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   Table of Contents - Current issue
May-August 2017
Volume 1 | Issue 1
Page Nos. 1-41

Online since Friday, December 22, 2017

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Neutrophil gelatinase associated lipocalin: a new marker for early diagnosis of acute kidney injury in ICU Highly accessed article p. 1
Hoda M El-Sayed, Hayam H Mansour, Essam Abd El-Aziz Abd El-Mobdy, Ragaa R Mohammed, Ahmed N Ajam, Haytham S Abd El-Hamid, Mohammed S El-Din Zaky, Mohamed H Biomy
Introduction Serum creatinine is a late marker of acute kidney injury (AKI) and its alterations are often not apparent until 48–72 h postinjury. Urine and plasma neutrophil gelatinase associated lipocalin (NGAL) measurements may represent early biomarker of AKI in intensive care, being able to predict this complication ∼2 days prior to the rise in serum creatinine. Aim To evaluate the role of plasma NGAL level as a marker for early diagnosis of AKI in ICU patients and if it is related to the severity of kidney injury and renal outcomes. Patients and methods Our study including 40 ICU patients, 20 patients admitted for surgical causes and 20 admitted for medical causes. For all participants, clinical examination, laboratory investigations were done in the form of serum creatinine, plasma NGAL, with daily measurement of urine output and estimation of glomerular filtration rate. Patients with AKI were classified according to Risk, Injury, Failure, Loss, End stage renal disease (RIFLE) classification, non-AKI patients served as controls for comparison. Results Out of 40 patients, 14 (35%) developed AKI, and according to RIFLE classification, seven (17.5%) were class R, four (10%) were class I, three (7.5%) were F. There was statistically significant comparison between operative time and development of AKI in surgical patients. Also patients who did not develop AKI had lowest NGAL level while AKI group showed rising level with RIFLE classes. Conclusion Plasma NGAL can be used as early biomarker for diagnosis of AKI and its level is increasing with the severity of AKI classes in ICU patients
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Intrauterine lignocaine versus paracervical block for pain relief during cervical dilatation and endometrial curettage p. 7
Alaa El Deen Mahmoud Sayed, Ahmed Shaaban Mohamed
Background Dilatation and curettage and fractional curettage are commonly performed gynecological procedures. Randomized-controlled trials have concluded that topical anesthesia effectively reduces pain in endometrial sampling and hysteroscopy. A major obstacle to the successful completion of outpatient gynecologic procedures is pain. Most patients can tolerate pain to complete necessary procedures, but studies show that pain scores are often high. Objective The aim of this study was to compare the efficacy of intrauterine instillation of lidocaine, paracervical block, and a combination of both techniques to control pain during endometrial curettage in a randomized, double-blinded trial in premenopausal and postmenopausal women. Patients and methods A total of 90 patients scheduled for endometrial curettage were allocated randomly to three groups: group L, group P, and group LP according to the type of anesthesia that was administered. Group L received lidocaine 2% injected into the uterine cavity (n=30). Group P received paracervical block (n=30). Group LP received combined intrauterine lidocaine and paracervical block (n=30). Women were observed for pulse rate and the mean arterial blood pressure was monitored continuously and recorded manually. The pain score assessed using 10 mm visual analog scale. Also, types and incidence of adverse events were reported. Results In terms of heart rate changes, there was a statistically significant increase in both groups L and P than group LP. The changes in the mean arterial blood pressure showed no statistical significance difference among the study groups. Statistically significant differences were found in the number of patients who received fentanyl and the total fentanyl required among the three groups; this was less in group LP than the other two groups. Also, the number of patients who received propofol was significantly lower in group LP compared with the other groups. In terms of the quality of intraoperative analgesia, there was statistically significant adequate analgesia in group LP compared with the other groups. Conclusion This study concluded that intrauterine lidocaine in combination with paracervical block significantly provides adequate intraoperative and postoperative analgesia, whereas intrauterine lidocaine alone or paracervical block alone provides intraoperative analgesia that requires the addition of intraoperative opioid analgesics and sometimes hypnotics and mostly requires immediate postoperative analgesia.
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Prognostic factors of brainstem infarction in a sample of Egyptian patients p. 14
Sayed A El-Zayat, Tarek M Abd El-Hamid, Khaled M Sobh, Ahmed F Abd El-Aziz, Mohie EL-Din T Mohamed, Mahmoud S Attia
Background Ischemic brainstem stroke is estimated to constitute 10% of all first ischemic brain strokes. Because the brainstem is involved in almost all of the important functions of the central nervous system, brainstem infarction (BSI) is relatively dangerous with a high mortality. Early prediction of the severity and degree of disability and identification of high-risk patients are critical for the treatment of patients with BSI. Objective This study aimed to evaluate patients with BSI in terms of clinical, laboratory, and radiological factors to study the outcomes of these patients. Patients and methods Patients were admitted at the Stroke Unit and Internal Neurology Department of Al-Azhar University Hospitals (Al-Hussein and Sayed Galal Hospitals), over a period of 6 months, from 1 December 2016 to 30 May 2017, with a diagnosis of acute BSI, confirmed by computed tomography brain and MRI brain with diffusion. The study included 31 patients and were subjected to clinical, laboratory, radiologic assessment (by computed tomography brain and MRI brain with diffusion), and assessment of severity by the National Institute of Health Stroke Scale (NIHSS) score at the time of admission and discharge. The modified Rankin Scale (mRS) score at discharge was used to divide patients into three groups: patients with mRS less than or equal to 2 were considered to have achieved a good outcome, those with mRS greater than 2–5 were considered to have achieved a poor outcome, and those who died had mRS equal to 6. Results Overall, 14 (45.2%) patients had a good prognosis, 13 (41.9%) patients had a poor prognosis, and four (12.9%) patients died. Dysphagia, vomiting, cranial neuropathy, and high NIHSS score on admission were associated with a poor outcome. There was no relationship between the outcomes of the studied patients in relation to age, sex, hypertension, atrial fibrillation, diabetes mellitus, ischemic heart disease, high lipid profile, smoking, previous cerebrovascular stroke, obesity. Conclusion Dysphagia, vomiting, cranial neuropathy, and high NIHSS score were associated with a poor prognosis.
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Prospective, comparative, randomized, and controlled study of endotracheal intubation conditions without muscle relaxant in children receiving general anesthesia p. 21
Abdelazim A.T. Hegazy
Introduction Intubation without the need for a muscle relaxant is a common practice in pediatric patients. Many drugs are used; sevoflurane and propofol are used to improve the intubation score and to decrease the usage of a muscle relaxant and avoid its side effects. Aim This study aimed to compare intubation conditions and hemodynamic responses to two induction regimens, without a muscle relaxant using an anesthetic, sevoflurane versus propofol, in children, who required general anesthesia. Patients and methods A prospective controlled study was carried out on 90 patients with ASA physical status I and II scheduled for elective pediatric day case surgeries. Patients were divided into three equal groups of 30 patients each. The patients in the S group received inhalational induction sevoflurane. The P group received 3 mg/kg propofol intravenously. The C group received 2 mg/kg succinylcholine after 3 mg/kg propofol intravenously as a control group; maintenance was performed by inhalation using sevoflurane after intubation in all groups. The intubation conditions, hemodynamic parameters (heart rate, peripheral oxygen saturation) induction time, and recovery time were all recorded and statistically analyzed. Results With respect to the intubation conditions, no patient in any of the two groups (S and P groups) needed rescue a muscle relaxant for intubation. The S group showed more acceptable and excellent intubation conditions versus the propofol groups (100 and 96.7%, respectively). The heart rate was comparable in all groups at all readings; except during intubation, reading was highly significantly low in the sevoflurane group. Induction time was longer in the sevoflurane group than in the other groups. The recovery time was short in the S group than in the propofol group. Conclusion Endotracheal intubation without neuromuscular blocking agents in pediatric patients undergoing day case surgeries was achieved with no severe respiratory or hemodynamic adverse events by using propofol (3 mg/kg) or sevoflurane 8% at induction and then reduced to a maintenance level after intubation.
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Percutaneous fixation of acute scaphoid fractures: a retrospective study p. 26
Ismail Yassin, Mohammad El-Nahas, Mostafa Awadallah
Objective The aim of this study were to determine whether the functional outcome of the evaluation of the effectiveness of percutaneous retrograde (volar) approach of insertion of cannulated Herbert’s screw to stabilize acute scaphoid fractures and to evaluate the functional outcome after this minimally invasive operative management of this problematic fracture. Background Scaphoid fracture is the most common carpal fracture. It accounts for ∼60–90% of carpal and 11% of hand fractures. Scaphoid fracture is a common fracture affecting mainly young active people during their work or while participating in sports activities. Patients and methods This is a retrospective observational study of patients undergoing surgery for percutaneous fixation of acute scaphoid fracture. In our study, 12 patients with less than 14-day-old fractures were fixed percutaneously by Herbert’s screw and reviewed for a minimum of 12 months (average of 24 months). The functional outcome of this method was assessed. Results Fracture union was achieved in 11 (91.6%) cases at a mean of 8.29 weeks (6–12 weeks), whereas one case was ununited. Conclusion This study proves that fixation of acute scaphoid fractures results in predictable satisfactory union rate and functional outcome. Moreover, it proves that percutaneous Herbert’s screw insertion carries no risk of damage to soft tissues or vascular supply.
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Cerebrovascular reactivity and neurogenic inflammation in migraine p. 29
Manal H Maabady, Ghada Saed, Seham El-Said, Eman M Saif Eldeen
Background The exact mechanism of migraine is still unknown; however, it is believed to be a neurovascular disorder, where the cerebral vascular reactivity is malfunctioning. Although several studies have found alterations in velocity of blood flow and in cerebral vasomotor reactivity of intracranial arteries in migraineurs in headache-free periods, as well as during migraine attacks, the results are inconclusive. Another theory of migraine is the neurogenic inflammation involving the release of various vasoactive neuropeptides, which evoke a cascade of events that have a role in migraine attacks. Aim of work To evaluate the role of both vascular and inflammatory theories in migraine with and without aura. Objective The objective of this study was to examine the cerebrovascular reactivity to repetitive flash stimulation during interictal period of migraine and determine the serum levels of transforming growth factor β-1 (TGFβ-1) as an inflammatory mediator in migraine with and without aura. Patients and methods The changes in peak systolic volume (PSV) of both middle cerebral and posterior cerebral arteries in response to repetitive flash stimulation were evaluated by transcranial Doppler in 35 migraineurs (23 patients with aura and 12 without aura), during interictal period, and in 25 age-matched and sex-matched apparently healthy control participants. Moreover, serum levels of TGFβ-1 were determined in both the patients and control participants. Results The middle cerebral artery in migraineurs shows significant increase in PSV after flash stimulation in comparison with control participants who showed a habituation in PSV levels in response to stimulation. In posterior cerebral artery, compared with normal participants, migraineurs showed significant increase in PSV measures and PSV changes at the beginning and after the end of stimulation. The lack of habituation is significantly pronounced in patients with migraine with aura, in comparison with those without aura. Regarding TGFβ-1 serum levels, they were significantly higher in migraineurs than control participants. Moreover, patients with migraine without aura show significantly higher serum levels of TGFβ-1 in comparison with patients with migraine with aura. Conclusion Lack of habituation of the cerebrovascular response in migrainers might contribute to a disturbance in the metabolic homeostasis of the brain that might induce migraine attacks. Neurogenic inflammation has a role in migraine attacks.
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Effect of female increased body mass index on intracytoplasmic sperm injection outcome p. 36
Mohamed Shehata
Background BMI is calculated by dividing the weight in kilograms by height in meters squared (kg/m2). It is known that the reproductive potential in obese women is decreased and to be associated with suboptimal outcomes after assisted reproductive technologies. Objective The aim of this study was to evaluate the effect of increased BMI on pregnancy outcome in women undergoing intracytoplasmic sperm injection (ICSI) cycle. Patients and methods This retrospective study was conducted on 200 Women at Assisted Reproductive Technology Unit, International Islamic Centre for Population Studies and Research (IICPSR), Al-Azhar University. Data were recruited from patient files at IICPSR from January 2013 to December 2015, who had ICSI trial during this period. Patients who were included in the study were subdivided into two groups according to BMI − first group: normal-weight women with BMI between 18 and 24.9 kg/m2 (100 cases); secondgroup: overweight and obese women weighing at least 25 kg/m2 (100 cases). The outcomes in the two groups were demonstrated in all stages of ICSI. Results The duration of infertility was progressively higher as BMI increased. Basal luteinizing hormone, follicle-stimulating hormone, and estradiol levels were higher in group 2 than in group 1. Higher total doses of gonadotropin were required in group 2 to obtain equivalent ovarian response than in group 1. No significant difference was observed on ovarian response and embryonic parameters. Serum estradiol level on ovulation triggering day was significantly higher in group 2. Ovarian hyperstimulation and cycle outcome were not significantly different between both groups. Conclusion Overweight and obesity appear to have independent adverse effects on ovarian response to stimulation and outcomes in women undergoing ICSI.
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