Awad Magbri | University of Benghazi (original) (raw)

Papers by Awad Magbri

Archives of Cardiology and Cardiovascular Diseases, Dec 31, 2017

Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotranspo... more Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotransporter 2 inhibitor Metabolic acidosis High anion gap acidosis Case history The case is that of 58 year-male with type 2 diabetes mellitus for 7 years, hypertension, hypercholesterolemia, who was admitted to the hospital with left lower limb cellulitis over the past 8 days. On work-up he was found to have high aniongap metabolic acidosis (AGMA) with anion gap of 25, his lactate levels were normal (D and L-lactate). He denies overdosing with any medications and his toxicology screen for methanol, ethanol, aspirin, and ethylene glycol were negative. He has no psychiatric history of note. He denies using over the counter medications like acetaminophen. No bowel surgery could be elicited. He felt dehydrated and nauseous but otherwise fine. His medications includes; carvedalol 25mg twice daily, hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin 81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeks ago to control his blood sugar level and A1C. Physical examination of the patient revealed, slightly dehydrated but well-nourished man, his vital signs; heart rate of 78 BPM and regular, BP 143/85 mmHg, temperature 98.7 F, and his oxygen saturation while breathing room air was 92%. Examination of the heart, abdomen, and chest were unremarkable. He had left lower leg cellulitis but no edema or tenderness. His work-up including chemistry-7 which showed sodium of 142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L, bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78 mg/L respectively. His blood glucose level was 178 mg/L with A1C of 8.2. His serum osmolality was 312 mosm/L, and his arterial blood pH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of 32mmHg. His calculated anion gap was 25 given his normal albumin level. His investigation also showed positive ketones in the serum and urine. His urine PH was 5.5 and the urine contain >800 mg of glucose.

The Journal of medical research, Nov 23, 2016

Case-The case is that of 52 year Caucasian male with motor vehicle accident, status post open red... more Case-The case is that of 52 year Caucasian male with motor vehicle accident, status post open reduction and internal fixation of the left hip. He sustained wound infection with osteomyelitis due to multidrug resistant pseudomonas infection. Extensive debridement of the wound was carried out but the hardware was left in place. He underwent treatment with polymyxin antibiotic for a month then the course was complicated by renal failure which resolved with polymyxin dose adjustment. However, the hard ware was removed after 2 months of treatment. At that time wound culture revealed MRSA infection. He received 4 weeks of Vancomycin and 6 week course of polymyxin after the hardware was removal. He was readmitted to the hospital with increasing pain and persistent drainage from the wound. Imagings were consistent with erosion of the femoral head with joint space loss, and septic arthritis with evidence of osteomyelitis and the presence of sinus tract to the skin surface. Wash out of the wound with debridement was carried out and another course of Vancomycin was instituted.

The Journal of medical research, Nov 23, 2016

A case of 28 years female with no significant past medical history presented with malignant hyper... more A case of 28 years female with no significant past medical history presented with malignant hypertension. She was found to have Polyarteritis nodosa involving the kidney on angiography. She was treated successfully with steroids and cytotoxic drugs and made uneventful recovery. Her kidney function remained stable and her BP was controlled on Po medications. Even though she was negative for hepatitis B infection, the association was strongly confirmed in about 10% of patients. PAN should be suspected in any patients with multisystem involvement with hypertension and minimal findings in urinalysis. Polyneuropathy and high ESR are also red flags for PAN.

Journal of Cardiology & Cardiovascular Therapy, Aug 22, 2018

The patient is 72-year-old Caucasian male with history of type-2 diabetes mellitus, coronary arte... more The patient is 72-year-old Caucasian male with history of type-2 diabetes mellitus, coronary artery disease with drug eluting stent, and congestive heart failure with ejection fracture of 40% was admitted to hospital with shortness of breath at rest. The patient noticed swelling of the legs for 4 weeks despite salt restriction and diuretics. His medications include Humalog (75/25) 20 units QD, frusemide 40 mg BID, metolazone 2.5 mg QD, spironolactone 12.5 mg QD, carvedilol 12.5 mg BID, Ramipril 10 mg QD, atorvastatin 40 mg QD, clopidogrel 75 mg QD, and aspirin 81 mg QD. His blood pressure was 100/60 mmHg, pulse 102 beats/ min, The patient had marked jugular venous distention, crackles at the lung bases, an S3 gallop, positive hepato-jugular reflux, and pitting edema up to the knees. His laboratory investigation showed sodium of 134 mEq/L, potassium of 3.8 mEq/L, chloride 90 mEq/L, bicarbonate 28 mEq/L, blood urea nitrogen 46 mg/L, creatinine 1.8 mg/L, with an estimated GFR of <60 mL/minute, and glucose of 100 mg/L. His HgbA1C was 7%. His urinalysis was significant for 2+ proteinuria. EKG showed tachycardia with nonspecific St and T wave changes, His weight was 98 kg. The patient developed type-2 cardio-renal syndrome and his diuretics, nesiritide, and nitroglycerine were stopped, and he was started on renal replacement therapy in the form of Continuous Veno-Venous Hemodiafiltration (CVVHDF) to improve both fluid overload and worsening renal function. Case Discussion Clinically, heart failure is classified into two major types based on the functional status of the heart: heart failure with preserved

Acta Psychopathologica, 2017

Hepatitis C virus is a single stranded RNA virus. It is a major cause of acute and chronic hepati... more Hepatitis C virus is a single stranded RNA virus. It is a major cause of acute and chronic hepatitis. The mode of infection is usually through intravenous drug abuse or transfusion of infected blood or blood products. Health care workers are at risk for needle stick and other with high-risk sexual behavior is also considered a major risk factor for HCV infection. The incidence of new cases of acute HCV infection has sharply decreased in the United States during the past decade, but the prevalence remains high with approximately 2.7 million Americans infected with the virus. Chronic HCV infection progresses in roughly 75% of patients after acute infection by the virus. Chronic HCV infection is slowly progressive disease and results in severe morbidity in 20-30% of infected persons.

Acta Psychopathologica, 2017

Journal of clinical nephrology and renal care, Dec 31, 2016

The Journal of medical research, Nov 23, 2016

The Case-The case is that of 69 year old female who went on vacation and fell on her knees. She n... more The Case-The case is that of 69 year old female who went on vacation and fell on her knees. She noticed progressive swelling of both legs over 2 weeks duration. During this period she gained 44 pounds in weight. She presented with sudden onset of edema of the lower extremity and weigh gain. She had 16 g/day of proteinuria. Past medical history is significant of hypertension of unknown duration. She had never seen a doctor in the last year. Her laboratory data showed 30 grams protein in 24 hrs urine, and her serum creatinine was 1.7 mg/dl. The baseline serum creatinine was not known.

Journal of urology and nephrology open access, May 16, 2017

Hepatitis C infection is a major cause of acute and chronic hepatitis. Health care workers and hi... more Hepatitis C infection is a major cause of acute and chronic hepatitis. Health care workers and high risk behaviors are at increased risk of infection. The incidence of a new cases of hepatitis C has sharply decreased in the United States, but the prevalence remained high (2.7 M) American infected with the virus. Chronic infection is progressive disease and results in severe morbidity in 20-30% of infected persons. Cutaneous manifestations (extra-hepatic) of hepatitis C infection are found in 20-40%. Kidneys and skin are the main organs involved after the liver. This mini-review highlights the common skin manifestation of the virus.

The authors discuss a case of aortic dissection in a young man with hypertension. The delay in co... more The authors discuss a case of aortic dissection in a young man with hypertension. The delay in considering the diagnosis and ordering the proper investigations secondary to the unusual presentation of the case complicated by the logistics of patient's transfer to specialized Cardiothoracic unit where surgery can be performed safely have impacted the unfortunate outcome.

The Journal of medical research, Jul 4, 2016

Background and Objectives: H. pylori are an accepted cause of chronic active gastritis and common... more Background and Objectives: H. pylori are an accepted cause of chronic active gastritis and commonly associated with both gastric and duodenal ulcer. Moderate to severe gastritis increases the relative risk of developing peptic ulceration and eradication of the bacteria reduces duodenal ulcer recurrence. The effect of H pylori on the duodenal brush border membrane enzymes have not been studied extensively in this infection. This study evaluates the duodenal brush border enzymes between the H. pylori positive and negatives patients. Design, setting, participants & measurements: One hundred and nine patients, age range 20-84 years, mean age 56 years were included in the study. They presented to the endoscopy suite of UCHG with upper gastrointestinal symptoms. The duodenal bulb was entirely normal and with no evidence of inflammation on endoscopic examination. Biopsies from the antrum were processed for histology and bacteriological culture. Two biopsies from the duodenal bulb were taken from each patient and were sealed in Para-film and stored at-20C0 until assayed for brush border enzymes.

Open journal of nephrology, 2022

We reported here a case of anticoagulant-related nephropathy (ARN) in an elderly patient with bac... more We reported here a case of anticoagulant-related nephropathy (ARN) in an elderly patient with background history of chronic kidney disease (CKD-stage 4, with an estimated glomerular filtration rate (eGFR) of <24 ml/min). He presented with an acute kidney injury on background of chronic kidney disease (AKI/CKD) with eGFR of 9 ml/min and serum creatinine of 6.0 mg/dl.

Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotranspo... more Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotransporter 2 inhibitor Metabolic acidosis High anion gap acidosis Case history The case is that of 58 year-male with type 2 diabetes mellitus for 7 years, hypertension, hypercholesterolemia, who was admitted to the hospital with left lower limb cellulitis over the past 8 days. On work-up he was found to have high aniongap metabolic acidosis (AGMA) with anion gap of 25, his lactate levels were normal (D and L-lactate). He denies overdosing with any medications and his toxicology screen for methanol, ethanol, aspirin, and ethylene glycol were negative. He has no psychiatric history of note. He denies using over the counter medications like acetaminophen. No bowel surgery could be elicited. He felt dehydrated and nauseous but otherwise fine. His medications includes; carvedalol 25mg twice daily, hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin 81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeks ago to control his blood sugar level and A1C. Physical examination of the patient revealed, slightly dehydrated but well-nourished man, his vital signs; heart rate of 78 BPM and regular, BP 143/85 mmHg, temperature 98.7 F, and his oxygen saturation while breathing room air was 92%. Examination of the heart, abdomen, and chest were unremarkable. He had left lower leg cellulitis but no edema or tenderness. His work-up including chemistry-7 which showed sodium of 142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L, bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78 mg/L respectively. His blood glucose level was 178 mg/L with A1C of 8.2. His serum osmolality was 312 mosm/L, and his arterial blood pH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of 32mmHg. His calculated anion gap was 25 given his normal albumin level. His investigation also showed positive ketones in the serum and urine. His urine PH was 5.5 and the urine contain >800 mg of glucose.

Annals of nephrology, Mar 11, 2019

The authors presented a case of serotonin syndrome cause by drug interaction. The patient is pres... more The authors presented a case of serotonin syndrome cause by drug interaction. The patient is presented with classical features of the syndrome with hyper-excitability, tremor, change in mental status, and low grade fever. The patient made uneventful recovery after the stoppage of the offending drugs. This case calls for the clinicians to be vigilant of the drug interaction that can cause unintended side effects to the patient under their care.

Archives of Cardiology and Cardiovascular Diseases, Dec 31, 2017

Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotranspo... more Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotransporter 2 inhibitor Metabolic acidosis High anion gap acidosis Case history The case is that of 58 year-male with type 2 diabetes mellitus for 7 years, hypertension, hypercholesterolemia, who was admitted to the hospital with left lower limb cellulitis over the past 8 days. On work-up he was found to have high aniongap metabolic acidosis (AGMA) with anion gap of 25, his lactate levels were normal (D and L-lactate). He denies overdosing with any medications and his toxicology screen for methanol, ethanol, aspirin, and ethylene glycol were negative. He has no psychiatric history of note. He denies using over the counter medications like acetaminophen. No bowel surgery could be elicited. He felt dehydrated and nauseous but otherwise fine. His medications includes; carvedalol 25mg twice daily, hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin 81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeks ago to control his blood sugar level and A1C. Physical examination of the patient revealed, slightly dehydrated but well-nourished man, his vital signs; heart rate of 78 BPM and regular, BP 143/85 mmHg, temperature 98.7 F, and his oxygen saturation while breathing room air was 92%. Examination of the heart, abdomen, and chest were unremarkable. He had left lower leg cellulitis but no edema or tenderness. His work-up including chemistry-7 which showed sodium of 142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L, bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78 mg/L respectively. His blood glucose level was 178 mg/L with A1C of 8.2. His serum osmolality was 312 mosm/L, and his arterial blood pH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of 32mmHg. His calculated anion gap was 25 given his normal albumin level. His investigation also showed positive ketones in the serum and urine. His urine PH was 5.5 and the urine contain >800 mg of glucose.

The Journal of medical research, Nov 23, 2016

Case-The case is that of 52 year Caucasian male with motor vehicle accident, status post open red... more Case-The case is that of 52 year Caucasian male with motor vehicle accident, status post open reduction and internal fixation of the left hip. He sustained wound infection with osteomyelitis due to multidrug resistant pseudomonas infection. Extensive debridement of the wound was carried out but the hardware was left in place. He underwent treatment with polymyxin antibiotic for a month then the course was complicated by renal failure which resolved with polymyxin dose adjustment. However, the hard ware was removed after 2 months of treatment. At that time wound culture revealed MRSA infection. He received 4 weeks of Vancomycin and 6 week course of polymyxin after the hardware was removal. He was readmitted to the hospital with increasing pain and persistent drainage from the wound. Imagings were consistent with erosion of the femoral head with joint space loss, and septic arthritis with evidence of osteomyelitis and the presence of sinus tract to the skin surface. Wash out of the wound with debridement was carried out and another course of Vancomycin was instituted.

The Journal of medical research, Nov 23, 2016

A case of 28 years female with no significant past medical history presented with malignant hyper... more A case of 28 years female with no significant past medical history presented with malignant hypertension. She was found to have Polyarteritis nodosa involving the kidney on angiography. She was treated successfully with steroids and cytotoxic drugs and made uneventful recovery. Her kidney function remained stable and her BP was controlled on Po medications. Even though she was negative for hepatitis B infection, the association was strongly confirmed in about 10% of patients. PAN should be suspected in any patients with multisystem involvement with hypertension and minimal findings in urinalysis. Polyneuropathy and high ESR are also red flags for PAN.

Journal of Cardiology & Cardiovascular Therapy, Aug 22, 2018

The patient is 72-year-old Caucasian male with history of type-2 diabetes mellitus, coronary arte... more The patient is 72-year-old Caucasian male with history of type-2 diabetes mellitus, coronary artery disease with drug eluting stent, and congestive heart failure with ejection fracture of 40% was admitted to hospital with shortness of breath at rest. The patient noticed swelling of the legs for 4 weeks despite salt restriction and diuretics. His medications include Humalog (75/25) 20 units QD, frusemide 40 mg BID, metolazone 2.5 mg QD, spironolactone 12.5 mg QD, carvedilol 12.5 mg BID, Ramipril 10 mg QD, atorvastatin 40 mg QD, clopidogrel 75 mg QD, and aspirin 81 mg QD. His blood pressure was 100/60 mmHg, pulse 102 beats/ min, The patient had marked jugular venous distention, crackles at the lung bases, an S3 gallop, positive hepato-jugular reflux, and pitting edema up to the knees. His laboratory investigation showed sodium of 134 mEq/L, potassium of 3.8 mEq/L, chloride 90 mEq/L, bicarbonate 28 mEq/L, blood urea nitrogen 46 mg/L, creatinine 1.8 mg/L, with an estimated GFR of <60 mL/minute, and glucose of 100 mg/L. His HgbA1C was 7%. His urinalysis was significant for 2+ proteinuria. EKG showed tachycardia with nonspecific St and T wave changes, His weight was 98 kg. The patient developed type-2 cardio-renal syndrome and his diuretics, nesiritide, and nitroglycerine were stopped, and he was started on renal replacement therapy in the form of Continuous Veno-Venous Hemodiafiltration (CVVHDF) to improve both fluid overload and worsening renal function. Case Discussion Clinically, heart failure is classified into two major types based on the functional status of the heart: heart failure with preserved

Acta Psychopathologica, 2017

Hepatitis C virus is a single stranded RNA virus. It is a major cause of acute and chronic hepati... more Hepatitis C virus is a single stranded RNA virus. It is a major cause of acute and chronic hepatitis. The mode of infection is usually through intravenous drug abuse or transfusion of infected blood or blood products. Health care workers are at risk for needle stick and other with high-risk sexual behavior is also considered a major risk factor for HCV infection. The incidence of new cases of acute HCV infection has sharply decreased in the United States during the past decade, but the prevalence remains high with approximately 2.7 million Americans infected with the virus. Chronic HCV infection progresses in roughly 75% of patients after acute infection by the virus. Chronic HCV infection is slowly progressive disease and results in severe morbidity in 20-30% of infected persons.

Acta Psychopathologica, 2017

Journal of clinical nephrology and renal care, Dec 31, 2016

The Journal of medical research, Nov 23, 2016

The Case-The case is that of 69 year old female who went on vacation and fell on her knees. She n... more The Case-The case is that of 69 year old female who went on vacation and fell on her knees. She noticed progressive swelling of both legs over 2 weeks duration. During this period she gained 44 pounds in weight. She presented with sudden onset of edema of the lower extremity and weigh gain. She had 16 g/day of proteinuria. Past medical history is significant of hypertension of unknown duration. She had never seen a doctor in the last year. Her laboratory data showed 30 grams protein in 24 hrs urine, and her serum creatinine was 1.7 mg/dl. The baseline serum creatinine was not known.

Journal of urology and nephrology open access, May 16, 2017

Hepatitis C infection is a major cause of acute and chronic hepatitis. Health care workers and hi... more Hepatitis C infection is a major cause of acute and chronic hepatitis. Health care workers and high risk behaviors are at increased risk of infection. The incidence of a new cases of hepatitis C has sharply decreased in the United States, but the prevalence remained high (2.7 M) American infected with the virus. Chronic infection is progressive disease and results in severe morbidity in 20-30% of infected persons. Cutaneous manifestations (extra-hepatic) of hepatitis C infection are found in 20-40%. Kidneys and skin are the main organs involved after the liver. This mini-review highlights the common skin manifestation of the virus.

The authors discuss a case of aortic dissection in a young man with hypertension. The delay in co... more The authors discuss a case of aortic dissection in a young man with hypertension. The delay in considering the diagnosis and ordering the proper investigations secondary to the unusual presentation of the case complicated by the logistics of patient's transfer to specialized Cardiothoracic unit where surgery can be performed safely have impacted the unfortunate outcome.

The Journal of medical research, Jul 4, 2016

Background and Objectives: H. pylori are an accepted cause of chronic active gastritis and common... more Background and Objectives: H. pylori are an accepted cause of chronic active gastritis and commonly associated with both gastric and duodenal ulcer. Moderate to severe gastritis increases the relative risk of developing peptic ulceration and eradication of the bacteria reduces duodenal ulcer recurrence. The effect of H pylori on the duodenal brush border membrane enzymes have not been studied extensively in this infection. This study evaluates the duodenal brush border enzymes between the H. pylori positive and negatives patients. Design, setting, participants & measurements: One hundred and nine patients, age range 20-84 years, mean age 56 years were included in the study. They presented to the endoscopy suite of UCHG with upper gastrointestinal symptoms. The duodenal bulb was entirely normal and with no evidence of inflammation on endoscopic examination. Biopsies from the antrum were processed for histology and bacteriological culture. Two biopsies from the duodenal bulb were taken from each patient and were sealed in Para-film and stored at-20C0 until assayed for brush border enzymes.

Open journal of nephrology, 2022

We reported here a case of anticoagulant-related nephropathy (ARN) in an elderly patient with bac... more We reported here a case of anticoagulant-related nephropathy (ARN) in an elderly patient with background history of chronic kidney disease (CKD-stage 4, with an estimated glomerular filtration rate (eGFR) of <24 ml/min). He presented with an acute kidney injury on background of chronic kidney disease (AKI/CKD) with eGFR of 9 ml/min and serum creatinine of 6.0 mg/dl.

Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotranspo... more Diabetes mellitus Diabetic ketoacidosis Euglycemic diabetic ketoacidosis Sodium-glucose cotransporter 2 inhibitor Metabolic acidosis High anion gap acidosis Case history The case is that of 58 year-male with type 2 diabetes mellitus for 7 years, hypertension, hypercholesterolemia, who was admitted to the hospital with left lower limb cellulitis over the past 8 days. On work-up he was found to have high aniongap metabolic acidosis (AGMA) with anion gap of 25, his lactate levels were normal (D and L-lactate). He denies overdosing with any medications and his toxicology screen for methanol, ethanol, aspirin, and ethylene glycol were negative. He has no psychiatric history of note. He denies using over the counter medications like acetaminophen. No bowel surgery could be elicited. He felt dehydrated and nauseous but otherwise fine. His medications includes; carvedalol 25mg twice daily, hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin 81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeks ago to control his blood sugar level and A1C. Physical examination of the patient revealed, slightly dehydrated but well-nourished man, his vital signs; heart rate of 78 BPM and regular, BP 143/85 mmHg, temperature 98.7 F, and his oxygen saturation while breathing room air was 92%. Examination of the heart, abdomen, and chest were unremarkable. He had left lower leg cellulitis but no edema or tenderness. His work-up including chemistry-7 which showed sodium of 142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L, bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78 mg/L respectively. His blood glucose level was 178 mg/L with A1C of 8.2. His serum osmolality was 312 mosm/L, and his arterial blood pH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of 32mmHg. His calculated anion gap was 25 given his normal albumin level. His investigation also showed positive ketones in the serum and urine. His urine PH was 5.5 and the urine contain >800 mg of glucose.

Annals of nephrology, Mar 11, 2019

The authors presented a case of serotonin syndrome cause by drug interaction. The patient is pres... more The authors presented a case of serotonin syndrome cause by drug interaction. The patient is presented with classical features of the syndrome with hyper-excitability, tremor, change in mental status, and low grade fever. The patient made uneventful recovery after the stoppage of the offending drugs. This case calls for the clinicians to be vigilant of the drug interaction that can cause unintended side effects to the patient under their care.