Outpatient Clinic Of Department Research Articles

#535 Roxadustat as a treatment of anemia after kidney transplantation

Abstract Background and Aims Roxadustat is a recently approved hypoxia-inducible factor prolyl hydroxylase inhibitor that has demonstrated favourable safety and efficacy in the treatment of renal anaemia. The goal of this study is to analyse the effect of roxadustat on the level of hemoglobin in a group of patient with chronic kidney disease with or without kidney transplantation. Method This is a monocentric study conducted on the patients of Transplant-nephrology department and/or Transplant-nephrology out-patient clinic of University Hospital Martin, Slovakia who have been treated with roxadusat since August 1st, 2022. Results 33 patients were included in the study. The average follow up of treatment with roxadustat was 4.2 months. The following parameters were recorded at the baseline: age, gender, estimated glomerular filtration rate—eGFR (CKD-EPI), treatment with iron and level of iron in serum, level of C-reactive protein, level of hemoglobin, starting dose of Roxadustat. We discovered a significant improvement in the levels of hemoglobin after one month of roxadustat treatment (P < 0.0001) and another significant improvement in follow-up (P ‚0,0373). There was no significant difference in eGFR, CRP or iron levels during follow up, so hemoglobin levels were not affected by inflammation or kidney function. In the next step the group of patients was divided based on history of kidney transplantation. Again, we confirmed significant improvement in hemoglobin levels in kidney transplantation group in first month of treatment (P < 0.0001) as well as in follow up (P < 0.0001). There was a significant improvement in hemoglobin levels in the first month of roxadustat treatment in the group of patients who did not undergo kidney transplantation (P = 0.0261). However, there was no significant difference between hemoglobin levels in month 1 and follow up in this group. Conclusion Roxadustat—as a new treatment option of anaemia for patients with chronic kidney diseases. Our first analysis confirmed that roxadustat is very effective not only in patients with CKD, but also in patients with anaemia after kidney transplantation.

#191 An unusual cause of hypocalcemia in a young patient

Abstract Background and Aims A 33-year-old man visited the Nephrology Department outpatient clinic with abnormal laboratory findings: his serum calcium level was 5.9 mg/dL in a recent health examination. He denied any underlying disease and was on no medications. He complained of a tingling sensation in his hands and of eyelid twitching. On physical examination, he showed Chvostek's sign. His laboratory findings including serum calcium level are shown in Table 1. He did not have any morphological abnormalities, such as a round face, brachydactyly, or dental anomalies. Method Since he showed hypocalcemia, normal 25-hydroxyvitamin D, and elevated parathyroid hormone (PTH) levels, the presence of PTH resistance was presumed. Under strong suspicion of pseudohypoparathyroidism (PHP) in this patient, DNA sequence analysis and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) of GNAS and STX16, genetic regions that are often affected by mutations or imprinting changes in PHP, was performed. No pathogenic mutations in GNAS and STX16 were detected by sequencing. Results Results of MS-MLPA of the GNAS locus demonstrated abnormal methylation patterns in the patient after HhaI restriction enzyme treatment. The methylation ratio showed a gain of methylation in the NESP55 region and loss of methylation in the AS, XL, and A/B differentially methylated regions (DMRs) in the patient as compared to a healthy control (Fig. 1). The patient was diagnosed with PHP type 1B (PHP1B) due to the methylation abnormalities in multiple DMRs. His parents both showed normal serum calcium levels; thus, no further genetic testing was conducted. He is on outpatient follow-up with adequate calcium replacement and no specific symptoms. Conclusion PHP is a rare disorder of unknown prevalence. It is characterized by hypocalcemia, hyperphosphatemia, and increased PTH levels. PHP1B is a subtype of PHP characterized by isolated renal PTH resistance, usually without physical abnormalities such as Albright hereditary osteodystrophy or other endocrine abnormalities. PHP1B can be sporadic or familial. The genetic characteristics of most sporadic PHP1B remains unclear, but GNAS imprinting abnormalities and hypomethylation at the A/B DMRs have been reported. Symptoms of PHP1B usually begin in childhood due to low calcium levels and may include numbness, seizures, tetany, cataracts, and dental problems. However, as in our case, specific symptoms may not occur until adulthood. Therefore, when evaluating the cause of hypocalcemia, it is necessary to differentiate PHP1B, even in adults, and particularly in cases with hyperphosphatemia and high PTH levels.

A giant primary ovarian fibrosarcoma in a South Sudanese patient

Ovarian fibrosarcomas account for less than 1% of all ovarian malignancies. Clinical diagnosis is extremely difficult. A 20-year-old, illiterate, married nulliparous woman presented to our Outpatient Department Clinic (OPD) with chronic abdominal distension. Ultrasound and CT scan revealed a very large intra-abdominal mass, 23.8x27.8x35.7cm. She underwent a laparotomy and left salpingo-oophorectomy with her uterus and right adenexum conserved. After surgery, the mass weighed 11.1kg and measured 43x38x35cm. Histological findings were in line with a giant primary ovarian fibrosarcoma. To date, as far as we are aware, this is the largest ever recorded primary ovarian fibrosarcoma.

Lung Cancer in Women-Sociodemographic, Clinical and Psychological Characteristics with Comparison to Men.

(1) Background: There is a difference in the course of lung cancer between women and men. Therefore, there is a need to evaluate various factors in the patient population treated in daily practice. The purpose of this study was to analyze the clinical, sociodemographic and psychological aspects of female lung cancer. To better express the results, we compared women and men. (2) Methods: Consecutive patients with a history of lung cancer treatment admitted to the outpatient oncology clinic (Department of Lung Cancer and Chest Tumours, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw) and the Department of Internal Medicine, Pulmonary Diseases and Allergy, were enrolled. We conducted analyses of the clinical, psychological and socioeconomic factors of women with lung cancer treated in everyday practice, including a comparison with a group of men. Demographic data were collected from a self-administered questionnaire. We used the Perceived Stress Scale (PSS-10) and Acceptance of Illness Scale (AIS) questionnaires for psychological evaluation. (3) Results: A total of 100 patients with confirmed primary lung cancer with a history of treatment were enrolled in the study (50 women and 50 men). We found a significantly shorter history of smoking in the group of women; at the same time, there were no differences in the reported incidence of COPD. Despite comparable results to men on the psychological questionnaire (PSS-10, AIS), women more often reported a willingness to be supported by a psychologist or psychiatrist due to lung cancer. However, they did not decide to consult them more often than men. Immunotherapy was a significantly less frequently used method in women. (4) Conclusions: We should be more active in finding out the willingness to consult a psychologist or psychiatrist among women with lung cancer. The diagnosis of COPD should be considered more often among women due to the lack of differences in the reported incidence of COPD between men and women, despite a clear contrast in the number of pack-years.

Assessment of adherence to carbamazepine using plasma and saliva samples, a study from Jordan

BackgroundThe measurement of carbamazepine levels in a biological sample is required to guide dosing, and prevent toxicity, and can be useful to assess medication adherence. AimThe primary aim of the presented study is to analyze carbamazepine levels in saliva and plasma samples of outpatients and to assess adherence to carbamazepine using saliva and plasma levels. MethodsAdults who used carbamazepine for at least one month were recruited from the outpatient clinic department of Princess Basma Hospital, a public hospital in Irbid. Saliva and blood samples (1 ml) were collected simultaneously from subjects, and using a microanalytical method with high-performance liquid chromatography coupled with an ultraviolet detector, the level of carbamazepine (in micrograms per milliliter) was ascertained. Analysis of adherence to carbamazepine was carried out using plasma and saliva levels. ResultsA total of 69 consecutive patients attending the neurology clinic were recruited, of whom 85.5% had epilepsy. Approximately one-third (34.8%) used carbamazepine as monotherapy, whereas the remainder used a combination of antiepileptic drugs to control seizures. Overall, about two-thirds (71.9%) of the studied samples were non-adherent in either plasma or saliva samples. By referring to the plasma sample carbamazepine concentration, 75.4% of the respondents were adherents, 15.9% had under-adherence, and 8.7% had over-adherence. A total of 85.9% of the responders were adherent using the carbamazepine level in saliva samples. Plasma and saliva carbamazepine levels were linearly correlated to one another. Polypharmacy was commonly utilized with the patients, as 42% of the patients used two medications, with a range of 1–7 drugs used concomitantly. The predictor associated with higher plasma and saliva carbamazepine levels, as determined by multiple linear regression analysis, was the occurrence of seizures less than once a month, as compared to seizures with higher frequencies. ConclusionSaliva carbamazepine levels show the potential to be used as an alternative matrix to assess medication adherence, with a considerable correlation with the plasma carbamazepine level. Healthcare professionals can address routine care non-adherence through such measures.

Clinical Profile of Post-COVID-19 Patients with Persistent Chest Pain: A Cross-sectional Study

Introduction: Chest pain in post-COVID-19 patients can be due to serious alarming post-COVID-19 sequelae, such as Coronary Artery Disease (CAD), pulmonary embolism, myocarditis, etc. Approximately one-fifth of patients attending clinical Outpatient Department (OPD) following COVID-19 recovery present with persistent chest pain. There is limited knowledge about the clinical profile of patients experiencing persistent post-COVID19 chest pain. Aim: To describe the clinical profile of such patients to fill the knowledge gap and acquire new insights into patients with post-COVID-19 persistent chest pain. Materials and Methods: A cross-sectional study was conducted, enrolling a total of 259 patients with persistent chest pain (i.e., chest pain lasting more than 24 weeks after COVID-19 diagnosis). After detailed history-taking and clinical and laboratory examinations, observed data were collected, compiled, evaluated, and analysed to achieve the study objectives. Results: Out of 259 patients, 133 (51.4%) had cardiac {85 (32.8%)} or pulmonary {48 (18.5%)} abnormalities. Among patients with cardiac abnormalities, CAD, arrhythmia, myocarditis/cardiomyopathy, pericarditis, and PAH were detected in 38 (14.6%), 18 (6.9%), 7 (2.7%), 11 (4.2%), and 11 (4.2%), respectively. Meanwhile, among patients with pulmonary abnormalities, 36 (13.9%) patients had organic residual lesions in the lung parenchyma, 7 (2.7%) had pleuritis, and 28 (10.8%) had pulmonary function abnormalities. The remaining 126 (48.6%) patients experienced chest pain due to non cardiopulmonary aetiologies like gastrointestinal {45 (17.3%)}, musculoskeletal {38 (14.6%)}, psychomotor {35 (13.5%)}, autonomic {8 (3.3%)}, etc. Conclusion: This study found that chest pain in post-COVID-19 patients arises due to multisystemic aetiologies such as cardiac, pulmonary, visceral, autonomic, psychomotor, musculoskeletal, etc. A wide spectrum of serious cardiac abnormalities (such as CAD, arrhythmia, myocarditis, pericarditis, PAH, etc.) contributes to about 1/3rd of cases of persistent chest pain in post-COVID-19 patients.

Efficacy of misoprostol in reducing the time and easiness the insertion of Levonorgestrel-releasing intrauterine device; Randomized controlled trial

Background: intrauterine devices (IUDs) have gained significant popularity as a prevalent form of reversible contraception. Levonorgestrel-releasing intrauterine devices (LNG-IUDs) have been found to be safe and cost-effective over an extended period. Furthermore, their efficacy is comparable to that of tubal sterilization. Aim: The aim of our study to reveled the effect of vaginal misoprostol on timing and the easiness of insertion of (LNG-IUDs) in previous cesarean sections women. Materials and method: One-hundred and eighty patients with a previous cesarean section attending for Mirena LNG-IUD insertion. This Randomized controlled trial set in Outpatient clinic in Department of Obstetrics and Gynecology, Faculty of Medicine, Helwan University Hospital at BADR city from March 2021 to March 2022. The current research assessed the effectiveness of 400mcg vaginal misoprostol 6 hours before LNG-IUD insertion in women who had only had a cesarean section before. Results: one hundred- eighty patients included in our Randomized control trial. Our results; There was statistically insignificant terms of anticipated pain, Pain after 20 min and satisfaction p-value>0.05.While, we found a statistically significant difference in Ease of insertion, Pain at insertion and Insertion time <0.001. Moreover, there was no statistically significant nausea, vomiting, shivering, fever, and need additional analgesia p-value>0.05. Conclusion: misoprostol is safe and effective in insertion the LNG-IUD because of the significant result in reduction of pain, timing and easiness of insertion.

Informing and Preparing Patients for Echocardiography

Aim. To examine the awareness and preparedness of patients for echocardiography regarding age, gender, education level, and the type of examination. Methods. A cross-sectional study included patients who came for echocardiography through the outpatient clinic and Clinical Departments of the Clinical Hospital Center Osijek during March and April 2023. A survey questionnaire developed for this research was used as the research instrument on patients’ awareness and preparedness for echocardiography. Results. The study included 106 participants, of which 52 (49%) were males and 54 (51%) were females, with 51% of them having undergone 1 – 3 echocardiographic examinations before. Most participants, 83 (78%), received information verbally. There was no significant difference in the awareness and preparation of participants for echocardiography regarding gender and age. Participants with higher education levels agreed that they knew how the examination was conducted before coming, unlike participants with lower levels of education, and there was a significant statistical difference between the groups (p=0.02). Participants who underwent transesophageal echocardiography stated that they were better informed and prepared compared to those who underwent transthoracic echocardiography (p=0.01). Conclusion. The results of the conducted research indicate that participants are well informed and prepared for echocardiographic examinations, with no significant differences based on gender and age. Participants who underwent transesophageal ultrasound of the heart considered themselves better informed and prepared compared to those who underwent transthoracic echocardiography.

Comparison of the Effectiveness of Intra-articular Infiltration of Hyaluronic Acid and Corticosteroids in the Management of Knee Osteoarthritis: A Prospective Comparative Study.

Background Knee osteoarthritis (KOA) is a chronic and progressive disease of the knee joint characterized by articular cartilage destruction. It is the most common cause of knee disability and pain globally. Various treatments are used for the management of KOA; however, the role of intra-articular injections in KOA management in Pakistan remains understudied. Therefore, this study aims to evaluate the effectiveness of intra-articular injections of hyaluronic acid (HA) and corticosteroids in the management of KOA. Methodology This randomized, prospective, comparative study was conducted among 88 patients diagnosed with KOA in the outpatient department clinic of orthopedics in Benazir Bhutto Hospital, Rawalpindi, from January 2022 to January 2023. For patient enrolment, structured inclusion and exclusion criteria and a simple random sampling technique were used. Before data collection, ethical approval and informed consent were obtained. Data collection was done via a self-structured and interview-based proforma. Data analysis was performed through descriptive statistics and independent t-tests using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results KOA was more prevalent in women (60, 68.18%) than men (28, 31.82%). The means for study variables such as age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 58.08 ± 7.89 years, 7.66 ± 1.8, and 71.86 ± 8.90, respectively. The incidences of right-sided and left-sided KOA were 57 (64.77%) and 31 (35.23%), respectively. Likewise, the frequency of grade II KOA was 55 (62.50%), while the frequency of grade III KOA was 33 (37.50%). Differences in the mean scores of both VAS and WOMAC between study groups were statistically significant at the second-week, sixth-week, and third-month follow-up visits. However, the mean scores of VAS and WOMAC were lower in group B than in group A at the second-week follow-up visit, whereas the scores were lower in group A compared to group B after the sixth week and third month of intra-articular injections. Conclusions Intra-articular injections of both HA and corticosteroids were adequately effective in the management of KOA-associated pain and functional restrictions; nevertheless, the benefits of corticosteroids were acute and short-term, whereas the outcomes of HA were gradual and long-term.

Effect of an Educational Intervention Program on Improving Self Care Practices of Asthmatic Children

Background: Asthma is the most common chronic disease of childhood, it is a chronic inflammatory disorder of the airways characterized by recurrent reversible airway obstruction leads to airway hyper reactivity, which causes the airways to narrow. The present study aimed to evaluate the effect of an educational intervention program on improving self-care practices of asthmatic children. A quasi experimental study was utilized. The study was conducted at pediatric Emergency Department and pediatric Outpatient Clinic at Suez Canal University Hospitals. The study subject included purposive sample of school aged children (40) with their accompanying mothers. Two tools were used; A structured interview questionnaire sheet, and observational checklists to assess children's knowledge and self-care practices regarding bronchial asthma. Results: Regarding knowledge and self-care practices of the studied children about bronchial asthma, the results showed that all children had unsatisfied knowledge and self-care practices pre-test that improved at post and follow up intervention phase where most of them had either satisfied level or partial satisfied level. The study concluded that implementation of the educational intervention program improved knowledge of the studied children about bronchial asthma, enhanced self-care practices, reduced frequency of asthmatic attack and reduced school absence days. The study recommended continuous educational intervention program based on actual need assessment for improving self-care practices of asthmatic children.

Safety of esthetic procedures in rheumatic patients: single-center survey of patients

The popularity of esthetic medicine is growing every year, also among patients with autoimmune inflammatory rheumatic diseases (AIRD). The objective of this study was to evaluate the safety of esthetic medicine (AM) procedures in patients with AIRD. A semi-structured, anonymous questionnaire regarding rheumatic and concomitant diseases and AM procedures was distributed among adult patients hospitalized in the rheumatology department or attending outpatient clinic in the National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw. The main outcome was the occurrence of an adverse event. A number of 512 patients took part in the survey and 15 were excluded (AM procedure preceded the diagnosis of AIRD). The study group consisted of 497 patients, of whom 47 had undergone AM procedures. The procedures performed included: tattooing (22 patients), piercing (16 patients), hyaluronic acid (7 patients), botulinum toxin (5 patients) injections, laser procedures (6 patients), plastic surgery (4 patients), mesotherapy (3 patients) and others. The vast majority of patients had these performed during remission or low disease activity. 70.2% of patients received treatment with disease-modifying antirheumatic drugs (DMARDs) during the AM procedure, with TNF-alfa inhibitors being the most common (63.6%). Adverse events occurred in 15% of patients. All were mild and transient site reactions. Most patients would like to repeat the AM procedure in the future. The use of esthetic medicine procedures in patients with AIRD, including those treated with biologic DMARDs, was associated with a risk of mild site reactions. Most of the patients expressed satisfaction with the results of the AM procedure.

Vertebral changes in the lumbar spine of adults presenting with chronic low back pain at a Referral Hospital in western Kenya

Background: Chronic low back pain is a common musculoskeletal symptom affecting the lower part of the spine. It is described as pain and discomfort around the lumbar region lasting for more than twelve weeks. The symptoms of chronic low back pain might range from a dull ache to a stubbing or shooting sensation. This nature of pain may be localized around the axial region or radiate to the lower limbs affecting the patients’ daily activities. The aim of this study, therefore, was to evaluate vertebral changes in the lumbar spine of adults presenting with chronic low back pain at Kakamega County General and Referral Hospital.
 Methods: This was a cross-sectional quantitative descriptive study whereby; patients’ data was collected during patients’ presentation at orthopedic outpatient clinic and MRI department. Purposive sampling of lumbar spine Magnetic resonance imaging scans was used to obtain data. A total of 144 patients were selected using the Yamane Taro formula. Anatomical vertebral changes of the lumbar spine were assessed from the selected MRIs to evaluate the structural causes of chronic low back pain. Descriptive statistics such as frequency and percentage were used in analyzing the data.
 Results: It was noted that osteophytes were the most pathological changes causing chronic low back pain while fractures were the least common. Osteophytic changes in the vertebra and desiccation of the intervertebral discs can predispose one to chronic lower back pain.
 Conclusion: The study recommends early screening and treatment of lower back pain to avert its sequelae.

Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US

Among adults who present for clinical evaluation of dizziness, there is a critical need to identify interventions, such as physical therapy (PT), to mitigate the risk of falls over time. The primary objective was to examine the association between receipt of PT and falls requiring medical care within 12 months of presentation for dizziness. Secondary objectives included identification of factors associated with falls requiring medical care and factors associated with receipt of PT after presentation for dizziness. This cross-sectional study examined US commercial insurance and Medicare Advantage claims from January 1, 2006, through December 31, 2015. In all, 805 454 patients 18 years or older with a new diagnosis of symptomatic dizziness or vestibular disorders were identified. Data were analyzed from October 1, 2021, to February 1, 2023. Receipt of PT services and the incidence of falls requiring medical care were measured. The association between receipt of PT and falls that occurred 12 months after presentation for dizziness was estimated after accounting for presentation setting (outpatient clinic or emergency department), Charlson Comorbidity Index (CCI; with higher scores indicating greater morbidity), diagnosis code, and sociodemographic characteristics. A total of 805 454 patients presented for dizziness from 2006 through 2015 (median [range] age, 52 [18-87] years; 502 055 females [62%]). Of these patients, 45 771 (6%) received PT within 3 months of presentation for dizziness and 60 060 (7%) experienced a fall resulting in a medical encounter within 12 months after presentation for dizziness. In adjusted models, patients least likely to receive PT were female (adjusted odds ratio [AOR], 0.80; 95% CI, 0.78-0.81), those aged 50 to 59 years (AOR, 0.67 [95% CI, 0.65-0.70] compared with patients aged 18-39 years), and those with more comorbidities (AOR, 0.71 [95% CI, 0.70-0.73] for CCI ≥ 2 vs 0). Receipt of PT services within 3 months of presentation for dizziness was associated with a reduced risk of falls over the subsequent 12 months, with the greatest risk reduction found within 3 months after PT (AOR, 0.14 [95% CI, 0.14-0.15] at 3-12 months vs 0.18 [95% CI, 0.18-0.19] at 6-12 months and 0.23 [95% CI, 0.23-0.24] at 9-12 months). Results of this cohort study suggest that receipt of PT after presentation for dizziness was associated with a reduction in fall risk during the subsequent 12 months; thus, timely PT referral for dizziness may be beneficial for these patients. Future research, ideally with a clinical trial design, is needed to explore the independent impact of PT on subsequent falls for adults with dizziness.

Evaluation of Etiology in Patients Who Admitted to Dermatology Outpatient Clinic with Acute Urticaria

Objective: The purpose of this review is to describe the causes of patients with acute urticaria who admitted dermatology outpatient clinic.
 
 Materials and Methods: Adult patients (age > 18 years) who were diagnosed with acute urticaria were included in our study. Our sample consisted of 159 patients with acute urticaria who applied to three different dermatology outpatient clinics between 2021-2022 years. Age, gender, duration of disease, history of angioedema, presence of triggering factor, history of chronic urticaria, and admission to the emergency department were collected retrospectively from records.
 Results: A total of 159 patients 102 (%64.1)were female and 57 (%35.8) were male. 82 (51.6%) patients had a triggering factor and no factor was detected in the remaining 77 (48.4%) patients. The total number of patients who admitted to the emergency department was 42 ( 26.4%). The most common triggering factor was drugs (n=31, 37.8%) followed by infections. The most commonly used drug type was Non-steroidal anti-inflammatory drugs and the most common infection was upper tract ınfections.
 Conclusion: Our study revealed that drugs and infections are common causative factors for acute urticaria consistent with the literature. When we examined patients with acute urticaria, especially in the emergency department or dermatology outpatient clinic, we need to keep in mind that detecting possible triggering factors can prevent the disease from recurring or the development of life-threatening symptoms.

Carpal Tunnel Syndrome in Rheumatoid Arthritis Patients

Abstract Background Carpal tunnel syndrome (CTS) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA). Aim and objectives to assess the presence and severity of Carpal tunnel syndrome in rheumatoid arthritis patients and its relation to disease activity. Patients and Methods This is observational cross sectional study, was carried out 30 rheumatoid arthritis patients recruited from Ain Shams University Hospital)inpatient internal medicine department and rheumotology outpatient clinic) in the period from November (2018) till November (2020). Result Only ultrasound assesment of CTS by measuring Of CSA>10 at wrist showed significant positive correlation with RA Patients ages, RA disease duration, CTS symptoms duration, CRP, RF and anti ccp positivity and negative correlation with HB% indicating association with disease compare to others activity. Conclusion CTS frequency in RA is found higher than normal population, especially in patients with additional risk factors of CTS. There was no relationship between CTS and disease activity, and CTS group had long disease duration and worse functional status. CTS could be a result of the chronic course in RA.

The Clinical Utility of Transcription Factor 7-Like-2 (TCF7L2) Gene Polymorphism rs12255372 in Type 2 Diabetes Mellitus

Abstract Background Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia resulting from defect of insulin secretion and/or increased cellular resistance to insulin. Aim of the Work Our study aimed to evaluate the association of TCF7L2 rs12255372 gene polymorphism with T2D. Patients and Methods The study was conducted on forty seven (47) diabetic patients who were recruited from the out-patient clinic and in-patient Department of Endocrinology at Ain Shams University Hospitals; in addition, twenty three (23) age- and sex-matched healthy subjects taken as healthy control group. Assay of TCF7L2 rs12255372 gene polymorphism was performed by real-time PCR analysis. Results The study had demonstrated that there was no significant association between TCF7L2 rs12255372 G>T gene polymorphism and T2D. However, there was significant association between the concordance of risk T allele and the occurrence of dyslipidemia. Conclusion Our study did not confirm the presence of significant association between the TCF7L2 rs12255372 (G/T) polymorphism and T2D inspite of higher frequency of T allele in diabetic patients than healthy controls, however, it pointed to the association between the concordance of T allele in T2D patients with poor glycemic control with sulphonylurea.

Relation of Serum Homocysteine Levels and Chronic Kidney Disease in Patients with Systemic Lupus Erythematosus

Abstract Background SLE is an autoimmune disease characterized by the production of autoantibodies to components of the cell nucleus in association with diverse clinical manifestations affecting almost all organ systems. It is a complex disease with variable presentations, course, and prognosis characterized by remissions and flares. The etiology of SLE remains unknown and is clearly multifactorial. Many observations suggest a role for genetic, hormonal, immunologic, and environmental factors. Objective To evaluate the relation between serum homocysteine levels and occurrence of chronic renal disease, renal functions, severity of proteinuria and progression to end stage renal disease in patients with systemic lupus erythematosus. Patients and Methods This study include 70 SLE patients with biopsy proven lupus nephritis who fulfill four or more of 2012 American College of Rheumatology (ACR) criteria for SLE. They were recruited from Rheumatology Outpatient Clinic and Rheumatology Inpatient Department of Ain Shams University Hospitals. Twenty healthy individuals were included as controls. Written consents were obtained from all patients participating in the study. Results In this study there was highly statistically significant difference between patients and controls as regards serum homocysteine levels, 17 patients had mild, 8 moderate and 5 severe hyperhomocysteinaemia, with (p- <0.001). Hypertension was recorded in 32 SLE patients (45.7%) and no one of controls was hypertensive. Carotid examination showed an overall increased intimal thickness (CIMT) in the 8 (11.4 %) SLE patients (3 of them have hypertension). There was highly statistically significant relation between levels of homocysteine with carotid intimal thickness imaging in patients group p-value <0.001. The current study proved that there statistically a significant correlation between serum homocysteine levels and class of CKD, 40 had normal and 30 had subnormal HC levels, mild HHC was observed in 17, moderate HHC in 8 cases, while sever HHC was 5 of cases with p- <0.001. Conclusion This study demonstrates that homocysteine is modifiable marker in SLE patients; hyperhomocysteinemia was significantly correlated with renal function and progression to end stage renal disease. The current study shows statistically significant relation between serum homocysteine levels and patients age, disease duration, diabetes mellitus, and hypertension. There were significant positive correlation between homocysteine levels and both blood urea nitrogen (BUN) and 24 hr urinary protein. Also, there statistically significant relation between homocysteine and CKD classes in SLE patients, 40% of patients with class IV LN had hyperhomocysteinamia.

Effect of Body Mechanics Training Program on Low Back Pain and Disability among Patients with Lumbar Disc Prolapse

Context: Lumbar disc prolapse is one of the most common spinal pathologies, which can be associated with debilitating pain and neurological dysfunction. Evidence suggests that patients with disc prolapse and low back pain must be taught proper body mechanics to move safely and with the least strain possible on their back.
 Aim: Evaluate the effect of body mechanics training program on low back pain and disability among patients with lumbar disc prolapse. Methods: A quasi-experimental research design (study and control group) was utilized to achieve the aim of this study. This study was conducted in the neurosurgery department and neurosurgery outpatient clinic at Benha University Hospital on a purposive sample of patients diagnosed with lumbar disc prolapse. Three tools for data collection were used; a Structured interviewing questionnaire for patients; a visual analog pain scale, and Oswestry low back pain disability questionnaire.
 Results: Showed that the total mean knowledge score for the study and control group was 33.500±3.862 and 8.140±6.402, respectively, after one-month post-program implementation, with a statistically significant difference between both groups. Also, 75% of the study group had mild pain, and 58% of the control group had moderate pain post-program implementation, with statistically significant differences between the study and control group post-program, where p=0.000. Regarding functional disability scores among study and control groups pre and one month after program implementation. It shows that (67% and 63%) of the study and control groups had severe disability pre-program implementation. In contrast, post-program implementation, 65% of the study group had moderate disability, while 13% of the control group had moderate disability.
 Conclusion: Implementing body mechanics training program for patients with lumbar disc prolapse improved knowledge, reduced pain severity, and reduced disability among the study group compared to the control group. A simplified colored booklet about using body mechanics when performing activities of daily living should be available for all patients with lumber disc prolapse.

Assessment of asthma mimics among newly diagnosed bronchial asthma patients in Zagazig University Hospitals

BackgroundBronchial asthma may mimic different diseases regarding their similar clinical presentations, so accurate assessment is required to exclude other possible diagnosis before confirming the diagnosis of bronchial asthma. The aim of the study was to identify the percentage of patients in whom the diagnosis of current asthma was confirmed or ruled out after clinical, spirometric assessment, and utilizing all the possible investigations.MethodsA cohort study of newly diagnosed bronchial asthma in adults aged ≥ 18 years were recruited from chest outpatient clinic and chest department. History taking, clinical examination, chest X-ray, and spirometry were done for all patients, while chest high-resolution computed tomography (HRCT), CT pulmonary angiography, or different endoscopies were done when indicated.ResultsTwo hundred recently clinically diagnosed asthmatic patients were recruited with a mean age of 43.2 and 53.4 years in the asthma group and asthma rule out group, respectively. About 55.5% of the studied patients were ruled out to have bronchial asthma after serial assessments of symptoms and spirometric function. There was increased chest wheeze as a respiratory symptom among asthma patients than the other group (p ˂ 0.001), while hemoptysis was significantly a more presenting symptom among patient group whose asthma diagnosis is ruled out (p = 0.009). About 87.6% of asthma confirmed group showed predominant reversible airway obstructive. The sputum cytology analysis of the bronchial asthma group of patients was 42.7% eosinophilic, 24.7% neutrophilic, and 32.6% mixed cellularity. After consuming all the available investigational tools, the most common diseases found among asthma rule out group were cardiac disorders, chronic obstructive pulmonary disease, psychological disorders, rhinitis, and gastro-esophageal reflux disease with percent of 11.5%, 9%, 8.5%, 8%, and 6%, respectively.ConclusionsUtilizing all the available investigational tools in the present study allowed to exclude bronchial asthma and diagnose critical diseases that need specific and urgent therapies as heart diseases, subglottic stenosis, pulmonary hypertension, and interstitial lung diseases.Trial registrationClinicalTrials.gov NCT05776537. Retrospectively registered on 6 March 2023.

Effects of a focused training on first-year osteopathic medical students' ability to incorporate point-of-care ultrasound in assessment of the anterior knee.

Patients frequently present to the outpatient clinic, urgent care, or emergency department with a painful, swollen knee. Differentiating the underlying etiology can be a challenge for both medical students and seasoned clinicians alike. Because this scenario can represent a time-sensitive emergency, developing skills to diagnose the underlying cause quickly and accurately is essential for proper management, whether the patient would benefit from osteopathic manipulation, prompt administration of antibiotics, or a more invasive procedure like joint aspiration or surgery. The objectives are to determine the effects of a focused ultrasound training on first-year osteopathic medical students' ability to identify normal sonographic anatomy of the anterior knee and to differentiate between three common pathologies: joint effusion, prepatellar bursitis, and cellulitis. First-year osteopathic medical students voluntarily participated in this cross-sectional study. The study protocol included a focused ultrasound training (online materials, brief didactic and single hands-on sessions) followed by a hands-on assessment. A written test and 5-point Likert scale questionnaire were administered before and after the focused training. Nine weeks later, students completed a follow-up written test. The proportion of students who correctly identified common pathologies on written tests before (pretest) and after (posttest) training and on the follow-up written test were compared utilizing the Fisher's exact test. A t test was utilized to compare data from the pretraining and posttraining questionnaires. Of 101 students completing the written pretest andpretraining questionnaire, 95 (94.1 %) completed the written posttest and posttraining questionnaire, and 84 (83.2 %) completed the follow-up written test. Students had limited previous experience with ultrasound; 90 (89.1 %) students had performed six or fewer ultrasound examinations before the focused ultrasound training. On written tests, students accurately identified joint effusion (22.8 % [23/101] pretest, 65.3 % [62/95] posttest, 33.3 % [28/84] follow-up test), prepatellar bursitis (14.9 % [15/101] pretest, 46.3 % [44/95] posttest, 36.9 % [31/84] follow-up test), and cellulitis (38.6 % [39/101] pretest, 90.5 % [86/95] posttest, 73.8 % [62/84] follow-up test). Differences were found between pretest andposttest for identification of all three pathologies (allp<0.001) and between the pretest and 9-week follow-up test for identification of prepatellar bursitis andcellulitis (both p≤0.001). For questionnaires, (where 1=strongly agree, 5=strongly disagree), the mean (standard deviation [SD]) confidence for correctly identifying normal sonographic anatomy of the anterior knee was 3.50 (1.01) at pretraining and 1.59 (0.72) at posttraining. Student confidence in the ability to differentiate joint effusion, prepatellar bursitis, and cellulitis utilizing ultrasound increased from 4.33 (0.78) at pretraining to 1.99 (0.78) at posttraining. For the hands-on assessment, 78.3 % (595 correct/760 aggregated responses) of the time students correctly identified specific sonographic landmarks of the anterior knee. When the evaluation combined real-time scanning with a prerecorded sonographic video clip of the anterior knee, 71.4 % (20/28) accurately identified joint effusion, 60.9 % (14/23) correctly diagnosed prepatellar bursitis, 93.3 % (28/30) recognized cellulitis, and 47.1 % (8/17) diagnosed the normal knee. Our focused training was effective at immediately increasing basic knowledge, as well as confidence of first-year osteopathic medical students when assessing the anterior knee with point-of-care ultrasound. However, spaced repetition and deliberate practice may be useful for learning retention.