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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 4 | Issue 1
Page Nos. 1-84

Online since Monday, April 20, 2020

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ORIGINAL ARTICLES  

A study to evaluate and compare the effect of amblyopia on both nerve fiber layer thickness and ganglion cell complex in either anisometropic or strabismic individuals p. 1
Abd Elmagid M Tag Eldin, Ahmad El-Sayed Hudieb
DOI:10.4103/sjamf.sjamf_62_19  
Background Anisometropia and high refractive errors are very annoying problems. Anisometropic amblyopia is one of the most common forms of amblyopia. Typical treatment includes refractive correction with glasses or contact lenses combined with occlusion. Anisometropic amblyopia is often detected later than other forms of amblyopia, because vision is generally good in the fellow eye, the eyes are typically orthotropic, and the child functions well with the use of the sound eye. A large fraction of the cases results from strabismus with constant unilateral fixation, which leads to amblyopia in the deviating eye. Amblyopia generally does not develop if fixation alternates, providing each eye with similar access to higher visual centers, or if strabismic deviation is intermittent (as a result of fusional vengeance or incomitance), so that there are periods of normal binocular interaction that preserve the integrity of the visual system. The visual system is sensitive to the effects of abnormal visual experience only during a limited time in infancy and childhood; this is referred to as the critical period or the sensitive period. Objective This study used SD-optical coherence tomography to compare retinal nerve fiber layer (RNFL) thickness and ganglion cell complex in amblyopic and fellow eyes of patients of varied ages. Twenty patients (10 patients with anisometropic amblyopia and 10 patients with strabismic amblyopia) with unilateral amblyopia underwent SD-optical coherence tomography examination for both amblyopic and follow eyes. Results and conclusion The study showed that there was no significant difference in RNFL between amblyopic and fellow eyes in the two groups of anisometropic and strabismic amblyopia. There was a statistically significant difference in ganglion cell complex thickness measurements between amblyopic eyes and fellow eyes in the two groups of anisometropic and strabismic amblyopia. There was a statistically significant difference between the two groups of patients regarding means of average RNFL thickness in the fellow eyes and means of inferior RNFL thickness in the fellow eyes.
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Correlation between thyroid imaging reporting and data system with histopathology in classification of thyroid nodules p. 11
Aya E Mohamed, El Shymaa E Ahmed, Marwa A Soliman, Nahed A Abdullatif
DOI:10.4103/sjamf.sjamf_73_19  
Objective This study aims to evaluate the reliability of the ACR-thyroid imaging reporting and data system (TIRADS) classification system in predicting thyroid malignancy by using pathology diagnosis as the reference standard. Patients and methods This was a prospective study that was carried out at Alzahraa University Hospital. Records of patients with focal thyroid nodules on ultrasound for which ultrasound-guided core needle was performed and pathology results were available, from January 2019 to June 2019, were selected for review. Correlation of the American college of Radiology - thyroid imaging reporting and data system (ACR-TIRADS) classification with pathology results was assessed. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated in a conservative and nonconservative method. The threshold for statistical performance was set at 0.05. Each sonographic feature was also compared with its pathology results. Results A total number of 20 patients with 51 nodules were eligible in the study; seven (13.7%) of 51 nodules were malignant. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 85.7, 97.7, 85.7, 97.7, and 96.1%, respectively. Conclusion The ACR-TIRADS classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adaptation and use.
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Psychological impact of obesity in children p. 17
Rania Hussein, Ragaa A.-E Mohammed, Inass H Ahmed
DOI:10.4103/sjamf.sjamf_98_19  
Background Obesity is a growing public health problem among both children and adults. Obesity comorbidities are not limited to somatic complications, but extend to involve several psychological consequences. Stigmatization represents a major psychological stress that adversely affects children’s self-esteem. Aim This study aimed to assess the prevalence of common psychiatric disorders (depression, anxiety, oppositional defiant disorder) in a group of obese children in comparison with those with normal weight. Participants and methods This case–control study included 60 children with obesity (BMI ≥95th age-specific and sex-specific percentiles) and 60 age-matched and sex-matched normal-weight children (BMI 5th–85th age-specific and sex-specific percentiles) as the control group. Detailed assessments of history and anthropometric indices of central and peripheral obesity, in addition to psychiatric assessment for depression, anxiety, and oppositional defiant disorder, were carried out. Results 46.7% of children with obesity were victims of bullying. Children with obesity have significantly higher rate of depression and low self-esteem in comparison with healthy peers. Girls were more affected than boys. There is a significant relation between depression and central obesity. The childhood depression inventory score is correlated directly to BMI and waist circumference. Conclusion Children with obesity are at a higher risk for depression, with the severity of depression correlated positively with BMI and central obesity.
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Comparative study between C-MAC, Air Traq laryngoscope, and Air Q in adult patients p. 22
Amany M Abdel Haliem, Enas M Ashrey, Soad S El gaby
DOI:10.4103/sjamf.sjamf_106_19  
Introduction Airway management is one of the cornerstones of anesthesia. The role of airway assessment is very important for airway management. So many devices have been introduced to improve tracheal intubation such as C-MAC video laryngoscopes (C-MAC VL) and Air Traq. Also, some of supraglottic airway devices have been modified for endotracheal intubation like Air Q intubating laryngeal mask airway. Aim The aim of the study was to compare C-MAC, Air Traq laryngoscopes, and Air Q in terms of hemodynamic changes such as primary outcome, and ease of intubation, success rate and intubation time, number of attempts, complications, and incidence of esophageal intubation such as secondary outcome, in patients who need tracheal intubation for elective surgeries. Patients and methods A total of 60 adult patients aged 21–65 years, with the American Society of Anesthesiology I, II, Mallampati I, II scheduled for elective tracheal intubation, were divided into three equal groups in a randomized controlled manner: group CM (n=20) intubation was done with C-MAC VL; group AT (n=20) intubation was done with Air Traq; group AQ (n=20): intubation was done with Air Q. Results There was statistically significant prolongation in the duration of intubation in the AQ group followed by AT group and then CM group. Ease of intubation, decrease in the number of attempts, and success rate were similar in CM, AT groups. In contrast, the AQ group showed difficulty in intubation and the failure rate was 15% (P=0.043). No complication or incidence of esophageal intubation occurred during intubation with the CM group or AT group, but AQ group showed increased incidence of esophageal intubation in 15% of patients. Conclusion We concluded that C-MAC VL is a more superior, easier, and protective method of safe intubation followed by Air Traq optical laryngoscope proved by ease of intubation, shorter time of intubation, and number of intubation needed with no incidence of esophageal intubation than Air Q intubating laryngeal mask.
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Effect of fentanyl addition to local anesthetic mixture in peribulbar block for cataract surgery p. 29
Aya Fouad, Manal Foad Abd-Elmoniem, Sameh Ghoneim
DOI:10.4103/sjamf.sjamf_108_19  
Background In peribulbar regional anesthetic blocks, injection of local anesthetic mixtures alone provide unsatisfactory surgical conditions as regards block intensity and duration especially for relatively lengthy operations. So, additives may improve the quality of the block and provide good postoperative analgesia. Aim To examine the effect of adding fentanyl to local anesthetics in peribulbar block on the onset and duration of lid and globe akinesia (primary outcome) and postoperative analgesia (secondary outcome). Patients and methods Patients were classified randomly allocated in a blind manner into two groups; each group contained 30 patients. The control group received a measure of 7 ml [3 ml lidocaine 2%+0.5 ml hyaluronidase (150 U)+2.5 ml bupivacaine 0.5%+1 ml saline] which was used locally and the fentanyl group received a measure of 7 ml [3 ml lidocine2%+0.5 ml hyaluronidase (150 U)+2.5 ml bupivacaine 0.5%+1 ml saline containing 20 μg fentanyl] which was used locally. Results Statistically significant decreased mean time of complete akinesia decreases the mean time to sensory block in the fentanyl group compared with the control group. Conclusion Fentanyl is an effective drug as an additive to local anesthetic mixture in peribulbar anesthesia, as it shortens the onset time of corneal anesthesia and globe akinesia, prolongs block duration, and good postoperative analgesia.
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Surgical management of cerebellopontine angle tumors p. 34
Elsayed Sabah Mohammed Ali, Gasser Hasan Rabee Al Shyal, Abd Elfattah Abu El Fotoh Shehab
DOI:10.4103/sjamf.sjamf_109_19  
Background Even though there is a high prevalence of tumors within the cerebellopontine angle (CPA), surgical management in this region remains a major obstacle owing to the critical neurovascular structures passing the CPA and constringed surgical access, with displayed complication rates. Aims The current study was conducted to evaluate the various clinical and radiological modalities that are used for diagnosis of CPA tumors and planning of their surgeries. Additionally, it aimed to compare the various surgical strategies that have been used for excision of CPA tumors along with the assessment of cerebrospinal fluid diversion role in CPA surgery. Patients and methods Patients with CPA tumor who have been diagnosed and treated surgically in 2-year interval between October 2017 and October 2019 were eligible for inclusion in the study. Surgeries were done via retrosigmoid or middle fossa approaches. Results Patients experienced considerable improvement of the clinical symptoms especially intracranial tension, particularly those subordinated to preoperative shunt. Subsequent to that patients revealed dramatic improvement of the tinnitus, headache, vertigo, ataxia, and unsteadiness of gait after surgery. In addition, facial palsy was the most predominant complication succeeded by cerebellar ataxia, hematoma at the tumor bed, left-side hemiplegia, local wound infection, and meningitis. Conclusion Retrosigmoid and middle fossa approaches accomplished significant outcome among patients with CPA tumors, counterpart hearing symptoms, bulbar affection, facial weakness, and cerebellar manifestations. Preoperative V-P shunt procedure improved noticeably the manifestations of increased intracranial tension.
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Serum and urinary neutrophil gelatinase-associated lipocalin in chronic liver disease patients and its value in detecting renal impairment p. 42
Eman Elsayed Elshemy, Hanaa Mohamed Omar, Asmaa Sobhy Ahmed, Eman Hesseen Eltaweel
DOI:10.4103/sjamf.sjamf_110_19  
Background Renal dysfunction is a common complication of liver cirrhosis. Renal dysfunction has a serious impact on the natural evolution of liver cirrhosis. Treatment and prognosis may be improved if an early diagnosis could be established and specific therapeutic interventions would be applied. Several new markers have become topics of research with studies mainly focused on cystatin c, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin (NGAL). Aim Evaluation of serum and urinary NGAL in chronic liver disease patients and its value in the detection of renal impairment. Patients and methods It was performed on 45 patients with chronic liver disease and they were classified into three groups: group I included 15 patients with compensated chronic liver disease. Group II included 15 patients with decompensated liver disease and normal kidney functions. Group III included 15 patients with decompensated liver disease and impaired kidney functions. Results There was highly significant increase in serum creatinine and urea level in group III in comparison to groups I and II and there was significant decrease in glomerular filtration rate in group II in comparison to group I and highly significant decrease in group III in comparison to groups I and II. There was significant decrease in serum Na in group II in comparison to group I and in group III in comparison to group II and highly significant decrease in group III in comparison to group I. Also, there was highly significant decrease in urinary Na in group II and group III in comparison to group I and significant decrease in group III in comparison to group II. As regard NGAL there was significant increase of serum and urinary NGAL in group III in comparison to group I and group II. Conclusion Serum and urine NGAL are excellent markers for early detection of renal impairment in patients with chronic liver disease.
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Biochemical and histological evaluation of testicular and hepatic acute toxicity induced by formaldehyde and the possible protective effect of curcumin in adult male albino rats p. 52
Wesam Abdelsalam Abdelwahab, Rehab Mohammed Mohammed Megahed
DOI:10.4103/sjamf.sjamf_111_19  
Background and aim Formaldehyde (FA) is an organic carbon compound with adverse health effects by inducing oxidative stress that affect multiple tissues of the exposed animals such as liver, brain, and gonads. Curcumin has desirable preventive therapeutic properties owing to its antioxidant and anti-inflammatory properties. This study aimed to evaluate toxic effects of FA on liver and testes of the adult male albino rats and assess the probable protective role of curcumin against these effects through biochemical and histological studies. Methodology Twenty-four adult male albino rats were divided into four groups: control, curcumin (100 mg/kg/day by intragastric tube), FA (10 mg/kg/day intraperitoneally), and FA+curcumin, daily for 2 weeks. Blood samples, livers, and testes were obtained for biochemical and histological evaluation. Results FA resulted in elevation of aspartate aminotransferase, alanine aminotransferase, and total bilirubin and decrease in albumin and testosterone levels and alterations in the normal hepatic and testicular structures. Treatment with curcumin improved these changes. Conclusion FA administration damages and deteriorates hepatic and testicular structures and functions, and curcumin improved that, which might be attributed to its antioxidative and anti-inflammatory properties. Recommendation It is recommended to use curcumin as a protective agent in FA toxicity.
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Different routes of misoprostol for same-day cervical priming prior to hysteroscopy: a randomized controlled single-blinded trial p. 59
Mazen A El Zahry, Sayed Taha, Taher Mostafa
DOI:10.4103/sjamf.sjamf_112_19  
Introduction Hysteroscopic surgery, with prior cervical ripening by misoprostol (a synthetic analog of prostaglandin E1), has been widely used to treat gynecological diseases, including submucosal myoma, endometrial polyps, and uterine synechia in nonpregnant women. The route of administration of misoprostol for cervical dilatation can be oral, vaginal, or sublingual. Aims The aim of the present study was to evaluate the efficacy of 400 μg misoprostol administered orally, vaginally, or sublingually on cervical ripening before hysteroscopy Patients and methods Study setting: Sayed Galal Hospital. Study duration: April 2017–April 2018. Number of patients: 300 patients. A prospective randomized controlled single-blinded trial. Nonpregnant women scheduled for hysteroscopy were divided randomly into four groups using sealed opaque envelopes to receive 400 mg of misoprostol, administered either orally (n=75) or vaginally (n=75) 6–8 h prior to surgery or 400 mg sublingually (n=75) 2–4 h prior to surgery or the control group (n=75) that received nothing. The primary outcome in this study was the preoperative cervical width as measured by the largest number of Hegar dilators. Duration of cervical dilatation was also recorded along with side effects related to misoprostol and complications during surgery for each group. Results The mean±SD cervical widths for oral, sublingual, vaginal, and control groups were 7.60±1.76, 7.56±1.64, 7.57±2.06, and 5.65±2.17 mm, respectively, which was statistically significant. Time to cervical dilatation was also significantly longer in the control group than in the other three groups. Misoprostol-related adverse effects and hysteroscopy-related complications were comparable among the four study groups. Conclusion All routes (oral, sublingual, vaginal) of administrations of misoprostol are equally effective in inducing proper cervical priming before hysteroscopy.
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Effect of caring for children with type I diabetes on parent’s life p. 66
Shaimaa M Arafa, Mervat E Alwakeel
DOI:10.4103/sjamf.sjamf_4_20  
Introduction Type 1 diabetes mellitus is one of the commonest chronic health conditions in children. The risk of complications in diabetes is common, so parents live with constant worry about their child’s health. The condition requires also a higher degree of behavioral regulation than normal children of the similar age. The children naturally must rely on their parents for instruction, support, and daily help. Therefore, type 1 diabetes mellitus is ‘a family condition’ challenging the patient’s social and familial circle. Objective The aim was to assess parental stress and quality of life (QOL) in parents of diabetic children. Participants and methods A case–control study was done on 100 parents, recruited from endocrine department and clinic at Al Zahra University Hospital, who were classified in two groups: group I included 50 parents of diabetic children and group II included 50 control parents of nondiabetic children. They were subjected to the following: sociodemographic data, parent stress index questionnaire, and QOL questionnaire. Results Stress is significant among parents of diabetic children, with significant statistical relation between both groups regarding depression, attachment, sense of competence, role restriction, and social isolation. A significant statistical relation was also found regarding duration of diabetes and child age. QOL was also significantly diminished in parents of diabetic children. Conclusion Parents of diabetic children are at increased risk for stress, which in turn affects their QOL.
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Pectoral nerve block for postoperative analgesia in breast cancer surgery p. 71
Mohamed O Alfy, Manal Foad
DOI:10.4103/sjamf.sjamf_7_20  
Background Breast cancer is the most common malignancy in women and its incidence continues to increase. Surgery is one of the mainstays of treatment of breast cancer, and modified radical mastectomy is one of the standard treatments, Pectoral nerve (PECS I and PECS II) block was reported to be good analgesia for breast surgery. Aim To compare PECS blocks in combination with general anesthesia versus general anesthesia alone in modified radical mastectomy surgery. Patients and methods Patients were classified randomly into two groups in a blinded manner, and each one contained 30 patients. Control group received general anesthesia only. PECS group received general anesthesia plus PECS guided by ultrasound (PECS I and PECS II). Results There was a statistically significant decrease in fentanyl requirement in the PECS group compared with the control group. There was a high statistically significant decrease in visual analog scale in the PECS group compared with the control group. There was a statistically significant increase the first time of rescue dose of opioid in PECS group compared with control group. Conclusion PECS blocks can produce excellent pain relief during postoperative hours. They hold great promise as under ultrasonic guidance they have become simple and easy-to-learn techniques.
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Assessment of the left ventricular function in hypertensive pregnant women with or without proteinuria: two-dimensional versus four-dimensional echocardiographic study p. 78
Shaimaa A Habib, Wael Abd Elatief Khafagy
DOI:10.4103/sjamf.sjamf_9_20  
Background Assessment of left ventricular (LV) function by speckle tracking echocardiography (STE) can detect subtle changes in LV function in preeclampsia. We aimed to assess LV function using two-dimensional (2D) versus four-dimensional (4D) echocardiography in hypertensive (HTN) pregnant women with or without proteinuria. Patients and methods This study comprised 50 HTN pregnant women with proteinuria as G1 and 50 HTN pregnant women with no proteinuria as G2, who were compared with 50 age-matched healthy pregnant women as G3. All were subjected to abdominal ultrasound and echocardiography. Calculation of cardiac output and total vascular resistance derived from 2D echocardiography was done. Assessment of LV systolic function including 2D and 4D ejection fraction (EF), systolic mitral annular velocity, and global longitudinal strain (GLS) by tissue-Doppler imaging (TDI) and 2D and 4D STE was done. Assessments of LV diastolic function, including mitral early and late diastolic velocities by pulsed-Doppler echocardiography (ME and MA), E/A and E/early diastolic mitral annular velocity (Ea) by TDI, and 2D left atrial volume index (LAVI) was performed. Results Interventricular septal wall thickness in diastole, LV posterior wall thickness in diastole, and LV mass index were significantly increased in G1 compared with G2 and G3. Cardiac output and total vascular resistance were significantly increased in G1 compared with G2. LV GLS by TDI, 2D, or 4D STE was significantly lower in G1 compared with G3 and G2, despite the insignificant difference in LVEF. E/Em and LAVI were significantly increased in G1 compared with G2 and G3. A positive correlation was found between 2D and 4D measures. A positive correlation was found between proteinuria and LV mass index and LAVI, whereas a negative correlation was found between proteinuria and LV GLS (2D/4D) and 4D EF. Conclusion Women with HTN associated with proteinuria had significant LV structural and functional changes. Use of newer echocardiographic modalities can detect early subtle changes in cardiac function in those patients.
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LETTER TO THE EDITOR Top

Direct-acting antiviral therapy in patients with chronic hepatitis C p. 84
Sora Yaasri, Viroj Wiwanitkit
DOI:10.4103/sjamf.sjamf_26_19  
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