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Background: Cardiovascular complications are very com-mon in diabetic patients. Type 2 diabetic patients have elevated whole blood viscosity which is associated with these vascular complications. Aim of Study: To determine the effect of aerobic exercises on blood viscosity in type 2 diabetic patients. Methods: Thirty type 2 diabetic men included in the study from Kasr Al-Ainy Hospital and from outpatient clinics at Faculty of Physical Therapy Cairo University. Their mean ± SD age, weight, height, BMI and HbA1c were 47.83±3.5 years, 91.8±5.82kg, 175.2±6.4cm, 29.69±2.1 (kg/m2) and 7.15±0.63% respectively. Whole blood viscosity was evaluated before and after the training program. All patients performed moderate aerobic exercise (65%-75%) in the form of treadmill exercise program 3 sessions per week for 8 weeks, the duration of the session was about 45 minutes and consist of warming up phase of slow walking on treadmill for 5 minutes (10%:20%), training phase 35 minutes and cooling down for 5 minutes (10%:20%). Results: There was a significant decrease in the total blood viscosity post-treatment and the percent of change was 4.56%. Conclusion: Aerobic exercise is a good way to reduce blood viscosity in patients with type 2 diabetes mellitus and this can help control vascular complications.

Tuberculosis remains a global public health problem over the past decades. Mycobacterium tuberculosis affect the lungs causing pulmonary tuberculosis and may affect other organs causing extrapulmonary tuberculosis. Organs most commonly affected are the central nervous system, gastrointestinal tract, spleen, liver, musculoskeletal and genitourinary systems. Various findings of pulmonary and extrapulmonary tuberculosis are established by different imaging modalities. The aim of our research is to study the distribution and imaging findings of pulmonary and extrapulmonary tuberculosis among Saudi and non-Saudi patients in King Abdulaziz university hospital. Retrospective study included 446 patients, 248 males and 198 females presented with both pulmonary and extrapulmonary TB ranging in age from 9 months to 102 years. Data were collected and statistically analyzed using SPSS program. The incidences of pulmonary and extrapulmonary TB are 74% and 19.7% respectively while 6.3% have both patterns. Pneumonic consolidation is the most dominant findings with pulmonary tuberculosis (43%). Brain is the most frequently affected organ with extrapulmonary tuberculosis (35.6%). Both pulmonary and extrapulmonary tuberculosis are more dominant in non- Saudi patients compared to Saudis. Radiological investigations play a crucial role in evaluation of various types of tuberculosis including computed tomography, plain X ray, Ultrasonography and magnetic resonance imaging.

Diabetic nephropathy (DN) is a major leading cause of kidney failure. So, early detection of DN by assessing urinary microRNAs (miRNAs) expression may be of clinical value. In this study, the diagnostic value of two urinary miRNAs (miR-210 & miR-34a) as biomarkers for diagnosis of DN was assessed using a simple colorimetric gold nanoparticle (AuNP) assay and real-time PCR. MiR-(210 & 34a) were markedly up-regulated in DN groups (micro-albuminuric and macro-albuminuric groups) compared to the non-albuminuric group and healthy controls. The sensitivity and specificity for the qualitative detection of urinary miR-(210 & 34a) using the AuNP assay were (78% and 72%) & (81% and 69%), respectively, which were consistent with the results of real-time PCR. There was a highly significant correlation between urinary miR-(210 & 34a) detected by either qRT-PCR or qualitative AuNP assay. Accordingly, this simple AuNP assay may be considered a valid test for the detection of these two urinary miRNAs as potential biomarkers that can aid in the noninvasive diagnosis of DN.

There is strong association between liver diseases and diabetes (DM) which is higher than expected by a chance association of two very common disorders. It can be classified into three categories: Liver disease related to diabetes, hepatogenous diabetes (HD), and liver disease occurring coincidentally with DM. The criteria for the diagnosis of diabetes associating liver disease are the same for primary diabetes. Two hours post glucose load is a better screening test for HD. HbA1c may not be suitable for diagnosis or monitoring of diabetes associating advanced liver disease. Apart from the increased cardiovascular risk in patients with type 2 DM (T2 DM) and NAFLD, the cardiovascular and retinopathy risk is low in HD. Patients with metabolic derangement should be screened for NAFLD which in turn may predict T2 DM development. Similarly, patients with established T2 DM should also be screened for NAFLD which further contributes to diabetes worsening. Diabetes is a significant risk factor for progression of the chronic liver disease. It is associated with poor patient survival. Treatment of diabetes associating liver disease appears beneficial. Metformin, if tolerated and not contraindicated, is recommended as a first-line therapy for patients with diabetes and chronic liver disease (CLD). If the hepatic disease is severe, insulin secretagogues should be avoided because of the increased risk of hypoglycaemia. Pioglitazone may be useful in patients with fatty liver disease. DPP-4 inhibitors showed effectiveness and safety for the treatment of T2 DM in CLD patients up to those with child B stage. GLP-1 receptor agonists and SGLT-2 inhibitors exhibit positive effects on weight and are associated with minimal risk of hypoglycaemia. Insulin must be used with caution, as hypoglycaemia may be a problem. Insulin analogues are preferred in the context of hypoglycaemia Statins can be used to treat dyslipidaemia in NAFLD, also the use of angiotensin II receptor antagonist for hypertension is safe and beneficial Given the clear association between diabetes mellitus and hepatocellular carcinoma, the strict control of glycaemia with insulin sensitizers can be essential in its prevention. The addition of DM to the currently used scores (Child-Pugh and MELD scores) may enhance the sensitivity and the specificity for prediction of morbidity and mortality rates in cirrhotic patients. In the new era of directly acting antiviral agents (DAAs) for HCV treatment, it is recommended to follow up lipid profile and blood sugar levels following SVR in order to adjust doses of medications used in diabetic (SVR is associated with reduction in insulin requirements) and dyslipidaemic patients (rebound increase in the lipid profile after clearing the virus may increase risk of cardiovascular disease (CVD)). The issues of post liver transplant diabetes and relation between DM and chronic HBV are highlighted. This narrative review and Consensus-based practice guidance (under revision and criticism) are based on a formal review and analysis of the recently published world literature on the topic (Medline search up to September 2017); and the experience of the authors and independent reviewers.

Podocyte injury and subsequent excretion in urine play a crucial role in the pathogenesis and progression of diabetic nephropathy (DN). Quantification of messenger RNA expression in urinary sediment by real-time PCR is emerging as a noninvasive method of screening DN-associated biomarkers. We aimed to study the expression of podocyte-associated genes in urinary sediment and their relation to disease severity in type 2 diabetic Egyptian patients with diabetic nephropathy.ology: Sixty patients with type 2 diabetes mellitus were recruited in addition to twenty non diabetic healthy volunteers. Relative mRNA abundance of nephrin, podocalyxin, and podocin were quantified, and correlations between target mRNAs and clinical parameters were examined.The urinary mRNA levels of all genes studied were significantly higher in diabetics compared with controls (p 0.001), and mRNA levels increased with DN progression. Urinary mRNA levels of all target genes positively correlated with both UAE and HbAThe urinary mRNA profiles of nephrin, podocalyxin, and podocin were found to increase with the progression of DN, which suggested that quantification of podocyte-associated molecules will be useful biomarkers of DN.

Introduction Cardiovascular diseases account for about 65% of diabetes-related mortality. Objective Noninvasive assessment of left ventricular functions in asymptomatic nonhypertensive nonischemic type 2 diabetics using echo heart and tissue Doppler imaging (TDI) for detecting structural and functional cardiac abnormalities, and correlating them with levels of Brain natriuretic peptide (BNP) for early planning of management before passing into overt heart failure (HF) were the objectives of this study. Patients and methods We studied 55 patients with type 2 diabetes and classified them into two groups: 26 patients with less than 10 years diabetes duration and 29 patients with more than 10 years duration. Full history, fasting blood glucose, postprandial blood glucose, glycated hemoglobin, creatinine, lipid profile, BNP, ECG, conventional echo, and TDI were performed for all patients. Results In all, 45 (80%) patients out of 55 patients have diastolic dysfunction, classified as 15 (27%) with type 1 diastolic dysfunction, 26 (47%) with type 2 pseudonormal diastolic dysfunction, and four (7%) patients with type 3 diastolic dysfunction. Systolic dysfunction (ejection fraction

Purpose. The current study aimed at assessing vitamin D level and vitamin D receptor polymorphism in hypothyroid Egyptian patients and its effect on hypothyroidism and thyroid morphology, also to find a causal relation between vitamin D and hypothyroidism. Methods. This case-control study was conducted on 35 hypothyroid patients and 35 matched unrelated healthy controls. Total serum 25-hydroxyvitamin D3 and thyroid antibodies were measured using a human ELISA kit. Genotyping was performed by using real-time PCR. HOMA-IR was also calculated (fasting insulin in mIU/L × fasting glucose in mg/dL/405). All subjects were assessed for thyroid morphology by thyroid ultrasonography. Results. Vitamin D level was lower in hypothyroid patients than in control subjects. Vitamin D was also inversely related to TSH, HOMA-IR, and levels of anti-TG and anti-TPO. VDR polymorphism (Fok1 and Apa1) had no relation to TSH or vitamin D levels in both patients and control groups. Low vitamin D levels were associated with increased thyroid vascularity and nodularity; furthermore, vitamin D was inversely proportional to thyroid gland volume. Correlation of HOMA-IR with the levels of both anti-TG and anti-TPO in the 70 subjects proved that HOMA-IR was positively correlated to both antibodies. Conclusion. This study confirmed the association of vitamin D deficiency with hypothyroidism, thyroid autoimmunity, increased volume, nodularity, and vascularity of thyroid gland in hypothyroid patients as well as increased HOMA-IR. It proved the association between HOMA-IR and thyroid autoimmunity. The study proved no association between VDR polymorphisms (Fok1 and Apa1) with either vitamin D levels or TSH levels.

Background and Objective. Type 2 DM and obesity are the coming epidemics and their association with NAFLD is well established; essential fatty acids are vital for body health yet the body cannot make them; 2 essential fatty acids are especially important: linoleic (omega-6) and alpha-linoleic (omega-3) acids; they can be considered as “bioactive lipids” and serve as functional foods.Methods. 50 type 2 Egyptian diabetic patients controlled on oral hypoglycemic drugs together with 20 age- and sex-matched healthy participants were enrolled in the study; all were subjected to complete history taking, BMI, fasting plasma glucose, HOMA-IR, ALT, AST, GGT, urea and creatinine, total lipid profile, hepatitis markers including hepatitis B surface antigen and hepatitis C virus antibodies, conjugated linoleic fatty acid “CLA,” and abdominal ultrasound for grading of NAFLD.Results. Our study in Egyptian diabetics with NAFLD revealed a low level of serum CLA compared to healthy control; such deficiency was more marked with advanced grades of NAFLD; lowest levels were observed in those with severe steatosis (NASH) with definite association between CLA and obesity.Conclusion. Insulin resistance is the main link between NAFLD, diabetes, and obesity. Conjugated linoleic acid (CLA) has a role in fat deposition in the liver and in development and improvement of insulin resistance. Fatty food had a documented role in the pathogenesis of obesity and diabetes but it can also be the cure.

In recent years, widespread use of mobile phones has led to a public debate about possible harmful effects on human health. A lot of researchers studied the possible effect of radiofrequency energy (RFE) emitted from cell phones on the human body. Up to our knowledge no one studied the effect of these waves on the thyroid gland by Ultrasonography (US). Our aim was to investigate the possible effects of EMR arising from cell phones on the thyroid gland using US. A prospective study was done on 180 participants, 110 females and 70 males, ranging in age from 15 to 65. A constructed questionnaire was distributed among them before performing US of the neck. Demographic data along with US findings were collected and statistically analyzed. A total of 46.7% of our participants had abnormal findings of the thyroid gland more in non smart phone users and more in females. The commonest abnormality was multinodular goiter (54%). Expanded researches are still needed to answer the question about the hazards of RFE on human health. All efforts should be made to encourage users of cellular phone to follow mobile device recommendations of manufacturers and avoid its possible hazards as possible.

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

Diabetes Mellitus is a serious global health concern affecting about 415 million or 8.8% of adults worldwide. Among other complications of the disease, diabetic foot ulceration (DFU) is one of the most serious, possibly leading to amputation. This study presents the design, implementation and testing of a method for predicting DFU based on dynamic pressure distribution. We recorded the dynamic plantar pressure measurements during normal gait for 56 diabetic patients with and without diabetic peripheral neuropathy and 28 control non-diabetic subjects. Defining newly extracted features, employing machine learning techniques and applying Support Vector Machine classifier, achieved a classification accuracy and precision of more than 94.6% and 95.2% respectively. These promising results show the potential of the proposed method for predicting DFU allowing for early treatment and the possibility of providing diabetic patients with proper off-loading footwear to redistribute plantar pressure.

Objective: The aim of this work was to compare the usefulness and sensitivity of ultrasonography (US) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of different hepatobiliary disorders. Methods: The study included 65 patients with various hepatobiliary disorders such as cholelithiasis, post cholecystectomy complications, neoplastic, inflammatory and developmental conditions of the pancreatico-biliary system. All patients underwent an initial abdominal US followed by MRCP, allowing a direct comparison of the results obtained by these two modalities. Correlation was also made with available clinical records, other imaging modalities, intraoperative findings and histopathology results. Results: While both modalities proved equally sensitive in revealing developmental and inflammatory diseases of the pancreatico-biliary system (values between 90 % -100%), MRCP showed a higher sensitivity for detecting pancreatico-biliary tumors (100% vs . 14.2%; p < .05) and cholelithiasis (96.2% vs . 74.0%; p < .05). MRCP also demonstrated a slightly higher sensitivity in revealing post cholecystectomy complications (92.8% vs . 78.5%), even though the difference did not reach statistical significance ( p = .317). A variety of other findings and anatomical variants of the biliary and pancreatic ducts were revealed only by MRCP. Conclusions: MRCP showed an overall higher sensitivity for revealing hepatobiliary disorders compared to abdominal US. The modality is especially useful when the findings revealed by abdominal US are inconclusive or when clinical suspicion persists despite negative US results.

Diabetes Mellitus (DM) is a metabolic disorder characterized by increased glucose level in the blood, resulting from defect in the insulin secretion, insulin action, or both. In advanced stage of disease; peripheral circulation of lower extremities is impaired which increases the risk for developing peripheral arterial diseases (PAD). buerger Exercises is a simple intervention for improving the peripheral circulation of patients with diabetes mellitus. The aim of the current study was to assess the effect of Buerger Exercises on improving the peripheral circulation among patients with type 2 DM as assessed by Ankle brachial Index (AbI) scale. Quasi experimental design was used. A non-probability purposive sample consists of sixty male and female adult patients with type 2 DM were selected. The study findings revealed that the post intervention mean ABI scores of both legs (Rt leg =1.097, Lt leg =1.086) were significantly higher than pre-intervention scores (Rt leg =.885, Lt leg =.937) (p=0.001). The use of Buerger Exercises is effective in improving the perfusion of lower extremities. Therefore, it is recommended that buerger Exercises can be used to improve the peripheral circulation of lower extremities among patients with type 2 diabetes mellitus.

To clarify the role of ghrelin in malnutrition in uremia and its relationship to fat composition using dual x-ray absorptiometry (DXA).This is a cohort study including Group I: 60 patients with end stage renal disease 30 on hemodialysis [group IA] and 30 pre-dialysis [group IB] and Group II: 20 controls. This study was carried out in Cairo University Hospital, Kasr Al-Aini, Cairo, Egypt in 2007. Body fat composition (total, differential, and lean body mass) was assessed using DXA, and plasma ghrelin was measured.Ghrelin was significantly higher in hemodialysis and pre-dialysis groups compared to the control group, and higher in hemodialysis group compared to the pre-dialysis group. In hemodialysis, ghrelin was negatively correlated with weight, body mass index (BMI), and truncal fat mass, and positively correlated with serum creatinine. In pre-dialysis, ghrelin inversely correlated with weight, BMI, and truncal fat mass, and positively correlated with serum creatinine, lean body mass. In control, plasma ghrelin showed negative correlation with weight, BMI, truncal fat mass, and body fat mass, and positive correlation with lean body mass.Ghrelin was markedly elevated in renal failure due to its decrease in excretion. Negative correlation between ghrelin and fat composition was detected in dialysis patients. Serial evaluation of body fat composition using DXA is recommended for assessment of nutritional status of those patients.