<strong>Background:</strong><span style="font-family:""><span style="font-family:Verdana;"> EEG is one of the most sensitive instrumental techniques for identifying sep...<strong>Background:</strong><span style="font-family:""><span style="font-family:Verdana;"> EEG is one of the most sensitive instrumental techniques for identifying sepsis-related neurological complications and a valuable tool in the ICU when clinical assessment is difficult. </span><b><span style="font-family:Verdana;">Aim of the Study:</span></b><span style="font-family:Verdana;"> To detect EEG changes in neonates with evidence of sepsis.</span><a name="_Toc508467354"></a> <b><span style="font-family:Verdana;">Patients and Methods</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> This was a prospective observational study for detecting EEG changes in cases of proven neonatal sepsis. This study was conducted at the NICU of Al Zahraa University Hospital for a period from October 2019 to March 2020. Our studied neonates were 50. This study included full-term newborns (37 to 42 weeks of gestational age) with clinical and laboratory evidence of sepsis (early and late onset). Neonatal birth asphyxia, jaundice, congenital malformations, suspected inborn error of metabolism and neonates electrolytes disturbances were excluded from the study. We record EEG changes during 20 min By an electroencephalogram</span><b> </b><span style="font-family:Verdana;">(EEG) with abioelectric amplifier (Deltamed, Bourgogne), (Philips) Screen.</span><b> <span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Among our studied neonates (neonates with evidence sepsis), 44.0% developed clinical seizures, 81% of the seizures group had abnormal EEG, 35.7% of No seizures group had abnormal EEG. Among our studied neonates, 56% had abnormal EEG EEG abnormalities were as follow, 26%/ had low voltage, 30% had spikes, 22% had sharp waves. </span><b><span><span style="font-family:Verdana;">Conclusion:</span><i> </i></span></b><span style="font-family:Verdana;">About 35% (one third) of neonates who didn’t develop clinical seizures had abnormal EEG, suggesting a poor correlation between clinical and electroencephalographic detection of seizures.</span></span>展开更多
To assess awareness, knowledge and perceptions of antenatal care-seeking women about cervical ripening (CR) and induction of labor (IOL), and their attitude towards these interventions. Methods: An observational descr...To assess awareness, knowledge and perceptions of antenatal care-seeking women about cervical ripening (CR) and induction of labor (IOL), and their attitude towards these interventions. Methods: An observational descriptive cross-sectional study which was conducted at an Egyptian teaching hospital. A questionnaire-based interview covered items on women’s demographic and clinical data, as well as their awareness, knowledge, perception and attitude towards specific methods of CR and IOL. Results: A total of 853 questionnaires were analyzed, and 442 respondents (51.8%) were aware of CR and IOL. Knowledge of Oxytocin use was noted in 215 participants (48.6%), of membrane sweeping in 85 (19.2%), of Foley’s catheter in 110 (24.9%) and of Misoprostol in 84 (19.0%). The procedures were perceived to prevent cesarean section in 219 respondents (49.5%). History of previous IOL was a predictor of awareness (OR: 5.19, 95% CI: 1.6 – 11.23, p = 0.001*). Conclusion: This study showed that only a slightly more than 50% of participants were aware of CR and IOL, and the overall knowledge and perception were sub-optimal. Nevertheless, the attitudes towards the procedures were positive. Improved counselling is required in order to further increase knowledge about CR and IOL, and also correct misbelieves particularly in women at risk of undergoing IOL.展开更多
Objective:Hepatocellular carcinoma(HCC)is the fifth most common malignancy worldwide.The identification of new simple,inexpensive and highly accurate markers for HCC diagnosis and screening is needed.This case-control...Objective:Hepatocellular carcinoma(HCC)is the fifth most common malignancy worldwide.The identification of new simple,inexpensive and highly accurate markers for HCC diagnosis and screening is needed.This case-control study evaluates the role of annexin A2 and voltage-gated calcium channelsα2δ1 subunit as serum biomarkers for HCC diagnosis.Methods:The study comprised three groups:group 1,50 patients with an initial diagnosis of HCC associated with chronic hepatitis C virus infection;group 2,25 patients diagnosed with chronic hepatitis C virus infection and cirrhosis without any evidence of HCC;and group 3,15 healthy controls.All participants were subjected to clinical and laboratory investigations,and radiological scanning.The serum levels of alpha-fetoprotein(AFP),annexin A2,and theα2δ1 subunit were evaluated by using ELISA technique.Results:The serum levels of annexin A2 significantly increased in patients with HCC(10.4±2.5 ng/m L;P<0.001)or with cirrhosis(9.31±1.8 ng/m L;P<0.001)comparing to that of healthy controls(0.296±0.09 ng/m L).However,there was no significant difference in serum annexin A2 levels in patients with HCC comparing to those with cirrhosis.Serumα2δ1 subunit significantly increased in patients with HCC(20.12±3.7 ng/m L)comparing to that in patients with cirrhosis(10.41±3.4 ng/m L,P<0.001)and healthy controls(10.2±2.9 ng/m L,P<0.001).Conclusions:The serumα2δ1 subunit may function as a new biomarker for HCC diagnosis.Conversely,serum annexin A2 has low diagnostic value as an HCC marker,especially in patients with underlying cirrhosis.展开更多
ACL reconstruction surgery shows low incidence of complications (1.38%) like DVT, Infection, patellar tendon rupture and fractures whether in the proximal tibia or the distal femur. We hereby present two cases that ha...ACL reconstruction surgery shows low incidence of complications (1.38%) like DVT, Infection, patellar tendon rupture and fractures whether in the proximal tibia or the distal femur. We hereby present two cases that have had the rare complication of proximal tibial fracture. The circumstances of each case are discussed together with discussion of similar cases described in the literature. We tried in the end to have an idea about the possible causes and how to prevent such a devastating event. Case presentation: Case 1 shows a 38-year-old female patient who had an ACL reconstruction surgery by BTB graft followed by iatrogenic proximal tibial fracture managed by open reduction internal fixation by T plate and screws. Case 2 shows a 28-year-old male patient who had an ACL reconstruction surgery by BTB graft also followed by Proximal tibial fracture 3 weeks later managed by open reduction internal fixation using a locked plate and screws. Discussion: Fractures are a rare complication that may follow ACL reconstruction surgery. These fractures can be femoral or tibial that may be due to the reduction of the bone strength as a result of the drill holes which behave as a stress riser. We also suggest that usage of osteotomes during grafting plays a role in these fractures. Management of these fractures is either by open reduction and internal fixation or closed reduction. What is known about the subject: Patellar fractures are a known complication of ACL reconstruction using patellar tendon graft. What this study adds to the existing knowledge: Raising the Knowledge that also the tibia can be fractured as a complication of patellar tendon harvesting not only the patella.展开更多
BACKGROUND Chronic liver disease,particularly cirrhosis,is associated with worse outcomes in patients infected with coronavirus disease 2019(COVID-19).AIM To assess outcomes of COVID-19 infection among patients with p...BACKGROUND Chronic liver disease,particularly cirrhosis,is associated with worse outcomes in patients infected with coronavirus disease 2019(COVID-19).AIM To assess outcomes of COVID-19 infection among patients with pre-existing hepatitis C with or without liver cirrhosis.METHODS This multicenter,retrospective cohort study included all cases of confirmed coinfection of severe acute respiratory syndrome coronavirus 2 and chronic hepatitis C with or without liver cirrhosis who were admitted to six hospitals(Al-Sahel Hospital,Al-Matareya Hospital,Al-Ahrar Hospital,Ahmed Maher Teaching Hospital,Al-Gomhoreya Hospital,and the National Hepatology and Tropical Medicine Research Institute)affiliated with the General Organization for Teaching Hospitals and Institutes in Egypt.Patients were recruited from May 1,2020,to July 31,2020.Demographic,laboratory,imaging features,and outcomes were collected.Multivariate regression analysis was performed to detect factors affecting mortality.RESULTS This retrospective cohort study included 125 patients with chronic hepatitis C and COVID-19 co-infection,of which 64(51.20%)had liver cirrhosis and 40(32.00%)died.Fever,cough,dyspnea,and fatigue were the most frequent symptoms in patients with liver cirrhosis.Cough,sore throat,fatigue,myalgia,and diarrhea were significantly more common in patients with liver cirrhosis than in noncirrhotic patients.There was no difference between patients with and without cirrhosis regarding comorbidities.Fifteen patients(23.40%)with liver cirrhosis presented with hepatic encephalopathy.Patients with liver cirrhosis were more likely than non-cirrhotic patients to have combined ground-glass opacities and consolidations in CT chest scans:28(43.75%)vs 4(6.55%),respectively(P value<0.001).These patients also were more likely to have severe COVID-19 infection,compared to patients without liver cirrhosis:29(45.31%)vs 11(18.04%),respectively(P value<0.003).Mortality was higher in patients with liver cirrhosis,compared to those with no cirrhosis:33(51.56%)vs 9(14.75%),respectively(P value<0.001).All patients in Child-Pugh class A recovered and were discharged.Cirrhotic mortality occurred among decompensated patients only.A multivariate regression analysis revealed the following independent factors affecting mortality:Male gender(OR 7.17,95%CI:2.19–23.51;P value=0.001),diabetes mellitus(OR 4.03,95%CI:1.49–10.91;P value=0.006),and liver cirrhosis(OR 1.103,95%CI:1.037–1.282;P value<0.0001).We found no differences in liver function,COVID-19 disease severity,or outcomes between patients who previously received direct-acting antiviral therapy(and achieved sustained virological response)and patients who did not receive this therapy.CONCLUSION Patients with liver cirrhosis are susceptible to higher severity and mortality if infected with COVID-19.Male gender,diabetes mellitus,and liver cirrhosis are independent factors associated with increased mortality risk.展开更多
BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 ...BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.展开更多
Objective: To assess whether changes in platelet indices, detectable by simple complete blood count (CBC), during pregnancy could be used as markers for prediction of development of preeclampsia (PE). Methods: A total...Objective: To assess whether changes in platelet indices, detectable by simple complete blood count (CBC), during pregnancy could be used as markers for prediction of development of preeclampsia (PE). Methods: A total of 2813 pregnant women who received regular antenatal care until delivery were included. Participants were divided into 3 groups: normotensive pregnant women (n = 2621), women with PE without severe features (n = 169), and women with PE with severe features (n = 23). Blood samples were collected during antenatal visits and/or during the period of in-patient hospital stay, and changes in platelet indices were compared among the three groups. Results: Platelet count (PC) was decreasing while mean platelet volume (MPV) and platelet distribution width (PDW) were increasing as PE progressed. Receiver operating characteristics (ROC) curve analysis showed that PDW had the largest area under curve (AUC) [0.980 (95% CI: 0.964 - 1.000)], making it the best marker for predicting development of PE. Also, PDW showed the most statistically significant correlation with mean arterial pressure (MAP) (r = 0.902, p = 0.000), making it the best marker for predicting severity of hypertension. Conclusion: This study provides evidence that PC decreases while MPV and PDW increase as pregnancy advances, and these changes are more pronounced in PE than normotensive pregnancy. These changes predate development of PE by 2 - 8 weeks and are proportional to the progress of this disorder. The selected platelet indices, especially PDW, have the potential to be utilized as markers for not only prediction of PE development but also severity of hypertension.展开更多
Objectives To evaluate the urinary kidney injury molecule-1(KIM-1)as a predictor for early detection of acute kidney injury in cases with obstructive nephropathy in an animal model and to correlate urinary KIM-1 with ...Objectives To evaluate the urinary kidney injury molecule-1(KIM-1)as a predictor for early detection of acute kidney injury in cases with obstructive nephropathy in an animal model and to correlate urinary KIM-1 with the progress of obstructive nephropathy on a histopathological basis.Materials and methods Three models of obstruction were induced in 90 male rats:unilateral partial ureteral obstruction with a normal contra-lateral kidney,with nephrectomy of a contralateral kidney(solitary kidney),and bilateral partial ureteral obstruction.Each group was further divided into 2 subgroups;the sham-group(10 rats)and the disease group(20 rats).Serum creatinine,blood urea nitrogen,and urinary KIM-1 were collected on days 0,7,and 14.Rats were sacrificed on the 7th and 14th day for histopathological examination of the obstructed kidney.Results By the end of first week,there was a significant rise of all biomarker levels in all groups when compared with basal levels.Similarly,biomarker levels at the 14th day were significantly higher than those obtained at the 7th day.The urinary KIM-1 level was not detected in the baseline condition.Expression of urinary KIM-1 showed a significant rise in all models ranging from 22 to 85 fold at the 7th day and even higher levels at the 14th day.Histopathological examination confirmed the presence of different forms of tubular injury.Conclusions Urinary KIM-1 is significantly elevated in obstructive uropathy.Such an elevation might be advantageous in the early diagnosis and subsequent early intervention of cases with partial ureteral obstruction.展开更多
文摘<strong>Background:</strong><span style="font-family:""><span style="font-family:Verdana;"> EEG is one of the most sensitive instrumental techniques for identifying sepsis-related neurological complications and a valuable tool in the ICU when clinical assessment is difficult. </span><b><span style="font-family:Verdana;">Aim of the Study:</span></b><span style="font-family:Verdana;"> To detect EEG changes in neonates with evidence of sepsis.</span><a name="_Toc508467354"></a> <b><span style="font-family:Verdana;">Patients and Methods</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> This was a prospective observational study for detecting EEG changes in cases of proven neonatal sepsis. This study was conducted at the NICU of Al Zahraa University Hospital for a period from October 2019 to March 2020. Our studied neonates were 50. This study included full-term newborns (37 to 42 weeks of gestational age) with clinical and laboratory evidence of sepsis (early and late onset). Neonatal birth asphyxia, jaundice, congenital malformations, suspected inborn error of metabolism and neonates electrolytes disturbances were excluded from the study. We record EEG changes during 20 min By an electroencephalogram</span><b> </b><span style="font-family:Verdana;">(EEG) with abioelectric amplifier (Deltamed, Bourgogne), (Philips) Screen.</span><b> <span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Among our studied neonates (neonates with evidence sepsis), 44.0% developed clinical seizures, 81% of the seizures group had abnormal EEG, 35.7% of No seizures group had abnormal EEG. Among our studied neonates, 56% had abnormal EEG EEG abnormalities were as follow, 26%/ had low voltage, 30% had spikes, 22% had sharp waves. </span><b><span><span style="font-family:Verdana;">Conclusion:</span><i> </i></span></b><span style="font-family:Verdana;">About 35% (one third) of neonates who didn’t develop clinical seizures had abnormal EEG, suggesting a poor correlation between clinical and electroencephalographic detection of seizures.</span></span>
文摘To assess awareness, knowledge and perceptions of antenatal care-seeking women about cervical ripening (CR) and induction of labor (IOL), and their attitude towards these interventions. Methods: An observational descriptive cross-sectional study which was conducted at an Egyptian teaching hospital. A questionnaire-based interview covered items on women’s demographic and clinical data, as well as their awareness, knowledge, perception and attitude towards specific methods of CR and IOL. Results: A total of 853 questionnaires were analyzed, and 442 respondents (51.8%) were aware of CR and IOL. Knowledge of Oxytocin use was noted in 215 participants (48.6%), of membrane sweeping in 85 (19.2%), of Foley’s catheter in 110 (24.9%) and of Misoprostol in 84 (19.0%). The procedures were perceived to prevent cesarean section in 219 respondents (49.5%). History of previous IOL was a predictor of awareness (OR: 5.19, 95% CI: 1.6 – 11.23, p = 0.001*). Conclusion: This study showed that only a slightly more than 50% of participants were aware of CR and IOL, and the overall knowledge and perception were sub-optimal. Nevertheless, the attitudes towards the procedures were positive. Improved counselling is required in order to further increase knowledge about CR and IOL, and also correct misbelieves particularly in women at risk of undergoing IOL.
文摘Objective:Hepatocellular carcinoma(HCC)is the fifth most common malignancy worldwide.The identification of new simple,inexpensive and highly accurate markers for HCC diagnosis and screening is needed.This case-control study evaluates the role of annexin A2 and voltage-gated calcium channelsα2δ1 subunit as serum biomarkers for HCC diagnosis.Methods:The study comprised three groups:group 1,50 patients with an initial diagnosis of HCC associated with chronic hepatitis C virus infection;group 2,25 patients diagnosed with chronic hepatitis C virus infection and cirrhosis without any evidence of HCC;and group 3,15 healthy controls.All participants were subjected to clinical and laboratory investigations,and radiological scanning.The serum levels of alpha-fetoprotein(AFP),annexin A2,and theα2δ1 subunit were evaluated by using ELISA technique.Results:The serum levels of annexin A2 significantly increased in patients with HCC(10.4±2.5 ng/m L;P<0.001)or with cirrhosis(9.31±1.8 ng/m L;P<0.001)comparing to that of healthy controls(0.296±0.09 ng/m L).However,there was no significant difference in serum annexin A2 levels in patients with HCC comparing to those with cirrhosis.Serumα2δ1 subunit significantly increased in patients with HCC(20.12±3.7 ng/m L)comparing to that in patients with cirrhosis(10.41±3.4 ng/m L,P<0.001)and healthy controls(10.2±2.9 ng/m L,P<0.001).Conclusions:The serumα2δ1 subunit may function as a new biomarker for HCC diagnosis.Conversely,serum annexin A2 has low diagnostic value as an HCC marker,especially in patients with underlying cirrhosis.
文摘ACL reconstruction surgery shows low incidence of complications (1.38%) like DVT, Infection, patellar tendon rupture and fractures whether in the proximal tibia or the distal femur. We hereby present two cases that have had the rare complication of proximal tibial fracture. The circumstances of each case are discussed together with discussion of similar cases described in the literature. We tried in the end to have an idea about the possible causes and how to prevent such a devastating event. Case presentation: Case 1 shows a 38-year-old female patient who had an ACL reconstruction surgery by BTB graft followed by iatrogenic proximal tibial fracture managed by open reduction internal fixation by T plate and screws. Case 2 shows a 28-year-old male patient who had an ACL reconstruction surgery by BTB graft also followed by Proximal tibial fracture 3 weeks later managed by open reduction internal fixation using a locked plate and screws. Discussion: Fractures are a rare complication that may follow ACL reconstruction surgery. These fractures can be femoral or tibial that may be due to the reduction of the bone strength as a result of the drill holes which behave as a stress riser. We also suggest that usage of osteotomes during grafting plays a role in these fractures. Management of these fractures is either by open reduction and internal fixation or closed reduction. What is known about the subject: Patellar fractures are a known complication of ACL reconstruction using patellar tendon graft. What this study adds to the existing knowledge: Raising the Knowledge that also the tibia can be fractured as a complication of patellar tendon harvesting not only the patella.
文摘BACKGROUND Chronic liver disease,particularly cirrhosis,is associated with worse outcomes in patients infected with coronavirus disease 2019(COVID-19).AIM To assess outcomes of COVID-19 infection among patients with pre-existing hepatitis C with or without liver cirrhosis.METHODS This multicenter,retrospective cohort study included all cases of confirmed coinfection of severe acute respiratory syndrome coronavirus 2 and chronic hepatitis C with or without liver cirrhosis who were admitted to six hospitals(Al-Sahel Hospital,Al-Matareya Hospital,Al-Ahrar Hospital,Ahmed Maher Teaching Hospital,Al-Gomhoreya Hospital,and the National Hepatology and Tropical Medicine Research Institute)affiliated with the General Organization for Teaching Hospitals and Institutes in Egypt.Patients were recruited from May 1,2020,to July 31,2020.Demographic,laboratory,imaging features,and outcomes were collected.Multivariate regression analysis was performed to detect factors affecting mortality.RESULTS This retrospective cohort study included 125 patients with chronic hepatitis C and COVID-19 co-infection,of which 64(51.20%)had liver cirrhosis and 40(32.00%)died.Fever,cough,dyspnea,and fatigue were the most frequent symptoms in patients with liver cirrhosis.Cough,sore throat,fatigue,myalgia,and diarrhea were significantly more common in patients with liver cirrhosis than in noncirrhotic patients.There was no difference between patients with and without cirrhosis regarding comorbidities.Fifteen patients(23.40%)with liver cirrhosis presented with hepatic encephalopathy.Patients with liver cirrhosis were more likely than non-cirrhotic patients to have combined ground-glass opacities and consolidations in CT chest scans:28(43.75%)vs 4(6.55%),respectively(P value<0.001).These patients also were more likely to have severe COVID-19 infection,compared to patients without liver cirrhosis:29(45.31%)vs 11(18.04%),respectively(P value<0.003).Mortality was higher in patients with liver cirrhosis,compared to those with no cirrhosis:33(51.56%)vs 9(14.75%),respectively(P value<0.001).All patients in Child-Pugh class A recovered and were discharged.Cirrhotic mortality occurred among decompensated patients only.A multivariate regression analysis revealed the following independent factors affecting mortality:Male gender(OR 7.17,95%CI:2.19–23.51;P value=0.001),diabetes mellitus(OR 4.03,95%CI:1.49–10.91;P value=0.006),and liver cirrhosis(OR 1.103,95%CI:1.037–1.282;P value<0.0001).We found no differences in liver function,COVID-19 disease severity,or outcomes between patients who previously received direct-acting antiviral therapy(and achieved sustained virological response)and patients who did not receive this therapy.CONCLUSION Patients with liver cirrhosis are susceptible to higher severity and mortality if infected with COVID-19.Male gender,diabetes mellitus,and liver cirrhosis are independent factors associated with increased mortality risk.
文摘BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.
文摘Objective: To assess whether changes in platelet indices, detectable by simple complete blood count (CBC), during pregnancy could be used as markers for prediction of development of preeclampsia (PE). Methods: A total of 2813 pregnant women who received regular antenatal care until delivery were included. Participants were divided into 3 groups: normotensive pregnant women (n = 2621), women with PE without severe features (n = 169), and women with PE with severe features (n = 23). Blood samples were collected during antenatal visits and/or during the period of in-patient hospital stay, and changes in platelet indices were compared among the three groups. Results: Platelet count (PC) was decreasing while mean platelet volume (MPV) and platelet distribution width (PDW) were increasing as PE progressed. Receiver operating characteristics (ROC) curve analysis showed that PDW had the largest area under curve (AUC) [0.980 (95% CI: 0.964 - 1.000)], making it the best marker for predicting development of PE. Also, PDW showed the most statistically significant correlation with mean arterial pressure (MAP) (r = 0.902, p = 0.000), making it the best marker for predicting severity of hypertension. Conclusion: This study provides evidence that PC decreases while MPV and PDW increase as pregnancy advances, and these changes are more pronounced in PE than normotensive pregnancy. These changes predate development of PE by 2 - 8 weeks and are proportional to the progress of this disorder. The selected platelet indices, especially PDW, have the potential to be utilized as markers for not only prediction of PE development but also severity of hypertension.
文摘Objectives To evaluate the urinary kidney injury molecule-1(KIM-1)as a predictor for early detection of acute kidney injury in cases with obstructive nephropathy in an animal model and to correlate urinary KIM-1 with the progress of obstructive nephropathy on a histopathological basis.Materials and methods Three models of obstruction were induced in 90 male rats:unilateral partial ureteral obstruction with a normal contra-lateral kidney,with nephrectomy of a contralateral kidney(solitary kidney),and bilateral partial ureteral obstruction.Each group was further divided into 2 subgroups;the sham-group(10 rats)and the disease group(20 rats).Serum creatinine,blood urea nitrogen,and urinary KIM-1 were collected on days 0,7,and 14.Rats were sacrificed on the 7th and 14th day for histopathological examination of the obstructed kidney.Results By the end of first week,there was a significant rise of all biomarker levels in all groups when compared with basal levels.Similarly,biomarker levels at the 14th day were significantly higher than those obtained at the 7th day.The urinary KIM-1 level was not detected in the baseline condition.Expression of urinary KIM-1 showed a significant rise in all models ranging from 22 to 85 fold at the 7th day and even higher levels at the 14th day.Histopathological examination confirmed the presence of different forms of tubular injury.Conclusions Urinary KIM-1 is significantly elevated in obstructive uropathy.Such an elevation might be advantageous in the early diagnosis and subsequent early intervention of cases with partial ureteral obstruction.
