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Parameters of Cardiac Electrical Instability in Chronic Haemodialysis Patients
Ahmed Abdel-Galeel,
Lobna Abdel-Wahid,
Samir Kamal Abdulhamid,
Ahmed Obiedallah,
Mohammed Aboel-Kassem Farghal Abdelmegid,
Hanan Sharaf El-Deen Mohammed
Issue:
Volume 3, Issue 3, May 2015
Pages:
78-85
Received:
9 March 2015
Accepted:
17 March 2015
Published:
23 March 2015
Abstract: Background: A large proportion of cardiovascular mortality in dialysis patients is caused by sudden death that is related to the dialysis procedure. Parameters of heart rate variability, P wave duration and dispersion and rate corrected QT and QT dispersion are readily used to assess cardiac electrical stability. However, there are relatively few data discussing the factors associated with arrhythmia in dialysis patients. Methods: The study included 30 patients on regular haemodialysis. All patients had full history taking (age, sex, duration of haemodialysis in months and smoking history), clinical examination, laboratory investigations (serum Mg, K, Na and complete blood picture), echocardiography and 24-hours Holter recording. Results: The study included 30 patient on regular haemodialysis (mean duration 30.9±13.2 months), 53.3% males with mean age 43.9±10.1 years. All ECG and Holter derived parameters showed statistically significant changes during haemodialysis. There were increase in P wave duration and dispersion, rate corrected QT interval and QT dispersion and decrease in heart rate variability, that are arrhythmogenic. Moreover, the incidence of both supraventricular and ventricular ectopics increased during dialysis. Smoking and long term dialysis were associated with more arrhythmia risk. Conclusions: Patients on regular haemodialysis are susceptible to cardiac arrhythmias. The process of haemodialysis itself is arrhythmogenic. Smoking and long term haemodialysis are associated with higher incidence of cardiac electrical instability.
Abstract: Background: A large proportion of cardiovascular mortality in dialysis patients is caused by sudden death that is related to the dialysis procedure. Parameters of heart rate variability, P wave duration and dispersion and rate corrected QT and QT dispersion are readily used to assess cardiac electrical stability. However, there are relatively few d...
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Correlation Between Epicardial Fat Thickness and Cardiovascular Risk in Hemodialysis Patients
Ashraf Abd El-Khalik Barakat,
Fatma Mohammed Nasr,
Amna Ahmed Metwaly,
Manar Abd El-Rouf Raafat Ameen
Issue:
Volume 3, Issue 3, May 2015
Pages:
86-94
Received:
6 March 2015
Accepted:
19 March 2015
Published:
26 March 2015
Abstract: Background: Cardiovascular diseases are common in hemodialysis (HD) patients and cardiovascular mortality is responsible for 50% of overall deaths in these patients. Epicardial fat thickness (EpFT) may be an effective marker for the prediction of cardiovascular diseases in hemodialysis patients. The thickness of EpF can be measured by echocardiography that can accurately estimate the actual amount of EpF. The aim of the current study is to assess the association between EpFT and carotid intima-media thickness (CIMT), left ventricular systolic and diastolic function and left ventricular mass index in patients with chronic kidney disease (CKD) undergoing hemodialysis to clarify the relationships between EpF and cardiovascular disease risk in these patients. Materials and Methods: Forty adult uremic patients from dialysis unit and twenty (age and sex matched) healthy control subjects were included in this study. Clinical evaluation, routine laboratory investigations, echocardiographic study including measurement of EpFT and carotid Duplex to estimate CIMT were done to all subjects. Results: we found highly significant increase in serum C-reactive protein and significant increase in serum phosphorus and triglyceride with significant decrease in serum calcium and high-density lipoprotein cholesterol in hemodialysis patients compared to the controls. Also, there were significant increases in left ventricular mass index, left atrium diameter, carotid intima-media thickness, epicardial fat thickness, peak velocity of the late filling wave due to atrial contraction (A wave) and deceleration time of E wave in hemodialysis patients compared to the controls. There were also highly significant decrease in E/A ratio in hemodialysis patients compared to healthy control subjects. EpFT measured by echocardiography in hemodialysis patients was positively correlated with body mass index, CRP, left atrium diameter, left ventricular mass index, deceleration time and CIMT and negatively correlated with high-density lipoprotein cholesterol and E/A ratio. Conclusion: Hemodialysis patients can be evaluated routinely by echocardiography for early detection of cardiovascular structural and functional changes which are common in these patients and epicardial fat thickness is an effective marker for the prediction of cardiovascular risk in hemodialysis patients.
Abstract: Background: Cardiovascular diseases are common in hemodialysis (HD) patients and cardiovascular mortality is responsible for 50% of overall deaths in these patients. Epicardial fat thickness (EpFT) may be an effective marker for the prediction of cardiovascular diseases in hemodialysis patients. The thickness of EpF can be measured by echocardiogra...
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Impact of Long-Term Enteral Feeding Tubes on Aspiration Pneumonia in a Tertiary Care Centre in Saudi Arabia
Muneerah Albugami,
Yasmin Al Twaijri,
Habib Bassil,
Ulrike Laudon,
Abeer Ibrahim,
Mohamed El Karouri,
Abdulaziz Al Rashed,
Abdelazeim Elamin,
Ahmed Sabry,
Rania Abdelreheem,
Abdulwahab Motieb,
Ali Al Araj,
Reem Hawary,
Sawsan Al Balawi
Issue:
Volume 3, Issue 3, May 2015
Pages:
95-102
Received:
8 March 2015
Accepted:
19 March 2015
Published:
30 March 2015
Abstract: It is a retrospective Chart Study. The objectives of the study are (1) to determine the incidence of Aspiration Pneumonia (AP) before and after long term feeding tubes insertion in four types of feeding tubes: percutaneous endoscopic gastrostomy (PEG), percutaneous fluoroscopy gastrostomy (PFG), jejunostomy feeding tube (JFT) and nasogastric tube (NGT) ,(2) to find out associations between the incidence of AP in patient who have feeding tubes and age , gender, rate of feeding (continuous or boluses) ,type of formula of used feeding ,use of thickener during oral feeding , persons deliver feedings and family training how to feed patients. (3) Factors that influenced patients’ outcomes. The findings of the study are: (1) No difference in incidence of AP before and after tube insertion. Feeding tubes have limited medical benefits for AP prevention. (2)Rate of feeding either continuous or bolus increase the frequency of AP. (3)No associations between the incidence of AP and age, gender, type of formula, use of thickener during oral feeding, person deliver feedings and family training about method of feeding. (4) Old age is a poor prognostic factor and HHC follow up is a good prognostic factor for outcome. (5) AP increases a patient's hospital readmission and length of stay in the hospital. There is an urgent need to have alternative strategies to reduce the cost.
Abstract: It is a retrospective Chart Study. The objectives of the study are (1) to determine the incidence of Aspiration Pneumonia (AP) before and after long term feeding tubes insertion in four types of feeding tubes: percutaneous endoscopic gastrostomy (PEG), percutaneous fluoroscopy gastrostomy (PFG), jejunostomy feeding tube (JFT) and nasogastric tube (...
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The Potential Roles of Superoxide Dismutase, Matrix-Metalloprotinase-9 and Interlukine -18 with the Prevalence and Progression of Type II Diabetes Mellitus
Shwan Ali Umar,
Shatha Rouf Moustafa
Issue:
Volume 3, Issue 3, May 2015
Pages:
103-116
Received:
17 March 2015
Accepted:
24 March 2015
Published:
30 March 2015
Abstract: Background and Objectives: Type II diabetes mellitus is becoming the most important health problems. It is important to find new pathogenic pathways to provide opportunities for early diagnosis and targets for novel treatments. Aims: to investigate the effect of type II diabetes mellitus on serum levels super oxide dismutase as a potential biomarkers of oxidant /antioxidant imbalance, matrix-metaloprotinase-9, and interlukine -18 as an inflammatory biomarkers and estimated their relationships with prevalence and progression of disease, to find out the effects of other confounding factors severity of disease, gender, and age on the serum interested parameters levels, finally detected the correlation coefficient between the studied parameters. Methods: This study was designed to examine the associations between the parameters with the prevalence and progression of disease in 50 patients, and an equal number of matched age –gender healthy adults were also enrolled in this study as a control group. The hypothesis of the study stated that oxidant /antioxidant imbalance and inflammatory process influence the risk of adverse clinical outcomes are worthy for investigating. To elucidate this hypothesis, the parameters were investigated using enzyme linked immunosorbent assay. Statistical Analyses: All analyses were performed with SPSS version 18. Results: Patients showed a significant variations in the serum focused parameters levels. The level of superoxide dismutase in patient and control groups were (301.684 ±97.041), (501.447 ±162.781) (ng/ml) respectively. The level of matrix–metalloprotinase-9 in patient and control groups were (2.632 ± 1.745), (1.506± 0.945) ng/ml respectively. The level of interlukine -18 in patients and control groups were (93.996 ±21.297), (48.400 ±26.375) (pg/ml) respectively. Conclusions: The prevalence of type II diabetes mellitus in the Erbil population constitutes a major health problem. Oxidative stress is increased in type II diabetes mellitus and this finding may explain the role of oxidant /antioxidants status imbalance leading to significant reduction in the serum superoxide dismutase level concomitant with increased inflammatory process leading to significant elevation of matrix- metaloptotinase-9 and interlukine -18, and these findings added a prognostic information to type II diabetes mellitus. Data demonstrated a highly significant association between the variation in the serum parameters levels with prevalence and progression of the disease. Accordingly, these parameters have been evaluated as potential tools for type II diabetes mellitus risk prediction. It can therefore be concluded that hyperglycemia influences the etiopathogenesis of type II diabetes mellitus.
Abstract: Background and Objectives: Type II diabetes mellitus is becoming the most important health problems. It is important to find new pathogenic pathways to provide opportunities for early diagnosis and targets for novel treatments. Aims: to investigate the effect of type II diabetes mellitus on serum levels super oxide dismutase as a potential biomarke...
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The Impact of the Oxidative Stress and Inflammatory Process on the Serum Levels of Malonaldialdehyde, Glutathione Peroxidase, and Interlukine-18 in Patients with Essential Hypertension
Salar Fatih Kudhur,
Shatha Rouf Moustafa
Issue:
Volume 3, Issue 3, May 2015
Pages:
117-126
Received:
23 March 2015
Accepted:
1 April 2015
Published:
9 April 2015
Abstract: Background and objectives: The oxidative stress, antioxidant status and inflammatory process are cooperative events involved in development and progression of essential hypertension. This study was as a step for elucidating the contribution of the malondialdehyde, glutathione peroxidase, interlukine -18 and lipid profile with the incidence, development, and progression of essential hypertension. Aims: The aims of this study were, to assess the change in serum malondialdehyde, glutathione peroxidase, interlukine-18 and lipid profile levels in patients with essential hypertension, moreover, find out the effect of other confounding factors age, gender and stage of the disease on the serum levels of focused parameters and finally detect the correlation between all interested parameters. Patients and Methods: This study was designed to examine the associations between the serum interested parameters levels with the incidence of essential hypertension in 50 patients of both genders, and for the comparing purpose an equal number of the matched age–gender healthy adults also enrolled in this study as a control group. The hypothesis that oxidant /antioxidant status and inflammatory process influence the risk of adverse clinical outcomes are worthy for investigating. Accordingly, malondialdehyde was measured using coloremetric method, while, glutathione peroxidase and interlukine -18 were measured using enzyme linked immmunosorbent assay and lipid profile was estimated using commercial kit. Results: Patients exhibited a significant elevation in the serum malondialdehyde, glutathione peroxidase, interleukin-18 and lipid profile levels as compared with the control group. Conclusion: The data of the present study indicated that an alteration in oxidant / antioxidant status and inflammatory process in patients with essential hypertension. This investigation provided the first evidence of the ability of malondialdehyde, glutathione peroxidase, interlukine -18 and lipid profile in combination patterns as a factors involved in essential hypertension pathophysiology, etiology and are regarded as a markers of prognostic significance and potential therapeutic targets for future. The demonstration of these parameters provided a new insights into understanding the independence of oxidative stress /antioxidant status and inflammatory pathways in essential hypertension incidence, development and progression.
Abstract: Background and objectives: The oxidative stress, antioxidant status and inflammatory process are cooperative events involved in development and progression of essential hypertension. This study was as a step for elucidating the contribution of the malondialdehyde, glutathione peroxidase, interlukine -18 and lipid profile with the incidence, develop...
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Assessment towards use of holy water as complementary treatment among PLWHA, Northeast, Ethiopia
Abush Kebede Ketema,
Zewdu Shewangizaw Weret
Issue:
Volume 3, Issue 3, May 2015
Pages:
127-131
Received:
13 March 2015
Accepted:
25 March 2015
Published:
31 March 2015
Abstract: Background: Holy water use in the form of a drink and a shower is the main treatment used by People living with HIV/AIDS (PLWHA) together with other spiritual practices. A growing number of PLWHA in Ethiopia today are relocating to holy water sites. The study was intended to determine the level of use of holy water as anti-retro viral treatment (ART) among PLWHA. Cross sectional study designs with systematic random sampling through interview among 422 respondents were done in Debrebrihan hospital and health center. Single proportion formula with p- value 0f 50% used to determine the sample size. Frequency and percentage were computed by the SPSS statically software. A total of 422 respondents was included in the study with a median age of 35 years; most of them were females 262 (62.1%) and 168 (39.8%) were married. Among the respondents 282 (66.8%) had experience of using holy water. The result also shown that, 73 (25.9%) of respondents reported that it is not convenient to take medication while using holy water with spiritual fear of using anti retro viral (ARV) drugs and holy water together 51 (69.9%). The study concludes that, the use of holy water as treatment of human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS) and more than half of the study participants visit the holy water site because of them believed that it is a result of sanity and punishment from God. Hence, finding implication towards use of mixed treatment for to adherence via proper advocacy, training and opening culturally appropriate treatment site is as a key fact regarding drug adherence in the treatment of PLWHA.
Abstract: Background: Holy water use in the form of a drink and a shower is the main treatment used by People living with HIV/AIDS (PLWHA) together with other spiritual practices. A growing number of PLWHA in Ethiopia today are relocating to holy water sites. The study was intended to determine the level of use of holy water as anti-retro viral treatment (AR...
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Association of Boron, Copper, Germanium, Magnesium, Selenium and Zinc with Incidence of Rheumatoid Arthritis
Shatha Rouf Moustafa,
Namir Al-Taweel,
Fadhil Mohsen
Issue:
Volume 3, Issue 3, May 2015
Pages:
132-140
Received:
22 March 2015
Accepted:
3 April 2015
Published:
14 April 2015
Abstract: Background and Objectives: Trace elements have an important role in numerous metabolic processes. This study aimed to investigate the association between the levels of boron, copper, germanium, magnesium, selenium and zinc with the incidence of rheumatoid arthritis, and assess their relationship with other confounding factors, such as age, gender and type of rheumatoid arthritis (rheumatoid arthritis with rheumatoid factor positive or negative). This study also aimed to evaluate the correlation coefficient between all studied parameters. Methods: This case-control study was conducted on 56 men and women Iraqi patients with rheumatoid arthritis. An equal number of apparently healthy adults were also enrolled in this study as the control group. The patients were free from any diseases except rheumatoid arthritis, which was confirmed by clinical examination and laboratory estimations of biochemical and hematological tests. Serum levels of the investigated parameters were estimated using flame and flameless atomic absorption spectrophotometry. Results: Results showed that the serum levels of the investigated parameters significantly reduced in the patient groups compared with the control group. No significant age differences were observed in relation to the investigated parameters. In terms of the levels of boron, copper, magnesium and selenium a significant differences were observed between men and women. By contrast, no significant differences were observed between men and women in terms of the levels of germanium and zinc. Conclusion: The serum levels of the investigated elements were significantly reduced in patients with rheumatoid arthritis. Thus, supplementation with trace elements could be necessary for rheumatoid arthritis therapy, and even more important to individuals who are at high risk of developing rheumatoid arthritis. These findings prove the possible association between decreased serum levels of the studied parameters with the incidence of rheumatoid arthritis. Therefore, the estimation of these trace elements could be a useful complementary non-invasive diagnostic tool to determine trace elements status for early diagnosis and therapy of rheumatoid arthritis.
Abstract: Background and Objectives: Trace elements have an important role in numerous metabolic processes. This study aimed to investigate the association between the levels of boron, copper, germanium, magnesium, selenium and zinc with the incidence of rheumatoid arthritis, and assess their relationship with other confounding factors, such as age, gender a...
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An Unusual Source of Systemic Thromboembolism
Olusegun Sheyin,
Bredy Pierre-Louis
Issue:
Volume 3, Issue 3, May 2015
Pages:
141-145
Received:
15 November 2014
Accepted:
12 April 2015
Published:
6 May 2015
Abstract: Pulmonary vein thrombosis (PVT) is a rare but potentially life threatening condition. This is a case of pulmonary vein thrombosis presenting with systemic thromboembolism despite treatment with anticoagulation. A 73-year-old woman, with past medical history of hypertension, peripheral arterial disease (PAD), and treated endometrial and breast cancer, presented with complaint of pain in her right foot of one-day-duration. She had a history of PVT diagnosed on chest CT angiogram one month prior to presentation, which was done to exclude pulmonary embolism when she presented with progressively worsening dyspnea. Physical examination was notable for an elderly woman in painful distress, with a cold, pulseless right foot with bluish discoloration of the skin of the forefoot and a clear line of demarcation from the proximal foot. The angiogram revealed occlusion of the right popliteal artery just above the knee with no appreciable blood flow within the distal vessels. Contrast CT of the abdomen and pelvis revealed multiple hypo-enhancing ill-defined hepatic masses, bilateral adrenal masses and mediastinal adenopathy. Echocardiogram revealed a large left ventricular thrombus and hyper-dynamic left ventricular systolic function. She was admitted for acute right foot ischemia and underwent popliteal exploration, open thrombectomy and embolectomy with restoration of pedal flow. However, she had repeat right popliteal exploration two days later due to further ischemic changes in the foot. Post-operatively, she developed multi-organ dysfunction including respiratory failure requiring endotracheal intubation and mechanical ventilation. She was terminally weaned from mechanical ventilation on request by her family and she died on the sixth day of admission. This case describes the occurrence of systemic embolization despite anticoagulation for pulmonary vein thrombosis. The large thrombus found in the left ventricle most likely represents a thrombus in transit from the superior left pulmonary vein en-route systemic embolization with consequent multi-organ dysfunction.
Abstract: Pulmonary vein thrombosis (PVT) is a rare but potentially life threatening condition. This is a case of pulmonary vein thrombosis presenting with systemic thromboembolism despite treatment with anticoagulation. A 73-year-old woman, with past medical history of hypertension, peripheral arterial disease (PAD), and treated endometrial and breast cance...
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Spirometery and Its Application in Medical Practice for Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD) Patients in Karachi, Pakistan
Muhammad Noman Rashid,
Izhar Fatima,
Farha Ahmed,
Ali Muhammad Soomro,
Beenish Noman
Issue:
Volume 3, Issue 3, May 2015
Pages:
146-152
Received:
24 May 2015
Accepted:
29 May 2015
Published:
11 June 2015
Abstract: Introduction: Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in districts of, Karachi. Material and Methods: It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Results: Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV1 was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. Conclusion: We conclude that spirometry is underused in general but especially by non-respiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed.
Abstract: Introduction: Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in districts of, Karachi. Material and Me...
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