Outpatient Clinic Of Department Research Articles

Serum Neutrophil Gelatinase-Associated Lipocalin and Iron Status in Predialysis Chronic Kidney Disease at Zagazig University

Background: The burden of chronic kidney disease (CKD) is substantial. Anemia is a common feature of CKD. Objective: The aim was to predict about iron status by serum neutrophil gelatinase-associated lipocalin (NGAL) levels and role of serum NGAL as biomarker of iron deficiency in CKD patients. Patients and Methods: A prospective, case-control comparative study that was conducted at Nephrology Outpatient Clinic and Internal Medicine Department, Zagazig University Hospitals. Seventy two participants were divided into two groups: Group I included 36 participants with no chronic kidney disease and group II that included 36 chronic kidney disease patients. Laboratory investigations included iron parameters and serum NGAL levels were measured Results: S. Iron, TIBC, S. Ferritin and calculated T. sat” were statistically analyzed and showed that there was a statistical significant difference between the two studied groups. NGAL level was higher in CKD group than in the non-CKD group. A significant positive correlation between serum NGAL and T sat & serum ferritin and there was a significant negative correlation between NGAL and eGFR, HB and serum iron. Conclusion: Patients had significantly higher NGAL levels when compared to controls and this means that it had an important role in iron metabolism in those patients. There was statistically significant direct correlation between serum NGAL levels and serum ferritin levels and T. sat and inverse correlation with iron. Serum NGAL could be a good biomarker for iron status in CKD patients but not better than the ordinary used methods “serum ferritin and T. sat”.

Measurement of Serum Lipid Level in Children with Congenital Heart Diseases

Background: The lipid profile is an important and independent predictor of coronary heart disease is. This process relates to cholesterol concentration, accumulation and deposition of lipids on the arterial wall. Objective: The aim of this study was the measurement of serum lipid profile (cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) in children with congenital heart diseases and to compare the results with those of healthy children. Patients and methods: This case-control study was carried out from July 2020 to December 2020 in Cardiology Unit of Pediatric Department Outpatient Clinic, Zagazig University Hospital on 44 children. Patients were divided into: Group (I): (Case group) included 22 children with congenital heart diseases, and Group (II) (control group) included 22 healthy children.All patients were subjected to dimensional transthoracic echocardiography with color flow Doppler (Vivid 7 dimension apparatus) and Laboratory investigations (total cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL). Results: The most frequent cardiac defect was ASD (22.7%) followed by VSD (13.6%), common A-V canal (9.1%), mitral regurgitation (9.1%), pulmonary regurgitation (9.1%), and PDA (9.1%). 18.2% of the studied patients had cyanotic congenital heart disease (CHD) and 81.8% had non-cyanotic CHD. There was statistically significant differences between the studied groups in lipid profile as case group had higher cholesterol, triglyceride, LDL and lower HDL than control group. Conclusion: We concluded in this study that patients had significantly higher serum lipid levels than age and sex-matched controls in light of these findings.

Outpatient experiences toward renewed OBGYN OPD’S services at king Saud medical city, Saudi Arabia, in Oct, 2020 - Jan, 2021

Background: Patient experience and satisfaction are essential and widely used metrics for assessing health-care quality, and they can provide valuable and unique insights into daily hospital care and are accepted as independent dimension of quality of care, they have effect on treatment results, the loyalty of patients towards the organization, and malpractice accusations. The aim of this article is to evaluate the patients’ experience toward the Obstetrics and Gynecology (OBGYN) renewed outpatient department services, using the Generic Short Patient Experiences Questionnaire (GS-PEQ), as an indicator, reflective of health care service quality and for improvement of quality.Materials and Methods: The study was conducted among patients (N = 483), of legal age, or patients’ guardians, of both genders, attending the OBGYN outpatient department clinics, of the women’s hospital, at King Saud Medical City (KSMC), in Riyadh, Saudi Arabia, during the period of October 2020 to January 2021. The Generic Short Patient Experiences Questionnaire (GS-PEQ) was randomly distributed to patients, immediately after attending the Outpatient clinical services, which is a self-administered questionnaire of multiple items that measures the most significant elements of patient perceived experience from an outpatient perspective. Results: The analysis showed that the majority of participants had positively responded to the questionnaire items, and 89.3% of participants were overall satisfied toward the OPD services provided. The socio-demographic data showed the majority of participants were females and in the age group of 31-40 years old, married, with a bachelor’s degree. The responses for every question were found to be significant, at P

Perceived Stress, Hardship, and Self-Reported Health Status of Persons Living with Diabetes Mellitus during Coronavirus Disease-19 Pandemic and Lockdown

Introduction: Coronavirus disease-19 (COVID-19) pandemic and subsequent complete lockdown have resulted in a lot of difficulties in availing essential services including medical care, especially among the persons living with Type 2 diabetes mellitus (DM). The situation was complicated by stress and fear due to unknown nature of the pandemic during initial phases. This study aimed at measuring the perceived stress and hardship faced by persons living with DM and assessing their health status during COVID-19 pandemic and lockdown in a tertiary care hospital in West Bengal. Materials and Methods: An institution-based, cross-sectional, descriptive study was conducted among diagnosed cases of Type 2 DM attending diabetic clinic outpatient department using an interview technique with the help of a predesigned pretested questionnaire that consisted of variables such as perpetual and experiential stress, hardship, and selected self-reported health parameters. Results: Out of a total of 304 study participants, majority responded positively regarding the items of perpetual and experiential stress. However, 80.8% of participants reported the reduction of income, and about 75% of them faced hardship of various extent to manage medicine and diet with low income. Only 9.1% of participants used teleconsultation as a sole method for health checkups. About one-third of participants considered their mental health status as poor or very poor, whereas two-third considered their physical health as good or excellent. Conclusion: Although our study participants did not have much stress or deterioration of health during lockdown, their income and regular care were affected to a certain extent. This emphasizes the need for context-specific measures.

Effect of Implementing Nursing Educational Protocol on Reducing Deep Venous Thrombosis among Orthopedic Surgery Patients

Background: Deep venous thrombosis is a most prevalent problem for orthopedic surgery patients. Nurses have been shown in the literature to play a significant role in reducing the incidence of deep venous thrombosis. Range of motion exercises increase blood flow to the lower extremities, and early mobilization has been shown to improve outcomes. Nurses are crucial in integrating these activities into their patients' regular care plans. Future research should concentrate on efforts to enhance nursing compliance with this exercise program .Aim of the study: To evaluate the effect of implementing nursing educational protocol on reducing deep vein thrombosis among orthopedic surgery patients. Research design: Quasi experimental research design was utilized to conduct this study (study and control group). Subjects: A purposive sample of 72 patients (36 patients for each group study and control). Setting: This study was carried out in orthopedic department and orthopedic outpatient clinic at Minia University Hospital. Tools of data collection: Demographic and medical sheet, the Autar DVT risk assessment scale and Deep vein thrombosis evaluation sheet. Results: There was a statistical significant difference between study and control groups regarding the occurrence of DVT especially Left limb DVT p.value (0.027*) after application of the nursing educational protocol. There were highly statistically significant differences between study and control groups regarding signs and symptoms of DVT in calf muscle regarding redness, swelling and absence of signs of DVT with p.value (0.012*, 0.001**, and 0.002**) respectively. While in thigh muscle presence of swelling show a statistical significant difference with p.value (0.005**) between the two groups. There was a statistical significant difference between study and control groups regarding the occurrence of DVT especially Left limb DVT p.value (0.027*) after application of the nursing educational protocol. Conclusion: Application of educational protocol was effective in reducing DVT among orthopedic surgery patients. Recommendations: Applying elastic stocking, exercising and range of motion had a positive effect on reducing incidence of DVT among orthopedic surgical patients. The in-service educational training program that illustrates purposes and benefits of applying elastic stocking, exercising and range of motion is very important.

Treatment delay of cancer patients in Indonesia: a reflection from a national referral hospital

BACKGROUND Cancer is a complex disease requiring a multidisciplinary approach in establishing prompt diagnosis and treatment. Treatment in a timely manner is crucial for the outcomes. Hence, this study aimed to provide information on treatment delay including patient and provider delays and its associated factors.
 METHODS Cancer patients were recruited conveniently in the outpatient clinic of Department of Radiation Oncology, Cipto Mangunkusumo Hospital, Indonesia between May and August 2015. All patients were asked to fill a questionnaire and interviewed in this cross-sectional study. Treatment delay was explored and categorized into patient delay and provider delay. Patient delay could be happened before (patient-delay-1) or after (patient-delay-2) the patient was diagnosed with cancer. Provider delay could be due to physician, system-diagnosis, and system-treatment delays.
 RESULTS Among 294 patients, 86% patient had treatment delay. Patient delay was observed in 153 patients, and 43% of them had a history of alternative treatment. An older age (p = 0.047), lower educational level (p = 0.047), and history of alternative treatment (p<0.001) were associated with patient delay. Meanwhile, 214 patients had provider delay, and 9%, 36%, and 80% of them experienced physician, system-diagnosis, and system-treatment delays, respectively. All types of provider delay were associated with patient delay (p<0.001).
 CONCLUSIONS Most of the patient had treatment delay caused by either patient or provider.

Vasculitis damage index in Beh\xe7et\u2019s disease

BackgroundVasculitis damage index (VDI) is a validated damage index for systemic vasculitis, and as Behçet’s disease is considered one of systemic vascular disease we aimed to study the relationship of the vasculitis damage index to clinical manifestations and comorbidity in patients with Behçet’s disease (BD) to determine if VDI could be used to assess damage in patients with BD.MethodsA total of 109 patients with BD were recruited from the Rheumatology Department (outpatient and inpatient clinic), Cairo University Hospitals. All patients were subjected to full history taking, clinical examination, and routine laboratory investigations. Disease activity was assessed by the BD current activity form, and the VDI was calculated in all patients. The relationship of the VDI to the disease clinical manifestations was studied. Mann–Whitney and Kruskal Wallis tests were used to estimate differences in quantitative variables. Spearman correlation test was used to test for correlation between quantitative variables.ResultsIn the current study, the VDI ranged from 1 to 10, with a mean of 3.5 ± 1.8. It was significantly associated with total thrombosis (P = 0.022); total neurological manifestations (P = 0.000), especially stroke and cranial nerve affection; uveitis (P = 0.005); avascular necrosis (AVN) (P = 0.015); osteoporosis (P = 0.01); impaired vision (P < 0.0001); cataract (P < 0.0001); and diabetes (P = 0.012). Generally, immunosuppressive treatment was significantly associated with VDI (P = 0.039), especially cyclophosphamide (P < 0.0001), biological agent (P = 0.008), chlorambucil (P = 0.003), and anticoagulant (P = 0.02). VDI was also significantly correlated with age (P = 0.033), disease duration (P = 0.029), and duration of eye involvement (P = 0.003).ConclusionVDI is significantly associated with most disease parameters of BD, except for parameters such as mucocutaneous manifestations and uncomplicated venous thrombosis; however, further studies may be needed to establish BD-specific damage index.

Effect of Different Nursing Educational Methods about Correct use of Inhaler Devices on Clinical Improvement for Asthmatic Patients

Abstract: Background: Most asthmatic patients use their inhalers incorrectly; As a result, they are more vulnerable to poor clinical control and exacerbation. The study aim: was to evaluate the effect of different nursing educational methods (video, educational booklet, both booklet & video) about correct use of inhaler devices on the clinical improvement for asthmatic patients. Methods: Design of the study: Quiz-experimental design. Setting: chest department and chest diseases outpatient clinics at Assiut University Hospitals Sample: 80 asthmatic patients were divided into four groups, 20 patients for each. Tools: Tool I: patient assessment sheet, Tool II: Global Initiative for Asthma scale (GINA), 2019, and Tool III: nursing educational methods. Results: According to the Global Initiative for Asthma scale, in excess of half of the patients (60.0 %) in the routine nursing instructions, booklet, and video groups had partially asthma control, while the majority of patients (80.0%) in the video and booklet groups had well asthma control. Conclusions: The group of patients who received the video and the booklet had a statistically significant effect on improving the level of asthma control. Recommendation: All asthma patients should be given written and visual information about how to use inhalers devices correctly to minimize the complications arising from the incorrect use of inhalers.

A Proteomics-Based Analysis of Blood Biomarkers for the Diagnosis of COPD Acute Exacerbation.

PurposeThe identification of blood biomarkers to diagnose acute exacerbation of chronic obstructive pulmonary disease (AECOPD) will have clinical utility. Here, we used a proteomics-based approach to identify biomarkers capable of identifying AECOPD.Patients and MethodsThis prospective, single-center pilot study enrolled 12 patients who came to Asan Medical Center (South Korea) via the outpatient clinic or emergency department with symptoms of AECOPD and were follow-up in the outpatient clinic during convalescence between 2015 and 2017. Paired blood samples collected from each patient during the treatment naïve AECOPD and convalescence stages were analyzed. A sequential window acquisition of all theoretical fragmentation spectra-mass spectrometry (SWATH-MS)-based proteome analysis was performed and a subset of the data were verified by ELISA.ResultsThe SWATH-MS analysis identified 226 plasma proteins across all samples examined. The median coefficient of variation for triplicate technical replicates of each sample was 1.13 ± 1.38%, indicating high precision of the technique. Fold-change and paired t-test analyses revealed that 14 proteins were present at higher levels in the AECOPD samples than in the convalescence samples. A gene ontology analysis revealed that these proteins are involved in the acute-phase response. A total of 15 proteins were present at higher levels during the recovery (convalescence) stage than during the acute exacerbation phase, and gene ontology analysis revealed that these proteins are related to lipid metabolism and transport. Verification of the SWATH-MS data was performed using ELISAs for three proteins that were up-regulated in AECOPD, namely, LBP, ORM2, and SERPINA3. Among them, SERPINA3 (p = 0.005) was up-regulated significantly in AECOPD compared with the convalescence state.ConclusionPotential plasma biomarkers of AECOPD were discovered using the SWATH-MS proteomics method, and functional molecular associations were investigated. SERPINA3 could be a promising diagnostic biomarker for the early identification and tracking of AECOPD.

Is All Psychiatry Forensic? Association between Mental Disorders and Legal Proceedings

ABSTRACT Background: Psychiatric disorders cause significant impact to the individual, leading to lack of productivity and involvement with the legal system. Objectives: The present study aims to determine the association of mental disorders and an individuals’ odds of involvement with the legal system Methods: Through a descriptive cross-sectional study, 126 patients selected according to convenience sampling were interviewed for the study on their appointment days at University of Sao Paulo School of Medicine hospital. They were divided into a case group (n = 63) with patients from the outpatient clinic of the Department of Psychiatry and a control group (n = 63), with patients from the outpatient clinic of Department of Internal Medicine. These patients were asked to answer a questionnaire on sociodemographic information, age, medical diagnosis, and legal proceedings as related to their diagnoses. Results: We found high difference between the groups, in longer absences 57.10% of psychiatric patients, with only 33.3% in clinical group. This difference also appears in the requirement for forensic medical exams - 65.1% of psychiatric patients versus 44.4% of clinical patients. Discussion: This data clearly shows that involvement of psychiatric patients in legal matters is quite common, and therefore it is increasingly important for psychiatrists to be aware of legal implications when evaluating their patients.

Impact of Buerger-Allen Exercises on Foot Perfusion and Pain Level for Diabetic Patients Risk with Peripheral Arterial Disease

Abstract The risk of peripheral arterial disease is markedly increased among individuals with diabetes. The current study aimed to evaluate diabetic patients' foot perfusion and their pain level after applying Buerger-Allen exercises. Subjects & methods: Quasi-experimental research design was used on a purposive sample of 100 type II diabetic patient in the General medical department and diabetic out-patient clinic, at Minia university hospital. Patients' interview questionnair, Ankle-brachial Index test and Numerical pain rating scale were used as tools for data collection. Results: There were highly statistically significant differences between the study group and control group regard Ankle-brachial Index measurements only post-application of Buerger-Allen exercises for six weeks (p ≤ 0.004). Moreover, results stated that the highest percentage (54.0%) among the study group who had moderate pain pre-application exercises but after they were performed exercises, their pain description became mild or no pain constituted (50.0% & 20.0%) respectively with highly statistical significant. Conclusion: Buerger-Allen exercise was efficient for improvement of lower peripheral arterial perfusion and there are highly statistically significant improvements in pain level among the study group. Recommendations: Diabetic patient must attend health education sessions based on evidence guidelines regard Buerger-Allen exercise which had a positive effect on the improvement of lower peripheral circulation.

The relationship between serum uric acid level and uric acid/creatinine ratio with chronic obstructive pulmonary disease severity (stable or acute exacerbation) and the development of cor pulmonale.

There are studies reporting that uric acid elevation is a marker for hypoxemia and pulmonary hypertension secondary to some diseases. The aim of this study is to investigate the relationship between serum uric acid level and uric acid/creatinine ratio with chronic obstructive pulmonary disease (COPD) exacerbation, hypoxemia in exacerbation and development of cor pulmonale. A total of 96 COPD patients who were admitted to Ondokuz Mayıs University Faculty of Medicine emergency department and Chest Diseases outpatient clinic and whose written consent was obtained were included in our study. Forty-three of these patients were in the period of exacerbation (Group 1), and 53 were in the stable period (Group 2). Complete blood count, blood biochemistry (including serum uric acid level) and arterial blood gas analysis were performed in our patients. In addition, spirometry and echocardiography findings were examined. Serum uric acid level of patients in the period of exacerbation group (Group 1) was 6.97±1.34 and in stable COPD group (Group 2) was 4.30±1.01 (P<.05). Uric acid/creatinine ratios in Group 1 was 8.00±2.06; in Group 2, it was 5.52±1.57 (P<.05). In patients with hypoxemia, serum uric acid level and uric acid/creatinine ratio were significantly higher than nonhypoxemic patients (P<.05). Serum uric acid level and serum uric acid/creatinine ratio of Group 1 were significantly higher than Group 2 (P<.001). Serum uric acid level and serum uric acid/creatinine ratio of patients who developed cor pulmonale were significantly higher than patients without cor pulmonale (P<.05). Serum uric acid level and uric acid/creatinine ratio were found to be higher in patients with exacerbation of COPD and those developing cor pulmonale. Consequently, it suggests that serum uric acid level and serum uric acid/creatinine ratio may be a stimulating laboratory test for the severity of COPD and the development of COPD induced cor pulmonale.

Study of Serum Calprotectin Level in Patients with Acne Vulgaris and its Correlation to Disease Severity

Acne vulgaris is a common skin condition that affects people all over the world. Acne vulgaris is characterised by the presence of open and closed comedones, papules, pustules, and nodules on areas of the body with hormonally sensitive sebaceous glands. Acne is thought to be caused by four key factors: increased sebum production, follicular hyperkeratinization, skin bacterial colonisation, and inflammation. Acne with severe symptoms is painful, disfiguring, scarring, and lowering self-esteem. The aim of this study was to determine the serum level of calprotectin in acne vulgaris patients and its relationship to disease severity. Subjects and Methods: In this sample, 60 people with acne vulgaris were paired with 30 people who appeared to be of similar sex and age as a control group. The patients were chosen from those who attended the Benha University Hospital's Dermatology and Andrology Department's Outpatient Clinic between April 2019 and October 2020. Our findings indicated that the AV group had a statistically significant higher level of serum calprotectin with mean SD (6.291.91ng/dl) than the control group with mean SD (2.040.65ng/dl) (p=0.004). The amount of serum calprotectin had a statistically significant positive relationship with the GAGS score (r=0.854; p0.001). The period of the disease, however, had no meaningful correlation (r=0.163;p=0.212). Conclusion: Serum calprotectin levels are higher in acne vulgaris patients relative to safe controls, and there is a statistically significant relationship between calprotectin levels and disease severity, suggesting that calprotectin may be used as a chemical biomarker to determine disease severity.

Evaluation of the Efficacy of 1% Alendronate Gel as Adjunctive Treatment in Class II Furcation Defects (Clinical, Radiographic and Biochemical Study)

Aim: This study was designed to evaluate the efficacy of 1% alendronate gel as an adjunctive therapy to scaling and root planing in the treatment of class II furcation defects. Subjects and method: Twenty-six patients with mandibular class II furcation involvement were selected from the out-patient clinic, Oral Medicine and Periodontology Department, Faculty of Dentistry, Al-Azhar University, Assiut Branch. They were divided into two equal groups. Group I received conventional periodontal therapy alone, while group II received conventional periodontal therapy combined with intra-furcal application of 1% alendronate gel as adjunctive therapy. All patients were evaluated clinically, radiographically as well as for RANKL level in GCF at base line, 3 and 6 months. Results: Both groups showed a high significant difference between base line and 6 months in all clinical parameters (PI, GI, VPD, CAL and HPD), radiographic parameters (bone density) and RANKL level in GCF. There was a statistical significant difference to group II when compared to group I in VPD and HPD at 6 months only and in CAL, bone density and RANKL level at 3 and 6 months. Conclusion: intra-furcal application of 1%Alendronate gel seemed an attractive effect as adjunctive therapy in improving the clinical, radiographic parameters and RANKL level in GCF in the treatment of class II furcation defects

Symptoms of Intoxication and Withdrawal in a Sample of Egyptian Patients Using Synthetic Cannabinoids: A Cohort Study

Introduction: Novel psychoactive substances that contain synthetic cannabinoids (SCs) have recently started to be used recreationally, especially by young adults. In contrast to the decline in the use of many novel psychoactive substances such as the cathinones and piperazines, it seems that the number of SC users is increasing. Although SC drugs mimic the psychotropic effects of cannabis, their undesired effects are unpredictable and more severe than those associated with cannabis. The majority of SC detected in herbal products has greater binding affinity to the cannabinoid CB1 receptor than Δ9-tetrahydrocannabinol, the primary psychoactive compound in the cannabis plant, and greater affinity at the CB1 than the CB2 receptor. In vitro and animal in vivo studies show SC pharmacological effects to be 2 to 100 times more potent than tetrahydrocannabinol. A limited number of studies have examined SC use among patients; hence little is known about the effects of their use on patients during intoxication, withdrawal, and 1 month after cessation of use of SC. Objective: This study is a cohort study aiming to investigate the symptoms of intoxication, withdrawal, and 1-month cessation of SCs. Patients and Methods: Between February 2019 and February 2020, 92 adult patients using SCs aged 18 to 65 years from both the Outpatient Clinic and Inpatient Department of Psychiatry, Ain Shams University and Masr El Gedida (El Matar) Psychiatric Hospital, Ministry of Health were subjected to full history taking using clinical history sheet for the assessment of medical symptoms and Addiction Severity Index (the Arabic version was used). Results: There was a significant association between the use of SCs and development of multiple symptoms, both medical and psychiatric symptoms, and even serious side effects necessitating emergency management. Regarding the most common symptoms reported by the patient, the most common cardiovascular symptom during intoxication was palpitations, while the most common reported psychiatric symptom was hallucinations developed during intoxication. It was found that the patients who were hospitalized due to medical problems had higher amount and longer duration of use of SC. Conclusion: SC use can cause an array of symptoms ranging from mild medical and psychiatric symptoms to extreme side effects.

Can Fall Risk Screening and Fall Prevention Advice in Hospital Settings Motivate Older Adult Patients to Take Action to Reduce Fall Risk?

Objective:We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action.Method:Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on their individual risk factors. Three months after screening, preventive steps taken by patients were surveyed.Results:Two hundred sixteen patients were screened. Of the 83 patients completing a 3-month follow-up, 51.8% took action; among patients who received tailored advice (n = 20), 70% took action. Patients most often adhered to advice on improving muscle strength and undergoing vision checkups (20%). Tailored advice and a reported low quality of life were associated with consulting a health care provider.Discussion:Patients at risk in these settings are inclined to take action after screening. However, they do not always adhere to the tailored prevention advice.

Clinical Characteristics and Management Practice among Patients Diagnosed with Atrial Ibrillation in Benghazi Libya, A Cross Sectional Study

Introduction: There are no data so far regarding the frequency and outcome of the different types of atrial fibrillation (AF) in the clinical setting for Libyan patients. Furthermore, it is unknown whether the actual clinical management and therapy of AF in Libya conform to the international guidelines. The aim of this study was to determine the frequency, demographic, and clinical characteristics of AF patients. Patients and Methods: Three hundred patients attending the outpatient clinic and cardiology department at Benghazi Medical Center and National Cardiac Center between May 2020 and October 2020 were included. Patients' data were obtained through medical records using the chart review. Patients were categorized into a clinical type of AF, based on the physician's perception of the AF at the time of presentation. Results: Three hundred patients with an established diagnosis of AF were enrolled, including 210 (70%) females and 90 (30%) males. The mean age at the time of diagnosis was 49.5 ± 21.5 years, with an age range of 29–79 years. Of them 139 (46.3%) were diagnosed as permanent AF, 132 (44%) paroxysmal AF, while new-onset AF was diagnosed in 29 (9.7%). The three clinical categories of AF were enrolled under the care of both cardiologists and internal medicine physicians, but permanent AF patients were more often enrolled under the care of a cardiologist. Patients with permanent AF were older compared with those with paroxysmal subtype (61.8 ± 9 and 50.1 ± 12, respectively), with significant female predominance (P = 0.03), and more often had coronary artery disease (CAD), valvular heart disease, and a previous stroke/TIA (P = 0.01, P = 0.124, and P = 0.002, respectively). Diabetes was the most prevalent associated medical condition, followed by hypertension and hyperlipidemia. CAD was diagnosed among 122 patients. Of permanent AF patients, 28 patients (20.1%) previously suffered from a stroke, mostly TIA, in contrast to 14 patients (10.6%) of the other AF patients. Conclusion: Our AF patients were characterized by an unfavorable cardiovascular risk profile. We recognize a lower rate of oral anticoagulation prescription, which needs further evaluation.

Assessment of Serum Level of Claudin‐3 and Its Association with Disease Severity in Patients with Psoriasis Vulgaris

Background: Psoriasis is a common inflammatory disorder of the skin. Psoriasis is a disease of multifactorial origin where certain environmental factors acting on individuals with specific genetic predisposition leads to an immune dysregulation. Claudins are transmembrane proteins, which participate in the formation of tight junctions by binding to the actin cytoskeleton. Claudin‐3 present in the blood is considered as a useful biomarker of intestinal permeability. Objective: To evaluate serum level of claudin-3 in patients with psoriasis in comparison to control group and correlate its levels with disease severity. Patients and methods: Fifty-three patients (32 males and 21 females) with psoriasis and forty normal healthy control (23 males and 17 females) who matched the cases group as regard age and sex were included in this work. They were randomly selected from the Dermatology Department outpatient clinic in Mansoura University Hospital. Results: Psoriasis group showed significantly higher level of claudin-3 when compared to control group (mean=58.3 versus 41.2; p 0.05 for each). Higher BMI, smoking and higher claudin-3 level were associated with prediction of higher PASI score in univariate analysis. While multivariate analysis revealed that only smoking and higher claudin-3 level were considered independent predictor of more severe psoriasis cases. Conclusion: Claudin-3 level was significantly higher in patients with psoriasis than healthy controls. PASI correlated with claudin-3 levels.

A Retrospective Study: Characteristics and Management of Gonorrhea

Background: Gonorrhea (GO) is a sexually transmitted infection that remains an important clinical and public health problem worldwide. Its incidence tends to increase both in males and females. Given the scale of the public health impact of GO, the selection of appropriate therapy is essential. Purpose: This study aimed to evaluate the characteristics, management, and recovery of gonorrhea patients. Methods: The research material was obtained from the medical record of gonorrhea patients at the Sexually Transmitted Infections (STI) Outpatient Clinic, Dermatology and Venerelogy Department, Dr. Soetomo General Academic Teaching Hospital, Surabaya, from January 2016 to December 2018. Result: We found 84 new GO patients (0.02%) out of the total new outpatients at the Dermatology and Venereology Department, Dr. Soetomo General Academic Teaching Hospital, Surabaya. Most of them were males (92.9%), 17–25 years age group (52.4%), unmarried (67.9%), and heterosexual (90.5%). The majority of therapy is dual therapy, was combination of doxycycline and cefixime (78%). Only 34 patients (40.5%) attended the follow-up visits, and 94.1% of them recovered, and 5.9% presented with cystitis. Conclusion: The characteristics features of GO varies in each variable. One of important to control GO is provide effective and appropriate treatment and routinely clinical and laboratories were needed control.

Indications and Outcome of Admission of Patients with Diabetes Into Benha University Hospitals, Egypt: A Prospective Study.

Background:Patients with diabetes have a 3-fold greater chance of hospitalization compared to those without diabetes. The risk factors for hospitalizations in diabetic patients constitute poor glycemic control, longer diabetes duration, and coexisting morbidity. Other factors include, old age groups, insulin use, hypoglycemia, presence of chronic renal insufficiency and diabetes-related hospitalizations in the preceding year are other important risk factors. Aim: Our aim of the study is to report the causes, patient characteristics, and outcome of admissions of diabetic patients to the wards and emergency unit of Benha university hospital Methods: The study included 260 patients with known history of type 1 or 2 DM who were admitted from the emergency department, outpatient clinic ,and other departments of the hospital.Demographic data and laboratory investigations were collected. Results: The study constituted mainly type 2DM (90.4%). The mean age of the study population was 57± 14 years, most of them were females (55.8%).The median duration of diabetes was 10 years.The most common reason for diabetes related hospitalizations were chronic complications of DM, whereas sepsis is the most common reason of non diabetes related .The mortality rate was 26.9%, of overall deaths, cardiovascular disease was the most frequent( 47.7%).Conclusion: The most frequent reason for hospitalization in diabetic related admissions was chronic complications of diabetes. Whereas, sepsis is the most common cause in diabetic non related admissions.Cardiovascular disease is still the main cause of death among diabetics.