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   2015| May-August  | Volume 21 | Issue 2  
    Online since August 6, 2015

 
 
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ORIGINAL ARTICLES
Diagnostic usefulness of the random urine Na/K ratio in predicting therapeutic response for diuretics in cirrhotic patients with ascites
Mohamed El Basel, Ahmed El Mazny, Ahmed Emam, Amal El Shehaby
May-August 2015, 21(2):60-65
DOI:10.4103/1687-4625.162394  
Background Ascites is a major complication of liver cirrhosis that carries a poor prognosis. Diuretics are used in treatment of ascites in addition to salt restriction. Monitoring of diuretic response can be achieved by measurement of 24-h urinary sodium. Aim of the study The aim of the study was to evaluate the accuracy of using spot urinary sodium/potassium ratio as an alternative to 24-h urinary sodium in assessment of dietary sodium compliance in patients with liver cirrhosis receiving diuretics. Patients and methods Sixty patients presenting with liver cirrhosis and ascites were admitted at Cairo University Hospital. All the patients were subjected to full history taking, clinical examination, laboratory investigations including liver function tests, renal function tests, 24-h urine sample (for measuring of sodium) and spot urine sample (for sodium and potassium). The studied patients were divided into two groups: diuretic resistant group (those with 24-h urinary sodium <78 mEq) and diuretic sensitive group (with 24-h urinary sodium >78 mEq). The patients in diuretic resistant group were 18 patients (30%) and those in diuretic sensitive group were 42 patients (70%). Results Spot urine Na/K ratio was significantly lower in patients in the diuretic resistant group (2.4 ± 2.2) than in the sensitive group (4.7 ± 2.3) (P < 0.05). The cutoff point of Na/K ratio that showed highest accuracy was 3.0. Conclusion This study revealed highly significant correlation between 24-h urinary sodium and spot urine sodium/potassium ratio with sensitivity 75% and specificity 91.67% at cutoff point of 3.
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Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt
Mabrouk El-Sheikh, Ghada Al-Ghazaly
May-August 2015, 21(2):47-54
DOI:10.4103/1687-4625.162384  
Background and objectives Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy and many studies have shown strong correlation between HD dose and clinical outcome measured by Kt/V. This study was conducted to evaluate HD adequacy in patients with end-stage renal disease to identify the prevalence and causes of inadequate HD and the impact of HD adequacy on patient outcomes. Patients and methods This cross-sectional study was conducted on 100 patients in the HD unit at Tanta University Hospital. All patients gave their consent and were informed about the study purpose. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. Statistical analysis was carried out for all collected data using SPSS 18. Statistical significance was determined at a P-value less than 0.05. Results The results revealed inadequate HD dose in 60% of the study population. The results also showed that, with increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings clearly showed a strong positive correlation between dialysis dose and Hb level, serum albumin level, normalized protein catabolic rate, and physical health. Conclusion A significant percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of the dialysis session, patients' complaints, and well-functioning vascular access.
  4,962 505 -
Disease characteristics of systemic sclerosis among Egyptian patients
Mohamed El Basel, Noha Khalil
May-August 2015, 21(2):41-46
DOI:10.4103/1687-4625.162378  
Introduction Scleroderma, or systemic sclerosis (SSc), is a chronic connective tissue disease that has been classified as one of the autoimmune rheumatic diseases. The usual hallmarks of SSc are autoimmunity, inflammation, widespread small-vessel vasculopathy affecting multiple vascular beds, and progressive interstitial and vascular fibrosis in the skin and internal organs. Aim of the work The aim of the study was to determine the disease characteristics and frequency of different clinical manifestations among Egyptian patients. Patients and methods Seventy-five patients with SSc, all fulfilling the criteria of the American College of Rheumatology for classification of scleroderma, were selected for this study. They were being followed up in Cairo University Internal Medicine department. The patients' data were collected by a review of their medical records. We compared the frequency of symptoms in scleroderma patients with both diffuse cutaneous and limited cutaneous sclerosis (dcSSc and lcSSc). Results Fourteen patients out of 75 (18.7%) had dcSSc and 61/75 (81.3%) had lcSSc. We found that within the limited subtype 11/61 (18%) were male and 50/61 (82%) were female, with a male to female ratio of 1: 4.6. Within the diffuse subtype, 3/14 (21.4%) were male and 11/14 (78.6%) were female, with a male to female ratio of 1: 3.7. Raynaud's phenomenon was the first presenting manifestation (in 77.3%), followed by arthritis (in 12%) and skin tightness (in 9.3%). Conclusion SSc is more common in the female population than in the male population. lcSSc is more common than dcSSc.
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Serum lipoxin A4 as a biomarker for systemic lupus erythematosus
Manal M SedkyAbdou, Dina Abbas Effat, Lamiaa Ali Mansour, Noha Mahmoud Abd El Baky, Mona Mohsen Abdel Salam
May-August 2015, 21(2):55-59
DOI:10.4103/1687-4625.162390  
Introduction Systemic lupus erythematosus (SLE) is an immune-complex mediated autoimmune disease characterized by protean clinical manifestations and fluctuating disease course. It was proposed that progression and flares of lupus and lupus nephritis are due to decreased production of lipoxin A4 (LXA4) and enhanced production of leukotrienes by the renal tissue and/or infiltrating leukocytes and macrophages. Objective The aim of this study was to assess the levels of serum LXA4 in SLE patients and in healthy controls, and to correlate them with various clinical and laboratory data as well as renal biopsy and disease activity indices. Patients and methods Forty adult female SLE patients were included in this study. The SLE patients were divided into two groups: group I included 20 patients without nephritis and group II included 20 patients with nephritis. Forty apparently healthy age-matched women served as the control group. Patients and controls were assessed for serum LXA4 using enzyme linked immunosorbent assay. Disease activity was assessed using systemic lupus erythematosus desease activity index (SLEDAI) and renal SLEDAI. Renal biopsy was performed for patients with lupus nephritis. Results SLE patients showed a higher median level of serum LXA4 compared with the control group (0.24 vs. 0.15 ng/ml), but with no significant statistical difference (P = 0.097). Moreover, there was no statistically significant difference in serum LXA4 between SLE patients with and without nephritis and the control group (P = 0.142). There was no significant correlation between serum LXA4 and various clinical and laboratory data, as well as renal biopsy and disease activity index. Conclusion LXA4 was suggested to be an important biomarker to search for in SLE. Our study showed no significant statistical difference between SLE patients and the control group as regards serum LXA4. Assessment of urinary LXA4 is recommended as it may be more valuable than serum LXA4 in reflecting organ affection in SLE, as well as disease activity, and comparing it with serum LXA4 level.
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The use of noninvasive continuous cardiac output to monitor the hemodynamic effects of propofol-fentanyl versus propofol-ketamine induction
Alaa A.A. Niazi
May-August 2015, 21(2):66-71
DOI:10.4103/1687-4625.162399  
Background Noninvasive continuous cardiac output monitoring method utilizing ECG and a pulse oximeter wave was based on hemodynamic analysis combined with pulse wave transit time. Propofol injection may induce a significant decrease in blood pressure. The use of ketamine with propofol may reduce the dose and the hemodynamic effect of propofol. Patients and methods Sixty female patients, ASA I and II, undergoing dilatation and curettage were divided into two equal groups. The first group received propofol (1 mg/kg) + fentanyl (1 μg/kg), whereas the second group received propofol (1 mg/kg) + ketamine (0.5 mg/kg) as induction agents. Continuous cardiac output monitoring was performed using pulse wave transit time technology. Hemodynamic data such as oxygen saturation through pulse oximetry, heart rate, and blood pressure were recorded every minute. Results Statistically significant differences between both groups were observed in diastolic, systolic, mean blood pressure, heart rate, and cardiac output. The propofol/fentanyl group showed a significant decrease in diastolic, systolic, and mean blood pressure, heart rate, and cardiac output compared with the propofol/ketamine group. Conclusion Noninvasive cardiac output measurement utilizing ECG, noninvasive blood pressure, and a pulse oximeter is a reliable method. Hemodynamic parameters including blood pressure, heart rate, cardiac output, and cardiac output index decreased with the induction of propofol and fentanyl combination, but were stable with the use of a propofol and ketamine combination.
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