eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
983
990
10.21608/mjcu.2020.110832
110832
Original Article
Diagnostic Value of Basic Fibroblast Growth Factor and Platelet-Derived Growth Factor-AB Circulating Levels in Hepatitis C Virus-Associated Hepatocellular Carcinoma
DOAA M. IBRAHIM, Ph.D. DALIA ABOUL AZM, M.D.
1
The Department of Biochemistry, Faculty of Science, Ain Shams University* and Early Detection and Cancer Prevention Unit, National Cancer Institute, Cairo University**, Cairo, Egypt
Abstract Background: As a hypervascular tumor, Hepatocellular Carcinoma (HCC) is characterized by neovascularization which plays an important role in its growth and progression. Basic Fibroblast Growth Factor (bFGF) is a potent endothelial cell mitogen and angiogenic factor that was found to be elevated in different cancers. Platelet-Derived Growth Factor-AB (PDGF-AB) is another factor implicated in enhanced proliferation and migration of pericytes and is a potent stim-ulator of angiogenesis in many tumors. Aim of Study: This study aimed to evaluate the circulating levels of bFGF and PDGF-AB and to examine their diagnostic significance in Hepatitis C Virus (HCV)-associated HCC. Methods: This study included one hundred subjects divided into healthy controls (n=25), HCV patients (n=25), and HCV-associated HCC patients (n=50). The levels of bFGF, PDGF-AB, and Alpha-Fetoprotein (AFP) in addition to the activities of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase as well as total bilirubin and albumin concentrations were determined in sera of the enrolled subjects. Results: Levels of bFGF and PDGF-AB were higher in HCC patients compared to controls and HCV patients and were found to be associated with increased susceptibility to HCV-associated HCC. Additionally, the diagnostic values of bFGF and PDGF-AB to distinguish HCC patients from non-cancerous patients were good, although they are still inferior to that of AFP. However, the combination of bFGF and PDGF-AB with AFP enhanced the efficacy of the latter. Conclusion: Serum bFGF and PDGF-AB may contribute to the pathogenesis of HCV-associated HCC, and they seem to be good diagnostic biomarkers of HCC along with AFP.
https://mjcu.journals.ekb.eg/article_110832_fb669b39000dc4f77b1da126b9c62535.pdf
Basic fibroblast growth factor (bFGF)
Platelet- derived growth factor-AB (PDGF-AB)
Alpha- fetoprotein (AFP)
Hepatocellular carcinoma (HCC)
Hepatitis C Virus (HCV)
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
991
997
10.21608/mjcu.2020.110833
110833
Original Article
Clinicopathological Significance of BRAF V600E Mutation in Egyptian Colorectal Cancer Patients
MONA A. KORA, M.Sc.; NANSY Y. ASAAD, M.D.
1
HALA S. EL-REBEY, M.D.; RANIA A. HASSANIN, M.D.
2
ALSHIMAA M. ALHANAFY, M.D.
3
The Departments of Pathology* and Oncology and Nuclear Medicine**, Faculties of Medicine, Menoufia University
Abstract Background: In Egypt, there is a rapid increase in Color-ectal Cancer (CRC) incidence with more aggressive course and younger age at presentation compared to western patients. Aim of Study: This study aimed to examine BRAF V600E mutation in Egyptian CRC patients. Material and Methods: This study is done by collaboration between Pathology and Clinical Oncology & Nuclear Medicine Departments, Faculty of Medicine, Menoufia University between January 2015 and August 2019 in which 81 CRC patients were studied. Expression of BRAF V600E protein was evaluated by immunohistochemistry. The results of the studied marker were correlated with different clinicopatho-logical parameters and survival data. Results: The frequency of BRAF V600E mutation was 51.9%. There was no statistical difference between different studied clinicopathological parameters including sidedness and BRAF V600E mutation. Regarding survival during this follow-up duration, no significant statistical differences were detected. Conclusion: In Egyptian CRC patients, BRAF V600E protein expression had no correlation with CRC prognosis. However, validation of our results in a larger sample size is necessary.
https://mjcu.journals.ekb.eg/article_110833_c14c768dbc6acb90b9cf3de1ec809e53.pdf
Egyptian colorectal cancer
BRAF V600E
protein expression
prognosis
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
999
1005
10.21608/mjcu.2020.110834
110834
Original Article
Induction of Labor Using One Dose versus Multiple Doses of Misoprostol: RCT
HISHAM M.M. HARB, M.D.; DINA Y. MANSOUR, M.D.
1
NAHED Sh. MOHAMMED, M.Sc.
2
The Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University* and Aswan Insurance Hospital
Abstract Background: Situations arise in obstetrics where it becomes necessary to end a pregnancy in the interest of the mother or baby or both. There is a growing interest in the use of miso-prostol, a prostaglandin E1 analogue for labour induction. Induction of labour is a common obstetric intervention and the use of misoprostol as an induction agent is important due to its low cost and stability at room temperature. These additional advantages make it a suitable agent, particularly in under-resourced settings and tropical countries. Aim of Study: This study was conducted to compare the rate of vaginal delivery within 24 hour among patients who undergo induction of labor between those who receive vaginal single dose of misoprostol with those receive up to 5 doses of this medication. Patients and Methods: The study was a randomized controlled open labeled clinical trial, study setting was Ob-stetrics and Gynecology Department of Ain Shams Maternity University Hospital (Emergency Department), the study timing was 6 months from March to September 2019, this study was conducted on 206 women who came to Emergency Department of Obstetrics and Gynecology Department of Ain Shams Maternity University Hospital. Results: The majority (70.87%) had V D in 24 hours in one dose group versus 75.73% in multiple doses without significant difference between both groups. Time from induc-tion to delivery in one dose group ranged from 10-32 with mean value of 17.990±5.579 while in multi-dose group was 10-33 (with mean value 18.204±5.206) without significant difference between groups. Latent period in one dose group ranged from 3-11 with mean value of 5.918±2.077 while in multi-dose group was 3-12 (with mean value 6.500±2.173) without significant difference between groups. There was non-significant difference between one dose and multiple doses in incidence of fetal distress as the majority in one dose group 92.23% than 90.29% in muti-dose group. Conclusion: The single-dose misoprostol appears to be an acceptable alternative to a multiple dose regimen for cervical ripening before the induction of labor. Our data indicates that there was no difference regarding the clinical efficacy between two labour induction regimens of vaginal misoprostol.
https://mjcu.journals.ekb.eg/article_110834_4f605c837b99375bbc42d671989bf8a1.pdf
Labor
Multiple doses
misoprostol
RCT
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1007
1016
10.21608/mjcu.2020.110835
110835
Original Article
Role of MRI in Evaluation of Anterior Knee Pain
TOUGAN T. ABDELAZIZ, M.D.; AHMED S. ABDELRAHMAN, M.D.
1
Abstract Background: MRI is well known for being particularly useful for scanning and detecting abnormalities in soft tissue structures like the cartilage tissues, tendons, and ligaments. Moreover, MRI can also aid in determining those patients with knee injuries who will require surgical intervention. MR imaging is recognized as a standard procedure and has replaced diagnostic arthroscopy as the primary diagnostic modality for many knee pathologies. Furthermore, MR images can be used to assess anatomic variants that may contribute to chronic patellar instability. Aim of Study: To go over several of the most common causes of Anterior Knee Pain (AKP), with emphasis on their MRI findings with the goal of allowing diagnosis that is more accurate and grading of some of the most common pathologies, for interpreting, reaching an efficient treatment and drastic improvement of this common complaint. Patients and Methods: This study included 25 patients (8 females and 17 males). Their ages ranging between 10-60 years (average age 30 years). All presented by anterior knee pain and were referred to Radiology Department of Ain Shams University Hospital or private centers for MRI examination after orthopedic consultation. This descriptive study was done to detect the role of MRI in the evaluation of anterior knee pain and apply advanced MRI techniques such as sagittal T2 mapping to visualize the articular cartilage of the knee. Most patients were subjected to MR imaging of the affected knee joints on high field strength scanners using Philips scanners Achieva or Intera (1.5T). Results: The present study revealed that 26% patellar tendon disorders which included (patellar Tendinopathy 21% and Osgood Schlatter disease 5%). Quadriceps tendon disorders represented 10% and they are including (Quadriceps Tendin-opathy 5% and Quadriceps tendon tear 5%). 69% of the sample size showed Patellar disorders represent and they are including (chondromalacia patella 32%, patellar instability 21%, transient patellar dislocation 11% and painful bipartite patella 5%). Hoffa's disease was demonstrated in 21% of the sample size and they are including (Hoffa impingement syndrome and Hoffa ganglion cyst), finally we have torn anterior horn of the lateral meniscus and they represent 5%. Conclusion: MRI is generally safe, accurate, and specific modality, which has been proven to be the modality of choice in the diagnosis of different knee pathologies that cause anterior knee pain in different age groups. Also it has a high specification in detecting the grades and types of some of these diseases or factors predispose to them as patella Alta and trochlear dysplasia.
https://mjcu.journals.ekb.eg/article_110835_92846402298c6888e04e96c57cfe868a.pdf
anterior knee pain
Patellar maltracking
T2 mapping
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1017
1022
10.21608/mjcu.2020.110836
110836
Original Article
Topical Finasteride versus Topical Spironolactone in the Treatment of Androgenetic Alopecia
AYMAN E. YOUSEF, M.D.; AHMED S. ABDELSHAFY, M.D.
1
MOUSA A.S. ALMABROUK, M.Sc.
2
The Department of Dermatology and Venereology, Faculty of Medicine, Zagazig University, Egypt* and Tripoli University, Libya**
Abstract Background: Androgenetic Alopecia (AGA) is a non-scarring alopecia that affects both males and females. It is characterized by a progressive miniaturization of hair follicles with a characteristic pattern distribution in genetically predis-posed men and women. Topical finasteride is being investigated as a new treatment for AGA with fewer side effects than oral finasteride. Topical Spironolactone is the most commonly used off-label anti-androgen for the treatment of AGA. In the treatment of AGA, it acts by decreasing the production and competitively blocking the androgen receptor in the target tissue. Aim of Study: The aim of this study was to evaluate the role and compare the effect of topical finasteride and topical spironolactone in the treatment of (AGA). Patients and Methods: After meeting inclusion and ex-clusion criteria and diagnosis of AGA was clinically established by the characteristic distribution of frontal and vertex hair in males and the Christmas tree pattern of diffuse hair loss at middle hairline in females. It was dermosopically established by the characteristic hair shaft thickness heterogeneity, peripilar brown depressions (peripilar signs) and focal atrichia and also folliscope established for hair density. Cases included in this study had Norwad-Hamilton Scale types I to VII for men and Ebling Scale types I to IV for women. Result: Our study shows that a topical spironolactone is better than topical finasteride in male and female group. Conclusion: In this study, topical finasteride and topical spironolactone are good options for management of androgenic alopecia but topical spironolactone is better than topical finasteride with few side effects when compared to oral administration.
https://mjcu.journals.ekb.eg/article_110836_e38786e7057303e85115bcb620bdc96b.pdf
Alopecia
Finasteride
Spironolactone
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1023
1029
10.21608/mjcu.2020.110837
110837
Original Article
Effect of High Intensity Interval Training on Blood Glucose Levels in Type 2 Diabetes
SALMA EL SHEIKH, M.Sc.; HEBA A. ABDEEN, Ph.D.
1
MARY W. FAWZY, M.D.
2
The Departments of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics, Faculty of Physical Therapy* and Internal Medicine, Faculty of Medicine**, Cairo University
Abstract Background: Patients with type 2 diabetes are at signifi-cantly increased risk for cardiovascular morbidity and mortality compared with age-matched healthy control subjects. Aim of Study: Was to determine the effect of high intensity interval training on blood glucose levels in type 2 diabetes. Subject and Methods: Forty diabetic patients of both sexes (12 males and 28 females). They were assigned into two groups equal in number. All patients were diagnosed clinically with established T2DM for more than 7-year duration. Their ages ranged from 45 to 55 years selected from outpatient clinic of Kasr El-Aini, Cairo University, Egypt. Study group with mean age (51.07±3.31) years. and Control group with mean age (51.36± 2.83 ) years. The study group included 20 patients (7 males and 13 females) who practiced high intensity interval training at intensity level of (85-90% of MHR), three times per week for 12 weeks in addition to their optimized oral hypoglycemic medications. Symptom limited exercise test was performed before and after training (12 weeks) to determine maximum heart rate. The control group included 20 patients (5 males 15 females) who only received their optimized oral hypoglycemic medications. Fasting and post prandial blood glucose were measured initially before starting the treatment and after the end of the sessions in both groups. Results: Post-treatment there were a significant improve-ment in both fating and two hours post prandial blood glucose. There were a significant decrease in fasting and two hours post prandial blood glucose. Conclusion: The high intensity interval training is an effective tool to decrease insulin resistance and hyperglycemia this effect is mediated, in part, by the decrease in fasting and two hours post prandial blood glucose in type 2 diabetic patients which consequently helps in the treatment type 2 diabetes.
https://mjcu.journals.ekb.eg/article_110837_ce0c2fcc786a58515e14366d0fb3671f.pdf
Type 2 Diabetes
High intensity interval training
Blood Glucose
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1031
1039
10.21608/mjcu.2020.110838
110838
Original Article
Role of PET/CT in Diagnosis and Follow-up of Non-Hodgkin Lymphoma and Assessment of Extranodal Lymphoma
MAGGIE S. ABD ELGAWAD, M.Sc.; ABEER M. ABD ELHAMEED, M.D.
1
SAMAR R. RAGHEB, M.D.
2
The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
Abstract Background: Malignant lymphoma is the most common hematological malignancy accounts for approximately 8% of all adult malignancies. Lymphomas are broadly divided into Hodgkin lymphoma and non-Hodgkin's lymphoma. Non-Hodgkin lymphoma accounts for about 5% of all cases of cancer. Non-Hodgkin lymphomas have the vast majority of cases and have a greater predilection to disseminate to extra-nodal sites. Aim of Study: The aim of this work is to study the role of PET/CT in the diagnosis and follow-up of Non-hodgkin lymphoma and assess its extranodal extention. Patients and Methods: The study was conducted on thirty patients where the diagnosis of non-hodgkin lymphoma have been pathologically confirmed, 18 males (60%) and 12 females (40%), their ages are ranged between 19 to 73 years old. All patients were subjected to full history taking, laboratory testing, biopsy and histopathology, the studied cases according to pathalogical type of non-Hodgkin lymphoma mostly were of B-cell type (80%) and (20%) T-cell type, CT scan and PET/CT examination. All patients were examined using Siemens Bio-graph true point PET/CT scanner. Results: Extranodal involvement was detected by PET/CT in 16 patients (53.3%). Their distribution was as follows; head and neck: 4 patients (13.3%), lung: 3 patients (10%), abdomen: 12 patients (40%), MSK: 10 patients (33.3%), while CECT detected 8 patients had extra nodal involvement their distribution was as follow; head and neck: 2 patients (6.6%), lung: 1 patient (3.3%), abdomen:7 patients (43.7%), MSK: 6 patients (16.6%). Thirty patients referred for initial assessment SUV max among the 30 patients referred for initial assessment ranged from 3.7-34.0 with mean value of 16.91±8.07 SD. In aggressive type of NHL SUVmax ranged from 10.5- 34.0 with mean value of 19.9±6.65 SD, the aggressive type of NHL is significantly higher (p£0.01) than in indolent type. The cases were staged according to the size in CECT and FDG activity in PET/CT; CECT detected 6 patients (20%) in stage I, 9 patients (29.3%) in stage II, 7 patients (23.3%) in stage III and 8 patients (26.7%) in stage IV. The PET/CT detected 4 patients (13.3%) in stage I, 8 patients (26.7%) in stage II, 5 patients (16.7%) in stage III and 13 (43.3%) patients in stage IV, therefore PET/CT was statistically significant at p£0.0004 in the initial staging. In follow-up assessment among the 20 patients referred after treatment; SUVmax among the 20 patients referred for follow-up assessment, their SUVmax of the initial PET/CT examination ranged from 3.7-34.0 with a mean value of 17.57± 8.54 SD, with a significant change (p£0.046) in their follow-up examination with SUVmax ranged from 0.0-28.0 with a mean value of 11.73±9.25 SD. CECT showed 4 patients (20%) in complete regression, 13 patients (65%) in stable disease and 1 patient (5%) in progressive disease while PET/CT showed 7 patients (35%) in complete remission, 4 patients (20%) in partial remission, 0 (0.0%) patients in stationary disease, 9 (45%) patients in progressive disease. Thus, PET/CT was concordant with CECT in 6 (30%) cases and disagreed with CECT in 14 (70%) cases with significance (p£0.015). Conclusion: PET/CT agreed with CECT in the initial staging of 13 (43.3%) cases while disagreed with CECT in initial staging of 17 (56.7%) cases, where PET/CT upstaged 13 (43.3%) cases and down staged 4 (13.3%) cases. In follow-up PET/CT was concordant with CECT in 9 (45%) cases and disagreed with CECT in 14 (55%) cases with significance (p£0.034).
https://mjcu.journals.ekb.eg/article_110838_83b22496eccf184feda522f8aabcfe1f.pdf
PET/CT
Non-Hodgkin lymphoma
extranodal lymphoma
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1041
1046
10.21608/mjcu.2020.110839
110839
Original Article
Comparative Study between the Effect of Dorzolamide/Timolol Fixed Combination and Brimonidine/Timolol Fixed Combination on Corneal Endothelium
MOHAMED A. ABD ELSHAFIK, M.D.; MOMEN M. HAMDI, M.D.
1
RANDA H.A. ABDELGAWAD, M.D.; SONDOS A. SAEED, M.Sc.
2
The Department of Ophthalmology, Faculty of Medicine, Ain Shams University* and Damietta Eye Hospital, Damietta**
Abstract Background: Glaucoma is one of the most important cause of irreversible blindness in the world. Elevated Intraocular Pressure (IOP) remains the main known risk factor for the development and progression of the disease. The main thera-peutic goal is to preserve visual function by reducing the IOP, which is the key modifiable risk factor. Aim of Study: Is to compare the effect and safety of Dorzolamide/Timolol-Fixed Combination (DTFC) and Bri-monidine/Timolol-Fixed Combination (BTFC), on corneal endothelium after 3 months. Patient and Methods: This comparative non-randomized controlled clinical trial study included 57 eyes of 57 patients which was conducted in Damietta Eye Hospital. Their age ranged from 20-70 years old. The study population was divided into two groups: First group receiving DTFC: Included 27 eyes of 27 patients with open angle glaucoma and second group receiving BTFC included 30 eyes of 30 patients with open angle glaucoma. Result: Show that this adjusted difference between group 1 and group 2 through 3 months follow-up had no statistical significance in all variables such as IOP (p=0.172), CCT (p=0.072) and CD (p=0.406). Conclusion: The patients that received two fixed-combination (dorzolamide/timolol) and (brimonidine/timolol) had no statistically significant effect on CCT and ECD after 3 months from using these drugs.
https://mjcu.journals.ekb.eg/article_110839_22ecf97f36ba4643fb84b68cbc50a32c.pdf
Dorzolamide
Brimonidine
combination
Glaucoma
cornea
endothelium
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1047
1054
10.21608/mjcu.2020.110840
110840
Original Article
Routine Investigations in the Antenatal Booking Visit: An Epidemiological Survey
REEM S. BEDEIR, M.Sc.; BOTHINA A. GHAZY, M.D.
1
ABD E-LFATTAH MOHAMMED, M.D.
2
The Department of Obstetrics & Gynecology, Faulty of Medicine for Girls, Al-Azhar University
Abstract Background: The antenatal care investigations is very important to determine the antenatal care problems, manage these problems and decrease the maternal morbidity and mortality. Aim of Study: Is to identify the medical pattern in the egyptian pregnant women from Kafr El-Sheikh according to the results of the booking test. Patients and Methods: Cross sectional study was done over 1260 pregnant women from 2015 to 2017 from the outpatient clinic of Obstetrics and Gynecology in Kafr El-Sheikh General Hospital, out of them 260 pregnant women stepped out of the study, all the pregnant women was asked to do the following antenatal care laboratory investigations, complete blood count, random blood sugar, Rh typing, cy-tomegalovirus (CMV) IgG antibodies, hepatitis B virus surface antigen, hepatitis C virus antibodies, high vaginal swap for bacterial vaginosis, urine analysis, all the data gathered for each woman in a file with her name for the statistical analysis. Results: Percentage of anemia was 47.1% with negative significant correlation with age, percentage of DM was 8.1%, percentage of Rh negative was 12.6%, percentage of CMV IgG was 85.7%, percentage of HBV was 2.4%, percentage of HCV was 7.9% with positive significant correlation with history of previous CS, percentage of bacterial vaginosis was 27% and percentage of UTI was 62%. Conclusion: A lot of women in Kafr El-Sheikh do not know the importance of the antenatal investigations and the control of the antenatal problems. Recommendations: There is need for give more concern about routine antenatal care investigations and it's importance and routine screening for anemia, DM, Rh, CMV, HBV, HCV, BV and UTI.
https://mjcu.journals.ekb.eg/article_110840_fcf93397451c489411659524514b957a.pdf
antenatal care
Anemia
Diabetes mellitus
Rh negative
Cytomegalovirus IgG
Hepatitis B virus
Hepatitis C virus
Bacterial Vaginosis
Urinary tract infection
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1055
1063
10.21608/mjcu.2020.110841
110841
Original Article
CD5+ B Lymphocytes in Systemic Lupus Erythematosus Patients: Relation to Disease Activity
NAHED MONIR SHERIF, M.D.; AHMED M. ELYASAKI, M.D.;
1
SOHA E. IBRAHIM, M.D.; HADEEL T. ALI MAHDI, M.Sc.
2
The Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University
Abstract Background: Systemic Erythematosus (SLE) is a chronic, complicated and challenging disease to diagnose and treat. The etiology of SLE is unknown, but certain risk factors have been identified that lead to immune system dysregulation with pathogenic autoantibody formation and immune complex deposition. Aim of Study: To assess blood concentration of CD5+ B cells in patients with SLE and to evaluate their relationship with SLE disease activity. Patients and Methods: The present study included forty SLE patients who were selected from outpatient clinic of Rheumatology and Rehabilitation of Ain Shams University Hospital and diagnosed according to new EULAR and ACR classification criteria. Based on SLEDAI, the patients were selected and divided into two groups. The first group included 20 patients with inactive disease and the second group included 20 patients with active disease. They were matched with ten healthy individuals as a control group, and all were subjected to full history, clinical examination, ESR, CRP, serum com-plements, anti-dsDNA, ANA, serum creatinine twenty-four hours urinary proteins as well as CD5+ B lymphocytes by flow cytometric analysis. Results: In the present study, the percentage of CD5+ B lymphocytes per total lymphocytes were significantly de-creased in SLE patients compared to healthy individuals. Moreover, the percentage of CD5+ B lymphocytes per total B cells were significantly decreased in SLE patients compared to controls. We also have found a statistically highly significant decrease in the percentage of CD5+ B cells in active SLE patients compared to inactive patients. As regards the corre-lation studies, the results revealed a positive correlation between CD5+ B cells and each of platelets, C3 and C4. Moreover, the diagnostic performance of CD5+ B cells was evaluated and our results showed that CD5+ B cells can discriminate SLE patients from controls, and can predict the disease activity. Conclusion: The proportions of CD5+ B cells were sig-nificantly decreased in SLE patients than normal people, and were significantly decreased in active SLE patients than inactive ones. These findings denote that CD5+ B cells may have a potential role in preventing autoimmunity development.
https://mjcu.journals.ekb.eg/article_110841_7294d32a28d9bd537a2022387c1d6cce.pdf
Systemic lupus erythematosus
CD5+ B cells
disease activity
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1065
1071
10.21608/mjcu.2020.110842
110842
Original Article
Evaluation of Lupus Low Disease Activity: Characteristics, Predictors, and Association with Disease Damage: A Retrospective Cohort from Two Tertiary Centers in Egypt
BASMA M. MEDHAT, M.D.; MERVAT E. BEHIRY, M.D.
1
NAGLAA AFIFI, M.D.
2
The Department of Rheumatology & Rehabilitation* and Internal Medicine Department**, Faculty of Medicine, Cairo University, Cairo, Egypt
Abstract Background: Remission in systemic lupus erythematosus (SLE) is seldom achieved; making Lupus Low Disease Activity (LLDA) an alternative yet promising target. Aim of Study: The aim of this study was to evaluate the prevalence of remission and LLDA achieved, and the charac-teristics and predictors of LLDA, and its potential association with disease damage. Patients and Methods: The medical records of 243 patients fulfilling the 2012 Systemic Lupus Collaborating Clinics (SLICC) classification criteria for SLE and managed at Cairo and Ainshams Universities from January to December 2019 were viewed. Remission was categorized to: (i) Complete remission off glucocorticoid (GC) and Systemic Lupus Ery-thematosus Disease Activity Index-2K (SLEDAI-2K) = zero (antimalarial only); (ii) Clinical remission off GC with sero-logic activity (SKLEDAI-2K £4); (iii) Clinical remission on GC £5mg/day (SLEDAI-2K score £ 4 and serologic activity). LLDA was defined as SLEDAI-2K £4 in the absence of major organ involvement, GC dosage £7.5mg/day. Disease damage was assessed through the Systemic Lupus International Col-laborating Clinics/American College of Rheumatology Damage Index (SDI). Results: Seventy two (29.6%) patients achieved LLDA at the last visit; whereas 142 (58.4%) patients had a SLEDAI-2K score >4 and/or received a GC dosage of >7.5mg. One (0.4%) and 28 (11.5%) patients achieved clinical remission off and on GC, respectively. None of the patients achieved complete clinical and serologic complete remission. Patients achieving LLDA had an older age of onset compared to those with higher disease activity (p=0.003), and a lower prevalence of fever (p=0.009), weight loss (p=0.07), cutaneous vasculitis (p=0.002), serositis (p=0.006), nephritis (p=0.02), a lower median SDI score, and lower prevalence of developing severe damage (SDI ³3) (p=0.04). Predictors of LLDA were an older age of onset [p=0.006 (OR=1.05; 95% CI=1.01-1.09)] and weight loss [p=0.009 (OR=5; 95% CI=1.9-16.5)]; whereas patients with LLDA were less likely to have cutaneous vas-culitis [p=0.01 (OR=0.2; 95% CI=0.06-0.7)] or pleurisy and/or pleural effusion [p=0.001 (OR=0.2; 95% CI=0.1-0.5)].Conclusion: Achieving remission was substantially low. Lupus Low Disease Activity (29.6%) was associated with a higher age of onset, several distinct clinical characteristics, and lower damage.
https://mjcu.journals.ekb.eg/article_110842_5cc6677e6cf4d091b361624506047da7.pdf
Systemic lupus erythematosus
Lupus low disease activity - Disease activity
Disease damage
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1073
1079
10.21608/mjcu.2020.110843
110843
Original Article
Pulmonary versus Extrapulmonary Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcome
ABDALLAH S. AYOUB, M.D.; AHMED H. WAHBA, M.D.
1
ABDELMAABOUD M.M. OMAR, M.D.
2
The Departments of Chest Diseases* and Clinical Pathology**, Faculty of Medicine, Al-Azhar University, Egypt
Abstract Background: Acute respiratory distress syndrome is a clinical syndrome characterized by a refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary to direct or indirect lung insult (pulmonary and extrapulmonary form). These two categories of ARDS patients are different regarding the respiratory mechanics, lung recruitment, gas exchange, and positive end-expiratory pressure response. Aim of Study: The aim of this work was to compare the clinical characteristics and outcomes between the two major ARDS subtypes; pulmonary and extrapulmonary. Patients and Methods: A prospective study was conducted during the period from July 2014 to January 2016 in Intensive Care Unit, El-Hussein University Hospital. It included 60 patients diagnosed as ARDS. They were subclassified into pulmonary and extrapulmonary ARDS groups according to the cause of lung injury. Both groups were compared regarding the clinical features, response to treatment and clinical outcome. Results: Patients with extrapulmonary ARDS developed more deteriorated liver and renal functions and arterial blood gases with a better response to elevated levels of PEEP and vasopressors with a mortality rate of 75%. In patients with pulmonary ARDS, mild organs dysfunction were developed with a better response to low levels of PEEP and a mortality rate of 25%. Conclusion: Subdivision of ARDS into pulmonary and extrapulmonary categories has worthy effect on both treatment and clinical outcome. Additionally, they are different in the degree of organ dysfunction and severity of clinical pictures. Recommendation: Proper assessment of patients with ARDS at admission to put them within a major category whether pulmonary or extrapulmonary ARDS. This simple classification will help physician to decide on treatment and to predict prognosis.
https://mjcu.journals.ekb.eg/article_110843_781b09b4df37d63e7d734bac5a447df9.pdf
Pulmonary ARDS
Extrapulmonary ARDS
Acute Lung Injury
Intensive Care Unit
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1081
1088
10.21608/mjcu.2020.110844
110844
Original Article
Supratentorial Cavernous Malformations: Surgical Management and Outcome
AMR MOHSEN, M.D.; AHMED ASEM, M.D.
1
WALEED ABBASS, M.D.
2
The Department of Neurosurgery, Faculty of Medicine, Cairo University
Abstract Background: Cavernous malformations are common vas-cular malformations composed of thin-walled sinusoids with no intervening brain parenchyma. Aim of Study: To evaluate the outcome of surgical resection of supratentorial cavernous malformations. Patients and Methods: 12 patients with supratentorial cavernous malformations operated upon in the period from June 2014 to December 2016 in Cairo University Hospitals were retrospectively studied for surgical outcomes including extent of excision, improvement of symptoms and development of complications. Pre-operative CT and MRI were performed in all patients in addition to angiography when the diagnosis was doubtful. Patients were followed-up clinically and radi-ologically for 1 year after surgery. Results: The study included 6 males and 6 females with an average age of 34.6 years. The lesion was frontal in 4, temporal in 4, parietal in 3 and occipital in 1 patient. Epilepsy was the most common presenting symptom occurring in 6 patients. Total resection was achieved in 11 (91.7%) patients. Total resection of the surrounding hemosiderin-stained brain was achieved in 9 (75%) patients. Improvement of pre-operative symptoms was achieved in 11 (91.7%) patients. Post-operative complications occurred in 2 (16.6%) patients. Conclusions: Surgical excision of symptomatic supraten-torial cavernous malformations provides good control of pre-operative symptoms and has a low rate of morbidity and mortality. The aim of surgery should always be total excision of the malformation.
https://mjcu.journals.ekb.eg/article_110844_458ad406eca9b19d4d708c803f32ddb0.pdf
Cavernous malformation
Hemosiderin ring
Microsurgery
Total resection
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1089
1095
10.21608/mjcu.2020.110845
110845
Original Article
T2 Mapping Sequence in the Assessment of Articular Cartilage of Knee Joint. Is There Added Value?
MOHAMED A. YOUSSEF, M.D.; USAMA M. ABDELWAHAB, M.D.
1
The Departments of Radiodiagnosis* and Orthopedic Surgery **, Faculty of Medicine, Tanta University
Abstract Background: The diagnosis of early degeneration in the knee cartilage in the patients underwent routine Magnetic Resonance Imaging (MRI) is of clinical significant. T2 map-ping of the knee hyaline cartilage is a rapid technique for quantitative and qualitative detection of the cartilage. T2 mapping of the cartilage is a quantitative procedure that provides informative color mapping and quantitative detection of the cartilage as morphology, water distribution and collagen fiber volume. Aim of Study: Was assessing the value of adding T2 mapping sequence to a routine MRI of the knee to evaluate articular cartilage of the knee joint. Patients and Methods: 50 patients with history of oste-oarthritis or knee injuries (28 males and 22 females) with age between 15-66 years (average age, 40.9 years) were included in our study underwent MRI of the knee joint to assess the ability of T2 mapping sequence in evaluation of the knee joint articular cartilage. Results: In this study we found that nine cases of increased T2 relaxation time corresponding to normal-appearing cartilage diagnosed by routine MRI. In this study, all lesions that were visible on routine knee MRI were diagnosed by T2 mapping, and some T2 lesions were not detected on the routine knee MRI. Conclusion: When T2 mapping sequence was added to the routine MRI of the knee the sensitivity for detecting knee cartilage lesions was increased, especially in the detection of early cartilage degeneration.
https://mjcu.journals.ekb.eg/article_110845_1ad267ad059ee3a5b979ab562e41d3f4.pdf
MRI
T2 mapping
Knee joint
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1097
1101
10.21608/mjcu.2020.110846
110846
Original Article
Prevalence of Bronchial Asthma among School Aged Children in Elmaraghah Center in Sohag Governorate
ABDELAKHER A. RASHIED, M.Sc.; MOHAMMED M. ABDEL SALAM, M.D.
1
SAFAA A. ELNAGGAR, M.D.; DINA M. SHOKRY, M.D.
2
The Departments of Pediatrics* and Community Medicine**, Faculty of Medicine, Zagazig University
Abstract Background: Asthma and wheezes are the most common acute and chronic diseases in childhood. Early detection and good management of asthma is very important to reduce the risk and improve the health status of the diseased children. Aim of Study: Is estimation of asthma prevalence among school-aged children at Elmaraghah Center in Sohag Gover-norate, also to identify the role of different risk factors associated in aetiology of asthma. Patients and Methods: This cross sectional survey study, was conducted on 1796 children, (897 males and 899 females) from six to twelve years old in public primary schools in Elmaraghah center in Sohag governorate, all patient groups were exposed to questionnaire adopted from (ISAAC). Results: The prevalence of asthma between children included in the current study was (12.5%). Atopic dermatitis, food allergy, drug allergy, passive smoking and family history were related to high prevalence of bronchial asthma. Conclusion: The prevalence of asthma was 12.5%, and allergy to food and drugs is the most important risk factor of bronchial asthma.
https://mjcu.journals.ekb.eg/article_110846_63a850c8589019dbc250003e26675d05.pdf
prevalence
bronchial asthma
allergy
Atopy
risk factors
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1103
1107
10.21608/mjcu.2020.110847
110847
Original Article
Further New Components in the Volatile Oil of Sage
HADI A. AL-NAJJAR, Ph.D.
1
The Department of Pharmacy, College of Health Sciences, Public Authority for Applied Education and Training (PAAET), Kuwait
Abstract Background: As mentioned in the first part of this study, sage leaves and their essential oils are very important and most commonly used in the food, drug and perfumery indus-tries. The volatile oil of dried leaves of "Sage" Salvia Offic-inalis was obtained by hydrodistillation method (1.2% v/w). Aim of Study: The present study was a continuation of the previous one where four new constituents Kuwaitine 1, 2, 3, 4 were unveiled further analysis was carried out along the same procedure to determine and evaluate the essential components of the volatile oil of sage by (GC-MS) provided further data exposing further constituents. Material and Methods: Crushed dried Leaves (100g), were subjected to hydrodistillation E.P. (1984) GC-MS analysis was performed on Hewlett Packard 5850GC CONNECTED TO AN HP 5970 quadruple nano spectrometer (70cw) and an HP 9000 work station with helium as the carrier gas. Results: As mentioned in part one of the study 26 com-ponents representing 95% of the total oil were identified. Four of these components were not reported before. Thujone, Camphor Camphene, Pinene, Myrecene, Eucalyptol, Terpinlen, Linolool, Borneol, a-Terpinol and most abundant constituents of the oil about (51%). In addition significant amounts of unreported constituents were found to be present such as Peak No. 19, 20, 23, 40 whose Mwt and suggested stu preliminary chemical structure were elucidated and called Kuwaitene 5, 6, 7, 8 by the Author. Conclusion: GC-MS analysis of the volatile oil revealed at least 35 components, most of which could be identified, four of which were not reported in the literature before (peak no. 19, 20, 23 and 40. M. Wts 136 (Bicyclo 4. 1.0 HEPTANE, 7 (I-methylethylidene) 196 (2-Nor bornanol), 196 Isomer (Terpinyl acetate), 332 (Sandaracopimar-15, en-8, beta-yl acetate) respectively) named by the author as "Kuwaitene 5, 6, 7, 8".
https://mjcu.journals.ekb.eg/article_110847_0477ae93ce91929d34becb53afff49fd.pdf
Sage
Salvia officinalis leaves
Volatile oil GC-MS
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1109
1115
10.21608/mjcu.2020.110848
110848
Original Article
Prognostic Value of Serum Retinoic Acid Receptor Responder Protein 2 (RARRES2) in Chronic Hepatitis C Patients
DALIA R. IBRAHIM, Ph.D.; PHEBE L. ABDEL-MESSEIH, M.D.
1
The Department of Biological Applications, Nuclear Research Center* and The Department of Health Radiation Research, National Center for Radiation Research and Technology**, Atomic Energy Authority, Cairo, Egypt
Abstract Background: Adipocytokines play an important role in the development of metabolic abnormality and fibrogenesis in Chronic Hepatitis C virus (CHC) infection. The prognosis of CHC is still ill-defined. Liver biopsy for staging liver injury comprises variable risks. Many biochemical markers that mirror liver injury progression have been suggested. Aim of Study: The aim of this work is to measure the levels of serum Retinoic Acid Receptor Responder Protein 2 (RARRES2) and leptin in normal weight female CHC patients, as well as to study the correlation between these cytokines and the markers of liver damage, to assess the prognosis of chronic hepatitis C. Subjects and Methods: This study included 100 normal weight (BMI <25) female subjects; 50 patients of CHC, aged (43.50±6.31), and 50 healthy controls, aged (44.32±5.10). CHC was confirmed by the Polymerase Chain Reaction (PCR). Laboratory investigations included albumin, bilirubin, pro-thrombin time (the Child Pugh score), fasting glucose, fasting insulin, insulin resistance (HOMA-IR), alanine aminotrans-ferase (ALT), aspartate aminotransferase (AST), AST/ALT and Alkaline Phosphatase (ALP) activities along with serum RARRES2, leptin and alpha-fetoprotein. Results: Serum RARRES2, leptin, total bilirubin, pro-thrombin time (INR), ALT and AST activities were significantly higher, and albumin was significantly lower in the normal weight female CHC patients compared to the control. A significant negative correlation between each of RARRES2 and leptin with albumin; and a significant positive correlation between RARRES2 and INR; indicate that these adipokines increase as liver function worsens. Conclusion: The serum levels of RARRES2 and leptin may be considered additional non-invasive markers of prog-nostic significance in CHC patients.
https://mjcu.journals.ekb.eg/article_110848_963ba75712cc494b0730d15eaa5b77e7.pdf
Retinoic Acid Receptor Responder Protein 2
leptin
Chronic hepatitis C
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1117
1129
10.21608/mjcu.2020.110849
110849
Original Article
Role of Microwave Ablation in Treatment of Lung Tumors
EMAD H.A. EMARA, M.Sc.; MONA O. ABOELEZZ, M.D.
1
HOSSAM EL DIN M. ABDEL RAHMAN, M.D.; SAMEH S. BIOMY, M.D.
2
THOMAS J. VOGL, M.D.
3
The Department of Radiology, Faculty of Medicine, Kafrelsheikh University*, The Department of Radio Diagnosis, Faculty of Medicine, Zagazig University**, Egypt and The Department of Diagnostic & Interventional Radiology, Faculty of Medicine, Johan Wolfgang Goethe University, Germany
Abstract Background: Image-guided percutaneous thermal ablation is a common excellent alternative option for treatment of non-operable primary and metastatic lung tumors. These techniques are based on heating effect on the tissue around a percutaneous applicator causing coagulative necrosis of the tumor cells. Microwave Ablation (MWA) is a commonly used locoregional interventional procedure in treatment of pulmonary tumors with satisfactory outcome. Aim of Study: The aim of the study was to evaluate the role of CT-guided microwave ablation of inoperable lung tumors. Subjects and Methods: This study was carried out at Diagnostic & interventional Radiology Department, Goethe University Hospitals, Frankfurt, Germany during the period from April 2017 to March 2020, included 40 patients with 52 lung malignant lesions, underwent CT-guided microwave ablation. All patients were subjected to complete clinical examination, pre-procedural laboratory investigations & imaging evaluation. Post ablation follow-up by chest CT was done after 24 hours, three, six, nine months, one year and every 6 months onwards to determine treatment response. Patients were either adequately ablated (no residual tumor activity) or had local progression (residual tumor activity). Results: Forty-four malignant lesions (84.6%) showed complete response to treatment and 8 lesions (15.4%) had local progression (residual activity). The median time to local tumor progression was 8.3 months. The median survival was 32 months for patient underwent MWA according to the Kaplan-Meier test. The overall survival rate at 1, 2, and 3 years was 97.5%, 90%, and 82.5%, respectively. Successful tumor ablation was significantly more frequent for lesions with a maximal axial diameter of 3cm or smaller (p=.0001). There were no deaths during the procedure and the mortality rate within 6 months after ablation was 0%. Early postablation complications included pneumothorax (13.5%), pulmonary hemorrhage (9.6%) and postablation syndrome (3.85%), Pleural Effusion (3.85%), Hemoptysis (3.85%). Manual evac-uation was done in 3 cases out of 7 sessions complicated by pneumothorax. No significant long-term complications were detected.Conclusion: Percutaneous CT-guided microwave ablation therapy for management of pulmonary tumors is safe and effective minimally invasive option and can improve local tumor control and survival rate in patients who are not candi-date for surgical resection.
https://mjcu.journals.ekb.eg/article_110849_5ead115837d0f541a52bc42ea107713a.pdf
Microwave ablation (MWA)
Radiofrequency ablation (RFA)
CT-guided
Local tumor control
Lung tumors
non-small cell lung cancer (NSCLC)
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1131
1142
10.21608/mjcu.2020.110850
110850
Original Article
Outcomes of Aortobifemoral Bypass for TASC II C and D Aortoiliac Occlusive Disease; Lessons Learned
EL-SAYED A. ABD EL-MABOOD, M.D.; MOHAMED F. ABDELHALIM, M.D.
1
The Department of General & Vascular Surgery, Faculty of Medicine, Benha University* and The Department of Vascular Surgery, Benha Insurance Hospitals**, Egypt
Abstract Background: Aortobifemoral Bypass (ABFB) remains effective and durable treatment option for Aortoiliac Occlusive Disease (AIOD) and of cost-benefit in our country because of high cost of endovascular intervention. Aim of Study: To assess results of aortobifemoral bypass technique in the management of Trans-Atlantic Inter-Society Consensus II (TASC II) C and D lesions in aortoiliac segment. Patients and Methods: This prospective study was con-ducted on 19 patients with symptomatic aortoiliac atheroscle-rotic TASC II C and D lesions. All patients were subjected to clinical evaluation, laboratory assessment, CT angiography scan, respiratory function tests and cardiac assessment by echo Doppler. Aortobifemoral bypass was performed for all patients who were divided into two groups A & B according to type of proximal anastmosis. Follow-up period was 30 months. Results: All patients passed uneventful intra-operative course without technical failure; midline incision was done in 12 patients (63.2%). Proximal anastomosis was end to side in group A (13 patients (68.4%)) and end to end in group B (6 patients (31.6%)). Mean operative time and PO hospital stay was longer in Group B: (4.6±1.9 hours, range: 3.2-5.7) and (7.2±2.9 days, range: 6-9 days) respectively. Graft patency was 100%, 94.7% and 89.4% at 12, 24 and 30 months respec-tively. Conclusions: Aortobifemoral bypass is still a good option in aortoiliac occlusive disease especially complex lesions; TASC II C and D lesions as it has long durability and can be tailored to appropriately selected patients. So ABFB is still valuable technique in the field of vascular surgery.
https://mjcu.journals.ekb.eg/article_110850_e67cda99515cdd3911eb0e3e14ddf182.pdf
TASC II C and D Aortoiliac lesions
Aortobifem-oral bypass
outcomes
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1143
1156
10.21608/mjcu.2020.110851
110851
Original Article
Frontal Sinus Variations and Prevalence of Frontal Recess Cells among Adult Egyptians: Computerized Tomography Study
ABDEL-FATTAH H. AL-EBIARY, M.D.; GAMAL H. MOHAMMED, M.D.
1
HADEEL S. EMAM, M.Sc.; REDA A. IMAM, M.D.
2
The Department of Anatomy & Embryology, Faculty of Medicine, Cairo University
Abstract Background: The frontal sinus is often considered as the most challenging area to approach in Functional Endoscopic Sinus Surgery (FESS). Considerable variations in the shape, capacity and symmetry of frontal sinus have been reported. Aim of Study: To provide better understanding of frontal sinus morphometry and anatomical variations of specific frontal recess cells and their prevalence among adult Egyptians. Material and Methods: Coronal and sagittal CT scans of sixty adult persons of the Egyptian population (30 males and 30 females, assigned into Group 1; from 20 to 30 years, group 2; from 31 to 50 years and group 3; more than 50 years) were done to demonstrate the anatomy of the frontal sinus. Results: A statistically significant difference in the width of the right sinus between group 2 and group 3 was revealed. Eighty percent of frontal sinuses were asymmetrical. Agger nasi cell was the most common encountered frontal recess cell and mostly bilateraly presented. The second common was Interfrontal sinus septal cell (IFSC). Statistically significant association was found between Fronta Bullar Cell (FBC) and frontal cell type 4 (FC4) but no statistically significant differ-ence was found between males and females except for frontal cell type 3 (FC3) which was higher among females than males. Statistically significant positive correlation between A-P length of left FR and AP length of right FR was revealed, while no significant correlation was found between AP length and volume of ANC. Conclusion: Awareness of frontal sinus dimensions frontal recess cells variations among Egyptians should be taken in consideration in safe frontal endoscopic surgery.
https://mjcu.journals.ekb.eg/article_110851_477f43a7cb2364904608958514736fe6.pdf
Frontal
sinus
Recess
Cells
Egyptians
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1157
1163
10.21608/mjcu.2020.110852
110852
Original Article
Clippless Laparoscopic Cholecystectomy Using Ultrasonic Dissection
HAMED A. ELBADAWY, M.D.; MAHMOUD M. SALAMA, M.Sc.
1
GAD Y. MEKKI, M.D.
2
The Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar* and Ain Shams** Universities, Cairo, Egypt
Abstract Background: The surgical removal of the gallbladder, or cholecystectomy, is one of the more commonly performed procedures by general surgeons. Cholecystectomy represents the most common biliary tract procedure and the second most common surgical procedure overall. Aim of Study: To evaluate the role of Harmonic scalpel in laparoscopic cholecystectomy in closure of cystic duct and artery and its complications. Patients and Methods: This prospective randomized study was conducted at El-Zahra University Hospital, Cairo, Egypt, on 100 consecutive patients between March 2017 and October 2019 with chronic calcular cholecystitis. Patient selection for the study was based on clinical diagnosis, ultrasonographic examination findings, laboratory investigations. All patients of the study were subjected to laparoscopic cholecystectomy using the harmonic scalpel for hemostasis and for sealing of the cystic duct without using any ligatures or clips. Results: The operative time in patients of the study ranged between 40-105min with a mean operative time of 55.4±15.6 min. In our patients post-operative bleeding occur in two cases (2%) which was minimal and stopped spontaneously, wound infection in 3 patients (3%), bile leak was present in one case (1%), which stop spontaneously after 5 days. Conclusion: The use of ultrasonic technology in the closure of the cystic duct has proven to be as safe and effective as the commonly used simple metal clips. Neither minor nor major bile leaks attributed to the use of ultrasonic technology were encountered throughout the study period.
https://mjcu.journals.ekb.eg/article_110852_9288fa06899fbe82c7835d1ed7366c00.pdf
Clippless laparoscopic cholecystectomy
Har-monic scalpel
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1165
1174
10.21608/mjcu.2020.110866
110866
Original Article
Involvement of Peroxisome Proliferator-Activated Receptor-a and g in Apelin Action on the Kidney in Type 2 Diabetic Rat Model
RANDA S. GOMAA, M.D.; NEVERTYTY M. MAHMOUD, M.D.
1
JEHAN SAEED, M.D.
2
The Departments of Medical Physiology*, Pharmacology** and Internal Medicine***, Faculty of Medicine, Zagazig University
AbstractBackground: Apelin is an adipokine that revealed numerousrenoprotective actions; however, its effect in diabeticnephropathy is controversial.Aim of Study: The objectives of the current study wereto determine the action of apelin administration on nephropathyin type 2 diabetic rat model and to clarify its possible mechanismsand if PPARs activation is involved in these mechanisms.Material and Methods: Thirty adult male wistar rats weresubdivided into control, diabetic and diabetic-apelin treatedrats. Type 2 diabetes was induced via a high-fat diet togetherwith a single low-dose of streptozotocin. Apelin was injectedintraperitoneally for 10 weeks. Serum glucose, insulin andlipid profile were estimated. Homeostatic Model Assessmentfor Insulin Resistance (HOMA-IR) was calculated. Renalfunctions were evaluated by serum urea and creatinine, urinaryalbumin excretion, urinary N-acetyl-beta-D-glucosaminidase(NAG) activity and histopathological inspection. Renal tissuehomogenate was assessed for Superoxide Dismutase (SOD),Malondialdehyde (MDA), Nitric Oxide (NO) content andPPAR-a and PPAR-g gene expression.Results: Apelin administration to diabetic rats improvedhyperglycemia, insulin resistance, dyslipidemia, renal functionparameters and pathological lesions in the kidney that resultedfrom induction of diabetes. It elevates renal SOD and NO,decreased MDA and increased PPAR-a and g gene expressionin comparison to diabetic rats.Conclusions: Apelin administration to diabetic rats improvedinsulin resistance, hyperglycemia, dyslipidemia andrenal functions which may be partially via its antioxidantproperties and NO dependent mechanism that struggled theharmful properties of diabetes on the kidney. Besides, apelininduced upregulation of both PPARa/g genes expression thatcould be involved in the renoprotective effect of apelin. Moreinvestigations for the mechanism by which apelin acts onPPARa/g are recommended.
https://mjcu.journals.ekb.eg/article_110866_1afeb54467fd7db346fdf482e0357e29.pdf
Apelin
PPARs
diabetic nephropathy
Oxidative Stress
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1175
1185
10.21608/mjcu.2020.110867
110867
Original Article
Assessment of the Treatment Response of Hepatocellular Carcinoma to Radiofrequency Ablation Using Dynamic and Diffusion MR Imaging according to LI-RADS v2018 Treatment Response Algorithm
SHAIMA F. ELKHOLY, M.D.; DALIA K. SEROUR, M.D.
1
The Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Egypt
Abstract Background: Hepatocellular carcinoma is the most com-mon primary liver malignancy and considered as the fifth most common cancer worldwide. Resection and liver trans-plantation have a high survival in adequately selected patients, however locoregional ablative therapeutic techniques has several advantages over surgery like hepatic parenchymal preservation and overall have less morbidity and mortality. Aim of Study: The aim of this study was to evaluate the role of diffusion and dynamic MR imaging in the assessment of the treatment response of hepatocellular carcinoma after radiofrequency ablation according to the LI-RADS treatment response v2018. Patients and Methods: A retrospective study included 40 patients with 45 HCC lesions underwent radiofrequency ablation and followed-up by dynamic and diffusion MR imaging. The data were collected from the PACS of Radiology Department, Cairo University Hospitals. The MR images were assessed according to LI-RADS 2018 treatment response algorithm. Results: According to LI-RADS treatment response cri-teria, dynamic MRI has sensitivity of 100%, specificity 95.8%, Positive Predictive Value (PPV) 94.1% and Negative Predictive Value (NPV) 100% compared to sensitivity of 64.3%, specif-icity 95.8%, PPV 90% and NPV 82.1% for the diffusion weighted images in the detection of tumoural viability. Arterial Phase Hyperenhancement (APHE) was found in 87.5% of viable lesions while delayed wash out was found in 100% of the viable lesions. Conclusion: Dynamic MRI is the cornerstone in the assessment of treatment response of hepatocellular carcinoma to radiofrequency ablation. Arterial phase hyperenhancement and delayed wash out are the main criteria for diagnosis of tumoural viability according to LI-RADS treatment response algorithm. Diffusion imaging and ADC measurement are good negative techniques for exclusion of tumoural activity and also can confirm the dynamic findings in viable cases.
https://mjcu.journals.ekb.eg/article_110867_0ef129c7fc48948013ad86773359869d.pdf
HCC
RFA
Diffusion MRI
LI-RADS
Treat-ment response
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1187
1192
10.21608/mjcu.2020.110868
110868
Original Article
Hepatic Iron Overload in Transfusion Dependent Chronic Hemolytic Anemic Patients: Where Does MRI R2* Relaxometry Stand?
WESSAM A. ELZAYAT, M.D.; MONA EL-KALIOUBIE, M.D.
1
The Department of Diagnostic and Intervention Radiology, Faculty of Medicine, Cairo University
Abstract Background: Hepatic iron overload in pediatric population with repeated blood transfusion is an important morbidity warranting the evolution of a noninvasive method of liver iron quantification. MR T2*/R2* relaxometry technique has shown promising results in this domain. Aim of Study: To show the value of MR T2*/R2* relax-ometry technique, in assessment of hepatic iron overload in a sample pediatric patient population at our hospital on repeated blood transfusions therapy for thalassemia and sickle cell anemia. Patients and Methods: A total of 44 patients, mean age 11.14±3.38 (range: 6-17 years old) patients with thalassemia and sickle cell anemia who had received more than 20 blood transfusions and on chelation therapy at the time of the examination, underwent MRI T2*/R2* relaxometry study. The corresponding iron overload was calculated for each patient, then correlation between R2* and serum ferritin level was done by using Pearson's correlation coefficient. Results: Serum ferritin levels ranged between 56.7 and 11524ng/mL (mean 3605.8ng/mL). R2* values ranged between 77.1 and 11426Hz (mean 2361Hz). Based on the calculated Liver Iron Concentrations (LIC) values which ranged between 0.47 and 42.55mg/g (mean 11.38mg/g) 9 patients (20.45%) showed normal hepatic iron load, 10 patients (22.73%) showed mild iron overload, 13 patients (29.55%) showed moderate overload and 12 patients (27.27%) showed severe overload. The correlation between R2* and serum ferritin was a weak positive one with a Pearson's coefficient of 0.49 (p=0.000645). The correlation between LIC and serum ferritin was a moderate positive one with a Pearson's correlation of 0.5 (p=0.000494). Conclusion: Quantification of liver iron deposition in children with chronic hemolytic anemia receiving multiple blood transfusions is empirical for chelation therapy monitor-ing. R2* relaxometry shows promising results as an effective quantitative tool for estimation of hepatic iron overload when compared to serum ferritin levels, therefore providing a safer alternative in contrast to tissue biopsy.
https://mjcu.journals.ekb.eg/article_110868_cbcbe7b581021eeea320f0fa0641b738.pdf
Chronic hemolytic anemia
iron overload
Liver MRI
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1193
1202
10.21608/mjcu.2020.110869
110869
Original Article
Dynamic Contrast - Enhanced Magnetic Resonance Imaging (DCE-MRI) in Diagnosis of Pulmonary Nodules
MOHAMAD M. ALHOUSINI ALASHWAH, M.D., F.R.C.R.; MONA A. EL-NENAEY, M.Sc.
1
AMR T. EL-BADRY, M.D.; BASEM AL-SHAFEY, M.D.
2
The Department of Radiodiagnosis, Faculty of Medicine, Tanta University*, Menshawy Tanta Hospital** and The Department of Chest, Faculty of Medicine, Tanta University***
Abstract Background: The differentiation between the benign and malignant pulmonary nodules has been considered as a major challenge for many years. Despite the fact that biopsy and histopathological evaluation are crucial for the definitive diagnosis, recent non-invasive imaging modalities are prom-ising in their results. Aim of Study: The aim of this study is to evaluate the role of Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) in diagnosis of pulmonary nodules. Patients and Methods: This study is a cross-sectional study that has been conducted on 60 patients with lung nodules referred to Radio Diagnosis and Imaging Department from Chest and Oncology Departments through the period from September 2018 to September 2019. Results: There were statistically significant differences between malignant and benign cases in terms of maximum net enhancement (p=0.003) and ADC value (p < 0.001). The mean maximum net enhancement was 474±94.417, the mean washout ratio was 5.45±2.17%, and the mean ADC value was 1.2±0.34 X 10–3mm2/sec. Malignant cases had significantly higher maximum net enhancement, washout ratio, and lower ADC values. The maximum enhancement curve was a signif-icant discriminator, which yielded a sensitivity of 92.6% and specificity of 96% at a cut-off value of ³375. In contrary, the ADC value had poor diagnostic accuracy in differentiating between malignant and benign cases. Conclusion: Dynamic contrast-enhanced MRI is valuable for diagnosis of pulmonary nodules and discrimination of benign from malignant ones.
https://mjcu.journals.ekb.eg/article_110869_67811c2eb560fc0c39bb85cde21ca375.pdf
Magnetic Resonance Imaging
Pulmonary nod- ules
Dynamic contrast enhanced
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1203
1211
10.21608/mjcu.2020.110870
110870
Original Article
Role of Osteopontin as a Potential Marker of Hepatocellular Carcinoma
EHAB A. ABD ELATTY, M.D.; AHMED E. ABD EL-ALIM, M.D.
1
REEM M. ELKHOLY, M.D.; KHALED M. ELSAYED, M.Sc.
2
The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Menoufia University and The Department of Internal Medicine, Hehia Central Hospital***
Abstract Background: Osteopontin is an important tumor marker, since it presents as an immobilized extracellular matrix molecule in addition to present as a secreted form in body fluids involving plasma. Osteopontin levels in the plasma were found to be significantly higher in Hepatocellular Car-cinoma (HCC) patients than in healthy control individuals and also higher than in patients with chronic liver diseases. Aim of Study: The aim of the present study is to evaluate the role of plasma OPN level as potential markers of HCC among HCV infected patients, compared to AFP. Also, its relationship with clinicopathological features of HCC patients. Study Design: This is a retrospective case control study. Subjects and Methods: The study included 100 adult subjects; they were classified in to 4 groups: Group 1: It included 30 apparently healthy individuals (control group). Group 2: It included 30 patients with HCV positive chronic hepatitis. Group 3: It included 20 patients with HCV positive liver cirrhosis without HCC. Group 4: It included 20 patients with HCV positive liver cirrhosis and HCC. Serum Osteopontin was measured by Enzyme-Linked Immunosorbent Assay ELISA. Results: The mean OPN level was (33.1±16.4) ng/ml, (27.8±13.8) ng/ml, (92.87±18.5) ng/ml and (232.13±59.7) ng/ml for control, HCV, cirrhosis and HCC groups respectively, p-value=0.0010 and there were highly statistical significant differences between the four groups (p < 0.001). The mean AFP level was (4.6±2.4) ng/ml, (8.01±2.76) ng/ml, (24.8±25.9) ng/ml and (639±2226.8) ng/ml for control, HCV, cirrhosis and HCC groups respectively, p-value=0.0014 and there were highly statistical significant differences between the four groups (p < 0.001). Conclusion: OPN can be used for diagnosis of HCC and differentiation between HCC and CLD, OPN has higher sensitivity and specificity than AFP and can be used for early diagnosis. Combination of OPN wih AFP has increased both sensitivity and specificity for detection of HCC.
https://mjcu.journals.ekb.eg/article_110870_631edb25c963f7d8e1c8c5da156239e7.pdf
Hepatocellular carcinoma
Chronic liver disease
Osteopontin
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1213
1218
10.21608/mjcu.2020.110871
110871
Original Article
Role of Multislice CT in the Evaluation of Non-Vascular Complications Following Hepatic Transplantation from Adult Living Donors
HAZEM H. SOLIMAN, M.D.; MEDHAT MADBOULI, M.D.
1
The Department of Radiology, Faculty of Medicine, Cairo University* and Theodor Bilharz Research Institute, Cairo**, Egypt
Abstract Background: Hepatic transplantation especially from living donors has allowed widespread utilization of the pro-cedure in management of terminal hepatic disease. Complications following hepatic transplantation are en-countered frequently. These complications may be either vascular or non-vascular complications. The non-vascular complications may include, biliary complications, infection and tumoral recurrence. Different diagnostic radiological procedures are used for identification of these complications including ultrasound, Doppler, computed tomography and magnetic resonance imaging. Recent advances in multislice computed tomography including the multiplanar and angiographic capabilities have expanded the role of computed tomography in the identification and differentiation of such complications. Aim of Study: The aim of this study is to highlight the importance of multi-slice CT in the identification and evalu-ation of the various non-vascular post-operative complications in recipients following hepatic transplantation. Patients and Methods: This is a prospective study that included 45 patients presenting with suspected post hepatic transplantation complications. Patients were referred to the Kasr Al-Aini Hospital Radiology Department between October 2017 to December 2019 to perform Multislice CT (MSCT) for further evaluation of underlying complications. Results: Non-vascular complications were found in 21 cases (46.6%). Biliary complications represented 57.1% of the non-vascular complications (7 cases biloma and 5 cases biliary stricture). Parenchymal complication included 2 cases of hepatic abscess (9.5%) and 2 cases of graft rejection (9.5%). Neoplastic complications included 4 cases recurrent HCC (19%) and 1 case neoplastic lympho-proliferative disorder (4.7%). Conclusion: MSCT of the liver is a feasible non-invasive procedure for evaluating non-vascular complications following liver transplantation allowing prompt and proper intervention.
https://mjcu.journals.ekb.eg/article_110871_fe915ec228e7f0bd7cef16372f254949.pdf
MSCT
hepatic
transplantation
Complica-tions
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1219
1225
10.21608/mjcu.2020.110872
110872
Original Article
The Role of EUS and EUS-FNA in Detection of Small Sized Liver Metastatic Lesions in Patients with Pancreatic and Gastro-Intestinal Primary Malignancy
HANAN ABDEL HAFEZ, M.D.; HUSSEIN HASSAN OKASHA, M.D.
1
AHMED MOHAMED HASHEM, M.Sc.; MOHAMED HASSANY, M.D.
2
SAEED M. EL-NAHAAS, M.D.
3
Endemic Medicine Department and Hepatology Unit*, Internal Medicine Department**, Faculty of Medicine, Cairo University and National Hepatology & Tropical Medicine Research Institute***, Cairo, Egypt
Abstract Background: Liver is common site of metastasis. Small liver masses (<2cm) are not easily detected by ultrasound or computed tomography. Endosonography allows visualization of liver anatomy. Aim of Study: To assess usefulness of endosonography and EUS-FNA in detecting small sized liver metastasis; not diagnosed by CT scan during TMN staging of gastro-intestinal and pancreatic malignancy. Patients and Methods: This prospective comparative study included 92 cases with pancreatic, peri-ampullary and GI malignancies. Patients undergone: CBC, serum bilirubin, AST, ALT, ALP, GGT, serum protocol albumin, prothrombin concentration, creatinine, AFP and CA19.9, abdominal ultrasound, pancreatic computed tomography scan and endosonography. EUS-FNA and cyto-logical examination were performed in 23 patients. Results: CT scan detected 27 patients with liver focal lesions, one patient was missed. While EUS detected 27 cases, and also one patient was missed. Among cases diagnosed by EUS, 4 cases were cholangitic abcesses, EUS-FNA was performed in 23 cases, revealing metastatic lesions in 21 patients, benign lesions in 2 patients (focal fat depletion). EUS had 95.45% sensitivity, 97.14% specificity, 91.3% positive predictive value (PPV), 98.55% negative predictive value (NPV) and 96.74% accuracy. CT had 95.45% sensitivity, 91.43% specificity, 77.78% PPV, 98.46% NPV and 92.39% accuracy. EUS-FNA, had 95.45% sensitivity, 100% specificity, 100% PPV, 98.5% NPV and 98.91% accuracy. Conclusions: EUS and EUS-FNA play a significant role in detecting small sized liver metastasis, where EUS and EUS-FNA showed a higher diagnostic accuracy compared to that of CT scan.
https://mjcu.journals.ekb.eg/article_110872_a5fa3f91a382f285747697c9a931a760.pdf
Endosonography
liver metastasis
Pancreatic malignancy
Gastro-intestinal malignancy
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1227
1232
10.21608/mjcu.2020.110873
110873
Original Article
Role of Anterior Approach in Management of Bilateral Cervical Locked Facet
RAMI TEAMA, M.D.
1
The Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt
Abstract Background: Cervical facet dislocation is the forward displacement of one cervical vertebra relative to another. Aim of Study: The aims of surgical intervention are rea-lignment and, decompression of the compressed neural struc-tures and instrumentation to stabilize the injured spine. Anterior approaches can regain normal cervical curvature and associated with little postoperative pain, better wound healing and appearance and less wound infection. Patients and Methods: A prospective study of 19 patients with bilateral cervical locked facet who underwent surgical treatment at benha university hospitals over a period of three years (Jan. 2017 / December 2019) is presented. Carefull general and neurological examination was done with preop-erative CT cervical spine as the main investigation. All cases were operated using anterior approach with the use of casper screws reduction technique to restore and stabilize the cervical curve. Results: The study group contained 16 women and 3 men. The age of patients in this study ranged from 21 years to 54 years and the mean age was 37 years. The mean follow-up period was 18 months. 15 cases presented with incomplete spinal cord injury. There were no intraoperative mortality or surgery related complications. 3 cases showed improvement while 2 cases died during follow-up due to chest problems. Conclusion: Anterior cervical decompression, reduction using casper pins elevation technique and fusion using in-tervertebral cage and plate system is very safe, effective method for the management of bilateral subaxial cervical locked facet with great success rate and very few complications in addition to familiarity to most neurosurgeons.
https://mjcu.journals.ekb.eg/article_110873_62e9cdcdde0038f8555e407cadbf079b.pdf
Cervical
Locked facet
anterior approach
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1233
1237
10.21608/mjcu.2020.110874
110874
Original Article
Autologous Priming of Cardiopulmonary Bypass in Adult Patients, Effect on Blood Transfusion, Hemodilution and its Effect on Body Systems
MAMDOOH EL SHARAWY, M.D.; NADER A. EL BOREY, M.D.
1
DINA M. OSMAN, M.Sc.; AHMED M.A. BAKRY, M.D.
2
The Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University
Abstract Background: Development of many techniques conserve blood in cardiac surgery has been established, to avoid the side effects of homologous blood transfusion. One of these techniques is the Retrograde Autologous Priming (RAP); which is a blood conservation technique designed to decrease the severity of hemodilution during cardiopulmonary bypass and thus decreasing perioperative transfusions. Aim of Study: The aim was to examine the safety and efficacy of RAP and its role in decreasing adverse outcomes on body systems after cardiac surgery. Patients and Methods: This work was performed on 60 adult patients indicated for open heart surgery as valvular heart disease or coronary heart disease. 30 patients were operated using RAP technique and 30 patients using ordinary priming method of cardiopulmonary bypass (CPB). Results: The CPB mean time was significantly shorter in the RAP group. The hemoglobin (Hb) level and hematocrit (Hct) concentration in the perioperative and postoperative time as significantly higher in the RAP group also the platelet count was significantly higher in the RAP group (p < 0.05) with decreased incidence of post-operative bleeding in the RAP group. Also, there was significant reduction in the incidence of post-operative liver affection; there was no statistically significant difference in postoperative renal, pulmonary and neurological complications (p>0.05) between the two groups. Conclusions: RAP is an efficient and economical method in limiting the amount of priming volume of the CPB system, causing less hemodilution, reducing intra- and postoperative blood transfusion and decreasing adverse effects of hemodi-lution on body systems.
https://mjcu.journals.ekb.eg/article_110874_c90c68759cff20a022af1e751cd3eeff.pdf
Retrograde autologous priming
autologous blood
Hemodilution
platelet count
Liver
kidney
pulmonary
Neurological complica-tions
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1239
1245
10.21608/mjcu.2020.110875
110875
Original Article
Calculatin the Effective Intravenous Heparin Dose: Comparison between Lean and Actual Body Weight-Based Dosing in Obese Patients
AMR F. ABO EL FOTOUH, M.D.; NADER E. AWAD, M.D.
1
JANE N.R. ABOULENEIN, M.D.; ASEM Sh. ABD EL KHALIQUE, M.Sc.
2
The Department of Cardiology, National Heart Institute and Faculty of Medicine, Mansoura University
Abstract Background: Despite the availability of newer anticoag-ulants, unfractionated heparin remains a mainstay anticoagulant for atrial fibrillation, acute coronary syndrome with or without percutaneous intervention, treatment and prevention of deep vein thrombosis (DVT), pulmonary embolism (PE), and other thromboembolic disorders. Aim of Study: The aim of this study is to investigate if intravenous heparin dosing based on lean body weight (LBW) of obese patients would be safe and effective in achieving activated partial thromboplastin time (APTT) within 24 hours compared to the usual practice. Patients and Methods: This is a case-control study con-ducted in Cardiology Department Sammanaud General Hos-pital from May 2017 to May 2018 to investigate if intravenous heparin dosing based on LBW of obese patients would be safe and effective in achieving target APTT within 24 hours compared to the usual practice. The study included 50 obese patients with a diagnosis of atrial fibrillation, suspected or confirmed deep venous thrombosis or pulmonary embolism, unstable angina or Non ST elelvation myocardial infarction with hemodynamic stability, or peripheral vascular disease. Patients aged >18 years randomized into two groups (1) and (2). Results: Studies found that unfractionated heparin dosage adjustments based on the patient's LBW provided therapeutic anticoagulation more rapidly and safely, but protocols based on total body weight increase the risk of a supra-therapeutic PTT. Conclusion: Unfractionated heparin remains a mainstay anticoagulant for atrial fibrillation, acute coronary syndrome with or without percutaneous intervention, treatment and prevention of deep vein thrombosis (DVT), pulmonary embo-lism (PE), and other thromboembolic disorders. As lean body weight contributes to approximately 99% of a drug's clearance, it is useful for guiding dosing in obesity. These findings may enhance the utility of LBW as body descriptor instead of TBW in calculating the effective doses of UFH in treatment of thromboembolic disorders.
https://mjcu.journals.ekb.eg/article_110875_5e0c92c68b9c6d96db15ff54ba7c045b.pdf
Intravenous heparin dose
Lean body weight- based
Actual body weight-based
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1247
1255
10.21608/mjcu.2020.110876
110876
Original Article
Comparison between Different Risk Scores in Predicting Hospital Mortality for Patients with Decompensated Liver Cirrhosis: A Single Center Study
MAHMOUD H. ALLAM, M.D.; MOHAMED A.S. KOHLA, M.D.
1
WESAM S. MORAD, M.D.
2
The Departments of Hepatology & Gastroenterology* and Epidemiology & Preventive Medicine**, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
Abstract Background: Predicting prognosis of patients with decom-pensated liver cirrhosis remains an important issue. Aim of Study: This study aimed to evaluate the predictive value of different patients' characteristics and risk scores as regard patients' outcome (death or survival). Patients and Methods: 672 patients with different com-plications of cirrhosis (gastrointestinal bleeding, hepatic encephalopathy, SBP, HRS and ascites) who were admitted to the National Liver Institute Hospital between 2015 and 2018 were included in this study. On admission to the hospital, assessment of patients by routine laboratory work-up (liver and kidney function tests and complete blood count), ultrasound of the abdomen, upper endoscopy for those with bleeding and ascitic fluid sampling for those with ascites. MELD, MELD-Na, CTP, ALBI and PALBI grades were calculated for all patients. At the end of hospitalization, patients outcomes were stratified as survived or died. Patients clinical and laboratory parameters were correlated with hospital mortality. Receiver Operating Curves (ROC) for risk scores were plotted to discriminate the predictive power of risk scores versus mor-tality. Results: The overall hospital mortality was 27.1%. Uni-variate analysis revealed age, total and direct bilirubin, albumin, transaminases, alkaline phosphatase, INR, serum creatinine, BUN, serum sodium and white cells count as significant, while multivariate analysis concluded age, total bilirubin, serum creatinine, Blood Urea Nitrogen (BUN), serum sodium (Na), INR and white blood cells count significance with hospital mortality, (p < 0.05). The area under receiver operating curve for MELD-Na was (0.85), MELD score (0.84), CTP score (0.82), AlBI grade (0.75) and PALBI grade (0.75), p < 0.001. Conclusion: MELD-Na and MELD scores are good pre-dictors for prognosis of patients with decompensated liver cirrhosis. But, ALBI and PALBI grade are promising scores which needs more validation.
https://mjcu.journals.ekb.eg/article_110876_aeecfc066e277f0b5f463d15b039e6f2.pdf
Decompensated cirrhosis
Predictor scores
Survival
HCV
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1257
1264
10.21608/mjcu.2020.110877
110877
Original Article
Comparison of Superficial Surgical Site Infection between Delayed Primary versus Primary Wound Closure in Complicated Appendicitis
ALAA A.S. MOSTAFA, M.D.; MOHAMED I.H. BORAI, M.D.
1
MOSTAFA K. HUSSEIN GHANEMA, M.Sc.
2
The Department of General Surgery, Faculty of Medicine, Ain Shams University
Abstract Background: Acute appendicitis is the most common cause of acute abdomen in adults. Open appendicectomy is the treatment of choice for complicated appendicitis. Perforated appendicitis has an infection rate 15-20% post-operative surgical site infection can increase morbidity. Thus it can lead to increase in post-operative pain, hospital stay, sepsis and patient dissatisfaction, Surgical Site Infection (SSI) and its associated complications like wound dehiscence, stitch sinuses, incisional hernias, hypertrophic scar and keloid formation are not only a source of discomfort for the patients but also discouraging for the surgeons. These complications prolong the post-operative stay of patient and increase the cost of treatment. Aim of Study: To compare the efficacy of primary wound closure with delayed primary wound closure in terms of wound infection after surgery for perforated appendix and get local evidence of the effectiveness of either procedure. Patients and Methods: This study was done between May 2018 and December 2018 in the General Surgery Department in Ain Shams University Hospital and Damietta General Hospital. The study included 50 patients presented with complicated appendicitis. The patients were divided into 2 groups A and B using lottery method. Patient in group-A underwent primary closure of the skin immediately after surgery while patients in group-B were subjected to delayed primary closure of the skin for perforated appendix. Results: In our study, in delayed primary closure there was 2 patients with positive signs of superficial surgical wound infection but in primary closure there was 11 patients. The total post-operative hospital stay in delayed primary closure ranges from 4 to 9 days and in primary closure ranges from 3 to 9 days with no significant difference between the two groups. Conclusion: Our study suggested that patients undergoing open appendectomy for complicated appendicitis, DPC was the preferable method for wound management than primary closure because of a lower incidence of wound infection DPC could be considered for wound management in patients with perforated appendicitis.
https://mjcu.journals.ekb.eg/article_110877_d65eea91b20a2d9ad1c43ed23dbd1dad.pdf
Surgical Site Infection
Coagulase Negative Staphylococci
Delayed primary skin closure
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1265
1268
10.21608/mjcu.2020.110878
110878
Original Article
Optical Coherence Tomography as a Diagnostic Tool of Ischemic Macular Edema of Diabetic Retinopathy
AMIRA M. HAZAA, M.B.B.Ch.; ABDELRHMAN G. SALMAN, M.D.
1
REHAM F. ELSHINAWY, M.D.; WAEL A. GOMAA, M.D.
2
The Department of Ophthalmology, Faculty of Medicine, Ain Shams University
Abstract Background: Diabetic Macular Ischemia (DMI) is recog-nized as an important cause of visual disability, it is considered as an important clinical feature of Diabetic Retinopathy (DR). Disorganization of Retinal Inner Layer (DRIL) is defined as the horizontal extent in microns for which any boundaries between the ganglion cell-inner plexiform layer complex, inner nuclear layer, and outer plexiform layer could not be identified.and considerd as featurer of capillary non perfusion. Aim of Study: To study the rule of dril assessed by Optical Coherence Tomography (OCT) in differentiation between the ischemic and non-ischemic diabetic maculopathy. Patients and Methods: 66 eyes of 66 patients were enrolled in prospective study and divided into 3 equal subgroups; control normal patients, patients with ischemic diabetic maculopathy and patients with non-ischemic diabetic macu-lopathy diagnosed by FFA. All patients underwent full oph-thalmological examination and OCT macula was done to assess the DRIL. Results: We found that there was highly statistically significant difference (p=0.000) between non ischemic and ischemic groups as regard presence or absence of DRIL. Sensitivity of DRIL (by OCT) is 86.36%, specificity is 81.82%, positive predictive value is 82.61% and negative predictive value is 85.71%. Conclusion: There was a statistically significant difference in presence or absence of DRIL between ischemic and non-ischemic diabetic retinopathy.
https://mjcu.journals.ekb.eg/article_110878_3b9c1d973e2f4a7169553bcd64fa3e8e.pdf
Diabetic maculopathy
DRIL
OCT
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1269
1277
10.21608/mjcu.2020.110928
110928
Original Article
Role of MRI in Detection and Local Staging of Rectal Cancer
AHMED H. HASSAN BEK, M.Sc.; SHAYMAA H.M. SALAH, M.D.
1
MOHAMED A. ALY, M.D.
2
The Department of Radio-Diagnosis and Interventional Radiology, Faculty of Medicine, Ain Shams University
Abstract Background: Colorectal cancer is one of the most frequent causes of cancer-related death worldwide. An accurate preop-erative rectal cancer staging is crucial to the correct manage-ment of the disease. Despite great controversy around this issue, pelvic magnetic resonance is said to be the standard modality. Aim of Study: The aim of this study is to assess the role of MRI in detection and local staging of rectal cancer. Patients and Methods: 30 patients with rectal carcinoma were included with MRI and histopathological assessment of cancer staging to evaluate MRI accuracy. All patients received pre-operative neoadjuvant chemotherapy. Results: T3 staging with MRI, calculation of sensitivity, specificity, negative and positive predictive value were 73.3%, 40%, 60% and 55% respectively. T4 staging with MRI, cal-culation of sensitivity, specificity, negative and positive predictive value were 100%, 77%, 100% and 40% respectively. Conclusion: MRI has a good sensitivity for tumor staging and nodal staging.
https://mjcu.journals.ekb.eg/article_110928_5a160b39cde29f6f4d2f5b6681c2807c.pdf
colorectal cancer
MRI
T
N staging
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1279
1285
10.21608/mjcu.2020.110929
110929
Original Article
Effect of Prone Position versus Diaphragmatic Release in Patients with COPD in ICU
ISAAC Z. ZARII, M.Sc.; SAMIR A. EL GAZAR, Ph.D.
1
YOUSSEF M. AMIN SOLIMAN, M.D.; NAGY L. NASSIF, Ph.D.
2
The Department of Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy* and The Department of Pulmonology, Faculty of Medicine**, Cairo University
Abstract Background: Chronic Obstructive Pulmonary Disease (COPD) is a major health problem characterized by chronic airflow limitation that is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Aim of Study: This study was carried out to compare the therapeutic effect of prone position versus diaphragmatic release in patients with COPD in ICU. Patients and Methods: Sixty patients with COPD were randomly assigned into two equal groups. The methods of assessment included Acid-base analyzer. Group (A) lied in prone position, for one hour for five consecutive days while Group (B) received diaphragmatic release technique for five consecutive days. Results: The results showed that there was significant increase in PaO2 and O2Sat in second group compared to the first group. In relation to ABG results and O2Sat. The study revealed that the results obtained in second group were superior to that of first group. Conclusion: It was concluded that diaphragmatic release technique superior to prone position in treatment of COPD in ICU.
https://mjcu.journals.ekb.eg/article_110929_adfb0451406ed8087a8f7873fe23175d.pdf
COPD
Diaphragmatic release – Prone position – Acid-Base analyzer
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1287
1295
10.21608/mjcu.2020.110931
110931
Original Article
Evaluation of Nutritional Status as a Prognostic Indicator for the Outcome in Liver Transplant Recipients
MOHAMED A.M. ALI, M.D.; RANDA A. SHOUKRY, M.D.
1
DALIA F. EMAM, M.D.; EMAN I. EL-DESOKI MAHMOUD, M.D.
2
MOHAMED I.I. AKP EL-BAB, M.Sc.
3
The Department of Anesthesiology, General Intensive Care Medicine & Pain Management, Faculty of Medicine, Ain Shams University* and Fellow of General Intensive Care, National Hepatology & Tropical Medicine Research Institute, Cairo**
Abstract Background: Mal-nutrition is a common complication of the end-stage liver disease and associated with increased morbidity and mortality rates. Numerous studies have proved that pre-operative mal-nutrition is related to higher risk of surgical morbidities and mortalities in general surgical patients. Mal-nourished patients tend to have high rates of infectious complications, prolonged intensive care unit (ICU) stay, hospital stay and increased mortality. Aim of Study: To determine the impact of nutritional status pre-liver transplant on recipients' course and the outcome post-transplant. Patients and Methods: Pre-operative nutritional assessment with Subjective global assessment (SGA) was done retrospec-tively for 52 patients, categorized as well-nourished, mild, moderate and severe mal-nourished and followed for post-operative course. Results: The causes of transplant were mainly decompen-sated chronic liver disease (46.2%), hepato-cellular carcinoma (32.7%) and auto-immune with HCC (11.5%). As a result of all these complications, the ICU stay, hospital stay, 28 day mortality were less in well-nourished patients in comparison to the mal-nourished one. Conclusion: The nutritional status pre-liver transplant is an important factor which can affect the outcome of the liver transplant patients. The mal-nourished patients showed a higher incidence of post-operative sepsis, a higher post-operative bilirubin levels, a more need for post-operative nutritional intervention, a higher incidence of need of re-intubation for mechanical ventilation, a higher incidence of post-operative renal impairment and neurological complica-tions. As a result of all these complications, the ICU stay, hospital stay, 28 day mortality were less in well-nourished patients in comparison to the mal-nourished one. So, pre-operative assessment and optimizing the nutritional status is an essential step before proceeding for surgery.
https://mjcu.journals.ekb.eg/article_110931_061c1efa78900c8c68fff2f14828d7b2.pdf
Malnutrition
Mal-nourished
Well-nourished
Liver transplantation
SGA
HCC
Decom-pansated chronic liver disease
TPN
Demo-graphic data
BMI
Post-operative
Nutritional intervention
stay
mortality
Liver functions
Sepsis
renal
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1297
1305
10.21608/mjcu.2020.110932
110932
Original Article
Peripapillary Choroidal Thickness Measurement in Glaucoma Patients Using Spectral Domain Optical Coherence Tomography
OSAMA A. RASLAN, M.D.; MOHAMED A. ZAKI, M.D.
1
TAMER F. ELIWA, M.D.; IBRAHIM G. TAWFIK HELAL, M.Sc.
2
The Department of Ophthalmology, Faculty of Medicine, A in Shams University
Abstract Background: Glaucoma, the leading cause of irreversible blindness worldwide, can adversely impact quality of life for patients with visual field defects even if they are unaware of their diagnosis. In many populations, POAG is the most common form of the disease. Aim of Study: To measure peripapillary choroidal thickness in eyes with primary open angle glaucoma versus normal eyes using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging mode (EDI). Patients and Methods: The present study involved Ninety eight eyes of fifty adult patients were included in this obser-vational, case control study. These cases were collected from out-patient ophthalmic clinic of Ain Shams University Hospital during the period from March, 2018 till March, 2019. Results: A total 98 eyes of 50 patients were included in this observational study, with mean age of 52.26 years old. 48% of patients were males [24/50], while females were 52% [26/50]. These cases were divided into control group (50 eyes of 25 healthy controls) and glaucoma group (48 eyes of 25 patients). Conclusion: Peripapillary choroidal thickness (PCT) in primary open angle glaucoma cases shows no significant correlation nor in early or sever cases, so PCT has no role in early detection or follow-up of primary open angle glaucoma cases.
https://mjcu.journals.ekb.eg/article_110932_6d03c06a197ed940fba1eba169a1d9a2.pdf
Primary Open angle glaucoma
Peripapillary choroidal thickness
Optical coherence tomog-raphy-enhanced depth imaging mode
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1307
1313
10.21608/mjcu.2020.110935
110935
Original Article
Effect of Using Perfluorocarbon Liquids on Postoperative Retinal Displacement in Vitrectomy for Treatment of Primary Rhegmatogenous Retinal Detachment: A Comparative Study
MOHAMED A. AZAB, M.Sc., MOSTAFA H. NABIH, M.D.
1
AYMAN M. KHATTAB, M.D.; ISLAM A. MOHALHAL, M.D.
2
Research Institute of Ophthalmology, Ministry of High Education, Giza* and Department of Ophthalmology, Faculty of Medicine, Cairo University***, Cairo, Egypt
Abstract Backdround: Perfluorocarbon liquids (PFCLs) are widely used for years as an adjuvant in vitrectomy for repair of retinal detachment. Studies have been made to find out the post-operative effects of using PFCLs on the retina. A new imaging modality, Fundus Autofluorescence (FAF) can describe retinal displacement after vitrectomy clearly, which we could not describe it before with other imaging modalities. Aim of Study: To compare the incidence of retinal dis-placement after vitrectomy for repair of primary rhegmatog-enous retinal detachment (RRD) with and without the use of (PFCLs) using (FAF), and correlate them with final best corrected visual acuity (BCVA) and postoperative symptoms of distortion if present. Patients and Methods: A comparative, prospective, inter-ventional, randomized study. Thirty eyes of thirty patients having primary rhegmatogenous retinal detachment were divided into 2 groups. Group A: 15 eyes underwent pars plana vitrectomy without the use of PFCLs and group B: 15 eyes underwent pars plana vitrectomy with the use of PFCLs. Fundus Autofluorescence and amsler grid were done following absorption of intraocular gas. Results: Retinal displacement evident on FAF was (53.3%) of cases in group A (without PFCL), and (40.0%) of cases in group B (with PFCL), respectively (p-value = 0.464). PFCL use has no statistical significance in the incidence of retinal displacement. There was no statistically significant difference in the final mean BCVA between the two groups. Postoperative distortion was detected in (85.7%) of eyes showing retinal displacement on FAF. Conclusion: Retinal displacement is common following RRD repair and the use of PFCLs does not seem to affect the incidence of displacement.
https://mjcu.journals.ekb.eg/article_110935_36c4f0f9afee3bbe7242716385b8e678.pdf
rhegmatogenous retinal detachment
Retinal displacement
Pars Plana Vitrectomy
Perfluor-ocarbon liquids
Fundus autofluorescence
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1315
1326
10.21608/mjcu.2020.110936
110936
Original Article
Can MDCT Measures of Upper Airway Dimensions and Central Obesity Indices Predict the Severity of Obstructive Sleep Apnea (OSA)?
BASMA GADELHAK, M.D.; MONA EL-BESHBISHI, M.D.
1
EMAN EL-NADY, M.Sc.; MOHAMED EL-GAMAL, M.D.
2
The Department of Diagnostic Radiology*, Faculty of Medicine, Mansoura University, Students' Hospital**, Mansoura University and Chest Medicine Department***, Faculty of Medicine, Mansoura University
Abstract Background: Comparative evaluation of the CT measures of upper air way, tongue adiposity and central obesity in a group of obstructive sleep apnea (OSA) patients and in a control group, and their potential role in grading of OSA severity. Aim of Study: The objective of the present study was to comparatively evaluate the different the upper air way, tongue adiposity and central obesity measures by CT scan in patients with obstructive sleep apnea syndrome (OSA) and in a control group, and their potential role in grading of OSA severity. Material and Methods: This prospective case control study was carried out on 17 OSA patients diagnosed by PSG and 16 control subjects. Non contrast MDCT scan of the upper airway and mid abdomen was performed on Philips 128 detector scanner, 1mm slice collimation during quite breathing. Axial and Sagittal reformatted images were assessed. Man-dibular plane hyoid distance (MPH), upper airway length (UAL), minimum cross-sectional area (MCA), transverse and antero-posterior diameters of the airway (TDA, APD), length and thickness of uvula and soft palate (LUV,TUV), tongue area and tongue base density (TA, TD) were measured. Image J program was used for quantification of neck and visceral adipose tissue (NAT, VAT). Results: Statistically significant difference was found in most CT measures between the OSA and control groups, the highest significant values were found with MCA, TDA, TUV and TA (p < 0.005). MCA and TA had the best diagnostic performance for OSA diagnosis. Statistically significant difference was found in MPH, UAL, MCA, TDA, TA, TD and NAT between the severe OSA and mild/moderate grades, The highest significant values was found with UAL and MCA (p=0.001, 0.002). For identifying severe OSA MCA, TDA and TA offered high diagnostic performances. Binary logistic regression found that TA and MPH were the significant predictors for severe OSA with overall % predicted=88.2%. Conclusion: Our results indicate that CT offers added value in OSA diagnosis and prediction of severity, multiple CT measures varied significantly between OSA and control group as well as between different OSA grades.
https://mjcu.journals.ekb.eg/article_110936_5646a51919c7f0429cdb7bea5e8f8c98.pdf
Computed tomography
Obstructive sleep apnea
Obesity
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1327
1332
10.21608/mjcu.2020.110938
110938
Original Article
Recurrent Achalasia after Surgical Treatment
AHMED MONIER, M.D.; ALI SALEM, M.D.
1
MOSTAFA ABU ZIED, M.D.; AMR SANAD, M.B.B.Ch.
2
MOHAMED DOSOKY, M.D.
3
The Department of Gastrointestinal Surgery Center, Faculty of Medicine, Mansoura Univeristy
Abstract Background: Laparoscopic Heller myotomy with a partial fundoplication is the mainstay of surgical treatment of achalasia of the cardia. The failure of surgical therapy in the treatment of achalasia is related to different causes that have not yet been conclusively defined in the literature. Aim of Study: To analyze different predictors of recurrence of achalasia after surgical treatment. Patients and Methods: This is a retrospective study that was conducted to patients who underwent surgical interventions for achalasia at Gastrointestinal Surgical center (GISC), Mansoura University, Egypt during the period between January 2007 and December 2017. The aim of this study is to analyze different predictors of recurrence of achalasia after surgical treatment. Results: 191 patients underwent Heller cardiomyotomy with a mean age of 37.08±14.98 years and mean body mass index of 24.78±6.98kg/m2. Recurrence of achalasia occurred in 33 (17.3%) patients. Surgical remyotomy was performed in 14 (42.42%) patients while balloon dilatation was performed in 19 (57.6%) patients. Factors associated with higher recur-rence rate were higher Eckhardt Score and younger age (p < 0.05). Conclusion: Age was negatively correlated with recur-rence. However, Eckhardt score was positively correlated with it. Moreover, binary logistic regression revealed that younger age is a strong predictor of recurrence after surgical management of achalasia.
https://mjcu.journals.ekb.eg/article_110938_a5bce6f2904f5a39f61a71688c21f00d.pdf
Achalasia
Heller’s cardiomyotomy
Surgical treatment failure
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1333
1341
10.21608/mjcu.2020.110940
110940
Original Article
Assessment of Urea and Creatinine in Vaginal Washing Fluid as a Method for Diagnosis of Premature Rupture of Membranes
SAFAA ABDEL-SALAM IBRAHIM, M.D.; AHMED MAHMOUD FARAG, M.D.
1
The Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
Abstract Background: Premature rupture of membranes (PROM) refers to rupture of fetal membranes prior the onset of labor. If it occurs before 37 weeks of pregnancy, it is known as preterm premature rupture of membrane (PPROM). Prolonged duration from PROM till delivery is associated with increased maternal and neonatal morbidities, in term and preterm preg-nancies. This includes chorioamnionitis, fetal and neonatal sepsis, placental abruption, prematurity, umbilical cord pro-lapse, and increased rate of cesarean delivery. Pregnant women with history of vaginal leaking or ultra-sound evidence of diminished amniotic fluid should be care-fully evaluated to avoid adverse pregnancy outcomes. Accurate diagnosis helps obstetricians to optimize maternal and neonatal outcomes by early intervention to decrease morbidities. Diagnosis of PROM is may be easy by inspection of leaking through the cervix or fluid accumulation via speculum examination. However, with small rupture of membrane or rupture bag of hind-water, it is difficult to see amniotic fluid leakage clearly and diagnosis can't be easily made, which might lead to delay in diagnosis and management. Methods of PPROM diagnosis include fern and nitrazine which are two commonly used and traditional tests. They are rapid and easy tests but not completely reliable because of high false positive and negative results, which may be related to technical errors or contamination by blood, semen or cervical mucus. Ultrasound evaluation of amniotic fluid can't differentiate PROM from other causes of oligohydramnios. However, tampon or amnio-dye test is a test of accurate diagnosis through aspiration and dye injection into amniotic fluid under ultrasound guidance. It is an aggressive test with has a risk of bleeding, placental abruption infection, miscarriage, and iatrogenic uterine perforation. The Amnisure test for ROM is accurate but expensive and not available in many centers. Thus, a simple, non-invasive, and inexpensive method of detecting PROM is needed. Urea and creatinine are excreted by kidneys through glomerular filtration. Amniotic fluid also contains these markers and their determination in the vaginal can be used as a diagnostic test for PROM.Aim of Study: This study was conducted to evaluate the diagnostic value of urea and creatinine levels in vaginal wash in patients with suspected PROM. Patients and Method: The study was carried out at Ob-stetrics and Gynecology Department, Zagazig University Hospitals. A total of 228 pregnant women were included in study, between completed 24 weeks to completed 37 weeks' gestation. Divided into two equal groups: Group A with definite PROM, control Group is B. All pregnant women included in this study were subjected to: Full history taking, general, abdominal and speculum examination, fern test and nitrazine test. Vaginal wash urea measurement by enzymatic urease examination method and vaginal wash creatinine measurement by RATE JAFFE method. Results: The study showed that there is statistically significant difference between the two groups regarding vaginal wash urea and creatinine. The best cut-off value of vaginal wash urea in prediction of PROM is >!6.85mg/dl with AUC of 0.958, sensitivity of 98.2%, specificity of 70.2%, PPV of 76.7%, NPV of 97.6% and accuracy of 93%. The best cut-off value of vaginal wash creatinine in prediction of PROM is >!0.465mg/dl with AUC of 0.992, sensitivity of 100%, specificity of 80.7%, PPV of 83.8%, NPV of 100% and accuracy of 90.4%. Combined use of vaginal wash urea and creatinine in prediction of PROM had sensitivity of 98.3%, specificity of 91.2%, PPV of 91.8%, NPV of 98.1% and accuracy of 94.7%. Conclusion: This study concluded that urea and creatinine assay in vaginal fluid is cheaper, faster and more valid test, possible candidate for being a gold standard test for diagnosis of PROM.
https://mjcu.journals.ekb.eg/article_110940_14069c452973a7d1459920c1b50a8d94.pdf
urea
creatinine
Premature Rupture of Mem-branes (PROM)
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1343
1347
10.21608/mjcu.2020.110941
110941
Original Article
Phytochemical Investigation of Gynandriris Sisirinchium (Kuwait Medicinal Plants)
HADI A. AL-NAJJAR, Ph.D.
1
The Department of Pharmacy, College of Health Sciences, Public Authority for Applied Education and Training (PAAET), Kuwait
Abstract Background: Gynandriris sisyrinchium is a traditionally used medicinal plant, yet there is no enough information about its phytochemical profile. In this endeavour. Aim of Study: We aimed to carry out a detailed phyto-chemical screening of the active constituents in the bulbs, stems, leaves and flowers of Gynandriris sisyrinchium growing wild in Kuwait. Material and Methods: Phytochemical screening were done for plant after collection from Kabd Area in Kuwait during March 2005. Results: The present study results reported moderate presence of cardiac glycosides, carbohydrates and saponins in the bulbs, while Flavonoides are more in the aerial parts. Triterpenes and sterols are present in slight quantities. Also it's clear that the plant is devoid of Alkaloids and Anthraqui-nones. Conclusion: The results of the current paper could serve as a starting point for further future investigation of the contents of the Gynandriris syrinchium plant.
https://mjcu.journals.ekb.eg/article_110941_b147f9594ef7fe828aaf8f620c8eb15b.pdf
Gynandriris sysirinchium
Iridaceae
Flavonoids
Cardiac glycosides
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1349
1355
10.21608/mjcu.2020.110943
110943
Original Article
Ultrasound Assessment of Pedal Soft Tissue Thickness in Diabetic Patients With and Without Peripheral Neuropathy
NEHAL T. MOHAMMED, M.D.; MOHAMAD M. MOTAWEA, M.D.
1
FADY A. KYRILLOS, M.D.
2
The Departments of Diagnostic Radiology* and Diabetes & Endocrinology**, Faculty of Medicine, Mansoura University, Egypt
Abstract Background: Foot ulcer is a serious complication of diabetes which can cause patient disability. High plantar pressure is one of the risk factors for ulcer formation. Pedal Soft Tissue (PST) thickness is essential in keeping its cush-ioning effect. Atrophy of PST leads to increase in the plantar pressure, which subsequently leads to ischemia and ulceration. Aim of Study: To compare the PST thickness opposite the Metatarsal Heads (MTHs) in diabetic patients with and without peripheral neuropathy using Ultrasound (US) as an easy, available, and non-invasive tool. Material and Methods: We examined the feet (n=96) of 48 diabetic patients using high-frequency US imaging (10- 13MHz). We divided the patients into 2 groups. The first group included 24 diabetic patients with peripheral neuropathy (mean age 56±6 years), and the second group included 24 diabetic patients without peripheral neuropathy (mean age 57±5 years). We measured and compared the vertical thickness of PST superficial to flexor tendons opposite all MTHs in between the 2 groups using independent-sample-t-test. Results: There was statistically significant difference in mean PST thickness under all left MTHs (first 5 vs. 6.4; second 6.1 vs. 7.8; third 6.2 vs. 7.4; fourth 5.6 vs. 6.9; fifth 4 vs. 5.7mm; p < 0.05), and the first, second, third and fifth right MTHs (first 5.1 vs. 6.3; second 6.1 vs. 7.5; third 5.8 vs. 7.3; fifth 4.4 vs. 5.9mm; p < 0.05) between the first and second groups, respectively. Age, Body Mass Index (BMI) and sex had no significant effect on PST thickness in both groups. Conclusion: Our study confirmed that US is effective, easy, available, harmless, low cost, non-invasive imaging tool that detects more PST atrophy in diabetic patients with pe-ripheral neuropathy than that occurs in diabetic patients without peripheral neuropathy.
https://mjcu.journals.ekb.eg/article_110943_bf4841498e05dfcb654967a28388f00d.pdf
Ultrasound
diabetes
Pedal soft tissue thickness
Neuropathy
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1357
1363
10.21608/mjcu.2020.110944
110944
Original Article
The Value of Immediate Computerized Tomography Following Emergency Surgery for Traumatic Brain Injury: Experience in A Tertiary Center in Egypt
MOHAMMED F. ADEL ALI, M.D.; HASHEM ABOUL-ELA, M.D.
1
AHMED ALI MOHAMED, M.D.; AHMED M. SALAH, M.D.
2
The Department of Neurosurgery, Faculty of Medicine, Cairo University
Abstract Background: Traumatic brain injury remains a major cause of death and disability all over the world. In Egypt it represents a major public health problem, representing 17.2% of trauma patients. Various factors determine the prognosis after TBI, the primary insult, which is irreversible and the secondary insults which continue to evolve during the subse-quent period after trauma. Aim of Study: In this study, we examined the value of immediate post-operative head CT scans in trauma patients to assess its efficacy and role in returning back to operation room. Results: We prospectively studied 145 patients with head injury who underwent surgery at Kasr Al-Ainy Hospitals during a period of 4 months between 10/2018 and 1/2019. All patients had immediate follow-up CT within 2 hours and another follow-up within 48 hours. The results of the immediate CT were: 121 cases improved (83.4%), expected worsening in 14 patients (9.7%) out of which 5 patients had redo surgery, unexpected worsening in 8 patients (5.5%) out of which 2 patients had redo surgery and 2 patients with unexpected new fining (none of them required redo). The 48 hours CT revealed no change in 133 patients (91.%), unexpected new finding in 12 patients (8.3%) most of these changes were in patients with ASDH. Conclusion: Unexpected change in the neurological ex-amination was the single most influential factor in determining the need for redo surgery. The low-cost, meticulous neurolog-ical examination appears to be superior to a routine CT scan in determining return to the operation room.
https://mjcu.journals.ekb.eg/article_110944_c0541dd69e4daf8cf9bcd6b26e4810ec.pdf
Traumatic brain injury
Computed tomography
Head injury requiring craniotomy
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1365
1371
10.21608/mjcu.2020.110945
110945
Original Article
An Option for Good Outcome of Intracerebral Hematoma
AHMED ALI, M.D.; HUSSEIN SOFFAR, M.D.
1
The Department of Neurosurgery, Faculty of Medicine, Cairo** and Bani Suif* Universities
Abstract Background: Intracerebral hematoma affects about 2.5 per 10,000 people each year. The incidence is more in males and older people. The mortality rate is about 44% in the first month. 20% of cases has a good outcome. Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. Often symptoms get worse over time. In many cases bleeding occurs in the brain tissue and the ventricles at the same time. Many procedures and techniques have been introduced for the management of intracerebral hematoma and debate always exist about the management of sizable intracerebral hematomas especially if the conscious level isn't markedly affected. Aim of Study: To evaluate the role of early evacuation of sizable intracerebral hematomas even if the conscious level isn't markedly deteriorated. Method: This is a retrospective study of 30 cases of intracerebral hematoma operated in Kasr El-Aini Hospitals and Bani Suef University Hospitals by evacuation assisted by microscope with a Glasgow Coma Scale more than 10 in most cases with a sizable intracerebral haemorrhage more than 30cc in the volume. Results: This study results was 22 (73%) male patients and 8 (27%) was female patients. The age group was 4 patients (13%) under 30 years, 22 patients (73%) were from 30-45 years and 4 patients (13%) were more than 45 years old. The Glasgow Coma Scale (GCS) on admission was 14-15 in 4 patients (13%) patients, from 10-13 was 14 patients (46%), and from 9 and less was 12 patients (41%). 20 patients (67%) case was diabetics, 23 patients (46%) cases was hypertensive, 2 patients (7%) had chronic renal failure on regular dialysis, 1 patient (3%) case was pregnant. The GCS post-operative was 14-15 in 20 patients (70%), 10-13 in 5 patients (16%), and from 9 and less in 5 (24%) cases. The operation done was evacuation in all cases, decompressive craniectomy in 8 patients (26%), ventriculosubgaleal shunt done (VSG) in 3 patients (10%). The side of the hematoma was left sided in 7 patients (24%), right in 23 patients (76%). Good out come in 25 cases (83%), recollection in 3 (10%) cases, residual hematoma in 2 (6%) of the cases, re evacuation done in 1 patient (3%). Mortality were 4 patients.Conclusion: Sizable intracerebral hematoma (volume more than 30cc) in good Glasgow coma scale mostly obeying orders, spontaneous eye opening, and aphasic or not, to obtain a good outcome is to evacuate the hematoma not to wait for conservative management.
https://mjcu.journals.ekb.eg/article_110945_e597c8a04e465fdeb4e3e5eadad4ba68.pdf
Intracerebral hematoma
The glasgow coma scale (GCS)
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1373
1380
10.21608/mjcu.2020.110946
110946
Original Article
Hybrid Approach as a Bailout for Treatment of Combined Iliac and Common Femoral Artery Lesions: "Is It Fit for Purpose?"
EL-SAYED A. ABD EL-MABOOD, M.D.; AHMED FOUAD AHMED, M.D.
1
The Department of General Surgery, Benha University* and Vascular Surgery Department, Benha Insurance Hospital**
Abstract Background: Open surgery of multilevel lower limb arterial disease has high morbidity. For treatment of such complex anatomy; Hybrid technique can provide durable and less invasive procedures tailored to medically high risk patients. Aim of Study: To evaluate hybrid management of symp-tomatic combined iliac and common femoral artery lesions. Patients and Methods: Prospective study was performed on 26 cases with symptomatic combined iliac and common femoral artery lesions. Hybrid approach was performed for all patients; open surgery for common femoral artery lesions and endovascular interventions for other lesions. Follow-up was 12 months. Results: All patients passed uneventful intra-operative course without technical failure; After the first month, primary patency was reported in 26 patients (100%) and limb salvage in 24 cases (92.3%). After 6 months; primary patency was observed in 24 cases (92.3%) and limb salvage in 22 patients (84.6%). After 12 months; primary patency was noticed in 18 patients (69.3%) and limb salvage in 20 patients (76.9%). Secondary patency was restored in 6 patients (23.1%). Conclusions: Hybrid approach; endovascular intervention for iliac and/or infrainguinal arterial lesions as an adjunct to open surgical repair of common femoral artery lesions, play a great role as a bailout for treatment of symptomatic combined iliac and common femoral artery lesions with satisfactory patency and limb salvage rates and allow effective, minimal invasive and durable therapeutic options especially in high risk patients.
https://mjcu.journals.ekb.eg/article_110946_8d68d4d22a6009a61f244cdf7b71dd39.pdf
Hybrid management
Combined aortoiliac and common femoral artery lesions
outcomes
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1381
1391
10.21608/mjcu.2020.110948
110948
Original Article
Fused PET/CT or CECT in Post-Therapeutic Assessment of Colorectal Cancer: A Study of the Efficacy of the Modality of Choice among Egyptian Patients
TALAAT A. HASSAN, M.D.; AHMED A. BAZ, M.D.
1
The Department of Radiology, Faculty of Medicine, Cairo University
Abstract Background: One of the most common cancers, colorectal cancer accounts for several tumor-related mortalities; its high recurrence rates either as a local recurrence of the disease or as a distant metastatic disease (up to 35-40%) have been reported in the treated patients within the first two years following surgery. There has been heated debate over the modality of choice for imaging of the recurrent colorectal cancer. Aim of Study: This study investigates the diagnostic performance of fused Positron Emission Tomography/ Com-puted Tomography (PET/CT) in comparison to Contrast-Enhanced Computed Tomography (CECT) as a follow-up and restaging imaging tool for post-therapeutic colorectal cancers among Egyptian patients. Subjects and Methods: Data were collected from 84 Egyptian patients (26 females and 58 males, age ranges from 35 to 80 years) who were treated from colorectal cancers. They were referred to a private imaging center for evaluation of their disease recurrence by fused PET/CT. Results: Disease recurrence was categorized as operative bed recurrence/residual (incomplete therapeutic response), nodal, and distal metastases. The site of the tumor recurrence was predominantly seen in the rectosigmoid region in 31 patients (36.9%), followed by the ascending colon where it was present in 13 patients (15.4%), then the transverse colon as depicted in 9 patients (10.7%); the descending colon recurrence was noted in 6 patients (7.1%), and the caecal recurrence existed in only one patient (1.3%). With reference to the gold standard (the histopathology reports with a correlation to the clinical and the follow-up examinations for the patients as well as the tumor markers (CEA) levels), the fused PET/CT had sensitivity, specificity, positive predictive value, negative predictive value, and an overall accuracy of 93.33%, 83.33%, 93.33%, 83.33% & 90.48% respectively as compared to CECT (73.33%, 58.33%, 81.48%, 46.67%, 69.05% respectively). Conclusion: Our findings indicate that fused PET/CT is more effective than the CECT regarding the detection of operative bed recurrent disease and incomplete therapeutic responses. PET/CT may also offer a cost-effective whole-body scan for restaging of the recurrent diseases through an accurate detection of the nodal and distant metastases.
https://mjcu.journals.ekb.eg/article_110948_c892d8220144dfdc28b8620626599c85.pdf
PET-CT
CECT
colorectal cancer
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1393
1397
10.21608/mjcu.2020.110950
110950
Original Article
Low Load Prolonged Stretch vs. High Load Brief Stretch in Treatment of Knee Contracture after Burn
HAIDY N. ASHM, Ph.D.; AHMAD A. MOHAMMED, Ph.D.
1
KHADRA M. ALI, Ph.D.; YASSMIN M. EL-TABAKH, M.Sc.
2
The Department of Physical Therapy for Surgery, Faculty of Physical Therapy*, The Department of General Surgery, Faculty of Medicine**, Cairo University and Physical Therapy Department, 6th October Hospital***
Abstract Background: Burn is defined as a traumatic injury to the skin or other organic tissue primarily caused by thermal or other acute exposures. Burns occur when some or all of the cells in the skin or other tissues are destroyed by heat, cold, electricity, radiation, or caustic chemicals. Burns are acute wounds caused by an isolated, non-recurring insult and progress rapidly through an orderly series of healing steps. Aim of Study: This study was conducted to investigate effect of low load prolonged stretchvs. High load brief stretch post burn knee contracture. Subjects and Methods: Thirty patients with knee contrac-ture following burn were conducted in the present study. All patients with age ranged from 25 to 45 years. They were selected from Om Al-Masreen Hospital, and Kasr El-Ainy Hospital. Patients assigned randomly into two groups (A and B) equal in number: Group (A) fifteen patients received low load prolonged stretch using weights (sand bags) 3 times/ week for 4 successful weeks. Group (B) fifteen patients received manual stretch 3 times/week for 4 successful weeks. Evaluation: Evaluations of both groups (A and B) were done before starting the treatment and at the end of study by Goniometer and Foot print to measure range of motion and cadence pre and post-treatment. Results: This study showed a statistically significant increase of knee joint ROM with percentage of improvement (14.4±4.89) in group (A), compared with group (B) with percentage of improvement (19.4±5.15). Conclusion: The present study concluded that low load prolonged stretch is more effective than high load brief stretch in treatment of knee contracture after burn.
https://mjcu.journals.ekb.eg/article_110950_3638fc6657af14948a0a0398b1314d1d.pdf
Low load prolonged stretch
Knee contracture
High load brief stretch
Goniometer
Foot print
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1399
1405
10.21608/mjcu.2020.110952
110952
Original Article
Turbinate Reduction in Endoscopic Surgery for Allergic Fungal Sinusitis: A Comparative Study
WAEL A. ALZAMIL, M.D.; ESSAM FATEHY, M.D.
1
The Department of Ear, Nose & Throat, Hearing and Speech Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
Abstract Background: Proper eradication of allergic fungal sinusitis (AFS) depends on three factors: First is proper preoperative evaluation and mapping via computed tomography and MRI. Second is the availability of adequate surgical tools in expe-rienced hands. Third is the proper postoperative endoscopic follow-up to detect and remove recurrence if possible. Aim of Study: To evaluate the role of inferior turbinectomy (IT) and partial middle turbinectomy (PMT) in patients with AFS managed by endoscopic sinus surgery (ESS) for the prevention of recurrence and adequate management of residual disease (postoperative salvage). Subjects and Methods: A prospective, comparative, ran-domized study conducted from February 2017 to January 2019. In all, 32 patients suffering from AFS were included. All patients have been presented and managed at the Depart-ment of Otolaryngology, Hearing and Speech Institute. Patients have been randomized into two groups of 16 patients each (groups A and B). The patients in group A have undergone ESS only, while the patients in group B have undergone ESS plus bilateral IT and PMT. Regular follow-up visits were done every 2 months for at least 6 months for both groups. Results: In group A, there was difficulty in proper assess-ment in 12 patients out of 16. Recurrence occurred in seven patients who showed rigorous assessment, which was managed via ESS adding to the maneuver bilateral IT and PMT. In group B, only two patients were difficult out of the 16. Recurrence occurred in three patients only and was managed easily in the outpatient office. No significant complications were detected in both groups. Conclusion: IT and PMT may be considered as essential steps in the surgery for AFS as they play a role in lowering the recurrence rate and facilitating better, more comfortable, and more effective postoperative management of recurrence if happened.
https://mjcu.journals.ekb.eg/article_110952_9564e6a14fec3542ee3587a59bc03668.pdf
Turbinate reduction
Recurrent allergic fungal sinusitis
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1407
1412
10.21608/mjcu.2020.110953
110953
Original Article
Treatment of Spontaneous Adult Thoracolumbar Spondylodiscitis With Interbody Fusion Using Autogenous Bone from Decorticated Spinous Process Supplanted with Posterolateral Transpedicular Rod-Screw Fixation
MAHMOUD M. WAHDAN, M.D.; MOATAZ A. ELAWADY, M.D.
1
AHMED M. DEABES, M.D.
2
The Department of Neurosurgery, Faculty of Medicine, Benha University
Abstract Background: Spontaneous spondylodiscitis, although rare, but carries the risk of developing neurological impairment. Aim of Study: We aim at introducing our experience with the treatment of spontaneous adult spondylodiscitis with interbody fusion using autogenous bone from decorticated spinous process supplanted with posterolateral transpedicular rod-screw fixation at the Neurosurgery Department of Benha University Hospital between January 2015 and November 2019. Patients and Methods: Between January 2015 and No-vember 2019, among 51 patients who were diagnosed with pyogenic thoracolumbar spondylodiscitis, 12 patients (8 males and 4 females) underwent curettage, drainage and interbody fusion using autogenous bone from the removed spinous process augmented with transpedicular rod-screw fixation. Results: All patients, but one, showed improvement of their preoperative pain and the level of inflammatory markers in the blood. This patient was diagnosed as having screw pull-out and needed surgical reinsertion with a larger screw. Conclusions: Lumbar interbody fusion using autogenous bone from decorticated spinous process supplanted with posterolateral transpedicular rod-screw fixation represents a reasonable substitute to the traditional anterior curettage, stabilization with additional posterior rod-screw fixation for the treatment of spontaneous lumbar spondylodiscitis.
https://mjcu.journals.ekb.eg/article_110953_a0ce537d949f27423cacaf4859cd2999.pdf
Spondylodiscitis
Lumbar Interbody Fusion
autogenous bone graft
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1413
1421
10.21608/mjcu.2020.110954
110954
Original Article
The Management of Care of Egyptian Patients with Diabetes: A Report from the International Diabetes Management Practices Study Wave 7
SALAH SHELBAYA, M.D.; MOHAMED HALAWA, M.D.
1
MERHAN NASR, M.D.
2
The Department of Endocrinology and Internal Medicine, Faculty of Medicine, Ain Shams University
Abstract Background: Diabetes Mellitus (DM) is a major and growing public health problem throughout the world. In developing countries, there is a scarcity in the published data regarding the quality of care of DM, including non-adherence of the patients, poor glycemic control, and the long-term consequences of DM. Aim of Study: The International Diabetes Management Practices Study (IDMPS) was developed to provide standard-ized data about the management of care of patients with diabetes in developing countries. In this report, we presented the results of the seventh wave of IDMPS about the manage-ment of care of DM in Egypt. Patients and Methods: IDMPS is an international, multi-center, observational, cross-sectional study to assess current practices in the management of care of people with DM. The primary outcome in the present study was the proportion of patients achieving glycemic targets (HbA1c) as per recom-mendations of International guidelines (HbA1c <7%) and as targeted by the treating physician. While the secondary out-comes included the proportion of patients achieving the triple target (defined as the combination of HbA1c <7%, Systolic/ Diastolic Blood Pressure [SBP/DBP] <130/80, and Low-Density Lipoprotein (LDL-CS) <100mg/dL), the proportion of patients with micro and macrovascular complications, the compliance to diet and lifestyle modification, the adherence to insulin therapy of T2DM treated by insulin, and the fre-quency and the severity of episodes of hypoglycemia in the past 3 months. Results: In Egypt, a total of 449 patients met the eligibility criteria for analysis. Of them, 149 (33.3%) were Type 1 DM (TIDM) patients and 300 (66.7%) were Type 2 DM (T2DM) patients. In patients with T2DM, 219 (73%) patients were on oral antidiabetic agents, 26 (8.7%) patients were on insulin therapy, and 55 (18.3%) patients received insulin plus hy-poglycaemic agents. The majority of T2DM, who were on insulin, received premix insulin alone. Sixty-three (42.3%) T 1DM patients were on basal + prandial insulin, 56 (37.6%) patients were on premix alone, 14 (9.4%) patients were on premix + prandial insulin, eight (5.4%) patients were on premix + basal insulin, six (4.0%) patients were on basal insulin alone, and two (1.3%) patients were on premix insulin alone. A total of 12 (15.4%) T 1DM patients were on premixed analogue insulin. A total of 12.2% and 17.8% of the T1DM and T2DM patients achieved the glycaemic target HbA1c <7% as per recommendations of international guidelines; while, 8.8% of T 1 DM patients and 13.6% of T2DM patients had an HbA1c below the targeted value per physicians' recommendation. The triple target was reached by only 1.4% of T1DM and 2.4% of T2DM patients. Only 214 (48.3%) patients had glucose meter; of them, 194 (90.7%) patients performed self-monitored blood glucose, mainly occasionally. In our cohort, a total of 49.7% of the patients reported one or more diabetes-related complications. In T2DM group, 51.7% of the patients had microvascular complications, mainly microalbuminuria and retinopathy. On the other hand, 17% of T2DM reported macrovascular complications, most commonly angina and myocardial infarction. Among T1DM patients, 42.9% experi-enced symptomatic episodes of hypoglycaemia in the past three months and 10.1% experienced severe episodes of hypoglycaemia in the past 12 months. Conclusion: In conclusion, the control of diabetes in Egypt is still poor with the vast majority of the patients do not achieve the targeted metabolic control as recommended by the international guidelines.
https://mjcu.journals.ekb.eg/article_110954_1d88323c19f022edeb63e04c6bad7ca0.pdf
Diabetes mellitus
Glycaemic control
Manage-ment of care
IDMPS project
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1423
1432
10.21608/mjcu.2020.110955
110955
Original Article
Prognostic Value of PET/CT and ALDH1 in Pancreatic Cancer and Correlation of Standardized Uptake Values with Clinical Characteristics and Survival
DINA MOGHAZY MOHAMED, M.D.; DAREEN ABDULAZIZ, M.D.
1
RANIA SOBHY ABOUKHADRAH, M.D.
2
The Departments of Radiology* and Pathology**, Faculty of Medicine, Tanta University
Abstract Background: Pancreatic malignancy is a rapidly growing cause of death in the world. Its survival rate is months even if discovered early. Aim of Study: We evaluated the correlations between PET/SUVs (Standard Uptake Values), clinical characteristics and cancer stem-like cells named aldehyde dehydrogenase 1 (ALDH1) in pancreatic cancer. We evaluated the diagnostic performance of SUV and its correlation with overall survival. Patients and Methods: Thirty-nine patients with pancreatic cancer were evaluated by PET/CT. The expression of ALDH1 was detected immunohistochemically in their cancer speci-mens. Results of PET/SUV were correlated with clinic-pathological character, ALDH1 and overall survival. Results: PET/SUV was associated significantly with tumor size (p=0.027). No significant correlation with other clinical-pathological characteristics. PET/CT showed sensitivity= 81%, specificity=78% and accuracy=82%. PET/SUV reflected the expression level of ALDH1 with significant correlation (p=0.001). Patients with high SUV and high expression of ALDH1 had a worse median overall. Conclusion: PET-CT was a non-invasive imaging modality that helped in pancreatic cancer especially in doubtful tumors. PET/CT was helpful tool to detect lymph nodes invasion and distant metastasis. It was associated with the expression level of ALDH1. High SUV and high expression of ALDH1were significantly correlated with a worse clinical outcome. PET/SUV and Cancer stem cells may serve as significant prognostic factors in predicting outcomes in pancreatic cancer patients.
https://mjcu.journals.ekb.eg/article_110955_0b4d41a061916e26141d8d160b5c5a38.pdf
Pancreatic carcinoma
PET/SUV
ALDH1
Survival
eng
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
2020-06-01
88
June
1433
1440
10.21608/mjcu.2020.110956
110956
Original Article
The Role of Magnetic Resonance Imaging in Diagnosis and Prognosis of Rheumatoid Arthritis
MOHSEN G.H. ISMAIL, M.D.; AHMED EL SHIMY, M.D.
1
ASMAA ZAID BAHLOL SAMIN, M.Sc.
2
The Department of Radiodiagnosis, Faculty of Medicine, A in Shams University
Abstract Background: Rheumatoid arthritis (RA) is one of the most common forms of arthritis. A progressive joint damage occurs early in the disease course even before being detected in conventional imaging, and eventually leads to irreversible joint deformity and severe functional impairment. Routinely, clinical assessment and laboratory investigations as well as conventional radiology are used for diagnosis of RA, however; they are not fair enough to establish early diagnosis and can't provide information about the disease activity. Estimating the disease activity at onset is fundamental to identify the prognosis of RA. Aim of Study: The aim of this study was to demonstrate the importance of MRI in detecting early signs of arthritis helping in early diagnosis of rheumatoid arthritis, and its ability to assess the degree of inflammatory activity as a prognostic parameter for the development of subsequent bone destruction. Patients and Methods: The twenty-five patients included in this study (14 females, 56%, and 11 males, 44%), were diagnosed with rheumatoid arthritis according to the 2010 ACR/EULA classification criteria. The clinically dominant wrist and hand joints were examined by MRI study for detec-tion of pathological signs of RA that include synovitis, BME, and erosions. Twenty (20) patients (80%) were found to have synovial thickening. Of which, 12 wrist joints (60%) were active, among them 5 joints (25%) had mild activity, 4 (20%) had moderate activity and 3 wrist joints had severe activity (15%). 17 patients had bone marrow edema (68%), more frequently at the radius and the lunate. Erosions was seen in 8 joints (32 %). The total positive MRI inflammatory findings, as well as each one of them alone, were compared and corre-lated with the 2010 ACR/EULA scoring system. Results: We found significant correlation and agreement between the total MRI positive findings and the 2010 ACR/EULAR criteria used for diagnosing RA, and MRI was more sensitive in detecting synovitis and BME in patients who didn't meet the criteria. Conclusion: The high sensitivity of MRI in detecting inflammatory signs, and the significant correlation with clinical and laboratory findings, indicates the potential importance of MRI study in diagnosing RA early in its course, and the assessment of disease activity that helps in prediction of joint destruction.
https://mjcu.journals.ekb.eg/article_110956_8ca0aca83064090e9becceddc792d147.pdf
Magnetic Resonance Imaging
Rheumatoid Arthritis