ABSTRACT
Background: Seborrheic keratosis is one of the most common benign epidermal tumors. Seborrheickeratoses are hyperkeratotic lesions of the epidermis, which often appear to be "stuck on" the surface of the skin. Cherry angiomas are very common acquired vascular skin lesions
Objective: To find any relation between seborrheic keratosis and cherry angioma
Patients and Methods: A total of one hundred male and female patients, presented with Seborrheic keratosis with or without associated cherry angioma [62% present CA and 38% absent CA], were included in the study. Full history taking and full examination was done between December 2015 and May 2017. Twelve biopsies were taken from 6 patients
Results: The age of the patients ranged from 18 to 88 years old. The male patients were [63%] and the female patients were [37%]. 17% of patients complained of itching, 20% had positive family history of Seborrheic Keratosis, 75% had skin photo type III. Flat Seborrheic Keratosis was 49% of the cases. The most common site of SK was face [76%]. The most common site of cherry angioma was abdomen [88.7%]. The examination of the biopsies revealed no histopathological correlation between seborrheic keratosis and cherry angioma
Conclusion: The patient with seborrheic keratosis sometimes may have cherry angioma in adjacent to it or in a different site which didn't necessarily means that they have the same pathological origin
ABSTRACT
Background and study aims: There is a lack of studies on erectile dysfunction [ED] in patients diagnosed with nonalcoholic fatty liver disease [NAFLD]. The present study aimed to estimate the prevalence of ED in patients with NAFLD and to determine the independent predictors of ED in these patients
Patients and methods: We conducted a prospective, hospital-based study of 192 consecutive male patients with NAFLD. All patients underwent clinical evaluation; abdominal ultrasonography; test for viral hepatitis markers; and estimation of liver chemistry panel, complete blood count, prothrombin time, serum lipids panel, serum testosterone, and fasting serum levels of glucose, insulin, and C-peptide
Results: The mean age of the study population was 42.4 +/- 7.7 years [79.1% >/= 40 years]. Of the 192 patients with NAFLD, 88 [45.8%] had ED, 28 [14.6%] had metabolic syndrome, 25 [13%] had type-2 diabetes mellitus [DM], and 131 [68.2%] had insulin resistance [IR]. The mean level of serum testosterone was 3.17 +/- 2.94 ng/mL, while the mean insulin resistance index was 2.9 +/- 1.7. Mild ED [38.6%] was the most frequent grade of ED. Age >/= 40 years [odds ratio [OR] 6.4; 95% confidence interval [CI] 1.7-24.1; p- 0.006], IR [OR 5.9; 95% CI 1.7-20.6; p- 0.005], and low serum testosterone [OR 5.1; 95% CI 1.5-17.1; p- 0.009] were the predictors of ED
Conclusions: ED is a common disorder in male patients with NAFLD; both IR and low serum testosterone contribute to its development. Treatment of IR may carry a dual benefit of improving erectile function and decreasing the grade of hepatic steatosis
ABSTRACT
Beta-ketothiolase [mitochondrial acetoacetyl-CoA thiolase, T2] deficiency is an autosomal recessive disorder characterized by impaired metabolism of ketones and isoleucine. In this study, we report on the first two siblings with T2 deficiency from Libya. Both siblings presented with ketoacidosis, but the severity and outcomes were quite distinctive. T2 deficiency in patient 1, the younger sister, manifested as recurrent severe episodes of ketoacidosis during the first year of life. She unfortunately experienced neu-rodevelopmental complications, and died at 14 months old, after her 5th episode. In contrast, patient 2, the elder brother, experienced only one ketoacidotic episode at the age of 4 years. He recovered uneventfully and has continued to achieve age-appropriate development to date. Upon analysis, the siblings' blood acylcarnitine profiles had shown increased levels of C5:l and C5-OH carnitine. ACAT1 mutational analysis revealed patient 2 is homozygotic for a novel mutation-c.674C > A [p.Ala225Glu]; this mutation was then confirmed by familial analysis. Transient expression analysis of C.674C > A mutant T2 cDNA revealed neither potassium ion-activated acetoacetyl-CoA thiolase activity, which represents T2 activity, nor mutant T2 protein. Therefore, this mutation is truly pathogenic. Interestingly, the incidence of T2 deficiency may be high among the Arab population. This disease should be considered in the differential diagnosis for unexplained ketoacidosis in children. Patients with T2 deficiency could have a favorable outcome if diagnosed and treated early
Subject(s)
Humans , Female , Infant , Child, Preschool , Siblings , Review Literature as Topic , Ketosis , Carnitine Acyltransferases , Acetyl-CoA C-AcyltransferaseABSTRACT
Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The aim of this study was to evaluate multidetector computed tomographic [MDCT] oesophagography as an alternative to endoscopy for screening oesophageal varices [EVs] and predicting bleeding risk. A total of 137 cirrhotic patients underwent MDCT followed by endoscopy and EVs were graded independently. The screening ability of CT for EV was evaluated by comparing the grades of EV at CT and at endoscopy. Prediction of bleeding risk by CT was determined by correlating the CT variceal grades, diameters and palisade vein dilatation with the endoscopic red colour [RC] sign. Extra-oesophageal findings were assessed by CT. Patients' acceptance for both examinations were compared. At endoscopy, 47 [34%] patients had grade 0 EV, 52 [38%] patients had grade 1 EV, 29 [21%] patients had grade 2 EV and nine [7%] patients had grade 3 EV. The sensitivity, specificity, positive and negative predictive values and accuracy of CT oesophagography for defining EV in all grades were 99%, 98%, 99%, 98% and 99%, respectively. The MDCT variceal grades, diameters and palisade vein dilatation were correlated with the severity of the RC sign. Important extra-oesophageal findings were determined by CT only. The acceptance of patients for CT oesophagography was significantly more than that for endoscopy [p < 0.001]. MDCT is a reliable, preliminary or adjunctive method that can be used for routine screening for EVs and the prediction of variceal bleeding
ABSTRACT
Background: HBV infection is a major Egyptian and global health problem. Occult hepatitis B virus [HBV infection has been reported in patients with chronic hepatitis C who are negative, for HBV, surface antigen [HBs Ag]. However, the significance of "silent" HBV in hepatitis C virus [HCV] infection is unknown. Overt HBV and HCV co-infection has been reported to be associated with a more severe liver disease, increased frequency of HCC and resistance to a-interferon [alpha-INF] therapy
Aim of work: to determine the prevalence and clinical significance of occult HBV infection in chronic HCV-positive HBs Ag-negative patients in Al-Ahrar General Hospitals
Study design: a cross sectional study was done on chronic hepatitis C virus infected patients [HBs Ag-negative] who were receiving their treatment, 150 patients were randomly selected at different stages of treatment. Their sera were investigated for the presence of anti-core antibodies by ELZSA then HB V- DNA was detected by polymerase chain reaction [PCR]
Results: HBV-DNA has detected in [4%] of HCV-injected patients. HBV-DNA was detected in [24%] of anti-HBc-positive chronic HCV patients' sera, it was not detected in any of anti-HBc-negative chronic HCV patients. There was no significant difference in any of the clinical and/or laboratory data tested between anti-HBc-positive patients with and without HBV-DNA in the serum
Conclusion: About 4% of HCV-infected patients had occult HBV infection. Occult HBV infection in patients with chronic hepatitis C does not seem to modify the progression of chronic liver disease in short term follow up on small numbers of patients. Anti-HBc antibody detection ELISA is a cheap and sensitive method, so it can be used as only a screening tool preliminary before HBV DNA detection by PCR for occult HBV
ABSTRACT
Purpose: To demonstrate the prevalence and possible risk factors of retinal complications of pegylated interferon plus ribavirin treatment on patients involved in the national campaign for treatment of chronic hepatitis C in Sharkia governorate in Egypt
Methods: The study included 646 patients with chronic hepatitis C who were receiving treatment with pegylated interferon- alpha and ribavirin combination. Ophthalmologic examination was carried out on all patients of the study that were at different times of the treatment course. Ocular examination consisted of best corrected visual acuity measurement, anterior segment biomicroscopy and dilated fundoscopy. Patients with retinopathy had colored fundus photography. Statistical analysis was done to determine the prevalence of retinopathy and the possible correlation of several variables [age, sex, duration of treatment, dose of ribavirin, virus load, type of peginterferon [PEG-IFN alpha-2a or PEG-IFN alpha-2b], diabetes, hypertension etc] to the occurrence of retinopathy in this group of patients
Results: Out of 646 patients, 120 patients developed interferon induced retinopathy, so the prevalence of interferon induced retinopathy is 18.6%. 85% of the patients with retinopathy were asymptomatic; there were statistically significant correlations between patients' age, body mass index, dose of ribavirin, diabetes mellitus, hepatitis C virus load, general side effects of interferon treatment and the occurrence of retinopathy
Conclusions: Interferon induced retinopathy is not uncommon side effect of interferon plus ribavirin treatment and stress on regular ophthalmologic follow up is mandatory especially in patients with risk factors
ABSTRACT
Infants with the chief complaint of crying can present a diagnostic dilemma to the health care provider [1]. Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse [2]. It appears to be caused by different etiologies, the role of lactose intolerance as a cause of infant irritability remains debatable. It has been hypothesized that some babies have a transient underlying lactase deficiency, leading to a buildup of lactose derived from breast milk or formula [3, 4]. The most accepted definition of colic is: unexplained crying and fusing lasting for more than three hours per day, occurring more than three days per week, and for more than three weeks [5]. This study was carried out to evaluate the relation between infantile colic and lactose intolerance. 200 full term babies, aged less than one year, were chosen from pediatric outpatient department, at Demietta University Hospital. The studied infants were classified into: cases [n-100]: infants presented with a chief complaint of persistent crying [colic] after exclusion of other causes as otitis media, other infections, major congenital anomalies, or surgical problems as inguinal hernia. Controls [n=100]: healthy non crying infants. Each infant enrolled in the study was submitted to detailed medical history and thorough clinical examination, anthropometric measurements and ratio, and stool pH determination by color fast pH indicator strips. Stool pH was considered acidic if it was less than 6 and normal if it was >/= 6. The majority of cases [85%] were had acidic stool pH versus only [3%] of control with highly statistical significant difference; p. value 0.000. Among those cases with acidic stool pH; 94% were stopped to cry after two weeks of lactose free milk administration. Lactose intolerance appears to be a common cause of infantile colic which could be evaluated relatively easily by using stool acidity test [fecal pH] or dietary elimination and challenge which leads to improvement of symptoms
Subject(s)
Humans , Male , Female , Infant, Newborn , Lactose Intolerance/etiology , Hospitals, UniversityABSTRACT
The aim of this study was to assess the effect of uncontrolled long standing asthma without corticosteroid therapy on the growth of pre-pubertal Egyptian children. This was an analytical study conducted at Damietta university hospital Two groups of patients suffering from uncontrolled moderate [n=30] or severe [n=18] asthma were compared for their physical and skeletal growth with a control group [n=30]. All enrolled children were followed up for 1 year. At enrollment the following investigations were performed: CBC, serum IgE, tuberculin test, chest x-ray and x-ray of lift hand and wrist [also at end of the study]. At start and end of the study, no statistically significant differences were detected between the 3 study groups regarding growth indicators [weight for height [W/H] and height for age [H/A] percent of median reference]. The percent of change in growth parameters [weight, height, BMI, upper segment lower segment ratio] were comparable from beginning to end of the study and the differences between groups were not statistically significant. At start and end of the study, bone age was delayed among asthmatic children than controls [p=0.00 each of them]. Both severe and moderate asthma groups were associated with lower standard deviation scores of bone age than controls group and the differences between groups were statistically significant [p=0.00 at start and end of the study]. Comparing growth indicators before and after controlling asthma clarified that no statistical significant differences were detected between asthmatic children and controls [W/H p=0.2, H/A p=0.2]. It was concluded that asthma did not influence the growth, however bone age was delayed
Subject(s)
Humans , Male , Female , Growth Disorders , Body Weight , Body Height , Body Mass Index , Hospitals, University , Follow-Up Studies , ChildABSTRACT
We assessed the clinical utility of using myocardial performance index [Tei index] and tissue Doppler imaging as noninvasive indices of right ventricular function in patients with congenital heart disease. Tei ilidex and trans annular [tricuspid] flow were performed in 100 subjects, 30 were completely healthy represented as control group and 70 had variable congenital heart disease, this group is subdivided according to the loading condition on the right ventricle into two subgroups volume loaded and pressure loaded right ventricle. In patients with volume, loaded right ventricle both Tei index and trans annular parameters did not differ significantly when compared to control group but they differ significantly in patients who have complex heart disease and pressure loaded right ventricle. Patients with Transposition of the great vessels and those with pulmonary hypertension had reversed Ea/Aa values. So Doppler tissue imaging and Tei index are valuable noninvasive tools for assessment of right ventricular function
ABSTRACT
To study the relation between SjO2 and the neurological outcome after head injury. Prospective randomized study. sixty adult patients ASA I and II with recent head injury [age 18-50 ys]. They were admitted to the Intensive Care Unit [ICU] for 48 hs. They were evaluated hemodynamically, neurologically [according to Glasgow Coma Scale-GCS], investigated for hemoglobin concentration, random blood sugar, serum urea and creatinine. Then they were monitored in the ICU for hemodynamics [non-invasive blood pressure-NIBP- systolic, diastolic and mean arterial blood pressure-MABP-], pulse oximetry, heart rate [HR], ECG, central venous pressure-CVP- through left internal jugular vein, and SjO2 through right internal jugular bulb catheter. According the base line reading of SjO2 the patients were classified into 3 groups; Group [1]: Low SjO2 < 55 mmHg, Group [2]: normal SjO2 55-75 mmHg, and Group [3]: high SjO2 >75 mmHg. In the ICU the patients were managed to minimize secondary brain insults for 48 hs. Samples for SjO2 monitoring were taken every 6 hs. After 48 hs the patients were re-evaluated neurologically according to Glasgow Outcome Scale [GOS] and classified into 2 groups; Group I: poor outcome [GOS 1-3, dead, vegetative or disable] and Group II: good outcome [GOS 4-5 are moderately disable or have good recovery]. 11 patients were excluded from the study because 3 patients died within the 48 hs and 8 patients reqiured mechanical ventilation. There was no significant statistical difference as regard height, weight, MABP, HR, pulse oximetry, CVP, mean hemoglobin concentration, serum urea and creatinine,. The difference in readings of SjO2 in the 3 groups was statistically significant in group[1] in all time of reading hours compared to group [2] and [3], Also when compared to the base line reading in the same group. The same with group [2]. As regard GOS; in group [1] was lower than other groups on admission to the ICU and all time of readings. Also, patients in Group [3] had poor outcome. This study confirm that an increased SjO2 occur significantly more in patients with poor outcome. Other methods of measurement of SjO2 are recommended as near infrared spectrography or trans-cranial doppler ultrasonography as these methods are less invasive and give continuous measurements of SjO2
Subject(s)
Humans , Male , Female , Intensive Care Units , Glasgow Coma Scale , Pulmonary Ventilation , Hemodynamics , Glasgow Outcome ScaleABSTRACT
To study the profile of oesophagogastroduodenoscopy [OGD] in children, review the indication, results of biopsies, safety of the procedures and its benefits. Between June 2002 and March 2004, 88 children [54 males and 34 females] were enrolled into study. Their ages ranged from 5 years to 12 years with average age 7.5 years [S.D. +/- 3.2 years]. OGD was performed under general anesthesia, after an 8-hour fasting. The indications of OGD were chronic abdominal pain in 62 [70.4%], repeated hematemesis in 19 [21.7%] and unexplained vomiting in 7 cases [7.9%]. Tissue biopsies were obtained from all abnormal lesions as well as random biopsies from the oesophagus [one], gastric body [one], antrum [two; one for pathology and one for rapid urease test], and duodenum [one]. Positive endoscopic findings were found in 68 [77.3%] cases, while normal or no pathological abnormalities were detected in 20 [22.7%]. The commonest lesion found was superficial gastric mucosal lesions in 21 [23.9%], followed by gastric ulcers [19.3%], reflux oesophagitis [11.5%] and oesophagitis [ulcers] [10.2%].Less commonly found lesions were hemorrhagic erosive duodenitis [4.5%], oesophageal varices [4.5%] and duodenal ulcers [3.4%]. Biopsies were taken from 43 [48.9%] children. In 32 [74.4%] out of them there were histological abnormalities. The most common findings were non-specific gastritis in 15 [34.9%] followed by Helicobacter pylori [H.pylori] infections in 10 [23.2%]. Less common were eosinophilic gastroenteritis in 4 [9.3%] and nonspecific inflammations in the oesophagus in 3 [7%]. OGD in children is safe, easy procedure with moderm instruments, with excellent results which aids in diagnosis and treatment of many gastrointestinal disorders in children
Subject(s)
Humans , Male , Female , Child , Diagnostic Techniques and Procedures , Gastrointestinal Diseases/diagnosisABSTRACT
To determine the prevalence of intestinal parasitic infections in Sohag city among 6-8 years old school children and its relation to socio-demographic factors, environmental factors, behavioral habits and complaints related to intestinal infestations. A total of 800 children [480 boys and 320 girls] have been randomly selected from ten primary schools belonging to Sohag district [five schools from villages [rural] and another five schools from main city and were enrolled into study. Their ages ranged from 72 months to 96 months with mean age of 77.5 months. Data were collected through questionnaire interview regarding socio-demographic clinical history and environmental conditions. All children have been examined in their schools with special interest to the general condition of the child, state of nutrition, abnormal facial pigmentation, pruritus around anus, vulvo-vaginitis, examination of nails as well as examination of eyes for signs of allergy, cardiac examination and other system examination. Fresh stool samples were prepared from children at their schools and examined microscopically. Blood samples were collected for complete blood count, serum iron and iron binding capacity. Further evaluation was needed in 120 children and included: anthropometric measurements, eye examination by ophthalmologist, skin examination by dermatologist, electrocardiography [ECG] and echocardiography Helminthic infestation was found in 512 [64%] out of the 800 children studied. Enterobius [E.] vermicularis was the most common parasite detected in all the 512 cases. Mixed infestations were found in 69 [8.6%] cases. Rural children had a higher percentage of parasitic infestation 341 [42.6%] than children in urban area 171 [21.4%]. Anemia detected in 395 children in the form of mild anemia in 160 [20%], moderate anemia in 151 [18.9%] and severe anemia in 84 [10.5%] according to grading of anemia by WHO classification. Intestinal parasitic infection is an important public health problem in Sohag city. Rural residence, mother education less than primary school, bad hygienic conditions were the significant associations. Health education on personal hygiene to the students and to the parents, especially to mothers is required