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Volume 59 (2021): Edition 2 (June 2021)

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Volume 58 (2020): Edition 4 (December 2020)

Volume 58 (2020): Edition 3 (September 2020)

Volume 58 (2020): Edition 2 (June 2020)

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Volume 57 (2019): Edition 4 (December 2019)

Volume 57 (2019): Edition 3 (September 2019)

Volume 57 (2019): Edition 2 (June 2019)

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Volume 55 (2017): Edition 2 (June 2017)

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Volume 54 (2016): Edition 4 (December 2016)

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Volume 54 (2016): Edition 2 (June 2016)

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Volume 53 (2015): Edition 4 (December 2015)

Volume 53 (2015): Edition 3 (September 2015)

Volume 53 (2015): Edition 2 (June 2015)

Volume 53 (2015): Edition 1 (March 2015)

Détails du magazine
Format
Magazine
eISSN
2501-062X
Première publication
30 Mar 2015
Période de publication
4 fois par an
Langues
Anglais

Chercher

Volume 58 (2020): Edition 4 (December 2020)

Détails du magazine
Format
Magazine
eISSN
2501-062X
Première publication
30 Mar 2015
Période de publication
4 fois par an
Langues
Anglais

Chercher

10 Articles
Accès libre

Use of statins, amiodarone, direct oral anticoagulants and NSAIDs in chronic liver disease: a guide for general clinicians

Publié en ligne: 17 Dec 2020
Pages: 181 - 187

Résumé

Abstract

Patients with chronic liver disease have associated comorbidities that require treatment, including cardiovascular disease, arrhythmias, cerebrovascular accidents and pain. These medications may affect the liver disease. Due to the complexity of medical problems in patients with chronic liver disease, treating clinicians benefit from targeted guidance for their care.

Mots clés

  • liver enzymes
  • aminotransferases
  • benefits
  • risk factors
  • recommendations
Accès libre

The cardiovascular complications of diabetes: a striking link through protein glycation

Publié en ligne: 17 Dec 2020
Pages: 188 - 198

Résumé

Abstract

Diabetes mellitus is a predominant cause of mortality and morbidity worldwide. One of its serious health problems is cardiovascular complications. Advanced glycation end products (AGEs) are a group of heterogeneous toxic oxidant compounds that are formed after a non-enzymatic reaction between monosaccharides and free amino groups of proteins, compound lipids, and nucleic acids. AGE interacts with various types of cells through a receptor for AGE (RAGE). The interaction between AGE and RAGE is responsible for a cascade of inflammation, oxidative stress, and disruption of calcium homeostasis in cardiac cells of diabetic patients. There is striking evidence that the AGE/RAGE axis with its consequences on inflammation and oxidative stress plays a major role in the development of cardiovascular complications. Therefore, considering AGE as a therapeutic target with foreseeable results would be a wise direction for future research. Interestingly, several studies on nutraceutical, pharmaceutical, and natural products have begun to reveal promising therapeutic results, and this could lead to better health outcomes for many diabetic patients worldwide. This article discusses the current literature addressing the connection between protein glycation and diabetes cardiovascular complications and suggests future avenues of research.

Mots clés

  • AGEs
  • diabetes
  • cardiovascular disease
  • glycation
  • RAGE
  • sRAGE
Accès libre

Update on Kaposi sarcoma-associated herpesvirus (KSHV or HHV8) – review

Publié en ligne: 17 Dec 2020
Pages: 199 - 208

Résumé

Abstract

Human herpesvirus 8 (HHV8), also known as Kaposi sarcoma-associated herpesvirus (KSHV), is one of the few pathogens recognized as direct carcinogen, being involved in the pathogenesis of Kaposi sarcoma, primary effusion lymphoma and multicentric Castleman disease. KSHV is a relatively recently discovered virus, with still limited possibilities for diagnosis and treatment. Therefore, ongoing studies are trying to answer the main issues related to the management of KSHV infection and its associated diseases. This review updates the current knowledge of the KSHV infection, discussing aspects related to epidemiology, virological features, clinical manifestations, diagnosis and treatment.

Mots clés

  • Kaposi sarcoma-associated herpesvirus
  • KSHV
  • Kaposi sarcoma
  • primary effusion lymphoma
  • multicentric Castleman disease
Accès libre

Combining clinical features and MEST-C score in IgA nephropathy may be a better determinant of kidney survival

Publié en ligne: 17 Dec 2020
Pages: 209 - 218

Résumé

Abstract

Introduction. IgA nephropathy (IgAN) is a heterogeneous disease with highly variable clinical and histopathological features. We investigated the effects of Oxford classification and clinical features on renal survival in patients with IgAN.

Methods. This retrospective observational study conducted from 2013 to 2017. Ninety-seven patients who were followed up more than six months were examined.

Results. A total of 97 patients (68% male and median age 40 years) were enrolled in this study. 13% of patients developed end stage renal disease (ESRD) within the median of 37 months of follow-up. Need for renal replacement therapy at the time of diagnosis, serum creatinine level of higher than 1.97 mg/dl, serum albumin level less than 3.5 gr/dl, 24-hour urine protein level of higher than > 3.5 g/day, the percentage of glomerulosclerosis higher than 53%, T2 score and total MEST-C score higher than two were found to be significant predictors of development of ESRD. None of the clinical or histopathological features were found to be significant predictor of steroid treatment sensitivity except T1-2 scores.

Conclusion. We think that IgA nephropathy is a heterogeneous disease that requires clinical and histopathological features to be evaluated together, but not individually, to determine renal survival.

What is new. Iga nephropathy is a heterogeneous disease and modern pathologic classification systems is not enough to predict to prognosis. Histopathological features to be evaluated with clinical features, but not individually, to determine renal survival. Also glucocorticoid treatment response seems to be independent from clinical and histopathological features except T1-2 score.

Mots clés

  • IgA nephropathy
  • glomerulonephritis
  • end stage kidney disease
  • glucocorticoid
  • Oxford classification
Accès libre

The consequences of the COVID-19 pandemic on perceived stress in clinical practice: experience of doctors in Iraqi Kurdistan

Publié en ligne: 17 Dec 2020
Pages: 219 - 227

Résumé

Abstract

Introduction. The healthcare workers are at high risk of developing stress-related problems during outbreaks. This study aimed to explore the perceived stress and its relation to the duration of dealing with COVID-19 patients in medical doctors.

Methods. The doctors who work in different medical settings in Iraqi Kurdistan during coronavirus outbreak were invited into this cross-sectional study. The doctors were invited from one pediatric, one emergency, one special corona, and one maternity and gynecology hospital. The “Perceived Stress Scale-10 (PSS)” measured the perceived degree of a doctor who experienced stress. The information was collected through a web-based technique to avoid the disease spread.

Results. Doctors’ mean duration of dealing with suspected/confirmed cases of COVID-19 was 1.2 (Range: 0–16 days). The mean stress score was 18.81 out of 40. Most of the doctors had a moderate level of stress (69.4%), followed by a low (21.1%) and a high level of stress (9.6%). The general physicians and medical lab specialties had higher stress scores; 21.56 and 19.88, respectively. The high level of stress was among general physicians and community and family medicine doctors; 20.0% and 25.0%, respectively. Whether or not doctors dealt with suspected/confirmed cases of COVID-19, did not have a significant difference over the perceived stress score; 19.02 vs. 18.87; P = 0.786). The mean score of stress was raised with increasing duration of dealing with suspected/confirmed cases of COVID-19; r = 0.202; P = 0.004 and decreased with increasing age (r = –0.141; P = 0.045), and clinical experience (r = –0.139, P = 0.048).

Conclusion. This study showed that medical doctors are at a moderate level of perceived stress during the COVID-19 outbreak in Iraqi Kurdistan.

Mots clés

  • stress
  • healthcare workers
  • clinical medicine
  • COVID-19
  • pandemics
Accès libre

Medication use and polypharmacy in patients referred to a tertiary gastroenterology practice

Publié en ligne: 17 Dec 2020
Pages: 228 - 232

Résumé

Abstract

Introduction. Commonly prescribed medications are associated with various gastrointestinal (GI) side effects but few data are available on prescription medication use and polypharmacy in a gastroenterology outpatient practice. We aimed to examine the prevalence of polypharmacy, defined as the simultaneous use of 5 or more medications.

Methods. A descriptive correlational study of consecutive outpatient consultations in 988 patients referred to a tertiary gastroenterology practice. Main outcome measurements were frequency of prescription medication use and polypharmacy.

Results. The most common GI symptoms were abdominal pain (72%), nausea (57%), and constipation (53%). The frequency of polypharmacy was 10%. Eighty percent of patients took at least one medication and 60% took two or more. The most frequently used medication classes were proton pump inhibitors (43%), followed by benzodiazepines (30%), selective serotonin-reuptake or norepinephrine-reuptake inhibitors (28%), non-steroidal anti-inflammatory drugs (27%), and opioids (21%).

Conclusion. There was a higher use of prescription medicine including antidepressants, and a lower frequency of polypharmacy in our study cohort compared to the general population. The use of medications may have contributed to the symptoms leading to our study’s population GI consultation.

Mots clés

  • adverse effects
  • gastrointestinal
  • polypharmacy
  • prescription medicine
Accès libre

Role of urinary podocalyxin in early diagnosis of diabetic nephropathy

Publié en ligne: 17 Dec 2020
Pages: 233 - 241

Résumé

Abstract

Introduction. Podocyte injury has been reported as an early feature of DN therefore, the assessment of podocyte injury can be accomplished by estimation of podocalyxin in urine. This study aimed to estimate the urinary podocalyxin levels and to determine the sensitivity and specificity of this biomarker for early detection of DN.

Materials and methods. A total of 90 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. Sixty of them were without diagnosed DN, and 30 with diagnosed DN. A control group consisted of 30 healthy subjects. All patients with T2DM were divided into three subgroups according to urinary microalbumin/creatinine ratio (UM/CR): normoalbuminuric, microalbuminuric and macroalbuminuric patients. Urine samples, were used for measurement of podocalyxin by ELISA, creatinine and microalbumin. Fasting venous blood samples was collected for biochemical analyses.

Results. The levels of urinary podocalyxin (u-PDX) were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied subgroups regarding u-PDX was found (p < 0.05). Levels of u-PDX are increasing gradually with the degree of DN (p < 0.029). u-PDX levels were positively correlated with UM/CR (r = 0.227, p = 0.002). A cut-off level of 43.8 ng/ml u-PDX showed 73.3% sensitivity and 93.3% specificity to detect DN in early stage. A cut-off level of 30 mg/g UM/CR showed 41.5% sensitivity and 90% specificity in predicting DN. u-PDX was elevated in 48,2% of normoalbuminuric patients.

Conclusion. Urinary podocalyxin be useful and more sensitive and specific marker in early detection of DN than microalbuminuria.

Mots clés

  • diabetic nephropathy
  • microalbumin
  • podocalyxin
  • ROC analysis
  • podocytes
Accès libre

CT-scan findings of COVID-19 pneumonia based on the time elapsed from the beginning of symptoms to the CT imaging evaluation: a descriptive study in Iran

Publié en ligne: 17 Dec 2020
Pages: 242 - 250

Résumé

Abstract

Background. Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.

Methods. Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan.

Results. The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%) and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased.

Conclusions. Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.

Mots clés

  • COVID-19
  • SARS-CoV-2
  • computed tomography
  • pneumonia
Accès libre

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Publié en ligne: 17 Dec 2020
Pages: 251 - 258

Résumé

Abstract

Introduction. COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies were found in some studies.

Aim. Assessment of protein S activity in patients with COVID-19 as a cause of this prothrombotic state, and of the association of protein S activity with worse outcome.

Methods. All patients admitted for COVID-19 disease in a university hospital between 15th of May and 15th of July 2020 were prospectively enrolled into this cohort study. Patients treated with antivitamin K anticoagulants and with liver disease were excluded. All patients had protein S activity determined at admission. The main outcome was survival, while secondary outcomes were clinical severity and lung damage.

Results. 91 patients were included, of which 21 (23.3%) died. Protein S activity was decreased in 65% of the patients. Death was associated with lower activity of protein S (median 42% vs. 58%, p < 0.001), and the association remained after adjustment for age, inflammation markers and ALAT. There was a dose-response relationship between protein S activity and clinical severity (Kendall_tau coefficient = –0.320, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001) or pulmonary damage on CT scan (Kendall_tau coefficient = –0.290, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001). High neutrophil count was also independently associated with death (p = 0.002).

Conclusion. Protein S activity was lower in COVID-19 patients, and its level was associated with survival and disease severity, suggesting that it may have a role in the thrombotic manifestations of the disease.

Mots clés

  • COVID-19
  • protein S
  • thrombophilia
  • thrombosis
  • neutrophilia
Accès libre

Delayed COVID respiratory failure: what every front line healthcare worker needs to know

Publié en ligne: 17 Dec 2020
Pages: 259 - 263

Résumé

Abstract

The pandemic of COVID-19 has presented several diagnostic challenges in both recognition of acute disease and also the temporal presentation of disease convalescence with return to normal activity. We present a case of delayed clinical progression of COVID-19 associated respiratory failure on day 25 after initial symptom onset and, notably, after initial full resolution of symptoms and negative RT-PCR nasopharyngeal testing. The patient’s delayed presentation of exertional dyspnea and the utilization of specific characteristics of chest radiography in confirmation with laboratory cytokine measurement allowed for clinical re-categorization of the patient’s status to active COVID-19 clinical disease and changed acute management. COVID-19 positive patients should be advised to continue to monitor for respiratory deterioration for a greatly extended period of time, even if RT-PCR testing is negative and initial clinical symptoms have resolved. Frontline healthcare workers, including first responders and primary care providers, also need to be aware to monitor for and recognize this delayed presentation.

Mots clés

  • COVID-19
  • SARS-CoV-2
  • respiratory failure
  • Cytokine Release Syndrome
  • chest radiography
10 Articles
Accès libre

Use of statins, amiodarone, direct oral anticoagulants and NSAIDs in chronic liver disease: a guide for general clinicians

Publié en ligne: 17 Dec 2020
Pages: 181 - 187

Résumé

Abstract

Patients with chronic liver disease have associated comorbidities that require treatment, including cardiovascular disease, arrhythmias, cerebrovascular accidents and pain. These medications may affect the liver disease. Due to the complexity of medical problems in patients with chronic liver disease, treating clinicians benefit from targeted guidance for their care.

Mots clés

  • liver enzymes
  • aminotransferases
  • benefits
  • risk factors
  • recommendations
Accès libre

The cardiovascular complications of diabetes: a striking link through protein glycation

Publié en ligne: 17 Dec 2020
Pages: 188 - 198

Résumé

Abstract

Diabetes mellitus is a predominant cause of mortality and morbidity worldwide. One of its serious health problems is cardiovascular complications. Advanced glycation end products (AGEs) are a group of heterogeneous toxic oxidant compounds that are formed after a non-enzymatic reaction between monosaccharides and free amino groups of proteins, compound lipids, and nucleic acids. AGE interacts with various types of cells through a receptor for AGE (RAGE). The interaction between AGE and RAGE is responsible for a cascade of inflammation, oxidative stress, and disruption of calcium homeostasis in cardiac cells of diabetic patients. There is striking evidence that the AGE/RAGE axis with its consequences on inflammation and oxidative stress plays a major role in the development of cardiovascular complications. Therefore, considering AGE as a therapeutic target with foreseeable results would be a wise direction for future research. Interestingly, several studies on nutraceutical, pharmaceutical, and natural products have begun to reveal promising therapeutic results, and this could lead to better health outcomes for many diabetic patients worldwide. This article discusses the current literature addressing the connection between protein glycation and diabetes cardiovascular complications and suggests future avenues of research.

Mots clés

  • AGEs
  • diabetes
  • cardiovascular disease
  • glycation
  • RAGE
  • sRAGE
Accès libre

Update on Kaposi sarcoma-associated herpesvirus (KSHV or HHV8) – review

Publié en ligne: 17 Dec 2020
Pages: 199 - 208

Résumé

Abstract

Human herpesvirus 8 (HHV8), also known as Kaposi sarcoma-associated herpesvirus (KSHV), is one of the few pathogens recognized as direct carcinogen, being involved in the pathogenesis of Kaposi sarcoma, primary effusion lymphoma and multicentric Castleman disease. KSHV is a relatively recently discovered virus, with still limited possibilities for diagnosis and treatment. Therefore, ongoing studies are trying to answer the main issues related to the management of KSHV infection and its associated diseases. This review updates the current knowledge of the KSHV infection, discussing aspects related to epidemiology, virological features, clinical manifestations, diagnosis and treatment.

Mots clés

  • Kaposi sarcoma-associated herpesvirus
  • KSHV
  • Kaposi sarcoma
  • primary effusion lymphoma
  • multicentric Castleman disease
Accès libre

Combining clinical features and MEST-C score in IgA nephropathy may be a better determinant of kidney survival

Publié en ligne: 17 Dec 2020
Pages: 209 - 218

Résumé

Abstract

Introduction. IgA nephropathy (IgAN) is a heterogeneous disease with highly variable clinical and histopathological features. We investigated the effects of Oxford classification and clinical features on renal survival in patients with IgAN.

Methods. This retrospective observational study conducted from 2013 to 2017. Ninety-seven patients who were followed up more than six months were examined.

Results. A total of 97 patients (68% male and median age 40 years) were enrolled in this study. 13% of patients developed end stage renal disease (ESRD) within the median of 37 months of follow-up. Need for renal replacement therapy at the time of diagnosis, serum creatinine level of higher than 1.97 mg/dl, serum albumin level less than 3.5 gr/dl, 24-hour urine protein level of higher than > 3.5 g/day, the percentage of glomerulosclerosis higher than 53%, T2 score and total MEST-C score higher than two were found to be significant predictors of development of ESRD. None of the clinical or histopathological features were found to be significant predictor of steroid treatment sensitivity except T1-2 scores.

Conclusion. We think that IgA nephropathy is a heterogeneous disease that requires clinical and histopathological features to be evaluated together, but not individually, to determine renal survival.

What is new. Iga nephropathy is a heterogeneous disease and modern pathologic classification systems is not enough to predict to prognosis. Histopathological features to be evaluated with clinical features, but not individually, to determine renal survival. Also glucocorticoid treatment response seems to be independent from clinical and histopathological features except T1-2 score.

Mots clés

  • IgA nephropathy
  • glomerulonephritis
  • end stage kidney disease
  • glucocorticoid
  • Oxford classification
Accès libre

The consequences of the COVID-19 pandemic on perceived stress in clinical practice: experience of doctors in Iraqi Kurdistan

Publié en ligne: 17 Dec 2020
Pages: 219 - 227

Résumé

Abstract

Introduction. The healthcare workers are at high risk of developing stress-related problems during outbreaks. This study aimed to explore the perceived stress and its relation to the duration of dealing with COVID-19 patients in medical doctors.

Methods. The doctors who work in different medical settings in Iraqi Kurdistan during coronavirus outbreak were invited into this cross-sectional study. The doctors were invited from one pediatric, one emergency, one special corona, and one maternity and gynecology hospital. The “Perceived Stress Scale-10 (PSS)” measured the perceived degree of a doctor who experienced stress. The information was collected through a web-based technique to avoid the disease spread.

Results. Doctors’ mean duration of dealing with suspected/confirmed cases of COVID-19 was 1.2 (Range: 0–16 days). The mean stress score was 18.81 out of 40. Most of the doctors had a moderate level of stress (69.4%), followed by a low (21.1%) and a high level of stress (9.6%). The general physicians and medical lab specialties had higher stress scores; 21.56 and 19.88, respectively. The high level of stress was among general physicians and community and family medicine doctors; 20.0% and 25.0%, respectively. Whether or not doctors dealt with suspected/confirmed cases of COVID-19, did not have a significant difference over the perceived stress score; 19.02 vs. 18.87; P = 0.786). The mean score of stress was raised with increasing duration of dealing with suspected/confirmed cases of COVID-19; r = 0.202; P = 0.004 and decreased with increasing age (r = –0.141; P = 0.045), and clinical experience (r = –0.139, P = 0.048).

Conclusion. This study showed that medical doctors are at a moderate level of perceived stress during the COVID-19 outbreak in Iraqi Kurdistan.

Mots clés

  • stress
  • healthcare workers
  • clinical medicine
  • COVID-19
  • pandemics
Accès libre

Medication use and polypharmacy in patients referred to a tertiary gastroenterology practice

Publié en ligne: 17 Dec 2020
Pages: 228 - 232

Résumé

Abstract

Introduction. Commonly prescribed medications are associated with various gastrointestinal (GI) side effects but few data are available on prescription medication use and polypharmacy in a gastroenterology outpatient practice. We aimed to examine the prevalence of polypharmacy, defined as the simultaneous use of 5 or more medications.

Methods. A descriptive correlational study of consecutive outpatient consultations in 988 patients referred to a tertiary gastroenterology practice. Main outcome measurements were frequency of prescription medication use and polypharmacy.

Results. The most common GI symptoms were abdominal pain (72%), nausea (57%), and constipation (53%). The frequency of polypharmacy was 10%. Eighty percent of patients took at least one medication and 60% took two or more. The most frequently used medication classes were proton pump inhibitors (43%), followed by benzodiazepines (30%), selective serotonin-reuptake or norepinephrine-reuptake inhibitors (28%), non-steroidal anti-inflammatory drugs (27%), and opioids (21%).

Conclusion. There was a higher use of prescription medicine including antidepressants, and a lower frequency of polypharmacy in our study cohort compared to the general population. The use of medications may have contributed to the symptoms leading to our study’s population GI consultation.

Mots clés

  • adverse effects
  • gastrointestinal
  • polypharmacy
  • prescription medicine
Accès libre

Role of urinary podocalyxin in early diagnosis of diabetic nephropathy

Publié en ligne: 17 Dec 2020
Pages: 233 - 241

Résumé

Abstract

Introduction. Podocyte injury has been reported as an early feature of DN therefore, the assessment of podocyte injury can be accomplished by estimation of podocalyxin in urine. This study aimed to estimate the urinary podocalyxin levels and to determine the sensitivity and specificity of this biomarker for early detection of DN.

Materials and methods. A total of 90 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. Sixty of them were without diagnosed DN, and 30 with diagnosed DN. A control group consisted of 30 healthy subjects. All patients with T2DM were divided into three subgroups according to urinary microalbumin/creatinine ratio (UM/CR): normoalbuminuric, microalbuminuric and macroalbuminuric patients. Urine samples, were used for measurement of podocalyxin by ELISA, creatinine and microalbumin. Fasting venous blood samples was collected for biochemical analyses.

Results. The levels of urinary podocalyxin (u-PDX) were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied subgroups regarding u-PDX was found (p < 0.05). Levels of u-PDX are increasing gradually with the degree of DN (p < 0.029). u-PDX levels were positively correlated with UM/CR (r = 0.227, p = 0.002). A cut-off level of 43.8 ng/ml u-PDX showed 73.3% sensitivity and 93.3% specificity to detect DN in early stage. A cut-off level of 30 mg/g UM/CR showed 41.5% sensitivity and 90% specificity in predicting DN. u-PDX was elevated in 48,2% of normoalbuminuric patients.

Conclusion. Urinary podocalyxin be useful and more sensitive and specific marker in early detection of DN than microalbuminuria.

Mots clés

  • diabetic nephropathy
  • microalbumin
  • podocalyxin
  • ROC analysis
  • podocytes
Accès libre

CT-scan findings of COVID-19 pneumonia based on the time elapsed from the beginning of symptoms to the CT imaging evaluation: a descriptive study in Iran

Publié en ligne: 17 Dec 2020
Pages: 242 - 250

Résumé

Abstract

Background. Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.

Methods. Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan.

Results. The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%) and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased.

Conclusions. Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.

Mots clés

  • COVID-19
  • SARS-CoV-2
  • computed tomography
  • pneumonia
Accès libre

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Publié en ligne: 17 Dec 2020
Pages: 251 - 258

Résumé

Abstract

Introduction. COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies were found in some studies.

Aim. Assessment of protein S activity in patients with COVID-19 as a cause of this prothrombotic state, and of the association of protein S activity with worse outcome.

Methods. All patients admitted for COVID-19 disease in a university hospital between 15th of May and 15th of July 2020 were prospectively enrolled into this cohort study. Patients treated with antivitamin K anticoagulants and with liver disease were excluded. All patients had protein S activity determined at admission. The main outcome was survival, while secondary outcomes were clinical severity and lung damage.

Results. 91 patients were included, of which 21 (23.3%) died. Protein S activity was decreased in 65% of the patients. Death was associated with lower activity of protein S (median 42% vs. 58%, p < 0.001), and the association remained after adjustment for age, inflammation markers and ALAT. There was a dose-response relationship between protein S activity and clinical severity (Kendall_tau coefficient = –0.320, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001) or pulmonary damage on CT scan (Kendall_tau coefficient = –0.290, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001). High neutrophil count was also independently associated with death (p = 0.002).

Conclusion. Protein S activity was lower in COVID-19 patients, and its level was associated with survival and disease severity, suggesting that it may have a role in the thrombotic manifestations of the disease.

Mots clés

  • COVID-19
  • protein S
  • thrombophilia
  • thrombosis
  • neutrophilia
Accès libre

Delayed COVID respiratory failure: what every front line healthcare worker needs to know

Publié en ligne: 17 Dec 2020
Pages: 259 - 263

Résumé

Abstract

The pandemic of COVID-19 has presented several diagnostic challenges in both recognition of acute disease and also the temporal presentation of disease convalescence with return to normal activity. We present a case of delayed clinical progression of COVID-19 associated respiratory failure on day 25 after initial symptom onset and, notably, after initial full resolution of symptoms and negative RT-PCR nasopharyngeal testing. The patient’s delayed presentation of exertional dyspnea and the utilization of specific characteristics of chest radiography in confirmation with laboratory cytokine measurement allowed for clinical re-categorization of the patient’s status to active COVID-19 clinical disease and changed acute management. COVID-19 positive patients should be advised to continue to monitor for respiratory deterioration for a greatly extended period of time, even if RT-PCR testing is negative and initial clinical symptoms have resolved. Frontline healthcare workers, including first responders and primary care providers, also need to be aware to monitor for and recognize this delayed presentation.

Mots clés

  • COVID-19
  • SARS-CoV-2
  • respiratory failure
  • Cytokine Release Syndrome
  • chest radiography

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