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Pattern and clinical profile of thalassemia among pediatric patients attending the Yemeni Society Centers for Thalassemia and Genetic Blood Disorders in Yemen
Hala A Al-Kherbash, Ahmed Al-Awdi, Nawal S Hasan
September-December 2017, 1(2):43-56
Background Thalassemia is a type of inherited anemia. Its management is complex and expensive, and requires a multiple-team approach. Optimal and sufficient clinical care is demanding. Aim The aim of this study was to determine the magnitude, sex and age distribution, clinical profile, complications, investigation, and management of transfusion-dependent β-thalassemia major among Yemeni pediatric patients attending the Yemeni Society Centers for Thalassemia and Genetic Blood Disorders in Yemen as, to our knowledge, no similar previous study has been carried out in Yemen. Patients and methods This was a prospective, cross-sectional, descriptive study carried out during the period from January 2015 to December 2016. A total of 109 Yemeni pediatric transfusion-dependent β-thalassemia major patients who attended the Yemeni Society Centers for Thalassemia and Genetic Blood Disorders in Yemen were included. Detailed assessment of history, clinical examination, investigations, treatment, and follow-up were performed for every patient. The data were collected from the medical records of the patients. Results There was a slight male predominance (53.2%), with a male to female ratio of 1.14 : 1. Approximately 33% of the patients were in the age group 7–10 years, followed by the age group 3–6 years. The mean age of the cases was 7.68±5.8 years. Positive parent consanguinity was present (74.2%) and the majority (64.2%) were first-degree relatives. The best outcome of thalassemia was among those patients 1.7 years old or younger at the time of diagnosis and those patients 2 years old or younger at first blood transfusion. Earlier initiation of chelating therapy yielded better outcomes and reduced the mortality rate with a highly statistically significant difference. The usage of a combination of both oral chelation and subcutaneous iron chelation (iron pump) therapies led to a noticeably better outcome and reduced the mortality rate markedly. A proportional relation was detected between serum ferritin level and mortality among the cases, with a statistically significant difference. The complication rate was high (40.2%). The mortality rate was also high (27.5%). Cardiac dysfunction was the major risk factor of death among our thalassemic patients as about 60% of the deaths were because of cardiac complications, with a highly statistically significant difference. Conclusion Increasing awareness of the morbidity and mortality of transfusion-dependent β-thalassemia major among pediatric Yemeni patients, with an emphasis on the great importance of premarital screening before marriage in Yemen, is mandatory. For better outcomes, routine investigations to detect early complications with proper treatment of the predisposing factors and complications are necessary.
  3,100 344 1
Treatment of genu valgum in children by percutaneous transverse metaphyseal osteotomy of the distal femur
Aly M Elgeuoshy, Galal M Mansour, Mohamed M Hegazy, Alhassan M Abdelhamid
September-December 2017, 1(2):57-62
Purpose The aim was to measure and correct the angular deformity of 15 patients with genu valgum by a new percutaneous technique. Materials and methods We conducted a prospective study to evaluate the results of using percutaneous supracondylar femoral osteotomy technique with casting as a minimally invasive surgical intervention for the treatment of genu valgum. Results The youngest patient was 7 years and the oldest was 20 years with an average age of 14 years. The range of hospital stay is from 1 or 2 days, but it decreased with the late cases in the study, which can be explained by the improvement in the learning curve of the technique. The least time of follow-up is 6 weeks, but two cases have been followed for 57 weeks with a mean of 24.90 weeks. Conclusion The percutaneous technique provides the privileges of acute correction without the need for dissection, minimizes the formation of ugly scar or keloid, minimizes the risk of infection, and allows for accurate correction. There is no need for plate fixation or a staged operation to remove hardware.On the other side, the percutaneous osteotomy has a learning curve and the compliant patient is crucial for a close assessment of the condition.
  2,351 199 -
Estimation of bladder wall thickness at different areas with ultrasound and its relation to cystocele
Basem I Foda, Adel Saad, Eman M El-Dydamony
May-August 2018, 2(2):47-51
Objective The aim was to verify our hypothesis that decreasing bladder wall thickness will facilitate ballooning of the bladder wall at this thin part that will be involved in a process of cystocele other than the last traditional reported factors. Patients and methods This prospective study included 80 female patients between 20 and 45 years of age who were divided into two groups. Group I: 40 women were normal (control group); 20 of them were married and 20 were virgins and Group II: Comprising 40 patients have clinical manifestations of cystocele. All underwent complete history taking, physical examination, translabial, and transabdominal ultrasound examination with measurement of anterior and posterior detrusor wall thickness (DWT); also multichannel urodynamic testing was done to diagnose if there is associated obstruction or not. Results In group I, the mean DWT in 20 virgin women was 3.28±0.79 at the anterior bladder wall and 2.72±0.77 at the posterior bladder wall by transabdominal ultrasound, whereas by translabial ultrasound it measured 3.34±0.83 at the anterior bladder wall and 2.62±0.94 at the posterior bladder wall. In 20 married women of the control group without cystocele the mean DWT was 2.85±0.72 and 2.70±0.75 at the anterior and the posterior bladder wall, respectively, by transabdominal ultrasound. Also, the mean DWT was 2.90±0.69 and 2.75±0.74 at the anterior and the posterior bladder wall, respectively, by translabial ultrasound. In group II the anterior and the posterior wall measured 2.95±0.95 and 2.25±0.73, respectively, by transabdominal ultrasound, while it measured 4.35±1.40 and 2.40±0.77, respectively, by translabial ultrasound. With obvious obstruction in group II, Pdet.Qmax. was 29.18±7.54 whereas it was 18.10±13.40 in group I. An increased level of Qmax was noticed in group I with a mean value of 25.73±8.56 whereas it was of a less value in group II (15.83±6.21). Conclusion Our findings verify our hypothesis that decreasing bladder wall thickness will facilitate ballooning of the bladder wall at this thin part. Moreover, an increase in intravesical pressure during micturition will form a pseudo-diverticulum of the bladder wall, which in turn had lost the scaffolding of the fascia and/or vaginal wall.
  2,117 157 -
Intrauterine lignocaine versus paracervical block for pain relief during cervical dilatation and endometrial curettage
Alaa El Deen Mahmoud Sayed, Ahmed Shaaban Mohamed
May-August 2017, 1(1):7-13
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.
  1,894 164 -
Comparison of SRK/T and Haigis formulae in the prediction of refractive outcome after phacoemulsification
Mona N Mansour, Rehab M Kamel, Hanan S Hegazy
May-August 2018, 2(2):85-89
Purpose To compare the accuracy of SRK/T and Haigis formulae used for intraocular lens (IOL) power calculation by a partial coherence interferometer in patients undergoing phacoemulsification surgery. Patients and methods A prospective interventional clinical study included 70 eyes of 60 patients, who underwent uncomplicated phacoemulsification with IOL implantation from October 2015 to December 2017. Preoperative axial length (AL), corneal curvature (keratometry), and preoperative anterior chamber depth (preoperative ACD) were measured using Nidek AL-scan optical biometer and the IOL power was determined using both SRK/T and Haigis formulae. The difference between the predicted value and the postoperative spherical equivalent was calculated for both the formulae by the end of the follow-up (3 months postoperatively). Results The mean errors of the two formulae were SRK/T: −0.225±0.61 D and Haigis: 0.171±0.68 D; the mean absolute errors of the two formulae were 0.534±0.36 and 0.533±0.44 D, respectively. There was no statistically significant difference between the mean error of the two formulas used in the overall performance, but was significant in eyes with an AL of more than 25 mm. The proportion of patients having a prediction error within ±0.50 D of SRK/T formula (54.29%) was comparable to those of Haigis (55.71%) and the prediction errors within ±1.0 D were 87.14 and 85.71%, respectively. There is a weak correlation between the mean AL, keratometry and the Haigis–SRK/T prediction differences (r2=0.273). Conclusion The calculation of IOL power using SRK/T and Haigis formulae resulted in an accurate postoperative refraction. In long AL subcategory, the mean absolute error of Haigis was less compared with the SRK/T formula.
  1,794 134 -
Prevalence of learning disabilities among a sample of primary school students
Reda M Ismail, Hala T Mohamed, Basma G Soltan
January-April 2019, 3(1):125-130
Objective The aim was to assess the prevalence and sociodemographic risk factors of learning disabilities in primary school students studying in a governmental school. Participants and methods The present cross-sectional study was conducted on primary school children. A total of 218 students, of both sexes, represented all primary grades. All students were subjected to modified psychometric tool (MST) to identify the risk students. The students with risk of learning disorders (LDs) on MST were evaluated by the following: (a) visual acuity, hearing test, and intelligent quotient and (b) semistructured clinical interview to confirm diagnosis of LDs according to DSM-IV. In addition, our study explored the correspondence between the prevalence of LDs and the following variables: age, sex, grade level, family history, order of birth of child, and history of epilepsy or severe trauma. Finally, assessment of socioeconomic status was done to identifying the social standards of students’ families. Results A total of 36 (16.5%) students of the total screened (n=218) were identified as at risk by MST; of them, six students had visual and hearing impairment and were excluded from the study. There was increasing prevalence of identified LDs with increasing age, grade level, positive family history, and history of epilepsy. Moreover, students who were identified with LDs were more likely to be from low socioeconomic status. In addition, an association was found between LDs and language developmental delay. Conclusion Learning disabilities were common in primary school students. Screening students for such disorder should be recognized and identified right within the primary school level.
  1,687 185 -
Self-fixating Parietex ProGrip mesh in inguinal and paraumbilical hernia repair
Ashraf I.A El-Sharkawy, Hazem A Mostafa Badr, Rasha Abd El-Aziz Abd El-Gany
January-April 2018, 2(1):32-40
Background Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years till using self-fixating Parietex ProGrip mesh. This mesh can be placed by an open approach which is becoming increasingly common in many countries. Objectives This study investigated the recent surgical treatment of open inguinal and paraumbilical hernia patients using self-fixating ProGrip Parietex mesh. Immediate complications reported were seroma, cellulitis, postoperative pain, mesh sepsis, testicular atrophy, and recurrence. Patients and methods This study was conducted between January 2015 and January 2017 at Al-Zahra Hospital Al Azhar University, and Al-Ameen Hospital, KSA with a 1 year follow-up. The patients underwent general, spinal, or epidural anesthesia. A dose of third-generation cephalosporin was administrated during the induction of anesthesia. Self-fixating Parietex ProGrip mesh with or without lateral slit with a rough surface placed on the floor of the inguinal canal for the repair of inguinal hernias or in subcutenous plane on anterior abdominal wall musculature in paraumbilical hernias. Results Self-fixating Parietex ProGrip mesh was used with a lateral slit for the spermatic cord, maked right and left for indirect inguinal hernia patients (69.79%) and direct hernia patients (27.01%). Self-fixating ProGrip Parietex mesh without slit with a rough surface was placed in the subcutaneous plane in patients with paraumbilical hernias (3.1%). Immediate complications such as seroma, cellulitis, and postoperative pain were studied. The mean operative time was ±35 min and the mean hospitalization discharge time was ±1.5 days. Conclusion The use of self-fixating Parietex ProGrip mesh technique for the repair of inguinal and paraumbilical hernias in this study seemed effective and safe, and is not associated with postoperative pain. No recurrence of hernia and no mesh sepsis were detected, with 1 year follow-up.
  1,606 125 -
Follow-up of hepatitis b virus vaccine response in healthy individuals
Nessren M.B El-Deen Mohamed, Hanna Abuo-El-Yazed Abuo-El-Hassan, Hend M.B El-Deen Mohamed
May-August 2018, 2(2):58-63
Background The long-term protective effect of hepatitis B virus (HBV) vaccine and the need for booster dose vaccination remain unclear. Detection of nonresponders to HBV vaccine and search for factors that lead to nonresponse will help in prevention of HBV infection, hepatocellular carcinoma related to hepatitis B infection and hepatitis D virus infection. Aim The aim of this study was to assess the benefit of follow-up of hepatitis B vaccine response and evaluate the persistence of seroprotection after HBV vaccination to determine the necessity of a booster dose in healthy individuals after 5 and 10 years of vaccination. Patients and methods Serum samples were tested for quantitative detection of hepatitis B surface antibodies (HBsAb) using ELISA for 30 individuals who received HBV vaccine of less than or equal to 5 years (group I) and 30 individuals who received HBV vaccine for more than or equal to 10 years (group II), and if the results were negative or less than 10 IU/ml, evaluations of hepatitis B surface antigen and hepatitis B core antibodies (total) were done. Results HBsAb was positive among 66.7% of each group, and the median HBsAb level was 59.73 and 51.21 in groups I and II, respectively. Conclusion Approximately 33% of the studied groups were nonresponders of HBV vaccine regardless of postvaccination years (5–10). Hepatitis B infection and occult hepatitis B infection results were negative in all of nonresponders. Recommendations Follow-up of HBsAb levels in vaccinated individuals after having completed three doses of hepatitis B vaccination on a large scale is important to detect nonresponses and revaccinate them.
  1,524 168 -
Neurofilaments as a biomarker of axonal loss in multiple sclerosis
Hoda Mohamed Ali Massoud, Eman Mohamed Saif Eldeen, Sahar Saied Khattab, Ghada Saed Abd Alazim
September-December 2017, 1(2):63-68
Background Neurofilaments (NF-H) might be a potential biomarker of CNS tissue damage in MS, but their potential predictive value for the future disease course, disability, disease progression, and treatment response needs to be investigated. Aim of the work The aim of this study is to evaluate the role of serum phosphorylated neurofilament H as a marker in multiple sclerosis and correlate it’s level with clinical expanded disability status scale (EDSS) and magnetic resonance imaging findings. Subjects and methods Study included 40 patients and 20 healthy control, 20 patients with relapsing remitting multiple sclerosis (RRMS) and 20 patients with secondary progressive multiple sclerosis (SPMS). All patients in this study were subjected to full history taking and clinical examination and scoring according to the EDSS scores, routine laboratory investigations, measuring of serum phosphorylated neurofilament-H (PNF-H) levels and neuroradiological assessment. Results Patients with secondary progressive multiple sclerosis were more likely to have a high serum (PNF-H) titer compared to patients with relapsing remitting multiple sclerosis, and these levels were significantly correlated with EDSS scores in both patients groups. Conclusion The increase in (PNF-H) titer during the progressive phase of the disease together with the correlation of (PNF-H) levels with all clinical scales and radiological lesions (e.g. gadolinium-enhanced lesions and black holes) suggests that cumulative axonal loss is responsible for sustained disability and that high (PNF-H) level is a poor prognostic sign.
  1,391 129 -
Prospective, comparative, randomized, and controlled study of endotracheal intubation conditions without muscle relaxant in children receiving general anesthesia
Abdelazim A.T. Hegazy
May-August 2017, 1(1):21-25
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.
  1,340 142 -
Prognostic factors of brainstem infarction in a sample of Egyptian patients
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
May-August 2017, 1(1):14-20
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.
  1,350 122 -
Neutrophil gelatinase associated lipocalin: a new marker for early diagnosis of acute kidney injury in ICU
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
May-August 2017, 1(1):1-6
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
  1,303 137 -
The role of ultrasound in the diagnosis and evaluation of diabetic neuropathy in nerve roots of the foot
Mohamed Abdel Latief Mahmoud, Ashraf T Yousef, Said S Said, Doaa M.M Abd El-Sameea
January-April 2018, 2(1):1-5
Background Neuropathies are characterized by a progressive loss of nerve fiber function. Diabetic peripheral neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes. The diagnosis of diabetic neuropathy is based primarily on characteristic symptoms and is confirmed with nerve conduction studies (NCS), which are time-consuming, slightly invasive, and occasionally not well tolerated for repeated evaluations. In contrast, ultrasonographic (US) examinations can be performed to assess peripheral nerves with less discomfort and have already been used for the evaluation of several disorders of the peripheral nervous system such as carpal tunnel syndrome. Patients and methods A total of 50 patients were included in the study, with 40 patients with type 2 diabetes and 10 controls. All cases underwent clinical history, local clinical examination, NCS, and real-time high-resolution US. Ultrasound examination The patients were examined in supine position, and the foot was bolstered with a pillow to expose the anterior and medial portion of the lower leg and foot. The transducer was placed immediately above the medial malleolus to locate the tibial nerve in the transverse (short axis) and the longitudinal (long axis) views. The 5.0–12.0-MHz multifrequency linear array probe was used for tibial nerve scanning. The instrument used was Philips HD3 ultrasound scanner. Result There was a statistically significant difference between case and controls regarding US cross-sectional area done for right and left tibial nerves, with high mean among cases (0.18±0.02 and 0.17±0.02, respectively). There was a statistically significant difference between US and NCS. There was no statistically significant difference between the two groups regarding the other measurements. Conclusion High-resolution US can be used as adjuvant tool for the NCS for diabetic patients suspected to have neuropathy.
  1,269 170 -
The role of serum retinol in nonalcoholic fatty liver disease
Fatma A.S Mourad, Zeinab H El Sayed, Heba A.M Showman, Mona M.M Abo Ragab, Nagwa Abd El-Ghaffar Mohamed
May-August 2018, 2(2):115-122
Background Retinol has been involved in the regulation of lipid metabolism and hepatic steatosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have emerged as the most common chronic liver diseases. A minority of affected patients develop subsequently hepatic fibrosis, whereas most of them exhibit simple steatosis. Indeed, the relation between retinol and NAFLD and NASH is still incomplete and unknown. Objective This study aimed to identify the clinical relevance of retinol in patients with NAFLD and NASH. Patients and methods This study enrolled 90 individuals who were selected from the outpatient clinic of Al Zahraa University Hospital, Egypt, which comprised 30 patients with NAFLD, 30 with NASH and 30 healthy persons as a control group. Serum glucose, lipid profiles, markers of liver damage, serum retinol, and abdominal ultrasound were studied. Results Serum retinol concentrations were significantly lower in NAFLD and NASH than in control, where the mean serum retinol concentration in patients with NAFLD was 23.02±2.9 and NASH was 11.7±2.3, and it was significantly lower than those in controls, with 36.1±2.7 (P<0.01). Conclusion Circulating retinol concentrations were lower in patients with NAFLD and were associated with hepatic lipid metabolism and insulin resistance.
  1,302 137 1
Role of computed tomography in diagnosis, follow-up, and minimally invasive treatment of acute pancreatitis
Hazem A.M Bader, Asmaa S Abd El Azeem
May-August 2018, 2(2):52-57
Background Acute pancreatitis is an inflammatory disease of the pancreas with variable involvement of other regional tissues or remote organ systems. It has a mild, self-limiting course in 80% of patients who recover without complications. The remaining patients have a severe disease with local and systemic complications, and this disease carries a mortality risk of 10–24%. Objective To examine the role of computed tomography (CT) in diagnosis, follow-up, and guided therapy in acute pancreatitis. Patients and methods The study was performed on 100 patients with acute pancreatitis from January 2014 to October 2016. There were 80 males and 20 females. Inclusion criteria Previously known acute pancreatitis attacks, clinically suspected acute pancreatitis, laboratory results suggesting acute pancreatitis, and patients with trauma with suspected pancreatic injury sequelae were the inclusion criteria. All patients were subjected to history taking; laboratory assessment, including serum amylase, lipase, creatinine levels, complete blood count, lipid profile (mainly triglyceride), and blood glucose; as well as CT scan to assess the pancreatic parenchyma, peripancreatic region, extrapancreatic ascites, pleural effusion, lung bases, and intestinal loops. Results The study included 100 patients whose age ranged from 9 to 83 years old, with a mean of 41.89 years. Overall, 80 (80%) patient were males and 20 (20%) patient were females. The CT showed sensitivity of 99.1% and specificity of 100% with positive predictive value of 100% and negative predictive value of 97% in the diagnosis of acute pancreatitis. Conclusion Acute pancreatitis can be severe and life-threatening. Imaging is central in the identification of complications, and radiological scoring systems can predict prognosis. With the current move toward minimally invasive treatment, the role of image-guided therapy is increasing and the need for surgical intervention is decreasing. CT is playing a golden role in diagnosis, follow-up, and guided therapy of acute pancreatitis.
  1,264 147 -
A study of correlation of fine-needle aspiration cytology with postoperative histopathological examination in patients with either solitary thyroid nodule or multiple nodules
Mohammed A Sirry, Elsayed M Abdelwahab, Heba T Abdelaziz, Maher F Badr
May-August 2018, 2(2):41-46
Background Fine-needle aspiration cytology (FNAC) of the thyroid gland is now a well-established, first-line diagnostic test for the evaluation of thyroid nodules with the main purpose of confirming benign lesions and thereby, reducing unnecessary surgery. Different imaging techniques are now used for diagnosis of thyroid nodules like radionucleotide scanning and ultrasonography. However, FNAC is still regarded as the single most accurate and cost-effective procedure, particularly if ultrasound is used as a guide for better sample collection, especially for cystic lesions. Aim The aim of the work is to evaluate the correlation of preoperative FNAC with postoperative histopathological examination in patients with either solitary thyroid nodule and multiple nodules. Patients and methods This prospective study was done between April 2016 and November 2017 on 100 patients presented to the General Surgical Department with either solitary or multiple thyroid nodule. This was done to assess the correlation between preoperative FNAC and postoperative histopathological examination. Results Statistical analysis of our study showed sensitivity, specificity, accuracy, false-positive fraction, false-negative fraction, positive predictive value, and negative predictive value of FNAC to be 92, 81, 84, 36, 3.3, 63, and 96%, respectively. Conclusion The FNAC is a sensitive, specific, and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings in our setting as well. The correlation of cytological and histopathological diagnoses is an important quality assurance method, as it allows cytopathologists to calculate their false-positive and false-negative results.
  1,245 166 -
Evaluation of serum YKL-40 and cardiovascular risk in chronic kidney disease
Fatma M El Senosy, Mona M Morsy, Nagwa A Mohamed, ALRomisa S Albanna
May-August 2018, 2(2):64-74
Background Chronic kidney disease (CKD) is a worldwide health problem. Patients with end-stage renal disease have high prevalence of atherosclerosis and consequently development of cardiovascular disease resulting in elevated mortality rates. YKL-40 has been shown to play a role in the pathogenesis of endothelial dysfunction, atherosclerosis, and abnormal angiogenesis. It is closely related to the early and late phases in the development of atherosclerosis. Aim To study serum YKL-40 levels in patients with CKD and to assess its correlation with high-sensitive C-reactive protein (Hs-CRP) and carotid intima-media thickness (CIMT) as a predictor for early atherosclerosis. Patients and methods A cross-sectional study included 40 CKD patients. Group I was classified into: Ia which 20 patients on regular hemodialysis and Ib which included 20 predialysis patients’ CKD (stages 4–5), compared with 40 healthy controls of the same age and sex (group II). Routine laboratory investigations were done and serum Hs-CRP and YKL-40 level were measured in both groups and healthy controls. CIMT was measured by B-mode ultrasound. Results There were a highly significant increase of serum YKL-40 and Hs-CRP levels and intima-media thickness of carotid artery in group I when compared with the control group and a highly significant increase in group Ia in comparison to group Ib. There were highly significance positive correlations between YKL-40 level and Hs-CRP, CIMT in groups Ia and Ib. Conclusion The study concluded that the serum level of YKL-40 is significantly elevated in patients with chronic renal failure both hemodialysis and predialysis and there was significant positive correlation between YKL-40 and CIMT as well as Hs-CRP in all patients with chronic renal failure. We suggest that YKL-40 had a role as an inflammatory marker and for early detection of atherosclerosis.
  1,238 133 -
Effect of female increased body mass index on intracytoplasmic sperm injection outcome
Mohamed Shehata
May-August 2017, 1(1):36-41
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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Impact of combining dexmedetomidine to ondansetron and dexamethasone for prophylaxis against postoperative nausea and vomiting after laparoscopic bariatric surgery
Mostafa M Sabra
May-August 2018, 2(2):90-96
Background Postoperative nausea and vomiting (PONV) are common and highly distressing following laparoscopic bariatric surgery. However, there is inadequate evidence regarding the impact of combining dexmedetomidine to dexamethasone and ondansetron. We aimed to study the impact of combining dexmedetomidine to dexamethasone and ondansetron in the prevention of PONV. Patients and methods Seventy-two adult patients scheduled for laparoscopic bariatric surgery were randomized in this double-blind study to receive either single dose of dexmedetomidine 1 µg/kg; ondansetron 4 mg; dexamethasone 8 mg (group D, n=36) or ondansetron 4 mg and dexamethasone 8 mg (group B, n=36), after induction of anaesthesia. Anaesthesia administration was performed similarly for both groups using a standard protocol. During the first 24 h postoperatively, the primary outcomes were the incidence of PONV. The severity of PONV and use of rescue antiemetic were the secondary outcomes. χ2-Test and Student’s t-test were utilized to evaluate significant differences in categorical and continuous variables. Results The incidence of PONV was significantly reduced in group D (13.9 vs. 52.8%, P<0.001). The severity of PONV was significantly lower in group D (34.22±10.48 vs. 62.50±13.34, P=0.03). Ondansetron consumption was reduced significantly during 24 h in group D (2.33±2.93 vs. 3.58±2.68, P=0.03). Conclusion Addition of dexmedetomidine to ondansetron and dexamethasone was efficacious in decreasing incidence, severity of PONV, and the total analgesic consumption during the first 24 h after laparoscopic bariatric surgery.
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Comparison of endoscopic retrograde cholangiopancreatography then laparoscopic cholecystectomy and laparoscopic common bile duct exploration in patients with common bile duct stones
Hazem A.M Badr, Ashraf A Elsharkawy
September-December 2017, 1(2):69-74
Background Choledocholithiasis is concomitant with gallstones in ∼3–10% of patients. In the pre-endoscopic and prelaparoscopic era, the standard treatment for patients suffering from gallstones accompanied with common bile duct stones (CBDS) was open cholecystectomy and common bile duct (CBD) exploration. With the advent of laparoscopic and endoscopic techniques, several alternative treatments, such as laparoscopic cholecystectomy (LC), preoperative or postoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and laparoscopic common bile duct exploration (LCBDE), have been developed to treat cholelithiasis. The management of stones in the CBD in the laparoscopic era is controversial. The aim of this study was to compare the efficacy, safety, and surgical outcomes of the LCBDE and ERCP with sphincterotomy, in patients with CBDS. Patients and methods The study was performed on 60 patients suffering from CBDS who were admitted and treated in our department in Al-Zahra Hospital and Al-Ameen Hospital, KSA between January 2014 and January 2016.The patients were divided into two groups according to the method of treatment. Group A included 20 patients who were treated by LCBDE whereas group B included 40 patients were treated by ERCP with sphincterotomy. Results This study was carried out on 60 patients with CBD stones. The patients were divided into two groups according to the method of treatment. Group A included 20 patients who were treated by LCBDE, whereas group B included 40 patients who were treated by ERCP with sphincterotomy. Conclusion The optimal management of patients with CBDS should depend on the condition of the patients, and the expertise of the operators. LCBDE is a feasible, safe, and effective procedure that carries low morbidity and mortality and will decrease the need for unnecessary ERCP in the future for suspected or proved choledocholithiasis.
  1,184 132 -
Comparative study between loupe-assisted and conventional subinguinal varicocelectomy
Hazem A Megahed, Hatem A Megahed, Salah G Ziada, Amr A Sarhan, MasoudKh El-Syed
September-December 2017, 1(2):75-79
Introduction In this prospective randomized study, the outcome and the complication rates of loupe-assisted subinguinal varicocelectomy (LASV) are compared with conventional subinguinal varicocelectomy. Patients and methods Between December 2014 and June 2017, 66 patients aged from 20 to 38 years old were enrolled in this study in Al-Azhar University Hospital, New Damietta, and Al-Zahraa University Hospital, Cairo. The patients were randomly subdivided into two groups: group A included 33 patients who underwent LASV using surgical loupes with three times magnification, group B included 33 patients who underwent conventional open subinguinal varicocelectomy. Postoperative complications along with preoperative and postoperative (3 months) seminal parameters were compared between the two groups. Moreover, the number of identified internal spermatic arteries was also compared between the two groups. Results The hydrocele formation was significantly lesser in group A treated by LASV [none of the patients (0%)] than group B treated by conventional subinguinal varicocelectomy (three patients; 9.09%). The recurrence rate was better in group A (one patient; 3.03%) than group B (two patients; 6.06%), but the result was nonsignificant regarding recurrence rate. Testicular hypertrophy does not occur in both groups. The average number of preserved arteries was more in group A than group B (0.95±0.51 in group A vs. 0.88±0.47 in group B). Semen parameters including semen concentration, sperm motility, and percentage of abnormal forms were improved in both groups, but the improvement was nonsignificantly better in group A than group B, so the improvement was nonsignificantly between the two groups, but it was significant between the preoperative and postoperative results within each group. Conclusion LASV is better than conventional open subinguinal varicocelectomy as loupe allows clear visualization of the testicular artery, lymphatics, and small venous channels, resulting in decrease in the incidence of complications, including hydrocele formation, testicular artery injury, and varicocele recurrence.
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Critical view of safety and Rouviere’s sulcus: extrahepatic biliary landmarks as a guide to safe laparoscopic cholecystectomy
Ayman M Elwan
May-August 2019, 3(2):297-301
Introduction Bile duct injury is a serious complication of cholecystectomy. To fulfill the criteria for a critical view of safety requires Calot’s triangle to be cleared free of fat and fibrous tissue. Rouviere’s sulcus is a 2–5-cm sulcus running to the right of the liver hilum anterior to the caudate lobe. Aim Our aim is to study critical view of safety and Rouviere’s sulcus as extrahepatic landmarks and their benefits in avoiding common bile duct injury. Patients and methods From January 2015 to December 2018 (35 months), in New Damietta University Hospital, 300 patients with calculous cholecystitis undergoing laparoscopic cholecystectomy were included in this study. Results Rouviere’s sulcus was present in 293 (97.7%) patients: open type was found in 175 (58.3%) patients, whereas closed type was found in 118 (39.3%) of patients. The sulcus was not present in seven (2.3%) of patients. A critical view of safety was inspected in all patients (100%). There was conversion to open cholecystectomy in two (0.7%) patients owing to severe adhesions which cannot be dissected laparoscopically. No mortality was recorded in the follow-up period. Conclusion Rouviere’s sulcus and critical view of safety technique are very helpful extrahepatic landmarks to avoid common bile duct injury and perform safe laparoscopic cholecystectomy.
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Impact of direct-acting antiviral therapy in Egyptian patients with chronic hepatitis C and liver cirrhosis
Mohammed H Elnadry, Sherif A Abdel-Aziz, Mohammed Ghareb, Ali A Ahamad, Nagah M Abu-Mohammed, Marwan M Tayel
September-December 2018, 2(3):181-188
Background and aims In Egypt, ∼14.7% of the population has hepatitis C infection and genotype 4 infection accounts for more than 90% of the hepatitis C virus infections. Available data with newer all-oral regimens in the treatment of genotype 4 infection suggest that sustained virological response (SVR) 12 rates in treatment-naïve cirrhotic and noncirrhotic patients are greater than 95%. The study aimed to evaluate the virological response 12 weeks after treatment (SVR12), change in the model for end-stage liver disease score, and adverse clinical events during the study period. Patients and methods This prospective study included 451 patients with chronic hepatitis C and liver cirrhosis over a 3-month period started at January 2017. And the study was ethically approved by the Medical Research Ethics Committee, Faculty of Medicine, Al-Azhar University. The enrolled patients were classified into three groups: group I included 162 patients with chronic hepatitis C and liver cirrhosis subjected to direct-acting antivirals (DAAs) therapy (100/162 compensated cirrhosis and 62/162 decompensated cirrhosis), group II included 234 patients known to have chronic hepatitis C without liver cirrhosis subjected to DAAs therapy, and group III included 55 patients with chronic hepatitis C and liver cirrhosis not subjected to DAAs therapy according to the national protocol of therapy (as a control group). Treatment was administered for 12 weeks that included variable regimens of DAAs according to the Egyptian Ministry of Health protocol. Results We included 451 patients with chronic hepatitis C infection and liver cirrhosis; 47.8% of the patients were male, 84.4% were treatment naive, and 54.9% had cirrhosis. Of the study participants, 150 patients in group I and 53 patients in group II received sofosbuvir+daclatasvir+ribavirin, 183 patients received daclatasvir+sofosbuvir (group II), seven patients in group II received sofosbuvir+ledipasvir, five patients received sofosbuvir+ledipasvir+ribavirin (in group I), and seven patients in group I and nine patients in group II received ombitasvir/paritaprevir/ritonavir+ribavirin. Twelve weeks after end of treatment (SVR12) were 91.3% and 96.5% observed in group I and group II, respectively irrespective of the regimen of therapy. Treated patients in group I had a mean negative change in model for end-stage liver disease (−0.722; SD, 2.603) representing an improvement in liver function, whereas untreated patients in group III showed a minimal mean positive change (0.00; SD, 2.92) representing a deterioration in liver function (P<0.001). Improvements were observed in the Child-score (Child–Pugh–Turcotte) in group I versus untreated patients in group III. Hepatic encephalopathy was evident in 6.1% of patients in group I after treatment versus 38.1% in untreated patients (group III), and ascites developed in 30.2% of patients after treatment (group I) versus 65.4% in untreated patients (group III). Conclusion Oral regimens of DAAs are effective in the treatment of hepatitis C virus infection even in patients with liver cirrhosis, leading to improvements in liver functions.
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Cerebrovascular reactivity and neurogenic inflammation in migraine
Manal H Maabady, Ghada Saed, Seham El-Said, Eman M Saif Eldeen
May-August 2017, 1(1):29-35
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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Serum magnesium level in maintenance hemodialysis and cardiovascular calcification
Hayam H Mansour, Ragaa R Mohamed, Manal F Khaled, Esraa M Khalil
January-April 2018, 2(1):26-31
Background Patients with chronic kidney disease have a high prevalence of vascular calcification, and cardiovascular disease is the leading cause of death. Magnesium (Mg) is a natural calcium antagonist and many studies have shown that low circulating levels of Mg are associated with vascular calcification. Aim of the work The aim of the study was to assess the relationship between serum Mg levels and vascular calcification in chronic hemodialysis (HD) patients. Patients and methods A cross-sectional study conducted on 60 patients with end-stage renal disease on regular HD in Al-Zahraa University Hospital (group I) compared with 30 healthy controls (group II), from June to December 2017. Patients with evidence of infection, chronic diarrhea, ileostomy, and those receiving Mg-based phosphate binders were excluded from the study. All studied groups were submitted to clinical examination, renal function, lipid profile, serum albumen, calcium, phosphorus, intact parathyroid hormone, Mg, carotid duplex, echocardiography, ECG, and lateral view plain abdominal radiograph. Results There were highly significant differences regarding Mg and carotid intimal medial thickness (CIMT) in group I compared with group II: 1.51±0.28, 0.89±0.30 and 2.47±0.18, 0.45±0.08 respectively, P<0.001. Echocardiographic findings showed calcified mitral and aortic valves in 12 (20%) patients and calcified abdominal aorta by abdominal X-ray radiograph in 20 (33.33%) patients. There were highly significant negative correlation between serum Mg and CIMT and abdominal aortic calcification in group I. Conclusion The patients on maintenance HD have lower serum Mg levels. It was associated with increased CIMT and vascular calcification if compared with healthy group and concomitant use of proton pump inhibitors may aggravate this hypomagnesemia. So serum Mg level in maintenance HD patients could be a potential biomarker for cardiovascular calcifications.
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