Egyptian Male Patients Research Articles

Atypical Duplex appendix arising from the ascending colon: a case report

BackgroundDuplex or vermiform appendix refers to the presence of an appendix beside the naturally occurring one. Although, duplex appendix emerges from the caecum most of the time, yet it is encountered in other parts of the colon. Inflammation of duplex appendix may represent not only a clinical, but also a surgical dilemma, and this would be confusing further among patients who already had prior appendectomy.Case presentationWe present a case of 29-years old Egyptian male patient with history of appendectomy one and half year before presenting to the emergency department with recurrent acute abdominal pain that was linked to duplex appendicitis abnormally emerged from the mid-ascending colon. The first episode was treated conservatively considering atypical right colon diverticulitis as a potential differential diagnosis. Seven months later the patient was treated by laparoscopic appendectomy and experienced an uneventful pot-operative course.ConclusionDuplex appendicitis, though rare, should be considered in the differential diagnosis of recurrent acute abdomen even after appendectomy.

Zavras-Kounis Type I Syndrome, Anaphylaxis, Wavy Double, and Wavy Triple Signs Post-Ceftriaxone-Responsive to Standard Anti-anaphylaxis

Rationale: Drug-inducing side effects are undoubtedly one of the most frequent entities in applied medicine. Drug-inducing allergic angina, allergic coronary spasm, and allergic infarction are different recognized as Zavras-Kounis syndrome. The Kounis–Zavras syndrome and allergic angina are designated as the simultaneous existence of angina and allergic reactions associated with clinical and laboratory signs of classical angina pectoris. Both the Wavy triple electrocardiographic sign (Yasser’s Sign) and the related Wavy double sign (Yasser’s Sign) are innovative diagnostic signs in hypocalcemia. A Wavy double electrocardiographic sign was prescribed in hypocalcemia which is mostly seen with either tachycardia or bradycardia. Ceftriaxone is a third-generation cephalosporin prescribed for several bacterial infections. World Health Organization considered it in the List of Essential Medicines. Patient concerns: A 22-year-old married, security man, smoker, Egyptian male patient was admitted to the critical care unit with anaphylaxis and angina after an intravenous injection of ceftriaxone. Diagnosis: Zavras-Kounis syndrome type I, anaphylaxis, Wavy double, and Wavy triple signs post-ceftriaxone injection. Interventions: Electrocardiography, oxygenation, and echocardiography. Outcomes: The dramatic disappearance of anaphylactic shock, Zavras-Kounis syndrome type I, and coronary spasm after the traditional treatment of anaphylaxis had happened. Complete clinical and electrocardiographic recovery had been achieved. Lessons: Ceftriaxone injection can induce anaphylactic shock, Kounis–Zavras type I syndrome, coronary spasm, and anaphylaxis. Kounis–Zavras type I syndrome, coronary spasm, and anaphylaxis can be reversed with treatment of the cause without using anti-ischemic or ant-arrhythmic measures. The identification of drug-induced disease is a pivotal step in the diagnosis and decision-making of any medical problems. Reassurance was recommended regarding ceftriaxone-induced coronary spasm accompanied by anaphylaxis.

Adverse sexual effects of COVID-19 in a sample of Egyptian male patients

Adverse sexual effects of COVID-19 in a sample of Egyptian male patients

CML-006 CML Blastic Crisis Diagnosis Based on a Lymph Node Biopsy in an Egyptian Male Patient: A Rare Case Report

Chronic myeloid leukemia (CML) is a clonal myeloproliferative triphasic clinical disorder characterized by a distinct genetic abnormality: the BCR-ABL fusion gene (Philadelphia chromosome). The presence of blasts in the lymph node (LN) is enough for a diagnosis of blast-phase CML. The case study herein is a very rare presentation. A case report of a 53-year-old Egyptian male patient who presented in 2020 with night fever and sweats. Oncology Center Mansoura University. Examination revealed firm, non-tender, generalized cervical and bilateral axillary lymphadenopathy. The patient's abdominal examination revealed moderate, firm, and non-tender splenomegaly. Complete blood count: white blood cell count 239 k/µL, normocytic normochromic anemia with hemoglobin 11 g/dL, and platelet count 321 k/µL. Differential leukocyte count revealed blasts (1%), myelocytes (12%), metamyelocytes (25%), polymorphonuclear leukocytes (50%), eosinophils (2%), basophils (3%), and lymphocytes (2%). Bone marrow (BM) examination was hypercellular; 70% of the total BM cellularity was replaced by myeloid series highlighted by myeloperoxidase, and few blasts (<1%) were CD34+, suggesting chronic-phase CML. BCR-ABL1 gene rearrangement by Q RT-PCR was 65.9% IS. The patient started imatinib 400 mg/d. LNs were suspicious, and excisional biopsy showed multiple fatty nodules -3.5×3 cm; the cut section was firm, grayish white, partially effaced, and replaced by infiltrate of myeloid series (MPO+, CD3-, CD30-, and CD79a) with a high Ki67 proliferation index. LN infiltration suggested a CML blastic crisis despite the fact that repeated BM aspirate samples revealed no increase in blasts. However, the new BM biopsy (BMB) revealed that most of the cellularity was replaced by myeloid series with CD117+ (15%) and CD34+. Acute leukemia risk assessment revealed FLT3- and inv(16)+, and FISH analysis indicated t(9:22). The patient was refractory to ICT and imatinib and was shifted to salvage. Complete remission was confirmed by PET/CT scan and BMB; however, he did not achieve a molecular response (Q RT-PCR for BCR-ABL1 15% IS). He was switched to dasatinib with consolidation chemotherapy, and HLA matching was done for results. This case report highlights the importance of a rare CML presentation with extramedullary infiltrates. A myeloid sarcoma should be excluded before setting the treatment plan.

Bifascicular Block with Electrocardiographic Sisiisiii Pattern in Mild Covid-19 Pneumonia with Slight Pleural Effusion; Differentiation versus Outcome

Rationale: Cardiovascular and chest involvement in a pandemic COVID-19 virus infection may be vital.Bifascicular heart block is affecting the conduction delay or block below the AVN in two of the three fascicles. There is a correlation between mortality with sudden cardiac death (SCD) and bifascicular block. SISIISIII pattern is meaning that the S-waves of amplitude is more than 1.5 mm in I, II, and III. It is a variable prognostic electrocardiographic finding. Patient concerns: A 67-year-old, retired officer, smoker, married, Egyptian male patient was admitted to the intensive care unit with right bundle branch block, left anterior fascicular block, and mild COVID-19 pneumonia with slight pleural effusion. Diagnosis: Bifascicular block with ECG SISIISIII pattern in mild COVID-19 pneumonia with slight pleural effusion. Interventions: Electrocardiography, oxygenation, non-contrast chest CT, and echocardiography. Outcomes: Good response and better outcomes despite the presence of several remarkable risk factors were the results. Lessons: Associated hypoxia in the current COVID-19 pneumonia may play an essential role in the present new bifascicular heart block. SISIISIII pattern represents a variable prognostic ECG finding such as RVH, pulmonary embolism, and congenital heart disease. The presence of left ventricular septal hypertrophy is considered another risk. The presence of the elderly male sex, heavy smoker, COVID-19 pneumonia, pleural effusion, bifascicular heart block, SISIISIII pattern, and interventricular septal hypertrophy are prognostic factors for the severity of the disease.

An Elderly COVID-19 Pneumonia with Stroke, and QTc Prolongation, Fragmentation of the QRS-complex, and Connected Aircraft Squadron Electrocardiographic Sign (Yasser’s sign); Multiple Risk and Serious Implications

Rationale: COVID-19 infection is a wide-world pandemic serious highly infectious multisystem disease. Neurological, cardiovascular, hepatic, and renal systems are commonly involved. Connected aircraft squadron electrocardiographic sign (Yasser’s sign) is a novel electrocardiographic sign which a relevant to T-wave changes and respiratory rate. This sign is a strong guide for tachypnea. QTc-interval prolongation is a serious signal for torsades de pointes, fatal ventricular tachyarrhythmias, and sudden death. Previously, fragmentation of the QRS-complex had already been considered a marker for structural heart diseases (SHD) triggering cardiac hypertrophy. Patient concerns: An 88-year-old, carpenter, smoker, married Egyptian male patient was admitted to the critical care unit with cerebrovascular stroke, cardiac involvement, and COVID-19 pneumonia. Diagnosis: COVID-19 pneumonia with acute neurological events and cardiovascular involvement. Interventions: Electrocardiography, oxygenation, non-contrasted chest CT, and brain CT. Outcomes: Good response and better outcomes despite the presence of several remarkable risk factors were the results. Lessons: The clinical and electrocardiographic response after using anti-COVID19 measures the signifying its role and suggest the diagnosis of COVID19 infection. The presence of COVID-19 pneumonia, stroke, QTc-interval prolongation, fragmentation of the QRS-complex, hypocalcemia, Connected aircraft squadron electrocardiographic sign (Yasser’s sign) with severe fatigue, elderly, and cigarette smoking are prognostic factors for the severity of the disease.

Camel-Hump T-Wave, Tee-Pee Sign, and Wavy Triple Sign (Yasser’s Sign) with Hypocalcemia and Hyperkalemia in Covid-19 Pneumonia with Lacunar Infarction

Rationale: A novel COVID-19 is a multi-systemic critical worldwide pandemic infection. Certainly, associated multiple electrolytes imbalance in COVID-19 pneumonia is a remarkable decisive event. Camel-hump T-wave, Tee-Pee sign, and Wavy triple sign (Yasser’s sign)are novel highly significant descriptive electrocardiographic signs that are seen in calcium and potassium disturbance. There is an established and strong relationship between and electrocardiographic abnormalities and electrolytes imbalance. COVID-19 pneumonia and cerebrovascular stroke are commonly seen in a patient with Coronavirus infection. Patient concerns: A 69-year-old married worker Egyptian male patient was presented to the emergency department with COVID-19 pneumonia and cerebrovascular stroke. Diagnosis: COVID-19 pneumonia with lacunar infarction, hypocalcemia, and hyperkalemia. Interventions: Chest CT scan, brain CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Initial bad and deterioration outcome but, the dramatic outcome had happened after later management. Lessons: The understanding of electrocardiographic signs regarding metabolic disorders such as electrolytes imbalance and other associated systemic diseases is very important. Elderly male sex, heavy smoker, COVID-19 pneumonia, cerebrovascular stroke, chronic renal impairment, ischemic heart disease, hypokalemia, hypocalcemia, and hypernatremia represent bad prognostic points and is indicating a high-risk condition.

Qrs-Complex Fragmentations and Right Ventricular Infarction in the Presence of Inferior Infarction with Triple-Vessels Disease; Bad Initials but a Good Outcome

Rationale: The term “fragmentation of the QRS complex” denotes the existence of high-frequency potentials (spikes) in the QRS-complex. It is either a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normally homogeneous depolarization status inside the myocardium. An associated right ventricular infarction with inferior infarction maybe carry a risk impact and serious complications. Patient concerns: A 64-year-old married, farmer, heavy smoker, Egyptian male patient presented with acute severe chest pain and inferior with right ventricular ST-segment elevation myocardial infarction and fragmentation of the QRS complex. Diagnosis: QRS-complex fragmentations and right ventricular infarction in the presence of inferior infarction with the triple-vessels disease. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, echocardiography, and percutaneous transluminal coronary angioplasty. Outcomes: Dramatic response of acute inferior with right ventricular ST-segment elevation myocardial infarction and QRS-complex fragmentations to streptokinase. Lessons: Despite the presence of inferior and right ventricular ST-segment elevation myocardial infarction with QRS-complex fragmentations, but there is no correlation with the severity of the disease. Dramatic clinical and electrocardiographic response signifying the role of streptokinase and fibrinolytic. The presence of fragmentation of the QRS-complex may have a bidirectional impact from seriousness to complications.

The Relationship between Gut Peptides (Polypeptide YY and Ghrelin) Serum Concentration and Metabolic Syndrome Components in Egyptian Male Patients

The Relationship between Gut Peptides (Polypeptide YY and Ghrelin) Serum Concentration and Metabolic Syndrome Components in Egyptian Male Patients

Prevalence of erectile dysfunction among Egyptian male patients with type 2 diabetes mellitus

Background and aimsThe relation between type 2 diabetes mellitus (T2DM) and erectile dysfunction (ED) has been identified in multiple studies. The aim of this cross-sectional study was to estimate the prevalence and to determine some associated factors of ED among a sample of adult Egyptian male patients with T2DM. MethodsThis cross-sectional study included 150 adult male patients with T2DM (aged 40–60 years) who attended the outpatient clinic of Diabetes in Alexandria Main University hospital. They were evaluated for the presence of ED which was assessed by the validated Arabic-translated five-item version of the International Index of Erectile Function-5 (IIEF-5) questionnaire. Fasting blood glucose (FBG), HbA1c, total serum cholesterol, HDL-C, total serum testosterone (TT) and urinary albumin creatinine ratio (uACR) were measured for all study subjects. ResultsThe prevalence of ED was 80% among the studied sample. Significant negative correlation was found between IIEF-5 score and age, duration of diabetes, FBG and urinary ACR; while there was a significant positive correlation between IIEF-5 score and serum total testosterone. On performing multiple linear regression analysis for the parameters affecting IIEF-5 questionnaire score, TT, urinary ACR, age and FBG were the independent predictors of ED. ConclusionED was a common finding in our sample of Egyptian men with T2DM. Poor glycemic control and albuminuria may be considered as independent risk factors for ED.

Clinical characteristics of Egyptian male patients with COVID-19 acute respiratory distress syndrome.

BackgroundCoronavirus disease 2019 (COVID-19) is a serious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in severe cases associated with acute respiratory distress syndrome (ARDS).ObjectiveTo describe the clinical characteristics of patients with ARDS-COVID-19.Materials and methodsThis study involved 197 male Egyptian participants, among them111 COVID-19 patients presented with ARDS, 60 COVID-19 patients presented with non-ARDS, and 26 Non-COVID-19 patients. We reported the analysis results of clinical and laboratory information, including blood routine tests, blood biochemistry parameters [aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine and C‐reactive protein (CRP)], thrombotic activity (D‐dimer) and serum ferritin and lactate dehydrogenase (LDH).ResultsThe levels of hemoglobin, AST, creatinine, monocyte count, monocyte %, RBC count, TLC, and platelet count were not significantly different among the groups. The lymphopenia and increased CRP, ALT, D-dimer, ferritin, and LDH were observed in patients with ARDS-COVID-19.ConclusionCOVID-19 patients with ARDS presented with lymphopenia, increased thrombotic activity, increased CRP, LDH, and ferritin levels. The results revealed that CRP, D-dimer, LDH levels, and lymphopenia have a significant association with the COVID-19 severity and can be used as biomarkers to predict the disease severity.

Spontaneous Negative Seroconversion of Both Hepatitis B and C in an Egyptian HD Patient

Background: Hepatitis b virus infection (HBV) was recognized as an important hazard for patients and staff in Hemodialysis Units (HDU), and this issue was first recognized in the 1960s with a set of guidelines for the control of HBV in HDU. HCV is a blood-borne infection and is the most significant cause of viral hepatitis which is mainly transmitted by blood transfusion. Thus, it is reasonable to perform initial screening for HCV in HD patients. Patients admitted or re-admitted to an HD unit are recommended to be tested for HBsAg, HCV, and HIV antibodies and to be followed up monthly or at least every three months after admission to HDU.&#x0D; We aim to present this case of spontaneous clearance of HBV and HCV positive after being positive for more than twelve years on HD.&#x0D; Case Presentation: A 66 years old Egyptian male patient with Chronic Kidney Disease (CKD) from Alexandria had started HD 14 years ago while he tested positive for HCV-Ab and HBs Ag positive, although fared well with normal liver function, while the source of infection was not known. HCV-Ab turned into seronegativity after twelve years on HD. Astonishingly, after 13 years on HD; the test of HBs Ag became negative and hepatitis B surface antibody appears by Elisa testing. This was noticed or observed following the implementation of quality enhancement of the HD parameters in most of the HD services provided units according to the regulations of Ministry of Health (MOH), and this was accompanied by better anemia and more frequent utilization of high flux dialysis with a consequent reduction to the need for blood transfusion in the last four years. Previous publications advocated hypothetical mechanisms of HCV clearance during the process of HD: namely, filtration of the virus particles through the pores of the dialysis membrane and or their adsorption to the HD membrane. These welcome spontaneous clearances of the HBV and HCV in this patient could be attributable to the improvement of anemia state and use of high flux dialysis that might have improved the immunity of this patient.&#x0D; Conclusion: Spontaneous clearance of HBV and HCV could potentially possible and could benefit from the improvement of both patients and HD states that could enhance the immune system or mechanical entrapment of the virus particles. Suggestions need further studies for confirmation.

Circulating miR-148a-5p and miR-21-5p as Novel Diagnostic Biomarkers in Adult Egyptian Male Patients With Metabolic Syndrome

BackgroundMetabolic syndrome (MetS) is a group of abnormalities related to metabolism that increase the risk of cardiac diseases, type 2 diabetes and mortality. MicroRNAs (miRs) act as regulators of many cellular and metabolic events, and any dysregulation of these tiny molecules can cause great disturbance in one’s health. The main purpose of this study was to ascertain the diagnostic potential of miR-148a-5p and miR-21-5p in MetS. MethodsSerum levels of miR-148a-5p and miR-21-5p were quantified in 118 male patients with MetS and 30 healthy controls by quantitative real-time polymerase chain reaction. Fasting plasma glucose, serum high-density lipoprotein cholesterol and serum triacylglycerol were measured by the colorimetric method. Blood pressure and anthropometric measurements were performed on each individual. All MetS patients had diabetes and had a large waist circumference, and were divided into 3 groups: group 1, dyslipidemic and hypertensive; group 2, normotensive; and group 3, normal lipid profile.Results: miR-148a-5p expression was significantly upregulated in all MetS patients: group 1, 70.3±8.07 (p<0.0001); group 2, 75.0±9.17 (p<0.0001) and group 3, 33.7±6.89 (p<0.0001), when compared with control subjects. However, miR-21-5p expression was elevated only in the sera of group 1 (36.9±8.39, p<0.0001) and group 3 (48.9±12.0, p<0.0001), when compared with controls. ConclusionsSerum levels of miR-148a-5p and miR-21-5p were higher in MetS patients than in healthy controls; consequently, these serum miRs can serve as novel biomarkers for diagnosis and prognosis of MetS.

Mildly symptomatic liraglutide-induced acute pancreatitis in a patient with type 2 diabetes mellitus: a case report

BackgroundAcute pancreatitis (AP) represents a serious clinical challenge as it can threaten the patient’s life if it is missed or improperly managed. Liraglutide is one of the glucagon-like peptide 1 receptor agonists (GLP1-RA) which represent a novel class of antidiabetic medications in the Egyptian market. Hereby, we report a case of liraglutide-induced acute pancreatitis with atypical presentation.Case presentationA 53-year-old Egyptian male patient with diabetes presented to the emergency department with abdominal discomfort and vomiting without significant abdominal pain. Serum lipase and amylase were elevated more than three folds the upper normal limit (NUL 300 and 110 U/L respectively); abdominal ultrasonography was inconclusive, but contrast-enhanced computed tomography was diagnostic. A diagnosis of liraglutide-induced AP was built after exclusion of other causes. After admission, his medications were modified and improved clinically after 1 week.ConclusionMildly symptomatic AP in diabetic patients is a clinical challenge as it can be missed. Therefore, in certain clinical situations, AP should be suspected in patients administrating liraglutide particularly for those with autonomic neuropathy.

Performance of bone mineral density and trabecular bone score in assessment of bone quality in Egyptian male patients with ankylosing spondylitis

BackgroundOsteoporosis is a common complication of ankylosing spondylitis (AS) even in the early stages of disease; however, previously published studies have demonstrated large discrepancies in the reported incidence of osteoporosis, based on measurement of bone mineral density (BMD). The aim of the present study was to compare bone quality using trabecular bone score (TBS) between AS patients and healthy controls and to evaluate factors associated with TBS in patients with AS.ResultsAnkylosing spondylitis patients had significantly lower BMD and T score at the neck of femur and lower total hip BMD than controls (BMD p = 0.010 and 0.032 respectively), (T score p = 0.006 and p = 0.025 respectively). The mean TBS was significantly lower in AS patients than in controls (p < 0.001). Lumbar spine TBS was directly correlated with BMI (p = 0.029) and BMD at the neck of femur (p = 0.016) and BMD of total hip (p = 0.007) while inversely correlated with the Bath AS Metrology Index (BASMI) (p = 0.026), the modified Stoke AS Spinal Score (mSASS) (p = 0.029), ESR (p = 0.031), and CRP (p = 0.033).ConclusionTBS evaluation detected lower bone quality in the lumbar spine in patients with AS when compared with matched controls, while lumbar BMD failed to identify it. These findings encourage the use of TBS as a beneficial tool to recognize the risk of axial osteoporosis as early as possible in AS patients. Also, we recommend its use for regular follow up of drug treatment for those patients.

Polymorphisms in Interleukin 13 Signaling and Interacting Genes Predict Advanced Fibrosis and Hepatocellular Carcinoma Development in Non-Alcoholic Steatohepatitis.

Background: non-alcoholic steatohepatitis (NASH) recently headlined hepatocellular carcinoma (HCC) worldwide. This study aims to unveil the role of some unaddressed critical players that might aid in understanding, predicting, and targeting NASH and NASH-HCC. Methods: Serum interleukin 13 (IL-13) levels and single nucleotide polymorphisms (SNPs) within interleukin (IL)-13 rs20541, IL-13 receptors (IL-13R1) rs2248841, (IL-13R2) rs5946040, signal transducer activator of transcription 6 (STAT6) rs167769, yes-associated protein (YAP1) rs11225163, programmed death-ligand 1 (PD-L1) rs2282055, and programmed death-ligand 2 (PD-L2) rs7854413 genes were analyzed by qRT-PCR. Multiple stepwise regression analysis was performed on a cohort of 134 Egyptian male patients diagnosed with NASH and NASH-HCC. RESULTS: higher serum alpha-fetoprotein (AFP) and higher serum IL-13 levels were directly associated with HCC development in NASH (odds ratio (OR) 19.6 and 1.9 p < 0.01). Reversibly, the presence of the C/C genotype in STAT6 rs167769 and the C allele carrier YAP1 rs11225163 were inversely associated with HCC in NASH patients (OR 0.015 and 0.047 p < 0.01). A predictive model was formulated with 97.5% specificity, 90.9% sensitivity, and 94.8% accuracy. Moreover, higher serum IL-13 levels and the presence of PD-L2 rs7854413 C allele carriers were associated with advanced fibrosis progression in NASH patients (OR 1.432 and 3.797 p < 0.01). Serum levels of IL-13 and C/C genotype in STAT6 rs167769 significantly increased the predictive capacity of serum AFP to predict HCC in F1–F2 and in F3–F4 fibrosis grades NASH patients. Conclusion: association between serum IL-13 and PD-L2 rs7854413 polymorphism successfully predict advanced fibrosis in NASH. However, HCC development in NASH is associated with higher serum AFP, IL-13 levels, and STAT6 rs167769, YAP1 rs11225163 polymorphisms.

Relation Between Severity of Helicobacter Pylori Induced Gastritis and Glycemic Control in Egyptian Male Patients with Type-2 Diabetes Mellitus

Relation Between Severity of Helicobacter Pylori Induced Gastritis and Glycemic Control in Egyptian Male Patients with Type-2 Diabetes Mellitus

Potential role of circulating microRNAs (486-5p, 497, 509-5p and 605) in metabolic syndrome Egyptian male patients.

Objective: This study aims to evaluate the expression pattern of circulating microRNAs (miR)-486-5p, miR-497, miR-509-5p, and miR-605 in the serum of metabolic syndrome (MetS) Egyptian male patients.Methods: In this study, the circulating miR-486-5p, miR-497, miR509-5p, and miR-605 were amplified and quantitatively detected by quantitative real-time polymerase chain reaction in sera of 55 MetS male patients in comparison to 20 male controls. The level of fasting plasma glucose and triacylglycerol (TAG) were measured using calorimetric assay. Blood pressure was measured using mercuric sphygmomanometer. Anthropometric measurements were done to each individual. Furthermore, MetS patients were defined according to the criteria proposed by the American Heart Association and divided into three groups according to MetS index.Results: The study was performed on three groups and a control group defined as follows: group 1: 15 MetS patients who fulfilled all diagnostic criteria of MetS; group 2: 20 MetS patients with normal blood pressure; group 3: 20 MetS patients with normal TAG levels.The levels of miRs are expressed as [median (IQR)]. miR-486-5-p and miR-497 expression were elevated in group 1 [31.9(49), p˂0.0001; 73.1(42.5), p˂0.0001], group 2 [36.4(15.7), p˂0.0001; 68.3(54.8), p˂0.0001], and group (3) [10.8(18.9), p=0.0014; 27.5(39.7), p=0.0012]. MiR-509-5p was elevated in groups 1 and 2 [501(468), p=0.0001], [309(436), p=0.0006], respectively, while normally expressed in group 3 [0.93(0.077), p=0.0001]. miR-605 was elevated in groups 1 and 3 [25.4(20.0), p=0.0018], [54.8(65.8), p˂0.0001], while normally expressed in group 2 [0.84(0.67), p˂0.0001].Conclusion: miRs (486-5p, 497, 509-5p, and 605) serum levels were higher in MetS patients than in healthy control subjects; therefore, these serum miRs can serve as early biomarkers and can be used to follow-up the prognosis of MetS.

The Tangled Relation Between Tobacco and Substance Abuse in Egyptian Male Patients

The Tangled Relation Between Tobacco and Substance Abuse in Egyptian Male Patients

Causative Relationship Between Drug Abuse And Sexual Dysfunction in Males

Objectives: Most studies investigate sexual dysfunction in drug abusers. However, no data is available about drug abuse in patients with sexual dysfunction especially in Upper Egypt. Therefore, this study aims to assess the pattern of drug abuse in patients with sexual dysfunction, and its potential impact on hormonal profile. Material and Methods: The study included 100 male patients with history of sexual dysfunction for at least 6 months. Initial evaluation with history, general & local examinations were done. Sexual dysfunction was evaluated with the Arabic version of Sexual health inventory for men (SHIM), Erection hardness score (EHS), and the Arabic Index of Premature Ejaculation (AIPE). Morning blood sample was used for assessment of Total Testosterone (TT), Luteinizing Hormone (LH), and Follicle Stimulating Hormone (FSH). Urine sample was screened by (ABON™ Multi-Drug) dipstick kits for the following drug abuse tramadol, opiate, THC (Cannabis), amphetamine, barbiturate, cocaine and benzodiazepines. Positive results were confirmed by the Immunoassay drug analyzer through the use of specific antibodies. Results: Patients' characteristics showed age 39 (31-45) years with 52% were smoker. Sexual dysfunction complaints included PE (76%), ED (57%), and combined (43%), with average duration of 11 (8-18) months. Patients' hormonal profile showed TT 6.3 (2.67-7.55) ng/ml, FSH 3.5(1.86-5.01) mIU/ml, and LH 3.1(2.1-5) mIU/ml. SHIM, EHS, and AIPE were 15 (12-19), 3 (2-3), and 19(16-24) respectively. Urine screening was positive in 39 % (39/100). Confirmation by drug analyzer revealed 4 patients were false positive. Therefore, the final result for drug abuse was 35% (35/100); with the most common drug was tramadol 19% (19/100) followed by THC (Cannabis) 12% (12/100). Patients with positive drug abuse had significantly higher smoking percent (p=<0.0001), higher driver occupation (p=0.018), and higher positive drug abuse history (p=<0.0001). There were no significant changes in both the sexual dysfunction severity and hormonal profile between positive and negative drug abuse groups. Through binary logistic regression, both smoking (OR=22.39, 95% CI: 4.20- 119.19, p=<0.0001), and history of drug abuse (OR=20.26, 95% CI: 5.21- 78.76, p=<0.0001) are significantly independent predictors for positive drug abuse test. Conclusions: Drug abuse is prevalent among Egyptian male patients with sexual dysfunction, especially tramadol. The drug abuse is common among smoker, and driver occupation. However, no hormonal disturbance could be shown in drug abuse patients. More patient awareness and legal regulations should be considered to reduce drug abuse in Egypt.