Exclusion criteria were age <18 or>75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months. Furthermore, CRP, C3, C4, IgG, IgA, and IgM levels were also evaluated. RESULTS: Mean age of the patients (n¼21, M/F 12/9) was 62.46 12.5 years. ESRD patients had reduced lymphocyte count (15796711l/L vs. 22766482l/L, p¼0.005) compared to controls. Likewise, whereas the percentages of B cell subsets were not particularly affected, the absolute number of almost all subsets was significantly smaller in ESRD patients

Hrombin Activatable Fibrinolysis Inhibitor (TAFI) Relationship with Insulin Resistance and Other Risk Factors of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus (DM)

4 Abstract: Type 2 Diabetes Mellitus (DM), is a global public health crisis that threatens the ec... more 4 Abstract: Type 2 Diabetes Mellitus (DM), is a global public health crisis that threatens the economies of all nations, particularly developing countries. Diabetes affects at least 285 million people worldwide and the number is expected to reach 438 million by the year 2030. Egypt is an African country with a population (82 million). By the 2025, Egypt is expected to be among the top ten countries that have the highest prevalence rates of diabetes in the world, notably type 2 DM. Cardiovascular complications are the main cause of mortality in patients with diabetes. Premature atherosclerosis, increased platelet reactivity and activation of coagulation factors with associated hypo fibrinolysis all contribute to increased cardiovascular risk in this population. In fact, type 2 DM is considered the most frequent acquired thrombophilic state. Under physiological conditions, fibrinolytic system is responsible for the lysis of fibrin clot, thus maintaining the blood fluidity. Recently, a...

Clinical evaluation of acute kidney injury in Al-Zahraa University Hospital, Cairo, Egypt

The Egyptian Journal of Internal Medicine, 2017

Background Acute kidney injury (AKI) is a very common problem. Early detection of injury with ini... more Background Acute kidney injury (AKI) is a very common problem. Early detection of injury with initiation of appropriate supportive care remains the mainstay of therapy. Aim The aim of the present study was to evaluate the incidence, etiology, prognosis, treatment, and outcome of AKI. Patients and methods This was a prospective, observational study of 212 patients (137 men and 75 women) who were admitted in all departments of Al-Zahraa University Hospital with AKI during the period from October 2014 to October 2015. Their ages ranged from 22 to 85 years. We included adults aged more than 18 years who presented with AKI, and we excluded patients on regular dialysis. Serum creatinine, sodium, potassium, urea, calcium, phosphorus and uric acid, complete blood count, pelviabdominal ultrasound, and daily measurement of urine output (UOP) were done. AKI patients were classified according to the RIFLE and Acute Kidney Injury Network staging. Result According to the RIFLE criteria, the number of risk, injury, failure, loss, and end-stage renal disease patients were 55 (25.9%), 62 (29.24%), 33 (15.56%), 38 (17.92%), and 24 (11.32%), respectively. According to the Acute Kidney Injury Network staging system, the number of stages I, II, and III patients were 61 (28.7%), 50 (23.5%), and 101 (47.6%), respectively. The length of hospital stay was significantly associated with severity of AKI. The main cause of AKI was dehydration in 82 (38.7%) patients and sepsis in 71 (33.5%). Oliguric patients were 147 (69.34%) and nonoliguric were 65 (30.66%). Moreover, prognosis of patients was complete recovery in 95 (44.81%), partial recovery in 81 (38.21%), and no recovery in 36 (16.98%). Conclusion AKI was more common among patients in ICU than those in any other department. Dehydration and sepsis were its leading causes.

Salivary changes in type 2 diabetic patients

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2017

Objective: this study was conducted to determine the effect of type 2 diabetes mellitus on saliva... more Objective: this study was conducted to determine the effect of type 2 diabetes mellitus on salivary secretion of glucose, amylase and immunoglobulin A levels and also to fined out if saliva could be used as anon invasive method to monitor glycaemic control in type 2 diabbetes. This study was conducted on 40 human subjectes, , They were 20 males and 20 females, their ages ranged from 35 years to 64 years ,and they were divided into two groups, the first one is the patient group which contains 20 diabetic paient. (10 males and 10 females ,aged between 38 years to 64 years). the second one is the control group which contains 20 healthy adult (10 males and 10 females ,aged between 35 years to 60 years) they were age and sex matched. .All studied group were subjected to clinical and laboratory investigation which includes post prandial blood glucose ,HA1C, salivary glucose , salivary amylase, and salivary immunoglobulin A. Results: there was a highly significant increase in the level of post prandial blood glucose , HBA1C; Salivary glucose, Salivary amylase & Salivary immunoglobulin A in diabetic group compared with control group and There was a significant positive correlation between post prandial blood glucose and salivary glucose in diabetic group. Conclusions: These results suggest that diabetes influences the composition of saliva and that saliva can be used as less painful ,non invasive biomarker for monitoring the blood glucose concentration in the patients with diabetes mellitus.

Relationship between vitamin D receptor gene polymorphism FokI and fetuin A as marker of vascular calcification in Egyptian hemodialysis patients

International Journal of Medical Arts, 2020

Background: Vascular calcification is a common complication in end-stage renal disease patients a... more Background: Vascular calcification is a common complication in end-stage renal disease patients and the leading cause of morbidity and mortality. Aim of the work: The current work aimed to evaluate the possible relationship between vitamin D receptor gene polymorphism FokI with fetuin-A and intact parathormone hormone in Egyptian hemodialysis patients. Patient and Methods: This study is a cross-sectional study including 50 hemodialysis patients attending the hemodialysis unit in Al-Zahra University Hospital and 30 apparently healthy persons as a control group. For all studied subjects, a detailed history was taken, physical examination, carotid intima-media thickness by carotid duplex, echocardiography, Laboratory investigations included serum levels of calcium, phosphorus, iPTH, fetuin, and genotype frequency by PCR Results: There was a highly significant increase in carotid intimal media thickness in the patient group Vs. control group & a highly significant decrease in serum Fetuin-A in the patient's group Vs. control group. There was a significant difference in the genotype distribution of FokI polymorphism among patients and control. There were significant negative relationships between FF genotype and iPTH and a highly significant negative correlation between serum fetuin-A and iPTH in the patient group. Conclusion: Vitamin D receptor gene FokI polymorphism FF genotyping is more frequent in hemodialysis patients who have higher iPTH and lower fetuin-A levels, which could identify the high-risk group susceptible to vascular calcification in hemodialysis patients. Further studies are needed.

Serum vaspin: as a predictor of ischemic heart disease in Egyptian hemodialysis patients

The Egyptian Journal of Internal Medicine, 2018

Vaspin is a compensatory adipokine with anti-inflammatory properties that can improve insulin sen... more Vaspin is a compensatory adipokine with anti-inflammatory properties that can improve insulin sensitivity and plays a cardioprotective role. The aim of this study was to evaluate the level of vaspin in patients with end-stage renal disease on hemodialysis (HD) and to determine whether it has any relation to the presence of ischemic heart disease (IHD) in these patients. The study was carried out on 45 HD patients who were divided into 15 patients with risk factors of developing IHD (group I) and 30 patients (group II) proved to have IHD by echocardiography and ECG compared with 20 healthy individuals (group III). We found that the mean±SD of serum vaspin was significantly lower in HD patients with IHD (0.57±0.27) ng/ml compared with the control group (0.74±0.20) ng/ml and there was a negative correlation between serum vaspin and serum creatinine in group I and group II. Also, an receiver operating characteristics study for patients with IHD (group II) yielded a vaspin cut-off value of 0.410 ng/ml with a sensitivity of 40%, a specificity of 100%, a positive predictive value of 100%, and an negative predictive value of 53%, whereas the cut-off value for serum vaspin was 0.485 ng/ ml in patients at risk of developing IHD, with a sensitivity of 100%, a specificity of 85%, a positive predictive value of 83%, and an negative predictive value of 100%. Lower vaspin level is associated independently with IHD in HD patients and can be used as a predictor of IHD in patients with end-stage renal disease.

Assessment of Vascular Calcification in Egyptian Patients with Chronic Kidney Disease

5 Abstract: Vascular calcification is common in chronic kidney disease (CKD) and associated with ... more 5 Abstract: Vascular calcification is common in chronic kidney disease (CKD) and associated with increased morbidity and mortality. This calcification starts to develop in the early stages of chronic kidney disease and is present in over 50% of patients at the time of dialysis commencement. The aim of this study is to assess the degree of calcifications that may involve the main arteries (carotid, aorta) in Egyptian patients with chronic kidney disease and whether there is significant correlation between the age, Parathormone hormone (PTH), serum calcium, serum phosphorus, Ca x Ph product, cholesterol and triglycerides and these calcifications. The study was conducted on 81 individuals classified into three groups: 41 patients with stage 5 chronic kidney disease on regular hemodialysis for at least one year (group A), 30 CKD patients in predialysis period (group B) and 10 persons of normal individuals as control group (group C). All patients and control were subjected to full medica...

SP394ROLE of TLR 2 & Il 6, IL18 in the Pathogenesis of Egyptian Prediaysis Stage 3 & 4 CKD Patients

Nephrology Dialysis Transplantation, 2018

Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by ... more Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by the world today with new cases being added at an alarming rate. Controlling traditional risk factors has not been effective in bringing down the incidence of the disease. CKD is associated with inflammation, morbidity, poor quality of life, decreased life-expectancy and death. Chronic inflammation is associated with complications and comorbidities frequently seen in CKD. Toll-like receptors (TLRs) are members of innate immune receptors that regulate inflammatory and immune responses and stimulate both immune and nonimmune cells to express inflammatory cytokines and chemokines. Objective: To evaluate the potential role of TLR-2 and proinflammatory cytokines in the pathogenesis of stage 3-4 CKD which could be used to pave the way for prophylactic or therapeutic procedures. Subjects and methods: This study was carried out on 20 patients with stage 3-4 CKD and 10 age and sex matched controls. The percentage of CD14 + monocytes expressing TLR-2 and mean florescence intensity (MFI) of TLR-2 on CD14 + monocytes were detected by flowcytometry, while the serum levels of interleukin-6 (IL-6) and IL-18 were measured by enzyme linked immunosorbent assay (ELISA). Results: There was insignificant difference between the percentage of CD14 + monocytes expressing TLR-2 in both patients and control groups(p > 0.05), while there was a highly significant increase in MFI of TLR-2 on CD14 + monocytes, serum IL-6 and serum IL-18 levels in stage 3-4 CKD patients when compared to controls (p ≤ 0.01). There was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum creatinine level (p≤ 0.05, r=0.538) and a highly significant positive correlation between IL-6 serum level and serum creatinine level in patients group (p ≤ 0.01, r= 0.672). Also there was a highly significant negative correlation between MFI of TLR-2 on CD14 + monocyte and estimated glomerular filtration rate (eGFR) (p ≤ 0.01, r=-0.667), and a significant negative correlation between IL-6 and eGFR in patients group (p ≤ 0.05, r=-0.516). Finally, there was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum IL-6 level in patients group (p≤ 0.05 , r = 0.473), while the correlation between serum IL-18 level and serum creatinine level, eGFR, MFI of TLR-2 on CD14 + monocyte and serum IL-6 level in patients group was insignificant (p> 0.05, r =0.168,-0.196,-0.057,-0.010 respectively). Conclusions: This study demonstrated that the expression of TLR-2 on CD14 + monocytes was up regulated in stage 3-4 CKD patients and was associated with inflammatory response as assessed by increased serum levels of IL-6 and IL-18. These findings indicated that TLR-2, IL-6 and IL-18 played a significant role in pathogenesis of CKD.

Detection Of Angiotensin Converting Enzyme Gene Polymorphism In Egyptian Patients With Diabetic Nephropathy

Introduction and aim of the study: Approximately 10 - 40% of diabetic patients develop diabetic n... more Introduction and aim of the study: Approximately 10 - 40% of diabetic patients develop diabetic nephropathy. The pathogenesis of this drastic complication is not clearly understood; but available data suggest that multiple factors contribute to this complication. Several publications suggested that genetic predisposition played a role in development of diabetic nephropathy which clusters within families in both type I and type II diabetes mellitus. The present study was performed to evaluate the association between angiotensin converting-enzyme gene (ACE) insertion (I)/ deletion (D) polymorphism and diabetic nephropathy, this could lead to better understanding of different phenotypes observed in diabetes and would determine whether a patient is genetically predisposed to such complication or not. Methods: The study was conducted on 40 patients with diabetic nephropathy (group I) and 30 diabetic patients without nephropathy (group II).Both groups were subjected to full history includ...

Asymmetric Dimethyl Arginine and Cell Free Total DNA as Diagnostic Markers in Preeclampsia

Clinical Medicine and Diagnostics, 2017

This study was conducted to evaluate the predictive value of cell-free total DNA (cfDNA), asymmet... more This study was conducted to evaluate the predictive value of cell-free total DNA (cfDNA), asymmetric dimethyl arginine (ADMA) and compare between them in early diagnosis of preeclampsia (PE). This study was carried on twenty-five females with multiple pregnancies and had preeclampsia (preeclampsia group); they were admitted to obstetrics & gynecology department and followed by nephrologist or seen in nephrology & gynecology outpatient clinics of Al-Zahra University Hospital. Preeclampsia was diagnosed by the increased blood pressure ≥140 mm Hg systolic and ≥90 mm Hg diastolic measured on two occasions at least four hours apart accompanied by proteinuria—urinary excretion of more than 0.3g protein in a 24hr specimen. The control group consisted of age-matched twenty healthy pregnant women who had no medical problems, were normotensive throughout pregnancy and had neither proteinuria nor hyperuricemia (control group). All studied groups were subjected to full medical history, clinical...

Fetuin a as an Early Marker of Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus

Background: Fetuin-A is a liver-derived plasma protein, mediates the formation and stabilization ... more Background: Fetuin-A is a liver-derived plasma protein, mediates the formation and stabilization of calciprotein particles formation, ensures mineral solubilization, thus preventing pathological calcification, also it promotes insulin resistance. Objective: To study the role of fetuin A as a marker for early diabetic nephropathy in type 2 diabetes mellitus. Subjects and Methods: Cross sectional study including 30 diabetic patients without microalbuminuria (group I), 30 diabetic patients with microalbuminuria (Group II) and age and sex matched 30 healthy subjects served as a control group. All patients and control subjects were thoroughly examined clinically. Fasting and post prandial blood sugar, HbA1c, renal function tests, lipid profile, creatinine clearance, albumin/creatinine ratio and serum fetuin A by ELISA were investigated. Results: Serum Fetuin A increased in diabetic nephropathy patients without microabuminuria compared to those with microabuminuria. Significant negative c...

Role of TLR-2, IL-6 and IL-18 in the Pathogenesis of Egyptian Predialysis CKD Patients

Background:Chronic Kidney Disease (CKD) is one of the most important health challenges faced by t... more Background:Chronic Kidney Disease (CKD) is one of the most important health challenges faced by the world today with new cases being added at an alarming rate. Controlling traditional risk factors has not been effective in bringing down the incidence of the disease. CKD is associated with inflammation, morbidity, poor quality of life, decreased life-expectancy and death. Chronic inflammation is associated with complications and comorbidities frequently seen in CKD. Toll-like receptors (TLRs) are members of innate immune receptors that regulate inflammatory and immune responses and stimulate both immune and nonimmune cells to express inflammatory cytokines and chemokines. Objective:To evaluate the potential role of TLR-2 and proinflammatory cytokines in the pathogenesis of stage 3-4 CKD which could be used to pave the way for prophylactic or therapeutic procedures. Subjects and methods:This study was carried out on 20 patients with stage 3-4 CKD and 10age and sex matched controls. Th...

Serum magnesium level in maintenance hemodialysis and cardiovascular calcification

The Scientific Journal of Al-Azhar Medical Faculty, Girls

Background Patients with chronic kidney disease have a high prevalence of vascular calcification,... more Background Patients with chronic kidney disease have a high prevalence of vascular calcification, and cardiovascular disease is the leading cause of death. Magnesium (Mg) is a natural calcium antagonist and many studies have shown that low circulating levels of Mg are associated with vascular calcification. Aim of the work The aim of the study was to assess the relationship between serum Mg levels and vascular calcification in chronic hemodialysis (HD) patients. Patients and methods A cross-sectional study conducted on 60 patients with end-stage renal disease on regular HD in Al-Zahraa University Hospital (group I) compared with 30 healthy controls (group II), from June to December 2017. Patients with evidence of infection, chronic diarrhea, ileostomy, and those receiving Mg-based phosphate binders were excluded from the study. All studied groups were submitted to clinical examination, renal function, lipid profile, serum albumen, calcium, phosphorus, intact parathyroid hormone, Mg, carotid duplex, echocardiography, ECG, and lateral view plain abdominal radiograph. Results There were highly significant differences regarding Mg and carotid intimal medial thickness (CIMT) in group I compared with group II: 1.51±0.28, 0.89±0.30 and 2.47±0.18, 0.45±0.08 respectively, P<0.001. Echocardiographic findings showed calcified mitral and aortic valves in 12 (20%) patients and calcified abdominal aorta by abdominal X-ray radiograph in 20 (33.33%) patients. There were highly significant negative correlation between serum Mg and CIMT and abdominal aortic calcification in group I. Conclusion The patients on maintenance HD have lower serum Mg levels. It was associated with increased CIMT and vascular calcification if compared with healthy group and concomitant use of proton pump inhibitors may aggravate this hypomagnesemia. So serum Mg level in maintenance HD patients could be a potential biomarker for cardiovascular calcifications.

Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Relationship with Insulin Resistance and Other Risk Factors of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus (DM) 1Emad A. Nafie, 2Nagwa Abd El-Ghaffar Mohammad, 3Gamila S.M. EL-Saeed, 1Amany M. Abdallah, 1Hayam H. Mansour, 1Gh...

World Journal of Medical Sciences

Cutaneous Manifestations in Egyptian Patients with Chronic Renal Failure on Regular Hemodialysis

Background. Hemodialysis patients experience frequent and various cutaneous manifestations of oft... more Background. Hemodialysis patients experience frequent and various cutaneous manifestations of often hypothetical pathogenesis. Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Objective. To evaluate the prevalence and nature of cutaneous lesions, associated with CRF patients on hemodialysis in Egyptian patients. Patients and methods. One hundred patients with CRF on regular hemodialysis from nephrology units were examined for cutaneous changes. Specific investigations like skin biopsy, culture and sensitivity for bacterial infections, potassium hydroxide mount and fungal culture were done when indicated. Results. All patients included in this study had at least one cutaneous manifestation attributable to CRF. The most prevalent findings was pruritus (55%), followed by xerosis (54%), hyperpigmentation (54%) and pallor (45%). Other cutaneous manifestations were wrinkles (40%), fungal infections (33%), ecchymosis (27%), dermatitis (23%), yellow face (22%)...

Semaphorin 5A, Anti-Nucleosome Antibodies and Ferritin: Disease Activity Markers in Patients with Systemic Lupus Erythematosus

Journal of Clinical & Cellular Immunology

Background: Systemic Lupus Erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder ... more Background: Systemic Lupus Erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder characterized by dysfunction of T and B lymphocytes. Although the prognosis of SLE has improved in the past few decades, the absence of biomarkers for residual activity in various organs and the early detection of disease flares hamper further management. Conventional serologic markers of SLE, such as anti-dsDNA and complement levels, are not ideal, as they are not sufficiently sensitive and specific for the diagnosis of the disease and monitoring of disease activity. Thus, novel biomarkers for SLE activity have to be developed. Semaphorin 5A (Sema 5A), antinuclosome antibody (Anu A) and ferritin may fall into this category of novel bio markers. Objective: To evaluate the role of serum Sema 5A, Anu A and ferritin in detection of SLE activity. Methods: The present study included 40 patients with SLE divided according to Systemic Lupus Erythematous Disease Activity Index (SLEDAI) into two groups: 20 active SLE and 20 inactive SLE patients. They were compared with 20, sex and age matched healthy individuals for control. Levels of Sema 5A, Anu A were measured by Enzyme-Linked Immunosorbent Assay (ELISA) and serum ferritin levels were measured by Electrochemiluminescence immunoassay (ECLIA). Results: There was highly significant increase in Sema 5A, Anu A and ferritin levels inactive when compared within active SLE patients and control subjects (P=0.000 and P=0.000 and P=0.000 respectively). There was a significant increase in ferritin level in inactive SLE patients when compared with control subjects (P=0.045) with no significant difference regarding Sema 5A, Anu A (P3=0.089 and 0.225 respectively). There were positive correlations between Sema 5A, Anu A, ferritin and each of SLEDAI, and CRP. Positive correlation also found between Sema 5A and each of Anu A and ferritin and between AnuA and ferritin. Negative correlation was found between Sema 5A and C3 and between Anu A, ferritin and C4. Significant relation was found between Sema 5A, Anu A, ferritin and each of ANA and anti-dsDNA in active SLE patients. Area under the curve (AUC) for ferritin, Sema 5A and Anu A were (0.861, 1.0 and 1.0 respectively). Conclusion: Our study showed that the serum proteins semaphorin 5A, antinuclosome antibodies and ferritin may be useful markers in monitoring disease activity in patients with SLE. Regarding area under the curve (AUC), these serum protein markers result in even better sensitivity and specificity profiles in picking up early relapse of SLE.

SP138Egyptian Experience of Ombitasvir/Paritaprevir/Ritonavir plus Ribavirin in Treatment of Chronic Hepatitis C Patients with End Stage Renal Disease on Regular Hemodialysis

Nephrology Dialysis Transplantation

Role of TLR-2, IL-6 and IL-18 in the Pathogenesis of Egyptian Predialysis CKD Patients

Clinical Medicine and Diagnostics, 2014

Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by ... more Background: Chronic Kidney Disease (CKD) is one of the most important health challenges faced by the world today with new cases being added at an alarming rate. Controlling traditional risk factors has not been effective in bringing down the incidence of the disease. CKD is associated with inflammation, morbidity, poor quality of life, decreased life-expectancy and death. Chronic inflammation is associated with complications and comorbidities frequently seen in CKD. Toll-like receptors (TLRs) are members of innate immune receptors that regulate inflammatory and immune responses and stimulate both immune and nonimmune cells to express inflammatory cytokines and chemokines. Objective: To evaluate the potential role of TLR-2 and proinflammatory cytokines in the pathogenesis of stage 3-4 CKD which could be used to pave the way for prophylactic or therapeutic procedures. Subjects and methods: This study was carried out on 20 patients with stage 3-4 CKD and 10 age and sex matched controls. The percentage of CD14 + monocytes expressing TLR-2 and mean florescence intensity (MFI) of TLR-2 on CD14 + monocytes were detected by flowcytometry, while the serum levels of interleukin-6 (IL-6) and IL-18 were measured by enzyme linked immunosorbent assay (ELISA). Results: There was insignificant difference between the percentage of CD14 + monocytes expressing TLR-2 in both patients and control groups(p > 0.05), while there was a highly significant increase in MFI of TLR-2 on CD14 + monocytes, serum IL-6 and serum IL-18 levels in stage 3-4 CKD patients when compared to controls (p ≤ 0.01). There was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum creatinine level (p≤ 0.05, r=0.538) and a highly significant positive correlation between IL-6 serum level and serum creatinine level in patients group (p ≤ 0.01, r= 0.672). Also there was a highly significant negative correlation between MFI of TLR-2 on CD14 + monocyte and estimated glomerular filtration rate (eGFR) (p ≤ 0.01, r=-0.667), and a significant negative correlation between IL-6 and eGFR in patients group (p ≤ 0.05, r=-0.516). Finally, there was a significant positive correlation between MFI of TLR-2 on CD14 + monocytes and serum IL-6 level in patients group (p≤ 0.05 , r = 0.473), while the correlation between serum IL-18 level and serum creatinine level, eGFR, MFI of TLR-2 on CD14 + monocyte and serum IL-6 level in patients group was insignificant (p> 0.05, r =0.168,-0.196,-0.057,-0.010 respectively). Conclusions: This study demonstrated that the expression of TLR-2 on CD14 + monocytes was up regulated in stage 3-4 CKD patients and was associated with inflammatory response as assessed by increased serum levels of IL-6 and IL-18. These findings indicated that TLR-2, IL-6 and IL-18 played a significant role in pathogenesis of CKD.