The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Evaluation of Ureteric Jet by Color Doppler Ultrasound in Pregnancy
4031
4035
EN
HODA S.
DARWISH, M.D.
The Department of Radio-Diagnosis, Faculty of Medicine, Suez Canal University, Egypt
10.21608/mjcu.2019.76616
Abstract<br />Background: Abdominal pain during pregnancy can be caused by many conditions related to diseases of abdomen, urinary system, gynecological and obstetric problems. One of the important conditions causing non obstetrical pain during pregnancy is renal colic. Ureteral jet is the phenomenon that seen when the dense urine from the ureter is expelled into the more dilute urine in the urinary bladder.<br />Aim of Study: Was to ass ureteric jet by color Doppler ultrasound in pregnant women.<br />Subjects and Methods: Total number of 75 pregnant patients with singleton pregnancy referred to our Radiology Department from Obstetrics and Gynecology Department, in their second and third trimester, presented with suspected urinary tract infections or hydronephrosis were included in our prospective study.<br />Renal and bladder grey scale and bladder color Doppler ultrasonography were performed; patient should be full bladder. Ureteral jet angle was also measured as the angle between the direction of the ureteral jet and intraureteral ridge. Patterns of the ureteric jet were also recorded. Doppler ultrasound of the bladder area was performed in a transverse plane while patient supine includes both ureteric orifices to visualize the bilateral ureteral jets and measures the angle. Number of ureteral jets was also recorded for a period of one minute to three minutes. Study was done also in the right and left lateral decubitus position and number of ureteral jets was also recorded for a period of one or three minutes. Right ureteral jets were recorded in left lateral decubitus position whereas left ureteral jets were recorded in the right lateral decubitus position. Renal Ultrasound was done to detect back pressure changes and its severity.<br />Results: We used Statistical Package for Social Sciences (SPSS) software version 10 for data assessment. Mean age of patients was 23±4 years. Average gestation age was 26.02± 2.56 weeks with minimum and maximum gestation age 21 and 33 weeks respectively. Mean number of ureteral jets seen in supine position at right side was 1.91±1.71 with minimum and maximum number of jets 0 and 4 respectively. Most frequent number of jets was “0” and seen in 36 cases (48%) of the patients.<br />Back pressure changes diagnosed in 52 patients (69%) was unilateral in 41/52 patients (78%) and bilateral in 11/52 cases (22%). Right kidney back pressure changes were seen in 35 patients and left side 6 cases. Mean ± SD ureteral jet angle was significantly greater in affected units with back pressure (67.9±16.5 degrees) than in non affected units (42.8± 12.2 degrees, p<0.0001). A cutoff angle of 55 degrees or greater was detected in cases with mild back pressure changes in our study. A cutoff angle of 70 degrees or greater was associated with more severe back pressure changes (moderate to severe backpressure changes). Out of 75 patients, 33 cases showing no backpressure changes and the ureteral jet angle was less than 55 degree in both ureteric orifices.<br />Conclusion: Color/pulse-wave Doppler US is avery useful tool for demonstrating ureteral jets and provides its charac-terization. Change in scanning position from supine to right/left decubitus position to ass ureteric jet in pregnant patients will be helpful and we suggest further studies to evaluate our cutoff angles.
Ureteral jets – Pregnancy – Color Doppler – Ultrasonography – Doppler waveform – Vesi-coureteric reflux
https://mjcu.journals.ekb.eg/article_76616.html
https://mjcu.journals.ekb.eg/article_76616_ddc5480e2052b03d8a739aa7ebe3d7f0.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Study of C-Reactive Protein Level in Patients with Stable COPD and in Acute Exacerbations
4037
4041
EN
HAMDY M. ZOAIR, M.D.;
MOUSTAFA A. ZEDAN, M.D.
MAHMOUD A. ARAFA, M.D.;
MOHAMED R. MORSY, M.D.
AMR A.
AL-MOOGY, M.Sc.
The Departments of Chest Diseases* and Clinical Pathology**, Faculty of Medicine, Al-Azhar University, Egypt
10.21608/mjcu.2019.76618
Abstract<br />Background: C-Reactive Protein (CRP) is an inflammatory mediator that is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) and can be used as diagnostic and prognostic adjuvant to assess the severity of disease.<br />Aim of Study: This study was the difference in the CRP level between stable COPD and AECOPD patients.<br />Subjects and Methods: Sixty COPD patients (30 with stable COPD and 30 with AECOPD) were included in this study and results were compared to those of 10 healthy age/sex-matched controls. Clinical history was taken and full clinical examination was done to assess the patients' conditions and rule out any co-morbidities that could be associated with increased CRP level. Blood samples were drawn to measure the CRP level, ABG and TLC. Pulmonary function test was also done.<br />Results: CRP level was significantly higher in COPD patients compared to healthy controls (p-value <0.0001). It was also significantly higher in AECOPD patients compared to patients with stable COPD (p-value <0.0001).<br />Conclusion: CRP level is generally increased in COPD patients, being significantly higher in the AECOPD patients than the stable ones, and thus can be used as a prognostic marker to assess the severity of the disease.
COPD – CRP
https://mjcu.journals.ekb.eg/article_76618.html
https://mjcu.journals.ekb.eg/article_76618_ce0cc22efd6d9209ff33a3f4a8ef58ed.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Impact of Moderate Intensity Aerobic Exercise on Irritable Bowel Syndrome in Post Cholecystectomy Patients
4043
4050
EN
OMAR A.E. MOHAMED, M.Sc.;
MARWA M. EID, Ph.D.
NESREEN A. ABD ELRASHID, Ph.D.;
AHMED A.E. ALI, M.D.
The Department of Physical Therapist, Tamya General Hospital*, The Department of Surgery, Faculty of Physical Therapy** and Plastic Surgery, Faculty of Medicine***, Cairo University, Egypt
10.21608/mjcu.2019.76619
Abstract<br />Background: Irritable bowel syndrome is a chronic func-tional disorder of the gastrointestinal system. Patients experi-ence abdominal pain and altered bowel habit, with either predominantly diarrhea, constipation, or both, the risk to develop Irritable Bowel Syndrome (IBS) after cholecystectomy is 2.2 times higher than in general population.<br />Aim of Study: To evaluate the effect of moderate intensity aerobic exercise training (60% MHR) (Treadmill Training) on Irritable Bowel Syndrome (IBS) symptom and Quality of Life in post cholecystectomy patients.<br />Patients and Methods: Thirty non-athletic post cholecys-tectomy patients complaining from Irritable Bowel Syndrome were recruited for this study; there age were ranged between 25 to 40 years, in the period between Oct. 2017 and Feb. 2019 from Kasr Al-Ainy Hospital. Patients who met the selection criteria were divided randomly into two equal groups, Group (A): They participated in 4 weeks of moderate intensity aerobic training program (60% MHR Treadmill Training) (3 sessions per week) plus receiving medical treatment protocol, Group (B) (Medical Treatment Group) received medical care only.<br />Measurements: Irritable bowel syndrome was assessed by Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) and Irritable Bowel Syndrome Quality of Life (IBS-QOL) Instrument Assessment was carried out before treatment and after 4 weeks of treatment in both groups.<br />Results: The result showed that there was a significant decrease in post-treatment values of IBS-SSS and IBS-QOL in comparison to pre-treatment values at both groups with (p-value <0.001). Post-treatment comparison between both groups showed significant difference in IBS-SSS and IBS-QoL variables, in favor of Group A (study group).<br />Conclusion: Moderate intensity aerobic exercise training (60% MHR) for 4 weeks is effective in treatment of IBS post cholecystectomy through reducing IBS symptoms and improving quality of Life.
Irritable Bowel Syndrome (IBS) – Aerobic exer-cises – Post cholecystectomy
https://mjcu.journals.ekb.eg/article_76619.html
https://mjcu.journals.ekb.eg/article_76619_dddddf19d402e20a88754e013a6f973d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Aerobic Exercise Effect on Improving Metabolism after Burn Injury
4051
4054
EN
FATEMA M. ABDALLA, M.Sc.;
SAMAH H. NAGIB, Ph.D.
NESSRIEN A.
ABDELRASHID, Ph.D.
The Department of Surgery, Faculty of Physical Therapy, Cairo University
10.21608/mjcu.2019.76621
Abstract<br />Background: Disturbance of metabolism is a common sign that is largely detected after trauma or burn injury and characterized by impaired organ functioning and wound healing. The disparity in research and the necessity to add to the existing literature base led to the development of this study.<br />Aim of Study: To investigate if aerobic exercise can improve the metabolism after burn injury10-15% TBSA in the body.<br />Material and Methods: Thirty burn patients with 10-15% TBSA their age ranged from 20-40 years were selected from the inpatients Burn Department of Ismailia General Hospital, or any hospital in Ismailia. The thirty patients were classified into two groups equal in number; each group consisted of fifteen patients. The first received a program of aerobic exercise in addition to circulatory and respiratory exercises (Group A) 3 times/week for four weeks and the second received a program of circulatory and respiratory exercises (Group B) 3 times/week for four weeks. The changes in the metabolic markers were measured at the beginning of the study and after four weeks from 15 April 2017 to 15 May 2017.<br />Conclusion: It was concluded that the aerobic exercise is associated with significant improvement (increase) in metabolic markers greater than respiratory and circulatory exercise in burn patients in a short term (up to four weeks).
Aerobic – Burn – Exercise – Metabolism – Total protein – Albumin – Circulatory – Respiratory
https://mjcu.journals.ekb.eg/article_76621.html
https://mjcu.journals.ekb.eg/article_76621_1a097af947e66021637d75867e8609dd.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Correlation between Diabetic Macular Edema and Best Corrected Visual Acuity in Different Categories of Diabetic Retinopathy
4055
4060
EN
AHMED H.S. ASSAF, M.D.;
AHMED A.A. EBEID, M.D.
MOUAMEN M.M. SELEET, M.D.;
ELSAYED A.A. MOHAMED, M.Sc.
The Department of Ophthalmology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.76623
Abstract<br />Background: Diabetic Retinopathy (DR) is a major cause of vision loss in the working age population and people with diabetes are 25 times more likely than the general population to go blind.<br />Aim of Study: To correlate the Best-Corrected Visual Acuity (BCVA) by ETDRS protocol with macular thickness measurement and morphology as obtained by OCT in a series of patients with diabetic macular edema, with or without diabetic retinopathy.<br />Patients and Methods: Cross sectional design, in total 102 of 51 selected Egyptian diabetic subjects, 20 males and 31 females were selected by convenient sample in the study during the period from Mars. 2018 to December 2018, all procedures were done at National Institute Of Diabetes And Endocrinology. Eyes enrolled in the study were divided into three groups as follows: Group 1: Eyes with DME and non clinically detectable DR, Group 2: Eyes with DME and NPDR, Group 3: Eyes with DME and PDR.<br />Results: In the present study,we found that the Diffuse Spongy Macular Edema (DSME) was the most common type of DME, we found a highly significant negative correlation between the CMT and BCVA. There was a significant corre-lation between the OCT pattern of DME and the severity of diabetic retinopathy. We also found a statistically significant decrease in BCVA in eyes with PDR in comparison to eyes with NPDR and eyes with no clinically detectable diabetic retinopathy.<br />Conclusion: Based on the data in our study, diffuse spongy macular edema was the most common type of DME with the least CMT and the highest BCVA, we also found the worst BCVA in PDR.
Diabetic macular edema – Best corrected visual acuity – Diabetic retinopathy
https://mjcu.journals.ekb.eg/article_76623.html
https://mjcu.journals.ekb.eg/article_76623_36490d5a69605eaf059514eb8601cd06.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of CD8 Cytotoxic T Lymphocytes in Hepatocellular Carcinoma: An Immunohistochemical Study
4061
4069
EN
ASMAA G. ABDOU, M.D.;
HALA S. EL-REBEY, M.D.
NANIS S. HOLAH, M.D.;
MERVAT S. SULTAN, M.D.
SHYMAA H.
IBRAHIM, M.Sc.
The Department of Pathology, Faculty of Medicine* and National Liver Institute**, Menoufia University, Egypt
10.21608/mjcu.2019.76624
Abstract<br />Background: Hepatocellular Carcinoma (HCC) is the most common primary malignancy of the liver in adults accounting for 85%-90% of liver tumors. It represents the sixth most common malignancy and the fourth leading cause of cancer-related death worldwide. There is an important role of CD8+ tumor infiltrating lymphocytes in host immune defense against tumour progression. Immunotherapy, with modern pharmacologic developments, is a new direction in cancer therapy and therefore immunobiology of hepatocar-cinogenesis is under investigation.<br />Aim of Study: Study expression of CD8 in Hepatocellular carcinoma and its correlation with clinicopathological param-eters and explore its effect on HCC prognosis.<br />Material and Methods: This study included 112 hepato-cellular carcinoma cases obtained from the archival material of Pathology Department, National Liver Institute, Menoufia University, between 2010 and 2017. All cases were stained for CD8 antibody. Survival data were available for all HCC cases.<br />Results: CD8 was expressed in 110 HCC cases (98.2%). There was a statistical significant association between high CD8 percentage and non-cirrhotic adjacent liver (p=0.035). On the other hand, there was a significant association between high CD8 percentage and large tumor size (<5cm) (p=0.015). There was no statistically significant association between CD8 expression and overall survival or recurrence.<br />Conclusion: We concluded that high CD8 might serve as bad prognostic parameter in HCC as it is associated with non-cirrhotic liver and large tumor size but it doesn't affect HCC overall survival or recurrence.
CD8 – HCC – Immunohistochemistry – Prognosis
https://mjcu.journals.ekb.eg/article_76624.html
https://mjcu.journals.ekb.eg/article_76624_69579a80ffb81fcb07ab1c66d3525f40.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Ankle Resisted Exercises on Venous Leg Ulcers Healing
4071
4076
EN
SAMAR NABIL, M.Sc.;
MARWA M. EID, M.D.
ABD EL HALIM A. ABD EL MOHSEN, Ph.D.;
HEBA M. MOHAMADY, Ph.D.
The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University* and The Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University**
10.21608/mjcu.2019.76625
Abstract<br />Background: Venous leg ulcers are open chronic wounds that occur within the gaiter region of the leg (from below the ankle, up to mid-calf) and are a consequence of venous insuffciency. They typically present as repeated cycles of ulceration, healing, and recurrence. Such ulcers can take weeks or months to heal, and 12-month recurrence rates are between 18% and 28%. They are painful, malodorous, prone to infection, and severely affect patients' mobility and quality of life, therefore resisted ankle exercises is improving calf muscle pump action by increasing ankle (plantar flexion) range of motion which improving venous system function in the lower leg and so improving 2nd and 3rd degrees of venous leg ulcers healing.<br />Aim of Study: The aim of this study was to determine the efficacy of resisted ankle exercises on healing of venous leg ulcers.<br />Subjects and Method: Thirty patients suffering from 2nd and 3rd chronic venous leg ulcers were recruited from Vascular Surgical Outpatient Clinic of Al-Hussien University Hospital. Their ages ranged from 45 to 60 years old: They distributed into two Groups (A & B). Group (A) "study group": Fifteen patients who received ankle resistance training exercise in addition to the traditional medical treatment. Group (B) "control group": Fifteen patients who received only the tradi-tional medical treatment. Resistance training exercise was applied in the form 20 or 25 repetitions maximum at the end of the twelve week, three sessions per week, every other day, for three months.<br />Results: Results showed that ankle resistance training exercise program was effective in improving healing of venous leg ulcers by decreasing ulcers' volume measured by sterilized saline solution by improving calf muscle pump function.<br />Conclusion: Application of 12 weeks ankle resisted exer-cises in patient with 2nd and 3rd degrees of chronic venous leg ulcers resulted in decreasing volume of venous ulcers and so increasing of healing rates.
Ankle resisted exercises – Venous leg ulcers healing
https://mjcu.journals.ekb.eg/article_76625.html
https://mjcu.journals.ekb.eg/article_76625_54fe2991a6edc879d0564b53997844de.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Aerobic Exercises on Functional Capacity in Patients under Hemodialysis
4077
4085
EN
MANAR F. MOHAMMED, M.Sc.;
AMIRA H. DRAZ, Ph.D.
RANIA N. KARKOUSHA, Ph.D.;
NESRIN G. EL-NAHAS, Ph.D.
Physical Therapist, Benha University Hospital*, The Departments of Physical Therapy for Basic Science** and Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics***, Faculty of Physical Therapy, Benha and Cairo Universities
10.21608/mjcu.2019.76627
Abstract<br />Background: Chronic kidney disease is the progressive deficiency of renal function for months and years, may reach life threatening stage.<br />Aim of Study: This study was conducted to determine the effect of aerobic exercise versus resisted exercise on urea reduction ratio and 6 minute walk test.<br />Subjects and Methods: Thirty patients of both sex with chronic renal failure were participated in the study, their age ranged from 25 to 35 years old and recruited from Hemodial-ysis Unit of benha University Hospital. They were randomly assigned into two equal Groups (A & B). Group A was received resistance exercise while Group B was received aerobic exercise. Both groups were received session twice per week for 2 months. Measurements were measured twice, before and after treatment: Urea reduction ratio and, 6 minute walk test.<br />Results: The results showed that there were significant improvement in urea reduction ratio and 6 minute walk test in both groups after treatment while there were no significant difference between two groups after treatment.<br />Conclusion: Both aerobic and resisted training exercise are effective in improvement dialysis efficiency and perform-ance. With no difference between both groups post-treatment.
Chronic kidney disease – Aerobic exercise – Resisted exercise
https://mjcu.journals.ekb.eg/article_76627.html
https://mjcu.journals.ekb.eg/article_76627_e16359260a792d1f247fff0e9e917b86.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Comparative Study between Pentacam and IOL Master in Measuring Anterior Segment Parameters in Eyes of Egyptian Individuals
4087
4092
EN
ALI H. SAAD, M.D.;
THANAA HELMY, M.D.
YASSER EL-ZANKALONY, M.D.;
MINA SAMEH, M.Sc.
The Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
10.21608/mjcu.2019.76634
Abstract<br />Background: Accurate values of anterior segment param-eters are important for diagnosing variety of diseases and for cataract surgery, glaucoma, refractive surgery and post-operative follow-up. The true values of Anterior Chamber Depth (ACD), corneal power (K-readings) and White-to-White (WTW) are essential in calculating the Intraocular Lens power (IOL). The measurement of the ACD and WTW is essential for the success of phakic IOL implantation in patients asking for refractive surgery. This is now possible because of the development of new, accurate diagnostic and surgical tools.<br />Aim of Study: To compare values of anterior segment parameters (ACD, K-reading, WTW) obtained by Pentacam and IOL master to know if there are significant differences in measurement results between both devices or only minimal differences which can be neglected.<br />Patients and Methods: This comparative cross sectional study included 40 eyes of 22 Egyptian individuals. Evaluation included best corrected visual acuity, slit-lamp evaluation and autorefractometer reading. Imaging by investigative method in the form of IOL master 500 and Pentacam Oculus. All investigations and examinations were done at Kobri El-Kobba military Hospital, Cairo. From January 2018 to August 2018.<br />Results: IOL master gives statistically significant higher value of K-readings (43.56±1.72 & 45.03±1.59 for K1 & K2 respectively) than Pentacam (43.28±1.73 & 44.72±1.58 for K1 & K2 respectively). Low significant difference between both devices in values of ACD (mean difference ± SD –0.03± 0.10). Pentacam measures longer WTW value (mean 12.10± 0.45) than IOL master (mean 12.00±0.41).<br />Conclusion: IOL master gives slightly higher K-reading than Pentacam. Both devices measure ACD accurately and give nearly similar results. IOL master gives reliable WTW estimation but pentacam measurement of WTW by inserting calipers on scheimpflug image may give different values than IOL master.
Anterior chamber depth – White-to-White – K- readings – IOL master – Pentacam
https://mjcu.journals.ekb.eg/article_76634.html
https://mjcu.journals.ekb.eg/article_76634_522f652014c7acf05eeb0104b8f33ee2.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Urinary Bladder Neoplastic Masses Findings through Multidetector-Row CT Urography
4093
4101
EN
OLA H. ABDUL AL AMEER, M.Sc.;
SAHAR M. EL GAAFARY, M.D.
ALI H.A.
NOOR AL DEEN, M.D.
The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.76635
Abstract<br />Background: Urinary bladder carcinoma is one of the most common tumors among the lower urinary tract, it is the seventh common malignancy and widely distributed in devel-oped countries.<br />Aim of Study: To elucidate the diagnostic potential and additive imaging data obtained with Multi-Detector Computed Tomography (MDCT) in early detection and characterization of urinary bladder neoplastic masses by comparing the result of the study with the conventional cystoscopy results.<br />Patients and Methods: This prospective descriptive study was conducted on forty patients, 36 was men and 4 women. The patients referred to Radio-Diagnosis Department, Ain Shams University Hospitals, Radio-Diagnosis Department in a period 6 months of data collection for suspicious bladder mass(es) after clinical assessment of patient or for further characterization of indeterminate bladder neoplastic mass lesion previously depicted on other radiological investigation as ultrasound examination.<br />Results: A statistically significant difference was found between positive and negative cystoscopic biopsy results for malignancy in relation to presence CT features of malignancy.<br />Conclusion: MDCT urography is useful for examination of patients especially when the CC is contraindicated such as hemorrhage, perforation, difficult to doing it or unsatisfactory in interpretation, and as a complementary technique in the evaluation of areas difficult to evaluate with CC, especially with the MDCT results satisfactory in finding lesions smaller than 5mm. MDCT urography gives us an opportunity for early detection bladder tumors because its reliability and accuracy and our results support that.
Urinary bladder neoplasm – Multidetector-row CT urography
https://mjcu.journals.ekb.eg/article_76635.html
https://mjcu.journals.ekb.eg/article_76635_695bcbe0b72aeabc0684696a78751725.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Efficacy of Exercise Combined with Music on Pain and Range of Motion in Pediatric Lower Limb Burn
4103
4107
EN
MARWA M. EID, Ph.D.;
ERENY S. WAHBA, Ph.D.
MOHAMED S.
MOHAMED, M.Sc.
The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University* and Physical Therapy Department, 6th October Hospital**
10.21608/mjcu.2019.76638
Abstract<br />Background: Music therapy is the use of music to improve health or functional outcomes. Music therapy is a creative arts therapy.<br />Aim of Study: This study was conducted to investigate effect music with exercise on range of motion and pain in pediatric lower limb burn.<br />Subjects: Thirty patients with 2nd degree lower limb burn were conducted in the present study. All patients with age ranged from 10 to 15 years. They were selected from El-Kasr El-Ainy Hospital and Om El-Masreen Hospital in Cairo, Egypt.<br />Methods: Patients assigned randomly into two Groups (A and B) equal in number: Group (A) fifteen patients received the traditional physiotherapy plus music with exercise v for 12 weeks (3 sessions/week). Group (B) fifteen patients received the recommended traditional physiotherapy for 12 weeks.<br />Evaluation: Evaluation of both Groups (A and B) were done before starting the treatment and at the end of study by visual analog scale and goniometer.<br />Results: This study showed a statistically significant improvement in range of motion and pain. Increase in flexion and extension and ankle dorsiflexion and planter flexion in Group A than Group B and significant improvement in pain in Group A than Group B.<br />Conclusion: Music with exercise is an effective modality for improving range of motion and pain.
Burn – Music therapy – Range of motion – Pain
https://mjcu.journals.ekb.eg/article_76638.html
https://mjcu.journals.ekb.eg/article_76638_4d37fb38e07a8a296c53ef5bc3efe709.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Does Supporting the Luteal Phase With Progesterone Only Without Estradiol Can Affect the Pregnancy Outcome in In-Vitro Fertilization Cycles?
4109
4114
EN
MONA M.B. RASHED, M.Sc.;
SHAHINAZ H. ELSHORBAGY, M.D.
TAREK M.E. EL HAWARY, M.D.;
MANAL M. ABDALLAH, M.D.
The Department of Obstetrics & Gynecology, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.76641
Abstract<br />Background: It is well established that luteal support with progesterone improves implantation in IVF cycles. Unfortu-nately, there are conflicting reports regarding the value of luteal phase estradiol supplementation on pregnancy rates.<br />Aim of Study: To compare the pregnancy rate if we use progesterone only versus the use of progesterone and estradiol as a luteal phase support in IVF cycles.<br />Study Design and Setting: A prospective randomized clinical trial.<br />Patients and Methods: This study has been carried out in Tanta University Hospital in co-ordination with private IVF centers in the period from October 2017-to June 2018.<br />This study included 60 women divided into two group:<br />•Group I consists of 30 patients who received vaginal admin-istration of progesterone supplementation in the form of 400mg prontogest twice a day.<br />•The second group consists of 30 patient in which 2mg estradiol valerate twice daily with prontogest suppositories has been used.<br />Results: The findings suggest that the pregnancy rate is higher with the estrogen and progesterone supplementation than the progesterone only supplementation in both groups who have used GnRH agonist or antagonist controlled ovarian stimulation protocol but it has not reached a statistically significant value.<br />Conclution: Supplementary administration of E2 to p for luteal phase support may be beneficial for better IVF outcome and it warrants further investigation.
Estrogen – IVF – Luteal phase support – Proges-terone
https://mjcu.journals.ekb.eg/article_76641.html
https://mjcu.journals.ekb.eg/article_76641_692a55397d8f7106f20a80556f5bd5c9.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Diffusion-Weighted Image in Correlation with T2 Sequence as an Imaging Biomarker for Urinary Bladder Cancer
4115
4119
EN
NANCY M. ABD EL-NOUR, M.Sc.;
RASHA S.A. HUSSEIN, M.D.
SAHAR
AL-GAAFARY, M.D.
The Department of Radiology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.76642
Abstract<br />Background: Recent functional diagnostic imaging tech-niques have emphasized the role and importance of MRI in pelvic organs imaging. Functional imaging by means of Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) and ADC value are now considered an essential part of the standard imaging protocols for evaluation of the pelvic organs.<br />DWI depends on the fact that water molecules can diffuse freely in low cellular tissues, while increased cellularity restricts its diffusion, a phenomenon called 'Brownian motion'. Therefore, in cases of malignant lesions which have high cellularity, water diffusion is restricted and appear as bight lesions, in contrary to most benign tumors which have low cellularity.<br />Aim of Study: To assess the diagnostic value of DWI in correlation with T2WI for preoperative urinary bladder tumor T-staging.<br />Patients and Methods: This is a prospective study that included twenty-six patients with hematuria and suspicious urinary bladder mass lesion on ultrasonography, age ranged from 54 to 70 years old, 22 patients were male while 4 were female. The patients were referred from the Urology Clinics, Ain Shams University, before cystoscopy and initial biopsy confirmation. MRI examination with DWI and T2WI was performed at the Radiology Department of Ain Shams Uni-versity Hospital in a period of 6 months from January to June 2018.<br />Results: In this study, 24 patients were confirmed to have urinary bladder cancer while one patient had nonspecific inflammatory reaction and another patient had infiltrating prostatic cancer. Regarding the detection of urinary bladder carcinoma the overall sensitivity, specificity, and accuracy using T2 images alone were 71.8, 73.2 and 72.4%, respectively, using DWI alone were 87.8, 87.8 and 88%, respectively and by using T2 plus DWI images were 87.8, 95.5 and 91.6%, respectively. The ADC value of 0.8 X 10–3mm2/sec was found to be a cut off value for differentiating low grade tumors (grade I-II) from high grade tumors (grade III) with sensitivity, specificity and accuracy of 71, 55.5 and 65% respectively. <br />Conclusion: DWI has several advantages that can provide information regarding the lesion's size, number, location, local staging. The estimation of ADC value helps to predict the tumor nature and grade. The sensitivity and accuracy of DWI is higher when correlated with T2WI, which greatly help in guiding the surgeons performing conventional cystoscopy.
Urinary bladder carcinoma – Staging of urinary bladder cancer – Diffusion weighted MRI – ADC value
https://mjcu.journals.ekb.eg/article_76642.html
https://mjcu.journals.ekb.eg/article_76642_bde635ebecb80f0dfb697fa1da116c96.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Non Affected Side Relaxation on Function Outcome in Patient with Bell's Palsy
4121
4127
EN
MOHAMED N. ELBAHRAWY, Ph.D.;
MOHAMED H. RASHAD, Ph.D.
YOUSSEF M. ELBALAWY, Ph.D.;
MUSTAFA S. MOHAMED, M.Sc.
The Department of Physical Therapy for Neuromuscular Disorders & its Surgery, Faculty of Physical Therapy, Cairo University
10.21608/mjcu.2019.76709
Abstract<br />Background: Facial paralysis is an extremely frightening situation and gives extreme stress to patients because obvious disfiguring face may cause significant functional, aesthetic, and psychological disturbances.<br />Aim of Study: To investigate the role of non affected side relaxation on function outcome in patient with Bell's Palsy (BP).<br />Patients and Methods: Thirty patients with unilateral BP were assigned into two equal groups (Group A & Group B): Group (A) received conventional physical therapy program (laser therapy, faradic stimulation, therapeutic facial massage and facial exercise) on the affected side only while Group (B) received a designed relaxation program (Transcutaneous Electrical Nerve Stimulation (TENS), therapeutic facial massage, intraoral massage and ice massage) on the non affected side plus conventional physical therapy program on the affected side. Sunnybrook Facial Grading System (SFGS) and Electroneuronography (ENoG) were used to assess the severity of facial nerve degeneration. Assessment using both SFGS and EnoG was done pre-treatment, post one month of treatment and post two month of treatment.<br />Results: The study has revealed that the function outcome has improved significantly in each group with no significant difference between both groups.<br />Conclusion: It can be concluded that a designed relaxation program of the non-affected side has no significant effect on the function outcome in patient with Bell's palsy.
Facial paralysis (FP) – Bell's Palsy (BP) – Sunnybrook Facial Grading System (SFGS)
https://mjcu.journals.ekb.eg/article_76709.html
https://mjcu.journals.ekb.eg/article_76709_3a00e5f09b0a9675e09ba23756eb0d8e.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Ameliorative Effect of Lycopene on Acrylamide-Induced Hepatotoxicity in Adult Albino Rats
4129
4135
EN
RABAB F. HINDAWY, M.D.;
FATMA F. HENDAWY, M.D.
The Departments of Forensic Medicine & Clinical Toxicology* and Pharmacology**, Faculty of Medicine, Benha University, Egypt
10.21608/mjcu.2019.76710
Abstract<br />Background: Acrylamide (ACR) is a chemical substance formed when starchy foods, such as potatoes and bread are cooked at high temperatures (above 120ºC). It can be formed when foods fried and baked. High acrylamide levels have carcinogenic, genotoxic, neurotoxic and hepatotoxic effects on living organisms.<br />Aim of Study: The present study designed to illustrate the biochemical and histopathological alterations of ACR on the liver of rats and the treatment of oxidative damage caused by acrylamide with the administration of a strong antioxidant, namely Lycopene (LYC), which is a naturally carotenoid pigment that is widely found in red foods such as tomato, watermelon, papaya, pink grape-fruit, pink guava and carrots.<br />Material and Methods: Sixty rats were divided into five groups (negative control, positive solvent control, Lycopene (10mg/kg/day), acrylamide (25mg/kg/day), and acrylamide (25mg/kg/day) + Lycopene (10mg/kg/day)). Treatment was oral for 6 weeks. The biochemical and histopathological alterations of ACR on the liver of rats and ameliorative effect of lycopene on acrylamide-induced hepatotoxicity were ex-amined.<br />Results: It was observed that acrylamide administration decreased serum reduced Glutathione (GSH) level when compared to the control group. On the contrary, it was also observed that Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), and Malondialdehyde (MDA) levels increased as a result of acrylamide administration. Histopatho-logical examinations of liver demonstrated dilated congested central vein and sinusoids, inflammatory cell infiltration, and hepatocellular necrosis in ACR group. Furthermore, ballooning degeneration was detected in hepatocytes. After Lycopene treatment, it was observed that GSH level increased while AST, ALT, and MDA levels decreased. All histopathological changes, were ameliorated when Lycopene was co-administered with acrylamide. Conclusion: In the present study, it was demonstrated that Lycopene ameliorates acryla-mide induced liver damage due to the strong antioxidant properties of Lycopene.
Acrylamide – Lycopene – Hepatotoxicity – Rats
https://mjcu.journals.ekb.eg/article_76710.html
https://mjcu.journals.ekb.eg/article_76710_24143a1797cb4bec28489c4598db11bc.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Intraoperative Cholangiography in Laparoscopic Cholecystectomy in Higher Risk Patients of Bile Duct Injuries
4137
4140
EN
SAMIR E. SHNEASHEN, M.Sc.;
MOHAMED ELSHEIKH, M.D.
MOHAMED A. HABLUS, M.D.;
HAMDY ABDELHADY, M.D.
The Department of Gastrointestinal, Liver and Laparoscopic Surgery, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.76712
Abstract<br />Background: Intraoperative Cholangiography (IOC) during Laparoscopic Cholecystectomy (LC) is a radiologic contrast-based examination of the bile duct which can represent a systemic approach to avoid Bile Duct Injuries (BDIs).<br />Aim of Study: The aim of this study was to evaluate the protective effect of selective use of IOC during laparoscopic cholecystectomy in patients with high risk for Bile Duct Injuries (BDIs).<br />Patients and Methods: This was a prospective study included 23 patients who presented for laparoscopic chole-cystectomy and had risk factors for bile duct injuries, under-went LC with IOC. Cases were analyzed as regard operative details and clinical outcomes.<br />Results: Cholangiography was successful in all the cases. The mean time of IOC added to LC was 22 minutes. There was a longer LC and IOC time in cases with positive CRP, pericholecystic fluid, mucocele and pyocele with positive significant differences. Although the pre-operative data 47.8% had history of obstructive jaundice, 21.7% a mucocele cases, 17.4% a pyocele cases, pericholecystic fluid in 30.4% and dilated CBD in 65.2%, only 13% showed abnormal IOC and needed further therapies (intraoperative ERCP in 2 cases and CBD exploration in 1 case). No bile duct injury in any case.<br />Conclusion: Intraoperative Cholangiography (IOC) was found to be safe, taking only an additional time of 22 minutes to total operative time. Although the pre-operative data, only 13% of cases needed further therapies (ERCP or CBD explo-ration). The use of IOC could be considered to improve patient safety and long term results.
Laparoscopic cholecystectomy – Intraoperative cholangiography – Bile duct injuries
https://mjcu.journals.ekb.eg/article_76712.html
https://mjcu.journals.ekb.eg/article_76712_9aed124457559d1d5bb8e7781812d4ef.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Parotid MR Sialography, Can it Help in Patients with Hepatitis C Virus Related Sicca Syndrome?
4141
4145
EN
AHMED A. MAHMOUD, M.D.;
MOHAMMED H. KAMEL, M.D.
MEDHAT M.
MADBOULY, M.D.
The Department of Radiology, Theodor Bilharz Research Institute, Cairo, Egypt
10.21608/mjcu.2019.76714
Abstract<br />Background: The Hepatitis C Virus (HCV) related sicca syndrome occurs in association with HCV infection in a range of 4-57%. Salivary gland chronic inflammation and B cell proliferation is triggered by HCV. MR sialography is a non-invasive method for salivary glands complex duct system combined with their parenchymal evaluation through conven-tional MR T2 images and source images.<br />Aim of Study: To identify changes in parotid magnetic resonance sialography (MR Sialography) in HCV related sicca syndrome patients.<br />Patients and Methods: Prospective study included 64 HCV related sicca syndrome patients (38 female, 26 male, mean age 44.6±10.5 years). All patients had performed parotid MR sialography. Severity of the disease was correlated with presence or absence of vasculitis and HCV disease duration.<br />Results: MR sialography changes were found in 25% of patients, (12/32 and 4/32 in patients with and without vasculitis, respectively). Among patients with vasculitis, those with abnormal MR sialography had longer disease duration along with more severe form of the disease.<br />Conclusion: Amongst HCV patients with vasculitis and longer disease duration, abnormal changes are identified on MR sialography.
HCV-related sicca syndrome – HCV-related vasculitis – Magnetic resonance sialography
https://mjcu.journals.ekb.eg/article_76714.html
https://mjcu.journals.ekb.eg/article_76714_a7934fa15eb75de8cd3b10375e5975eb.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Left Ventricular Global Function Analysis by Multi-Detector CT Threshold Based Three Dimension Segmentation Method in Patients with Coronary Artery Disease: A Comparative Study with Two Dimensional Echocardiography
4147
4154
EN
HANAN A. BAHAAELDIN, M.Sc.;
IBRAHIM A. LIBDA, M.D.
AHMED A. EL-SAMMAK, M.D.;
EKHLASE M. HUSSIEN, M.D.
FARIDA M.
EL-FAWAL, M.D.
The Departments of Radiology* and Cardiology**, Faculty of Medicine, Zagazig University
10.21608/mjcu.2019.76716
Abstract<br />Background: Evaluation of global left ventricular function in patients with Coronary Artery Disease (CAD) is important for clinical diagnosis, risk assessment, therapeutic decisions, and prognosis. Because MDCT is a noninvasive imaging modality frequently used for the assessment of coronary artery disease, its ability to assess the LV volumes and EF has to be evaluated and compared with Two Dimensional Standard Echocardiography (2DSE).<br />Aim of Work: To evaluate the role of MDCT threshold based segmentation method in quantification of global left ventricular function in patients with coronary artery disease and compare MDCT data with 2D-echocardiography as the standard of reference.<br />Patients and Methods: Sixty patients with suspected coronary artery disease underwent contrast enhanced MDCT using retrospective gating. Ten phases of cardiac cycle were processed to assess end-systolic and end-diastolic phase at LV short-axis view. 2DSE was performed within two weeks before MDCT. Left Ventricular Ejection Fraction (LVEF), Left Ventricular End-Diastolic Volume (LVDV) and Left Ventricular End-Systolic Volume (LVSV) were calculated using the three dimensional threshold based segmentation method (in MDCT) and modified Simpson method (in echocar-diography).<br />Results: LVEF, LVDV and LVSV were 51.9±10.9, 182.5± 45.2 and 89.8±40.2 and 51.6±10.5, 175.4±32.3 and 87.2±30.6 on MDCT and echocardiography respectively with excellent correlation between the two modalities (p;0.001) using Pear-son's correlationcoefficient. A Bland-Altman analysis showed that MDCT had slightly higher LVEF, LVDV and LVSV values with mean value of differences of 0.6%, 7ml and 2.5ml respectively, MDCT segmentation method had an accuracy of 91.6%, 95% and 98.3% respectively.<br />Conclusion: MDCT threshold based 3D segmentation method is an accurate method for quantitative evaluation of global left ventricular function compared to 2D echocardiog-raphy.
MDCT – Global left ventricular function – Cor-onary artery disease
https://mjcu.journals.ekb.eg/article_76716.html
https://mjcu.journals.ekb.eg/article_76716_512c947177f42ecacee99e669a5e74b2.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
A Comparative Study on the Protective Role of Obestatin, Quercetin and their Combination on the Injured Rat Gastric Mucosa Induced by Stress
4155
4163
EN
MAHMOUD E. SALAMA, M.D.;
MAGDI A. EL-DAMARAWI, M.D.
The Department of Physiology, Faculty of Medicine, Tanta University, Egypt
10.21608/mjcu.2019.76719
Abstract<br />Background: Modern life contains a lot of nervous stresses which considered as the origin of many diseases.<br />Aim of Study: Comparison between the protective effect of obestatin, quercetin and their combination on the stress-induced gastric ulcer in rats.<br />Material and Methods: Sixty healthy adult Wistar male albino rats weighed 180-220g were used. Ten rats were con-sidered as normal control (Group I). Stress-induced gastric ulcers were produced in the other 50 rats. These rats were divided into 5 groups: Group II (with no medication), Group III (pretreated with misoprostol), Group IV (pretreated with obestatin), Group V (pretreated with quercetin) and Group VI (pretreated with both obestatin and quercetin). All medi-cations were used for 2 weeks before induction of ulcer.<br />Results: In all groups the following parameters were measured; TBARS, antioxidant enzymes activities, myeloper-oxidase activity in gastric tissue, ulcer index, and plasma tumor necrosis factor-a. Comparing the results of Groups IV and V to that of Group II showed that, the use of obestatin or quercetin separately can ameliorate the condition to some extent with variable superiority. Also, the combined pretreat-ment of these rats with obestatin and quercetin produced more significant improvement; approaching normal; of all the tested parameters than the use of each drug separately. Moreover, the results in Group VI were far superior over the use of the standard drug misoprostol in Group III.<br />Conclusion: The combined use of obestatin and quercetin as a prophylactic measure against the development of stress-induced gastric ulcer is more effective than the use of each drug separately.
Gastric ulcer – Quercetin – Obestatin – Stress
https://mjcu.journals.ekb.eg/article_76719.html
https://mjcu.journals.ekb.eg/article_76719_03ba7e8b09e9b78e7a28aac4cf38eb7b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Methylenetetrahydrofolate Reductase (MTHFR) Gene Polymorphism (677CT) and Increased Susceptibility to Migraine in Egyptian Population: A Case-Control Study
4165
4173
EN
DOAA M.A. ELZOGHBY, M.D.;
MONA M. OSMAN, M.D.
RANDA M. AMIN, M.D.;
HEBA H. ALY, M.D.
NEHAL E. MAHMOUD, M.D.;
DALIA M. ELFAWY, M.D.
AHMAD SWEED, M.D.;
SOMIA ABDELHAMID BAWADY, M.D.
The Departments of Clinical Pathology1, Neuorology2, Internal Medicine3, Anaestesiology & Pain Management4 and
Otolaryngology5, Faculty of Medicine, Ain Shams University, Cairo, Egypt
10.21608/mjcu.2019.76721
Abstract<br />Background: Migraine is a recurrent neurovascular disor-der which lowers the quality of life. Middle-aged women are more susceptible to migraine than men. It is either migraine with aura (MA) or migraine without aura (MO). Molecular genetic studies of migraine have investigated many polymor-phisms possibly associated with migraine particularly rs4846049 and A1298C polymorphisms. Methylenetetrahy-drofolate Reductase (MTHFR) gene 677CT polymorphism is one of the proposed genetic changes affecting migraine.<br />Aim of Study: This study aimed at assessing its role in migraine in Egyptian population and its relation to the clinical manifestations of the disease and to find a possible link to effectiveness or resistance to 677CT treatment protocols.<br />Subjects and Methods: This study was conducted on (180) subjects who were divided into two groups: Group I (patients, group) which included (120) adult patients with migraine recruited from Headache Clinic in Ain Shams University Hospitals and were diagnosed with migraine according to ICHD diagnostic criteria 3rd edition beta version (2013), and Group II (control group) which included (60) age-and sex-matched apparently healthy subjects. MTHFR 677CT poly-morphism was assessed using Restriction Fragment Length Polymerase Chain Reaction (RFLP-PCR) technique.<br />Results: The study demonstrated a significant association between MTHFR gene polymorphism (C677T) and migraine (p<0.001), Odd's Ratio (OR)=6.0, 95% CI (1.84-19.59). Both heterozygous (CT) and homozygous (TT) female patients were significantly more susceptible to develop migraine than both heterozygous (CT) and homozygous (TT) males (x2: 12.48, p<0.05). Patients with homozygous type (TT) showed positive significant risk to develop aura (50%) (p<0.001), OR=45.0, 95%CI (5.26-385.19) while patients with hetero-zygous type (CT) showed positive significant risk to have attacks of migraine associated with photophobia (58.3%) (p<0.001), OR=21.0, 95%CI (3.10-142.21) or phonophobia (56.5%) (p<0.001), OR=13.0, 95%CI (2.09-81.05) or both. Significant statistical difference was seen on comparing between MTHFR gene polymorphism (677CT) and attack severity (x2: 8.57, p<0.05), while no significant difference was seen between gene polymorphism and analgesic treatment dose (x2: 1.86, p>0.05).<br />Conclusion: The study demonstrates a significant associ-ation between MTHFR gene polymorphism (677CT) and occurrence of migraine and its preceding and accompanying clinical manifestations in Egyptian population, attack severity and increased risk of disease occurrence. Unfortunately, MTHFR gene polymorphism (677CT) showed no statistical association with analgesic treatment dose.
Methylenetetrahydrofolate reductase 677CT polymorphism,Migraine,Homocysteine,PCR-RFLP
https://mjcu.journals.ekb.eg/article_76721.html
https://mjcu.journals.ekb.eg/article_76721_b589b468336100ed2395472f7f8cce84.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Role of Magnetic Resonance Imaging in Evaluation of Leiomyoma after Uterine Artery Embolization
4175
4184
EN
MOUNIR S. GUIRGUIS, M.D.;
ALLAM E. ALLAM, M.D.
DALIA S.M.
SAEED, M.Sc.
The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.76727
Abstract<br />Background: Uterine leiomyomas are the most common benign tumours in women and accounts for the majority of hysterectomies in the world. MR imaging performed before and after uterine artery embolization is the best imaging modality to diagnose, map, and characterize fibroids.<br />Aim of Study: To emphasize the utility of MR imaging in the post-procedural assessment for uterine leiomyomas patients who underwent uterine artery embolization.<br />Patients and Methods: A retrospective study was carried out on 15 patients who underwent MRI scan as a six-month follow-up after uterine artery embolization for treating uterine fibroids during the period from October 2018 to March 2019.<br />Results: The mean uterine volume was significantly reduced by 61% (p-value 0.015), the mean dominant fibroids volume significantly reduced by 79% (p-value 0.004) and the dominant fibroids showed significant lack of enhancement 100% (p-value <0.001) that indicted treatment success and in assessing the outcomes and complications as only 1 (6.7%) patient detected with pyometra (uterine infection). In this study we noted significant improvement of bleeding in 69.2% and of pain in 11.1% with slight improvement of pressure symptoms in 66.7%.<br />Conclusion: 6-month follow-up MRI has an important role in evaluation of UAE success through uterine and dom-inant fibroid volume reduction and lack of enhancement, and evaluation of the outcomes and complications including fibroid regrowth, fibroid change site, pyometra and uterine necrosis.
MRI – Uterine leiomyomas – Uterine artery embolization
https://mjcu.journals.ekb.eg/article_76727.html
https://mjcu.journals.ekb.eg/article_76727_10a5e5607b4f0f4d8267362695a1a6d4.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Touch the Plaque Open Technique of LAD Endarterectomy During CABG Surgery Guarantees Fair Postoperative Outcome and Preserved LV Functional Performance
4185
4192
EN
AHMED
SABER, M.D., F.R.C.S.
The Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
10.21608/mjcu.2019.76730
Abstract<br />Background: The rising number of severely diffused diseased left anterior descending (LAD) coronary artery (which is the most important target) met during coronary artery bypass grafting (CABG) surgeries represents a chal-lenging test to the cardiac surgeon and requires a more complex maneuvers rather than simple distal segment arteriotomy anastmosis in order to secure complete myocardial revascu-larization which is the main goal of the surgery. Touch the plaque open technique of LAD endarterectomy combined with left internal thoracic (mammary) artery (LIMA) patch plasty is one of the available solutions.<br />Aim of Study: Impact of application of touch the plaque open technique of LAD endarterectomy combined with LIMA patch plasty on the postoperative outcome, left ventricular (LV) function and clinical status of the patients is evaluated.<br />Patients and Methods: This retrospective observational non-randomized study included 21 patients who presented with ischemic heart disease (IHD) requiring primary surgical myocardial revascularization (primary CABG surgery). In-cluded patients are those with multi-vessel coronary artery disease, left main or left main-equivalent coronary artery disease and one or two coronary artery disease. They had anginal pain grade III according to Canadian Cardiovascular Society (CCS) grading of angina pectoris. Intraoperatively they had long segment-diffusely diseased LAD that was dealt with touch the plaque open technique of LAD endarterectomy combined with LIMA patch plasty. Postoperative mortality, morbidity outcomes, LV function, overall hospital complica-tions, haemodynamic and functional clinical status, and overall one-year survival were evaluated.<br />Results: Mean age was 58.23±7.54 years. Female patients represented 42.85%. The overall hospital complication rate was 28.57%. No mortality happened during the follow-up period (overall one-year survival rate was 100%). Preoperative mean LVEF% was 46.3±3.7% (range 37-59%). Evident im-provement in both clinical status and LVEF% was observed. Prior-to-hospital discharge LVEF% showed mild improvement with a mean 50.1±1.3% (p>0.05) and at one-year follow-up showed significant improvement with a mean 57.5±3.4% (p<0.05). 85.71% were in CCS grade I at one-year follow-up (p<0.01).<br />Conclusion: Touch the plaque open technique of LAD endarterectomy combined with LIMA patch plasty provides satisfactory operative and postoperative results without adding more burden to the surgery. It secures complete revasculari-zation of the LAD myocardial territory and improvement of the LV function and resultant improvement of the clinical and haemodynamic status of the patients. Utilization of LIMA patch plasty and strict anticoagulation management postoper-atively is highly recommended.
Touch the plaque open technique – LAD endar-terectomy – CABG
https://mjcu.journals.ekb.eg/article_76730.html
https://mjcu.journals.ekb.eg/article_76730_52d988e4aaef2bf55dda08316d5e64c2.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Carpal Tunnel Syndrome and the Double Crush Syndrome Hypothesis: Revisited
4193
4198
EN
HEBA RAAFAT, M.D.;
AMIRA A. LABIB, M.D.
MOHAMED R.A.
SALEH, M.D.
The Departments of Clinical Neurophysiology Unit*, Faculty of Medicine, Cairo University and Orthopaedic Surgery**, Helwan University, Egypt
10.21608/mjcu.2019.76731
Abstract<br />Background: The commonest application of the double crush hypothesis is its association to median nerve entrapment at the wrist. The double crush concept has gained popularity because it provides a reason to evaluate the cervical spine and roots when treating carpal tunnel syndrome (CTS). It is more likely for CTS to occur as DCS rather than occurring by itself. Up to 90% of CTS patients are misdiagnosed, whereas only 10% have the problem at their wrists.<br />Aim of Study: To examine the validity of DCS hypothesis in CTS patients, to support or disregard the theory.<br />Patients and Methods: This study was conducted on 80 patients; 40 patients claiming failed carpal tunnel release operation (Group I) and 40 cases presenting with brachialgia (Group II). Diagnostic work up included neurological exam-ination, Phalen test, Tinel sign, electromyographic examination (EMG) and nerve conduction studies (NCS) and cervical MRI. Group I patients had undergone the EMG and NCS at our laboratory pre and post operatively.<br />Results: EMG and NCS showed 10 cases with CTS (25%), 20 (50%) with DCS and 10 (25%) with cervical radiculopathy in group I, while group II patients showed 10 cases (25%) with CTS and 30 (75%) with DCS. In all patients, 50 cases (62.5%) showed DCS. On comparing the EMG and NCS preoperative results of Group (I), with their postoperative follow-up results, there was a high statistically significant difference (p-value <0.001) with 34 cases (85%) who showed improvement of the NCS results, while 6 cases (15%) deteri-orated postoperatively. There was a high statistically significant difference between both; CTS and DCS (p-value <0.001), denoting a positive correlation between the two syndromes.<br />Conclusion: The DCS hypothesis was supported, while the concept of frequent failure of CTS release surgery was not supported for the benefit of DC hypothesis.
Carpal tunnel syndrome – Double crush syndrome – Electrophysiological studies – Cervical radic-ulopathy
https://mjcu.journals.ekb.eg/article_76731.html
https://mjcu.journals.ekb.eg/article_76731_141199620f2f2d16e63dcae26220ce63.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Circulating Adipocyte Fatty Acid Binding Protein (A-FABP): Predictor of Metabolic Syndrome in Patients with Type 2DM
4199
4206
EN
EMAN S. EL-HADIDI, M.D.;
WESSAM EL-SAYED, M.D.
DOAA M.A. ELZOGHBY, M.D.;
MARAM M.M. MAHDY, M.D.
SAFEYA M.
ADEL, M.Sc.
The Departments of Clinical Pathology*, Internal Medicine**, Faculty of Medicine, Ain Shams University and Clinical Pathology***, Ministry of Health
10.21608/mjcu.2019.76733
Abstract<br />Background: The circulating portion of adipocyte fatty acid binding protein (A-FABP) acts as a humoral factor potentially controlling inflammatory responses and insulin action in adipocyte. Most individuals with Type 2 diabetes mellitus (2DM) exhibit intra-abdominal obesity, insulin re-sistance and subsequent occurrence of metabolic syndrome (MetS).<br />Aim of Study: This work aimed at evaluating A-FABP as a marker for MetS in type 2DM.<br />Subjects and Methods: The study included (180) subjects divided into group I (120) adult patients with type 2DM diagnosed according to ADA 2016. They were subdivided into subgroup Ia (60 without MetS) and subgroup Ib (60 with MetS). Group II (control group) included (60) age- and sex-matched apparently healthy subjects. Circulating A-FABP was measured by ELISA. In addition, assay of fasting insulin (F.insulin), lipid profile, hsCRP, and calculation of HOMA-IR.<br />Results: Highly significant increase in levels of A-FABP, F.insulin, HOMA-IR and hsCRP was observed in subgroup Ia compared to control group (Z: 5.691,4.902, 5.908, and 0.477; p<0.01; respectively). Sub-group Ib versus sub-group Ia revealed significant elevated levels of A-FABP and F.Insulin (Z: 5.276, p<0.01 and Z: 2.469, p<0.05; respectively) while HOMA-IR and hsCRP showed no significant difference be-tween both subgroups (p>0.05). In subgroup Ib, there was a significant positive statistical correlation between A-FABP and weight and BMI (r:0.379 and 0.386, p<0.05; respectively). Stepwise multi-regression analysis indicated that triglycerides and A-FABP are the most sensitive independent predictors of MetS in diabetic patients (F-ratio:64.4 and p<0.001).<br />Conclusion: High serum A-FABP level is strongly asso-ciated with MetS in type 2DM. It is a promising independent marker of MetS and is beneficial in its early diagnosis.
Type 2DM – Metabolic syndrome – A-FABP – ELISA – predictor
https://mjcu.journals.ekb.eg/article_76733.html
https://mjcu.journals.ekb.eg/article_76733_0d79492ebbdcb12bbe1e71e3d495d1ae.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Neuro Dynamic Mobilization on Pain and Hand Grip Strength in Cervical Radiculopathy Patients
4207
4212
EN
HEBA MOHAMMED, M.Sc.;
ENAS ELSAYED, Ph.D.
YOUSSEF ELBALAWY, Ph.D.;
AZZA GHALLY, Ph.D.
The Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University* and The Department of Neuropsychiatry, Faculty of Medicine, Tanta University**, Egypt
10.21608/mjcu.2019.76737
Abstract<br />Background: Cervical Radiculopathy (CR) is a patholog-ical condition of the cervical roots, which results in sensory and motor deficits. There is evidence supporting the influence of neural mobilization in relieving CR symptoms.<br />Aim of Study: The aim of the study was to evaluate the effect of neuro dynamic mobilization on hand grip strength and pain in patients with chronic cervical radiculopathy.<br />Methods: Thirty participants with cervical pain radiating to the upper limb were recruited from the Outpatient Depart-ments of El-Menshawy General Hospital from 16-11-2019 till 4-4-2019, their age ranged between 30-50 years. Patients were divided into three equal groups Group (1) received neural mobilization for ulnar, median, and radial nerves in addition to selected physical therapy program. Group (2) received neural mobilization for ulnar and median nerves in addition to the selected physical therapy program while Group (3) received only the selected physical therapy program for four weeks. Assessment of pain using visual analogue scale (VAS) and hand grip using jamar hand-held dynamometer were done before and after treatment.<br />Results: The findings revealed a statistically significant decrease of pain scores within each group and increase in hand grip strength within each group post-treatment (p<0.05). Also, there was no a statistically significant difference in handgrip strength between the affected and unaffected sides after treatment in Group (1) which received median, ulnar, and radial nerves neurodynamic mobilization (p<0.05). On the opposite side, the results showed a statistically non-significant difference between the three groups regarding pain and hand grip strength after treatment (p>0.05).<br />Conclusion: Addition of radial nerve mobilization to ulnar and median neuro dynamic mobilization technique is effective in improving symptoms of chronic CR.
Cervical radiculopathy – Neuro dynamic mobili-zation – Grip strength – Visual analogue scale
https://mjcu.journals.ekb.eg/article_76737.html
https://mjcu.journals.ekb.eg/article_76737_1a67d241f480ad056dbac77ef718f6ad.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Radiofrequency Ablation versus Partial Splenic Artery Embolization in Hypersplenism
4213
4220
EN
MONA O. ABOELEZZ, M.D.;
ESSAM MOHAMED HEMMAT, M.D.
IBRAHIM M.M. ELADL, M.Sc.;
MAHMOUD ABDO ASHOUR, M.D.
The Departments of Radio Diagnosis* and Internal Medicine**, Faculty of Medicine, Zagazig University, Egypt
10.21608/mjcu.2019.77409
Abstract<br />Background: Radiofrequency Ablation (RFA) has under-gone tremendous progress with the advances in modern technologies because of its minimal invasiveness, good toler-ance, and rapid recovery more than Partial Splenic Artery embolization (PSE) in treatment of hypersplenism.<br />Aim: The aim of the study was to correlate results from RFA and PSE with clinical and laboratory findings in patients with hypersplenism.<br />Subjects and Methods: This study was carried out at Radio-Diagnosis Department, Zagazig University Hospitals during the period from October 2015 to July 2018, included 34 patients, 17 patients subjected to RFA, and the other 17 patients subjected to partial PSE. All patients were subjected to complete clinical examination, laboratory investigations. Post procedure follow-up after 2 weeks, then every 1 month in the first 3 months and every 3 months during the 1 year.<br />Results: Both techniques increased the hemoglobin, leu-cocytic count, and platelets significantly in comparison with the pre-operative values in each group (p<0.05). Comparing the post-operative values in both groups, comparable rise in the hemoglobin level occurred (p<0.05). On the other hand, PSE group had significantly higher rise of leucocytic count and platelets than RFA group (p<0.01).<br />Conclusion: PSE was more effective in treatment of thrombocytopenia and leucopenia, but with a significant increase in morbidity. Moreover, serious adverse events after PSE will push us to find safer techniques to avoid these losses. On the other hand, RFA had some advantages, such as easier technique, more confined lesions, and fewer complications.
Radiofrequency ablation – Partial splenic artery embolization – Hypersplenism – Spleen
https://mjcu.journals.ekb.eg/article_77409.html
https://mjcu.journals.ekb.eg/article_77409_0e4975ad008fd915e975dee6aefae029.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Prolonged Daily Screen-Time among Saudi Secondary School Students
4221
4226
EN
HASSAN M.
AL-MUSA, C.A.B.F.M.
The Department of Family & Community Medicine, King Khalid College of Medicine, Kingdom of Saudi Arabia
10.21608/mjcu.2019.77410
Abstract<br />Background: Media is a powerful educational tool for children and adolescents, but they may have a great negative effect on their health. Prolonged screen-time is a risk for several chronic diseases.<br />Aim of Study: To assess daily screen-time among Saudi secondary school students.<br />Subjects and Methods: Following a cross-sectional study design in Abha City, a total of 384 secondary school students were included. A self-administered questionnaire was devel-oped by the researcher to assess students' screen-time (i.e., more than two hours per day).<br />Results: Screen times of about three-fourths of secondary school students were more than two hours. Smartphones were the most frequently used electronic devices (71.1%), followed by the watching television (54.4%), videogames (50.8%), and computers (39.1%). Screen times increase significantly during weekends (p<0.001). Screen times were significantly higher among males (p=0.001). Students with higher Grade Point Average (GPA) had significantly more screen times (p<0.001). Moreover, students' prolonged daily screen-time was signifi-cantly associated with higher family monthly income (p=0.03).<br />Conclusions: Most secondary school students have pro-longed daily screen time. The most frequently used electronic devices are smartphones. Use of electronic devices increases during weekends and entertainment is the most frequent purpose for prolonged screen time. Screen-time is significantly higher among boys, those with high GPA and among students in families with high monthly income.<br />Recommendations: Health education of adolescents and their parents to raise their awareness regarding health risks associated with prolonged screen-time and how they can positively influence their children by enforcing family rules to limit using electronic devices.
Screen-time – Electronic devices – Adolescents
https://mjcu.journals.ekb.eg/article_77410.html
https://mjcu.journals.ekb.eg/article_77410_bba053cfe5d3742ae8c732cff9f03253.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Association between Resistin, Leptin and Adiponectin with Obesity and Type 2 Diabetes Mellitus
4227
4237
EN
MOHAMED T. ABD-ELREHEEM, Ph.D.;
AYMAN S. SOLIMAN, M.D.
WAFAA I RASHEED, M.D.;
AMIRA M. JAWAD, M.D.
NOHA T.
ABD-ELREHEEM, M.D.
10.21608/mjcu.2019.77411
Abstract Background: Obesity is an important public health concern among all age groups in the world and is a risk to develop insulin resistance and associated metabolic diseases. Fat tissue exerts important endocrine functions, which are mediated by a complex network of various soluble factors, derived from adipocytes, called adipocytokines including tumor necrosis factor a (TNF-a), Interleukin (IL) 6, leptin, adiponectin and resistin. Some adipokines play a major role in insulin resistance and cardiovascular complications associated with obesity, especially central or visceral obesity. Aim of Study: The aim of this study was to discover the role of leptin, adiponectin and resistin as a link between obesity and insulin resistance type 2 diabetes through assess-ment of their levels in normal weight, obese before and after weight reduction as well as obese diabetic subjects. Patients and Methods: Forty-five female subjects divided into four groups, 15 subjects with normal weight-as control group (group I), 15 obese subjects (group II), 10 subjects from group II followed a weight reduction regimen for 2 months (group III) and 15 obese diabetic subjects (group VI). Serum insulin, leptin, adiponectin and resistin were measured by ELISA. Lipid profile was measured by a spectrophotometric method. Anthropometric measurements were also performed. Results: The study showed that the obese and obese diabetic subjects have got higher serum leptin and resistin levels when compared with controls. In contrast, serum adiponectin concentration was significantly lower in obese before diet and obese diabetic subjects when compared to the control group. After weight loss, significant improvement has been observed in all parameters. The findings from bivariate correlation analysis were further explored using multiple linear regression analysis which confirmed that resistin rather than adiponectin and leptin was an important determinant of insulin resistance. Conclusion: This study concluded that even modest weight loss can improve metabolic risk factors through modulation of some adipokines.
Obesity – Diabetes – Insulin resistance – Leptin – Adiponectin – Resistin
https://mjcu.journals.ekb.eg/article_77411.html
https://mjcu.journals.ekb.eg/article_77411_5a80af6728d1c246a3274379405dd5fd.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Laparoscopic versus Open Cholecystectomy in Cirrhotic Patients: A Prospective Comparative Study
4239
4245
EN
BOSAT E. BOSAT, M.D.;
NABIL A. ALANSARY, M.Sc.
MOSTAFA
A. AHMED, M.D.
The Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar* and Ain Shams** Universities, Cairo, Egypt
10.21608/mjcu.2019.77412
Abstract Background: Prevalence of gallstones in cirrhotics is estimated at 29-46% and thus is three times as high as those without liver cirrhosis. Cirrhosis increase incidence of gall-stones formation (black stones) with an overall prevalence of 25% to 30%. Aim Study: To compare between the rationale, risk and morbidity of open cholecystetomy versus and laparoscopic cholecystectomy in cirrhotic patients. As regard to operative time, intra operative and post-operative blood loss, time to resume diet, complications, mortality incidence, and post-operative subjective pain score. Patients and Method: This study was a prospective com-parative study on laparoscopic versus open cholecystectomy in cirrhotic patients. The cases were performed in the period from April 2016 till October 2018. 100 patients with sympto-matic gallstone disease and liver cirrhosis including Child class A or Child class B, were randomly divided into two groups, Group (A): Laparoscopic Cholecystectomy (LC) and Group (B): Open Cholecystectomy (OC). Results: In LC group two cases (4%) were converted to open cholecystectomy. Mean surgical times were significantly shorter in LC (Group A) group. The mean +SD (in minutes) of OC (Group B) and LC (Group A) was 97.69±15.79 versus 63.58±9.93, respectively, (p<0.001), associated with significantly higher intraoperative bleeding in OC group (p<0.001). The mean time to resume diet (hours) was 10.69± 5.41 in (Group A) it was significantly earlier than in (Group B) 24.15±6.74 (p<0.001). The length of hospital stay (days) was significantly longer in (Group B) with a mean hospital stay 5.08±1.56, compared with a mean hospital stay 2.60±0.61 for (Group A) (p<0.001) with low post-operative morbidity and no operative mortality. Conclusion: Laparoscopic Cholecystectomy (LC) offers safe and effective surgical treatment for cirrhotic patients of (Child class A and early B) suffering from gallstone disease, as it has lower morbidity, shorter operative time; early re-sumption diet with less need for blood transfusion and reducing hospital stay than OC.
Cirrhosis – Laparoscopic cholecystectomy (LC) – Open cholecystectomy (OC)
https://mjcu.journals.ekb.eg/article_77412.html
https://mjcu.journals.ekb.eg/article_77412_219b125e99633c62b3ff23a3b2dfc2e9.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Recent MRI Study of Acute Shoulder Trauma
4247
4254
EN
AYMAN M. IBRAHIM, M.D.;
ALLAM E.S. ALLAM, M.D.
SHERIF
A. KAMAR, M.D.
The Departments of Radiology* and Anatomy**, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.77413
Abstract Background: Magnetic Resonance Imaging (MRI) is considered a reliable technique for the evaluation of the different causes of shoulder pain. The anatomy of the shoulder is unique, with amazing flexibility and range of motion. Many causes of painful shoulder syndrome are there; shoulder impingement come on top of the list, large number of factors could cause shoulder impingement syndrome. Two major categories were identified: structural factors and functional factors. Aim of Study: Is to review an accurate and highly sensitive diagnostic evaluation of frequently encountered acute traumas of shoulder joint in athletes. Patients and Methods: 40 patients shared in this study, patients with symptoms of painful shoulder and limited movements of their shoulders to Sport Injuries Orthopedic Clinic. Informed oral consent explaining the procedure details was obtained from all patients prior to inclusion in the study. The privacy of participants and confidentiality of data were guaranteed during the various phases of the study. All patients underwent history taking, clinical provisional diagnosis, radiological investigations in the form of Magnetic Resonance Imaging. Descriptive statistics were done for quantitative data as minimum & maximum of the range as well as mean ± SD (standard deviation). Image analysis was conducted by two radiology fellows, each with an experience in interpretation Musculoskeletal (MSK) MR images, both were blinded to the results and reports and independently evaluated the MR images. Results: Effusion, Bankart, Hillsachs and Rotator cuff tear were the most frequent MRI findings. Majority of cases had two-three findings. No significant difference according to mode of trauma regarding age and sex. Weight lifting was significantly the most frequent regarding traction mode of trauma; team sport was significantly the most frequent regard-ing direct impact mode of trauma, while weight lifting and team sport had non-significant difference regarding Fall on Out Stretched Hand (FOOSH). Conclusion: Careful history taking of the patient like type of the sport, mode of trauma and severity of trauma is a very important tool that can help the radiologist to predict different lesions could be found in the study of each patient and finally reach an accurate diagnosis in an easier way and saving lots of time doing so.
MRI – Shoulder – Trauma – Athletes
https://mjcu.journals.ekb.eg/article_77413.html
https://mjcu.journals.ekb.eg/article_77413_d7212c1d762603112dc497821eabbbad.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Use of Platelet Rich Plasma in Chronic Plantar Fasciitis
4255
4262
EN
MOHAMED A.I. ABUALSOUD, M.Sc.;
MAMDOUH F. LASЮN, M.D.
AHMED EL-SAYED EL-TANTAWY, M.D.;
MOHAMED OSAMA RAMADAN, M.D.
The Department of Orthopedic Surgery, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.77428
Abstract Background: Chronic plantar fasciitis is the most common cause of foot complaints making up to 11-15% of the foot symptoms requiring professional care among adults. Also, it is a common problem that affects sport participants as well as inactive middle-aged individuals. Many modalities of treatment were prescribed to relieve the symptoms such as rest, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), brac-ing, physical therapy and corticosteroid injection. Newer treatment modalities have been tried, such as extracorporeal shock wave treatment, iontophoresis, and injection of botulism toxin. In case of lack of response to conservative treatment, the last resort is surgery with the primary objective of relieving pain. One novel treatment strategy is the use of local injection of platelet rich plasma. These platelets release a large propor-tion of biologically active growth factors that are thought to accelerate and improve the regeneration and healing process. Aim of Study: This study is designed to be a prospective study, aiming to evaluate the clinical outcome of patients who were diagnosed to have chronic plantar fasciitis and treated with platelet rich plasma local injection. Patients and Methods: The study was conducted on 40 patients (16 males-24 females) from September 2017 to August 2018 with chronic planter fasciitis attending the outpatient clinic of the Orthopedic Department of Tanta University Hospitals. Their ages ranged from 30 to 57 years with mean age of 42.17. All patients had inferior heel pain that is usually worse with their first steps in the morning or after a period of inactivity, with maximal tenderness over the antero-medial aspect of the inferior heel and not responding to conservative treatment. Patients were treated by local injection of platelet rich plasma at maximal tender point of the heel. They were followed-up after one month, two months, three months and six months using Visual Analogue Scale, Roles and Maudsley Score, and American Orthopedic Foot and Ankle Society Score. Results: All patients were successfully followed-up for 6 month. According to VAS of pain, the mean VAS of pain had improved from 8.03±1. 12 pre-injection to 2.28-}1.18 post injection. According to Roles and Maudsley score, 9 patients with excellent results, 22 patients with good results, 7 patients with accepted results and 2 patients with poor results. Accord-ing to AOFAS, the mean of AOFAS had improved from 49.80-} 8.93 pre-injection to 82.0-}8.94 post injection. The final end results were satisfactory in 31 patients out of 40 and 9 patients ended by unsatisfactory results. There were no complications reported during follow-up of the cases.
Platelet rich plasma – Chronic plantar fasciitis
https://mjcu.journals.ekb.eg/article_77428.html
https://mjcu.journals.ekb.eg/article_77428_44f19c6bc2e60e6b18110d80c2034b09.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Cranioplasty Following Firearm Injury in Patients from War in Yemen: Retrospective Review of 23 Patients
4263
4268
EN
MOHAMED E. ELHAWARY, M.D.;
MICHAEL Z. JOHNY, M.D.
The Department of Neurosurgery, Faculty of Medicine, Benha University* and Nasser Institute Hospital
10.21608/mjcu.2019.77429
Abstract Background: Cranioplasty, the repair of a skull vault defect by insertion of an object (bone or nonbiological materials such as metal or plastic plates), is a well-known procedure in modern neurosurgery. Brain protection and cosmetic aspects are the major indications of cranioplasty. Aim of Study: This study is to compare the cosmetic outcome and complications rate after cranioplasty in patients with firearm injuries, coming from war in Yemen to our neurosurgery center in Egypt, with cranial bony defects. Patients and Methods: Patients were selected with the following inclusion criteria: 1-Size of defect: Patients with bony defects more than 3cm. 2-Location of the defect: Frontal, parietal and occipital defects, (temporal defects are covered with muscle and usually doesn't need repair). We reviewed 23 patients retrospectively, underwent crani-oplasty between March 2017 and November 2018. Titanium mesh (TM; 17 patients) and poly methyl methylacrylate (bone cement) reconstructed grafts (BC; 6 patients) were used as implants. Results: More than 95% of cases (22 patients) presented to us with history of primary wound debridement, bullet extraction (in some cases) and wound closure in Yemen before coming to our center in Egypt. Before surgery, 18.8% (4 patients) presented with pseu-domeningiocele formation, 2 patients presented with CSF leaking skin fistula. Intra-operatively, 82.6% (19 patients) of them didn't undergo any kind of duroplasty. Regardless of implanted materials, more than 82.6% (19 patients) of the CP patients were satisfied with the cosmetic outcome. No statistically significant difference was observed among the two groups. The TM group showed lower complication rates compared with BC group, while the BC group demonstrated a higher post-CP subgaleal collection rate (33.3%, 2 patients) than the TM group (5.8%, 1 patient). However, no significant difference in the incidence of post-CP infection was observed among the two groups. Conclusion: In comparison with TM and BC, cranioplasty with TM shows benefits in terms of lower post-CP complica-tion, less intraoperative bleeding loss, shorter operation time and in-hospital stay.
Cranioplasty – Cranial bone defect – Firearm injury – War in Yemen
https://mjcu.journals.ekb.eg/article_77429.html
https://mjcu.journals.ekb.eg/article_77429_e44db57f9a9582c78a32950a88491b0f.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Progranulin Protects Rat Testis From Ischaemic Reperfusion Injury
4269
4276
EN
EMAN R. ABOZAID, M.D.;
NAGLAA A. AHMED, M.D.
The Department of Physiology*, Faculty of Medicine, Zagazig University, Egypt and Physiology Department**, Faculty of Medicine, Najran University, KSA
10.21608/mjcu.2019.77430
Abstract Background: Ischemic reperfusion (I/R) damage of the testis is a common problem, it is mainly caused by testicular torsion and detorsion. Progranulin (PGRN) has been reported to have prominent anti-inflammatory and protective effects on I/R injury in the heart, brain and kidney, however, its effects on testicular I/R lesion have not been evaluated. Aim of Study: To examine the effects of progranulin on rat testicular ischaemia/reperfusion induced by torsion/ detor-sion and the possible underlying mechanisms. Material and Methods: In this study, rats were divided into 4 groups: (i) Sham; (ii) Testicular ischemia/reperfusion (I/R), 2h of ischemia followed by 6 h of reperfusion; (iii) I/R treated by PGRN (0.01mg/rat) administered 1.5h after the induction of ischaemia. (iv) I/R treated by PGRN (0.1mg/rat) administered 1.5h after development of ischemia. At the end of the study, some testicular oxidative stress markers, inflam-matory, apoptotic markers and serum testosterone were meas-ured, in addition to histopathologic study. Results: Significant decreases in serum testosterone levels, testicular superoxide dismutase (SOD) and glutathione per-oxidase (Gpx) activity with increase in tissue malondialdehyde (MDA) were observed in I/R group when compared with controls. These antioxidant levels were increased in PGRN treated groups with significant decrease in MDA levels. While an increase in tumor necrosis factor-alpha (TNF-a), IL-1b, caspase-8 and caspase-3 levels were found in the torsion/ detorsion group, significant decrease in the levels of these inflammatory cytokines and apoptotic markers were observed in PRGR treated groups in a dose dependent maner. Conclusion: These results demonstrate that PGRN signif-icantly produced protective effects on testicular tissue damage through antioxidant, anti-inflammatory and antiapoptotic mechanisms.
Progranulin – Ischaemia – Reperfusion – Testis
https://mjcu.journals.ekb.eg/article_77430.html
https://mjcu.journals.ekb.eg/article_77430_2684510a4e0181f2b35a209a806293b6.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Diagnosis of Fetal Facial and CNS Malformations during Mid-Trimester Anomaly Scan: Does Three-Dimensional Ultrasonography Have Any Added Value?
4277
4284
EN
AMR A.A.M. GBR, M.Sc.;
HOSSAM ELDIN MANSOUR ABDELRAHMAN, M.D.
SAID ABDELMONEM EBRAHIM, M.D.;
DALIA O. EL-HAIEG, M.D.
The Departments of Radiodiagnosis* and Obstetrics & Gynecology**, Faculty of Medicine, Zagazig University, Egypt
10.21608/mjcu.2019.77431
Abstract Background: The ability of three dimensional ultrasound to acquire and save volume datasets, reconstruct any plane in the volume and allow off-line re-examination and manipulation of these datasets, makes this technology superior to two dimensional ultrasound in many areas. Aim of Study: This study was conducted to determine if there is any added value of 3D US examination in diagnosis of fetal malformations during mid-trimester anomaly scan. Subject and Methods: Pregnant women referred for mid-trimester anomaly scan were prospectively evaluated by 2D US. Fetuses suspected to have malformation by 2D US or with increased risk of a recurrence or strong family history of a congenital abnormality, were evaluated by 3D US. Women confirmed to have fetal malformations postnatally were included. Results: Sixty malformations were confirmed postnatally. 2D US established the diagnosis of fifty seven (95%) malfor-mations and two malformations were detected exclusively by 3D US, and the difference was highly significant [McNemar chi-squared statistic=18, p=<0.0001]. Fifty nine malformations were diagnosed by both 2D and 3D US. Conclusions: 3D US significantly improved the number of detected fetal malformations, than that detected by 2D US. 3D imaging is superior in specific diagnostic problems. Rather than representing an alternative, 3D US is complementary to the conventional 2D US in the field of prenatal diagnosis.
Ultrasound – Two-dimensional – Three- dimensional – Fetal malformations
https://mjcu.journals.ekb.eg/article_77431.html
https://mjcu.journals.ekb.eg/article_77431_28698a93be070bdfca6dc2bc2c09bc89.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Outcome of Lumbar Trans-Pedicular Fixation in Management of Recurrent Lumber Disc Herniation
4285
4290
EN
AHMED M. NABEEL, M.D.;
MAHMOUD M. WAHDAN, M.D.
ATEF A. SALEM, M.D.;
MOHAMED A. MANSOUR, M.D.
ALI
S. ALI, M.Sc.
The Departments of Neurosurgery* and General Surgery**, Faculty of Medicine, Benha University
10.21608/mjcu.2019.77432
Abstract Background: Recurrent lumbar disc herniation is one of the common problems facing most of neurosurgeons and spine surgeons. Treatment options include conservative management (pharmacological and physical therapy) and finally surgical intervention. Surgical options include repeat discectomy and adhesolysis with or without instrumented spinal fusion. Fusion is usually suggested for patients with deformity, instability, or associated axial low back pain. Aim of Study: This study aims to evaluate the role of trans-pedicular fixation in the management of recurrent lumbar disc herniation. Patients and Methods: The study was carried out on 20 patients with recurrent lumber disc herniation underwent surgery for discectomy with trans-pedicular fixation with postero-lateral inter-transverse fusion at neurosurgery depart-ment at Benha university hospital, in the duration between 12/2016 to 12/2018 with minimum follow-up 6 months. All the patients were clinically examined carefully, Preoperatively and post-operatively, low back pain and radiculopathy were assessed by visual analogue score (VAS). Patients were radiologicaly investigated by MRI and dynamic X-rays. Results: All the patients were improved clinically imme-diately after surgery. The Median VAS for back pain and radiculopathy significantly decreased from 8 pre-operatively to 2 post-operatively. Post-operative radiological assessment was done for all 20 patients by CT LSS to asses accuracy of instrumentation and fusion. Conclusion: Using Trans-pedicular fixation and fusion for treatment of recurrent LDP provide adequate Clinical improvement for LBP and sciatica giving chance for better nerve root decompression and avoid mico-instability.
Recurrent,Lumbar disc prolapse – Fixation
https://mjcu.journals.ekb.eg/article_77432.html
https://mjcu.journals.ekb.eg/article_77432_7071c9932725af07330f321e8e95729d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Success Rate of Left Varicocele Embolization in Management Recurrent Varicocele after Surgery
4291
4295
EN
HAYTHAM MOHAMED NASSER, M.D.;
HATEM SAYED, M.D.
The Departments of Radiology* and General Surgery**, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.77433
Abstract Background: Varicoceles dilation of veins are present in 15% of men. Varicocele can be asymptomatic or symptomatic. Symptoms include pain and/or infertility. Varicocele recurrence depend mainly on the used technique for repair. The recurrence rate ranges from 1.05-14.97%. Aim of Study: The purpose of this study is to measure the success rate of the embolization technique in patients with recurrent left symptomatic varicocele after surgery. Patients and Methods: This cross sectional study included 15 patients with symptomatic (pain or infertility) recurrent left varicocele after surgery. Embolization was done at Ain Shams University hospitals from October 2017 to December 2018. Results: Varicocele embolization for recurrent varicocele after surgery has technical success of 93.3%. Conclusion: Embolization is an effective way to treat recurrent varicocele after surgery.
Varicocele (VC) – Gonadal Vein (GV) – Butyl Cyanoacrylate (BC) – Primary Infertility (PI) – Percutaneous Embolization (PE)
https://mjcu.journals.ekb.eg/article_77433.html
https://mjcu.journals.ekb.eg/article_77433_8a244f1f42b9331b3ed5d30d7eba6a42.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
A Study on the Truth Telling of Yemeni Doctors to Terminally Ill Patients
4297
4302
EN
AHMED
S. ALGEFRI, M.D.
The Department of Medicine, Faculty of Medicine and Health Sciences, University of Aden, Yemen
10.21608/mjcu.2019.77434
Abstract Background: Dealing with terminal illness involves more than symptoms management and patient comfort, it involves changing roles within family units; difficulties with coping; added responsibilities for family members; major decisions concerning care of the patients; increased concern about financial matters and legal issues. Aim of Study: This work was conducted with the objective of exploring the attitude of Yemeni graduated doctors in regard to ethical issues in terminally ill patients. Subjects and Methods: A cross-sectional descriptive study was applied. A total number of 130 doctors representing all graduated doctors from the Faculty of Medicine, Aden Uni-versity, Yemen participated in the study. The opinions of doctors were obtained by means of self-administrated ques-tionnaires that included different criteria regarding terminally ill patients that was filled by doctors. Results: The results show that the majority of doctors give different opinions in relation to different aspects in dealing with terminal ill patients and gave justifications for that. The main reason identified by doctors for not telling the truth to terminally ill patients was that the patient would not like to know the truth, and the main reason for not telling the truth to the patient family was to protect the family from emotional stress. Conclusions: The study concluded that truth telling to terminally ill patients was a common dilemma in that 'to tell' or 'not to tell' was the main question which was evaluated differently by doctors.
Truth telling – Terminal ill patient
https://mjcu.journals.ekb.eg/article_77434.html
https://mjcu.journals.ekb.eg/article_77434_4f50c848f3e49b49a99838a9d5b8cbeb.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Montelukast Efficiency in Improving the Deleterious Gastrointestinal Effects of Dexamethasone in Rats
4303
4313
EN
GHADA F. SOLIMAN, M.D.;
MARIAN Y. WISSA, M.D.
HEBA
MORSI, M.D.
The Departments of Medical Pharmacology* and Medical Biochemistry & Molecular Biology**, Faculty of Medicine, Cairo University, Egypt
10.21608/mjcu.2019.77436
Abstract Background: Montelukast and dexamethasone are used in combination in the treatment of asthma. Treatment by steroids resulted in gastric mucosa weakening enhancing the occurrence of ulcer in addition to its effect on the motility and contractility of gastrointestinal tract. Aim of Study: The present study was designed to evaluate the anti-ulcer effect of montelukast, a selective leukotriene (LT) D4 receptor antagonist compared to famotidine and its effect on the motility and contractility of the small intestine in gastric ulcer induced by dexamethasone and aggravated by cold stress. Material and Methods: Adult male rats were divided into 5 groups: The first received normal saline. The other groups were given dexamethasone intraperitoneally (4mg/kg/day) for 5 days. The third group received famotidine 40mg/kg/day while the fourth and fifth groups received montelukast 30 and 60mg/kg/day orally respectively thirty minutes after dexam-ethasone. At the end, rats were exposed to cold stress then sacrificed to extract the stomachs and intestines to determine gastric ulcer score and intestinal transit then the response of small intestine to acetyl choline was recorded. Then the stomachs were divided for histopathological and biochemical studies. Results: Dexamethasone treatment resulted in ulceration of gastric mucosa, increased intestinal transit, diminished intestinal contraction and increased oxidative stress. The group treated with montelukast 60mg/kg/day showed a sig-nificant decrease in mean gastric ulcer score, intestinal transit but increase of intestinal contractility. All treated groups showed significant MDA decrease, improved histopathological picture of the stomach while the two montelukast treated groups showed significant increase in SOD. Conclusion: Montelukast with high dose shows a prom-ising role in eliminating the undesirable effects induced by corticosteroids especially if associated with stress.
Montelukast – Dexamethasone – Famotidine – Intestinal transit – Gastric ulcer
https://mjcu.journals.ekb.eg/article_77436.html
https://mjcu.journals.ekb.eg/article_77436_c0f7dbe95108866efce89638c47936dd.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Acute Scrotum in Neonates: Clinical, Radiological and Surgical Correlation
4315
4327
EN
MOHAMMED ZAKI, M.D.;
MOHAMED Y. BATIKHE, M.D.
The Department of Radiology* and Pediatric Surgery Unit, Department of Surgery**, Faculty of Medicine, Sohag University, Egypt
10.21608/mjcu.2019.77438
Abstract Background: Acute scrotum in neonates is a significant medical and surgical entity to deal with. It may be due to diverse causes. Aim of Study: To evaluate the radiological findings of acute scrotum in neonates and compare them with clinical and surgical data; especially as regards testicular and intestinal viability. Patients and Methods: Thirty boys (neonates) examined for acute scrotum. Clinical evaluation was done to all patients. Suitable radiological imaging was done according to the case including sonography, color Doppler and may be X-Ray. Medical or surgical management was achieved accordingly. Results: The study includes the following lesions; unilat-eral testicular torsion in 5 cases, bilateral testicular torsion in one case, complicated inguinal hernia in 12 cases, epididymitis and epididymo-orchitis in 6 cases, scrotal pyocele in 2 cases, scrotal hematoma in one case, skin infection with scrotal edema in two cases and meconium peri-orchitis with scrotal edema in one case. Sonography with color Doppler has the sensitivity, specificity and accuracy of 100%, 85% and 90% respectively as compared with surgical and clinical data. Conclusion: Acute scrotum in neonates and infants has many causes. Radiology has a major role in the differential diagnosis of these causes and correlated well with surgery. Still surgical exploration is to be considered when radiological evaluation is not conclusive.
Acute scrotum – Torsion – Complicated inguinal hernia – Ultrasonography – Neonates
https://mjcu.journals.ekb.eg/article_77438.html
https://mjcu.journals.ekb.eg/article_77438_3867fe1556b214e57c3f851de230b920.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Risk Factors of Pathological Unconjugated Hyperbilirubinemia among Yemeni Newborn
4329
4335
EN
NAFISA H. Al-JAIFI, Ph.D.;
ARWA A. Al-HARAZI, M.D.
ALI F. Al-ERYANI, M.D.;
AHLAM A. SOWILEH, M.Sc.
The Department of Pediatrics, Faculty of Medicine and Health Sciences, Sana'a University* and The Department of Pediatric Specialist, Saudi German Hospital Sanaa**
10.21608/mjcu.2019.77439
Abstract Background: Jaundice is a clinical condition that is often present in pediatric practice and constitutes one of the major issues within the neonatal period and it is either physiological or pathological. Although most newborn who have jaundice are otherwise healthy, they need close monitoring for serum bilirubin level as bilirubin is potentially toxic to the central nervous system. Risk factors may be maternal or neonatal in origin. This preliminary study focuses on the detection of the risk factors of pathological unconjugated hyperbilirubinemia due to lack of information on this topic in Yemen. Aim of Study: To determine the most common aetiology and risk factors of pathological unconjugated hyperbilirubine-mia and their relation to serum bilirubin. Patients and Methods: The study was prospective cross-sectional descriptive study of newborns with pathological unconjugated hyperbilirubinemia admitted to neonatal intensive care unit (NICU) at Al-Thawra General Modern Teaching Hospital and Al-Sabeen Maternity and Childhood Teaching Hospital during a period of 12 months starting on June 2012 to end of May 2013.Of the total admitted cases, two hundred cases were selected according to the inclusion and exclusion criteria. Data was collected, tabulated and analyzed by using Statistical Package for the Social Sciences (SPSS) version 20. Results: The risk factors of pathological hyperbilirubine-mia were Neonatal sepsis which was the most common aeti-ology and associated risk factor and was present in 70% of the cases, ABO incompatibility was present in 14% of the cases, Rh incompatibility was present in 8% of the cases, Cephalohaematoma (excessive bruising) was present in 6% of the cases, and G6PD deficiency was present in 2% of the cases. Conclusion: Pathological unconjugated hyperbilirubinemia is one of the major problems in neonatal morbidity and mortality in Yemen. Neonatal sepsis was the commonest aetiology and associated risk factor of pathological hyperbi-lirubinemia and the major cause of death in this study. We need to do early screening for detecting hyperbilirubinemia and we need to adopt early essential newborn care and resus-citation guideline on a national level to conduct appropriate management.
Unconjugated hyperbilirubinemia – Newborn – Neonatal intensive care unit – Phototherapy – Neonatal sepsis – Risk factors
https://mjcu.journals.ekb.eg/article_77439.html
https://mjcu.journals.ekb.eg/article_77439_fa8dab4fa5c1090fdfc3585171932a47.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Evaluation of Cancer-Associated Fibroblasts Markers in Hepatocellular Carcinoma
4337
4343
EN
GHADA A. ABD EL-FATTAH, M.D.;
RASHA M. ABDRABUH, M.D.
The Department of Pathology, Faculty of Medicine, Benha University
RANIA
G. ROSHDY, M.D.
10.21608/mjcu.2019.77440
Abstract Background: Cancer associated fibroblasts (CAFs) are main components of tumor microenvirnoment. They act an essential role in tumor progression, invasion and unrespon-siveness to chemotherapy. Aim of Study: This work aims to study the relation of CAFs with hepatocellular carcinoma (HCC) developement and progression. Material and Methods: This is an uncontrolled retrospec-tive study carried upon 30 cases of HCC. Cases were collected from archives of Pathology Department and Early Cancer Detection Unit (ECDU), Faculty of Medicine, Benha Univer-sity, and from International Medical Center during the years 2010-2015. Podoplanin (D2-40), alpha smooth muscle actin (a-SMA) and CD31 immunohistochemichal staining were performed and evaluated for each case. Results: Both D2-40 and a-SMA showed different distri-butions and levels of expression. D2-40 positivity was localized to the peri-tumoral area, while a-SMA was detected in both intra- and peritumoral areas. Expression of both markers was not statistically related to each other (p>0.05). D2-40 was positive in 73.3% of casesand a-SMA showed high expres-sionin 60% of cases. Both positive D2-40 and high a-SMA showed positive relations to tumor grade (p
Cancer associated fibroblasts (CAFs) – Hepato-cellular carcinoma (HCC) – Podoplanin (D2-40) – Alpha smmoth muscle actin (a-SMA) – CD31 – Microvessel density (MVD) – Lymphatic vessel density (LVD)
https://mjcu.journals.ekb.eg/article_77440.html
https://mjcu.journals.ekb.eg/article_77440_84def76d282933398139091a5007af4d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Immunohistochemical Differentiation between Reactive and Malignant Mesothelial Proliferations in Pleural Effusion
4345
4353
EN
MOHEBAT H. GOUDA, M.D.;
MOHAMMED ELMAHDY, M.D.
GEHAN M.
ELOSEILY, M.D.
The Departments of Pathology*, Chest**, Faculty of Medicine, Benha University, Egypt and Department of Pathology***, Faculty of Medicine, Assiut University, Egypt & Almarefa University, KSA
10.21608/mjcu.2019.78251
Abstract<br />Background: The differentiation between benign and malignant mesothelial cells in pleural effusion in some cases can be a challenge. In the current study, we investigated the value of immunohistochemistry (IHC) in making that differ-entiation.<br />Aim of Study: This study aims to examine the value of IHC expression of desmin, EMA, GLUT-1, p53, Ki67, and BAP1 in discrimination between benign and malignant mes-othelial proliferation in pleural effusions and compare their results regarding sensitivity and specificity.<br />Material and Methods: Pleural fluids from 30 cases diagnosed as malignant meothelioma (MM) epitheloid type and 20 cases diagnosed as reactive mesothelial hyperplasia (RMH) were selected, and stained with immunohistochemical stains included BAP-1, desmin, epithelial membrane antigen (EMA), glucose-transport protein 1 (GLUTÅ]1), Ki67, and p53.<br />Results: BAP-1 was negative in 5% (1 of 20) cases of reactive MH and in 63.3% (19 of 30) of MM cases (p<.005). GLUTÅ] 1 was positive in 15% (3 of 20) of benign and 70% (21 of 30) of malignant cases (p<.005). Desmin was positive in 80% (16 of 20) cases of reactive MH and in 10% (3 of 30) of MM cases (p<.001). EMA was positive in 10% (2 of 20) of benign and 96.7% (29 of 30) of malignant cases (p<.001). P53 showed strong nuclear positivity in 5% (1 of 20) of benign and 53.3% (16 of 30) of malignant cases (p<.001). Ki67 showed strong nuclear positivity in >40% of mesothelial cells in 10% (2 of 20) of benign and 16.7% (5 of 30) of malignant cases (p=0.40). EMA negativity and desmin positivity were found in 75% (15 of 20) of reactive MH cases and 3.3% (one of 30) of MM cases. EMA positivity and desmin negativity were found in 5% (1 of 20) of reactive MH cases and 90% (27 of 30) of MM cases (p<.001). Positivity for both of Desmin and BAP-1 was detected in 80% (16 of 20) of RMH cases. The combination of Desmin and BAP-1 negativity was detected in 60% (16 of 30) of MM cases (p-value p<.001).<br />Conclusions: Cases showed positivity for EMA and neg-ativity for desmin strongly favors malignant mesothelioma. On the contrary, cases showed negative EMA and positive desmin strongly favors Reactive mesothelial hyperplasia. also the combination of Desmin and Bap-1 postivity favors diagnosis of RMH, and the combination of Desmin and BAP-1 negativity favors the diagnosis of MM. Similarly, cases showed strong membranous expression of GLUT-1 and/or strong nuclear expression of p53 strongly favors diagnosis of malignant mesothelioma. Proliferative index showed detected by Ki67 showed no significant difference between reactive and malignant cases.
BAP-1 – P53 – Ki67 – Desmin – EMA – GLUT-1 – Reactive mesothelial hyperplasia (RMH) – Malignant mesothelioma (MM) – Immunohisto-chemistry (IHC)
https://mjcu.journals.ekb.eg/article_78251.html
https://mjcu.journals.ekb.eg/article_78251_86d70e605e595a7f853fc8eeba7891c0.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Comparative Study between 3D Balanced Fast Field Echo Sequence and 3D Driven Equilibrium Sequence in the Assessment of the Inner Ear Structure and Internal Auditory Canal Nerves
4355
4362
EN
AHMED S. ABDELRAHMAN, M.D.;
ALIAA S. SHEHA, M.D.
MENA E.Y.
EKLADIOUS, M.D.
The Department of Radiology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.78252
Abstract<br />Background: MR cisternography using three dimensional (3D) heavily T2-weighted imaging techniques is considered the main imaging modality for identification and assessment of inner ear structures anatomy and pathology as well as for identification of the posterior fossa cranial nerves, and there are two techniques that are usually used which are fast spin-echo including Driven equilibrium (DRIVE) and fast gradient-echo techniques including Balanced fast field echo (bFFE).<br />Aim of Study: To compare the image quality of 3D DRIVE and 3D bFFE sequences in the assessment of the inner ear structures and internal auditory canal cranial nerves.<br />Material and Methods: 15 patients underwent MR imaging of the temporal bone using both 3D bFFE and 3D DRIVE sequences with a comparison between the two sequences as regards the clarity of cranial nerves and inner ear structures.<br />Results: The 3D bFFE sequence was statistically signifi-cantly better than 3D DRIVE for demonstration of the cochlear, and vestibular nerves, and it was slightly better for visualizing the facial nerve as well as the cochlear inner structure. The 3D DRIVE showed a statically insignificant supremacy over 3D bFFE for visualization of the three semicircular canals and vestibule.<br />Conclusion: The 3D bFFE shows slightly better imaging quality over 3D DRIVE with the advantage of less imaging time.
MRI – 3D bFFE – 3D DRIVE – IAC
https://mjcu.journals.ekb.eg/article_78252.html
https://mjcu.journals.ekb.eg/article_78252_9169533ab794d332adaf648725fdc507.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Impact of Two Different Anesthetic Techniques on Immune Response and Postoperative Pain for Abdominal Hysterectomy
4363
4369
EN
ENAS MOHAMMED ASHREY, M.D.;
BOSAT ELWANY BOSAT, M.D.
The Departments of Anesthesia, Intensive Care & Pain Management* and General Surgery**, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
10.21608/mjcu.2019.78253
Abstract<br />Background: Spinal anesthesia is a famous technique used for lower abdominal surgery, however when it is con-traindicated, general anesthesia can be used.<br />Aim of Study: The aim of this study was to evaluate the impact of anesthetic techniques on immune response and postoperative pain for patients undergoing benign abdominal hysterectomy.<br />Material and Methods: Forty adult female patients (Amer-ican physical status (ASA) I-II, 30-60 years) scheduled for abdominal hysterectomy (AH) were allocated to receive either general or spinal anesthesia. Hemodynamic variables were recorded and blood samples were collected for analysis of [Tumor necrosis factor (TNF), Interlucin-6 (IL-6) and Inter-lucin-10 (IL-10)] levels. Also, Visual Analog Scale (VAS) for postoperative pain with surgeon and patients satisfaction were recorded.<br />Results: Serum analysis of IL-6 and TNF showed signif-icant increase 30min after induction of anesthesia and 4 hours postoperatively in Spinal group (p<0.001), while IL-10 showed significant increase 4 hours postoperatively in general group (p=0.0001). VAS was lower in Spinal group than general group (p=0.027), with higher patients and surgeons satisfaction scores in spinal group (p=0.0305) & (p=0.0803) compared with general group.<br />Conclusion: Our study concluded that spinal anesthesia increase proinflammatory cytokine IL-6 and TNF during and after surgery, thus stimulating cell immunity and improve postoperative analgesia with better surgeon and patients satisfaction than general anesthesia.
Abdominal hysterectomy – General anesthesia – Spinal anesthesia – Visual analog scale
https://mjcu.journals.ekb.eg/article_78253.html
https://mjcu.journals.ekb.eg/article_78253_49675468e96e6b9f3fc40bdb9bd6e18a.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Ultrasound Diagnostic Value in Assessment of Vocal Cord Mobility before Neck Surgery
4371
4377
EN
HAYTHAM MOHAMED NASSER, M.D.;
MOHAMMED ALEEM, M.D.
The Departments of Radiology* and Otorhinolaryngology**, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.78254
Abstract<br />Background: The preoperative assessment of vocal cord mobility in patient scheduled for neck surgery is mandatory. The diagnostic approach differs from traditional ones as flexible fiberoptic, indirect laryngoscopy, to less tradition ones as CT and MRI.<br />Ultrasound is non invasive, safe, repeatable, bedside, non ionizing radiation dependent technique together with the advancement of technology providing high resolution real time images and short cine videos. This is hand to hand with good patient compliance for the technique.<br />Aim of Study: To evaluate the diagnostic value of ultra-sound in the assessment of vocal cords mobility before neck surgeries.<br />Patients and Methods: This cross section study was carried out between October 2016 and November 2018 on 60 patients (25 males and 35 females) in Ain Shams University Hospitals. They were all scheduled for neck surgeries for different reasons. After taking full clinical history, complete head and neck examination, flexible fiberoptic and/or indirect laryn-goscopy, patients underwent sonographic examination. Patients were divided into two groups. The first group (I) with no clinical symptoms or signs suggestive of vocal foldparalysis. The second group (II) with unilateral abductor vocal fold paralysis. The acquired static photos and dynamic cine videos were accurately examined to delineate various laryngeal structures and to assess interarytenoid distances and arytenoid cartilage mobility during full inspiration and during phonation.<br />Results: After identification of laryngeal structures, we could identify in recorded cine videos immobile arytenoids cartilage on the paralytic side during both inspiration and phonation with sensitivity (80%), specificity (90%), PPV (80%) and NPV (90%). Another important finding is noted that the percent of change in interarytenoid distances was much less in group II than in group I.<br />Conclusion: Preoperative ultrasound examination of vocal cord mobility proved to be valid identifying the various laryngeal structures with high potency in judging vocal cord mobility either by short real time cine videos or measuring interarytenoid distances. We recommend to consider laryngeal ultrasound as reliable imaging modality in preoperative as-sessment of vocal cord mobility prior to neck surgery.
Ultrasonography – Vocal cord paralysis – Laryn-geal imaging – Airway
https://mjcu.journals.ekb.eg/article_78254.html
https://mjcu.journals.ekb.eg/article_78254_1d342afc2ac6fc42244e7031e64bc3b5.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Effect of Vitamin D3 on the Contractile Response of Isolated Rat Uterus
4379
4386
EN
EMAN R. ABOZAID, M.D.;
HANY A. EL KATTAWY, M.D.
The Department of Medical Physiology, Faculty of Medicine, Zagazig University*, Obesity Management and Research Unit, Faculty of Medicine, Zagazig University** and Physiology Department, Faculty of Medicine, Almaarefa University,
Saudi Arabia
10.21608/mjcu.2019.78255
Abstract<br />Background: Vitamin D receptors (VDR) are expressed in many reproductive tissues indicating a potential role of vitamin D3-VDR in the regulation of reproductive functions. Nevertheless, the data about the effect of vitamin D3 in the uterus are scarce.<br />Aim of Study: This study was designed to evaluate the potential effects of vitamin D3 on spontaneous, KCl-induced and oxytocin-induced contractions in the rat uterus in vitro.<br />Material and Methods: The study was conducted on 10 healthy adult female albino non-pregnant rats. Full-thickness longitudinal muscle strips were dissected from each non-pregnant rat and then myometrial tension was recorded. The strips were mounted vertically in organ baths and exposed to vitamin D3 and different uterotonic agents to delineate the potential action of vitamin D3 on the rat myometrial contrac-tility. Spontaneous contractions were recorded using mechan-ical activity recording system. We evaluated the effects of 3 different dosed of vitamin D3 on spontaneous uterine contrac-tions; then on concentrated KCl-induced uterine contractions and oxytocin (OT)-induced uterine contractions. Furthermore, the effects of vitamin D3 on spontaneous uterine contractions pretreated with nifedipine; a voltage-gated L-type Ca2+ channel antagonist were investigated.<br />Results: Vitamin D3 significantly inhibited the spontaneous uterine contractions in a dose dependent manner. Moreover, vitamin D3 inhibited the uterine contractions whether induced by oxytocin or concentrated KCl. Administration of nifedipine resulted in a significant decline in the force amplitude of spontaneous uterine contractions. In the presence of vitamin D3, the uterine relaxant effect of nifedipine was significantly augmented.<br />Conclusions: The inhibitory effects of the in vitro admin-istration of vitamin D3 on rat uterus may yield novel insights into its therapeutic use. Further, it may be recommended to be used as a novel tocolytic agent for preventing unwanted uterine contractions in early pregnancy and relieving pain related to dysmenorrhea.
Vitamin D3– Oxytocin – Uterus – Contractility
https://mjcu.journals.ekb.eg/article_78255.html
https://mjcu.journals.ekb.eg/article_78255_856dc534f95a4e323b854a41624daad6.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Tight Junction Protein (Claudin-4) and Inflammatory Regulator (COX-2) Expression in Nasopharyngeal Carcinoma: An Immunohistochemical Study
4387
4395
EN
RASHA M. ABDRABUH, M.D.;
RANIA G. ROSHDY, M.D.
The Department of Pathology, Faculty of Medicine, Benha University
10.21608/mjcu.2019.78256
Abstract<br />Background: Claudin 4 is one of the tight junction proteins which considered one of the protective barriers that are mostly involved in the regulation of intercellular communication, paracellular transport and apical cell-to-cell adhesion. Over-expression of COX-2 and subsequent increase in prostaglandins (PGs) concentration have emerged in recent years as important players in cancer progression.<br />Aim of Study: To explore immunohisto chemically the expression of both claudin-4 and COX2 in nasopharyngeal carcinoma and correlate their expression with each other and with different clinicopathological parameters.<br />Material and Methods: This retrospective study was done upon formalin fixed, paraffin blocks of 32 nasopharngeal carcinoma cases and 6 non-neoplastic nasopharyngeal epithe-lium. The materials were obtained from archieves of Pathology Departement and Early Cancer Detection Unit (ECDU), Faculty of Medicine, Benha University during the years 2012- 2017. The immunohistochemical stain with Claudin 4 and COX2 was done and evaluated for each case.<br />Results: High expression of claudin 4 was observed in 44% of studied nasopharyngeal cases with statistically signif-icant correlation with tumor stage and distant metastasis (p<0.05). Positive expression of COX2 was detected in 75% of neoplastic group and statistically correlated with depth of tumor invasion, nodal invasion and tumor stage (p<0.05). A statistically significant correlation was detected between overexpression of COX2 and low expression of claudin4 in the studied neoplastic cases (p<0.05).<br />Conclusion: Claudin -4 has different tumorigenic effects besides their known adhesion attributes. Because of that, we believe that claudin 4 with other clinicopahological parameters may be a promising prognostic molecular indicator in na-sopharyngeal cancer cases and can be taken as a novel bi-omarker for the predication of distant metastasis and survival. This work also highlights COX-2 expression's potential as an indicator of cancer progression that can contribute to assess-ment of prognosis and treatment decisions. Therefore, COX-2 inhibitors may have considerable potential as therapeutic agents.
Claudin-4 – COX2 – Nasopharyngeal carcinoma
https://mjcu.journals.ekb.eg/article_78256.html
https://mjcu.journals.ekb.eg/article_78256_d45eb2c1b94e403634f7439df5089817.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Relationship between the Nursing Work Load and the Quality of Nursing Care at a Selected Hospital in Menofya Governorate
4397
4403
EN
ABEER T. ABD EL-HAMID, M.Sc.;
EGLAL A. ABD EL-WAHAB, D.N.Sc.
SAHAR H.
ALY, D.N.Sc.
The Department of Nursing Administration, Faculty of Nursing, Cairo University
10.21608/mjcu.2019.78257
Abstract<br />Background: Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes and organizations are to be effective, they should have the required quality and quantity of human resource and be able to properly utilize them, additionally, nurses are key personnel in providing direct patient care. They are recom-mended to spend all the time with the patient, monitoring patients' conditions and delivering patient care.<br />Aim of Study: The current study explore the relationship between nursing workload and quality of nursing care at a selected hospital in Menofya Governorate.<br />Subjects and Methods:<br />Design: A descriptive correlational design was utilized for this study to achieve the stated aim.<br />Setting: The study was conducted in a selected hospital at Menofya Governorate.<br />Sample: Convenient sample, this sample consist of 250 nurses who working as staff nurse in all shift.<br />Tool: For the purpose of this study, a developed question-naire for nurses was utilized that consist of two parts: The first part was related to the nurse work load, the second part was observational check list to assess the quality of nursing care provided.<br />Results: Show that nursing work load factors were per-ceived by staff nurses as follow: (Interpersonal factors, envi-ronmental factors, administrative factors and nursing factors) (93.84%, 93.65, 92.97, 92.80), also, the study results show that the highest mean percentage of quality of nursing care dimensions that provided by staff nurses was for patient safety (84,87%, 83%), while the lowest mean percentage of quality of nursing care dimensions that provided by staff nurses was for nursing factor (31,65%).<br />Conclusion: The present study concluded that there was no statistical significant corerelation between nursing work load and quality of nursing care. <br />Recommendations: Hospital should assess nursing work load factors periodically to use results for creation of positive work atmosphere for productivity and quality of nursing care should be assessed periodically to assure meting the quality standards for protection the patient safety.
Nursing work load – Quality of nursing care
https://mjcu.journals.ekb.eg/article_78257.html
https://mjcu.journals.ekb.eg/article_78257_5cd7efb31ff62164ec5e8a7a2ddcf919.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Adaptation to Arabic Language, Validity and Reliability Test of Boston Carpal Tunnel Questionnaire in Carpal Tunnel Syndrome Patients
4405
4411
EN
SAMAR A.E. MOHAMMED, M.Sc.;
WADIDA H. EL SAYED, Ph.D.
MAGDA R.
ZAHRAN, Ph.D.
The Department of Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
10.21608/mjcu.2019.78258
Abstract<br />Background: Carpal tunnel syndrome is a frequent cause of compression neuropathy. So, it is necessary to measure function and symptoms which are highly important to patients with carpal tunnel syndrome and have the most impact on quality of life.<br />Aim of Study: To translate and test face validity, content validity, feasibility, internal consistency reliability and test retest reliability of Arabic-language version of Boston carpal tunnel questionnaire in carpal tunnel syndrome patients.<br />Material and Methods: Fifty patients with carpal tunnel syndrome was recruited, 95 sheets (test and retest sheets) were filled out, two expert panels (each consists of ten experts) participated in this study. Forward translation, development of preliminary initially translated version, backward translation, and development of the pre-final version and testing of pre-final version by experts then testing of the final version on patients was done. Index of clarity, expert proportion of clearance, index of content validity, expert proportion of relevance, descriptive statistics, missed item index, Cronbach's alpha and Spearman's rank correlation coefficient were used for statistical analysis.<br />Results: The study showed that scale index of clarity equals 87.14%, the mean proportion of clearance equals 87.14%, scale index of content validity equals 96.67%, the mean proportion of relevance equals 96.67%. The questionnaire items were filled by 95% in all sheets. The questionnaire needed less than 7 minutes to be filled. Cronbach's alpha equals 0.915 (0.877, 0.915) and all Spearman's correlations between test and retest results were statistically significant.<br />Conclusion: Arabic-language version of Boston carpal tunnel questionnaire has face and content validity, feasibility and Internal consistency and test retest reliability enough in assessment of carpal tunnel syndrome.
Validity – Reliability – BCTQ
https://mjcu.journals.ekb.eg/article_78258.html
https://mjcu.journals.ekb.eg/article_78258_afa317bf9ccec5036826d950e332f536.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Diagnostic Significance of Serum Serotonin Levels in Prediction of Esophageal and Fundal Varices in Cirrhotic Patients
4413
4419
EN
MAHA Z. OMAR, M.D.;
EMAN G. BEHIRY, M.D.
MOHAMED A.
MOHAMED, M.D.
The Departments of Hepatology Gastroenterology & Infectious Diseases*, Clinical & Chemical Pathology** and Internal Medicine***, Faculty of Medicine, Benha University, Egypt
10.21608/mjcu.2019.78259
Abstract<br />Background: Serotonin known to be a neurotransmitter can regulate several key aspects of liver biology.<br />Aim of Study: This study aimed to determine the role of serum serotonin levels (5-HT) as a non-invasive marker in the prediction of esophageal and fundal varices in cirrhotic patients.<br />Patients and Methods: The study included seventy cirrhotic patients with hepatitis C virus and fifteen apparently healthy subjects as a control group. Patients were further sub-classified according to upper Gastrointestinal Endoscopy into three groups: Group A: Included 30 cirrhotic patients without esophageal varices (OV), Group B: Included 29 cirrhotic patients with OV, Group C: Included 11 cirrhotic patients with OV and fundal varices. All subjects were subjected to full history taking, clinical evaluation, routine laboratory investigations and serum-serotonin by ELISA.<br />Results: The mean level of serum Serotonin showed a gradual increase in cirrhotic patients with the highest level in oesophageal and fundal varices (94.04±8.51ng/ml), followed by patients with oesophagal varices only (39.2±18.38ng/ml), and both groups were significantly increased than the patient group with no oesophageal varices. There was a positive correlation between serum serotonin level and serum creatinine level, presence and grading of oesophagal varices and the presence of fundal varices. Serum serotonin level at a cutoff value 32.2ng/ml had a sensitivity of 72% and a specificity of 60% in prediction of OV in cirrhotic patients but at cutoff level 28.4ng/ml had low sensitivity (55%) and bad specificity (25%) in discrimination between grads of OV, while serum serotonin level at a cutoff value 79. 1ng/ml had a sensitivity of 100% and a specificity of 96.6% to diagnose patients with oesophagal and fundal varices. Applying multivariate analysis, serum serotonin level was an independent predictor for oesophagal varices.<br />Conclusion: Serum serotonin levels could be used as a serum non-invasive marker for the presence of gastro-oesophageal varices, but it could not discriminate between the grades of oesophageal varices.
Serotonin – Varices – Cirrhosis
https://mjcu.journals.ekb.eg/article_78259.html
https://mjcu.journals.ekb.eg/article_78259_fed5180ab17a5cee8fbe046f9e8432c0.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Firearm Injury of the Spine; Clinical Experience and Surgical Outcome
4421
4424
EN
KHALID BIN MADHI, M.D.;
GHALEB AWADH, M.D.
ABDELHAKEEM A.
ESSA, M.D.
The Department of Neurosurgery, Hadramoot University, Yemen* and Assiut University, Egypt**
10.21608/mjcu.2019.78260
Abstract<br />Background: Occurance of firearm injury in the civilian population has been increased in recent years, due to difficulties in management of firearm injuries to spine and debates make it a devastating injuries.<br />Aim of Study: To discusses the etiology, diagnosis and type of treatment in patients exposed to firearm injury to spine region.<br />Patients and Methods: This study include 3 male patients exposed to Firearm injury to spine.<br />1st one 17 year-old exposed to Firearm by assault from others the entrance of projectile from the back paraspinal area opposite S1 level, then it lodge to S1-S2 level left side radiologically.<br />2nd patient was 37 year-old exposed to Firearm, the bullet entrance from abdomen then lodge at level L5- S1 right side.<br />3rd case exposed to gunshot injury in ware the entrance was in the back para median opposite D12 and bullet demon-strated radiologically on D12.<br />All patients were admitted to hospital pre operation assessment, examination and investigation done, diagnostic imaging of spine by X-ray and computed CT-scan.<br />Results: Regarding the age distribution among 3 patients between 17-45 years, they are males) we see motor and sensory more affected than sphincter, back pain occur in one case only. All patients were surgically treated for extraction of firearm projectiles. No mortality in our study.<br />Conclusion: The ideal management of firearm injury to spine remains a matter of controversy.<br />We Recommend: Further studies with larger number of patients.
Firearm injury of the spine – Infection – Bullet – Sciatica
https://mjcu.journals.ekb.eg/article_78260.html
https://mjcu.journals.ekb.eg/article_78260_f39b591f93b4dd2eca62a022265f7cbb.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Relationship of Angiotensin I-Converting Enzyme Genotype to Liver Fibrogenesis in Non-Alcoholic Steatohepatitis
4425
4431
EN
KARIMA DIAB, M.D.;
HATEM RABIE, M.D.
HATEM ATTIA, M.D.;
ABDEL MOATY A. ODA, M.D.
AMR A. ELSHORMILISY, M.D.;
SOMIA M. MOHAMED, M.D.
EMAN E. ELSHEMY, M.D.;
NESSREN M. BAHAA EL-DEEN, M.D.
10.21608/mjcu.2019.78261
Abstract<br />Background: Multiple genetic and environmental factors may lead to fibrogenesis in patients with Non-alcoholic fatty liver (NAFL). Many studies investigated the relation of angiotensin I-converting enzyme (ACE) genotyping to liver fibrosis in chronic liver disease; and the results are contradic-tory.<br />Aim of Study: In the current study, ACE genotype was assessed in NAFLD patients to show its possible association with development liver fibrosis.<br />Subjects and Methods: The study included 162 patients of NAFLD disease, 49 (30.25%) patients with mild fibrosis, 65 (40.12%) with moderate fibrosis and 48 (29.63%) with severe fibrosis in addition to 138 volunteers was enrolled as a healthy controls. All patients and controls were investigated to serum glucose and fasting insulin level and HOMA-IR was calculated. Liver function tests, both serum ACE and trans-forming growth factor-beta (TGF-b) were done. ACE geno-typing [insertion/deletion (I/D)] was done by PCR.<br />Results: Fasting glucose and insulin, HOMA-IR, AST, ALT and GGT were significantly higher in NAFLD patients than healthy controls. The homozygous frequency I/I and D/D or D/I of ACE were not significantly different between NAFLD patients and controls. The D/D genotype was associated significantly with the severity of liver fibrosis, D/I polymor-phism with moderate fibrosis and I/I genotype with mild fibrosis. The higher D allele frequency was associated with severe fibrosis, while I allele was frequent in mild fibrosis. The HOMA-IR, ALT, serum ACE and TGF-b were increased significantly in the patients carrying D/D homozygous gene more than those carrying homozygous I/I or D/I polymorphism. The serum ACE and TGF-b were significantly higher in NAFLD patients compared to control and the most higher levels was reported in cases with severe liver fibrosis than moderate and mild liver fibrosis.<br />Conclusion: ACE (D/D) genotype was closely associated with liver fibrosis severity and ACE (I/D) polymorphism was observed in moderate stage of fibrosis. The allele D is seems to be a risk factor for liver fibrosis development than allele I. The knowledge of the ACE genotypes in NAFLD patients may be important for treatment decision in those patients and beneficial in the follow-up of the disease progression.
NAFLD – Liver fibrosis – ACE – TGF-b
https://mjcu.journals.ekb.eg/article_78261.html
https://mjcu.journals.ekb.eg/article_78261_81f0ba7d7670fe8493dfe25dd8b5656c.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Ultrasound Guided PECS II Block versus Thoracic Epidural in Modified Radical Mastectomy for Post-Operative Pain Relief
4433
4439
EN
HORIA A. FARRAN, M.D.;
SAWSAN G. MOHAMED, M.D.
The Department of Anaesthesiology, Intensive Care and Pain Management, Faculty of Medicine for Girls Al-Azhar University
10.21608/mjcu.2019.78262
Abstract<br />Background: Breast cancer is women's most common malignancy and has steadily increased incidence over the past decade. Despite recent breast cancer surgery advances, this procedure is often associated with postoperative pain, nausea, and vomiting, contributing not only to increased patient discomfort, but also to extended hospital stays and associated costs. A significant risk factor for the development of chronic pain following breast surgery is acute postoperative pain due to insufficient or ineffective pain control.<br />Aim of Study: Assess the effectiveness of ultrasound guided PECS block to thoracic epidural blockage in breast cancer surgery to minimize postoperative pain, analgesic requirements and complications.<br />Patients and Methods: After Ethical Committee at Al-Zahraa University Hospital accepted, 50 female patients, age from 42-67 years, were included in the study with ASA physical status I-II patients scheduled for unilateral modified radical mastectomy and axillary lymph node dissection, randomly blind assigned, split two different groups of 25 patients in each, Thoracic epidural block (TEB group); patients were received a single shot of 15ml of 0.25% bupivacaine between T4 and T5 vertebrae. PECS group: Ultrasound-guided PECS block, the patients were received 0.25% of 10ml bupi-vacaine injected at fiscal plain between the pectoral s major and minor muscles (PECS I) also 0.25% of 20ml of pectoral-minor injection above the Serratus anterior muscle (PECS II). Primary outcome in the form of post-operative visual analogue scale (VAS) to assess pain in density. Secondary outcome in the form heart rate (HR), mean blood pressure (MBP) intra operative fentanyl consumption and, first request of analgesia, total amount of pethidine/24 hrs. were recorded and other any post-operative complication were assessed.<br />Results: The patients of TEB group, the mean heart rate and the mean MAP were highly significant decrease than PECS group. Intra operative fentanyl consumption as statis-tically significant decrease in PECS group compared with TEB group. VAS pain scores was high statistically significant decrease immediately and at 4 hrs. post-operative in PECS group than TEB group. The time for the first request for pethidine was highly significantly longer in the PECS group than in TEB group. Amount of pethidine at 24 hrs. was high significant lower in PECS group in comparison with TEB group. Complications recorded as hypotension and bradycardia post-operative nausea and vomiting (PONV) occurrence in TEB group.<br />Conclusion: PECS blocks provided superior post-operative analgesia, low pain scores and less total pethidine consumption in the early postoperative period and maintained hemodynamic stability compared to TEB.
TEB group – Post-operative nausea – Voming PONV – PECS
https://mjcu.journals.ekb.eg/article_78262.html
https://mjcu.journals.ekb.eg/article_78262_d70d1fbfa60364cb13acbb442b112335.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
A Comparative Study between Laparoscopic Inguinal Hernia Repair and Open Lichtenstein Mesh Repair
4441
4447
EN
MOSTAFA M.
SALAMA, M.D.
The Department of General Surgery, Faculty of Medicine, Al-Azhar University
10.21608/mjcu.2019.78263
Abstract<br />Background: This prospective study was conducted in a university hospital for comparing the results of two different techniques for surgical repair of inguinal hernia: Open mesh repair and laparoscopic mesh repair to detect the effectiveness of each operation and complications if any.<br />Aim of Study: The aim of this work is to compare the results of mesh repair of inguinal hernia by open technique and by laparoscopic transabdominal preperitoneal technique (TAPP).<br />Patients and Methods: The study included 92 cases of an inguinal hernia. They were selected by nonprobability sampling method. These cases were operated at Al Hussein University Hospital between January 2016 to September 2018. Inclusion criteria included patients with uncomplicated hernia. The age/sex, incidence, BMI, mode of presentation, co-morbidities, operative time, postoperative complications, pain and return to work were all evaluated and compared with many of standard published literature.<br />Results: Postoperative wound infection developed in 6 cases of open hernioplasty and 1 case in laparoscopic surgery. Seroma at the operated site were found in 5 cases of open hernioplasty. The return to normal daily activity was 21 days after open technique compared to 13 days in TAPP. The mean duration of procedure was 59.5min in open surgery while it was 99min in laparoscopic group.<br />Conclusion: Laparoscopic hernioplasty has a comparable result with an open procedure which should be considered in the surgical treatment of inguinal hernia.
Hernia – Mesh – Open – TAPP
https://mjcu.journals.ekb.eg/article_78263.html
https://mjcu.journals.ekb.eg/article_78263_4811974e5ccf69a95310aa8fa8c71ce7.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
A Comparative Study between Nitroglycerin and Magnesium Sulfate during Shoulder Arthroscopic Surgery in the Beach Chair Position
4449
4455
EN
AMIRA A. AWAD, M.D.;
MOHAMED N. AHMED, M.Sc.
The Departments of Anesthesia & Intensive Care* and Orthopedic Surgery**, Faculty of Medicine for Girls, Al-Azhar University, Egypt
10.21608/mjcu.2019.78264
Abstract<br />Background: This study was designed to compare the efficacy of intravenous infusion of nitroglycerin versus mag-nesium sulfate for controlled hypotensive anesthesia during arthroscopic shoulder surgery in Beach Chair Position (BCP).<br />Aim of Study: To compare the efficacy of nitroglycerin versus magnesium sulfate in inducing deliberate hypotension and satisfactory surgical field in patients undergoing arthro-scopic shoulder surgery.<br />Material and Methods: Fourty patients scheduled for arthroscopic shoulder surgery under general anesthesia in BCP, randomly assigned into two equal groups, nitroglycerin group (NTG group, n=20) received infusion of 0.5-5μg/kg/min and magnesium group (Mg group, n=20) received 40mg/kg, as slow bolus before induction in 100mL saline solution over 10min then 15mg/kg/h by infusion during the operation to achieve a mean arterial blood pressure (MAP) of about 50 to 65mmHg.<br />Results: Controlled hypotension was achieved in both groups. There was no significant difference in MAP between two groups in first 30mins after infusion then magniseum group produced significantly lower MAP values till stopping of infusion. Heart Rate (HR) was significantly lower in mg group compared with the NTG group. More patients required fentanyl consumption intraoperative (p<0.0001) and frequent administration of rocuronium (p=0.001) in NTG group. How-ever, there was longer extubation time and recovery time in Mg group compared with the NTG group. Bleeding score was insignificantly lower in Mg group and surgeon's satisfaction score was significantly better (p=0.035) in the Mg group.<br />Conclusions: Nitroglycerin and magnesium sulfate can effective in achieving hypotensive anesthesia during arthro-scopic shoulder surgery. However, MgSO4 provide a favorable surgical field condition and better surgeon's satisfaction.<br /><br />
Controlled hypotension – Nitroglycerin – Mag-nesium sulfate – General anesthesia – Beach chair position – Arthroscopic shoulder surgery
https://mjcu.journals.ekb.eg/article_78264.html
https://mjcu.journals.ekb.eg/article_78264_22bf5bbeddd99ae1b7c64183bc94979f.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Diagnostic Accuracy of Ultrasonography and Magnetic Resonance Imaging for Detection of Fetal Anomalies
4457
4466
EN
ATINAS A.M.A. KANDIL, M.Sc.;
MAHMOUD A. DAWOOD, M.D.
HAYTHAM H. ELSAEED, M.D.;
NOHA M.A. IBRAHIM, M.D.
The Department of Radiology, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.78265
Abstract<br />Background: Three dimensional ultrasound is the standard modality used for the imaging of the fetus. It is widely available, easy to apply, cost-effective, safe for the fetus and allows real-time imaging. MR imaging is an alternative modality that uses no ionizing radiation, has excellent tissue contrast and a large field of view, is not limited by obesity or overlying bone, and can image the fetus in multiple planes, no matter the fetal lie. This study was carried out on 40 patients which have been suspected by 2D ultrasound as having fetal malformations. Post-natal evaluation was done by both imaging (2D ultrasound and X-ray) and clinical examination, it was a criterion for our study to compare the accuracy of 3D ultrasonography and MR imaging in diagnosis of fetal malformations.<br />Aim of Study: To compare the precision and accuracy of 3D ultrasonography and MR imaging in diagnosis of fetal malformations and correlate their results with the postnatal findings.<br />Patients and Methods: This prospective study included fourty (40) pregnant female patients which have been suspected by 2D ultrasound as having fetal malformations.<br />Results: We have found that 7 cases of all patients were diagnosed as normal with no any congenital anomalies which represented 18% of all cases and 33 of those cases were diagnosed as abnormal cases who were clearly demonstrated congenital anomalies which represented 82% of all cases as suggested by MRI findings, however the results we have by 3D US were 6 cases who were diagnosed as normal which represented about 15% and 34 cases were diagnosed as ab-normal cases which represented about 85% of all cases.<br />According to the postnatal final diagnosis which diagnosed by imaging or clinical examination, we have found that 8 cases from 40 cases were diagnosed as normal and 32 cases from 40 cases were diagnosed as abnormal.<br />Conclusion: MR imaging as an adjunct to prenatal 3D US may provide valuable information that could add to the prenatal evaluation and treatment of some fetal anomalies, particularly those involving the central nervous system.
3D Ultrasound – MRI – Fetus,Malformations – Congenital – Anomalies
https://mjcu.journals.ekb.eg/article_78265.html
https://mjcu.journals.ekb.eg/article_78265_c1dffe144cf6d952989778003af6c415.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Post-Operative Follow-up of Colorectal Cancer: Computed Tomography or F-18 Positron Emission Computed Tomography? That is the Question
4467
4476
EN
LINA T. HABLAS, M.Sc.;
MOHAMED M. HEFEDA, M.D.
AHMED M. WAFAIE, M.D.;
HANAN M. ELAHWAL, M.D.
The Department of Radiology, Faculties of Medicine, Tanta* and Cairo** Universities
10.21608/mjcu.2019.80679
Abstract<br />Backgroud: In Egypt, the Colorectal cancer is considered the 7th commonest cancer, local recurrence, distant metastasis or both occurs in 30-50% of patients after operations. Both Computed Tomography (CT) and Positron Emission Tomog-raphy (PET) are well established in the diagnosis of Colorectal Cancer Recurrence (CRCR).<br />Aim of Study: In this study, we aimed to evaluate the diagnostic performance of 18F-FDG PET/CT in postoperative follow-up of CRC patients and the detection of local recurrence and distant metastasis as compared with CT.<br />Patients and Methods: 62 post-operative patients with colorectal carcinoma underwent whole body FDG PET/CT. The final histopathological and formal clinical follow-up findings were used as gold standard to determine the sensitivity and specificity of FDG PET/CT and enhanced CT of the same periods.<br />Results: The sensitivity, specificity and accuracy of PET/CT in diagnosis of local recurrence was 92%, 91.89% and 94.44% respectively. The sensitivity, specificity and accuracy of contract enhanced CT in diagnosis of local recur-rence was 72%, 89.19% and 82.5% respectively. The sensi-tivity, specificity and accuracy of PET/CT in diagnosis of distant metastasis was 91.12%, 81.08% and 88.64% respec-tively. The sensitivity, specificity and accuracy of contrast enhansed CT in diagnosis of local recurrence was 72.55%, 86.49% and 78.41% respectively.<br />Conclusion: In patients with suspected CRCR, FDG-PET/CT appears to be a significantly more accurate method than CT alone for detection of local recurrence and distant metastasis, FDG-PET/CT is sufficiently accurate to become a routine follow-up of patients after colorectal resection.
Post-operative colorectal cancer – PET – PET/CT – CT
https://mjcu.journals.ekb.eg/article_80679.html
https://mjcu.journals.ekb.eg/article_80679_30b82de6af56b342e062a5c4422a6740.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
MRI Evaluation of Hepatic Iron Overload in Chronically Transfused P-Thalassemic Children
4477
4484
EN
SAMAR Sh. ALI EMAM, M.Sc.;
ABEER MAGHAWRY A. MOHAMED, M.D.
SUSAN
A.A. ABDUL RAHIM, M.D.
The Department of Radiology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.80683
Abstract<br />Background: Patients with chronic hemolytic anemia like thalassemia need repeated blood transfusions which lead to iron overload. MRI has emerged for the noninvasive assessment of iron overload in various tissues.<br />Aim of Study: The aim of this study is to assess the role of MRI in the evaluation of hepatic iron overload in multi transfused P-Thalassemic children and to correlate the results with serum ferritin levels.<br />Patients and Methods: In 45 cases of multi-transfused child with thalassemia, Liver Iron Concentration (LIC) was measured by MRI T2* and compared to serum ferritin (tradi-tional marker of iron overload).<br />Results: There were a significant positive correlation between serum ferritin and LIC (r=0.557 and p<0.01) when SF level below 4000ng/ml, and the correlation became very weak when serum ferritin above 4000ng/ml. Also, there were a significant negative correlation of LIC with T2* (r=–0.999 and p<0.01) and a significant positive correlation with R2* (r=1.000 and p<0.01) and no significant correlation with age, sex, splenectomy and frequency of blood transfusion.<br />Conclusion: MRI T2* provides accurate reproducible and non-invasive technique for assessing tissue iron concentration. Through the widespread application of this technique it should be possible to improve management of tissue iron overload allowing earlier chelation intensification.
Thalassemia – MRI T2* – Liver iron concentration
https://mjcu.journals.ekb.eg/article_80683.html
https://mjcu.journals.ekb.eg/article_80683_d28a4caca91654bb9d49f60bdeccdab8.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Relationship between Serum Glypican-4 Level and Metabolic Parameters in Experimentally-Induced Non-Alcoholic Fatty Liver Disease in Adult Male Albino Rats
4485
4495
EN
DOAA A. ABDEL-MOETY, M.D.;
NOURELHUDA A. MOHAMMED, M.D.
HAYAM
E. RASHED, M.D.
The Departments of Physiology* and Pathology**, Faculty of Medicine, Zagazig University, Zagazig, Egypt
10.21608/mjcu.2019.80684
Abstract<br />Background: Glypican-4 (GPC4) is a novel adipokine thataffects insulin signaling, and adipocyte differentiation. Serum GPC4 level was associatedwith obesity-related param-eters such as hyperglycaemia, Insulin Resistance (IR), and elevated liver enzymes aspartate Amino-Transferase (AST), and alanine Amino-Transferase (ALT).<br />Non-Alcoholic Fatty Liver Disease (NAFLD) has emerged as one of the manifestations of metabolic syndrome. It is usually associated with IR, dyslipidemia, and elevated AST & ALT levels.<br />Few studies were performed to elucidate the role of GPC4 in the development of NAFLD in human, and its relation to other metabolic parameters. But, its exact role hasn't been clarified yet.<br />Aim of Study: To estimate serum level of GPC4 in NAFLD induced by high fat diet in adult male albino rats, and to examine its relationship to other metabolic parameters.<br />Material and Methods: A total number of 60 healthy adult male local strain albino rats were divided into 2 main groups: Control group (I) (n=30) were fed on standard chow, and was further subdivided according to the period of their nourishment on standard chowinto 3 equal subgroups (n=10), subgroup (IA), for 4 weeks, subgroup (IB), for 12 weeks, andsubgroup (IC), for 24 weeks High Fat Diet (HFD) fed group (II) (n=30) were fed on high fat chow, and was further subdivided accord-ing to the period of their nourishment on HFDinto 3 equal subgroups (n=10), subgroup (IIA): For 4 weeks, subgroup (IIB), for 12 weeks, andsubgroup (IIC), for 24 weeks. Body Mass Index (BMI), Abdominal Circumference (AC) were measured. Serum GPC4, glucose, insulin, ofhomeostasis model assessment (HOMA-IR)-index, Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), AST, ALT, and C-Reactive Protein (CRP) were estimated. Liver histopathology was studied.<br />Results: GPC4 was positively correlated with BMI, AC, TC, TG, LDL, AST, ALT, and CRP in all HFD-fed rats groups. Concerning, IR and HOMA-IR, it was found that, GPC4 was positively correlated with both of them in HFD-fed rats for 4 weeks and 12 weeks groups, however, no correlations were reported between GPC4 and IR & HOMA-IR in HFD-fed rats for 24 weeks group.<br />Conclusion: Serum GPC4 level was increased in HFD-fed rats for 4 weeks and 12 weeks groups as a compensatory mechanism to overcome IR, and was reduced in HFD-fed rats for 24 weeks group due to failure of compensation as a result of marked progress of IR.
Glypican 4 – Non-alcoholic fatty liver – Rats
https://mjcu.journals.ekb.eg/article_80684.html
https://mjcu.journals.ekb.eg/article_80684_a37db53da39791ae6a62a39e0afa62ca.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Multidiscipilinary Apprach to Metastatic Skull Lesions; Endovascular Embolization, Gross Total Excision and Carnioplasty
4497
4504
EN
MOHAMED SHADAD, M.D.;
ESSAM ABD EL-HAMID, M.D.
MAHMOUD
SHOAIB, M.Sc.
The Department of Neurosurgery, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.80689
Abstract<br />Background: Metastatic skull lesions are being more frequently diagnosed. There are many reports of skull metas-tases from approximately all cancer types. Clinical presentation of these lesions includes cosmetic complaints and neurological deficits attributable to site of the lesion. Management modal-ities of metastatic skull lesions include radiation therapy, chemotherapy, pre-operative endovascular embolization and surgical excision.<br />Aim of Study: The aim of this work is to evaluate the outcome of metastatic skull tumor embolization, gross total resection and cranioplasty.<br />Patient and Methods: This study included 8 patients with metastatic calvarial skull lesions admitted to Department of Neurosurgery, Tanta University between January 2015 and March 2018. All patients were subject to 2 stages of manage-ment; endovascular embolization, surgical excision and crani-oplasty.<br />Results: This study included 8 patients (4 male and 4 female) with main age 53 years. Pathologic types included; 3 patients with renal cell carcinoma, 2 with cancer breast, 2 with hepatocellular carcinoma and 1 with thyroid adenocar-cinoma. All patients were presented for cosmetic reason except one patient who had right hemiparesis. In all patients, near total pre-operative embolization was done without technique-related morbidity or mortality. Gross total excision was possible in all patients. Excision was followed by cranioplasty using a titanium mesh. Operative complications included aseptic necrosis of the edge of the wound in one patient and healed in 1 month by daily dressing. One patient died because of unrelated cause 2 days post-operatively.<br />Conclusion: Multidisciplinary approach to metastatic skull lesions by adding pre-operative embolization to excision and cranioplasty to such lesions provides better chances of gross total excision with minimal morbidities.
Skull – Calvarial – Metastasis – Endovascular embolization – Surgical excision – Titanium – Cranioplasty
https://mjcu.journals.ekb.eg/article_80689.html
https://mjcu.journals.ekb.eg/article_80689_f9cbc6dc3fc3c71e86ba1ac03ec19e1a.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Value of Apparent Diffusion Coefficient and Relative Cerebral Blood Volume Calculated by MRI for Grading of Brain Tumors
4505
4511
EN
ISMAIL M. ABDEL HAKIM, M.Sc.;
AHMED TOHAMY AHMED, M.D.
The Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University, Egypt
10.21608/mjcu.2019.80695
Abstract<br />Background: MRI is the standard technique for diagnosis of brain tumors, but the challenge is determination of brain tumor grade.<br />Aim of Study: To assess the role of Apparent Diffusion Coefficient (ADC) and relative Cerebral Blood Volume (rCBV) in brain tumors grading.<br />Patients and Methods: Our prospective comparative analytic study involved 26 patients that were diagnosed to have brain tumors. All patients were subjected to revision of their medical history, full neurological and cognitive functions assessment, anatomical brain assessment by conventional MRI examination of the brain, diffusion and perfusion MRI with measurement of mADC & rCBV values respectively. Correlation of results with the histopathological findings of the resected tumors as a gold standard were performed.<br />Results: The diagnostic capability of mADC by using cut off value of <1.28 X 10–3mm2/s had a sensitivity of 81.2%, specificity of 100% at p-value of 0.0001. All the low-grade tumors had low perfusion (rCBV <3.22 & <2.33) while most of the high-grade tumors had high perfusion (rCBV >3.22 & >2.33) with significant difference in between (p=0.001 & 0.002). The diagnostic capability of rCBV by using cut off value of >3.22 & >2.33, had a sensitivity of 68.4%, 90.9 respectively and a specificity of 100% at p-value of <0.00. Multivariant logistic regression revealed that rCBV higher than 2.33 and mADC !91281.34 fitted the statistical regression for prediction of high grade tumors in intra-axial brain tumors (p=0.002).<br />Conclusion: Diffusion and perfusion imaging are useful for characterizing intra-axial brain tumors. rCBV measurement can be used to determine the grade of glioma with no added advantage of ADC map.
Diffusion – Perfusion – MRI – Brain tumor – Glioma
https://mjcu.journals.ekb.eg/article_80695.html
https://mjcu.journals.ekb.eg/article_80695_2e175ad3b461c400d364d4e495d2b68e.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Measurement of Hepatic Hemodynamics by Triphasic CT in the Evaluation of Patients with Liver Cirrhosis
4513
4519
EN
SARA S. ABOU-ALFOTOUH, M.Sc.;
AHMED TOHAMY AHMED, M.D.
The Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University, Egypt
10.21608/mjcu.2019.80696
Abstract<br />Background: Liver biopsy has been the main method for diagnosis, but it is an invasive method, with many complica-tions, so a non-invasive method is needed to assess the severity of liver cirrhosis.<br />Aim of Study: To assess the severity of liver cirrhosis by measurement of hepatic blood flow using triphasic CT.<br />Patients and Methods: Our case control, single centre study involved 30 patients with chronic diffuse parenchymatous liver disease (which were further divided into Child-Pugh A, B, and C subgroups) and 30 healthy volunteers. All cases underwent supervision of their medical history, clinical ex-amination, liver function tests, and triphasic CT scan. Meas-urement of contrast enhancement fraction (CEF) as a parameter of hepatic blood flow was calculated using triphasic CT, assessment of ROI (region of interest) in HU for the hepatic parenchyma in both arterial and venous phases were done. The contrast enhancement (CEF) was obtained by dividing the contrast concentration in the hepatic arterial phase by that in the portal venous phase using ROI measurement in HU. CEF values and the ROI measurements from the study and control groups were compared.<br />Results: The differences in the ROI measurements were statistically significant between the subgroups with multiple comparisons, except between the control and the Child-Pugh (A) group. The ROI measurement in the portal phase was higher than that measured in the hepatic arterial phase in both the study and control groups. There was a decrease in ROI measurement in both the arterial and portal phases with increase of the Child-Pugh grade; more evident in the portal phase. The value of CEF in the control group was 0.74. The CEF values increased with increasing Child-Pugh grades in the study group. There were noticeable differences for CEF between Child-Pugh A and B groups, Child-Pugh A and C groups and Child-Pugh B and C groups. The CEF increased as liver function (Child-Pugh grade) deteriorated in the study group.<br />Conclusion: Measurement of hepatic blood flow and CEF by using triphasic CT can be used to evaluate the liver hemo-dynamics and severity of liver cirrhosis.
Liver cirrhosis,Triphasic CT,Contrast enhance-ment fraction
https://mjcu.journals.ekb.eg/article_80696.html
https://mjcu.journals.ekb.eg/article_80696_0acdab0f0e4f742b6a751d103d1a4e2b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
A Comparative Study of Conventional Cytology and Cellblock Method in Diagnosis of Pleural Effusion and their Correlation with Clinicopathological and Radiological Diagnosis
4521
4527
EN
MAHA A. MOHAMMED, M.D.;
ZEINAB H. EL-BADAWI, M.D.
HALA S.E. ALAA EDIN, M.D.;
KHALED M. ABD EL-AAL, M.D.
EMAN M.S.
MUHAMMAD, M.D.*
The Department of Pathology, Faculty of Medicine, Sohag* and South Valley** Universities and The Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University***, Egypt
10.21608/mjcu.2019.80697
Abstract<br />Background: Cytological Smear (CS) is extremely useful in patients with pleural effusions especially when malignancy is suspected. Cellblock (CB) technique is another method for examination of pleural fluid. In this study we aimed to compare the diagnostic yields of CS and CB technique and the combi-nation of both, regardless of the etiology of Pleural Effusion (PE), and to compare their results with clinicopathological and radiological results.<br />Aim of Study: This study aims to compare the diagnostic yields of CS and CB techniques and their combination in diagnosis of PF regardless of its etiology.<br />Material and Methods: 140 cases of PE samples were obtained, CS and CB were done, results were compared with each other and correlated with the clinicopathological and radiology results when available.<br />Results: Agreement between results of CS and CB was 87.86% (p=0.0001). There was an agreement between CS at one side and either radiological findings or biopsy at the other side; 88.89% and 88.1% respectively (p=0.0001 for each). There was an agreement also between CB results and either radiological findings or biopsy; 94.87% and 95.24% respec-tively (p=0.0001 for each).<br />Conclusions: Our study showed that the CB method yielded better results in diagnosis of malignancy in PE. Therefore, this technique could be considered as a useful adjuvant in evaluating PE fluid cytology and final cytodiag-nosis, along with the routine CS method.
Cytological Smear (CS) – Cellblock (CB) – Cytology – Pleural Effusion (PE)
https://mjcu.journals.ekb.eg/article_80697.html
https://mjcu.journals.ekb.eg/article_80697_f74917e3a04bf62c847a7a2038fc1217.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Hepatitis C Viral Load as a Predictor of Short Term Outcome of First-Ever Acute Ischemic Stroke
4529
4536
EN
HESHAM M. HEFNY, M.D.;
AL-AMIR BASSIOUNY MOHAMED, M.D.
HASSAN MOHAMED ELNADY, M.D.;
HAZEM KAMAL ELHEWIG, M.D.
SAFAA KHALAF, M.D.;
AMAL H. ALI, M.D.
The Departments of Clinical Pathology1, Neurology & Psychology2, Tropical Medicine & Gastroenterology3 and Medical Microbiology & Immunology4, Faculty of Medicine, Sohag University
10.21608/mjcu.2019.80698
Abstract<br />Background: Cerebrovascular disease is a great health burden. Hepatitis C Virus (HCV) infection has a role in the development of carotid atherosclerosis and recently associated to poor outcome in patients with stroke.<br />Aim of Study: The aim of this work was to investigate the prognostic value of HCV viral load on acute first-ever ischemic stroke outcome.<br />Patient and Methods: Sixty patients diagnosed with acute stroke were enrolled and divided into 41 patients with and 19 without chronic HCV. Stroke severity was assessed and correlated with HCV viral load which was determined By RT-PCR. The morphological and functional status of the liver was evaluated by ultrasonography and laboratory investigations including liver function tests.<br />Results: The outcome was favorable in 35% and unfavo-rable in 65%. The high level of HCV RNA in stroke patients was found to be an independent predictor of stroke outcome after controlling for age, hypertension, DM and stroke severity. Patients who died had significantly higher levels of HCV RNA than survivors.<br />Conclusion: High viremia is an independent predictor of short term outcome of first ever stroke.
Stroke – Chronic HCV – Risk factor – Outcome
https://mjcu.journals.ekb.eg/article_80698.html
https://mjcu.journals.ekb.eg/article_80698_4d8254ba0f268d92d1863edb82679ae1.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Management of Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Complications
4537
4544
EN
AYMAN H. IBRAHIM, M.D.;
MOHAMMAD M. SALEM, M.D.
MUHAMMAD
A. MOBASHER ATIYA, M.Sc.
The Department of General Surgery, Faculty of Medicine, Al-Azhar University
10.21608/mjcu.2019.80699
Abstract<br />Background: Endoscopic retrograde cholangiopancrea-tography (ERCP) is considered as a diagnostic and therapeutic procedure used to treat problems associated with biliary and pancreatic diseases. The benefits of ERCP over surgical treatment are well documented; however, there is complications including infection, pancreatitis, hemorrhage, and perforation can occur even in expert hands. Several factors may affect, such as patient selection, skills of the operator, and the how complex the procedure was. This work studies ERCP compli-cation rates, predictive factors for incidence and management plans to improve outcomes.<br />Aim of Study: To spot complications that happened post-ERCP and how to manage it.<br />Patients and Methods: In a prospective, 2-years study from September 2017 to September 2019 of 50 patients underwent ERCP and notice if complications happened and the risk factors for that complication.<br />Results: 20% had post-ERCP complications, with pancre-atitis (8%), perforation (8%) and infection (cholangitis and cholecystitis) (4%). Perforation was considered the most serious complication of ERCP. It demands early diagnosis and good management. Surgical intervention the urgent solu-tion to manage post-ERCP perforation (3 of the 4 perforated patients underwent surgical intervention.<br />Conclusion: ERCP is a safe and widely used all over the world. To overcome its complications it demands good prep-aration for patients, increase our experience, short procedure especially in risky patients, and close observation post-ERCP patients aiming at early diagnosis of complications and early management if happened.
ERCP – Post-ERCP perforation – ERCP compli-cations
https://mjcu.journals.ekb.eg/article_80699.html
https://mjcu.journals.ekb.eg/article_80699_c08d393c265e2464fb39e8f2f9d93525.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Knowledge, Attitude and Practice of Primary Health Care Physicians about Adult Vaccination in Abha City, Saudi Arabia
4545
4553
EN
TURKI A. AL-GHANEM, M.D.;
ABDULQADER A.T. SUMAYLI, M.D.
OSSAMA
A. MOSTAFA, M.D.
Ministry of Health* and Family & Community Medicine Department**, King Khalid College of Medicine, Saudi Arabia
10.21608/mjcu.2019.80700
Abstract<br />Background: Adult vaccination has gained as much atten-tion as childhood vaccination nationwide and worldwide in recent years. Several studies have been performed with a variety of suggestions regarding adult vaccination.<br />Aim of Study: To assess knowledge, attitude and practices of physicians providing primary health care (PHC) regarding adult vaccination and their own vaccination coverage as well as to explore the possible reasons for low vaccination coverage.<br />Material and Methods: Following a cross-sectional research design, this study included 103 PHC physicians in Abha City. Based on a similar previous study, a self-administered questionnaire was adopted for data collection.<br />Results: Only 6% of PHC physicians had good knowledge, while 41% had positive attitude toward adult vaccination, while 10% had negative attitude. Most PHC physicians (70%) had poor practice regarding adult vaccination, while only 10% had good practice. PHC physicians' knowledge was significantly better among older and non-Saudi physicians (p<0.001 and p=0.001, respectively). PHC physicians' positive attitude toward adult vaccination was significantly higher among female participants (p=0.013), non-Saudi physicians (p=0.004) and those with experience in PHC more than 10 years (p=0.044). PHC physicians' good practice regarding adult vaccination was significantly higher among older phy-sicians and among those with experience in PHC more than 10 years (p=0.004). The most frequently stated reasons for low adult vaccination coverage were “Lack of coordinated immunization programs for adults” (63.1%), “Physicians do not inform patients about adult vaccination because they do not have enough time” (61.2%) and “Lack of availability of up-to-date records and recording systems” (55.3%).<br />Conclusions: Knowledge of PHC physicians regarding adult vaccination is suboptimal although most of them do not have negative attitude toward adult vaccination. Their practice regarding adult vaccination is mostly poor. There are several identified obstacles against implementing vaccination of adults.<br />Recommendations: To construct a national guideline for adult vaccination. To organize continuing medical education courses on adult vaccination for PHC physicians. Obstacles against adult vaccination should be further studied and over-come.
Vaccination – Primary care – Knowledge – Attitude
https://mjcu.journals.ekb.eg/article_80700.html
https://mjcu.journals.ekb.eg/article_80700_20b3f798ebd6d9bc3737b8cea091cd28.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Reduction of Airway-Related Complications by Dexmedetomidine in Nasal Surgeries
4555
4562
EN
AHMED M. ABD ELGALEEL, M.D.
AHMED G.M. HEGAZY, M.D.
The Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
10.21608/mjcu.2019.80701
Abstract<br />Background: Nasal surgeries can stimulate various sites from the nasal mucosa to the diaphragm and the presence of endotracheal tube can induce some complications like cough-ing, laryngospasm and laryngeal oedema . To reduce airway reflexes, tracheal extubation should be performed by special technique or use of some drugs as dexmedetomidine which has sedative and analgesic effects, without affecting respiratory status.<br />Aim of Study: The primary outcome of this study is to evaluate the effect of dexmedetomidine adminstration on airway reflexes during extubation in nasal surgeries, the secondry outcome of this study is evaluation of hemodynamic response to the added medication (dexmedetomidine) and way of extubation.<br />Patients and Methods:<br />Type of study: Prospective randomized single-blinded, clinical comparative study.<br />Number of Patients: 60 patients of both sexes, (ASA) class I and II, admitted for elective nasal surgeries, randomly allocated into two groups each of 30 patients, Group N: “No Stimulation” technique, This technique avoids extubation under light anesthesia and ensures extubation only when consciousness is returned. It requires absolutely no stimulation during emergence and performing extubation only when the patient wakes up spontaneously and opens his eyes. Group D: Dexmedetomidine-group, who received intravenous (I.V) dexmedetomidine 0.5-1mg/kg bolus in 100ml of normal saline over 10 minutes at the end of surgery, followed by 0.2pg/kg/hr which was stopped immediately when extubation was done.<br />Results: The following parameters were assessed between the two groups: Airway reflexes, hemodynamics, extubation time, Regarding airway reflexes (coughing, bucking, laryn-gospasm and oozing from the wound) the results of our study showed that the incidence of coughing and bucking were significantly less in group D more than group N. As regard hemodynamic response the present results showed that the changes in MAP during emergence extubation were signifi-cantly less in dexmedetomidine group than “No Stimulation” technique group. As regard extubation time it was prolonged in group N more than groups D. <br />Conclusion: This study showed that the use of dexme-detomidine reduce the airway reflexes and hemodynamic response further to the advantage of short extubation time compared with the “No Stimulation” technique.
Recovery – Airway reflexes – Nasal surgeries – Technique – Tracheal –“No Stimulation” – Rhi-noplasty – Dexmedetomidine
https://mjcu.journals.ekb.eg/article_80701.html
https://mjcu.journals.ekb.eg/article_80701_9d8c2bd6f086a99b60f1de6e24c3a20b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Transarterial Embolization of Direct Carotid Cavernous Fistula by Coils
4563
4570
EN
MOHAMED SHADAD, M.D.;
HAZEM NEGM, M.D.
The Department of Neurosurgery, Faculty of Medicine, Tanta* and Menoufia** Universities
10.21608/mjcu.2019.80703
Abstract<br />Background: Type A CCFs (direct CCFs) usually resulting from tear in the carotid wall. Clinical presentations were due to increased venous pressure and presents by classic triad of exophthalmos, chemosis, and bruit. Cerebral angiography still the gold standard in diagnosis, classification and planning of treatment. Type A CCFs mandates endovascular intervention.<br />Aim of Study: The aim of this study to evaluate safety and efficacy of transarterial approach by using coils for treatment of direct CCFs.<br />Patients and Methods: This study conducted on all patients with direct carotid cavernous fistula admitted to Department of Neurosurgery, Tanta University between December 2010 and November 2016.<br />Results: Twelve patients including 10 male and 2 female, with a mean age of 33 years. All patients had symptoms and signs related to direct CCF. In 12 patients (100%) complete obliteration of the CCF was achieved at control angiogram at the end of the procedure. ICA was preserved in 9 patients (75%) while carotid occlusion in addition was done in 3 patients (25%) without permanent morbidity or mortality.<br />Conclusions: Transarterial embolization of direct carotid cavernous fistula by coils is effective, safe technique and better alternative to balloons in the treatment of direct carotid cavernous fistula.
Transarterial embolization – Direct carotid cavernous fistula – Coils
https://mjcu.journals.ekb.eg/article_80703.html
https://mjcu.journals.ekb.eg/article_80703_9fb920444b21ea877a4fd5efbc075f7e.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Ultrasound in Assessment of Menisco-Ligamentous Injuries of Knee Joint in Comparison with Magnetic Resonance Imaging
4571
4577
EN
SALLY M.A. HUSSEIN, M.Sc.;
MARWA I. FAHMY, M.D.
KHALED
A. MOHAMED ALI, M.D.
The Department of Radiology, Faculty of Medicine, A in Shams University
10.21608/mjcu.2019.80706
Abstract<br />Background: While considering the Magnetic Resonance Imaging (MRI) as 'gold standard' for detection of knee liga-mentous and meniscal injuries, we are determining the use-fulness of Ultrasound (US) in various knee injuries and correlate the findings of US with the findings of MRI.<br />Aim of Study: to assess the diagnostic utility of ultrasound in patient with suspected ligaments or menisci injuries of knee joint keeping MRI as the Gold standard.<br />Material and Methods: This prospective study included 30 patients who were referred to the Radiology Department with clinically suspected meniscal/ligamentous injury of the knee. After detailed clinical examination, US examination of the involved knee was performed together with an examination of the contralateral normal knee, followed by MRI of the symptomatic knee in all 30 patients. The MRI findings were considered as final. Sensitivity and specificity for ultrasound in knee injuries was calculated with correlation with MRI.<br />Results: In the present study, the majority of patients were in age group 18-57 years, 70% were males and 30% were females (of a total of 30 patients). A total of 30 patients were diagnosed as having ligamentous/meniscal tears on US and MRI. In the diagnosis of meniscal/ligamentous tears, the strength of agreement between US and MRI was good.<br />Conclusion: US of the knee shows promising results in the diagnosis of meniscal/ligamentous tears. A wide availability, cost effectiveness and better tolerability of US make it a modality of first choice for evaluating knee injuries.
Meniscus – Ligament – Knee injury
https://mjcu.journals.ekb.eg/article_80706.html
https://mjcu.journals.ekb.eg/article_80706_d0181ed5c0bc5727de595179236021d2.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Assessment of Left Ventricular Asynchrony after Permanent Cardiac Pacing by Using Speckle Tracking Echocardiography
4579
4586
EN
SALLY M. TEIMA, M.Sc.;
ESSAM M.E. MAHFOUZ, M.D.
ABDUL RAZEK A. MAATY, M.D.;
AHMED H. ELADAWY, M.D.
The Department of Cardiology, Faculty of Medicine, Mansoura University
10.21608/mjcu.2019.80707
Abstract<br />Background: Echocardiography is important in assessing Left Ventricular (LV) Mechanical Dysynchrony (LVMD) and left ventricular function after permanent pacemaker. At present, Real-Time Three Dimensional Echocardiography (RT3DE) and tissue Doppler imaging (TDI) are the most sensitive and commonly used techniques for the quantification of LVMD. Global longitudinal strain (GLS) and LV dyssynchrony as-sessment enables us to detect early signs of LV dysfunction after cardiac pacing.<br />Aim of Study: To evaluate LV mechanical dyssynchrony and LV function in different pacing modes after permanent cardiac pacing by using TDI and speckle tracking echocardi-ography and to correlate these changes with other clinical, electrocardiographic and echocardiographic data.<br />Patients and Methods: Seventy patients were enrolled in this prospective cross sectional observational study, (mean age 60.99±13.77 years, 42 females), in Mansoura Specialized Medical Hospital over a period of 1 year from April 2018 to April 2019. All patients were assessed by thorough history taking, clinical examination, 12 lead surface ECG, echocar-diography, 2D speckle tracking echocardiography STE to assess GLS and tissue Doppler imaging TDI.<br />Results: Regarding diastolic function by pulsed wave Doppler PWD: There was significant decrease in E/e¢ ratio (p<0.001 *), significant increase in myocardial performance index Tei index (p<0.001 *). Regarding internal dimensions and systolic function: There was significant increase in the following: Left Atrial Dimension (LAD) (p=0.001*), Left Ventricular End Systolic Dimension LVESD (p<0.001*) and Left Ventricular End Diastolic Dimension LVEDD (p<0.001 *) while there was significant decrease in ejection fraction EF (p<0.001 *) and fractional shortening FS (p<0.001 *). Regarding parameters of LV dysynchrony: There was significant increase in the following: Aortic preejection delay APED (p<0.001*), interventricular mechanical delay (p<0.001 *) and septal posterior wall motion delay SPWMD by M mode (p<0.001 *). Regarding parameters assessed by tissue synchronization imaging TSI: There was significant increase in the following: SD-Ts (p=0.001 *) and all segments Max delay (p=0.027*). <br />Regarding parameters assessed by STE: There was significant decrease in global longitudinal strain GLS (p=0.034*) while there was significant increase in TP-SD by STE (p<0.001*).<br />Also, there was significant decrease in global longitudinal strain GLS (p<0.001*) and significant increase in TP-SD by STE (p=0.001*) in DDD group. While there was significant decrease in global longitudinal strain GLS (p<0.001 *) and significant increase in TP-SD by STE (p<0.001*) in VVI group.<br />Conclusion: GLS and 2D STE can help in the detection of subclinical left ventricular dysfunction after permanent pacemaker implantation before appearance of symptoms. Also, cardiac pacing leads to LVMD whatever the pacing mode is which may needs later on upgrading to cardiac resynchronization therapy CRT.
LVMD – GLS – Pacemaker – Speckle tracking echocardiography
https://mjcu.journals.ekb.eg/article_80707.html
https://mjcu.journals.ekb.eg/article_80707_601cdaf7bb62b0753829a215087c1ca8.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Efficacy of Intermittent Compression Therapy versus Kinesio Tape on Cellulite in Females
4587
4595
EN
AMIRA A. NEWAGY, M.Sc.;
HALA M. HANAFY, Ph.D.
MARWA A. RAHMAN, Ph.D.;
ROKIA A. SOLIMAN, M.D.
The Department of Physical Therapy for Women Health, Faculty of Physical Therapy, Cairo University* and The Department of Biological Anthropology, National Research Centre**
10.21608/mjcu.2019.80708
Abstract<br />Background: Cellulite is defined as changes in the surface contour of the skin that result in orange peel or “mattress” appearance of the skin. Cellulite is not defined as a pathologic condition, but is a substantial cosmetic concern for many adult females.<br />Aim of Study: To evaluate the efficacy of intermittent compression therapy versus Kinesio tape on cellulite in females.<br />Subjects and Methods: They were selected from students of Faculty of Physical Therapy Cairo University since October till end of December 2018, thirty females with femoral adipose tissue cellulite grade ³1 according to Nurnberger-Muller scale at their thighs. Their ages ranged from 19-25 years and their body mass indices did not exceed 35kg/m2. They were divided randomly into two groups, Group (A) (kineso tape group): Was consisted of 15 females; they all received kinesio tape for 6 weeks in addition to low caloric diet (1200kcal/day) and condition related advices. Group (B) (intermittent compression therapy group): Was consisted of 15 females, they received intermittent compression therapy for 6 weeks in addition to low caloric diet (1200kcal/day) and condition related advices as in group (A) inclusion criteria thirty females suffering from grade ³1 cellulite according to Nurnberger-Muller scale with femoral adipose tissue, their ages ranged from 19-25 years, their body mass indices did not exceed 35kg/m2. Exclusion criteria history of uncontrolled hypertension, malignancy, mental disorders, diseases of skin (dermatological diseases), inflammation within treatment area and history of Deep Venous Thrombosis (DVT).<br />Results: The percent decrease in the mean value of ultra-sound in both groups (A & B) were 4.81% and 14.36% respectively, the percent decrease in the mean value of round tape measurement in both groups A and B were 2.39% and 3.64% respectively and there was statistical significant decrease in the median value of photonumeric cellulite severity scale in group B [8.0 (4.50-11.)] when compared with its corres ponding value in group A [9.5 (6.0-12.0)] with Z-value=–2.124 and p-value=0.034.<br />Conclusion: The results of this study showed that the use of KT and intermittent compression therapy resulted in sig-nificant reduction in femoral adipose tissue cellulite were observed favouring intermittent compression therapy approach.
Cellulite – Intermittent compression therapy – Kinesio tape
https://mjcu.journals.ekb.eg/article_80708.html
https://mjcu.journals.ekb.eg/article_80708_d47d645908d397f085237cb6bb3694b4.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Dynamic Contrast Enhanced MRI and Diffusion Weighted Imaging in Evaluation of H.C.C after Chemo-Embolization
4597
4609
EN
TAMER YOUSEF, M.Sc.;
SUZAN BAHIG, M.D.
NAGLAA SHEBRYA, M.D.;
AYA YASSIN AHMED, M.D.
The Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.80772
Abstract<br />Background: Hepatocellular Carcinoma (HCC) is the most common primary malignant disease of the liver and is the third leading cause of death from cancer worldwide. Dynamic Contrast-Enhanced MRI (DCE MRI) can play a significant role as an imaging of H.C.C, especially in the detection of viable tumor foci, the differentiation between necrosis and viable tumor after TACE and early prediction of response. Diffusion-weighted MRI shall be more frequently used for tumor response evaluation to TACE because they provide detailed anatomic and functional or metabolic change information during tumor treatment, particularly during tar-geted chemotherapy.<br />Aim of Study: Detection of the value of DCE (Dynamic contrast enhanced) MRI and DWI (Diffusion Weighted Imag-ing) in evaluation of HCC (Hepatocellular Carcinoma) necrosis after TACE (Trans-Arterial Chemo-Embolization).<br />Material and Methods: Pre-contrast T1 and T2 WIs fol-lowed by diffusion weighted MR images (several b factors 20, 500, 800s/mm2) then DCE MRI study using a 3 Telsa scanner followed by measuring different ADC values obtained in 30 patients underwent TACE for treatment of 40 HCC lesions for assessment of tumoral necrosis. ADC cut-off number was estimated using the ROC curve after measuring ADC values for all cases.<br />Results: Statistical analysis demonstrated that Dynamic MRI had sensitivity of about 100% and 95.24% for specificity, While DWI has level of sensitivity of about 52.63% and 90.5% as a degree of specificity.<br />The difference between well-ablated and residual/newly developed groups'.<br />ADC values was found to be significant statistically (p-value <0.001) and best cut-off variable that maximize specif-icity and sensitivity is 1.35, where sensitivity level reaches about 78.9% and specificity level reaches about 85.7%.<br />Conclusions: Depending on our study, dynamic MRI showed very high sensitivity while DWI with ADC mapping series alone have low level of sensitivity so it promotes reader confidence and might be used in case of gadolinium contra-indications or in case of incapability of breath holding ade-quately.
HCC – TACE – Dynamic MRI – DWI – ADC
https://mjcu.journals.ekb.eg/article_80772.html
https://mjcu.journals.ekb.eg/article_80772_66b6dcfca8a052646aa646437bf8d2ba.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) in Differentiating Post Therapeutic Changes from Recurrent Malignant Breast Lesions
4611
4618
EN
MAI F. MOHAMED, M.Sc.;
HOSSAM ABD EL-KADER, M.D.
AHMED
M. EL-CHIMY, M.D.
The Department of Radiology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.80773
Abstract<br />Background: Patients follow-up subsequent to conservative breast therapy (BCT) is essential due to tumor recurrence with rates ranging between 1% and 2% annually. It occurs commonly during a period of 3-7 years after being subjected to BCT. Timely and early detection of breast cancer recurrence is believed to remarkably improve and assist long-term sur-vival.<br />Aim of Study: To assess new advances of Magnetic Res-onance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) in diagnosis of recurrent breast cancer after conservative surgery, chemotherapy and radiotherapy and differentiate it from post therapeutic changes.<br />Patients and Methods: The current study was conducted on 20 patients proved to be breast carcinoma by histopatho-logical grading. Six patients were presented with breast lump, three patients were presented by nipple discharge, four patients were presented by diffuse breast enlargement and seven patients were presented for post-operative follow-up at El-Demerdash Hospital during the period from October 2018 to April 2019.<br />Results: A strong positive correlation is detected between choline peak findings and the level of Ki67, the higher the choline the higher the Ki67 the more aggressiveness is the tumor.<br />Conclusion: Both dynamic contrast enhanced MRI and MRS are valuable tools in the evaluation of post-operative breast having high sensitivity and specificity to differentiate between benign post-operative changes and recurrent malignant tumor. On the other hand, MRI on the breast can assist to avoid unnecessary interventions and optimizes diagnosis of recurrence in its early stages.
Magnetic resonance imaging – Magnetic reso-nance spectroscopy – Malignant breast lesions
https://mjcu.journals.ekb.eg/article_80773.html
https://mjcu.journals.ekb.eg/article_80773_81aa67111152127db7b25956b0e96aef.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Does the Diffusion Weighted Images and Subtration MRI of Hepatocellular Carcinoma has a Role in Predicting Outcome of Transarterial Chemoembolization?
4619
4631
EN
REEM H. BASSIOUNY, M.D.;
RASHA T. KHATTAB, M.D.
SAEED
A.S. EL MALLAH, M.Sc.
The Department of Radiodiology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.80774
Abstract<br />Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and has a poor prognosis unless treated. Ablative therapies are promising treatment options for patients who are not eligible for surgery.<br />Aim of Study: Is to evaluate the predictive values of diffusion-weighted imaging (DWI) and Subtration MRI in evaluating the efficacy of transcatheter arterial chemoembol-ization (TACE) in treatment of patients with hepatocellular carcinoma (HCC).<br />Patients and Methods: This study included 30 patients with pathologically proven HCC (38 HCC lesions) who were referred to the Radiology Department of Ain Shams University Hospitals and National Liver Institute, Menofiya University for post therapeutic assessment after transarterial hepatic chemoembolization. The study was carried on over a period of 12 month (from August 2017 to August 2018). Patients' ages ranged from 59 to 73 with a mean of age 59.6 years. Of the 30 patients only 6 were females and 24 were males.<br />Results: We found that dynamic study is the gold standard in detection of recurrent lesions. Well defined nodular en-hancement, thick irregular marginal enhancement or gross enlargement of the lesion with arterial phase enhancement and contrast wash out were considered positive for malignancy. Ill-defined persistent enhancement or well defined rim marginal enhancement were considered benign post ablation changes. We found that subtraction technique was essential in differ-entiation between the normal hyperintense T1 signal of the ablation zone and arterial enhancement of the lesion. The high signal intensity seen in T1 images post TACE was explained by haemorrhagic coagulative necrosis. Subtraction imaging is ideally suited for such a role where the unenhanced T1-weighted sequence is subtracted from the identical contrast enhanced sequence.<br />Conclusion: We conclude that in evaluation of HCC after TACE, ADC calculated at DWI had weaker correlation to tumor necrosis degree than did findings with subtraction contrast-enhanced MRI. However, there was no difference between both methods in diagnosis of complete tumor necrosis.<br />We suggest that whenever possible, gadolinium contrast enhancement and subtraction imaging be used for assessment of tumor necrosis after TACE.
Diffusion weighted images – Subtration MRI – Hepatocellular carcinoma – Transarterial chem-oembolization
https://mjcu.journals.ekb.eg/article_80774.html
https://mjcu.journals.ekb.eg/article_80774_7a52fd91e6780acc3423e8296cac114d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Social Phobia among Tramadol and Opioid Users
4633
4644
EN
AMIRA ELSAIED ELASHRY, M.Sc.;
HOSSAM ELDIEN FATHALLAH ELSAWY, M.D.
AMR ADEL HAIBA, M.D.;
SHEREEN DESOKY ABOHAMAR, M.D.
The Department of Neuropsychiatry, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.80776
Abstract<br />Background: Substance use disorder is a global health problem as it is associated with a lot of disabilities e.g. occupational, familial, financial and psychological. Co-occurrence of Tramadol and Opioid use disorder is more frequent among subjects with generalized anxiety, social phobia or depression and these psychiatric disorders may trigger substance use.<br />Aim of Study: The purpose of this study was to identify the relationship between social phobia and tramadol and opioid use, and if it has a role in starting drug use.<br />Patients and Methods: A sequential sample of 103 Tra-madol and/or Opioid users of both genders, 18-50 years old was collected from patients admitted to Psychiatry, Neurology and Neuro-Surgery Center in Tanta University through the period from the first of June to the end of December 2017. Social phobia was assessed by Raulin and Wee scale for social phobia.<br />Results: Tramadol users had obviously increased level of social phobia after one month of withdrawal. Although opioid users had a higher level of social phobia at base line, the level of social phobia didn't increase by the same degree of tramadol. Among tramadol users depression increased after one month while among opioid users depression was severe at base line then decreased gradually. Users of both drug experience lower level of depression than those of opioid users only. Tramadol users had little variation of anxiety all over the study while users of opioid had higher level of anxiety that increased after one month of withdrawal.<br />Conclusion: Tramadol withdrawal leads to significant social phobia and depression that should be proberly treated while Opioid use disorder leads to significant depression especially with longer duration of drug use.
Social phobia – Tramadol and Opioid
https://mjcu.journals.ekb.eg/article_80776.html
https://mjcu.journals.ekb.eg/article_80776_940a1902d65743b0682f13f51abd9da7.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Prevalence of Congenital Anomalies of Uterus in Sohag Government: A Descriptive Study by Trans-Vaginal Three Dimensional Ultrasound
4645
4650
EN
SAYED A. SAYED, M.D.;
SALWA M. OUIES, M.D.
BOTHYNA
Z. ELSAYED, M.Sc.
The Department of Human Anatomy and Embryology, Faculty of Medicine, Assuit* and Sohag** Universities
10.21608/mjcu.2019.80777
Abstract<br />Background: A large number of uterine anomalies are detected routinely in reproductive medicine. The prevalence of these congenital uterine anomalies in women with repro-ductive failure remains unclear especially in Upper Egypt.<br />The Aim of Study: Was to estimate the prevalence of congenital uterine anomalies in women with infertility in Sohag by Transvaginal Three Dimensional Ultrasound (TV3DUS).<br />Methods: This study was a descriptive cross-sectional study carried out for 977 infertile women in 2018 based on reviewing of radiological images at Sohag governorate. After taking informed and written consent, a detailed history, general and systemic examination was done. All the cases underwent TV3DUS performed during the postmenstrual phase. Exami-nations had been performed using flips iu220 machine by a single operator and was commented as either normal or abnormal uterine cavity.<br />Results: A total of 977 women were included in the study. 808 (82.7%) had a normal uterus and 169 (17.3%) had a congenital uterine anomalies. The most common anomalies were arcuate [n=84 (49.7%)] and septate [n=62 (36.8%)] uterus, followed by unicornate [n=9 (5.3%)] and then T-shaped and hypoplastic uterus [n=4 each (2.3% each)], lastly didelphys and bicornate [n=3 each (1.8% each)].<br />Conclusions: TV3D ultrasound is an accurate and simple method to detect and classify congenital uterine anomalies and should become the first diagnostic step in the assessment of the uterine cavity. Prevalence of uterine congenital anomalies in Sohag was 17.3%. The most common type of uterine congenital anomalies was arcuate uterus.
Arcuate – Infertility – Ultrasound – Uterus – Anomalies
https://mjcu.journals.ekb.eg/article_80777.html
https://mjcu.journals.ekb.eg/article_80777_a6e232f26ed224f2318058b577bb097a.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Cervical Sagittal Balance as a Predictor for the Outcome of Multimodal Treatment Program for Non Specific Neck Pain
4651
4659
EN
MOHAMED A. NEAMTALLAH, M.Sc.;
NEVEEN ABDALATEF, Ph.D.
REHAM H. DIAB, Ph.D.;
ALIAA A. DIAB, Ph.D.
The Department of Basic Sciences, Faculty of Physical Therapy, Cairo University
10.21608/mjcu.2019.80827
Abstract<br />Background: Sagittal balance represents the position of the occiput to the thoracic inlet. Sagittal balance keep normal lordotic curve in cervical region so any disturbance in cervical balance lead to pain and disability. Also it an important concept in spinal reconstruction and cervical sagittal imbalance has been linked to poor health-related quality of life scores due to disabling symptoms of neck pain and neurological deficit.<br />Aim of Study: The purpose of this study was to investigate the influence of cervical balance as predictor for the outcome measures of multimodal treatment program in patient with non specific neck pain.<br />Patients and Methods: Forty patients with non specific neck pain participated in this study. Patients were subdivided into two groups, twenty in each group. The first group was the group A with cervical sagittal imbalance, and the second group was the group B with cervical sagittal balance. Both groups received multimodal treatment (cervicothoracic stabi-lization training designed to restore cervical muscle endurance and coordination, relaxation training to reduce unnecessary muscle tension, behavioral support to reduce anxiety and fear of pain, eye fixation exercises to prevent dizziness and seated wobble-board training to improve postural control). We measured pain by Visual Analogue Scale (VAS), neck function by Neck Disability Index (NDI) and cervical Range of Motion (ROM) by cervical goniometer.<br />Results: Within-group analysis there was a significant difference of, NDI and ROM (flexion, extension, RT rotation and LT rotation) pre-treatment at groups A, B (p=0.0001). There was no significant difference of VAS, LT bending and RT bending pre-treatment (p-value >0.05). Between group analyses there was significant difference of NDI and ROM (flexion, extension, RT bending, LT bending, RT rotation and LT rotation) in two groups post-treatment as p-value <0.05 except VAS.<br />SVA (Sagittal Vertical Axis) contribute to interpretation of changes in ROM NDI except VAS.<br />Conclusion: Cervical sagittal balance is effective in predicting multimodal treatment outcome measures (ROM and neck function) in Nonspecific Neck Pain (NSNP). Patients with cervical sagittal balance have better outcome measures (improving ROM and improving neck function) than patients with cervical sagittal imbalance in case of non specific neck pain.
Cervical – Sagittal balance – Multimodal – Treatment
https://mjcu.journals.ekb.eg/article_80827.html
https://mjcu.journals.ekb.eg/article_80827_376b528972756a3c52ac2d3f80687bac.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Study of the Protective Effect of Nigella Sativa Oil on Tartrazine-Induced Hematological Disorders in Rats
4661
4670
EN
RAMEZ A. BARHOMA, M.D.;
AMIRA M. ELSHAMY, M.D.
ALAA
I. AMER, M.D.
The Departments of Physiology*, Biochemistry** and Pathology***, Faculty of Medicine, Tanta University, Egypt
10.21608/mjcu.2019.80828
Abstract<br />Background: Tartrazine is a food colorant used in most food products that consumed almost every day. In view of the adverse effects of its excessive ingestion, it is essential to investigate new and safe protection. Nigella sativa oil, by its beneficial medicinal effects may offer a good protective therapy in this issue.<br />Aim of Study: In this study the possible protective effect of Nigella Sativa Oil (NSO) on hematological disorders induced by tartrazine was investigated.<br />Material and Methods: Thirty male Wistar rats were included in this study and divided into three groups: Control group (treated by distilled water), tartrazine treated group (20mg/kg/day), Nigella sativa+ tartrazine treated group (10ml NSO/kg/day + tartrazine treatment). Hematological state was evaluated by measuring total Red Blood Cells (RBCs) count, Packed Cell Volume (PCV), Hemoglobin (Hb) concentration, Mean Cell Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Total White Blood cells (WBCs) count and total platelets count. Moreover, oxidative markers; Malondialdehyde (MDA) and reduced glutathione (GSH), were measured in kidney, spleen, Bone Marrow (BM) and RBCs. In addition, bone marrow was examined for histopathological changes.<br />Results: Tartrazine significantly decreased RBCs count, Hb content, PCV, total WBCs count, lymphocytic, monocytic and granulocytic counts, and significantly increased the MCV, MCH and the platelet count, it also significantly decreased GSH, and increased MDA levels in RBCs, kidney, spleen and BM tissues. Histopathological examination provoked increased number of megakaryocytes and occurrence of myelofibrosis in BM of tartrazine group. Treatment with Nigella sativa oil significantly improved all the tartrazine-induced disturbances.<br />Conclusion: The findings of the current study revealed that Nigella sativa oil improved the tartrazine-induced hema-tological disorders, most probably through its antioxidant properties.
Nigella sativa oil – Tartrazine – Hematological disorders – Antioxidant properties
https://mjcu.journals.ekb.eg/article_80828.html
https://mjcu.journals.ekb.eg/article_80828_1786261807014bcff563402801182155.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Comparision between Low-Dose CT and Ultrasound in Diagnosis of Renal and Uretral Stones in Adults
4671
4677
EN
DOAA N. ANAS, M.Sc.;
KHALED I. ELSHAFEY, M.D.
HOSSAM M. ABDELHAFIZ, M.D.;
ALSHYMAA Z. ALSHAHAWY, M.D.
The Department of Radiology, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.80829
Abstract<br />Background: Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the examination of decision for renal colic when compared to ultrasonography; be that as it may, radiation presentation can be a worry.<br />Aim of Study: Comparison between low dose CT and ultrasound in diagnosis of renal and uretral stones in adults.<br />Patients and Methods: This prospective study was con-ducted on fifty Egyptian adults meeting the inclusion criteria of hading flank pain, suspected to have urinary tract calculi and recruited from Urology Department of Tanta University to Radiology Department at Tanta University Hospitals. All patients were applied to careful history taken, clinical and laboratory examination then underwent imaging studies which include renal ultrasound examination and MDCT-KUB using low dose protocol. Each depicted stone was documented whether it is renal or uretric. All the stones were also defined as single or multiple, unilateral or bilateral and the maximum diameter of them. In case of upper urinary tract calculi reliable secondary signs of obstructing calculi were demonstrated. These include hydronephrosis, hydroureter, ipsilateral renal enlargement and ureter rim sign. The findings were confirmed by comparing to the previous standard CT scans that were done and detected in the medical records for 20 patients, uretroscopy in 12 patients, percutenous nephro lithotomy in 8 patients, medical treatment and more follow-up for 10 patients. The sensitivity, specificity and size accuracy of US was determined using low dose CT as the standard.<br />Results: Low dose CT showed number of renal and ureteral stones more than ultrasound with statistical significant p-value <0.001 with overall stones detected by ultrasound is 43 stones (5 ureteral and 38 renal) while low dose CT showed 96 stones (40 ureteral and 56 renal). The ultrasound missed 12 stones with 80% with mean size 4mm at uretrovesical junction and 10 stones with 83.8% with mean size 6mm at upper third of ureter. The ultrasound missed 100% of the ureteral stones in middle or distal ureter due to abdominal gases. The ultrasound overestimate the size in size group [4 to 1 0mm] by 3.3mm with statistically significant p-value detected. The ultrasound sensitivity, specificity, accuracy for renal stones detection were 67.8%, 100% and 81.2% respectively when compared to low dose ct and the ultrasound sensitivity, specificity, accuracy for ureteral stones detection were 6.90%, 100% and 43.75% respectively when compared to low dose.<br />Conclusion: Low dose CT shows up as preferred imaging modality for uorolithiasis over ultrasound because of its high sensitivity and accuracy in identifying renal and ureteral stones.
Uorolithiasis – Ultrasonography – Low dose CT
https://mjcu.journals.ekb.eg/article_80829.html
https://mjcu.journals.ekb.eg/article_80829_d3293a5b61b906d758abcb7e65433289.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Expression of Nerve Growth Factor and Tyrosine Kinase A in Laryngeal Squamous Cell Carcinoma: A Novel Study
4679
4683
EN
MOSTAFA A. ABOU SARIE, M.D.;
HALA M. EL-HANBULI, M.D.
LUBNA
O. ABDEL-SALAM, M.D.
The Department of Pathology, Faculty of Medicine, Fayoum* and Cairo** Universities, Egypt
10.21608/mjcu.2019.80830
Abstract<br />Background: Laryngeal Squamous Cell Carcinoma (LS-CC) is a common cancer worldwide so knowing the biological markers related to this tumor aggressiveness can help improv-ing the patient's management. A recent attention was payed towards Nerve Growth Factor (NGF) and its receptors in tumorigenesis.<br />Aim of Study: This work aimed at studying for the first time the immunohistochemical expression of NGF and its TrkA receptor in LSCC and determine the possibility of finding a relationship between their expression and the different clinico-pathological data of the patients especially the clinical stage of the disease.<br />Material and Methods: Using the immunohistochemical staining, the expression of NGF and TrkA was evaluated in 60 LSCC tissues.<br />Results: The result showed that the expression of both NGF and TrkA was significantly related to the nodal status, the tumor and the clinical stages of the patients (p<0.001).<br />Conclusion: The increased expression of both markers in advanced clinical stage of the disease suggested considering them as potential markers not only as prognostic factors, but also as a therapeutic target in LSCC.
Laryngeal Squamous Cell Carcinoma (LSCC) – Nerve Growth Factor (NGF) – Tropomyosin-related kinase A (TrkA)
https://mjcu.journals.ekb.eg/article_80830.html
https://mjcu.journals.ekb.eg/article_80830_b16c0a0fe7e723ce5e27431087f6a617.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Effect of Tamsulosin on Stone Free Rate after SWL: A Placebo Controlled Study
4685
4689
EN
TARIK OSMAN, M.D.;
KARIM OMAR, M.D.
AHMED
SAMY, M.Sc.
The Department of Urology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.80831
Abstract<br />Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is a noninvasive technique for the treatment of kidney stones. Most ESWL is carried out when the stone is present in the renal pelvis.<br />Aim of Study: To evaluate the efficacy of alpha blocker (tamsulosin) to enhance stone fragments clearance from urinary tract after ESWL on renal pelvic stones.<br />Methods: This is prospective randomized study which was carried out at Urology Department Ain Shams University Hospital during the period from August 2017 till July 2018. After hospital ethical committee approval, a total of 56 patients fulfilling inclusion criteria with symptomatic single renal pelvic radiopaque stone £1cm were included in this study. All patients underwent ESWL therapy for their stone. Patients were randomized into two groups; group A (received tamsu-losin 0.4mg) and group B (received placebo).<br />Results: After two weeks of follow up PUT was done and revealed post ESWL SFR (stone free rate) on placebo group was 86.9% and SFR on tamsulosin group was 92.5% (p-value=0.2) (no statistically significant difference) on the other hand post ESWL pain was significantly more among group B (placebo group) of 73.9% compared to group A (tamsulosin group) of 3.7% (p-value=0.0023), and Dizziness in tamsulosin group was 18.5% of the group patients experienced it while none of the placebo group complained of that, (p-value= 0.003).<br />Conclusion: When the stones were (£10mm, no improve-ment was seen in the success rates by adding Medical Expulsive Therapy (MET) in the form of alpha blocker than placebo, as has been reported in other studies, but post ESWL pain is less with adding tamsulosin.
ESWL – Renal stone – Alpha blocker
https://mjcu.journals.ekb.eg/article_80831.html
https://mjcu.journals.ekb.eg/article_80831_bb5744982fa97150d5f1dc0c18693323.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Influence of Silicone Oil Tamponade after Vitrectomy on Intraocular Pressure
4691
4697
EN
AMANY A.M. TAWFIK, M.Sc.;
NEGMELDIN H. ABDALLAH, M.D.
LAMIA S. ELEWA, M.D.;
NOURELDIN HUSSEIN, M.D.
The Department of Ophthalmology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.80832
Abstract<br />Background: Glaucoma is a complicated disease in which damage to the optic nerve leads to progressive, irreversible vision loss. Glaucoma is the second leading cause of blindness.<br />Aim of Study: The aim of this study is to determine the possible influence of the silicone oil tamponade after vitrec-tomy on the intraocular pressure which is a major risk factor for developing secondary glaucoma and the effect of starting with anti-glaucoma therapy during the first 6 months post-operative.<br />Patients and Methods: This prospective study was con-ducted from February 2018 to August 2018 and involved 35 patients (25 patients with retinal detachment, 10 patients with advanced proliferative diabetic retinopathy). All patients had vitrectomy with silicone oil tamponade. All patients signed an informed consent to participate in the study.<br />Results: Early elevation of IOP is equally present in the patients with RD as well as in those with PDR. However, a qualitative analysis of the two groups of patients showed higher IOP in patients with PDR. Silicone oil significantly affect visual acuity in both groups of patients causing deteri-oration of the visual acuity which affect PDR group more than RD group.<br />Conclusion: Silicone oil as a tamponade agent after pars plana vitrectomy may cause rise in the IOP values in the early post-operative period in some patients. Therefore the timely detection and appropriate antiglaucoma treatment is extremely important since every elevation of the IOP may interfere with the positive outcome of the surgical procedure and functional visual outcome.
Silicone oil tamponade – Vitrectomy – Intraocular pressure
https://mjcu.journals.ekb.eg/article_80832.html
https://mjcu.journals.ekb.eg/article_80832_c15c83243841ce8ff7e574b4f488633b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Isosorbide Mononitrate versus Misoprostol for Cervical Ripening in Early Missed Abortion
4699
4705
EN
MUHAMMED I.M. LABAN, M.Sc.;
MOUSTAFA Z. MOUSTAFA, M.D.
HESHAM M.E. BORG, M.D.;
NAGLAA A. HUSSEIN, M.D.
The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.80833
Abstract<br />Background: First-trimester pregnancy loss is the most common complication of human reproduction with an inci-dence ranging between 50 and 70% of all conceptions. The uterine cervix has to be firm enough to retain the conceptus through the pregnancy. Cervical ripening and maturation is very important prerequisite for the successful termination of pregnancy. Misoprostol softens the cervix and cause uterine contractions used for ripening of the cervix before surgical or for medical abortion. Isosorbide mononitrate promote cervical smooth muscle relaxation has been applied clinically as cervical ripening agents. First trimester abortion is termi-nated by surgical evacuation of the uterus.<br />Conclusion: Cervical preparation is beneficial prior to surgical abortion and should be routine if gestation more than 10 weeks using one of cervical ripening agents Misoprostol or IMN.<br />Aim of Study: To compare efficacy and safety of Isosorbide Mononitrate (IMN) and misoprostol for cervical ripening prior to surgical termination of missed abortion aged between 8 and 12 weeks.<br />Patients and Methods: Eighty patients aged between 20 & 35 years presenting with missed abortion in early weeks of gestation and requiring medical or surgical evacuation of the retained products of conception were included in this prospective clinical study. Number of doses required to achieve cervical ripening, Induction-Ripening interval (I/R) was recorded. Amount of operative blood loss and other safety indices were assessed.<br />Results: Number of doses to achieve cervical ripening using (Misoprostol) was significantly less than number of the (IMN) doses and with further analytical statistics about 66% of cases have successful ripening using (Misoprostol) compared to only 31% using (IMN). The mean (I/R interval) was as follows; 18.5 hours for (Misoprostol) and 22.5 hours for (IMN); with much less operative blood loss for the Misoprostol group than the IMN group.
Abortion – Cervical ripening – Misoprostol – Isosorbide MonoNitrate (IMN)
https://mjcu.journals.ekb.eg/article_80833.html
https://mjcu.journals.ekb.eg/article_80833_546f4ca763cd6635ebc3259c2fe0979f.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Value of Non-Alcoholic Fatty Liver Diseases Detected by Fibroscan in the Prediction of Coronary Heart Diseases Detected by Multi-Slice CT Angiography
4707
4717
EN
NERMIN M. NAGA, M.Sc.;
MANAL F. HAMISA, M.D.
SAMIA M. SHARAF ELDEEN, M.D.;
RASHA L. YOUNIS, M.D.
The Departments of Diagnostic Radiology* and Cardiology**, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.80834
Abstract<br />Background: Non-alcoholic hepatic steatosis, considered to be the hepatic manifestation of Metabolic Syndrome (MS), is the commonest liver disease in industrialized countries and it is associated with increased incidence for Coronary Artery Disease (CAD).<br />A high percentage of hepatic steatosis was detected in patients who examined by invasive coronary angiography with increased incidence of relevant coronary artery disease in patients with fatty liverin comparison to those who did not have signs of lipid accumulation in liver on ultrasound.<br />Aim of Study: This study aims to assess the frequency of non-alcoholic fatty liver diseases in coronary heart disease patients by using a new diagnostic tool: TE (Fibroscan) and coronary CT angiography.<br />Patient and Methods: A total number of 60 patients suffered from Non-Alcoholic Fatty Liver Disease (NAFLD) to be examined by fibroscan examination with CAP parameter and then computed tomography coronaries angiography by using agaston score.<br />Results: The age of the patients ranged from (32-72) years with mean age of 52 years, 34 male patients (56.7%) and 26 female patients (43.3%), in this study there were 28 patients suffered from hypertension, 28 patients suffered from DM, 20 patients were smokers, 18 patients were obese and 6 patients had no risk factors with overlap of the risk factors. In this study there were 18 patients did not suffer from coronary stenosis, 10 patients suffered from minimal stenosis, 6 patients suffered from mild stenosis, 16 patients suffered from moderate stenosis and 10 patients suffered from severe stenosis according to Agaston score. According to CAP parameter in this study there were 12 patients suffered from mild steatosis, 16 patients suffered from moderate steatosis, 28 patients suffered from severe steatosis and 4 patients did not suffered from steatosis.<br />Conclusions: The fibroscan is the best non-invasive technique in diagnosis of the hepatic steatosis. The multi-detector CT coronary angiography is a good method in diag-nosis of the coronaries diseases and stenosis provide excellent diagnostic results. Nonalcoholic hepatic steatosis that deter-mined by fibroscan, is strongly correlated with coronary artery atherosclerosis therefore, be a relevant predictor of coronary-diseases.
Coronary artery disease (CAD) – Fatty liver diseases – Slice CT angiography
https://mjcu.journals.ekb.eg/article_80834.html
https://mjcu.journals.ekb.eg/article_80834_6ad205f434242ef7132ca60fb0df8d6b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Imaging of Pregnancy Associated Breast Cancer
4719
4722
EN
LAMIAA M.B. HASHEM, M.D.;
AHMED A.M. ABDELMAWLA, M.D.
AMR
FAROUK I. MOUSTAFA, M.D.
The Department of Radiology, Faculty of Medicine* and National Cancer Institute***, Cairo University, The Department of Surgical Oncology, National Cancer Institute, Cairo University**
10.21608/mjcu.2019.80835
Abstract<br />Background: Pregnancy-Associated Breast Cancer (PABC) is breast cancer presenting either during pregnancy or in the first postpartum year.<br />Aim of Study: The purpose of this study was to calculate the incidence of pregnancy associated breast cancer in patients presenting with clinically palpable masses during pregnancy or first postpartum year and to evaluate the role of sonomam-mography in the diagnosis of pregnancy associated breast cancer.<br />Patients and Methods: The study included 100 female patients with clinically palpable breast masses discovered during pregnancy and first year of lactation. All patients were evaluated by Ultrasound. Mammography was only performed on 23 patients. Mammographic and sonographic findings were evaluated retrospectively. No further diagnostic evaluation was done in case of benign radiological findings, yet biopsy was the next step performed if findings were suspicious.<br />Results: In total, 100 women were enrolled in this study; the mean age of this study population was 29 years. Among the studied cases only 15 cases (n=15/100, 15%) were malig-nant, their age ranged from 26 years to 40 years with average 34.6, four of them (n=4/15) were presented by right breast palpable lumps and 11 (n=11/15) by left breast palpable lumps. Ultrasound helped to classify 2 cases (n=2/15) as BIRADS 4 and the rest (n=13/15) as BIRADS 5. Ultrasound guided biopsy was then performed for the 15 patients confirming their malignant nature.<br />Conclusion: Even though the majority of the pregnancy-associated breast masses are benign; a strict evaluation of any lesion is still required to exclude malignancy.
Pregnancy,lactation,breast cancer,PABC,Ultrasound,Pregnancy-associated breast masses
https://mjcu.journals.ekb.eg/article_80835.html
https://mjcu.journals.ekb.eg/article_80835_036e6df63144e7deff26f24a00b98260.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Screening of Siblings of Diabetic Children for Prediction of Developing T1DM by Use of Urinary C-Peptide Creatinine Ratio
4723
4728
EN
ADEL A. ERFAN, M.D.;
AHMED M. ALI, M.D.
AMIRA Y. ABD EL-NABY, M.D.;
BASMA Z. MOSTAFA, M.Sc.
The Department of Pediatrics, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.84643
Abstract<br />Background: Diabetes Mellitus is considered an epidemic with increasing incidence over years. UCPCR above 0.2nmol/ mmol is suggestive of remaining pancreatic reserve and is also safe and noninvasive. Screening for type 1 diabetes in siblings of children with T1DM is recommended.<br />Aim of Study: To screen the siblings of children with T1DM for risk of development of diabetes by using Urinary c-peptide creatinine ratio.<br />Patients and Methods: A prospective case control study was carried out on 43 child who were classified into two groups: 21 children as a control group and 22 siblings of children with T1DM. These diabetic children were diagnosed and followed-up at Endocrinology Unit, Pediatric Department, Tanta University Hospitals. The duration of the study was one year.<br />Results: Study showed that one child had a diabetic level of fasting blood glucose. It forms 4.5% of siblings of diabetic children. UCPCR for siblings ranged between 0.052-1.393 with a mean 0.23 and SD ±0.29, while it ranged between 0.159-1.69 with a mean 0.49 and SD ±0.35 in control. The UCPCR was statistically significant (p=0.009*). Negative correlation between fasting blood glucose and UCPCR had a cut off 0.17 with 60% sensitivity and 95% specificity.<br />In Conclusion: C-peptide is a useful indicator of beta cell function, and production of insulin. Urinary C-peptide creat-inine ratio may be used as screening test to predict childrende-veloping type 1 diabetes mellitus.
type 1 diabetes mellitus,Screening,Urinary C-Peptide Creatinine Ratio
https://mjcu.journals.ekb.eg/article_84643.html
https://mjcu.journals.ekb.eg/article_84643_af5d3814d99573c7b224ace1e9f06403.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Role of High Resolution Ultrasound in the Assessment of Knee Osteoarthritis
4729
4735
EN
SAMAR M.I. SHAABAN, M.Sc.;
MARWA I. FAHMY, M.D.
TAREK W.
HEMADA, M.D.
The Department of Radiology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.84644
Abstract<br />Background: Osteoarthritis (OA) is a common musculoskeletal<br />disease with high prevalence worldwide. Knee OA<br />is primary diagnosed using conventional radiography, however,<br />changes of articular cartilage or menisci cannot be directly<br />assessed using conventional radiology. Ultrasound (US) can<br />be used to assess soft tissue degeneration directly.<br />Aim of Study: The aim of this study is to evaluate the<br />efficacy of High Resolution Ultrasound (HRUS) in the assessment<br />of structural abnormalities found in knee osteoarthritis.<br />Patients and Methods: The study was conducted upon 20<br />patients with knee OA (12F, 8M; mean age 53 years), each<br />subject was evaluated for the presence of medial and lateral<br />femoral cartilage thinning, medial and lateral femoral and<br />tibial osteophytes, medial and lateral meniscal degeneration,<br />joint effusion and Baker's cyst using ultrasound and MRI,<br />considering MRI as a reference standard.<br />Results: The overall sensitivity of the ultrasound in the<br />detection of knee OA parameters was good (89.3%), the<br />overall accuracy was excellent (90%), the overall specificity<br />was excellent (93.1%). The Positive Predictive Value (PPV)<br />and the Negative Predictive Value (NPV) were 98.3 and 65.9<br />respectively. The p-value was highly significant (<0.01) when<br />comparing assessment of knee osteoarthritis parameters between<br />ultrasound and MRI.<br />Conclusion: Ultrasound assessment of the knee joint is<br />an accurate imaging method for detection of knee osteoarthritis<br />parameters including medial and lateral femoral articular<br />cartilage thinning, medial and lateral osteophytes, medial and<br />lateral meniscal degeneration, joint effusion and Baker's cyst.<br />Thus, Knee ultrasound can be used as a complementary<br />imaging technique to radiography, especially when MRI is<br />not available, to assess tissue-specific structural OA degeneration<br />not detected by conventional radiographs.
osteoarthritis,knee,Ultrasound,MRI
https://mjcu.journals.ekb.eg/article_84644.html
https://mjcu.journals.ekb.eg/article_84644_4adb39b9bf6a210e1190e22679ddea7e.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Keratin 17 Immunohisto chemical Expression and Prognostic Value in Bladder Urothelial Carcinoma
4737
4746
EN
SHAIMAA M.M. BEBARS, M.D.;
WALAA ABD EL GAWAD GHANAM, M.D.
RASHA
MOHAMED SAMIR SAID, M.D.
The Department of Pathology, Faculty of Medicine, Aswan* and Suez** Universities, Egypt
10.21608/mjcu.2019.84645
Abstract<br />Background: Bladder cancer is the 2 nd most common site<br />of cancer in Egyptian males (12.7%), compared to other<br />countries, the incidence and mortality rates are high. The ratio<br />of Squamous Cell Carcinoma (SCC) & Urothelial Carcinoma<br />(UC) types showed a shift towards UC. Keratin 17 (K17) is<br />an oncoprotein that has a role in tumor progression. K17 is<br />overexpressed in SCC, triple negative breast cancer & others.<br />Aim of Study: This study aimed to explore the expression<br />of K17 protein in UC in bladder biopsies of Egyptian cases.<br />Also, to correlate K17 expression with the available clinicopathological<br />data of the studied cases.<br />Patients and Methods: This study was carried out on 60<br />cases of Egyptian bladder UC. Sections of the collected<br />paraffin blocks were performed and applied for Immunohistochemical<br />staining with K17, mouse monoclonal anti-human<br />K17 antibody. Positive K17 cases assessed for intensity<br />staining and distribution of positive stained cells into (mild,<br />moderate and strong) staining results.<br />Results: K17 showed high expression in UC Egyptian<br />patients biopsies (56.7%), strong intensity was found in more<br />than half of positive cases while it was negative in normal<br />urothelium. K17 is more expressed in papillary UC pattern<br />and more related to bad prognosis features as high grade and<br />muscle invasion. Significant association was detected between<br />positive K17 and squamous differentiation in UC cases. All<br />moderate intensity (100%) and majority of strong staining<br />(77.8%) were of papillary UC (p<0.001). In addition, significant<br />association was found between moderate & strong K17<br />intensity and negative schistosomiasis ovae cases (p=0.003).<br />Conclusion: Our study calls for considering high expression<br />of K17 in UC especially papillary pattern, high grade &<br />muscle invasion. This study also sheds light on significant<br />association of K17 in UC with squamous differentiation &<br />absence of Schistosomiasis.
Urothelial carcinoma,K17,Immunohistochemistry,biomarker
https://mjcu.journals.ekb.eg/article_84645.html
https://mjcu.journals.ekb.eg/article_84645_8c13a2364c03472468706bdeb8bbac73.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Detection of Breast Cancer Recurrence by Using Positron Emission Tomography with 18 Fluorodeoxyglucose (FDG-PET)-Computed Tomography (CT) and Tumor Markers
4747
4752
EN
ALAA M. KOHLA, M.Sc.;
MANAL F. HAMISA, M.D.
KHALID A. ABO DEWAN, M.D.;
FATMA ZAKARIA, M.D.
The Department of Radiodiagnosis and Medical Imaging, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.85086
Abstract Background: Breast cancer is responsible for nearly 15% of death in female cancer related death in western countries and is cosidered the second leading cause to death due to cancer in females. In Egypt, it is the most common cancer in female, representing about 38.8% of total cancer cases in women. Early diagnosis of recurrent breast cancer is crucial to selection of the most appropriate therapy. FDG-PET/CT has been used for diagnosis, staging, monitoring response to therapy, and restaging patients with breast cancer. Although FDG-PET/CT may have limited diagnostic value in detecting small primary breast tumors, in staging of the axillary region, and in detecting osteoblastic metastases, it is superior to conventional imaging modalities in detecting distant metastases and in monitoring response to therapy. Aim of Study: To evaluate the role of PET/CT and tumor markers in detection of breast cancer recurrence in Clinical Radio-Diagnosis Department. Patients and Methods: Twenty five female patients their age was from 22-67 years (mean 43 years) all with breast cancer history and elevated serum tumor markers after their initial diagnosis were retrospectively evaluated. PET/CT results were confirmed by further imaging, and follow-up. Changes in further management based on PET/CT were recorded. Results: The patients' age was from 22-67 years. Most of them were (60%) were premenopausal. In this study, 92% had Infiltrating Ductal Carcinoma (IDC) while only 2 patients (8%) had Infiltrating Lobular Carcinoma (ILC), fourteen patients (56%) had recurrence of tumor, and 11 (44%) patients showed no further evidence of disease. Fourteen patients had abnormal PET/CT studies, and 11 patients had normal studies with an overall sensitivity, specificity, and accuracy of 85.7%, 81.8%, and 84%, respectively. PET/CT was compared with contrast-enhanced CT and had a higher sensitivity (85.7% vs. 71.4%), specificity (81.8% vs. 45.4%), and accuracy (84% vs. 60%). PET/CT was also compared with tumor markers and had a higher sensitivity (85.7% vs. 78.5%), specificity (81.8% vs. 18.1%), and accuracy (84% vs. 52%).Conclusion: FDG-PET/CT was superior to conventional imaging modalities in diagnosis of breast cancer recurrence.
PET-CT,Cancer breast,Increased tumor markers
https://mjcu.journals.ekb.eg/article_85086.html
https://mjcu.journals.ekb.eg/article_85086_eea50594af6f3f839d930d608d0b5867.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Relationship between Tweleve Hour Shift and Patient Safety at Cairo University Hospitals
4753
4758
EN
SHIMAA M. ABD-ELKADER, M.Sc.;
MAHSAN I. ABD-ELMEGEED, D.N.Sc.
FATMA A.
ABED, D.N.Sc.
The Department of Nursing Administration, Faculty of Nursing, Cairo University
10.21608/mjcu.2019.85087
Abstract Background: Patient safety has become a priority in healthcare system and among health care workers. Nurses play a major role in patients' safety through twelve hour shift because they are accountable for direct and continuous patient care. So errors occur for a variety of reasons, including the effects of twelve hours shift. It is estimated that 1.3 million health care errors occur each year and of those errors 48,000 to 98,000 result in the deaths of patients. Aim of Study: To assess the relationship between twelve hour shift and patient safety. Subjects and Methods: A descriptive research design was utilized to collect data from (150) staff nurses working in all Medical, Surgical Departments and Intensive Care Units at National Cancer Institute which is affiliated to Cairo University having at least one year of experience. Data was collected by using Hospital Survey of Patient Safety Culture (HSOPSC) and patient safety assessment manual. Results: The study revealed that the dimension with the highest positive responses was; teamwork within units (mean= 4.61) and the lowest positive response was in the dimension of non-punitive response to error (mean=1.81) and also feedback and communication about error (mean=2.71). Conclusion: The study concluded that there was a signif-icant relation between 12 hour shifts and patient safety dimen-sions. Recommendations: The study recommended Schedule sensibly for nurses to decrease fatigue that leading to error. Head nurses should be encouraged to establish non-punitive environment as well as a teamwork spirit among nursing staff working in critical care and general ward staff nurses. Develop a well-established system for incident reporting, and all staff nurses should be informed and trained about it.
Twelve hour shift,Patient Safety
https://mjcu.journals.ekb.eg/article_85087.html
https://mjcu.journals.ekb.eg/article_85087_1cca208c39921db07b2f25bc3117bb80.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Male Circumcision: Contemporary Practice Pattern of the Egyptian Pediatric Surgeons
4759
4764
EN
MOHAMED A. SHEHATA, M.D.;
HISHAM A. ALMETAHER, M.D.
MOHAMED
A. MANSOUR, M.D.
The Departments of Pediatric Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
10.21608/mjcu.2019.85213
Abstract Background: To determine the practice pattern of male circumcision among pediatric surgeons in Egypt. Aim of Study: This study proved a shortage of communi-cation between the surgeons and the parents. And it was limited by the inability to correlate the clinical practice with the outcome results and the fact that not all members of EPSA responded to e-mails or personal communication. Patients and Methods: During 33rd Congress of Egyptian Pediatric Surgical Association in 2018, the pediatric surgeons were asked to fill a 22-question survey about their practice in male circumcision. Results: Correct responses were received from 126 sur-geons; 27% of responders operated more than 150 cases per year, 35% performed circumcision at the neonatal period, 45.2% used bone cutting forceps, 88.1% preferred electrocau-tery for sealing minute bleeding vessels; (81.7% use bipolar diathermy and only 6.4% used monopolar diathermy), 8% of the responders never used sutures in circumcision. There is a wide variation in the type of anesthesia and analgesia used. 61% recommended removal of the dressing after 24 hours. 70.4% of the responders regularly reviewed the cases in the outpatient clinics. Conclusion: The current survey reflects the diversity in the practice patterns of circumcision among pediatric surgeons in Egypt. Guillotine method using bone cutting forceps still the commonest method used. Other methods are limited due to the unavailability of the devices in most institutions. The pain control measures and the post-procedure care should be improved.
Anesthesia,Bleeding,Circumcision,Electro-cautery
https://mjcu.journals.ekb.eg/article_85213.html
https://mjcu.journals.ekb.eg/article_85213_634d86241992dddba6861b470da1ba01.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Objective and Subjective Outcome of Corneal Collagen Crosslinking in Keratoconic Patients According to Keratoconus Grading
4765
4768
EN
MONA T. MOSTAFA, M.Sc.;
SHERIF Z. MANSOUR, M.D.
THANAA HELMY, M.D.;
SAMAH M. FAWZY, M.D.
The Department of Ophthalmology, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.85214
Abstract Background: Keratoconus is a progressive bilateral disease characterized by corneal thinning. Cross linking is one of the most effective treatments of keratoconus and here we studied its objective and subjective effects. Aim of Study: This study aims to investigate differences in objective and subjective outcome of collagen corneal crosslinking of different keratoconus grades. Patient and Method: Twenty-four eyes of twenty-four patients with keratoconus were enrolled in this prospective study arranged into 2 groups according to k reading (Group I: Less than 48, Group II: 48-52); 12 eyes of patients in each group all the eyes underwent full ophthalmological clinical evaluation (Best Spectacle Corrected Visual Acuity (BSCVA) by log MAR and wave light Pentacam assessment to investigate Keratometry readings, Central Corneal Thickness (CCT), and Aberrations scan by Zernike analysis. Evaluations were done at baseline and 3 months' post CXL. Results: The BCVA insignificantly deteriorated in group I & II after 3 months follow-up by (0.016±0.04) p=0.166 and (0.016±0.08) p=0.503 respectively. The mean average K insignificantly decreased in group I & II by (0.216±0.63) p=0.261 and (0.250±1.66) p=0.619 respectively. The mean central corneal thickness increased in group I by (11.00±31.97) p=0.258 while decreased in group II by (5.750±16.75) p=0.259. The mean of total aberration of group I decreased by (0.033± 0.09) p=0.219, while in group II increased by (0.666±0.49) p=0.503. Conclusion: We found insignificant decrease in (BCVA, Average K,) in the two groups the mean CCT increased in group I and decreased in group II. The mean of total aberration decreased in group I while increased in group II.
cornea,crosslinking,Keratoconus
https://mjcu.journals.ekb.eg/article_85214.html
https://mjcu.journals.ekb.eg/article_85214_b35b4084c1111a1426566ab46e12379b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Possible Effect of DHEA on Hepatic and Metabolic Dysfunction in a Rat Model of Male Hypogonadism
4769
4776
EN
HATEM BIN MOHAMMED AL-NAABI, M.D.;
HUSSEIN F. SAKR, M.D.
10.21608/mjcu.2019.85215
Abstract Background: Male hypogonadism is characterized by androgen deficiency in the body. Several studies have shown that testosterone deficiency is inducing a metabolic syndrome and insulin resistance. Although of the unwanted effects of exogenous testosterone replacement therapy, it is the main treatment of male hypogonadism. One of the safe treatment options is Dehydroepiandrosterone (DHEA) replacement therapy which is the precursor of testosterone. Up to date and to the best of our knowledge, no one investigates the effect of DHEA on glucose-6-phosphatase enzyme in a rat model of male hypogonadism and its impact on the metabolic dys-function. Aim of Study: The aim of the research is to investigate the possible protective effect of DHEA on hepatic and meta-bolic dysfunction in a rate model of male hypogonadism through examining its effect on glucose-6-phosphatase enzyme. Moreover, it studies the possible therapeutic effects of the male androgen (DHEA) on the hepatic steatosis and insulin resistance triggered by testosterone deficiency. Material and Methods: Thirty-two Wistar Kyoto rats were divided into 4 groups as follows (I) Untreated controls, (II) Untreated orchidectomized, (III) Control, treated with DHEA and (IV) Orchidectomized, treated with DHEA. Treatment was carried three times per week for 12 weeks. Cobas c111, Roche diagnostic, USA machine was used to measure the level of the glucose, liver enzymes and lipid profile. Enzyme-Linked Immunosorbent Assay (ELISA) was used to measure the plasma level of testosterone hormone, insulin and glucose-6-phosphatase enzyme. Results: As expected, the plasma testosterone decreased significantly in ORCH rats, with significant increase in glucose, lipid profile as well as significant decrease in insulin as compared to control rats. Moreover, our data revealed insig-nificant increases in plasma testosterone in ORCH + DHEA with significant increase in ORCH + DHEA compared to control + DHEA. DHEA did not significantly affect G-6-Pase enzyme. Also, ORCH shows significant increase in triglyceride and cholesterol as well as the ORCH + DHEA.<br />Conclusion: Testosterone deficiency and DHEA replace-ment therapy have no effects on glucose 6-phosphatase enzyme. Male hypogonadism is a risk factor for metabolic syndrome and NAFLD that could not be treated effectively with DHEA.
DHEA,hepatic,Metabolic,Hypogonadism
https://mjcu.journals.ekb.eg/article_85215.html
https://mjcu.journals.ekb.eg/article_85215_7965eb5196746429b1c25ab7ecd35856.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Pre-Equipped Vehicles Applicants in Egypt: An Electrophysiologic Descriptive Study
4777
4782
EN
RADWA M. AZMY, M.D.;
DALIA NEGM ELDIN MOHAMED, M.D.
MYE
A. BASHEER, M.D.
The Departments of Clinical Neurophysioloy Unit*, Faculty of Medicine, Cairo University and Biostatistics & Cancer Epidemiology**, National Cancer Institute, Egypt
10.21608/mjcu.2019.85216
Abstract Background: Regulations in Egypt offer duty free pre-equipped cars to people with special physical needs. Egyptian patients applying for this service need to submit a medical evidence of their physical disability. A detailed electrophysi-ologic session (electromyography and nerve conduction stud-ies; EMG/NCS) plays a key role in diagnosing lower motor neuron affection. Thus, and on regular basis, the Clinical neurophysiology unit at Kasr Al Ainy hospital receives patients referred from the Specialized Medical Councils of the Egyptian Minstery of Health to disclose the neuromuscular disability, if present. Aim of Study: Analyzing medical records at the Clinical Neurophysiology Unit in Kasr Al-Ainy Hospital, for the patients attending for EMG/NCS during the year 2018. The EMG/NCS is a prerequisite to apply for having a duty free pre-equipped vehicle through the ministry of health. Material and Methods: This is a retrospective, descriptive study. Data extracted from the medical records included the patients' national identification card included the age, gender, governorate of residence, occupation and marital status as well as the date of examination, limbs examined and electro-physiologic diagnosis reached. Results: Various valuable community data were reached. Significant results were found in relation to Egyptian geo-graphic sectors and electrophysiologic diagnoses concluded among other variables analyzed. Conclusions: We are suggesting additional investigations to patients with non-abnormal electrophysiologic results, to document their physical disability. We are also recommending further analyses of the relevant current status of Upper Egypt regional unit.
Pre-equipped Vehicles,Poliomyelities,Nerve injuries,Physical special needs
https://mjcu.journals.ekb.eg/article_85216.html
https://mjcu.journals.ekb.eg/article_85216_af64f3e069445e33bf9a72f341e6d0e2.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Task Oriented Approach on Balance in Ataxic Multiple Sclerosis Patients
4789
4794
EN
MOSHERA H. DARWISH, Ph.D.;
NEVIN M. SHALABY, Ph.D.
AHMED S. ALI, Ph.D.;
HABIBA Z. SOUBHY, M.Sc.
The Department of Physical Therapy for Neuromuscular Disorders, Faculty of Physical Therapy* and The Department of Neurology, Faculty of Medicine**, Cairo University, Egypt
10.21608/mjcu.2019.85219
Abstract Background: Multiple Sclerosis (MS) is a common, com-plex neurological disease. Balance Disorders (BDs) and ataxic symptoms are the most frequent and challenging symptoms in MS, lead to abnormal postural stability which have adversely effect on patients independence, participation and quality of life. Aim of Study: To investigate the effect of task oriented training exercises on balance in ataxic MS patients. Subjects and Methods: Thirty patients from both sexes diagnosed with remitting and Relapse Multiple Sclerosis (R.RMS) with ataxic symptoms and EDSS score ranged from 2 to 4.5, were recruited from multiple sclerosis specialized clinic in the Neurology Department, Faculty of Medicine, Cairo University and were randomly assigned into two equal groups. Results: In control group there is significant improvement in Stability Index (SI), Anterior Posterior Stability Index (APSI) and non-significant improvement of Mediolateral Stability Index (MLSI), and berg balance scale. In the study group there is a significant improvement in all balance meas-ures between pre and post treatment assessment. Study group results were highly significant than the control group (p<0.05) in all study measures. Conclusion: Task oriented training approach in addition to conventional balance rehabilitation is effective for improving balance in ataxic MS patients. Therefore, task-oriented training may be considered as an essential part of the physical therapy program for balance rehabilitation in MS patients.
Multiple sclerosis,Ataxia,balance,Task oriented training
https://mjcu.journals.ekb.eg/article_85219.html
https://mjcu.journals.ekb.eg/article_85219_eadf3455cd4c50fb866fd37d0dc56b4c.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Combining ACL Oblique Coronal MRI with the Routine Knee MRI Protocol in the Diagnosis of ACL Bundle Lesions. Can It Add A Value?
4795
4801
EN
YASSER I. ABD ELKHALEK, M.D.;
MOUSTAFA ABDEL KAWI, M.D.
MERHAN
NASR, M.Sc.
The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams* and Helwan** Universities, Cairo, Egypt
10.21608/mjcu.2019.85220
Abstract Background: The Anterior Cruciate Ligament (ACL) is formed of two bundles. Routine MRI protocol is usually insufficient to delineate both bundles structure, so diagnosis of AM and PL bundle injury is often limited, and development of further imaging orientation and pulse sequences is key for further improving characterization of these bundles. Accurately grading the ACL tears and differentiating between complete and partial tears as well as assessing the two bundles is key in improving the clinical and surgical management. Aim of Study: The purpose of this study is to evaluate the diagnostic value of combining oblique coronal images to the routine MRI protocol for better assessment of the ACL bundles, thus improving management outcome by performing two MRI protocols and comparing them to the arthroscopic findings. Patients and Methods: This prospective study was con-ducted between January 2016 and February 2018 in Ain Shams University Hospitals and private centers. The study population has consisted of 32 patients (26 men & 6 women), ranging between 19-45 years, with mean age of 27.11 years. All patients were suspected of ACL injury referred from the outpatient clinic of orthopedic. All patients were examined by MRI examinations com-posed of sagittal T2-weighted Fast-Spin Echo (FSE), coronal T2-weighted FSE, and axial T2-weighted. The sagittal images were planned on axial localizer by 15-degree medial angling on perpendicular line to the bicondylar line and by oblique coronal MRI were the oblique coronal STIR images named were planned on midsagittal localizer in the plane parallel to the ACL and the roof of the intercondylar notch (Blumensaat's line). A consultant orthopedic surgeon did a diagnostic arthros-copy for all included patients using standard parapatellar portals visualizing the ACL with direct visualizing of both bundles and accordingly classifying each bundle as torn or intact. Results: The Oblique coronal MRI showed a better agree-ment with the diagnostic arthroscopy than routine MRI [weight-ed Kappa; k=0.865 & 0.753 respectively]. For diagnosis of Anteromedial Bundle (AMB) tear the sensitivity was 90.9%, specificity 80%, with overall accuracy of 87.5%. For diagnosis of Posterolateral Bundle (PLB) tear. The sensitivity was 95.5%, specificity 90%, with overall accuracy of 93.8%. Conclusion: The adding of oblique coronal imaging to routine MRI protocol revealed better delineation of the ACL bundles, increasing the accuracy of diagnosis each or both bundle lesions, providing significant benefit in further man-agement and outcome in patient with suspected ACL injury.
Magnetic Resonance Imaging,ACL tears,Coronal oblique cuts
https://mjcu.journals.ekb.eg/article_85220.html
https://mjcu.journals.ekb.eg/article_85220_43ddb9fb30b143bac38671e9d024468f.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Tranexamic Acid Effect on Doppler Indices of the Uterine Artery in Patients with Menorrhagia Related to Copper IUCD (Cu 380) Insertion
4803
4808
EN
SAFAA A. IBRAHIM, M.D.;
AHMED ELSAYED MANSOR, M.D.
The Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig Univerisity
10.21608/mjcu.2019.85221
Abstract Background: The intent of this survey was to inquire the tranexamic acid effects on Doppler indices of the uterine artery in patients with menorrhagia due to IUD insertion. Aim of Study: The aim of the study was to assess the effective role of treatment by tranexamic acid on uterine artery vascular resistance in cases of menorrhagia associated with copper IUCD (Cu380) insertion. Patients and Methods: The study was implemented in outpatient clinics of the Gynecology Department on patients with menorrhagia. We studied 212 cases of menorrhagia after 3 months of IUCD insertion to exclude insertion related bleeding and fulfilled the inclusion, they were appraised for 6 menstrual cycles. During the first 3 control cycles, the magnitude of bleeding was recorded on the Pictorial Blood Assessment Chart to affirm heavy menses. During the next 3 cycle, random assignment of cases into tranexamic acid and placebo groups was done. They were divided into two equal groups, group 1 (tranexamic acid group) and group 2 (placebo group). The group 1 received 500mg tranexamic acid four times daily from first to fifth days of the cycles, PI (Pulsatility Index) and RI (Resistance Index) were measured from Rt. and Lt. uterine arteries on the first month of the control cycles and during the third month of intervention cycles. MBL (Menstrual Blood Loss) was appraised using a validated pictorial blood chart during the intervention. SPSS version 15 for Windows was used for data analysis. Results: In group 1, the mean PI and RI fell significantly with treatment (PI 2.26-1.78, p=0. 001); (RI 0.87-0.68, p= 0.031). There was a reduction of approximately 48% in MBL with treatment (120.0-65ml, p=0.001). In group 2, there was an insignificant change in either the PI or the RI and there was no significant reduction in menstrual blood loss. Conclusion: Tranexamic acid significantly reduces uterine artery vascular resistance in patients with menorrhagia due to IUD insertion. This effect is afield to be the main role of tranexamic acid in the reduction of the menstrual blood loss.
Menstrual blood loss,Tranexamic acid,Intra-uterine device,uterine artery Doppler
https://mjcu.journals.ekb.eg/article_85221.html
https://mjcu.journals.ekb.eg/article_85221_709a25337a2420c55d3d6dab916cce80.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Early Results of Cementless versus Hybrid Total Hip Arthroplasty in Patients with Posttraumatic Osteoarthritis
4809
4814
EN
AHMED ZAGHLOUL, M.Sc.;
MAHMOUD S. KORKOR, M.D.
WAIL L. ABDELNABY, M.D.;
AKRAM HAMMAD, M.D.
The Department of Orthopaedic Surgery, Faculty of Medicine, Mansoura University, Egypt
10.21608/mjcu.2019.85222
Abstract Background: Various types of THA were used in treatment of different forms of osteoarthritis. In this study, we aimed to compare the early results of cementless versus hybrid Total Hip Arthroplasty (THA) in treatment of Posttraumatic Oste-oarthritis (PTOA). Aim of Study: Prospective comparative study. Patients and Methods: Twenty two cases were included in the study and they were divided into two equal groups; group A that performed cementless THA, group B that under-went hybrid THA. Perioperative circumstances of perioperative complications, operating room time, blood transfusion require-ments and length of hospital stay were reported. Post-operative evaluation was done using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS) and Harris Hip Score (HHS). Results: Demographic data did not differ between the three study groups (p>0.05). Group B showed a significantly longer operative time (p=0.001). However, complications rate, blood transfusion requirements and length of hospital stay did not differ between the study groups (p>0.05). Addi-tionally, no statistically significant difference (p>0.05) was detected between groups as regard as Patient Reported Out-come Measures (PROMs). Conclusion: Intrathecal dexmedetomidine is superior to both dexamethasone and bupivacaine alone regarding duration of analgesia and pain severity. Moreover, it has more rapid onset and longer duration of sensory blockade. No significant side effects were noted when compared to the remaining groups.
Total Hip Arthroplasty (THA),Posttraumatic Osteoarthritis (PTOA)
https://mjcu.journals.ekb.eg/article_85222.html
https://mjcu.journals.ekb.eg/article_85222_788b344c7c6c560d60e4cd54ab4ba8b2.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Possible Ameliorating Effect of Curcumin on the Pancreas of Experimentally Induced Hypothyroidism in Rat: Histological, Immunohistochemical and Biochemical Study
4815
4823
EN
MOGEDA M. NASRALLA, M.D.;
MOHAMED F. EL SHAFIE, M.D.
The Department of Anatomy & Embryology, Faculty of Medicine, Cairo University* and The Department of Pharmacology & Toxicology, Faculty of Pharmacy, Al-Azhar University**
10.21608/mjcu.2019.85223
Abstract Background: Hypothyroidism is reported as the most common thyroid disease in humans which is caused by thyroid hormones deficiency. Aim of Study: To evaluate the role of curcumin in preven-tion of the possible histopathological, immunohistochemical, and biochemical changes on the pancreas of experimentally induced hypothrodism in adult male rat. Material and Methods: Forty adult male albino rats weighing (150-200gm) were allotted in four groups, ten animals each. Group 1 (control group) received no medication, Group II (curcumin group) were given curcumin 100mg/kg/b.w orally by gastric gavage for 6 weeks Group III: (Hypothyroid group) was rendered hypothyroid by administration of pro-pylthiouracil (PTU) (Thyrocil) 15mg/kg b.w orally by gavage for 6 weeks. Group IV (hypothyroid and curcumin treated group) received the same dose of PTU for 6 weeks with the addition of curcumin starting 2 weeks after PTU administration (after confirmation of the hypothyroidism state) to the sixth week. The pancreas was dissected out and subjected to histo-logical and immunohistochemical study. Results: The pancreas of hypothyroid rats showed histo-logical changes in the form of pale small size islets. Inside the islets the cells appeared vacuolated with pyknosis of their nuclei. Immunohistchemical study showing a decreased number of insulin-immunoreactivity. Biochemical results revealed a significant decreased pancreatic tissue Superoxide dismutase, reduced glutathione, Catalase, Glutathione-S-transferase and Glutathione peroxidase as well as increased pancreatic tissue Malondialdehyde compared with those of controls. Hypothy-roid and curcumin group revealed an improvement in these histological, immunohistochemical and biochemical changes. Conclusion: Data so far obtained indicated that Curcumin has antioxidant effect that could possibly account for its potential in the current study to ameliorate all the histological, Immunohistochemical and biochemical parameters altered by hypothyroidism.
antioxidants,histology,Immunohistochemistry,Propylthiouracil,Pancreas biochemical cur-cumin
https://mjcu.journals.ekb.eg/article_85223.html
https://mjcu.journals.ekb.eg/article_85223_3bb8124c633d5d967bc36bf7da6022bb.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Diffusion Weighted Magnetic Resonance Imaging in Characterization of Pulmonary Masses
4825
4833
EN
HEBA ALLAH H. AMIN, M.Sc.;
DINA MOGHAZY MOHAMED, M.D.
OMNIA A. GAD, M.D.;
ALSHAYMAA Z. ELSHAHAWY, M.D.
The Departments of Radiodiagnosis & Medical Imaging* and Oncoloy & Nuclear Medicine**, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.85224
Abstract Background: Lung malignancy is the most common cause of death in the developed countries. Male to female ratio is 3:1. Consumption of Tobacco upsurges the rate of evolving lung cancer by 30 folds. Other risk factors include repeated exposure to aspects like carcinogens, asbestos, pulmonary fibrosis and radiotherapy. Aim of Study: The aim of this study is to assess the role of diffusion weighted magnetic resonance imaging in charac-terization of pulmonary masses. Patients and Methods: This study was carried out on forty (40) patients 8 females and 32 males who had Pulmonary mass on the X-ray or CT chest and aged above 18 years old. All the studied patients underwent to detailed history taking, laboratory studies and radiological examination using MRI (GE 1.5 Tesla) using body phased-array Coil and DWI (b-value 0, 500, and 800s/mm2). Results: Thirty lesions were malignant, and 10 lesions were benign. The malignant masses showed significantly higher signal intensity on DWI than benign masses (p<0.001), and the mean ADC value of malignant lesions was significantly lower than that of benign lesions (p<0.001). By ROC curve, an ADC cut-off value of 1.6 X 10–3mm2/s was considered the threshold value, and the sensitivity and specificity were 100% and 90% respectively. Conclusion: Diffusion-weighted MRI and ADC can sig-nificantly differentiate between benign and malignant pulmo-nary masses.
Diffusion MRI,ADC,benign,malignant,Pulmonary lesions
https://mjcu.journals.ekb.eg/article_85224.html
https://mjcu.journals.ekb.eg/article_85224_10dc732e9b8c57018dd9d5dacb6ad1b3.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Spectrum of Imaging Findings by Dynamic MRI Post Hepatic Intervention by Loco-Regional Therapies for Hepatocellular Carcinoma
4835
4840
EN
HEND M. ABDELHAFEEZ, M.Sc.;
MOHAMED TAHA ABDELHAQ, M.D.
ASHRAF M. ENITE, M.D.;
WESSAM MOSTAFA, M.D.
The Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University* and Ministry of Health**
10.21608/mjcu.2019.85225
Abstract Background: Liver cirrhosis and Hepatocellular Carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. Aim of Study: To study the role of dynamic contrast enhanced MRI in follow-up of after treatment by different loco regional procedures and review the spectrum of imaging findings. Subject and Methods: This study was conducted on 45 patients with different age group 30 to 73 years with the mean age of 58 years having different site, size and shape of hepato-cellular carcinoma (proved mainly by combination of elevated alpha-fetoprotein, typically neoplastic enhancement by spiral CT or dynamic MRI and having hepatitis C or/& B viruses). Results: MRI was found to be of great value in the follow-up of cases of HCC that underwent locoregional therapy specially in diagnosing residual or recurrent tumor tissue in the embolized lesions and in detecting new developed lesions. This technique can be implemented simply and reliably. The study found that almost all of the embolized lesions in the unresolved group of patients (residual/recurrence) showed enhancing areas within in the arterial phase, the study also found that 68.9% of the embolized lesions in the resolved group of patients (complete tumor ablation) were not enhanced at all while 24.4% of them showed delayed marginal enhance-ment. Conclusion: MRI is a powerful tool in detection of tumor viability and complications after locoregional treatment of hepatocellular carcinoma.
Magnetic Resonance Imaging,Hepatocellular carcinoma,Locoregional treatment,Treatment response of HCC
https://mjcu.journals.ekb.eg/article_85225.html
https://mjcu.journals.ekb.eg/article_85225_63d75dccecbaa850f03727c05413e743.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Serum Ammonia, TNF-Alfa and IL-6 Levels on the Degree and Outcome of Hepatic Encephalopathy in Egyptian Cirrhotic Patients
4841
4846
EN
SAIED
ABDEL-BAKY GAD, M.D.
The Department of Internal Medicine, Faculty of Medicine, Zagazig University
10.21608/mjcu.2019.85226
Abstract Background: Hepatic Encephalopathy (HE) is a major complication of liver cirrhosis characterized with neuropsy-chiatric symptoms it's etiology is multifactorial. Aim of Study: Aim of the study serum ammonia, TNF-alfa and IL-6 levels on the degree and outcome of hepatic encephalopathy in Egyptian cirrhotic patients. Patient and Methods: The study included 90 patients with liver cirrhosis complicated with HE (patients group) and 60 cirrhotic patients without HE as control group (group 3), the patients group divided into subgroups according to the grade of encephalopathy from the beginning the study, group A encephalopathy: Grade 1 and 2 and group B encephalopathy: Grade 3 and 4. All patients were followed-up for 7 days, then divided into 2 groups according to the response to treatment; group 1: Complete recovery and group 2: With improper response. Results: There were statistical difference between patients groups (group 1and 2) and control group (group 3) in terms of blood ammonia levels (67.5±22.5, 13±4.8), serum TNF-a levels (21.6±3.2, 2.3±.2) and mean serum IL-6 (63.9±15.9, 4±1.29) respectively. There were statistical difference between group 1 and group 2 in terms blood ammonia levels (46±12.8, 86.5±30.5), mean serum TNF-a levels (7.1±2.9, 29.4±13.3) and mean serum IL-6 (19±9.2, 93.9±20.9). Results also, showed statistical significant difference between group 2A and group 2B in terms of blood ammonia level (79.2±20.6, 173.7±38.7), mean serum TNF-a levels (18.1±5.3, 39.9±14.5) and mean serum IL-6 levels (69.2±11.1, 118.2±13.8). In group 2 there were significant positive correlation between serum TNF with blood ammonia level (r=0.843, p=0.001), serum IL-6 (r=0.732, p=0.001) and between IL-6 and blood ammonia level (r=0.699, p=0.001). Conclusion: There is a strong relation between high blood level of ammonia, TNF alfa, IL-6 and grade and outcome of HE in cirrhotic patients.
Liver cirrhosis,TNF-alfa,IL-6
https://mjcu.journals.ekb.eg/article_85226.html
https://mjcu.journals.ekb.eg/article_85226_d98d1bc1473eff2ed45e981216658f45.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Continuous Lumbar Drainage in Cerebrospinal Fluid Leak: A Prospective Study
4847
4851
EN
AHMED HOSAMELDIN, M.D.;
ASHRAF A. OSMAN, M.D.
MOHAMED
G. ABDEL TAWAB, M.D.
The Department of Neurosurgery, Faculty of Medicine, Fayoum University, Egypt
10.21608/mjcu.2019.85227
Abstract Background: Cerebrospinal Fluid (CSF) leak is one of the most disturbing issues that face neurosurgeons. Aim of Study: The aim of this study is to illustrate the efficacy of Continuous Lumbar Drainage (CLD) as a prophy-lactic and therapeutic method for CSF leak with assessment of clinical outcome and early post-operative sequelae. Patients and Methods: This study was prospectively conducted on patients with traumatic or post-operative CSF leak and those susceptible for post-operative CSF leak as skull base and spinal intradural surgeries in the period from May 2015 to November 2015 at the Neurosurgery Departments of Cairo and Fayoum Universities. These patients were sub-jected to insertion of CLD. Results: Excellent results in 15 patients who showed cessation of CSF leak within 4 days of CLD, good results in 4 patients who showed cessation of CSF leak within 5 days of CLD and fair results only with one patient required re-exploration then showed cessation of CSF leak within 5 days of CLD. Conclusion: The present analysis of the data reveals that CLD is used as a prophylactic measure and a line of treatment for CSF leak. It may be used pre, intra or post-operatively. This study recommends the use of CLD in cases with CSF leak or suspected post-operative CSF leak.
leak,Cerebrospinal fluid (CSF),Lumbar drain
https://mjcu.journals.ekb.eg/article_85227.html
https://mjcu.journals.ekb.eg/article_85227_6bb3ffb59d6a164fe2dcbafff5f74474.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Graft Related Factors Affecting the Recipient Outcome in Living Donor Liver Transplantation
4853
4866
EN
MOHAMMED ABDEL WAHAB, M.D.;
MOSTAFA M. ABO ZAID, M.D.;
EHAB A. ELHANAFY, M.D.;
HELMY EZZAT, M.D.
MOHAMMED
S. MAHMOUD, M.Sc.
The Department of Surgical, Gastroenterology Center, Faculty of Medicine, Mansoura University, Egypt
10.21608/mjcu.2019.85228
Abstract Background: Multiple risk factors have been incriminated in poor outcome and survival after Living Donor Liver Trans-plantation (LDLT). We conducted this study to identify graft-related factors that affects recipient outcome and survival after LDLT. Patients and Methods: This is a combined retrospective and prospective study that was conducted at Mansoura Uni-versity Gastrointestinal Surgical Center GISC. We included 460 transplant recipients in the period between June 2004 and July 2016. Moreover, the prospective arm included 50 patients who underwent living donor liver transplantation as a sample size from starting the study in July 2016. After careful pre-operative preparation for both donor and recipient, cases were scheduled for living donor liver transplantation. All cases were performed by the same transplant surgical team using the standard surgical procedure. After procedure, patients were transferred to the liver transplant ICU for 1 week, then to the liver high care unit. In addition to clinical evaluation, follow-up of the recipients was performed by laboratory and radiological investigations. Evaluation of the liver by abdom-inal CT was routinely performed 2 to 3 times over the first year after LT, and then once or twice per year. Results: It was evident that acute rejection was associated with shorter cold ischemia time (31.84 vs. 42.58 minutes-p=0.016). Moreover, larger biliary stoma size was also asso-ciated with acute rejection (4.24 vs. 3.73mm -p=0.045). Re-garding bile leakage, it was found to be associated with smaller hepatic venous reconstruction diameter (26.11 vs. 27.38mm-p=0.036). Additionally, it was found that incidence of biliary strictures was associated with longer warm ischemia time (51.85 vs. 45.32 minutes-p=0.019), smaller vs venous recon-struction diameter (7.41 vs. 8.52-p=0.024), and smaller biliary reconstruction diameter (3.51 vs. 3.84mm -p=0.033). Cases who developed primary graft dysfunction were having signif-icantly prolonged warm ischemia time (66.92 vs. 46.52 min-utes -p 0.011). Chronic graft rejection was associated with larger Makuuchi vein reconstruction diameter (13.40 vs. 9.62mm -p=0.020). However, other graft related factors did not seem to be different between cases who developed and who did not develop chronic rejection.<br />Portal vein thrombosis was associated with larger Maku-uchi vein reconstruction diameter (20 vs. 9.6mm -p=0.001). Cases who developed hepatic artery thrombosis post-operatively were having larger Makuuchi vein reconstruction diameter (20 vs. 9.71mm -p=0.003), and lower numbers of single arterial reconstruction (p=0.003). In addition, cases who developed disease recurrence after transplantation were having larger arterial reconstruction diameter (2.63 vs. 2.45-p=0.020), and more ratio of multiple biliary ductal anastomoses (p=0.018). HCC recurrence after transplant was associated with larger portal vein reconstruction diameter (12.66 vs. 11.43mm -p=0.004), larger arterial recon-struction diameter (2.78 vs. 2.47mm -p=0.029), and smaller biliary reconstruction diameter (3.24 vs. 3.83-p=0.008). On assessment of graft related factors on survivals, all factors were found to be non-significant apart from number of venous anastomoses that was significantly affecting survival (p= 0.042). Conclusion: Multiple graft related factors were studied as risk factors for outcome, survival, and recurrence after LDLT. The rate of early graft failure is low. This was due to optimum donor selection as regards age, sex, Body Mass Index (BMI) and ABO-compatibility; computer-assisted plan-ning and decision making in calculating optimum GRWR; short cold ischemic time; high level of expertise in our center; and timely detection of vascular, biliary and immunological complications responsible for early graft failure together with early and efficient management. Nevertheless, most of the underlying risk factors affecting either outcome, recurrence, or survival were different from each other according to the complication type as previously shown in the results. This necessitates the need for multiple studies to be conducted at this perspective. However, these studies should be specific targeting only one or a small group of complications to get more specific results.
Living Donor Liver Transplantation (LDLT),Hepatocellular carcinoma (HCC)
https://mjcu.journals.ekb.eg/article_85228.html
https://mjcu.journals.ekb.eg/article_85228_31c4a83e69fb88a149a6d6ed57d16a9d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Three-Dimensional Conformal Radiotherapy with Concomitant Boost and Weekly Cisplatin in Muscle-Invasive Transitional Cell Bladder Carcinoma
4867
4875
EN
NADA S. SHAMS EL-DIN, M.Sc.;
ASHRAF F. BARAKAT, M.D.
MOHAMMED F. SHETA, M.D.;
MOHAMMED H. RADWAN, M.D.
The Departments of Clinical Oncology* and Urology**, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.85229
Abstract Background: Local control of MIBC by bladder-sparing approach is unsatisfactory. In order to improve the effectiveness of radiotherapy, we have designed a protocol that combines TURB with a non-conventionally fractionated radiotherapy “concomitant boost. Aim of Study: To evaluate the response rate and toxicity criteria in patients with transitional cell bladder cancer treated with maximum Transurethral Resection (TUR), followed by 3-D conformal radiotherapy with a concomitant boost and weekly cisplatin with shortening of overall treatment time. Patients and Methods: Between July 2017 to June 2018, 20 patients with a T2-T3 N0M0 transitional cell carcinoma of the bladder underwent transurethral resection of bladder tumor as much as safely possible (maximum TURBT). They received radiotherapy delivered in short overall treatment time with a concomitant boost technique. With this technique, a dose of 40Gy in 2-Gy fractions was administered to the small pelvis with a concomitant boost limited to the bladder tumor area plus a margin of 15Gy in fractions of 0.75Gy. The total tumor dose was 55Gy in 20 fractions in 4 weeks. Weekly Cisplatin (30mg/m2) was administered weekly concurrently with radiotherapy. Cisplatin was interrupted in case of hema-tological or renal toxicity. The National Cancer Institute Common Toxicity Criteria, version 5, scale was used to assess the chemotherapy and acute radiation toxicity {Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0, November 2017}. We assessed late toxicity using The Radiation Therapy Oncology Group/The European Organiza-tion for Research and Treatment of Cancer (RTOG/EORTC) Late Radiation Morbidity Scoring Scheme. Results: The feasibility of the treatment was good. Severe acute toxicity >!G3 was observed in two patients (10%). Severe late toxicity >!G3 was observed in one patient (5%). Fourteen patients (70%) showed a complete and three (15 %) a partial remission after treatment. Conclusion: In external radiotherapy for muscle-invasive bladder cancer a concomitant boost technique coupling a partial bladder boost with shortening of the overall treatment time provides a high probability of local control with acceptable toxicity.
CBAHRT (concomitant boost accelerated hyper fractionated radiotherapy),Concomitant weekly cisplatin,Response rate,Acute and late toxicity criteria
https://mjcu.journals.ekb.eg/article_85229.html
https://mjcu.journals.ekb.eg/article_85229_bff3dd6cefc7d776b2ee33f12fb3610d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Computer Vision Syndrome and Associated Factors among Students of Faculty of Medicine, Cairo University
4877
4881
EN
MARWA M. AHMED, M.D.;
NAGWA E. SAAD, M.D.
EHSAAN M. ALMEHELMY, M.D.;
FATMA F. YOUSEF, M.Sc.
The Departments of Family Medicine* and Ophthalmology**, Faculty of Medicine, Cairo University, Egypt
10.21608/mjcu.2019.85230
Abstract Background: Computer Vision Syndrome (CVS) is an emerging health problem which is unceasingly increasing worldwide. It refers to a group of eye and vision problems experienced during or related to computer and other VDTs use. Aim of Study: The objectives were to determine the prevalence of CVS among students of Faculty of Medicine in Cairo University and to detect the relation of various factors in computer use with occurrence of symptoms. Patients and Methods: This study is a cross-section study in which 260 medical students from different grades of Faculty of Medicine in Cairo University were included. Participants were interviewed using self-administered Computer Vision Syndrome Questionnaire (CVS-Q). Results: The current study reveals that 75% of medical students in Faculty of Medicine suffered from CVS. Headache (81.5%) and eye pain (63.8%) are the most frequent CVS symptoms experienced by the students. CVS prevalence is found to be more among female students (78.7%) than among male ones (71%). It is also found to be more among glasses wearers (78.8%) than among non-glasses wearers (70.7%) and much more among contact lenses wearers (92.9%) than among non-contact lenses wearers (72.8%). There is significant linear correlation between duration of use of VDTs (by hours/ day) and the score of CVS. Conclusion: This study revealed that CVS is a prevalent problem among students of Faculty of Medicine, Cairo Uni-versity.
computer vision syndrome,Medical students,Computers use,Laptops
https://mjcu.journals.ekb.eg/article_85230.html
https://mjcu.journals.ekb.eg/article_85230_76feba8b35fd1e1b601c922239731122.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Monitoring of Breast Lesions after Breast Conservative Therapy: Does A Combination of Dynamic and Functional MRI Techniques Can Add Value in Early Detection of Recurrent Malignancy?
4883
4893
EN
MOHAMAD F. SHERIF, M.D.;
NAGLA L. DABEES, M.D.
SAMAR G. YONES, M.D.;
OM YOSEF A. KHEDR, M.D.
The Departments of Diagnostic Radiology* and Oncology & Nuclear Medicine**, Faculty of Medicine, Tanta University and The Department of Medicine, Faculty of Medicine, Al-Menshawy Hospital***, Tanta
10.21608/mjcu.2019.85231
Abstract Background: To assess efficacy of combined dynamic and functional MRI techniques in early detection of recurrent malignancy after breast conservative therapy and differentiating it from other post-operative lesions. Aim of Study: To assess efficacy of combined dynamic and functional MRI techniques in early detection of recurrent malignancy after breast conservative therapy and differentiating it from other post-operative lesions. Patients and Methods: Thirty female patients who under-went breast conservative therapy were involved in this pro-spective study. Patients were examined by sono-mammography that aroused suspicious of breast lesions followed by DCE-MRI & DWI-MRI to exclude recurrence. DWI was performed using b-values of 50, 400, 800s/mm2. All patients were subjected to histopathological confirmation which was the gold standard in this study. Results: Eight patients had pathologically proven recur-rence and 22 patients showed spectrum of post-operative changes. DCE- MRI diagnosis (considering lesion morphology, enhancement pattern) overestimated 2 lesions were scored BIRADS 4 and proved pathologically as fat necrosis. When adding the data elicited by the DWI to the DCE-MRI assessment, the statistical analysis presented 100% sensitivity, 95.4% specificity, 88.9% PPV, 100% NPV and 96.6% accuracy. Conclusion: Combination of functional & dynamic MRI techniques added high significant value in follow-up of breast lesion occurred after BCT as it can avoid biopsy in positive patients, to send negative patients to follow-up and reserving biopsy in the cases with a clinico-radiological mismatch. Breast MRI should be the imaging modality of choice in detection of the tumoral recurrence, and differentiating it from other post-operative lesions.
Breast Conservative Therapy,Dynamic and Functional MRI Techniques,Early Detection of Recurrent Malignancy
https://mjcu.journals.ekb.eg/article_85231.html
https://mjcu.journals.ekb.eg/article_85231_eea5c92c89c171b65e23f115454352a9.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Diagnostic Performance of Contrast Enhanced Spectral Mammography in Detecting Occult Breast Lesions in Patients with Dense Breasts
4895
4900
EN
NIVINE CHALABI, M.D.;
NOHA M. OSMAN, M.D.
The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.85383
Abstract Background: Contrast Enhanced Spectral Mammography (CESM) is an evolving imaging technique using contrast media to enhance the sensitivity for breast cancer detection and to extend the capability of mammography. Aim of Study: To evaluate the added benefit of Contrast Enhanced Mammography (CESM) in detecting occult breast lesions that escaped conventional Digital Mammography (DM). Patients and Methods: 68 female patients (121 breasts) with dense breasts were enrolled in this study. CESM was performed after conventional DM which was negative. CESM results were compared to sonography and histopathologic results. Diagnostic accuracy of CESM in differentiating malignant from benign lesions was determined. Results: By using CESM, 18 cancers were detected in 68 patients with negative conventional mammographic studies. CESM had sensitivity 88.9%, specificity was 100%, PPV was 100%, NPV was 60% while the overall diagnostic accuracy of CESM was 85.7% in cancer detection. Conclusion: CESM has the potential to increase breast cancer detection rate over conventional DM especially in women with dense breasts. CESM has high specificity and positive predictive value in identifying malignant breast lesions. CESM is a promising tool for screening women with dense breasts and high risk for breast cancer.
Contrast enhanced spectral mammography,Breast cancer detection,Digital mammography,dense breast
https://mjcu.journals.ekb.eg/article_85383.html
https://mjcu.journals.ekb.eg/article_85383_e62dbdb655e43d513751b6d8c063bd2a.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Potential Protective Role of Vitamin E in Lung of Adult Male Albino Rat Exposed to Bisphenol A
4901
4915
EN
HEBA O. MOHAMMED, M.D.;
RADWA M. Al-SAYED, M.D.
KHALED A. ABULFADLE, M.D.;
AZZA I. FARAG, M.D.
The Departments of Human Anatomy & Embryology* and Physiology**, Faculty of Medicine, Zagazig University, Egypt
10.21608/mjcu.2019.85385
Abstract Background: Bisphenol A (BPA) is a worldwide manu-factured chemical in plastic industry. Exposure to BPA through food and drinking water in plastic containers leads to human health problems. Aim of Study: This study intends to explore the possible protective role of vitamin E against BPA induced functional and structural changes in the lungs of adult male albino rats. Material and Method: Twenty four adult male albino rats were divided randomly into 4 equal groups of 6 rats each; Group I (controls) divided into 2 subgroups: Subgroup (A) (negative control group): Fed on regular diet and water for 8 weeks. Subgroup (B) (vehicle control group): Received (1ml of corn oil) by oral gavage/day for 8 weeks. Group II (vitamin E alone) received 200mg Vitamin E/kg/day; Group III (BPA alone) received 500mg BPA/kg/day; Group IV (BPA and vitamin E co-administered) as in groups II and III. The drugs were administered through oral gavage for 8 weeks, at the end of the experiment, heart rate (HR) and mean arterial blood pressure (MABP) were estimated for all the animals. Blood samples were withdrawn for chemical examinations, and after sacrifice fresh lung specimens were collected for histological examination. Results: Administration of Vitamin E in cooperation with BPA significantly decreased MDA levels, MPO and Caspase-3 activities. In addition, it increased GSH, CAT and SOD activities significantly in rat lung tissues. Also, plasma levels of TNF-a, IL-1b, IL-6 and LDH were significantly decreased. Blood gases analysis showed no significant difference in pH, but showed increase in PaO2 decrease in PaCO2 significantly. Moreover hemodynamics changes in the form of significant decrease in MABP and HR. Vitamin E protected lungs against BPA induced histopathological changes like inflammation, congestion, inter alveolar septum thickening, alveolar damage, collagen fibers percent area and fatty infiltration, also the immunohistochemical changes were altered as depicted by significant decrease in the cluster of differentiation 68 (CD68) +ve cell count and decreased expression of nuclear factor kappa B (NF-kB) in immunestained cells of the lung tissue.<br />Conclusion: BPA exposure induced oxidative stress, inflammation and structural lung injury which were signifi-cantly less by coadminstration of vitamin E supplementation.
bisphenol A,Oxidative Stress,Vitamin E,lung
https://mjcu.journals.ekb.eg/article_85385.html
https://mjcu.journals.ekb.eg/article_85385_76358f271fded8eb1cff6cf20b5b01e0.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Plaque Burden and Characterization by Multislice Coronary CT Angiography in Patients with Coronary Artery Disease
4917
4930
EN
ASMAA S. ORABY, M.Sc.;
REDA ABDEL SAMIE AL ARABAWY, M.D.
TAIMOUR M. ABDULLA, M.D.;
MOHAMMED M. DAWOUD, M.D.
The Departments of Radio-Diagnosis & Medical Imaging* and Cardiovascular Medicine**, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.85386
Abstract Background: Although degree of coronary luminal nar-rowing continued to guide therapeutic intervention in clinical cardiology, CT coronary angiography provides additional information about atherosclerotic plaque characteristics such as plaque morphology which recently showed good correlation with acute coronary syndrome as an independent factors. Aim of Study: The purpose of the study is to characterize atherosclerotic plaques as regard plaque burden and morpho-logical features to avoid acute coronary syndrome later on. Patients and Methods: 60 patients; 36 patients were with stable coronary artery disease and 22 patients were with unstable coronary artery disease. All patients were scanned first with coronary artery calcium scoring then, contrast enhanced coronary angiography. Coronary CT angiography was evaluated for morphologic features. Results: High risk plaque criteria were identified as NRS, LAP <60, plaque burden >0.7 and R.I >1.1. Characterization of the calcified lesions had the advantage of assessment of post contrast calcium which showed high correlation with pre contrast calcium volume of traditional calcium score as reference (rs=0.97) Hence, accurate detection of the degree of stenosis (p=<0.001). Conclusion: Characterization of coronary plaques by quantitative coronary plaque analysis improved image quality for calcified plaques and correlate well with high risk plaque criteria.
CAD= Coronary Artery Disease – CCS= Calcium Score – CCTA=Coronary Computed Tomography Angiography – CTA=CT Angiography – SC= Spotty Calcification – LAP=Low Attenuation Plaque,RI=Remodeling Index – NR=Napkin Ring,HRP=High-Risk Plaque – HU=Housenfield Unit – ROI=Region of Interest – PCI=Percutaneous Coronary Intervention – CABG=Coronary Artery Bypass Graft
https://mjcu.journals.ekb.eg/article_85386.html
https://mjcu.journals.ekb.eg/article_85386_7240c59462863daf9261b991b0623cd2.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Correlation between Epicardial Adipose Tissue Volume and Coronary Artery Disease Incidence in A Group of Patients Complaining of Chest Pain
4931
4939
EN
IBRAHIM M. HELMY, M.D.;
MANAL A. ELREFAEI, M.D.
YARA
M. AHMED ZIADA, M.D.
The Department of Radio-Diagnosis, General Organization for Teaching Hospitals and Institutes (GOTHI)
10.21608/mjcu.2019.85387
Abstract Background: Coronary artery disease is associated with many risk factors; one of them is the regional fat distribution that was found to play an important role in the development of atherosclerosis, vascular dysfunction as well as inflammatory promotion [1]. The current study analyses the long standing clinical impact of increased EAT volume evaluated by CT in a group of personnel without any previous documentation of having CAD [2]. Aim of Study: The aim of this study is to evaluate the relation between the volume of the epicardial adipose tissue versus incidence and severity of Coronary Artery Disease (CAD); thus depicting the association between their occurrence, if any. Patients and Methods: Fifty patients presented by chest pain showing suspicious symptoms of CAD were investigated by coronary artery CTA on Toshiba 640 CT scan during nine months duration. A pre-contrast study was performed for each patient followed by standard coronary artery CTA protocol. Image processing and measurements were done on Toshiba 640 work station where measurements were performed at the mid-diastolic phase using retrospective cardiac gating about 75% of PR interval. The data were analyzed independently by two consultant radiologists with experience of 10 to 20 years in cardiac imaging. Results: The estimated epicardial adipose tissue volume ranged from 30 to 226 CM3 with mean of 93Cm 3±50.7SD and median of 92.5cm3. The least Agatstone CA scoring was 0, and the maximum one was 1400, while estimated mean was 253±383 SD. Pearson correlation revealed significant correlation be-tween EAT volume and each of calcium scoring and CAD severity.<br />Receiver operator characteristic curves were performed for the coronary artery disease as well as both EAT and CA scoring as etiological factors revealing statistically significant results. Conclusion: Although the epicardial tissue fat has a protective, immuno-modulator buffering effect, the EATV was found to be proportional to the incidence of CAD and could be used as a bad prognostic factor for coronary artery disease. Conflicts of Interest: None.
Coronary Artery Disease,Epicardial adipose tissue
https://mjcu.journals.ekb.eg/article_85387.html
https://mjcu.journals.ekb.eg/article_85387_b8c29ad7c175f344ab088877955cb0c0.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Titanium Mesh for Correction of Stahl's Ear Deformity
4941
4946
EN
WAEL A. ALZAMIL, M.D.;
ESSAM FATEHY, M.D.
MOHAMMED
M. GABALLAH, M.D.
The Department of Ear Nose and Throat, Hearing and Speech Institute, General Organization for Teaching Hospitals and Institutes, Egypt
10.21608/mjcu.2019.85388
Abstract Background: Stahl's bar is a rare auricular malformation that can bring social stigma to the patient. Stahl's deformity is congenital anomaly, characterized by an accessory third crus in the ear cartilage, giving rise to an irregular helical rim and paradoxically bent scaphoid fossa along its two axes [1]. Correction of such ear deformity can be a challenging task for the surgeons. There are no standard techniques for correcting this deformity [2]. Several different techniques are described in literature which yield unpredictable results. The conventional techniques of correcting this deformity include either excision of the cartilage, repositioning of the cartilage, or scoring techniques, also correction using internal sutures [3]. We studied a new technique for correction of this deformity using titanium mesh. The technical details of the surgery are described along with a review of literature on correcting similar anomalies. Aim of Study: Our aim is to evaluate and discuss the efficacy and safety of using titanium mesh to correct Stahl's ear deformity. Subjects and Methods: A prospective randomized study conducted from June 2017 to March 2019. In all, 7 patients having the Stahl's bar deformity, two bilateral and five unilat-eral (9 ears) included. All patients have been presented and managed at the Department of Otolaryngology, Hearing and Speech Institute. Patients have been managed surgically to correct the deformity. Surgery was by implanting a piece of titanium mesh which has been shaped and tailored to reverse the paradoxically bent scaphoid fossa. The titanium mesh with its new curve was put inside a small sub-perichondrial pocket along the long axis of the deformed bar. Regular follow-up visits were done every month for at least 6 months. Results: The operative time ranged from, 45 to 70 minutes with a mean of 62 minutes. Surgery was easy straight forward, Blood loss was minimal. As regards the final outcome, the affected auricles regained its normal appearance with fine scaphoid fossa and helical rim intraoperatively. The ears that were operated were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications.<br />Summary: Correction of Stahl's bar deformity can be accomplished easily and safely by implanting a pre shaped titanium mesh forcing the abnormally curved cartilage to regain its normal curvature.
Stahl's bar,Titanium mesh auriculoplasty
https://mjcu.journals.ekb.eg/article_85388.html
https://mjcu.journals.ekb.eg/article_85388_9deaa7116bba9bb59f94117909bbc819.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Morphometric and Phasic Activity Changes of Urinary Bladder in Hyperthyroid Rats and the Possible Protective Effect of Folic Acid
4947
4956
EN
GHADA E. ELGARAWANY, M.D.;
SAFA R. ELFIKY, M.D.
AMANY A. SALEH, M.D.;
DALIA F. EL AGAMY, M.D.
The Departments of Medical Physiology*, Pharmacology** and Biochemistry and Molecular Biology***, Faculty of Medicine, Menoufia University, Egypt
10.21608/mjcu.2019.85392
Abstract Background: Hyperthyroidism was one of the most com-mon endocrine disorders. Urinary tract dysfunctions were common symptoms in hyperthyroid patients. Folic acid is affected by Thyroid dysfunction as hyperthyroidism is asso-ciated with subclinical deficiency and depletion of folate stores. Aim of Study: To study the morphometric and the in-vitro contractility changes of the urinary bladder in hyperthyroid rats, and the protective effect of folic acid and its possible mechanisms. Material and Methods: Forty male albino rats divided into four groups: Control, hyperthyroid, folic and (hyperthyroid + folic) groups. TSH, T3, T4, MDA & PGE2 were measured. Rats were then sacrificed. The weight, morphometric changes and phasic activity of the urinary bladder were assayed. Results: Hyperthyroid group significantly decreased TSH and increased T3 (Triiodothyronine), T4 (thyroxine), MDA (malondialdehyde) and PGE2 (prostaglandin E2), bladder weight, wall, and lumen areas with unchanged wall thickness, and increased smooth muscle and urothelium areas with unchanged collagen area and increase the contractile response of the urinary bladder strips to acetylcholine when compared to the control group. Co-administration of folic acid to hyper-thyroid rats significantly increased TSH and decreased T3, T4, MDA and PGE2, bladder weight, wall, lumen areas, smooth muscle, urothelium areas and the contractile response of the urinary bladder strips to acetylcholine when compared to the hyperthyroid group. Conclusions: Folic acid protects against enhanced bladder contractility and bladder remodeling in hyperthyroid rats possibly through ameliorating the increased thyroid hormones levels, anti-oxidative, and anti-inflammatory properties.
Folic acid,Hyperthyroidism,Morphometric changes,Phasic activity
https://mjcu.journals.ekb.eg/article_85392.html
https://mjcu.journals.ekb.eg/article_85392_963df293e7c2d1efc533cc09f6250edb.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Serum Adropin as a Biomarker for Cardiac Dysfunction in Experimentally Induced Male Albino Rat Heart Failure Model
4957
4965
EN
NOURELHUDA A. MOHAMMED, M.D.;
SHEREEN E. TAWFEEK, M.D.
HADEEL
A. ELSHERBINI, M.D.
The Departments of Medical Physiology* and Anatomy & Embryology**, Faculty of Medicine, Zagazig University and The Department of Anatomy, College of Medicine, Jouf University***
10.21608/mjcu.2019.85396
Abstract Background: Heart Failure (HF) remains to be one of the major worldwide causes of mortality and morbidity. Adropin is a recent peptide hormone that may play a role in energy homeostasis and metabolism. Some studies revealed that adropin plays a crucial role in the pathogenesis of heart failure others suggesting that it may be important for maintaining cardiovascular system potency. Aim of Study: To find out the possibility of using adropin as a biomarker for detection of cardiac dysfunction, in exper-imentally induced heart failure in male albino rats. Material and Methods: This study was conducted on 2 groups of male albino rats (180-200g): Control group (I) (n=10), in which rats fed normal chow. Chronic heart failure group (II) (n=10), in which chronic heart failure was induced by subcutaneous injection of Isoproterenol at a dose of 5mg/kg once daily for 14 consecutive days. Echocardiographic meas-urements were done, whole Body Weight (BW) was measured, serum levels of adropin & brain natriuretic peptide were measured. Whole Heart Weight (WHW) were measured, then (WHW/BW ratio were calculated). Finally, histopathological examination of heart tissues was done to evaluate the cardiac tissue structural changes. Results: Induction of heart failure resulted in cardiac function deterioration developed after 14 days, as proved by the significant increase in brain natriuretic peptide (4.4±0.02 vs. 1.4±0.06 p<0.001), reduction of ejection fraction (50.7±3.02 vs. 71.60±3.43 p<0.001) along with corresponding histopatho-logical changes in ventricular tissues. There was a significant increase in adropin levels in heart failure group (4.8±0.15 vs. 2.7±0.10 p<0.001). Furthermore; those levels were positively correlated with the previously affected parameters. Conclusion: This study suggested that adropin may act as a mediator in cardiac dysfunction and can be used as a marker for early diagnosis of cardiovascular system affection.
adropin,Heart failure,Rats
https://mjcu.journals.ekb.eg/article_85396.html
https://mjcu.journals.ekb.eg/article_85396_3e3daf7ef838cfd9b808298a6361575c.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Efficacy and Safety of Intralesional Injection of Tuberculin PPD in Treatment of Plantar Warts
4967
4974
EN
NAHLA R. GHALY, M.D.;
AMAL A. EL-ASHMAWY, M.D.
MAI
M.G. ABOU ZEID, M.Sc.
The Department of Dermatology and Venereology, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.85399
Abstract Background: Many destructive and immunotherapeutic modalities have been used for the management of plantar warts; however, an optimal treatment with high efficacy and absent or low recurrence has not been explored to date. Tuberculin purified protein derivative (PPD) shown promising results for treatment of viral warts without ablation. Aim of Study: To evaluate the efficacy and safety of intralesional (IL) PPD in the treatment of plantar warts. Patients and Methods: Twenty patients with plantar warts were included in this study and divided into two equal groups; group I was treated using IL tuberculin PPD every 2 weeks, group II was treated with IL saline every 2 weeks, till complete clearance or for a maximum of 3 sessions. The patients were followed-up for a period of 6 months. Results: There was a statistically highly significant im-provement in the therapeutic group compared with control group. This modality was well tolerated, with no remarkable side effects and no recurrence in cured patients during follow up period. A significant positive correlation existed between the number of sessions and treatment response. There was a significant negative correlation between the number of lesions and response to treatment. Conclusion: Intralesional PPD is safe and effective treat-ment alternative for the treatment of plantar warts even if they are recalcitrant or multiple, with no post-procedural downtime and better results and patient satisfaction.
Intralesional immunotherapy,Purified protein derivative,Warts
https://mjcu.journals.ekb.eg/article_85399.html
https://mjcu.journals.ekb.eg/article_85399_ad84d9f302d2da7ba054d9e3dc58e4ca.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Non-Traumatic Lateral Hip Pain: MRI Findings
4975
4983
EN
NOURELHUDA A. MOHAMMED, M.D.;
SHEREEN E. TAWFEEK, M.D.
HADEEL
A. ELSHERBINI, M.D.
The Departments of Medical Physiology* and Anatomy & Embryology**, Faculty of Medicine, Zagazig University and The Department of Anatomy, College of Medicine, Jouf University***
SHERIF A. ABO-HEDIBAH, M.D.;
WALAA A. GOUDA, M.D.
SAMEH
A. ALY, M.D.
The Department of Radiodiagnosis, Faculty of Medicine, Cairo*, Menofia** and Banha*** Universities
10.21608/mjcu.2019.86287
Abstract Background: Imaging findings play important role in diagnosis and directing the treatment for lateral hip pain. MRI plays a crucial role in the structural diagnoses accompanyin-glateral hip pain include tendinosis, and partial- or full-thickness tears of the gluteal tendons. Aim of Study: Todescribe the MRI findings related to the non-traumatic lateral hip pain. Patients and Methods: A retrospective study was per-formed including forty patients (35 females and 5 males, between the ages of 23 and 76 the mean ± SD, 50.1±13.6 years) presented with unilateral or bilateral LHP and all patients underwent MRI for both hips. Two radiologists reviewed the MR images for identification of the lateral hip pathology. Results: In the 40 patients included in our study, there were (16) patients complaining of unilateral hip pain and (24) patients complaining of bilateral hip pain. (34) patients showed MRI features of tendon, muscle & bursal pathologies (either unilateral or bilateral), (4) patients showed AVN of the painful hip and (2) cases were diagnosed as transient migratory osteoporosis. Conclusion: MRI is a valuable method to identify the structural diagnoses accompanying lateral hip pain.
MRI,Lateral hip pain
https://mjcu.journals.ekb.eg/article_86287.html
https://mjcu.journals.ekb.eg/article_86287_d8d9873e78966d78baf21c1d1e974c38.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Inter-Observer Accuracy of “Fat Pad Sign” in Determining Radiological Elbow Joint Effusion with Different Levels of Experience
4985
4992
EN
DOAA M. FOUAD, M.D.;
NARIMAN ABOL OYOUN, M.D.
The Departments of Radiology, South Egypt Cancer Institute* and Orthopedics & Traumatology, Assiut University Hospital Assiut University**
10.21608/mjcu.2019.86288
Abstract Background: Joint Effusion is considered as an important indicator of many joint morbid conditions. In the sitting of trauma, fat pad displacement in lateral elbow radiograph may be the only clue of occult fractures as it is referred to elbow effusion. Likewise, it's a sign of early internal joint morbidity in many articular diseases. The classic lateral radiograph is considered as the primary choice for determining elbow joint effusion because of being simple, available and reasonable tool. Aim of Study: The current study aimed to evaluate the inter-observer accuracy of fat pad signs of elbow lateral radiograph in detecting elbow joint effusion with the impact of observer experience on it. MRI was used as the gold standard. Patient and Methods: The current study is a descriptive validation study in which 52 patients were included prospec-tively in it. Inclusion criteria were positive elbow effusion by MRI with available lateral elbow radiograph within 3 days of the MRI study. Radiographs were read by 2 groups: Group I (2 senior radiology residents of 3 years' experience: Reader A & B), and group II (2 radiologists with MD degree, reader C & D). Each observer provided his readings by either proved effusion, denied effusion or asked for further evaluation. Readers were independently and blinded to the patients' clinical data. Results: The diagnostic accuracy percentages of elbow effusion detection for each reader compared to MRI were calculated as follows: Proper detection were from 59.6% to 61% in low experience, and 76.9% to 82.7% in high experience. Missed cases were (19%) in low experience and (3.8%) to (7.7%) in high experience group. While cases needed further evaluation were 19.2% to 21.2% in low experience and in high experience were ranging from 13.5% to 15.4%. Then agreement between each reader were estimated. The same level of experience showed perfect agreement, (Kappa of 0.922 and 0.965). While lower agreement was detected in different experience group with Kappa of 0.51 to 0.641, which is moderate and substantial agreement. Conclusion: The current study emphasizes that validity of radiographs in detection of elbow effusions widely varied with levels of experience. MRI is important beside lateral radiograph for detection of elbow effusion especially in low experience to avoid missed occult fractures and early morbid joint affection.
elbow,Effusion,Fat pad sign,Radiography,Levels of experience
https://mjcu.journals.ekb.eg/article_86288.html
https://mjcu.journals.ekb.eg/article_86288_69e26900cb1e0032ff007bcd4cc3be2f.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Epidemiologic Study of Female Sexual Dysfunction in Delta of Egypt
4993
4997
EN
AHMED A. GAAFAR, M.Sc.;
AHMED S. EL ABD, M.D.
HASSAN H. ELTATAWY, M.D.;
MOHAMMED A. GHALWASH, M.D.
The Department of Urology, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.86289
Abstract Background: Female sexual dysfunction (FSD) is charac-terised by disturbances in sexual desire and psycho-physiological changes associated with the sexual response cycle. Female sexual dysfunction (FSD) is defined as disorders of libido, arousal, orgasm, and sexual pain that lead to personal distress or interpersonal difficulties. It is a common problem, affecting 30-78% of women. Aim of Study: Was to report the epidemiologic aspects of female sexual dysfunction in Delta of Egypt. Patients and Methods: This study was designed as a cross-sectional one and conducted on married women attending urology and/or gynecology outpatient clinic in Delta of Egypt mainly Tanta University Hospitals; between April 2017 and October 2018. Counseling was performed to explain the goals, steps and security of information of the study with 2822 attending married women to outpatient clinics, 310 women refused to share in the. The response rate was 89%. The number of included women in the study was 2512. Results: Based on the total sexual function score, 1455 (57.9%) had sexual complaints (group A) while 1057 women (42.1 %) had no sexual disturbance (group B). The total score of FSFI ranged from 4.6 to 25.7 in group A (mean=) and from 27.3 to 35.1 in group B (mean=). (p=0.001) Comparison of the individual domain scores showed that women in the sexual dysfunction group had significantly lower scores in all domains as compared to those without sexual dysfunction (p=0.001). Conclusion: Female sexual dysfunction is highly prevalent problem but underestimated due to cultural, religious factors, lack of awareness and information about sex.
Female sexual dysfunction (FSD),Female sexual function index (FSFI),Ceserian section (CS)
https://mjcu.journals.ekb.eg/article_86289.html
https://mjcu.journals.ekb.eg/article_86289_e79a764739c8420879731bf024fb0487.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Comparison between Immediate Effect of Postero-Anterior and Antero-Posterior Cervical Mobilization on Chronic Mechanical Neck Pain
4999
5003
EN
BASEM M. MOHAMED, M.Sc.;
NEVEEN A. ABDEL RAOOF, Ph.D.
RANIA
R. MOHAMED, Ph.D.
The Department of Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
10.21608/mjcu.2019.86290
Abstract Background: Chronic mechanical neck pain is a common problem that can cause economic and social problems for an individual, although there were different types of joint mobi-lization that have an effect on pain but it still debates which type is more effective than others. Aim of Study: This study was conducted to compare the immediate effect of different techniques of cervical mobiliza-tion (anterior posterior-posterior anterior) on pain intensity in chronic mechanical neck pain. Subjects and Methods: Forty five chronic mechanical neck pain patients were recruited and assigned into 3 groups 2 study and one control group, Group A, B and C with their mean age SD (27.6±6.77), (27.07±6.42) and (28.8±6.99) years with BMI (27.32±2.37), (26.43±2.08) and (26.38±2.14) KG/m2 were recruited and assigned into three groups (two study and one control groups). The study groups (A) and (B) received the mobilization technique (posterior anterior-anterior posterior respectively) and the control group (C) received only ultra-sound assessment was conducted by VAS for pain intensity. Results: There was significant difference in each group (A), (B), and (C) pre and post treatment on pain intensity (p=0.0001). While comparison between the two-study group and the control group, in post treatment effect on pain there was non-significant difference between group (A and B) (p=0.285) and significant difference between groups (A and C), and (B and C) (p=0.0001). Conclusion: There was an immediate effect of posterior anterior-anterior posterior mobilization on pain intensity in patients with chronic mechanical neck pain, but in compare between the two different technique the posterior anterior mobilization had the more immediate effect on decreasing pain.
Mobilization,Chronic mechanical,Neck pain,VAS
https://mjcu.journals.ekb.eg/article_86290.html
https://mjcu.journals.ekb.eg/article_86290_6ac75a276c2ec4c5446c0b45ceaf1264.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Aerobic Training on Blood Viscosity in Hypertensive Women
5005
5008
EN
EMAN N. NAWARA, M.Sc.;
NESREEN ELNAHAS, Ph.D.
ZAHRA HASSAN, Ph.D.*;
MAATHER KAMEL, M.D.
The Departments of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University* and Biochemistry, Faculty of Medicine, Menofeya University**
10.21608/mjcu.2019.86291
Abstract Background: Blood viscosity level increases in hyperten-sive patients. Objective of this study was to determine the effect of aerobic training on blood viscosity in hypertensive women. Aim of Study: To investigate effect of aerobic training on blood viscosity in hypertensive women. Material and Methods: Thirty obese diabetic women participated in this study chosen from Al-Bagour public hospital in 2018. The patients were assigned into two equal groups. Each group included 15 patients. The patients in both groups were matched in age ranged from (50-65 years old) and body mass index ranged from (25 to 29.9Kg/m2), with mild to moderate hypertension and had high blood viscosity >4.5 relative to water. All patientsreceived medications ac-cording to physician prescription, Group A received a program of aerobic training using treadmill 3 days/week for 8 weeks with intensity 60-80% MHR started with 20 minutes and increased by 5 minutes every two weeks till reaching 40 minutes at 8th week. Warm up phase 5-10 minutes, cool down phase 5-10 minutes in form of walking on treadmill at low speed.while group B acted as control group. Results: The data revealed a statistically decrease in blood viscosity level in group A than in group B after treatment (p<0.05). The percentage of improvement in group A was 20% while it was 7.2% in group B. Conclusion: Aerobic training had valuable effect on blood viscosity level in women with hypertension.
Aerobic training,Blood viscosity,Hypertension
https://mjcu.journals.ekb.eg/article_86291.html
https://mjcu.journals.ekb.eg/article_86291_0b31b859820b785770ddb3dc7a686a96.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Ultrasound-Guided Microwave Ablation of Unresectable Hepatocellular Carcinoma: Short Term Response and Predictors of Success
5009
5020
EN
TAMER M. DAWOUD, M.Sc.;
MOHAMED M. HEFEDA, M.D.
KHALED E. EL-SHAFEY, M.D.;
TALAL A.Y. AMER, M.D.
The Departments of Radiology*, Radiodiagnosis**, Faculty of Medicine, Tanta University and Radiodiagnosis Department***, Faculty of Medicine, Mansoura University
10.21608/mjcu.2019.86292
Abstract Background: Microwave ablation (MWA) refers to all electromagnetic methods of inducing tumor destruction. Aim of Study: The aim of this study was to evaluate the outcome of ultrasound-guided microwave ablation of unre-sectable hepatocellular carcinoma using cold shaft antenna. Material and Methods: A total of 65 patients with Hepa-tocellular carcinboma (HCC) were referred to interventional Radiology Department for ablation of presumed non resectable tumor. The study group included 49 (75.4%) male and 16 (24.6%) female, with an average age (±SD) of 55±7.2 years (range, 48-72 years). Conventional gray scale ultrasound and triphasic computed tomography were performed for all patients before ablation. The microwave system used was HS AMICA (apparatus for microwave ablation, hospital service, Rome, Italy), with electronically controlled microwave generator. A 14 Gauage cooled shaft electrode named AMICA-probe was used to deliver microwave power to the liver tissue. The patients were then followed-up with contrast enhanced com-puted tomography (CT) and serum a-fetoprotein levels. Results: Among the 65 patients, complete ablation was achieved in 60 patients after initial treatment (92.3%). Initial complete ablation rates in patients with nodules <2cm, 2- 5cm, and >5cm were 100%, 92.1%, and 85.7% respectively. The probability of achieving a complete ablation was signif-icantly greater in patients with tumor size of <5cm. Conclusion: Sonographically guided MWA is an effective ablative method that can be applied in unresectable HCC of various sizes and different locations with reasonable safety.
Microwave ablation,Unresectable Hepatocellular carcinoma,Thermal ablation,Ultrasound guid-ed thermal ablation
https://mjcu.journals.ekb.eg/article_86292.html
https://mjcu.journals.ekb.eg/article_86292_2797f7ac2902d661a4b07013ad30d620.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effects of Sildenafil Citrate on the Structure of the Testis and the Possible Protective Role of Selenium in Adult Albino Rats: An Electron Microscopic Study
5021
5029
EN
DORRIA A.M. ZAGHLOL, M.D.;
SALWA M. OUIES, M.D.
WAIL M. GAD EL-RAB, M.D.;
SAFAA M. EL-MAHDY, M.Sc.
The Department of Human Anatomy & Embryology, Faculty of Medicine, Assuit*, Sohag** and Al-Azhar Universities, Assiut***
10.21608/mjcu.2019.86293
Abstract Background: Sildenafil citrate used for treatment of erectile dysfunction and was reported to be supportive to men with erectile dysfunction including who suffer from diabetes, hypertension, spinal cord injuries, multiple sclerosis, depres-sion, schizophrenia and men after prostatectomy. Selenium has a considerable attention as an essential micronutirent for both animal and human being. It is a potentially antioxidant agent. Aim of Study: This work aimed to study the possible protective effects of selenium on the testes of the adult albino rats treated with sildenafil citrate by transmission electron microscope. Material and Methods: Thirty adult albino rats were used and divided into three equal groups: Group I (control group), group II; received sildenafil citrate orally in a dose of 10mg/kg body weight for 8 weeks, group III: Received selenium in a dose of 10mg/kg orally before the treatment with sildenafil citrate. At the end of the experiment, the testes were obtained, and subjected to the transmission electron microscopic studies. Results: After treatment with sildenafil citrate spermato-gonia appeared with shrunken nucleus and vacuolated cyto-plasm. Sertoli cells appeared dislocated with ill-defined cell membrane. The primary spermatocytes and spermatids ap-peared with irregular shaped nuclei and abnormal acrosomal cape. Leyding cells appeared with irregular nuclei and vacu-olated cytoplasm. Spermatozoa appeared distorted with swollen mitochondrial sheath. Selenium showed some improvement in the ultrastrucure of the testis with spermatogonia appeared with large nucleus and less vacuolated cytoplasm. Sertoli cells appeared at their normal sites with indented euchromatic nucleus. Primary spermatocytes and spermatids appeared with normal shape. Leydig cells appeared with less vacuolation and euchromatic nuclei. Most of spermatozoa appeared with intact form. Conclusion: Sildenafil citrate had a toxic effect on all of the germinal cells and administration of selenium partially improved these toxic effects.
testis,Sildenafil citrate,selenium
https://mjcu.journals.ekb.eg/article_86293.html
https://mjcu.journals.ekb.eg/article_86293_2fc0cbc30d9922b213702be0945b1990.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Comparative Study of Risk Factors for Opaque Bubble Layer Formation in Femtosecond-Laser Assisted LASIK
5031
5040
EN
AHMED S. ABDEL WANES, M.Sc.;
ABDELRAHMAN G. SALMAN, M.D.
AZZA M.A. SAID, M.D.;
BASSEM F.A. RIAD, M.D.
The Department of Ophthalmology, Faculty of Medicine, Zagazig* and Ain Shams** Universities**
10.21608/mjcu.2019.86294
Abstract Background: Refractive surgery had undergone a remark-able evolution during the last 25 years. The introduction of excimer laser in practice of refractive surgery was an exciting innovation. Aim of Study: To determine risk factors responsible for opaque bubble layer formation in femtosecond-laser assisted LASIK. Patients and Methods: This retrospective comparative study was conducted on patients who were eligible for FSL-assisted LASIK at El-Watany Eye Hospital in the period from January 2015 to January 2017. Two hundred eyes were included in the study divided into 100 had OBL developed during surgeries and 100 did not develop OBL. Results: The results of the present study revealed a statis-tically significant difference between both groups regarding preoperative central corneal thickness, corneal canal length offset and steep keratometry being higher in OBL formation group. Regarding regression analysis central corneal thickness and corneal astigmatism were statistically significant inde-pendent predictor of OBL formation. Conclusion: OBL is one of FSL complications. Increased corneal thickness, steep keratometry and increased corneal canal length offset and were risk factors of OBL formation during surgeries. Regarding regression analysis; central corneal thickness and corneal astigmatism were statistically significant independent predictor of OBL formation.
Opaque bubble layer,Femtosecond-Laser,LASIK
https://mjcu.journals.ekb.eg/article_86294.html
https://mjcu.journals.ekb.eg/article_86294_1c3ac1fd6e85d3125371b0f8375453dc.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Cryotherapy versus Transcutaneous Electrical Nerve Stimulation on Patients with Hypertension
5041
5046
EN
MICHAEL W. HANNA, M.Sc.;
ZAHRA M.H. SERRY, Ph.D.
MONA M. TAHA, Ph.D.;
BASSEM EL ZAREF FOUAD, M.D.
The Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University* and The Department of Cardiology, National Heart Institute**
10.21608/mjcu.2019.86295
Abstract Background: One billion of the world's population has hypertension, resulting in four million deaths per year. Data on the prevalence of hypertension in the Arab world are very limited. Only 13 studies were identified in the literature from 10 Arab countries. The overall estimated prevalence of hyper-tension was 29.5%, which indicates a higher prevalence of hypertension among Arab compared to people from the USA (28%) and sub-Saharan African (27.6%). Aim of Study: Of this study was to investigate the effect of cryotherapy versus transcutaneous electrical nerve stimu-lation on hypertensive patients. Subjects and Methods: Forty men were recruited from Disuq General Hospital, Disuq, Kfr El-Shiekh. They were assigned into two equal groups. Their ages ranged from 40 to 50 years. Group (A) with mean age (46±3.5) years and Group (B) with mean age (47.8±2.7) years. Group (A) received ice application for 30 minute three times per week for 4 weeks. Group (B) received TENS application for 30 minute three times per week for 4 weeks. Blood pressure was measured before and after every session as acute effect of applications and also was measured after 2 weeks and after 4 weeks as a chronic effect. Results: As an acute effect: In group (A) there were significant differences in systole except in 3rd, 4th and 6th sessions while there were significant differences in diastole except 7th session. In group (B) there were significant differ-ences in systole and diastole. As a chronic effect: In group (A) there were no significant differences in systole while there were significant differences in diastole. In group (B) there were significant differences in systole and diastole. Conclusion: Ice and TENS applications had significant effect on improving hypertension but in favor to TENS appli-cation.
Cryotherapy,Transcutaneous electrical nerve stimulation,Hypertension
https://mjcu.journals.ekb.eg/article_86295.html
https://mjcu.journals.ekb.eg/article_86295_02590ed62d2a636e73f2544b1d9c1627.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Comparison between the effect of Leptin, Omega-3 Polyunsaturated Fatty Acids, and Vinegar on the Duodenal Ulcer in Male Albino Rats Through a Histological and Biochemical Study
5047
5058
EN
HADER I. SAKR, M.D.;
OLFAT G. SHAKER, M.D.
MOUSTAFA E. MOTAWEE, M.D.;
AHMED A. DAMANHORY, M.D.
10.21608/mjcu.2019.86296
Abstract Background: Duodenal ulcer is a major health problem that many scientists are interested in its management to avoid complications and the side effects of the usual treatments. Aim of Study: Demonstrating and comparing the possible effects of chronic administration of omega-three polyunsatu-rated fatty acids, leptin, and vinegar on duodenal ulcer in male albino rats, with the possible underlying mechanisms involved in such effects. Material and Methods: Four groups of experimental animals were used, with 16 rats in each: the control group (I), w-3 fatty acids fed (II), Leptin fed (III), and vinegar fed (IV). For each group, we estimated, from the gross duodenal exam-ination, the ulcer score and index, and percentage ulcer protection. Also, histology appearance of the duodenal mucosa was examined together with the measurement of duodenal HCO3-amount, CCK, and secretin gene expression. Results: In comparison to control group, the ulcer score and index were diminished significantly while percentage ulcer protection, HCO3-amount, and expression of secretin and CCK genes were increased significantly in rat groups fed with w-3, vinegar, and leptin. Vinegar has a more protective effect than w-3 and leptin. Conclusion: We conclude that vinegar, w-3, and leptin have a protective effect against induction of duodenal ulcer, and vinegar had a better effect against ulcer induction followed by w-3 and finally leptin.
Duodenal ulcer,w-3 fatty acids,leptin,vinegar,CCK,Secretin
https://mjcu.journals.ekb.eg/article_86296.html
https://mjcu.journals.ekb.eg/article_86296_7893b5b0ab889d1114fae31c09db77d3.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Correlation between Forward Head Posture and Spinal Sagittal Balance
5059
5064
EN
RASHA S. EL KHOLY, M.Sc.;
ALIAA D. ATYA, Ph.D.
MARWA Sh.M. SALEH, Ph.D.;
MOHAMED H. SHAABAN, Ph.D.
The Departments of Basic Science, Faculty of Physical Therapy* and Anatomy & Emberyology, Faculty of Medicine**, Cairo University, Egypt
10.21608/mjcu.2019.86327
Abstract Background: Forward head posture and other forms of spinal sagittal imbalance at nowadays are a major cause of pain and disability among patients presenting to the spine clinic in daily practice. However, it is unclear if there are correlation between forward head posture and whole spinal balance or no therefore, the purpose of this study was to investigate the correlation between FHP and spinal sagittal balance. Aim of Study: This current study was planned to measure the correlation between FHP and spinal sagittal balance. Material and Methods: This study was carried at El-Sheikh Zayed Specialized Hospital out patient clinic of Physical Therapy. From December 2017 to April 2019. 30 subject aged between 25-35 years old from both sexes with radiological CVA <70' are included in this study, standard full-length lateral radiographs performed in all participant. FHP was assisted by CVA and we assess C7 plumb line for total spinal balance, Co-C2 angle for upper cervical lordosis, C2-C7 (SVA) and C2-C7 angle for lower cervical lordosis, T1 sagittal tilt, T4-T12 angle for thorathic kyphosis, L1-S1 angle for lumber lordosis and Sacral Slope (SS). Correlation analysis was used to identify the direction and strength of the relationship between forward head posture and spinal sagittal balance variables. Results: Forward head posture angle is negatively strong correlated to C2-C7 SVA and has a negative intermediate correlation with T1 tilting and C0-C2 angle but it has aweak positive correlation with C7-S 1 SVA, on the other hand it has an no correlation with C2-C7 angle, sacral slope, lumber lordosis and thoracic kyphosis. Conclusion: Increasing in forward head posture angle leads to increase in C7-S1 SVA and decrease in C2-C7 SVA, T1 tilting and C0-C2 angle. While it has no effect on C2-C7 angle, sacral slope, lumber lordosis and thoracic kyphosis.
Forward head posture,Sagittal balance,Full-length lateral radiographs
https://mjcu.journals.ekb.eg/article_86327.html
https://mjcu.journals.ekb.eg/article_86327_b25baebf94302d427cd92d7e028afa5f.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Comparison between the Early Outcome of Fallot Repair with Preservation of the Pulmonary Valve Annulus versus Transannular Patch Repair
5065
5073
EN
MOHAMED ATTYA, M.D.;
AMR BASTAWISY, M.D.
WALEED ISMAIL, M.D.
MICHEAL W. REFAAT, M.B.B.Ch.
The Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.86328
Abstract Background: This disease of heart is named after Fallot who correlated the pathologic and clinical manifestations of this cardiac malformation in his description of L'anatomie pathologique de la maladie bleu by 1888. He was the first to appreciate the complex of this cardiac malformation which he coined a “Tetralogy” consisting of pulmonary stenosis, Ventricular Septal Defect (VSD), dextroposition of the aorta, and RV hypertrophy. Aim of Study: To collect, review and analyze the data of Fallot patient undergoing total repair and to compare the early outcome of Fallot repair with preservation of the annulus versus transannular patch. Patients and Methods: This is a retrospective analysis which conducted at the Cardiothoracic Surgery at Ain Shams University Hospital from the first of January 2014 till the end of December 2016. Results: The majority of patients with TOF have a bicuspid or tricuspid PV, which is the most favorable surgical anatomy for preserving the PV, independent of the presence or degree of leaflet dysplasia. We believe that the preservation of the PV annulus and PV function during early repair of TOF, by combining intraoperative PV dilation and additional surgical procedures, can be extended to the majority of patients with classic TOF. The recent introduction of more-complex PV plasty techniques allowed us to further extend the applicability of PV-preservation techniques. Conclusion: The optimal repair technique would be there-fore, dictated to the anatomical substrate of the lesion, the patient's age, prevailing surgical practice and other patient preoperative characteristics which all should be taken into relevance in an effort to improve patient outcomes.
Transannular patch repair,Pulmonary valve annulus,Fallot
https://mjcu.journals.ekb.eg/article_86328.html
https://mjcu.journals.ekb.eg/article_86328_38285d41f9019d4fd7aef8a44708fce7.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Acupuncture Transcutaneous Electrical Nerve Stimulation on Upper Limb Function in Stroke Patients
5075
5082
EN
MARAM A. MAHMOUD, M.Sc.;
EMAN S. FAYEZ, Ph.D.
MAGED M. ABDEL NASEER, M.D.;
RANIA M. TAWFIK, Ph.D.
The Department of Physical Therapy, Emergency Hospital, Cairo University Hospitals*, The Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy** and Neurology, Faculty of Medicine***, Cairo University
10.21608/mjcu.2019.86329
Abstract Background: Stroke is the leading cause of long-term disability; the restoration of movements and associated func-tions is a common concern of stroke patients. However, the restoration of the upper limb function is often poor, being seen in less than half of patients. Electrical stimulation is shown to be effective in enhancing the upper extremity functional recovery in stroke patients. Aim of Study: To determine the effect of acupuncture TENS on upper limb function in stroke patients. Procedures: This study was conducted on thirty male stroke patients. Patients were randomly assigned into two equal groups: The study group (GI) and the control group (GII). Group I (study group): This group received acupuncture (TENS) in addition to the selected physical therapy program. Group II (control group): This group received the selected physical therapy program only. Fugel-Meyer Scale was used to assess the upper limb function and Modified Ashworth scale (MAS) was used to assess the spasticity grades before and after four weeks of the treatment program. Results: The results showed that: There was a significant difference of Fugel-Meyer Scale scores and mean values of spasticity grades in study group after the designed treatment program. Conclusion: The acupuncture Transcutaneous Electrical Nerve Stimulation (TENS) has a significant effect in reduction of spasticity and improvement of upper extremity function following stroke.
Acupuncture,Transcutaneous electric nerve stimulation,Electro acupuncture,stroke,Upper limb function
https://mjcu.journals.ekb.eg/article_86329.html
https://mjcu.journals.ekb.eg/article_86329_8d12172bd80530606911eba42d8bb9bf.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Midterm Results of Mitral Valve Replacement for Heart Disease in Females in Child Bearing Period - Mechanical Versus Tissue Valves
5083
5091
EN
GAMAL SAMY, M.D.;
HANI ABDEL-MABOOD, M.D.
MAHMOUD YASSIN, M.D.;
MAHMOUD YASSIN, M.D.
The Department of Cardio-Thoracic Surgery, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.88435
Abstract Background: Current guidelines limit mitral valve replace-ment to irrepairable valve pathology that will result in poor durability outcomes, especially in patients unlikely to tolerate future reinterventions. There are two basic types of prosthetic heart valves used in current clinical practice: Mechanical and bioprosthetic valves. Young women planning pregnancy are considered high risk patients who require careful selection of the optimal prosthetic heart valve. Some authors advocate that mechanical heart valve prostheses, which require lifelong anticoagulant therapy (warfarin), are not appropriate because of the teratogenic potential of anticoagulants. However, the main issue with bioprosthetic heart valves is their finite lifespan and high risk of reoperation in the future. Aim of Study: To primary outcome: To compare midterm results of post-operative outcome between mechanical versus tissue valves in the terms of morbidity in females in the childbearing period. Hence guide future choice of prosthetic valves in females in childbearing period. Secondary outcome: To discuss the rate maternal complication for both types of valves during pregnancy. Patients and Methods: This study was conducted at the Cardiothoracic Surgery Department, Souad Kafafi University Hospital and Ain Shams University Hospitals. The study period starting between 2013 to 2018. Results: Our results showed that the pre-operative Left Ventricular End Diastolic Diameter (LVEDD), Left Ventricular End Systolic Diameter (LVESD) were significantly lower in the mechanical group and the Ejection Fraction (EF) was significantly lower in tissue group. The MVA was significantly lower and the pressure gradient was significantly higher in tissue group than mechanical group. Post-operatively, the LVEDD and LVESD remained significantly lower in mechan-ical group; however, the EF was comparable between both groups. Although, the post-operative pressure gradient was higher in tissue group, but it is not reflected on the durability of the valve at this age group regarding the midterm results of our study, and there were no statistically significant differ-ences between both groups in terms of MVA, incidence of new regurge, or paravalvular leak.<br />Conclusion: Tissue valves appear to be the preferred option for women in childbearing period with MVD with better mid-term results than mechanical valves. The present study demonstrated that women with mechanical valves had a high rate of pregnancy loss. The risk of cardiovascular complications is higher in mechanical valves, as the main risks are related to the need of anticoagulation therapy (hem-orrhagic and thromboembolic complication) additional risks related to ventricular and valvular dysfunction as well. Fur-thermore the rate of reoperation is much higher in mechanical valves. However the risk of complications is lower in tissue valves, it can be significant in the presence of bioprosthetic dysfunctions. So, large-scale, studies are still needed to confirm our findings.
Left ventricular end diastolic diameter,Left ventricular end systolic diameter
https://mjcu.journals.ekb.eg/article_88435.html
https://mjcu.journals.ekb.eg/article_88435_bbd63bdefaa759aac5362ed0246d305b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Partial Splenic Artery Embolization (PSE) in the Treatment of Hypersplenism
5093
5104
EN
AHMED M. AMIR, M.Sc.;
EISHA R. MOHAMED, M.D.
LOBNA K. SAKR, M.D.;
AHMED S. SAEED, M.D.
10.21608/mjcu.2019.88436
Abstract Background: Hypersplenism mainly manifest by throm-bocytopenia with or without obvious bleeding tendency that become an obstacle to undergo any surgical intervention or receive some therapeutic regime. This dilemma can be solved using the evolving partial splenic artery embolization (PSE) techniques. Aim of Study: The primary aim is to evaluate the role and efficacy of PSE in the treatment of hypersplenism. Patients and Methods: In the period between March 2016 and August 2018, this prospective case series study was conducted and included 26 patients (11 males and 15 females) with their age ranging from 14 to 72 years old. All patients suffered from hypersplenism secondary to liver cirrhosis and had thrombocytopenia ranging from 20,000/µL to 83,000/µL, with 17 of them had associated leucopenia ranging from 1,250/µL to 3,420/µL. 20 patients had hypercellular and 6 patients had normocellular bone marrow. They all underwent one session of PSE by the usage of two sizes of either PVA or Microspheres with the extent of planned embolization volume was set between 30%-70% of initial spleen size. Results: Up to 1 year follow-up, the platelet counts rose significantly with patients reached their normal values in 1st, 3rd, 6th months and 1st year follow-ups were 80.8%, 71.4%, 91.7% and 83.3% respectively. In all 17 patients who had associated leucopenia, their leucocytic counts rose significantly with patients reached their normal values in 1st, 3rd, 6th months and 1st year follow-ups were 88.2%, 87.5%, 83.3% and 75% respectively. No significant improvement regarding the RBC counts in all patients. Among the 24 patients who had clinical manifestations; 22 (91.7%) of them showed clinical improvement and 2 (8.3%) patients showed less improvement. Conclusion: PSE with careful care is an effective non-surgical minimally invasive procedure in avoiding the potential post-procedure complications and achieving remarkable he-matologic response on controlling hypersplenism.
Partial Splenic Embolization (PSE),Hypersplen-ism,Splenomegaly,thrombocytopenia
https://mjcu.journals.ekb.eg/article_88436.html
https://mjcu.journals.ekb.eg/article_88436_502d0ed3e04659cc450b011c3b305228.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Added Value of Quantitative DWI MRI in Differentiation between Benign and Malignant Osseous Musculoskeletal Tumours
5105
5112
EN
MOMENA E. ELSADAWY, M.D.;
KHALED A. ALI SHEHATA, M.D.
The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.88437
Abstract Background: MRI has a key role in identification of MSK masses, especially in depiction of their nature, borders, regional involvement and their relation to the surrounding organs and neurovascular bundle. MRI aids clinicians in assessment of osseous tumors to depict the extra-osseous component, and the regional location as well, since both parameters are crucial for the pre-operative assessment. Aim of Study: To evaluate the role of Diffusion Weighted Imaging (DWI) in differentiation of benign and malignant osseus musculoskeletal (MSK) tumors and its added value clinically on patient's management. Patients and Methods: The study included 100 patients; 65 males (65%), and 35 females (35%). Their ages ranged from 3 to 69 years with mean age about 31 years. Patients were selected based on clinical and X-ray image suspicion of MSK tumors. Signal intensity of the lesion on DWI was determined and Attenuation Diffusion Coefficient (ADC) map was measured. The Region of Interest (ROI) for each lesion was placed at least 3 times, and then the mean ADC value for the lesion was calculated. Histopathological findings and clinical follow-up were used as standard of reference. Results: Twenty one 21 (21%) patients had benign tumors, 73 (73%) patients had malignant tumors and 6 (13.6%) patients had tumor like lesion. The cut-off value for mean ADC was <1 X 10–3mm2/sec. The gold standard of this study was the histopathological correlation and the imaging-clinical correl-ative features for the benign lesions. Conclusion: DWI MRI technique that is easily included in a routine MR study with short scanning time offering valuable data about the cellularity of a MSK lesion and properly differentiating benign and malignant lesions.
MRI,DWI,ADC map,Musculoskeletal tumors
https://mjcu.journals.ekb.eg/article_88437.html
https://mjcu.journals.ekb.eg/article_88437_a872589c1851405a47a004bb2b71f103.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Effectiveness of Gastrografin Study and Multidetector CT Study in Evaluation of Early Complications of Laparoscopic Sleeve Gastrectomy Complications
5113
5120
EN
MOMENA
ESSAM ELSADAWY, M.D.
The Department of Radiodiagnosis and Nucleur Medicine, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.88438
Abstract Background: Laparoscopic sleeve gastrectomy is a rela-tively recent surgical technique that was estimated to account for about 5% of all bariatric surgery. Post-operative compli-cations detection could be done by either fluoroscopic gastro-grafin meal or multislice CT study before and after contrast administration. Aim of Study: To compare between the effectiveness of the main imaging modalities of early post-operative compli-cations of laparoscopic gastric sleeve surgery, including fluoroscopic gastrografin meal and multislice CT study. Patients and Methods: The study included 150 patients; 128 females (85%), and 21 males (15%). Their ages ranged from 26 to 55 years with mean age about 41 years. Patients were selected based on clinical suspicion of post-operative complications. Fluoroscopic gastrographin study and multi-detector CT study have been done. Operative findings corre-lation and clinical follow-up were the standard of reference. Results: Forty (30%) patients had matched fluoroscopic and CT findings, 110 (70%) patients had positive CT findings but, negative fluoroscopic findings. 0% had positive fluoro-scopic findings and negative CT findings. The leak was suspected in 80 patients, 5 patients with active bleeding that was clinically suspected, but the exact site of bleeding could not be identified by CT, 37 patients had serous fluid collection, splenic infarction was noticed in 5 patients, 3 patients developed post-operative hematoma one of them become infected, anterior abdominal wall hematoma seen in 5 patients, one patient developed portal vein thrombosis. Conclusion: Multidetector CT is better imaging modality in precise detection of early post laparoscopic sleeve gastrec-tomy complications than fluoroscopic gastrografin imaging.
CT,Laparoscopic sleeve gastrectomy (LSG),Fluoroscopic gastrografin meal
https://mjcu.journals.ekb.eg/article_88438.html
https://mjcu.journals.ekb.eg/article_88438_cec023f2ee9427b3a926e103596b6efc.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Beneficial Effect of Quercetin Against Dimethoate Induced Cerebellar Cortex Injury in Adult Male Albino Rat: Histological and Immunohistochemical Study
5121
5134
EN
AMIRA E. ALSEMEH, M.D.;
EMAN M.A. ABDELGHANY, M.D.
NANCY
H. HASSAN, M.D.
The Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Egypt
10.21608/mjcu.2019.88800
Abstract Background: The organophosphorus compound dimethoate is pesticide that widely used across the world to control worms and insects. It is highly toxic and causes neurobehavioral disorders. Quercetin is a natural flavonoid that is profusely found in fruits and vegetablesand is known for its antioxidants property and its ability to improve oxidative stress and promote cellular survival. Aim of Study: To assess neurotoxicity and structural alterations of cerebellar cortex caused by dimethoate and explore the neuroprotective potential effect of quercetin. Material and Methods: The study was carried out on 32 adult, male Wister albino rats weighing 180-200g, they were randomly divided into four groups: Normal control, dimethoate treated (30mg/kg alternate day), quercetin treated (50mg/kg daily) and combined dimethoate + quercetin treated. All the treatments continued for 60 days. All animals were anesthe-tized, cerebellum was removed to prepare the specimens for histological, immunohistochemical and biochemical exami-nation. Results: The results revealed asign of toxicity and a significant decrease in body weight of animals treated with dimethoate which were substantially improved upon concurrent supplementation with quercetin. Further, treatment with dimethoate resulted in a significant decrease in the activity of acetyl cholinesterase in cerebellum tissue which was increased upon co-treatment with quercetin. On the contrary, we noticed a significant increase in the levels of MDA in cerebellum which were revealed significant reduction upon supplementation of quercetin. Light microscopic examination of cerebellum showed histoarchitectural alterations with significant up regulation of apoptotic marker (caspase-3) and astrogliosis marker Glial Fibrillary Acidic Protein (GFAP) in cerebellar tissue, Although, there were a significant down regulation of synaptophysin (SYP) immunoexpression. These changes were improved upon co-treatment with quercetin. Therefore, we conclude that quercetin when used as a prophy-lactic intervention would afford safeguard against dimethoate induced neurotoxicity.
Quercetin,dimethoate,cerebellar cortex
https://mjcu.journals.ekb.eg/article_88800.html
https://mjcu.journals.ekb.eg/article_88800_d95e2afaa1de543a5d309b7c600e1e85.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Impact of Endoscopic Biliary Drainage on Intrinsic Hepatic Blood Flow in Human
5135
5142
EN
MAHMOUD ALLAM, M.D.;
AHMED ATTIA, M.D.
ESSAM EL SHIMI, M.D.;
MOHAMED EL WARAKI, M.D.
WESAM
MORAD, M.D.
The Departments of Hepatology*, Interventional Radiology** and Epidemiology & Preventive Medicine***, National Liver Institute, Menoufia University, Egypt
10.21608/mjcu.2019.88801
Abstract Background: Obstructive jaundice affects a significant portion of people with injurious effect on the liver. Aim of Study: The study aimed to study the impact of biliary drainage on hepatic blood follow. Patients and Methods: This was a prospective study, conducted from January 2018 to December 2018. Thirty-six patients with biliary obstruction aged 21-72 years, 26 out of them have calcular obstructive jaundice, and the rest of the patients have malignant biliary obstruction. The majority of cases were non-cirrhotic (32 versus 4). Liver tests; (bilirubin level, alkaline phosphatase, GGT, albumin, INR, ALT and AST), and Kidney function tests (blood urea and serum creatinin) and CBC were done. Plus, other pre-ERCP assess-ments were done. Abdominal Ultrasonography (US) and Doppler study of portal and hepatic veins and hepatic artery with measurement of Hepatic artery Resistive Index (RI), Portal vein diameter and congestive index were done, CT and MRCP if indicated and ERCP for all patients. Two weeks after ERCP, all included patients underwent repetition of the same laboratory and Doppler US. Results: Significant changes in patients' laboratories and in liver hemodynamics were noticed after biliary drainage. The mean values of hepatic artery RI were significantly higher and mean values of portal vein maximum velocity (V max) were lower in studied patients before and after biliary drainage. Conclusions: Liver hemodynamics measured by Doppler Ultrasound of hepatic artery RI &V. max of portal vein may be a good predictor of liver injury in biliary obstruction.
Endoscopic,Biliary drainage,Intrinsic,Blood flow
https://mjcu.journals.ekb.eg/article_88801.html
https://mjcu.journals.ekb.eg/article_88801_69f06b8557c6f57b1a643e531338f3a8.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Role of Diffusion-Weighted Magnetic Resonance Imaging in Discrimination of Endometrial Carcinoma from Benign Diseases Affecting the Endometrium
5143
5156
EN
NERMIN Y. SOLIMAN, M.D.;
MAHA M. ZAKI BILAL, M.D.
MOUSTAFA M. MOHAMED AL-KHIARY, M.D.;
EMAN M.H.M. ABO EL-ATA, M.D.
MARIAM
Y.M. FARID, M.Sc.
The Departments of Radiology* and Gynecology & Obstetrics**, Faculty of Medicine, Mansoura University, Mansoura, Egypt
10.21608/mjcu.2019.88805
Abstract Background: Evaluation of the role of diffusion-weighted imaging (DWI) in differentiation between endometrial carci-noma and benign diseases affecting the endometrium. Aim of Study: To assess the efficacy and the diagnostic accuracy of DWI in discrimination of endometrial carcinoma from benign endometrial and subendometrial diseases with pathologic correlation. Material and Methods: This study included 100 female patients with endometrial and subendometrial pathologies, their ages ranged from 20 to 85 years. Conventional T2- weighted, pre- and post contrast T1-weighted and DW-MRI images with b values 0, 500, 1000 s/mm2 were obtained. The mean ADC values of all lesions were recorded. Results were compared, correlated with final histopathological diagnosis reached by hysteroscopy, endometrial biopsy and surgical findings. Results: Patients were divided according to the final histopathological diagnosis into two categories (category I: included 40 patients with endometrial carcinoma and category II: included 60 patients with benign endometrial and suben-dometrial diseases). In DWI qualitative analysis; all studied cases with endometrial carcinoma displayed high signal intensity, however; there was overlap in DWI SI as regard benign diseases. The mean ADC value of endometrial cancer was 0.73±0.10 x10-3mm2/s which was significantly lower than that of benign diseases 1.36±0.32 x10-3 mm2/s (p<0.001). The cut off value for differentiation between endometrial cancer and benign diseases was 0.915 X10-3mm2/s with sensitivity, specificity and accuracy of 97.5%, 88.3% and 92.0% respectively. Conclusion: DWI combined with ADC measurement provides valuable information for evaluation of suspicious endometrial and subendometrial pathologies and is able to discriminate endometrial carcinoma from benign diseases affecting the endometrium with high diagnostic accuracy.
Diffusion-weighted,MRI,DWI,ADC
https://mjcu.journals.ekb.eg/article_88805.html
https://mjcu.journals.ekb.eg/article_88805_d836b4e955c4a2edad9ff576d92bc623.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Cable-Tie Seton for Treatment of Complex Fistula in Ano
5157
5162
EN
MOSTAFA M. SALAMA, M.D.;
AHMED ABD EL AL SULTAN, M.D.
The Department of General Surgery, Faculty of Medicine, Al-Azhar University
10.21608/mjcu.2019.88807
Abstract Background: Seton is defined as a string-like material that can be tied through the fistula to induce an inflammatory reaction leading to fibrosis that fixes the sphincter and prevents its retraction when it is divided. Seton is commonly used by surgeons for treatment of complex anal fistula (complexity means: Fistula crossing >30% to 50% of the external anal sphincter, recurrence, multiple tracks, or co-existence of anal incontinence). Aim of Study: To detect the anal incontinence and recur-rence rate when we treat patients suffering from complex anal fistula by cable tie seton at a university hospital. Patients and Methods: Our study is a prospective case series including patients with complex anal fistula i.e. recurrent fistula, managed with cable tie seton from May 2015 to July 2018. Patients were followed up in the outpatient clinic after one week of seton insertion and then every two week. At each visit time, the cable-tie was tightened enough if found loose without anesthesia. Incontinence was inquired about using wexner's score. Results: During the study period, Seventy nine patients were treated. Their age was (mean ± standard deviation) 41±10.6 years. Tightening of the seton was done with a median of six times (3-15 times range). All patients had complete healing in 11.2±5.7 weeks. Follow-up was done for all patients for a variable period with minimum of one year and none of the them had any anal incontinence. Recurrence was noticed in 4 (5%) patients. Conclusion: The cable tie seton proved to be safe for the patients, cost effective and had low morbidity when used for the treatment of complex fistulae in-ano. Therefore, it can be recommended as standard method for treating complex fistulae-in-ano.
Seton,Fistula in ano,Recurrence
https://mjcu.journals.ekb.eg/article_88807.html
https://mjcu.journals.ekb.eg/article_88807_4f1b99c45feae989cf95baa2eb6dba76.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Ameliorative Role of Melatonin on CA1 of Hippocampus and Frontal Cortex in Induced Social Isolation in Adult Male Albino Rat
5163
5172
EN
AMANY
E.M. HAMOUD, M.D.
The Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Cairo, Egypt
10.21608/mjcu.2019.88810
Abstract Background: Social Isolation (SI) which means absence or insufficient contact with others is a key factor in psychiatric disorders development, which might be necessary for effective psychological treatment as social rehabilitation. Social expe-rience during the infantile period affects brain function and behaviour in rodents, dogs and human. Aim of Study: The current study was designed to elucidate the neuroprotective role of MT on experimentally-induced SI on CA1of rat hippocampus and frontal cortex. Material and Methods: Twenty adult albino rats were divided into four groups, control, sham control, SI and SI + MT. The Body Weight (BW), Brain Weight (BrW) were determined. Brain sections were subjected to histological, morphometric, biochemical and statistical studies. Results: SI induced various histological changes in both hippocampus and frontal cortex in the form of degeneration and absent neurons. SI also caused a significant (sig) increase in area % of caspase 3 and TNF Immunoexpression (IE) were recorded. Sig decrease in the activity of Total Antioxidant Capacity (TAC), Brain Derived Neurotropic Factor (BDNF), Superoxide Dismutase (SOD) activity, Acetyle Choline Este-rase (ACHE), dopamine level as well ARC gene, and a sig increase in Malondialdehyde (MDA) levels, FOS gene, sero-tonin and AB-42. Concomitant administration with MT im-proved sig the previously mentioned changes. Conclusion: SI might lead to various neurological degen-erations as indicated by the histological, morphometric, biochemical changes. These changes were ameliorated by concomitant administration with MT.
Brain,Hippocampus,Social isolation,Mela-tonin,antioxidant
https://mjcu.journals.ekb.eg/article_88810.html
https://mjcu.journals.ekb.eg/article_88810_3b4b073d9885f571480d6ab06d7c8e7e.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Percutaneous Pedicle Screw Fixation in Management of Dorsal and Lumbar Fracture Spine
5173
5178
EN
EL-GOHARY M. EL-GOHARY, M.D.;
MOHAMED A.S. SAWAN, M.D.
MOHAMED F. IBRAHIM, M.D.;
AHMED M. ALI, M.D.
MOHAMED
S.A. AZIZ, M.D.
The Department of Neurosurgery, Faculty of Medicine, Cairo* and Beni Seuf** Universities
10.21608/mjcu.2019.88814
Abstract Background: Percutaneous pedicle screw fixation is a minimally invasive spine surgery offers patients the benefits of decreased blood loss, fewer complications, and a more rapid return to daily activity. Aim of Study: To evaluate the percutaneous fixation as regard surgical procedure in the management of unstable dorsal and lumbar spine fracture and the clinical outcome. Patients and Methods: This study included 30 patients with traumatic thoracolumbar fractures. These patients were treated by percutaneous pedicle screw fixation. This study was conducted in Cairo University Hospitals from June 2011 to February 2014. They were neurologically free. Results: This series consist of 30 patients presenting with wedge and burst fractures of thoracic and lumbar spine (D12- L4). They were treated with percutaneous fixation. These patients were assessed pre-operative and post-operative looking into following points: (A) Clinical and functional assessment; (B) Radiological assessment (C) Intraoperative post-operative complication. Conclusion: Percutaneous spine fixation is a safe technique for treatment of thoracolumbar wedge and burst fractures with no neurological affection. It has the advantage of short time surgery, no blood loss, no muscle damage. Moreover, short hospital and bed stay are important benefits of percutaneous spine fixation.
vertebrae,percutaneous,Screw,fixation
https://mjcu.journals.ekb.eg/article_88814.html
https://mjcu.journals.ekb.eg/article_88814_3ceea310a71ca1faa70ff65b4ef4ce15.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Deep Breathing on Heart Rate Variability Following Coronary Artery Bypass Graft
5179
5186
EN
ZEINAB M. HELMY, Ph.D.;
ABEER A. FARGHALY, Ph.D.
AYMN S. GADO, M.D.;
HAIDY M. EL MOSALAMY, M.Sc.
The Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy* and The Department of Cardiothoracic Surgery, Faculty of Medicine**, Cairo University
10.21608/mjcu.2019.88815
Abstract Background: Autonomic complications are among the most frequently reported complications after Coronary Artery Bypass Graft (CABG) surgery. However, the risk of autonomic complications and it’s consequences is not equal for all patient, pre-operative, intraoperative and post-operative management modify the autonomic nervous system. HRV might assume an important role as a potential detector of autonomic system instability in the early post-operative phase in Intensive Care Unit and during hospital stay. Aim of Study: The aim of this study was to investigate the effect of using inspiratory muscle trainer as a method of deep breathing exercises rehabilitation, on autonomic nervous system modulation by analyzing heart rate variability and on functional capacity through 6-minute walk test in phase 1 cardiac rehabilitation post coronary artery bypass graft (CA-BG). Material and Methods: Forty male patients who underwent CABG aged from 40-60 years old and recruited from the Cardiothoracic Surgery, Kasr El-Ainy Hospital, Cairo Univer-sity enrolled in that study. They were assigned into two groups: Group (A) studying group: Consisted of 30 patients, which received inspiratory muscle training by inspiratory trainer in addition to routine physiotherapy programme according to department protocol in for of, percussion, vibration, and breathing exercises). Group (B): Controlled Group: The control group consisted of 20 patients, which received routine chest physiotherapy program, percussion, vibration, and breathing exercises). Programme started at first day after weaning from mechanical ventilation and end at the day of discharge. Results: Data obtained from two groups at the beginning of the study and after the end of the study before discharge from hospital regarding root square of successive differences between RR intervals (RMSSD) to calculate heart rate varia-bility and 6 minute walking distance were statistically analyzed and compared within the same group and between the two groups. Group A showed a significant increase in the RMSSD, and walking distance through 6 minute compared with that of group C (p<0.05) within the same group, and between the two groups. Using inspiratory muscle trainer in phase 1 cardiac rehabilitation post Coronary Artery Bypass Graft (CABG) is effective to enhance vagal tone through increasing heart rate variability and functional capacity. Conclusion: Within the limitation i of the current study, it is concluded that, inspiratory muscle training as a method of deep breathing technique ay improve heartrate variability as an indicator for vagal activity, that in turn improve cardiac sympathovagal balance, it was also included that the deep breathing by inspiratory trainer will also improve functional capacity which measured by distance travelled in 6 minute walk test.
Heart Rate Variability,Inspiratory trainer,CABG coronary artery bypass graft
https://mjcu.journals.ekb.eg/article_88815.html
https://mjcu.journals.ekb.eg/article_88815_42234a2704c55da55db0f6271ba6be5f.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Equivocal and Suspicious Breast Lesions: Can Contrast Enhanced Spectral Mammography Alter their BIRADS Categorization?
5187
5192
EN
NIVINE A. CHALABI, M.D.;
WALAA A.M.H. ATTIYA, M.D.
MOHAMED
E. EL-SHINAWI, M.D.
The Departments of Radiology* and Breast Surgery**, Faculty of Medicine, Ain Shams University
10.21608/mjcu.2019.88819
Abstract Background: Contrast Enhanced Spectral Mammography (CESM) is an advanced technique to detect the tumor neoan-giogenesis by using the dual energy technique with acquisition of a pair of low and high-energy images only after contrast medium injection. The potential clinical applications are the clarification of mammographically equivocal lesions, the detection of occult lesions on standard mammography, partic-ularly in dense breast, the determination of the extent of disease, the assessment of recurrent disease and the monitoring of the response to chemotherapy. Aim of Study: To assess the potential of Contrast Enhanced Spectral Mammography (CESM) to upstage/downdstage the BIRADS category of equivocal and suspicious breast lesions. Patients and Methods: Thirty female patients with 44 equivocal and suspicious breast lesions, were enrolled in the study, age ranged from 20 to 76 years. All patients underwent conventional mammography and ultrasound then CESM. Results: Mammography + Ultrasound categorized 40/44 lesions (90.9%) lesions to be malignant (BIRADS 4,5) and 4/44 lesions (9.1%) to be benign (BIRADS 1,3). CESM cate-gorized 35/44 lesions (79.5%) to be malignant (BIRADS 4,5) and 9/44 lesions (20.5%) to be benign (BIRADS1,3). Disa-greement about BIRADS category was observed in 25% of the examined lesions including upgraded and downgraded lesions in 11.36% and 13.6% respectively. 100% of up/down graded lesions also proved CESM to be correct in reference to the final diagnosis. Conclusion: CESM has better diagnostic performance than mammography plus Ultrasound and provides a valuable tool to accurately evaluate equivocal and suspicious breast lesions.
Contrast Enhanced Spectral Mammography (CESM),Suspicious Breast Lesions
https://mjcu.journals.ekb.eg/article_88819.html
https://mjcu.journals.ekb.eg/article_88819_6d67b186c1e996e0c2bcc9fce108a244.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Impact of Acne Vulgaris on Patients' Quality of Life
5193
5199
EN
NOHA E. MOHAMAD, M.D.;
SAWSAN Kh. ELSAYED, M.D.
LAILA A. REFAAT, M.D.;
WESAM MORAD, M.D.
The Department of Dermatology & Venereology, Faculty of Medicine, Fayoum University
10.21608/mjcu.2019.88821
Abstract Background: Acne is a common inflammatory skin disor-der manifested by comedones, papules and pustules mainly at face. Acne may be complicated by nodules, cysts and residual scarring that affect life quality. Aim of Study: Was to determine the impact of acne on health related quality of life comparing with normal healthy control. Patients and Methods: The current study included 400 subjects aged from 13 to 18 years old. They were divided into patients' group and control group, each included 200 subjects with age and sex matched. The patients group with mean age of (15.6±1.54); the female patients constituted 113 (56.5%). According to acne severity, the patient group included moderate acne (117) patients and severe acne in 83 patients. The control group included 114 (57%) females. Full history taking, general examination including measuring of BMI, dermatologic ex-amination to determine site, extent and grading. Results: Acne negatively affects self-perception in com-parison with control while no difference in social role between cases and control. There is a positive correlation between self-perception and the other domains, while there is a negative correlation between acne symptoms and other domains of quality of life. Conclusions: Acne can affects social and psychologic impact on life quality. Recommendations: Assessment of life quality in acne patients is a must and should be taken into consideration before deciding line of treatment.
Acne,quality of life,self-perception
https://mjcu.journals.ekb.eg/article_88821.html
https://mjcu.journals.ekb.eg/article_88821_a8da47bab0e63b277b1fe75b637c32d3.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Fibrosis Stage as a Predictor of Outcome after Resection for Hepatocellular Carcinoma
5201
5206
EN
MAHMOUD H. ALLAM, M.D.;
MOHAMED A.S. KOHLA, M.D.
ALIAA SABRY, M.D.;
OSAMA HIGAZY, M.D.
WALEED ABOGHARBIA, M.Sc.;
ASHRAF ABOGABAL, M.D.
The Departments of Hepatology & Gastroenterology* and Hepatobiliary Surgery**, National Liver Institute, Menoufiya University and Kobry Al-Qubaa Military Hospital, Cairo***, Egypt
10.21608/mjcu.2019.89610
Abstract Background: As liver stiffness measured by FibroScan® can reflect the degree of liver fibrosis, liver stiffness meas-urement can predict the liver functional reserve. Aim of Study: To evaluate the relationship between liver fibrosis stage and the risk of post-operative hepatic decom-pensation in patients with liver cirrhosis undergoing hepate-ctomy for hepatocellular carcinoma. Patients and Methods: This prospective study was con-ducted on forty adult patients with HCV-related HCC eligible for hepatic resection between May 2015 and February 2017. Liver stiffness measurement by Fibroscan® was prospectively done for all enrolled patients. Patients' demographics, comor-bidities, laboratory and radiological data were collected. Results: Hepatic decompensation occurred in 14 patients (35%) after liver resection. Analysis of ROC curve of liver stiffness measurement done before resection revealed a value equal to or higher than 15.4KPa as the best cutoff value for liver fibrosis stage predicting post-operative hepatic decom-pensation with a sensitivity of 100%; specificity 100%, a positive predictive value 100% and negative predictive value of 100%. Conclusion: Liver stiffness measurement by transient elastography (Fibroscan®) may be a reliable tool to predict hepatic decompensation after liver resection for HCC.
Liver Stiffness,Elastography,FibroScan,fibrosis,Hepatocellular carcinoma resection,hepatitis C
https://mjcu.journals.ekb.eg/article_89610.html
https://mjcu.journals.ekb.eg/article_89610_52357305ee0b21a677b3c28c5d245b75.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Impact of Nursing Care Hours on Hospital Cost and Patient Satisfaction in Emergency Department
5207
5215
EN
NASHWA M. SALAH, M.Sc.;
EGLAL A. ABD EL-WAHB, D.N.Sc.
EMAN A.
ETAWY, D.N.Sc.
The Department of Nursing Administration, Faculty of Nursing, Cairo University
10.21608/mjcu.2019.89611
Abstract Background: Nurse can play an important role in helping reduce costs based on the unit census and patient acuity. Actually when nursing hours exceed the needed hours by patients, nurse managers typically are required to submit a report explaining the reason. Nurses can help make a difference in their unit budgets by not overstaffing their unit, avoiding excessive use of unscheduled leave and monitoring the use of supplies. Aim of Study: To explore the impact of average nursing care hours on hospital cost and patient satisfaction in Emer-gency Department. Material and Methods: Design: Descriptive, exploratory, correlational design was utilized to carry out the study. Setting: The study was conducted in Emergency Depart-ment at Soud Kafafi University Hospital. Sample: Convenient sample included twenty-five nursing staff worked in Emergency Department and random sample of Emergency Department conscious patients, the number of study sample was one thousand patients. Tools: Four tools were utilized for data collection, the first tool was patients triage level assessment; the second was financial record sheet, the third Nursing Care Hours Cost and the fourth was patient satisfaction questionnaire. Results: The study findings revealed that there was highly significant statistical strong positive effect between nursing care hours and hospital cost (Adj R2=.925, B=.385, p=.000). While, there is no statistical significant correlation between nursing care hours with patient satisfaction. Conclusion: The study concluded that positive effect between nursing care hours and hospital cost while no statistics effect was found between nursing care hours and patient satisfaction. Also, patients with highly acuity level consuming high nursing care hours and hospital cost. Recommendations: It is recommended that the head nurse should measure nurses direct care hours costs per patient in order to find out patient level nursing costs/intensity, the study recommend to develop strategies to measure nursing at nurse-patient encounter for developing nursing business intelligence by optimizing care vs costs and matching right nurse care provider.
Nursing care hours,Hospitals costs,emergency department,patient satisfaction
https://mjcu.journals.ekb.eg/article_89611.html
https://mjcu.journals.ekb.eg/article_89611_e4217e646ccb9238f1cde860b52023a0.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Percutaneous Nephrolithotomy for Large and/or Complex Renal Stone: A Pro spective-Multicentre Study
5217
5223
EN
ALAA A. EL SHENNAWY, M.D.;
AHMAD SEDDIQ, M.D.
SAMI A. ABBAS, M.D.;
MOHAMED FAWZY, M.D.
EHAB N. EISSA, M.D.;
AYMAN M. EDREES, M.D.
The Departments of Urology*, Anesthesia**, National Institute of Urology & Nephrology and The Department of Urology, Al-Azhar University, Girls Div. ***, Cairo, Egypt
10.21608/mjcu.2019.89759
Abstract Background: Percutaneous Nephro-Lithotomy (PNL) is a well-established technique for removal of renal stones. Large and complex renal stones are difficult stones to deal with. Aim of Study: This study is to evaluate our results of PNL for treatment of large and complex renal stones concerning Stone Free Rates (SFR) and complications. Patients and Methods: From 2012 to 2017, four hundreds and four renal units with large and/or complex renal stones were subjected to PNL. Eighty nine percent were males and 11% were females. Average stone Surface Area (SA) was 872mm2. Results: Stone Free Rate (SFR) was 79% for cases sub-mitted to PNL alone and 88.4% for those managed with auxiliary procedures. Hospital stay ranged from 2 to 21 days (Av. 3.6 days). Overall complication rate was 8% and were managed conservatively. Conclusion: PCNL is a safe and effective procedure for management of large and complex renal stones. There was a significant decrease in overall stone free rate and increased complication rates with increased stone surface area. Stones >1500mm2 are difficult stones for any modality. Multimodal approach should be thought of for large and complex renal stones.
kidney,Kidney calculi,Percutaneous nephro-lithotomy,Intracorporeal lithotripsy,Large,complex,Minimally invasive
https://mjcu.journals.ekb.eg/article_89759.html
https://mjcu.journals.ekb.eg/article_89759_569628460a5511ba42188742382f61af.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Chronic Nicotine Exposure on Maternal Renal Adaptations in Pregnant Rats: The Possible Role of Nitric Oxide
5225
5235
EN
ALAA H. MUSALLEM, M.Sc.;
SALMA E. NASSAR, M.D.
REHAB E. ABO ELGHEIT, M.D.;
RAMEZ A. BARHOMA, M.D.
The Department of Physiology, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.89760
Abstract Background: Nicotine exposure during pregnancy contin-ues to be a widespread public health problem, impacting both fetal and postnatal health. Although the deleterious effects of nicotine on fetal development and the newborn have been extensively investigated, few studies have focused on its negative effects on the maternal adaptations to pregnancy especially relevant on renal functions. Aim of Study: To study the effects of chronic nicotine exposure on the maternal renal adaptations during pregnancy and the possible underlying mechanisms. Material and Methods: Thirty six adult virgin female albino rats, divided into two main groups, each subdivided into three subgroups; all received treatment for four weeks. Group I (virgin): Subdivided into; saline treated: Received daily subcutaneous saline injections, nicotine treated: Received daily nicotine bitartrate (1mg/kg) subcutaneous injections, combined with transdermal nicotine patches (5.2mg nico-tine/day) application, and nicotine and L-arginine treated: Received the same nicotine therapy plus 0.25% L-arginine added to drinking. Group II (pregnant): Subdivided into; saline treated: Received daily subcutaneous injections of saline (2 weeks prior to mating and 1 st two weeks of gestation), nicotine treated: Received daily subcutaneous injections of nicotine bitartrate (1mg/kg), with transdermal nicotine patches, and nicotine and L-arginine treated): Received same nicotine therapy plus 0.25% L-arginine added to drinking water. Results: Physiological effects of the pregnancy on renal function were significantly improved by L-argini ne. Similarly, nicotine exposure to virgin group produced a significant increase in serum and urinary Na+, significant decrease in renal total protein, nitric oxide with renal oxidative stress compared to their control group. Co-administration of nicotine and L-arginine to virgin group produced a significant decrease in serum Na+, urinary albumin and renal MDA levels, and significant increase in the urinary Na+ level, renal total protein, NO and GSH levels compared to the virgin nicotine group. Similarly, nicotine administration to pregnant group produced a significant increase in serum and urinary Na+, FENa, urinary albumin levels, together with significant de-crease in GFR, UFR and renal total protein, NO and GSH levels. While co-administration of nicotine and L-arginine to pregnant group produced a significant decrease in serum Na+, FENa, urinary albumin levels, with significant increase in the GFR, UFR and renal total protein, NO and GSH levels. Conclusion: We concluded that chronic nicotine exposure potentially impaired maternal renal adaptation to pregnancy which was improved greatly by L-arginine, implicating NO as crucial player.
L-arginine,glutathione,Malondialdehyde,Nicotine,Pregnancy
https://mjcu.journals.ekb.eg/article_89760.html
https://mjcu.journals.ekb.eg/article_89760_66c32a7520c363823a6a5c8a6124db0d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Effect of Crocin on Letrozole-Induced Polycystic Ovarian Syndrome
5237
5243
EN
YASMIN M. EID, M.Sc.;
ELHAM M. NASIF, M.D.
MOHAMMED M. SHEBL, M.D.;
MOHAMMED M. MADI, M.D.
The Department of Physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
10.21608/mjcu.2019.89762
Abstract Background: Letrozole (LET), a non steroidal aromatase inhibitor. Produce an animal model to study Polycystic Ovarian Syndrome (PCOS). Clomiphene Citrate (CC), first-line in treatment of PCOS. Crocin is a carotenoid used as traditional medicine to treat many diseases. Aim of Study: Study effect of crocin on letrozole-induced polycystic ovarian syndrome. Material and Methods: Forty local strainfemale rats were used in this study; these animals were divided into four main groups (ten rats each). Group I: Normal group. Group II (Letrozole-induced PCOS group): These ani-malswere adminstred LET once daily in a dose of 1mg/kg for 21 consecutive days by oral gavage. Group III; Crocin-treated group: Received LET as group II, then crocin 50mg/Kg once daily by intraperitoneal injection for 6 weeks. Group IV (CC treated group): Received LET as in group II, then CC 1mg/kg once daily by oral gavage for 6 weeks. Blood samples were collected by cardiac puncturefor analysis ofserumtestosterone. FSH, LH, estradiol, glucose, insulin and total cholesterol. HOM-IR where calculated. Ovaries were be dissected out. One ovary from one animal of each group was preserved in 10% formalin for histopathological study. Results: Letrozole treatment resulted in, increase in serum testesterone, FSH, LH, glucose, insulin, cholesterol levels and also, decrease in serum estradiol level. However, after injection of crocin, all parameters studied returned back to nearly normal levels as in control group there were no changes between crocin treated or CC treated groups. These results were confirmed by histopathological examination. Conclusion: These findings highlighted the important role played by crocin in treatment of polycystic ovarian syndrome.
Polycystic Ovarian Syndrome,Crocin,Clomi-phene citrate
https://mjcu.journals.ekb.eg/article_89762.html
https://mjcu.journals.ekb.eg/article_89762_6f639b71e8d44892aa4272533e24156e.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Detection of Plasma Level of Amyloid Protein Precursor in Children and Adolescent with Down Syndrome
5245
5254
EN
FATMA AL ZAHRAA N.M. SHERAI, M.Sc.;
MOHAMMED A. ROWISHA, M.D.
MAALY M. MABROUK, M.D.;
HEBA E. DAWOUD, M.D.
The Departments of Pediatrics* and Clinical Pathology**, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.89763
Abstract Background: Down syndrome (DS, Trisomy 21) is a genetic disease resulting from the presence of all or part of an extra 21 chromosome and may affect the function of any organ and system. It is the most common chromosomal ab-normality, with a frequency of 1:800 to 1:1000 births. In Egypt, it varies between 1 in 555 in one study to 1 in 770 in another. Amyloid Precursor Protein (APP) is a membrane protein concentrated in the synapses of neurons. APP prote-olysis generates beta amyloid (AR), which forms amyloid plaques found in the brains of Alzheimer's disease patients. In DS, there is increase in production of (AR), so children and adolescents are more susceptible for dementia and Alzhe-imer's disease. Aim of Study: It was to compare plasma Amyloid protein (AR) level in children suffering from DS with its level in the controls and correlation between (AR) level and Intelligent Quotient (IQ) of the studied subjects. Patients and MethoDS: This study was carried out on 40 Egyptian children divided into: 20 children with DS with age range (3-16 years) under follow-up at Genetics Unit of Pediatric Department Tanta University Hospital and 20 healthy children with normal karyotyping matched for sex and age. All patients and controls were subjected to complete history taking, clinical examination, and laboratory investigations including (karyo-typing, cholesterol & triglycerides level, thyroid function test, random blood sugar, Intelligent Quotient (IQ), and beta amyloid protein serum level. Results: Serum Beta amyloid protein level was signifi-cantly higher in children and adolescents with DS in compar-ison with healthy control. Conclusion: We concluded that serum Beta amyloid protein level was significantly higher in children and adoles-cents with DS in comparison with healthy control. We also concluded that there was a significant positive correlation between serum beta amyloid protein level and age of children and adolescents with Down syndrome and there is no corre-lation between AR and IQ.
Down syndrome,Serum Beta amyloid protein (AR) by ELISA
https://mjcu.journals.ekb.eg/article_89763.html
https://mjcu.journals.ekb.eg/article_89763_09b018ceb3963c1e390d795c3cdc0d6e.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Potential Effect of Irisin and/or Moderate Intensity Exercise on Metabolic Homeostasis in Obesity in Male Albino Rats
5255
5262
EN
ABEER A.
ABOZEID, M.D.
The Department of Physiology, Faculty of Medicine, Tanta University, Egypt
10.21608/mjcu.2019.89764
Abstract Background: Exercise may encourage myokines secretion such as irisin. Irisin is one of the myocytokines that is related to energy homeostasis and obesity. Aim of Study: Study the effect of irisin and/or moderate intensity swimming exercise on metabolic homeostasis in high fat induced obesity in male albino rats. Material and Methods: The present work will be carried out on 50 male albino rats, they were divided into 2 groups I: Control group 10 rats fed with normal diet and intraperitoneal injected with 150ml saline daily for 8 weeks II: Obese group 40 rats were fed with high fat diet they are subdivided into 4 subgroups 10 rats each IIa. Control obese IIb. Irisin treated Obese these rats are intraperitoneal injected with irisin in a dose of 100ng/ml per day for 8 weeks IIc. Exercise treated Obese the exercise groups will swim for 30min a day, 5 days a week for 8 successive weeks IId. Irisin and exercise treated obese group rats will be treated as subgroup b and c. At the end of the experimental period, the following parameters were measured for all animals: Body Weight (BW), Body Mass Index (BMI), abdominal circumference. Blood samples were obtained to measure serum insulin, fasting blood glucose, calculate Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and, Homeostatic Model Assessment of Insulin Sensitivity (HOMA-S), measure serum Irisin, osteopontin, Total Cholesterol (TC), LDL cholesterol level, HDL cholesterol level, Triglycerides (TG), Free Fatty Acids (FFA), Nitrite/Nitrate and Malondialdehyde (MDA). Results: Final BW in irisin and/or exercise animals are significantly decreased as compared to final BW of control obese group. Animal treated with Irisin and exercise shows insignificant change as compared to final BW in normal control group. BMI, abdominal circumpherence, serum insulin, fasting glucose, Homa IR, osteopontin, TC, LDL, TG, FFA, MDA are significantly increased in obese rats as compared to normal control, either Irisin injection or exercise results in significant decrease in all these parameters, when Irisin injection is combined with exercise it causes significant decrease when compared to control obese and insignificant difference with normal control group. As regard Irisin level, HOMA insulin sensitivity, HDL and Nitrite/Nitrate they are significantly decreased in obese rats as compared to normal control, either irisin injection or exercise results in significant increase in these parameters, if Irisin injection is combined with exercise it causes significant increase in these parameters reaching the normal control level. Conclusion: Irisin and/or moderate intensity swimming exercise initiate a novel strategy for the treatment of obesity also the potential use of irisin as a predictive marker for insulin resistance has a therapeutic potential in obese rats.
Obesity irisin,exercise,Osteopontin
https://mjcu.journals.ekb.eg/article_89764.html
https://mjcu.journals.ekb.eg/article_89764_541b2dc2be6805581f7bd0cc91ab6cfc.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Ventricular Shunting Paradigm in Surgical Management of Arrested Hydrocephalus in Children with Distorted Mental Status
5263
5268
EN
MAHMOUD SAAD, M.D.;
MOHAMED RAAFAT, M.Sc.
AHMED ZAHER, M.D.;
HATEM BADR, M.D.
The Department of Neurosurgery, Faculty of Medicine, Mansoura University, Egypt
10.21608/mjcu.2019.89767
Abstract Background: Wide range of psychomotor development abnormalities can occur in compensated hydrocephalus, ranging from minor cognitive changes up to mental retardation; this may be attributed to the difficulty in differentiation between compensated hydrocephalus and slowly progressive hydrocephalus. Aim of Study: To establish whether CSF shunting proce-dures can improve the cognitive development in children with arrested hydrocephalus and apparent clinically normal. Patients and Methods: This study is a prospective rand-omized controlled trial included 20 consecutive children with arrested hydrocephalus in preschool age with no other cause of mental retardation. All the patients had deviated IQ (intel-ligence quotient) below than average) and they were subdivided into 2 groups: Group I control group; 10 patients had been followed-up clinically and group II study group; 10 patients had been surgically managed through ventriculoperitoneal shunting. Anterior fontanelle, orbitofrontal circumference and IQ are assessed initially and 6 months later and compared in both groups. Results: Ventricular shunt improved papilledema (5 out of 6 became normal fundi), improved cognitive function (5 out of 8 mild MR became average 90-110 IQ test). Ventricular shunt did not improve the ventricular size in all patients in both groups who still having papilledema. Conclusions: Young children with arrested HCP without any signs of increased ICP and average IQ should be followed carefully to detect any cognitive delay or decompansation. Ventricular shunting is helpful to improve psychomotor development in patients with cognitive delay.
Arrested hydrocephalus,cognitive impairment,Shunting,Anterior fontanel,Orbitofrontal circumference
https://mjcu.journals.ekb.eg/article_89767.html
https://mjcu.journals.ekb.eg/article_89767_21c30a07ae3280c98574ea5753c7eb2b.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Case Report: Hepatitis E Viral Infection after Kidney Transplantation. Guidelines Revisited
5269
5273
EN
MOHSEN EL KOSSI, M.D.;
SANAA FADEL, Ph.D.
Consultant Nephrologist Doncaster Royal Infirmary Hospital, Doncaster, UK* and Department of Microbiology & Immunology, Faculty of Pharmacy, Cairo University, Egypt**
10.21608/mjcu.2019.89769
Abstract Clinical practice guidelines of hepatitis E treatment post solid organ transplantation would undoubtedly help improve management of these cases. Whilst hepatitis E viral infection runs a benign course in healthy individuals, it can lead to persistent hepatitis and liver cirrhosis in immunocompromised patients including patients with solid organ transplantation. Available treatment options of these cases lack supporting robust evidence and they are derived from limited number of case series. There are no randomised clinical trials that help inform clinicians' decision making. This results in some gaps in the current guidelines that may require further attention. We hereby present a kidney transplant recipient who developed hepatitis E viral infectio
Hepatitis E Viral Infection,Kidney Transplan-tation
https://mjcu.journals.ekb.eg/article_89769.html
https://mjcu.journals.ekb.eg/article_89769_aad1f8886279ad128c9d0af9fd3ff350.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Double Consecutive Lumbar Discectomy: Is Fixation a Rule?
5275
5281
EN
MOHAMED GABER ABDEL TAWAB, M.D.;
MOSTAFA A. LATIF, M.D.
The Department of Neurosurgery, Faculty of Medicine, Fayoum University, Egypt
10.21608/mjcu.2019.89770
Abstract Background: Lumbar Disc Prolapse (LDP) represents less than 5% of all low back problems. Most of cases treated with conservative management. Surgery is needed in only 10% of cases. We will evaluate the need for hardware fixation after double consecutive lumbar discectomies. Aim of Study: Our study aims to answer the question of whether decompression-only surgery is sufficient for patients with double consecutive lumbar disc prolapse or they neces-sarily require spinal fixation and fusion. Patients and Methods: Our work was conducted on 30 patients with double consecutive LDP from January, 2016 to December, 2017 at Fayoum University Hospital. Double consecutive lumbar discectomy was done in all patients. Regular follow-up was done up to 6 months. Results: All cases had no instability 6 months after surgery. Four patients experienced mechanical low back pain 3 months postoperatively. MR images revealed facet joint arthropathy in two cases improved by medical treatment and the others required facet joint injection. Conclusion: Double consecutive lumbar discectomy is not considered a risk of instability but larger studies might be needed.
Consecutive,prolapse,Discectomy
https://mjcu.journals.ekb.eg/article_89770.html
https://mjcu.journals.ekb.eg/article_89770_6fb52b8314bb96d500e6cde6e96345ca.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Efficacy of Diffusion-Weighted MRI in Thyroid Nodules
5283
5291
EN
HOSSAM EL-DIN GALAL MOHAMMAD, M.D.;
MOSTAFA Th. HUSSEN, M.D.
REHAM S. SAYED, M.Sc.;
MARWA I. ABDELGAWAD, M.D.
GEHAN
S. SEIFELDEIN, M.D.
The Departments of Diagnostic Radiology* and Clinical Oncology**, Faculty of Medicine, Assiut University
10.21608/mjcu.2019.89774
Abstract Background: Differentiation of benign from malignant thyroid nodules remains a challenge. Diffusion-weighted magnetic resonance imaging is a recent non-invasive imaging can differentiate between benign and malignant lesions. Aim of Study: Evaluate the efficacy of Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) in discrmination between benign and malignant thyroid nodules comparing the results of Apparent Diffusion Coefficient (ADC) value with histopathological results. Material and Methods: This case-control study included 30 patients with solitary (dominant solid or mixed solid and cystic) thyroid nodules on the basis of ultras ono graphic examination (US) and 10 persons with normal thyroid of matching age and sex. All were subjected to clinical assess-ment, radiological assessment included thyroid US, color Doppler examination and conventional non contrast MRI, DWI and ADC maps were obtained. ADC values of each nodule were correlated with histopathological results. Results: The cut-off value for the differentiation of benign from malignant thyroid nodules was 1.3 X l0–3mm2/s with mean of (1.39±0.11 X l0–3mm2/s) for benign nodules and (0.81±0.17 X l0–3mm2/s) for malignant ones with the sensi-tivity and specificity are 100% and 88.9% respectively. The overall accuracy is 95%. Conclusion: Preliminary results showed that DW-MRI provides very useful and promising imaging to evaluate the nature of a thyroid nodule and in discrmination between benign and malignant nodules.
Diffusion-Weighted Magnetic Resonance Images (DW-MRI),Apparent Diffusion Coefficient (ADC) value,Thyroid nodules
https://mjcu.journals.ekb.eg/article_89774.html
https://mjcu.journals.ekb.eg/article_89774_c64d51d243fa01ead6745260d887c217.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Outcome of Transarterial Chemoembolization (TACE) in Patients with Hepatocellular Carcinoma
5293
5297
EN
ALI A.S. GHWEIL, M.D.;
AHMED O. MOHAMED, M.D.
SHAMARDAN EZZELDIN S. BAZEED, M.D.;
AHMED A.A. MOHAMMED, M.Sc.
The Departments of Tropical Medicine & Gastroenterology* and Radiology**, Faculty of Medicine, Qena University
10.21608/mjcu.2019.89785
Abstract Background: Transarterial Chemoembolization (TACE) is recommended as a treatment for unresectable Hepatocellular Carcinoma (HCC) in patients with normal compensated liver. The efficacy of TACE in cirrhotic patients with compromised liver function is unknown. Aim of Study: To evaluate the outcome following Tran-sarterial Chemoembolization (TACE) in patients with unap-plicable locoregional therapy in Hepatocellular Carcinoma (HCC). Patients and Methods: This Prospective Cohort study conducted on 50 patients with HCC at Tropical Medicine and Gastroenterology Department Qena University Hospital. Results: 56% of patients reached complete response within one month of treatment in mean duration of follow-up of 58.28 months, 66% of patients had recurrence 40% in <1 year and 26% 1-2 years, 34% of recurrence were target tumor progression, 20% intrahepatic new lesion and 12% both, total deaths were 46% of patients. Conclusions: TACE offers a reasonable palliative therapy for HCC.
Transarterial Chemoembolization (TACE),HCC
https://mjcu.journals.ekb.eg/article_89785.html
https://mjcu.journals.ekb.eg/article_89785_c1ed29363256ab2efc6cc55d802d27a3.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Correlation between Overactive Bladder Symptoms and Urodynamic Findings in Men and Women
5299
5308
EN
MOHAMED S. MOHMOUD, M.D.;
AYMAN M. EDREES, M.D.
SAYEDA
I. ALY, M.D.
The Department of Urology, Al-Zahraa Hospital, Al-Azhar Faculty of Medicine, Al-Azhar University** and El-Sahel Teaching Hospital*
10.21608/mjcu.2019.89787
Abstract Background: Overactive Bladder (OAB) is defined by the International Continence Society (ICS) as urgency, with or without urge incontinence (UUI), usually with frequency and nocturia, if there is no proven infection or other etiology. Aim of Study: To evaluate the correlation between over-active bladder symptoms (OAB) and urodynamic Detrusor Overactivity (DO) in non neurogenic bladder in both genders. Patients and Methods: We reviewed the records of 202 patients who attended Al-Zahra'a Univesity Hospital between October 2013 and October 2018 with overactive bladder symptoms urgency, with or without urge urinary incontinence usually with frequency and nocturia, with presence or absence of DO in two groups. All patients were subjected to: Full history taking, voiding diary, clinical examination, laboratory investigations, radiological investigations, urodynamic studies (UDS) and cystoscopic biopsies for histopathological exam-ination. Also we evaluate OAB symptoms, urodynamic pa-rameters with histopathological findings. All patients under-went uroflowmetry: The maximum flow rate, average flow rate and voided volume were recorded. Post Voiding Residual urine (PVR) volume was recorded. Cystometry: The intravesi-cal, intra-abdominal, detrusor pressure, first desire to void, strong desire to void, Maximum Cystometric Capacity (MCC), total volume infused, bladder compliance and detrusor over-activity were evaluated. Cystoscopy and random bladder biopsies from all patients and stained with Hematoxylin and Eosin for histopathological examination of smooth muscle, the urothelium, lamina propria, and adventitia. We used another special stain Massons trichrome to visualize collagen and degenerative changes of smooth muscle bundles. Results: Detrusor overactivity DO was diagnosed in (63.36%) 128 OAB patients after urodynamic studies. Of men 42.9% and 36.1% of women with urgency had DO (OAB dry) while 57.1 % of male 63.9% of female patients with urgency and Urge Urinary Incontinence (UUI) were (OAB wet) had DO. Of women 23.8% with no DO were also OAB wet having urodynamic Stress Urinary Incontinence (SUI). Combination of symptoms was more precise in predicting DO in OAB patients. Patchy areas of myohypertrophic and degenerative histological pattern were observed more in group I in both male and female patients. Conclusions: We concluded that there was better correla-tion between OAB symptoms and the urodynamic diagnosis of DO in women than in men, wet OAB more in women than in men in the same group I. Urgency, frequency and UUI in men, nocturia and UUI in women were significantly increased in predicting DO. Combination of objective parameters from the bladder diary, filling cystometry and histopathological findings have a better correlation with the occurrence of DO.
Urodynamic studies,Overactive bladder,Detrusor overactivity,Histopathological finding
https://mjcu.journals.ekb.eg/article_89787.html
https://mjcu.journals.ekb.eg/article_89787_ef15f0490eaa5080e3d26faf2dff6d9d.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Effect of Epidural Neostigmine Combined with Levobupivacaine on Neuraxial Analgesia during Labor
5309
5314
EN
HORIA A. FARRAN, M.D.;
ABEER E. FARHAT, M.D.
The Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine for Girls, Al-Azhar University
10.21608/mjcu.2019.89799
Abstract Background: Neuraxial analgesia is the gold standard for conducting painless labor either by epidural route or combined spinal epidural. Aim of Study: This study is to evaluate the effect of adding neostigmine to levobupivacaine for epidural labor analgesia on mother and neonate. Patient and Methods: After approval from local ethical committee and obtaining written informed consent this pro-spective randomized double-blind study was conducted on 60 laboring mothers, aged between 21 to 38 years, ASA I & II, single pregnancy, gestational age >!37 weeks in active cervical dilatation (!95cm) subjected to normal labor by epidural analgesia. Parturient were randomly divided into two groups: Group L (n=30): Received 15ml of 0.125% levobupivacaine. Group N (n=30): Received 15ml of 0.125% levobupivacaine + 6mic/kg neostigmine. Onset of sensory block, duration of analgesia, maternal hemodynamics, motor block and total dose of levobupivacaine were recorded. Maternal outcome in the form of (duration of labor, mode of delivery), Apgar score at (1 and 5min) and side effects were also recorded. Results: There was faster onset of sensory block and prolonged duration of analgesia with neostigmine group compared with other group. No significant difference between both groups as regard hemodynamics. No motor blockade in both groups. There was significant reduction in the total dose of levobupivacaine with neostigmine group. There was shorter duration of labor with neostigmine group. No significant difference as regard mode of delivery, Apgar score and com-plications between the two groups. Conclusion: Neostigmine can be utilized as a safe adjuvant with levobupivacaine to provide a better quality of analgesia and reduce dose of local anesthetic during management of labor pain. Also it's safe for both mother and fetus.
Neostigmine,Levobupivacaine,Labor epidural analgesia
https://mjcu.journals.ekb.eg/article_89799.html
https://mjcu.journals.ekb.eg/article_89799_608e755420fffe8c75c0b06758ed88b4.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
The Role of Anogenital Distance Measurement in the Prediction of The Efficacy of Varicocelectomy in Primary Male Infertility
5315
5321
EN
ABD ELRAHMAN W. BEDAIR, M.Sc.;
AHMED F. GHAITH, M.D.
KHALID A. SALEM, M.D.;
AYMAN A. HASSAN, M.D.
The Department of Urology, Faculty of Medicine, Tanta University, Egypt
10.21608/mjcu.2019.89801
Abstract Background: Anogenital distance is a marker of genital development and adult testicular function. It is currently difficult to assess which patients are most likely to benefit from varicocelectomy. The present study showed that men with a longer AGD had a higher likelihood of improvement after varicocelectomy. Aim of Study: Is to evaluate the role of Anogenital Distance (AGD) measurement in the prediction of the efficacy of varicocelectomy on the improvement of semen parameters in primary male infertility. Material and Methods: •A prospective study included sixty male patients presented with primary infertility and clinical evident primary varic-ocele with altered semen parameters. •All patients underwent measuring the distance from the posterior aspect of the scrotum to the anal verge in millimeters using a digital caliper. •All patients underwent varicocelectomy (subinguinal ap-proach) by the same experienced surgeon using intraoperative Doppler and magnification loupe. •All patients were followed-up with semen analysis after 6 months of varicocele repair. Results: •Overall, 76.7% of our patients (46 patients) revealed improvement in their semen parameters after 6 months of varicocelectomy, men with longer AGD had better improve-ment in their semen parameters after surgery than men with shorter AGD, 30 patients (88.2%) with AGD >!30mm vs. 16 patients (61.5%) with AGD <30mm. •In patients with AGD >30mm. The sperm concentration increased from 13.5 to 18.8 million sperm per ml (p-value <0.001), the progressive motility (A + B) increased from 27.9% to 39.5% (p-value <0.001), the mean abnormal forms decreased from 57.2% to 36.2% (p-value <0.001). While in the other group with AGD <30mm there was no statistical differences in different semen parameters post-operatively. Conclusions: AGD may provide a novel metric to assess intrinsic testicular function and predict efficacy of varicocele repair.
genitalia,Anogenital distance,Varicocele
https://mjcu.journals.ekb.eg/article_89801.html
https://mjcu.journals.ekb.eg/article_89801_4ebfc2dde7120607b32407b29d1c6cf1.pdf
The Clinical Society of Cairo University
The Medical Journal of Cairo University
0045-3803
2536-9806
87
December
2019
12
01
Incidence of Neonatal Sepsis and the Causative Organisms in Neonatal Intensive Care Unit of Tanta University Hospital
5323
5332
EN
SHIMAA M. EL-MASHAD, M.Sc.;
SARA M. HAMAM, M.D.
MOHAMED S. EL-FARARGY, M.D.;
HAMED M. EL-SHARKAWY, M.D.
The Department of Pediatrics, Faculty of Medicine, Tanta University
10.21608/mjcu.2019.89803
Abstract Background: Neonatal sepsis is considered a major cause of morbidity and mortality among neonates worldwide. Pre-mature infants are more susceptible to sepsis. Diagnosis and management of sepsis are great challenges facing neonatolo-gists in NICUs. Aim of Study: The aim of this study was to evaluate the incidence of neonatal sepsis at neonatal Intensive Care Unit in Tanta University Hospital. The study was carried out on all admitted neonates with clinical signs and symptoms of sepsis at the time of admission or who developed sepsis during their hospital stay. Patients and Methods: This study was prospectively conducted over a period of 12 months from August 2017 to August 2018, at NICU in Tanta University Hospital. Results: A total of 330 neonates admitted to our TUH NICU along one year from August 2017 to August 2018 were divided into 2 groups as regard clinical and laboratory findings of sepsis. The 2 groups were: Group 1 (case): Sepsis group included (145) neonates who showed clinical presentation and laboratory findings of sepsis and Group 2 (control): Non sepsis group included (185) neonates who were free and not showing any manifestations of sepsis or any laboratory findings of sepsis. Conclusions: The incidence of neonatal sepsis in our TUH NICU was about 43.94% along one year and the most common organisms was klebsiella (31.03%) followed by staph aureus (20%).
Neonatal sepsis,Incidence,Klebsiella,Staph aureus
https://mjcu.journals.ekb.eg/article_89803.html
https://mjcu.journals.ekb.eg/article_89803_d76348156206aaf3d8ab3c5d1053ff26.pdf