The Egyptian Journal of Internal Medicine
ISSN / EISSN: 11107782 / 20909098
Published by: Springer Nature
Total articles ≅ 425
Latest articles in this journal
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-6; https://doi.org/10.1186/s43162-022-00171-3
Background and aim: Malnutrition is a common problem among patients with inflammatory bowel disease and up to 18–62% of ulcerative colitis (UC) patients were reported to be malnourished. This study aimed to assess micronutrient status among naïve UC patients and its correlation with disease severity. Methods: A prospective case-control study carried out on 46 patients who visited our endoscopy unit between April 2019 and April 2021. The patients were classified into 3 groups of mild, moderate, and severe UC based on colonoscopy findings, and histopathological examination. Serum was collected and assayed for levels of iron, magnesium, zinc, selenium, and copper. Results: Forty-six (17 male, 29 female) patients divided into 2 groups (23 naïve UC patients and 23 healthy individuals) with the mean age of 32 years were included in the study. The serum levels of magnesium, zinc, and selenium were significantly lower in the UC group (p < 0.001, 0.018 and < 0.001, respectively). However, iron and copper levels were not significantly different between the 2 groups. In discriminating severe from mild-moderate UC cases, there was a statistically significant result of magnesium at cutoff 1.8 or less in discriminating severe from mild to moderate UC cases with an AUC of 0.950 and p value of < 0.001. Conclusion: Micronutrients should be assessed in patients in UC patients to alert to the fact that correction of these deficiencies could facilitate achievement of remission. Further research is needed to confirm if magnesium levels could serve as a predictor of the disease severity.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-5; https://doi.org/10.1186/s43162-022-00168-y
Background: Copper sulfate is a bright blue crystal used primarily for agricultural purposes, as a pesticide, disinfectant, feed, and soil additive. Acute volunteer poisoning of copper sulfate is not common in the world and in Iran. Case presentation: We reported the case of a 15-year-old girl who presented to the emergency department after ingestion of an unknown amount of copper sulfate following a struggle at school. She had become acquainted with the toxic compound through school textbooks. On admission to the hospital, she had abdominal pain and a sore throat with a normal serum copper level. The patient stated that she had three episodes of bluish vomiting. She underwent symptomatic treatment and was monitored for 3 days. The outcome was favorable, and she had no signs and symptoms of organ failure. Conclusions: As a result, copper sulfate poisoning depending on the consumed dose can be mild or very severe with a high mortality rate. The authors discuss the various pathogenesis and treatments of this rare poisoning by reviewing the available literature.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-7; https://doi.org/10.1186/s43162-022-00170-4
Background: Susac syndrome is a rare disease with multisystem manifestations. While the exact pathogenesis is not known, it has been proposed to be an autoimmune endotheliopathy affecting the microvasculature of the brain, retina, and inner ear. The disease is characterized by a triad of encephalopathy, vision loss, and hearing loss. However, patients may not have the triad at initial presentation and present with only a single finding. Case presentation: A 25-year-old male resident of Panu Akil presented to Combined Military Hospital Lahore with complaints of dizziness and vertigo associated with severe migraine like headaches. He experienced sudden painless loss of vision in his right eye and was admitted to the medical intensive care unit. On examination, he had right-beating nystagmus and diplopia along with scintillating scotoma. After his admission, contrast-enhanced magnetic resonance imaging (MRI) was done which showed numerous enhancing bilateral white matter internal capsule micro-infarcts indicating typical “string of pearls” sign and a snowball lesion on the corpus callosum. His fundus fluorescein angiography (FFA) did not exhibit any branched retinal artery occlusions (BRAO). Fundoscopy showed the presence of drusen spots. His pure tone audiometry was unremarkable. Based on the highly characteristic findings present on the MRI, a diagnosis of Susac syndrome was made. He was started on injection methylprednisolone 1 gm IV in 500 ml normal saline over 1 h once a day for 5 days and then once a week for 8 weeks. He was also started on tablet mycophenolate mofetil 500 mg once daily for 7 days. Patient showed marked clinical improvement afterwards. Conclusions: Susac syndrome is a rare multisystem illness with an often insidious presentation. Patients can be misdiagnosed due to the nonspecific nature of the early complaints present in the disease. High index of suspicion is required for timely diagnosis and adequate management. Although no specific guidelines exist, management consists mainly of immunosuppressants.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-7; https://doi.org/10.1186/s43162-022-00169-x
Myelofibrosis (MF) is a haematopoietic stem cell tumour caused by the lack of BCR-ABL translocation due to point mutations in Janus kinases (JAKs). In previous years, dealing with MF included several protocols such as traditional drugs that control general symptoms, splenectomy, blood transfusion, and allogeneic haematopoietic stem-cell transplantation (HSCT). Allogeneic HSCT is remaining the only treatment that has the potential to alter MF’s progression. However, clinical trials of JAK inhibitors and non-JAK targeted therapies have been increasingly carried out in earlier years. The most prominent JAK inhibitors for the treatment of MF are ruxolitinib, fedratinib, momelotinib, pacritinib, gandotinib, ilginatinib, itacitinib, and lestaurtinib. On the other hand, the non-JAK targeted therapies that showed strong efficacy and safety are alisertib, imetelstat, pembrolizumab, nivolumab, and sotatercept. In this review, we summarized the recent clinical trials carried out on these drugs to understand their efficacy and safety. Also, we talked briefly about allogeneic HSCT as powerful therapy until the present for patients suffering from MF.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-10; https://doi.org/10.1186/s43162-022-00167-z
Problem considered: Research has shown that health care personnel is at higher risk of acquiring the disease than the general population. In spite of this challenge, there has been a low vaccination record among the Health Workers The aim of this study was to investigate the relationship between knowledge, attitude, perception, and practice of hepatitis B vaccination among health workers in Akure South Local Government Area of Ondo State, Nigeria Methods: An institution-based cross-sectional study was conducted with 260 health professionals working at primary health centers (40), private hospitals (60), and tertiary health institutions (160). Data was collected by using self-administered questionnaires distributed at the participant’s work unit and analyzed using SPSS version 20. Results: The result showed that there was a statistically significant relationship between the knowledge of Health workers about the HBV vaccine and vaccine uptake. While all the non-vaccinated health workers showed interest in taking the vaccine, the majority of them (80.4 %) suggested that the vaccine should be given free to health workers. Conclusion: The study revealed that the health workers had a good knowledge of hepatitis infection but not the vaccination which affected vaccine uptake as a significant relationship exists between the two. Also, the greatest hindrance to the uptake of the vaccine is the cost of the vaccine. HBV vaccination should be made compulsory as part of occupational protection measures and made readily available gratis for all health workers.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-4; https://doi.org/10.1186/s43162-022-00162-4
Background: Psoriasis is a chronic inflammatory disorder of the skin; the hallmark of psoriasis is sustained inflammation that leads to uncontrolled keratinocyte proliferation and dysfunctional differentiation. Psoriasis shows clear autoimmune-related pathomechanisms, in which autoantigen-specific T cells contribute to the development, chronification, and overall course of the disease. Psoriasis is primarily a skin disease, but other internal organs may be involved; affliction of the joints is well established, but kidney involvement is yet to be universally agreed upon, although some recent studies have linked psoriasis to kidney disease and certain glomerular diseases including secondary renal amyloidosis, Ig A nephropathy, and membranous glomerulopathy. Case presentation and conclusion: In this paper, we report a case of primary membranoproliferative glomerulonephritis (MPGN) with nephrotic impure syndrome in a psoriatic patient. The etiological investigation was negative with normal serum complement and ASO titers and were negative for HBV, HCV, HIV, and ANA. The patient improved on prednisolone and angiotensin-converting enzyme inhibitors. To our best of knowledge, cases of MPGN associated with psoriasis are rare and we would like to shed light on this association.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-8; https://doi.org/10.1186/s43162-022-00165-1
Background: Diabetes and stroke prevalence rates are increasing worldwide, and both are major human health threats causing disability and death. Diabetes is a well-known independent risk factor for stroke. In addition, diabetes increases the prevalence of other stroke risk factors; however, few studies evaluate whether diabetes may influence stroke presentation. Aim of the work: This study was conducted to assess the risk factors and clinical presentation of stroke in patients with and without diabetes. Patients and methods: This cross-sectional study was conducted on 200 patients with radiologically confirmed acute cerebrovascular stroke, selected from tertiary care hospitals in Alexandria, Egypt. They were divided into 2 groups: group 1: 100 patients with diabetes for more than 5 years and group 2: 100 nondiabetic patients. All patients were evaluated for risk factors, stroke types, and clinical presentation. Results: Compared with nondiabetic patients, diabetic patients with stroke had a significantly higher prevalence of hypertension (p = 0.031) and dyslipidemia (p = 0.016) and higher incidence of ischemic stroke (p = 0.030), and they were more likely to present with motor deficit (p = 0.045) and dysarthria (p = 0.048). There was a modest difference between diabetic and nondiabetic group regarding OCSP ischemic stroke subtypes, but it was non-significant. Conclusion: There was a significant difference in stroke risk factors, pathological types, and presentation between diabetic and nondiabetic patients, but not in ischemic stroke anatomical subtypes.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-2; https://doi.org/10.1186/s43162-022-00166-0
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-10; https://doi.org/10.1186/s43162-022-00164-2
Background: Simultaneous increase in transaminases and bilirubin is an indicator of hepatic dysfunction in malaria. Malaria-induced hyperbilirubinemia has been associated with acute kidney injury and pathogenesis of cerebral malaria which are significantly associated with mortality in malaria infection. This retrospective study was designed to assess the lipid profile, and hematological, renal and hepatic function data of malaria patients in Sir Yahaya Memorial hospital Birnin Kebbi from 2016 to 2020 who are 18 years and above. Methods: The data of all patients between 2016 and 2020 who are 18 years and above were collected. Complete data of 370 subjects who met the inclusion criteria which consist of 250 malaria subjects and 120 control subjects were analyzed. Results: The results showed that females constitute 65.2% of malaria patients with complete records while the remaining 34.8% were males. Age distribution of the patients showed that the infection was more prevalent among 26–45 years and least among 65 years and above. Anemia and thrombocytopenia were prevalent among the female malaria patients compared to the male patients. Liver and kidney function parameters analyzed correlate positively with the gender. The infected male showed higher dysfunction in liver parameters while infected female patients showed significant dysfunction in kidney function parameters and lipid profile. Conclusions: In conclusion, to prevent the potential widespread of acute renal and hepatic failure with the attendant morbidity and mortality among malaria patients, it is recommended that liver and kidney function tests be mandated for patients with recurring malaria and those with a history of treatment failure in the endemic area to ensure early diagnosis of malarial induced kidney and liver injury among malaria patients.
The Egyptian Journal of Internal Medicine, Volume 34, pp 1-10; https://doi.org/10.1186/s43162-022-00163-3
Introduction: The COVID-19 pneumonia is a heterogeneous disease with variable effect on lung parenchyma, airways, and vasculature leading to long-term effects on lung functions. Materials and methods: Multicentric, prospective, observational, and interventional study conducted during July 2020 to May 2021, in the MIMSR Medical College and Venkatesh Hospital Latur India, included 1000 COVID-19 cases confirmed with RT-PCR. All cases were assessed with lung involvement documented and categorized on HRCT thorax, oxygen saturation, inflammatory marker, ferritin at entry point, and follow-up during hospitalization. Age, gender, comorbidity, and use of BIPAP/NIV and outcome as with or without lung fibrosis as per CT severity were key observations. CT severity scoring is done as per universally accepted standard scoring tool as score < 7 as mild, 7–14 as moderate, and score > 15 as severe affection of the lung. Statistical analysis is done by using chi-square test. Observations and analysis: In study of 1000 COVID-19 pneumonia cases, age (< 50 and > 50 years) and gender (male versus female) have significant association with ferritin in predicting severity of COVID-19 pneumonia (p < 0.00001) and (p < 0.010), respectively. CT severity score at entry point with ferritin level has significant correlation in severity scores < 8, 8–15, and > 15 documented in normal and abnormal ferritin level as in 190/110, 90/210, and 40/360, respectively (p < 0.00001). Ferritin level has significant association with duration of illness, i.e., DOI < 7 days, 8–15 days, and > 15 days of onset of symptoms documented normal and abnormal ferritin levels in 30/310, 160/300, and 130/70 cases, respectively (p < 0.00001). Comorbidity as diabetes mellitus, hypertension, COPD, IHD, and obesity has significant association in COVID-19 cases with normal and abnormal ferritin level respectively (p < 0.00001). Ferritin level has significant association with oxygen saturation in COVID-19 pneumonia cases; cases with oxygen saturation > 90%, 75–90%, and < 75% are observed as normal and abnormal ferritin level in 110/100, 150/340, and 60/240 cases, respectively (p < 0.00001). BIPAP/NIV requirement during the course of COVID-19 pneumonia in critical care setting has significant association with ferritin level; cases received BIPAP/NIV during hospitalization were documented normal and abnormal ferritin level in 155/445 and 165/235 cases, respectively (p < 0.00001). Timing of BIPAP/NIV requirement during course of COVID-19 pneumonia in critical care setting has significant association with ferritin level; cases received BIPAP/NIV at entry point < 1 day, 3–7 days, and after 7 days of hospitalization were documented significance in fourfold raised ferritin level in 110/70, 150/160, and 30/80 cases, respectively (p < 0.00001). Follow-up of ferritin titer during hospitalization as compared to entry point abnormal ferritin has significant association in post-COVID lung fibrosis (p < 0.00001). Follow-up of ferritin titer during hospitalization as compared to entry point normal ferritin has significant association in post-COVID lung fibrosis (p < 0.00001). Conclusion: Ferritin is easily available, sensitive and reliable, cost-effective, and universally acceptable inflammatory marker in COVID-19 pandemic. Ferritin has very crucial role in COVID-19 pneumonia in predicting severity of illness and assessing response to treatment during hospitalization. Follow-up of ferritin titer during hospitalization and at discharge can be used as early predictor of post-COVID lung fibrosis.