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Areej Alkhateeb,1 Hossam Eldin M Mahmoud,1 Mohammed AK,1 Mohammed H Hassan,2 Abdel Rahim Mahmoud Muddathir,3 Ahmed G Bakry1 1Cardiology Division of Internal Medicine Department, South Valley University Hospital, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 3Department of Hematology and Blood Transfusion, Faculty of Medical Laboratory Science, Alzaeim Alazhari University, Khartoum, SudanCorrespondence: Abdel Rahim Mahmoud Muddathir, Department of Hematology and Blood Transfusion, Faculty of Medical Laboratory Science, Alzaeim Alazhari University, Khartoum, Sudan, Email abdelrahimm@gmail.comBackground: The prognostic role of the soluble circulating suppression of tumorigenicity 2 marker (sST2) in different cardiovascular diseases (CVD) is still under investigation. This research aimed to assess the serum levels of sST2 in the blood of individuals with ischemic heart disease and its relation to disease severity, also to examine any changes in sST2 levels following a successful percutaneous coronary intervention (PCI) in those patients.Methods: A total of 33 ischemic patients and 30 non-ischemic controls were included. The plasma level of sST2 was measured using commercially available ELISA assay kit, at baseline and 24– 48 h after the intervention in the ischemic group.Results: On admission, there was a significant difference between the group of acute/chronic coronary syndrome cases and controls regarding the sST2 plasma level (p < 0.001). There was an insignificant difference between the three ischemic subgroups at the baseline sST2 level (p = 0.38). The plasma sST2 level decreased significantly after PCI (from 20.70 ± 1.71 to 16.51 ± 2.43, p = 0.006). There was a modestly just significant positive correlation between the acute change in post-PCI sST2 level and the severity of ischemia as measured by the Modified Gensini Score (MGS) (r = 0.45, p = 0.05). In spite of the highly significant improvement in the coronary TIMI flow of ischemic group after PCI, there was insignificant negative correlation between the post- PCI delta change in the sST2 level and the post-PCI TIMI coronary flow grade.Conclusion: A significantly high plasma level of sST2 in patients with myocardial ischemia and controlled cardiovascular risk factors showed an immediate reduction after successful revascularization. The high baseline level of the sST2 marker and the acute post-PCI reduction was mainly related to the severity of ischemia rather than left ventricular function.Keywords: soluble circulating suppression of tumorigenicity 2 marker, percutaneous coronary intervention, acute/chronic coronary syndrome, severity of ischemia, modified gensini score, revascularization

Zaki F Aref,1 Shamardan Ezzeldin Sayed Bazeed,2 Asmaa Nafady,3 Dalia Fahim Mohammed Fahim,4 Ali A Ghweil,5 Mennatallah Ali Abdelrhman Sayed,6 Heba Mohammad Qubaisy,7 Mahmoud Khalefa,8 Usama A Arafa,9 Badawy Shahat Badawy,10 Ahmed Shawkat Abdelmohsen,11 Mohammed H Hassan,12 Aida A Abdelmaksoud1 1Department of ENT, Faculty of Medicine, South Valley University, Qena, Egypt; 2Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena, Egypt; 3Department of Clinical and Chemical Pathology, Faculty of Medicine, South Valley University, Qena, Egypt; 4Audiovestibular Medicine, Faculty of Medicine, Minia University, Minia, Egypt; 5Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena, Egypt; 6King Salman International University, Faculty of Medicine, El Tor, Egypt; 7Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt; 8Department of ENT, Faculty of Medicine, Aswan University, Aswan, Egypt; 9Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt; 10Department of ENT, Faculty of Medicine, Luxor University, Luxor, Egypt; 11Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt; 12Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, EgyptCorrespondence: Mohammed H Hassan, Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt, Tel +20 1009097968, Email mohammedhosnyhassaan@yahoo.com; mohammedhosnyhassaan@med.svu.edu.egBackground: Helicobacter pylori is assumed to cause many gastric and extragastric diseases. We aimed to assess the possible association role of H. pylori in Otitis media with effusion (OME), nasal polyps and adenotonsillitis.Patients and Methods: A total of 186 patients with various ear, nose and throat diseases were included. The study comprised 78 children with chronic adenotonsillitis, 43 children with nasal polyps and 65 children with OME. OME patients were assigned to two subgroups: those who have and those who did not have adenoid hyperplasia. Among the patients with bilateral nasal polyps, 20Â individuals had recurrent nasal polyps and 23 had de novo nasal polyps. Patients who have chronic adenotonsillitis were divided into three groups: those with chronic tonsillitis and those who underwent tonsillitis, those with chronic adenoiditis and adenoidectomy was performed, and those with chronic adenotonsillitis and underwent adenotonsillectomy. In addition to examination of H. pylori antigen in stool samples of all included patients, real-time polymerase chain reaction (RT-PCR) for detection of H. pylori in the effusion fluid was performed, additionally, Giemsa stain was used for detection of H. pylori organism within the tissue samples when available.Results: Frequency of H. pylori in effusion fluid was 28.6% in patients with OME and adenoid hyperplasia, while in those with OME it was only 17.4% with a p value of 0.2. Nasal polyp biopsies were positive in 13% patients of denovo, and 30% patients with recurrent nasal polyps, p=0.2. De novo nasal polyps were more prevalent in the positive stools than recurrent ones, p=0.7. All adenoid samples were negative for H. pylori, only two samples of tonsillar tissue (8.3%) were positive for H. pylori, and stool analysis was positive in 23 patients with chronic adenotonsillitis.Conclusion: Lack of association between Helicobacter pylori and occurrence of OME, nasal polyposis or recurrent adenotonsillitis.Keywords: Helicobacter pylori, otitis media with effusion, nasal polyps, adenotonsillitis

Mohammed H Hassan,1 Sawsan Abuhamdah,2,3 Bakheet EM Elsadek,4 Ashraf Abdelwahab,5 Tarek Hamdy Abd-Elhamid,6 Hanan M Fayed,7 Amany Abbass,8 Ahmed Alamir Mahmoud Abdallah,9 Marwa Mohamed,5 Wafaa Mohamed Abd-Elmagid5 1Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 2College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates; 3Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan; 4Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt; 5Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt; 6Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt; 7Department of Chemical and Clinical Pathology, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 8Department of Chemical and Clinical Pathology, Faculty of Medicine, Sohag University, Sohag, Egypt; 9Medical Biochemistry Department, Faculty of Medicine, Sohag University, Sohag, EgyptCorrespondence: Mohammed H Hassan, Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt, Tel +20 109 8473605, Email Mohammedhosnyhassaan@yahoo.com; mohammedhosnyhassaan@med.svu.edu.egIntroduction: Verruca vulgaris is a benign hyperkeratotic proliferation of the epidermis. Few studies look at the differences in serum and tissue macrophage migration inhibitory factor (MIF) levels in verruca vulgaris, as well as its gene polymorphisms that have yet to be explored. The current study provided in-depth evaluation of MIF in serum and tissues of patients with verruca vulgaris, and establishes for the first time the possible association of MIF gene polymorphisms with common warts.Methods: This case-control study included 50 patients who were diagnosed clinically as common warts in comparison with 50 age and sex-matched controls. Clinical examination was done on all included cases. Serum MIF was measured using enzyme-linked immunosorbent assay (ELISA), while its tissue expression was analyzed using Western blotting and immunohistochemical techniques for the included participants. Analysis of MIF-173 G˃C single nucleotide polymorphism was performed by polymerase chain reaction (PCR) using restriction fragment length polymorphism (RFLP) technique.Results: The overall results revealed significantly lower MIF tissue expression in lesional and perilesional skin biopsies from cases compared to the controls using Western blot and immunohistochemical analysis. Yet, the difference in the serum MIF levels between cases and controls was not significant (p ˃ 0.05). GC genotype of the studied MIF rs755622 G>C SNP could be considered as a protective genetic factor against the occurrence of verruca vulgaris among Egyptians with OR (95% CI) equal 0.444 (0.199– 0.989).Conclusion: MIF and its genetic variants are thought to play a pathogenic role in verruca vulgaris development and recurrence.Keywords: macrophage migration inhibitory factor, MIF rs755622 G>C SNP, common warts, RFLP-PCR, western blot, immunohistochemistry

COVID-19 is an emerging disease all over the world and spreading at an unpredicted rate, resulting in significant influences on global economies and public health. Clinical, laboratory, and imaging characteristics have been partially described in some observational studies. Not enough systematic reviews on predictors of critical illness and mortality in COVID 19 have been published to date. In this review, we had illustrated the prognostic predictors of COVID-19 by gathering published information on the risk factors related to the outcomes of SARS-CoV-2 infections.

Ali A Ghweil,1 Heba A Osman,1 Mohammed H Hassan,2 Abeer MM Sabry,3 Reem E Mahdy,4 Ahmed RH Ahmed,5 Ahmed Okasha,6 Ashraf Khodeary,7 Hesham H Ameen8 1Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt; 3Internal Medicine and Gastroenterology Department, Faculty of Medicine, Helwan University, Helwan, Egypt; 4Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt; 5Pathology Department, Faculty of Medicine, Sohag University, Sohag, Egypt; 6Radiology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 7Clinical Pathology Department, Faculty of Medicine, Sohag University, Sohag, Egypt; 8Clinical Pathology Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, EgyptCorrespondence: Mohammed H HassanDepartment of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena 83523, EgyptTel +20 109 847 3605Email mohammedhosnyhassaan@med.svu.edu.egBackground and aim: Gastric carcinomais a frequent neoplasm with poor outcome, and its early detection would improve prognosis. This study was designed to evaluate the possible use of new biomarkers, namely SAA and HMGB1, for early diagnosis of gastric cancer.Methods: A total of 100 patients presenting with gastric symptoms were included. All patients underwent upper endoscopic evaluation, histopathological diagnosis and serum CEA, SAA, and HMGB1 measurements.Results: Patients were classed endoscopically with neoplastic, inflammatory, and normal-appearing gastric mucosa: 50, 25, and 25 patients, respectively. Histologically, half the patients had chronic gastritis and the remaining cases gastric carcinoma of diffuse (n=28) or intestinal (n=22) type. SAA at cutoff of 18.5 mg/L had the best validity to differentiate gastritis from gastric carcinoma, with AUC, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 0.99, 98%, 100%, 100%, and 98%, respectively, followed by HMGB1 at cutoff of 14.5 pg/μL, with AUC, sensitivity, specificity, PPV, and NPV of 0.91, 70%, 96%, 94.6%, and 76.2%, respectively. Sensitivity, specificity, PPV, and NPV of serum CEA at cutoff of 2.9 ng/mL to differentiate gastritis from gastric carcinoma were 42%, 72%, 60%, and 55.4%, respectively, with AUC of 0.53. Nonetheless, higher serum levels of both SAA and HMGB1 reflected higher tumor grade (P=0.027 and P=0.016, respectively) and advanced tumor stage (P-OBrk-0.001 for both).Conclusion: Serum levels of both SAA and HMGB1 could be of great value for early diagnosis of gastric carcinoma, comparable to the diagnostic role of serum CEA, which is not valid for early diagnosis of gastric cancer.Keywords: gastric carcinoma, early detection, SAA, HMGB1, CEA

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Asmaa M El-Kady,1 Mostafa I EL-Amir,2 Mohammed H Hassan,3 Khaled S Allemailem,4 Ahmad Almatroudi,4 Alzahraa Abdelraouf Ahmad5 1Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, Egypt; 2Department of Medical Microbiology and Immunology, Faculty of Medicine, South Valley University, Qena, Egypt; 3Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt; 4Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudia Arabia; 5Department of Medical Parasitology, Faculty of Medicine, Assiut University, Assiut, EgyptCorrespondence: Asmaa M El-KadyDepartment of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, EgyptTel +201114229741Email Asmaa.elkady@med.svu.edu.egIntroduction: Schistosomiasis is an important neglected tropical disease (NTD) in several developing countries. Praziquantel is the principle and efficacious chemotherapeutic agent that has been used to treat schistosomiasis for decades. Unfortunately, emerging resistance to praziquantel with accompanying reduced efficacy is reported in some localities. Hence, genetic diversity among parasite populations is of significant interest in assessing the effects of selective pressure generated by praziquantel therapy that might result in encouraging the emergence of new genotypes that are either non-susceptible or drug-resistant. The present study aimed to investigate the genetic diversity of Schistosoma haematobium among human populations using the RAPD technique to help clarify disease epidemiology and transmission.Materials and Methods: S. haematobium eggs were isolated from 50 of 134 patients from four different localities in Qena Governorate, Upper Egypt. These patients complained of terminal hematuria and burning micturition. Samples were used for molecular analysis using RAPD-PCR primers (A02, A07, A09, A10).Results: Twenty S. haematobium isolates (40%) were amplified using the selected RAPD primers. Amplification patterns of these isolates showed distinct variation in the size and number of amplified fragments, indicating high genetic variation among these isolates.Conclusion: To the best of our knowledge, this study is the first to characterize the genetic diversity of S. haematobium in human populations in Upper Egypt. Future studies on a larger geographic scale involving many districts in Upper Egypt should be encouraged. Information from such a study would provide better insight into clonal lineages of S. haematobium in this endemic area. In turn, understanding transmission of the parasite may have a major role in establishing control strategies for urogenital schistosomiasis in Upper Egypt.Keywords: Schistosomiasis haematobium, RAPD, Upper Egypt, genetic diversity

Ali A Ghweil,1 Mohammed H Hassan,2 Ashraf Khodeary,3 Ahmed Okasha Mohamed,4 Haggagy Mansour Mohammed,5 Ahmed Alyan Abdelazez,1 Heba Ahmed Osman,1 Shamardan Ezzeldin S Bazeed1 1Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena 83523, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena 83523, Egypt; 3Clinical Pathology Department, Faculty of Medicine, Sohag University, Sohag 82519, Egypt; 4Department of Radiology, Faculty of Medicine, South Valley University, Qena 83523, Egypt; 5Department of Chest Diseases, Faculty of Medicine, South Valley University, Qena 83523, EgyptCorrespondence: Mohammed H HassanMedical Biochemistry Department, Faculty of Medicine, South Valley University, Qena, EgyptTel +201098473605Email Mohammedhosnyhassaan@yahoo.comBackground: The risk factors, disease characteristics, severity, and mortality of COVID-19 are unclear, particularly in Egypt.Objective: The objective was to analyze the patients’ characteristics, hematological, biochemical, and chest imaging findings among the cohort of patients with COVID-19 in Egypt and also to shed light on the predictors of COVID-19 severity.Patients and Methods: A retrospective study was conducted on 66 patients with COVID-19 in Egypt. Medical history, imaging data (CT chest findings), and measured hematological and biochemical parameters at diagnosis were recorded in the form of complete blood counts and differential counts; CRP, ESR, serum ferritin, creatinine, and liver function tests . Results of real-time reverse transcription-polymerase chain reaction (rRT-PCR) for detection of SARS-CoV-2 RNA at diagnosis and during follow up of these patients were also recorded.Results: The study included 36 patients with mild to moderate COVID-19 and 30 patients with severe/critical infection. There was a significant older age among severe (62.6 years old ± 10.1SD) than mild to moderate infection (55.5 ± 10.1) (p˂0.05). Fever, dry cough, dyspnea, and sore throat malaise were highly frequent among COVID-19 patients, while headache and diarrhea were the least frequently occurring manifestations. All included cases (30 patients, 100%) with severe COVID-19 showed crazy-paving appearance (in the form of reticular and/or interlobular septal thickening) with or without GGO. There were significantly lower mean values of WBCs, lymphocytic count, total protein, and albumin among the severely infected than those who had mild to moderate COVID-19 infection, p˂0.05 for all. Additionally, there were significantly higher mean values of CRP, ESR, ferritin, ALT, and AST among patients with severe/critical COVID-19 when compared with those having mild to moderate COVID-19, p˂0.05 for all.Conclusion: Among the studied demographic, clinical, hematological, biochemical, and imaging data, dyspnea, diabetes mellitus, lymphopenia, raised CRP, ESR, ferritin, ALT, AST, low albumin, and presence of CT chest findings could be considered as predictors for COVID-19 severity using binary logistic regression analysis.Keywords: COVID-19, Egypt, clinical data, hematological parameters, SARS-CoV-2 RNA, biochemical markers, severity

Mohamed H Aly,1 Sayed S Rahman,2 Waleed A Ahmed,3 Mansour H Alghamedi,4 Abudlrahman A Al Shehri,5 Amna M Alkalkami,2 Mohammed H Hassan6 1Internal Medicine Department, Security Forces Hospital Makkah (SFHM), Makkah al-Mukarrammah, Saudi Arabia; 2Nephrology Department, Internal Medicine Department, Security Forces Hospital Makkah (SFHM), Makkah al-Mukarrammah, Saudi Arabia; 3Infectious Disease Unit, Internal Medicine Department, Security Forces Hospital Makkah (SFHM), Makkah al-Mukarrammah, Saudi Arabia; 4Gastroenterology and Hepatology Department, Internal Medicine Department, Security Forces Hospital Makkah (SFHM), Makkah al-Mukarrammah, Saudi Arabia; 5Rheumatology Department, Internal Medicine Department, Security Forces Hospital Makkah (SFHM), Makkah al-Mukarrammah, Saudi Arabia; 6Medical Biochemistry Department, Faculty of Medicine, South Valley University, Qena, EgyptCorrespondence: Mohammed H HassanMedical Biochemistry Department, Faculty of Medicine, South Valley University, Qena, EgyptTel +201098473605Email mohammedhosnyhassaan@yahoo.comAbstract: COVID-19 is an emerging disease all over the world and spreading at an unpredicted rate, resulting in significant influences on global economies and public health. Clinical, laboratory, and imaging characteristics have been partially described in some observational studies. Not enough systematic reviews on predictors of critical illness and mortality in COVID 19 have been published to date. In this review, we had illustrated the prognostic predictors of COVID-19 by gathering published information on the risk factors related to the outcomes of SARS-CoV-2 infections.Keywords: COVID 2019, SARS-CoV-2, predictors, critical illness, mortality

Background The risk factors, disease characteristics, severity, and mortality of COVID-19 are unclear, particularly in Egypt. Objective The objective was to analyze the patients’ characteristics, hematological, biochemical, and chest imaging findings among the cohort of patients with COVID-19 in Egypt and also to shed light on the predictors of COVID-19 severity. Patients and Methods A retrospective study was conducted on 66 patients with COVID-19 in Egypt. Medical history, imaging data (CT chest findings), and measured hematological and biochemical parameters at diagnosis were recorded in the form of complete blood counts and differential counts; CRP, ESR, serum ferritin, creatinine, and liver function tests . Results of real-time reverse transcription-polymerase chain reaction (rRT-PCR) for detection of SARS-CoV-2 RNA at diagnosis and during follow up of these patients were also recorded. Results The study included 36 patients with mild to moderate COVID-19 and 30 patients with severe/critical infection. There was a significant older age among severe (62.6 years old ±10.1SD) than mild to moderate infection (55.5 ± 10.1) (p˂0.05). Fever, dry cough, dyspnea, and sore throat malaise were highly frequent among COVID-19 patients, while headache and diarrhea were the least frequently occurring manifestations. All included cases (30 patients, 100%) with severe COVID-19 showed crazy-paving appearance (in the form of reticular and/or interlobular septal thickening) with or without GGO. There were significantly lower mean values of WBCs, lymphocytic count, total protein, and albumin among the severely infected than those who had mild to moderate COVID-19 infection, p˂0.05 for all. Additionally, there were significantly higher mean values of CRP, ESR, ferritin, ALT, and AST among patients with severe/critical COVID-19 when compared with those having mild to moderate COVID-19, p˂0.05 for all. Conclusion Among the studied demographic, clinical, hematological, biochemical, and imaging data, dyspnea, diabetes mellitus, lymphopenia, raised CRP, ESR, ferritin, ALT, AST, low albumin, and presence of CT chest findings could be considered as predictors for COVID-19 severity using binary logistic regression analysis.

Hassan AM, Osman HA, Mahmoud HS, et al. Infect DrugResist. 2018;11:895–901.On page 896, “Investigatory workup” section, first bulletpoint, second sentence should read from “Four millilitersof blood was taken in a plain glass tube, and after clotting,the tube was centrifuged at 3,000 rpm for 5 min. Then, theserum was separated for use in estimating liver function(including liver enzymes, albumin, bilirubin-total anddirect, prothrombin time, prothrombin concentration, andINR), serum creatinine, protein:creatinine ratio, andRF . . . ” to “Two milliliters of blood was taken in citratedtubes and after centrifugation, the separated citratedplasma has been used for estimation of prothrombintime, prothrombin concentration, and INR, while theremaining two milliliters of blood was taken in a plainglass tube, and after clotting, the tube was centrifuged at3,000 rpm for 5 min. Then, the serum was separated foruse in estimating liver function (including liver enzymes,albumin, bilirubin-total and direct), serum creatinine, RFand in addition to urinary protein:creatinine ratio, all weremeasured . . . ”Following a review of our paper post-publication, wefound the incorrect information for these sentences.This correction of sentences has no impact to the findingsof the study. The authors apologize for this error.Read the original article

Understanding the contributory role of increased fibroblast growth factor23 (FGF23) and secondary hyperparathyroidism to changes in minerals and bone metabolism among chronic kidney disease (CKD) patients is a challenge. So the present study aimed to evaluate the role of FGF23 in CKD of various grades and potential utility for early diagnosis of disturbed bone and mineral metabolism among such patients. This hospital based-cross sectional study has been conducted on 100 CKD patients of various grades. Colorimetric assays of serum urea, creatinine, phosphorous and calcium, while, ELISA assays of parathormone hormone (PTH) and FGF23, were done to all included patients. The overall results showed frequent abnormally high serum FGF23 among CKD grade 3 and 4 compared to other grades. Also there was significant positive correlation between the serum FGF234 levels and the CKD grade (r=0.21, p = 0.03). Significant positive correlations between serum levels of FGF23 vs. both urea and PTH (r=0.19, p=0.04 and r= 0.31, p=0.002 respectively) with significant negative correlations between serum FGF23 levels vs. both total calcium and eGFR (r=-0.21, p=0.02 and r=- 0.39, p=0.0001 respectively). There were non-significant correlations between serum FGF23 and age, weight, height, BMI and phosphorous (p˃0.05). FGF23 is better negative than positive predictive biomarker for calcium and phosphorous disturbances in CKD patients at cut off point 2.9 and 3.1 pg/ml respectively. In conclusion, FGF23 is an emerging biomarker in CKD and its follow up measurement could be helpful for early diagnosis of CKD-MBD.