Alexandria Journal of Medicine最新文献

{"title":"Baseline characteristics and treatment pattern of type 2 diabetes patients in Jordan: analysis from the DISCOVER patient population","authors":"J. Haddad, M. A. Al Hyari, Monther S. Al Momani, Ahmad A. Al Omari, F. Ammari, Firas O. Annabi","doi":"10.1080/20905068.2020.1747733","DOIUrl":"https://doi.org/10.1080/20905068.2020.1747733","url":null,"abstract":"ABSTRACT Introduction: Jordan has limited published data on T2DM and its treatment patterns. This analysis of the DISCOVER study, focusing on Jordan, is aimed at describing the characteristics of patients and treatment patterns according to the real-world setting in T2DM patients initiating a second-line antidiabetic treatment Methods: The DISCOVER study is an ongoing, multi-country, multicenter, observational, prospective, and longitudinal cohort study. The baseline data of patients’ characteristics, clinical and laboratory variables, micro- and macro-complications, and treatment choices were captured on a standardized case report form. Results: Two hundred and seventy-one patients were enrolled from 13 different clinical sites in Jordan. Sixty percent of the patients were male. The participants overall mean age was 53.8 ± 11.3 years with a mean BMI 30.8 ± 5.0 kg/m 2. The mean duration of T2DM was almost 6 years and the mean documented HbA1c and fasting plasma glucose were e 8.4% ± 1.6 and 180.9 ± 63.7 mg/dL, respectively, at the initiation of second-line antidiabetic treatment. Almost 25% of the participants were reported to be either current smokers or ex-smokers. More than 40% of patients had comorbidities such as hypertension or dyslipidemia. Diabetes related microvascular and macrovascular complications were documented in 10.3% and 12.5% of patients, respectively. Metformin (MET) alone was used as a first-line therapy in almost one-half of the patients and in combination with sulfonylurea (SU) in approximately one-third of the patients. The most commonly used second-line therapy was the combination of MET and dipeptidyl peptidase-4 inhibitors (DPP-4i) with 29.9% followed by the triple therapy of MET, SU, and DPP-4i with 28%. Conclusion: A substantial number of patients were young with uncontrolled diabetes and at high risk for micro- and macrovascular complications. Therefore, a comprehensive management with early treatment intensification and risk factors modifications are required to achieve target goals.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"51 - 55"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1747733","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44490007","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}

{"title":"Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis","authors":"M. Agha, M. Sallam, M. Eid","doi":"10.1080/20905068.2020.1767529","DOIUrl":"https://doi.org/10.1080/20905068.2020.1767529","url":null,"abstract":"ABSTRACT Background Despite acute appendicitis is the most common underlying etiology of the acute abdomen, a considerable list of other pathologies should be considered; despite sharing almost the same clinical presentation. This study aimed to re-enhance the importance and sensitivity of CT scan as a solitary imaging tool, in the evaluation of patients with acute right lower abdominal pain. Patients and methods It is a retrospective study of the last 1000 patients, referred with acute right lower abdominal pain for CT scan examination. Biphasic CT scan abdomen protocol was applied for all. Results Cecal carcinoma was detected in three patients (0.3%), epiploic appendicitis in five (0.5%), omental infarct in two (0.2%), appendicular mucocele in two (0.2%), appendicular NET in one (0.1%), cecal diverticulitis in four (0.4%), Chron’s disease in six (0.6%), intussusception in one (0.1%) and FB in one (0.1%) and appendicular perforation in one (0.1%), acute simple appendicitis 398 (39.8%) and 577 (57.7%) were unremarkable. Conclusion Despite acute appendicitis is the most common cause of the acute abdomen, many other surgical and non-surgical etiologies should also be considered, with a higher sensitivity of CT as a solitary diagnostic tool of imaging.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"56 - 67"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1767529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43334665","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}

{"title":"Diabetes mellitus in primary and secondary schools in Africa: an exploratory review","authors":"A. Otovwe, Efegbere Henry Akpojubaro","doi":"10.1080/20905068.2020.1833278","DOIUrl":"https://doi.org/10.1080/20905068.2020.1833278","url":null,"abstract":"ABSTRACT Introduction The prevalence of Diabetes Mellitus (DM) is currently reported to be on the increase in the school environment among teachers and students in Africa. This review highlighted the current state of DM in primary and secondary schools in Africa. Methods The review assessed critical literature on African Journals Online, Google Scholar search, PubMed, Medline, and Science Direct as well as information available about DM in the Africa continent. Relevant search terms included prevalence of DM in primary schools, the prevalence of DM in secondary schools, prevalence of DM among teachers and students, knowledge of DM among teachers and students, risk factors of DM among teachers and students in Africa. Results The review highlighted the prevalence of T2DM among teachers, while prediabetes and T1DM were reported among students. Furthermore, only two studies were identified to assessing knowledge of DM among teachers while few studies reported poor knowledge of DM among students. Conclusion The issue of DM in both primary and secondary schools should be given the needed attention by the concerned stakeholders. This is because of the possible escalation of T1DM and T2DM within the school environment in Africa in the nearest future.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"166 - 172"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1833278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49553103","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}

{"title":"Evaluation of serum kallistatin level as a predictor of esophageal varices in cirrhotic patients","authors":"Osama M. Sobhey, Amal A Jouda, A. Metwally, N. Shawky, Mohammad N. Elkhashab","doi":"10.1080/20905068.2020.1714191","DOIUrl":"https://doi.org/10.1080/20905068.2020.1714191","url":null,"abstract":"ABSTRACT Introduction : The Baveno VI consensus recommended the use of noninvasive predictors to identify patients at high risk of esophageal varices (EV) in whom endoscopic evaluation is most needed. Kallistatin is a protein molecule synthesized by the liver, and its level declines with the deterioration of liver functions. We aim to explore the role of kallistatin as a predictor of esophageal varices. Methods: This case–control study included 70 cirrhotic patients (35 patients with EV and 35 patients without EV). The laboratory investigations and upper GI endoscopy were performed, and the serum kallistatin level was measured in all patients. Results: The mean level of serum kallistatin was significantly lower in patients with varices (12.2 ± 5.6 vs 16.9 ± 4.8 µg/ml, p = 0.009). It also shows a significant decline in patients with large varices. Kallistatin can predict the presence of EV and large EV at cut off values of 15.8 and 8.9 µg/ml, respectively, with sensitivity and specificity of 71.4% and 54.3% for EV and 50% and 94.8% for large EV. Discussion : Kallistatin is a promising marker that can be used to predict the presence of esophageal varices especially when they are large and risky.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"21 - 26"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1714191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49647718","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}

{"title":"Medial sural artery perforator flap in reconstruction of soft tissue defect in upper and lower extremities: a clinical study","authors":"Shereif Ibrahim Salah Eldin Hegazy, Nasser Ahmed Gozlan, Hossam Elkafrawi, M. Elshafei, H. Kholosy","doi":"10.1080/20905068.2020.1851442","DOIUrl":"https://doi.org/10.1080/20905068.2020.1851442","url":null,"abstract":"ABSTRACT Background: The quality of soft tissue reconstruction in upper and lower extremities caused by trauma, infection, burns, and tumor resection affects the patient function and esthetic outcome. Many flaps have been described in the literature to reconstruct such defects. Medial sural artery perforator flap is one of the options for reconstruction of upper and lower extremities. Patients and methods: Starting from July 2019 through August 2020, 20 pedicled and free MSAP flaps were used for reconstruction of upper and lower limbs soft tissue defects. Results: total flap loss occurred in two cases, partial flap loss occurred in two cases and the flap was abandoned in two cases. Otherwise, all flaps survived well. Conclusion: MSAP flap is an excellent option in the reconstruction of soft tissue defects in upper and lower extremities.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"210 - 219"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1851442","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42920777","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}

{"title":"The association between thyroid function and nutritional status in patients with end-stage renal disease on hemodialysis","authors":"W. Shehab-Eldin, M. Shaaban, Mai Abdel Samed Atia, S. Zewain","doi":"10.1080/20905068.2020.1863040","DOIUrl":"https://doi.org/10.1080/20905068.2020.1863040","url":null,"abstract":"ABSTRACT Introduction: Malnutrition is common in patients with End-Stage Renal Disease (ESRD) on hemodialysis (HD) which significantly affects their quality of life. ESRD is associated with thyroid dysfunction which may affect morbidity and mortality. Changes in thyroid function in this population could be a marker of malnutrition. Our aim was the assessment of the nutritional status of patients with ESRD on HD and its association with thyroid function. Methods: A cross-sectional study was conducted on 84 patients with ESRD on HD. Nutritional status was assessed by anthropometric measurements and Subjective Global Assessment (SGA) Score. Serum FT3, FT4, and TSH concentrations were determined. CBC, kidney function tests, serum albumin, serum iron, total iron-binding capacity, serum cholesterol, and CRP were measured. Patients’ comorbidity status was determined using the Charlson Comorbidity Index (CCI). Results: The mean SGA score for studied patients was 13.73 ± 4.4, mean values of thyroid functions were: TSH 2.99 ± 2.93uIU/ml; FT4 1.08 ± 0.21 ng/dl and FT3 2.55 ± 0.52 pg/ml. According to SGA score, 26.2% of patients had normal nutritional status, 69% had mild to moderate malnutrition and 4.8% had severe malnutrition. SGA had significant negative correlation with FT3, while there was no significant correlation between it and FT4 or TSH. Serum FT3 concentration inversely correlated with age (r = −0.25, P= 0.02), CCI (r = −0.48, P= 0.0001), CRP (r = −0.46, P= 0.0001), and SGA (r = −0.49, P= 0.0001), and positively correlated with serum albumin (r = 0.47, P= 0.0001). In multivariate regression analysis, SGA was independently associated with FT3 (β, −1.36; 95% confidence interval, −2.5 to −0.2, P= 0.02) Conclusions: Malnutrition is prevalent among patients with ESRD on HD. FT3 is a marker of malnutrition and could be used as an accessible and reproducible periodical method to detect such states.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"220 - 225"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1863040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42355579","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}

{"title":"Doxycycline: a new treatment option for COVID-19","authors":"I. Anwar, Eman Kamal El-dien Anwer, M. Abdallah","doi":"10.1080/20905068.2020.1790957","DOIUrl":"https://doi.org/10.1080/20905068.2020.1790957","url":null,"abstract":"Dear Sir, Coronavirus disease-19 (COVID-19) is a pandemic disease which is caused by SARS-CoV2 virus. It is one of the biggest single-stranded positive-sense RNA viruses. SARS-CoV2 RNA dependent RN...","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"130 - 131"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1790957","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41791364","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}

{"title":"Predicting successful weaning in patients treated with venovenous extracorporeal membrane oxygenation","authors":"Tayseer M. Zayton, E. El-reweny, H. Tammam, K. M. Gharbeya","doi":"10.1080/20905068.2020.1728881","DOIUrl":"https://doi.org/10.1080/20905068.2020.1728881","url":null,"abstract":"ABSTRACT Introduction: Increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure may increase resource requirements and hospital costs. Prediction of successful weaning in these patients may improve resource use and patients outcome. The Respiratory ECMO Survival Prediction (RESP) score has been proposed as an outcome prediction tool for patients undergoing venovenous (VV-ECMO). However, it was developed and validated on patients established on ECMO. This may limit its usefulness as an adjunct tool for decision-making process at the pre-ECMO stage. Aim: The aim of the work was to assess the efficacy of RESP score as a tool to predict successful weaning in patients treated with VV-ECMO before initiation of treatment. Patients and methods: The study was carried out on 23 adult patients who were admitted to the units of Critical Care Medicine Departments in Egyptian Armed Forces Hospitals within 1 year and were treated with VV-ECMO; all of them received the same treatment as recommended by ELSO guidelines for adult respiratory failure. They were classified into two groups according to ECMO weaning successfulness at the end of the study: group I (successful weaning) and group II (failed weaning). Complete physical assessment, laboratory investigations, and RESP score calculation were done before ECMO initiation. Results: Pre-ECMO RESP score, in group I it ranged from −8 to 7 (mean 1.75 ± 3.65), while in group II it ranged from −11 to 1 (mean −6.38 ± 1.88), there was statistically significant difference between the two groups (p = 0. 003). The ROC curve of RESP score showed an AUC of 0.880 (95% CI 0.658–0.981) (p < 0.001). The best cutoff value was −1, at that level the sensitivity was 69.7%, specificity was 81.5%. Calculated positive predictive value of RESP score was 88.9% while negative predictive value was 63.6%. Conclusion: RESP score may be effective tool to predict ECMO weaning successfulness before initiation of ECMO.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"32 - 41"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1728881","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45231082","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}

{"title":"Transmissibility and mortality trends of COVID-19 epidemic in Egypt","authors":"Mohamed Masoud, G. Gewaifel, Nahla Gamaleldin","doi":"10.1080/20905068.2020.1845442","DOIUrl":"https://doi.org/10.1080/20905068.2020.1845442","url":null,"abstract":"ABSTRACT Background: Since identification of the first case on Feb. 14, Egypt had implemented several control measures. This research aimed at study the time trend of the transmissibility and mortality of COVID 19 in Egypt. Methods: Published data on daily reported cases and deaths since the start of the epidemic till week 19 were used. We estimated the basic reproductive number (R0) during the early phase of the epidemic using the simple exponential growth method (SEG) and time dependent method (TD). Then we estimated time varying effective reproductive number (Re) after implementation of the control measures by applying the TD method. Moreover, the trend in the Case Fatality Rate (CFR) throughout the study period was studied. Results: With SEG method, R0 was found to be 2.26 (2.15–2.38) and 2.58 (2.43–2.72) for infectious period of 8 and 10 days, respectively. While by the TD method, R0 was estimated to be 2.34 (95% CrI: 2.05–2.64) and 3.01 (95% CrI: 2.64–3.40) for mean ± SD of SI equals 5.8 ± 2.6 and 7.5 ± 3.4, respectively. With TD method, Re decreased from the initial value of R0 to reach 1.30 (95% crI: 1.17–1.45) in week 7. After that Re values fluctuated closely around 1. CFR reached its peak (7.7%) on April 12 then it decreased to its lowest value (3.4%) after two months before increasing slightly again to (4.1%) in the last days. Conclusion and recommendation: The initial Basic reproductive number was high in Egypt. Effective reproductive number dropped after control measures till fluctuating around one. CFR also declined over time but slight increase in the last days was observed. After relaxation of the control measures, we recommend the instantaneous monitoring of the transmissibility and mortality in Egypt.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"189 - 195"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1845442","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48006400","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}

{"title":"Evaluation of serum levels of Interleukin-4 in Egyptian patients with refractory gastroesophageal reflux disease","authors":"T. Yosef, A. Ahmed, A. Mansour, Mahmoud Ahmed AbuFayyoud, Ahmed M. Elghandour","doi":"10.1080/20905068.2020.1845441","DOIUrl":"https://doi.org/10.1080/20905068.2020.1845441","url":null,"abstract":"ABSTRACT Introduction: Gastroesophageal reflux disease is defined as bothersome symptoms and/or complications caused by the reflux of stomach contents. About 40–50% of patients develop refractory gastroesophageal reflux disease (R-GERD), with poor improvement of symptoms with treatment. Many pathogenic mechanisms share in development of R-GERD, among which is the important role of T-helper 1 and T-helper 2 response mediated by cytokines. The interleukin-4 is a cytokine known of its anti-inflammatory effect. In this study, we aimed to evaluate the level of interleukin-4 in Egyptian patients with R-GERD versus those with GERD. PATIENTS AND Methods: Our study included 25 patients with reflux symptoms who received PPIs for less than 8 weeks with improvement of symptoms, versus 25 patients with refractory reflux symptoms who received PPIs for more than 8 weeks without improvement of symptoms. Interleukin-4 levels were assessed in both groups by ELISA. Results: There was a statistically significant difference between the two groups as regard interleukin-4 levels (p < 0.012) which was higher in the patients with (R-GERD), the mean level of IL-4 was 37.31 ± 56.07 in GERD group while in R-GERD group, it was 102.78 ± 112.29. The diagnostic accuracy of interleukin-4 revealed a sensitivity of 56% and specificity of 76% at cutoff value >58.25 pg/ml, with an acceptable accuracy of 0.6. Conclusions: The present study concluded that IL-4 is significantly higher in patients with R GERD with cut off value > 58.25 pg/ml. Therapeutic strategies that modulate the production of IL-4 may provide a good solution for treatment of R GERD.","PeriodicalId":7611,"journal":{"name":"Alexandria Journal of Medicine","volume":"56 1","pages":"196 - 202"},"PeriodicalIF":0.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20905068.2020.1845441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44228646","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}