2024-03-29T11:13:06Z
https://mjcu.journals.ekb.eg/?_action=export&rf=summon&issue=22430
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
A Comparative Study Assessing Surgical Outcome of Excision of Giant or Multiple Benign Breast Lesions Using Circumareolar Incision versus Round Block Technique
ASHRAF EL-ZOGHBY, M.D.;
HANY R. WAKIM, M.D.
DINA H. AHMED, M.D.;
AHMED F. AMER, M.D.
ABDEL-RAHMAN A.
ABDEL-AZIZ, M.Sc.
Abstract Background: Breast disease seriously affects the physical and mental health of women. In recent years, the incidence rates of Benign Breast Tumors (BBTs) and malignant tumors have been rising. The traditional surgical resection method for the various types of BBT leaves obvious scars and affects the appearance of the breast, with the continuous development of the social economy and the gradual improvement of living standards, demands for breast appearance are higher. Surgery should not only cure the breast disease, but it should also avoid damage to the functions and appearance of the breasts. Benign breast lesions, especially when multiple or giant, constitute a difficulty in obtaining complete wide excision with minimal breast deformity and minimal small scars in addition to the high risk of recurrence. In cases of benign breast lesions, bad cosmetic results are unacceptable neither by the patients nor by the surgeons. Aim of Study: The aim of the study is to compare between post-operative outcome of surgical excision of giant or multiple benign breast lesions (giant fibro adenomas or phylloids tumors) through a circum-areolar incision versus round block technique as regard cosmetic & oncological outcome & patient satisfaction. Patients and Methods: It was a prospective randomized study that included 20 patients aiming to compare between post-operative outcome of surgical excision of giant or multiple benign breast lesions (giant fibro adenomas or phylloids tumors) through a circum-areolar incision versus round block technique as regard cosmetic & oncological outcome & patient satisfaction. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Circum-areolar incisions and Round block techniques were proposed for patients in whom breast conservative treatment is possible on oncologic grounds but where a standard resection without reconstruction would lead to a poor cosmetic outcome. Study period: March 2020 to October 2020. Results: It was found that there is a rapid progress in the development of diagnostic methods and interventional methods of diagnosis. This increased the accuracy of these methods and their ability to differentiate benign from malignant tumors. Also the round block techniques proved to have a better outcome than the circumareolar technique in all the previous mentioned criteria. Conclusion: The application of oncoplastic surgery to benign breast disease is a new revolution in the surgical management of cases and should be the standard of care for selected cases.
Assessing surgical outcome
Giant
Multiple benign breast lesions
Circumareolar incision
Round block technique
2021
06
01
461
471
https://mjcu.journals.ekb.eg/article_167783_2df3f18fc51c20386547a133690e9447.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
18F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer
NOHA F.A. EL-QASSAS, M.Sc.;
RANIA A. MAAROUF, M.D.
ASMAA M.M.
SALAMA, M.D.
Abstract Background: Breast cancer is the most common cancer and the second leading cause of cancer mortality in women. Accurate diagnosis and staging are essential for the selection of the most appropriate therapeutic strategy and major deter-minants of patient prognosis and survival. Aim of Study: The purpose of our study is to evaluate the potential role of 18F-FDG PET/CT in monitoring treatment of breast cancer and assessment of recurrence after surgical or systemic treatment. Patients and Methods: This study is retrospective study, was conducted on (25) female patients over a period of 6 months between 2018 and 2019. Their ages ranged from 34 to 78 years with mean age of 52 years, all patients have positive history of breast cancer treatment. Those patients were referred to the Radio Diagnosis Department & Nuclear Medicine Department in Ain Shams University. Results: FDG-PET-CT is the investigation of choice for post-treatment follow-up of breast cancer. It has a great role in detection of newly developed lesions and detection of the disease progression. Conclusion: FDG-PET-CT is highly useful for monitoring response to therapeutic interventions. This technique can identify response to therapy earlier than any other imaging method currently available which greatly improves patient management by allowing termination of ineffective and toxic therapies. PET-CT proved to be helpful in the evaluation of anatomic regions that have been previously treated by surgery or radiation in which the discrimination between post-treatment scar and recurrent tumor can be problematic.
breast cancer
Positron Emission Tomography/ Computed Tomography18F-Fluoro Deoxy Glu-cose
2021
06
01
473
479
https://mjcu.journals.ekb.eg/article_167785_e1627d698c9d03ed81bcc15b77ca3472.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Effect of Honey Supplementation on Plasma Levels of Short Chain Fatty Acids in Malnurished Children
MAMDOUH A. MOHAMED, M.D.;
YASMIN G.A. EL GENDY, M.D.
JIHAN S. HUSSEIN, M.D.;
REDAB A. SAAD, M.Sc.
Abstract Background: Malnutrition in children is a global public health problem with wide implications. It is estimated that malnutrition is the underlying cause of 45% of global deaths in children below 5 years of age. Honey, has antioxidant, antimicrobial, immunomodulator and anticancer effects. Additionally, honey is appropriate synbiotic combinations can be more effective in benefiting the host than individually administering probiotic or prebiotic. Aim of Study: To evaluate effect of honey supplementation on plasma levels of short chain fatty acids in Malnurished childrenand to evaluate honey supplementation on malnurished infants and children regarding anthropometric measurements. Material and Methods: An interventional study. Forty patients of both sexes, aged 6 months to 2 years, were randomizally collected into two equal groups [intervention group 20 patients] and [control group 20 patients]. The study was conducted at Children Hospital of Ain Shams University, Cairo, Egypt during the period from 2018 to 2019. The grading of malnutrition was based on WHO z-score. The dietary intervention consisted ofhoney in a dose of 2ml/kg/day for 8 weeks. Main outcome measures: Evaluate effect of honey supplementation on malnourished children regarding plasma levels of short chain fatty acidsand anthropometric measurements. Results: Honey consumption in a group of malnourished children resulted in a positive effects as improving anthropo-metric measures and increase short chain fattyplasa levels. Conclusion: Honey intervention in a group of children with moderate to severe malnutrition resulted in positive effects on Short Chain Fatty Acids (SCFAs) plasma levels andanthropometric measures, further studies that include a larger number of patients are recommended toconfirm that honey, has beneficial effects, as a complementary agent, in children with Malnutrition.
Honey
short chain fatty acids
Malnutrition
2021
06
01
481
489
https://mjcu.journals.ekb.eg/article_167787_2a54d040547691b8645ed6465f2958a0.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Prediction of Surgical Outcome as Regards Stone Free Rate and Complications after Percutaneous Nephrolithotomy Using S. T. O. N. E. versus sResc Scoring Systems
AHMED S. HEGAZY, M.D.;
MOHAMMED I. SHABAYEKA, M.D
ABDELRAHIM G.A.
ELSHERBINY, M.Sc.
Abstract Background: Nephrolithiasis is a major worldwide source of morbidity, constituting a common urological disease affect-ing 10-15% of the world population. Aim of Study: To compare the S.T.O.N.E versus sResc scoring system in prediction of the surgical outcome as regards stone free rate and complication after PCNL. Patients and Methods: A prospective randomized clinical study conducted in Department of Urology, Faculty of Med-icine, Ain Shams University Hospitals. Study period was 6 months from 3-2020 till 9-2020. Results: STONE total score involved size, tract length, degree of obstruction, number of involved calyces and stone density. STONE score was 6.8±1.7. S-ReSC total score was 3.1±1.6. A significant statistical association between both scores was found (c2: 119.681, p < 0.001). Mean STONE score was 6.19±1.20 compared to 7.92±1.89 in free and residual group of patients respectively (t: 4997; p < 0.0001). Mean S-ReSC score was 2.14±0.88 compared to 4.76±1.30 in free and residual group of patients respectively (t: 4997; p < 0.0001). Both scores were higher significantly in patients with residual stones. The ROC curve shows that the best cut off point for S-ReSC score to detect residual free rate was found >2 with sensitivity 100%, specificity 76.19% and Area Under Curve (AUC) 95% while the best cut off point for STONE score to detect residual free rate was found >6 with sensitivity 70.3%, specificity 68.3% and Area Under Curve (AUC) 76.4%. Conclusion: Both S-ReSC and S.T.O.N.E Nephrolithom-etry Scores can be used to stratify the complexity of renal stone before PCNL to predict the stone clearance and compli-cation.
Stone free rate
PCNL
Nephrolithotomy
S. T. O. N. E
sResc
2021
06
01
491
498
https://mjcu.journals.ekb.eg/article_167788_2ec7d2f1f282bcad1809a0b04e55effa.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Effect of Honey Supplementation on Plasma Levels of Short Chain Fatty Acids in Healthy Infants
MAMDOUH A. MOHAMED, M.D.;
YASMIN G.A. EL GENDY, M.D.
JIHAN S. HUSSEIN, M.D.;
EMAN M.A. GAML, M.Sc.
Abstract Background: Honey is a sweet and flavorful natural product, which is consumed for its high nutritive value and for its positive effects on human health, including antioxidant, antimicrobial, antiinflammatory, woundhealing, antitumor, immunomodulator, prebiotic and probiotic properties. Honey is produced by honey bees from plant nectars, plant secretions and excretions of plant-sucking insects. Concerning its nutrient profile, it represents an interesting source of natural macro-and micro-nutrients, consisting of a saturated solution of fructose, glucose, and to Fructo-Oligosaccharides (FOS) that can serve as prebiotics, but also of a wide range of minor constituents, especially phenolic compounds. Aim of Study: Evaluation of the effect of honey supple-mentation on plasma levels of short chain fatty acids in healthy infants and on the anthropometric measurements. Subjects and Methods: This study was a single arm pro-spective interventional study. Twenty healthy infants aged 1 to 2 years were consecutively recruited from the Outpatient Pediatric Clinic of Ain Shams University, Egypt during the period from January, 2020 to February, 2020. Each infant received 2g honey/kg/day for 8 weeks. The plasma level of SCFAS and the anthropometric measurements were compared before and after honey intervention. Results: There was a statistically significant increase in plasma level of SCFAS (formic, acetic and butyric) after honey intervention in the studied group (p-value <0.05). There was also a statistically significant increase in the body weight (p-value 0,001) and OFC (p-value 0,03 1). Honey consumption did not produce any adverse effect in the studied group for 8 weeks. Conclusion: 8 weeks of honey consumption resulted in increased plasma SCFAS level (formic, acetic and butyric) and increase in the body weight and OFC.
Honey
short chain fatty acids
Occiput frontal circumference
2021
06
01
499
504
https://mjcu.journals.ekb.eg/article_167791_cbd894a5111c74f23d13dbb7f775bdc3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Retrospective Evaluation of Outcome of Rerouting Technique in Management of Horseshoe Perianal Fistula, Single Institution Experience
YASSER M. ABDEL-SAMIA, M.D.;
IBRAHIM M. ABDEL-MAKSOUD, M.D.
SALEM A.
FAGR, M.Sc.
Abstract Background: Complex anal fistula is a topic of debate from ancient times due to its difficult treatment and its effect on patients quality of life. The most complex anal fistula is the branched transsphincteric fistula with secondary extension in the perianal spaces forming the configuration U-shaped or horseshoe fistula. Many surgical technique have been described for treatment of this fistula as fistulotomy as was described by Hanly 1965 but he noted high risk of anal incontinence despite the complete eradication of the deep post anal sepsis. Aim of Study: To evaluate retrospectively patients with complex horseshoe fistula for them re-routing technique was done with respect to operative time, occurrence of incontinence and rate of recurrence of the fistula. Patients and Methods: This study is a retrospective ob-servational study that was conducted on 30 patients who had complex horseshoe perianal fistula and underwent re-routing technique for the fistula in the last 3 years; from January 2017 to December 2019. Follow-up of the patients was for 6 months. They were recruited from General Surgery Department, Ain Shams University Hospitals (El-Demerdash), Ain Shams University, Egypt. Results: Of the 30 patients, 27 patients (90%) preserved complete and full continence. Only 3 patients (10%) developed incontinence post-operatively after the second stage, stage of rerouting. Of the 3 patients developed incontinence, 2 patients (6.7%) developed only gas incontinence which is according to wexner scoring system was "sometimes" that occurred less than once per week and only 1 patient (3.3%) developed gas and liquid stool incontinence which according to the wexner score system was "rare" that occurred less than once per month. All 3 cases developed incontinence didn't need to wear pads and there was no effect on their life style. After 6 months follow-up of the patients, recurrence occurred only in 2 patients (6.7%) at 3.5 and 5 months which was not statistically significant. Conclusion: Rerouting technique is a suitable proper sphincter preserving procedure for the management of the complex horse shoe perianal fistula with low recurrence rate, very acceptable and satisfactory magnitude of preservation of anal continence with no effect on patient's quality of life.
Horseshoe perianal fistula
Rerouting
2021
06
01
505
511
https://mjcu.journals.ekb.eg/article_167836_f1f794da6c3d2c7e8719fa417f1845f9.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Retrospective Comparative Study of the Incidence of Hypocalcaemia in Total Thyroidectomy between Ain-Shams University as a Referral Center and Damanhour Medical National Institute
HASSAN S. TANTAWY, M.D.;
AHMED Y. EL RIFAI, M.D.
MOHAMED A.
ELSHAMY, M.Sc.
Abstract Background: Post-operative hypocalcaemia is one of the most serious complications of total thyroidectomy with variable degrees of morbidity. Aim of Study: The aim of this study was to to compare the incidenceandto examine several preoperative and imme-diate post-operative factorsfor development of hypocalcaemia after total thyroidectomy in patients who underwent total thyroidectomy in Ain-Shams University and Damanhour Medical National Institute. Patients and Methods: This retrospective study was conducted in Ain-Shams University Hospital and Damanhour Medical National Institute in the period between December 2015 and December 2019. It included 62 patients who under-went total thyroidectomy. The data was collected from patients' files in the Record Department. Results: There were 52 female and 10 male patients. The mean age was 38 years. Multi-nodular goiter was the most common indication of total thyroidectomy. The mean pre-operative serum Ca was 8.1mg/dl in group A and 8.3mg/dl in group B. 3 (9.7%) patients in group A and 7 (22.5%) in group B developed post-operative hypocalcemia. The highest fre-quency of transient hypocalcaemia was on 2nd post-operative day in group A and on 0 day in group B. There was only one patient 3.2% who required calcium and vitamin D supplement for more than six months. Conclusion: Hypocalcaemia is one of the major concerns following total thyroidectomy that can be prevented by me-ticulous surgical technique, identification and preservation of parathyroid glands and its vascularity. Post-operative monitoring of serum calcium & early treatment can prevent significant morbidity.
hypocalcaemia
Parathyroid glands
Total Thyroidectomy
2021
06
01
513
518
https://mjcu.journals.ekb.eg/article_167838_74a25875b63e8320db7a6b264cb9acb5.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Role of Ultrasound Elastography in Evaluation for Axillary Lymph Nodes of Patients with Breast Cancer
AHMED M. MONIB, M.D.;
MARIAM K.F. MIKHAIL, M.Sc.
MOHAMED G.
MANSOUR, M.D.
Abstract Background: Axillary lymph node status is the most reliable prognostic indicator for disease recurrence and patient survival in breast cancer. Axillary ultrasound is an important mean for detecting metastatic LNs, being non-invasive, avail-able & cheap. Aim of Study: To investigate the role of strain elastography combined with conventional ultrasound in the diagnosis of axillary lymph nodes in patients with breast cancer. Patients and Methods: 24 patients diagnosed with breast cancer with enlarged axillary lymph node were included in this study over the course of six months, they were examined bu B mode ultrasound and ultrasound elastography. Finally, findings of B-mode US and elastography were compared with pathological results (reference standard). ROC analysis was constructed to obtain best cutoff values for B-mode criteria, alasticity score and strain ratio. Results: Elastography score and strain ratio had a higher specifcity (83.3% vs. 33.3%) and a lower sensitivity (88.9% vs. 100%) than gray-scale ultrasonography. Of all the 6 benign axillary lymph nodes analysed in the present study, 2 were determined to be metastatic by gray-scale ultrasonography, while these diagnoses were corrected by RTE. As regards the semi-quantitative assessment; strain ratio, in our study there was a significant increase in mean strain ratio in the malignant nodes (1-8.3) than the benign ones (0.7-3.4) (p=0.005), with the best cutoff value 2.5 which yielded sensitivity of 88.89, specificity of 83.33,accuracy of 90%, PPV 94.1%, NPV 71.4%. Conclusion: Ultrasound elastography by its qualitative (elasticity score) and quantitative (strain ratio) evaluation has proved to useful in differentiation between benign and malig-nant nodes as a complementary to conventional ultrasound. Using elasticity score/strain ratio; 11 out of 18 pathologically proved malignant nodes, were diagnosed as malignant, 5 out of 6 benign nodes were diagnosed as benign.
Lymph nodes
Ultrasound Elastography
Elas-ticity
breast cancer
2021
06
01
519
527
https://mjcu.journals.ekb.eg/article_167840_01c978058b41efde9ebf9c2e43618dc9.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Serum Magnesium Level and Inflammation in Obese Medical Students at Ain Shams University
NEVIEN F.A. HENDAWY, M.D.;
AMANY H.M. HASANIN, M.D.
REEM M. SALLAM, M.D.;
AHMED N. HASSAN, M.D.
Abstract Background: Chronic systemic low-grade inflammation is a key feature of obesity because of adipose tissue inflam-mation with overexpressed pro-inflammatory cytokines. Magnesium (Mg) deficiency is one of the pathophysiological links between inflammation and obesity. Detection of factors contributing to obesity are therefore fundamental strategy in obesity management. Aim of Study: To determine the relationship between the serum level of Mg, dietary intake of Mg and inflammation among a sample of Medical Ain Shams students. Subjects and Methods: The current study is a descriptive study of 60 medical students divided into two equal groups. Group 1 includes normal weight students with BMI between 18.5-24.9kg/m2 and group 2 includes obese students with BMI >!30kg/m2. Results: There was a significant increase in BMI, Waist Circumference (WC), Waist Hip Ratio (WHR), C-Reactive Protein (CRP), and decrease in serum Mg and dietary intake of Mg in the obese group compared to normal weight group. Moreover, BMI, WC, and WHR were positively correlated with CRP and negatively correlated with serum Mg. Serum Mg and dietary intake of Mg were negatively correlated with CRP. Conclusion: Our study may lend an additional support to the positive relationship between obesity and inflammatory status. Also, it confirms the negative relationship between obesity/inflammatory stress to Mg status in this subset of obese students as compared to normal weight students in Faculty of Medicine, Ain Shams University.
Obesity
Inflammation
C-reactive protein
Magnesium status
2021
06
01
529
533
https://mjcu.journals.ekb.eg/article_167841_45de41a797e9415d971d7cdaf0c7bcac.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Comparative Study between Hemorrhoidectomy with Harmonic Scalpel Versus Electrocautery
AHMED E. MORAD, M.D.;
ADEL M. ABDULLAH, M.D.
KAREEM A. KAMEL, M.D.;
REEM S.M.M. ABUELANIN, M.Sc.
Abstract Background: Hemorrhoidal disease is a very prevalent disorder that arises from engorgement of internal and/or external vascular plexuses surrounding the anal canal. Hem-orrhoidectomy is the standard treatment for grade III or grade IV internal hemorrhoids; in spite of this, pain after conventional hemorrhoidectomy is still a major challenge. Aim of Study: To compare the outcome of hemorrhoidec-tomy using Harmonic scalpel without ligation of the pedicle versus electrocautery with ligation of the pedicle as regarding cost, operative time, post-operative bleeding, pain, and healing process. Patients and Methods: This study was a prospective, clinical, randomized, trial that included 50 patients grade III internal hemorrhoids with external components or grade IV disease. The patients were divided into two groups: Group I that included 25 patients underwent electrocautery with ligation of the pedicle and Group II which included 25 patients under-went Harmonic scalpel hemorrhoidectomy without ligation of the pedicle. Results: There was statistically significant association between type of procedure and operative time (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant lower pain score at day 1, 3, 7, 15, and 30. There was statistically significant association between type of procedure and time to heal (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant shorter time to complete healing. On the contrary, there was statistically significant association between type of procedure and hospital stay (p=0.18). There was statistically significant association between type of procedure and late complications (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statisti-cally significant less incidence of late complications. Conclusion: It is concluded that there was significantly reduced post-operative pain after Harmonic Scalpel hemor-rhoidectomy compared with electrocautery controls. The diminished post-operative pain in the Harmonic Scalpel group likely results from the avoidance of lateral thermal injury.
Hemorrhoidectomy
Harmonic Scalpel
Elec-trocautery
Post-operative pain
2021
06
01
535
541
https://mjcu.journals.ekb.eg/article_167843_2a2680cb4bd74bf90ef9a681bce4ceaf.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Comparative Study between Two Doses of Intravenous Ondansetron on Maternal Haemodynamics during Elective Caesarean Delivery under Spinal Anaesthesia
SOHAIR A. MOHAMED, M.D.;
RANDA A. SHOUKRY, M.D.
MUSTAFA M. HUSSIEN, M.D.;
AHMED S. KHALIFA SAYED, M.Sc.
Abstract Background: Hypotension is one of the most common intra-operative complications associated with spinal anaesthe-sia. Its incidence in caesarean section has been estimated to be as high as 50-60%. Despite fluid preloading, lateral uterine displacement and the use of vasopressor agents. It occurs due to sympathetic block which leads to autonomic nervous system disturbances and a decrease in systemic vascular resistance. This can occur because the level of block must be at least at T4 to ensure adequate analgesia severe hypotension following spinal anaesthesia in caesarean section is a dangerous com-plication. If it is unnoticed or inadequately treated, it can lead to serious maternal or fetal compromise. Aim of Study: To evaluate the effect of two doses of prophylactic ondansetron on spinal anesthesia-induced hypo-tension and bradycardia among patients undergoing elective cesarean deliveries. Patients and Methods: This study was carried out in Ain Shams Hospital Obstetric Theatres from March 2020 to September 2020. Written informed consent was obtained from every parturient included in the study. Ethical approval for this study was provided by the Ethics Committee of Faculty of Medicine, Ain Shams University. FAMSU MS 155/2020 (FWA 000017585) 23/2/2020. Results: In our study, there is statistically significant difference between the studied groups regarding dose of vasopressor use. About 53.3% and 46.7% of those within ondansteron 4mg group received 10 and 12.5mg respectively. About 51.1% and 48.9% of those within ondansteron 8mg group received 12 and 15mg respectively. In terms of side effects, no patient within either group developed shivering, vomiting or bradycardia. Regarding nausea, there is statistically non-significant difference between the studied groups regarding occurrence of nausea. Conclusion: Prophylactic bolus of intravenous onandsetron 8mg and to a lesser extent 4mg could decrease the fall in the MBP of parturients following spinal anesthesia as well as ephedrine needed dose that could decrease neonatal acidosis associated with ephedrine use.
Bezold-Jarisch reflex
American Society of Anesthesiologists
2021
06
01
543
551
https://mjcu.journals.ekb.eg/article_167845_b85e914d9d1950bb30871295f4702dd7.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Blood Viscosity Response to Aerobic Exercise in Type 2 Diabetic Men
TAHA A. ELBRAGILY, M.Sc.;
NAGWA H. BADR, Ph.D.
NAGLAA M. ELSAYED, M.D.;
SAMAH M. ISMAIL, Ph.D.
Abstract Background: Cardiovascular complications are very com-mon in diabetic patients. Type 2 diabetic patients have elevated whole blood viscosity which is associated with these vascular complications. Aim of Study: To determine the effect of aerobic exercises on blood viscosity in type 2 diabetic patients. Methods: Thirty type 2 diabetic men included in the study from Kasr Al-Ainy Hospital and from outpatient clinics at Faculty of Physical Therapy Cairo University. Their mean ± SD age, weight, height, BMI and HbA1c were 47.83±3.5 years, 91.8±5.82kg, 175.2±6.4cm, 29.69±2.1 (kg/m2) and 7.15±0.63% respectively. Whole blood viscosity was evaluated before and after the training program. All patients performed moderate aerobic exercise (65%-75%) in the form of treadmill exercise program 3 sessions per week for 8 weeks, the duration of the session was about 45 minutes and consist of warming up phase of slow walking on treadmill for 5 minutes (10%:20%), training phase 35 minutes and cooling down for 5 minutes (10%:20%). Results: There was a significant decrease in the total blood viscosity post-treatment and the percent of change was 4.56%. Conclusion: Aerobic exercise is a good way to reduce blood viscosity in patients with type 2 diabetes mellitus and this can help control vascular complications.
Aerobic exercise
Whole blood viscosity
Diabetes mellitus
Cardiovascular complications
2021
06
01
553
557
https://mjcu.journals.ekb.eg/article_167846_e54002a79aa857443425eefbe109ddb0.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Incidence of Recurrent Differentiated Thyroid Carcinoma in Paediatrics and Adolescents after Thyroid Surgery: A Meta-Analysis Study of Last 20 Years
MUHAMMAD B. ABDALFATAH, M.Sc.;
AYMAN A. ALBAGHDADY, M.D.
AHMED M. KAMAL, M.D.;
EHAB M.A. FADL, M.D.
Abstract Background: Childhood onset differentiated thyroid cancer is distinct from the adult-onset disease being more aggressive at the time of initial evaluation with a higher risk category for disease recurrence; however, it is ultimately less lethal. Unfortunately, there is no consensus regarding the means of follow-up, timing and management strategy regarding pediatric differentiated thyroid cancer. For these reasons, unique man-agement for children and adolescents with thyroid tumors are needed. Aim of Study: To locate relevant studies comparing incidence of recurrent differentiated thyroid carcinoma in paediatrics and adolescents after thyroid surgery modalities most commonly used in childhood onset differentiated thyroid cancer that are published in the period from June 1999 to June 2019, revising all these studies, and designing meta-analysis study to assess the overall results and define which management may provide better outcome and fewer rate of complications. Patients and Methods: The search strategy above will be viewed,and articles that appear to fulfil the inclusion criteria will be retrieved in full. Each article identified will be reviewed and categorized into one of the following groups: Included or excluded. When there will be a doubt, a second reviewer will assess the article and a consensus will be reached. Results: Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2019. Conclusion: All children will require life-long surveillance after thyroid surgery, especially for thyroid cancer. Paediatric thyroid cancer is rare. (The incidence of differentiated thyroid cancer is 1 per 1,000,000 in children less than 10 years of age). It is a treatable disease with an excellent prognosis. Treatment with radioactive iodine is recommended for most children after total thyroidectomy for papillary and follicular cancer. Radioiodine ablation should be carried about 4 weeks after surgery, with a diagnostic scan 6 months later. Regular review should include neck palpation, serum thyroglobulin, and ultrasound with cytology if necessary. In case of a cancer, follow-up ultrasound and TSH-suppressed thyroglobulin (Tg) level assessment is performed 6 months after initial therapy and at least annually thereafter, although it may be preferable to observe patients every 6 months for at least 5 years after diagnosis of more advanced initial or metastatic cancer. Assessment of free T4, T3, and TSH levels is indicated every 6 months, and 1-2 months after dosage changes. Calcitonin is a marker of recurrent disease in medullary cancer. This suggests that an aggressive operative approach to lymph node resection may be safer (lower recurrence, lower complications) in experienced hands than a less complete resection in a lower volume center.
Thyroid malignancy
Paediatrics
Thyroidec-tomy
2021
06
01
559
567
https://mjcu.journals.ekb.eg/article_167848_4466eab4190ce91113b0e6490dd6f035.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Comparison between Batwing versus Wise Pattern Mammoplasty for Upper Pole Breast Tumors
ASHRAF O.M. ALI, M.D.;
EHAB H. ABD EL-WAHAB, M.D.
AHMED G. OTHMAN, M.D.;
ABD EL-RAHMAN M. ESSAM, M.Sc.
Abstract Background: Since the recorded time, breast has been a symbol for motherhood, fiminity, and sexuality, it has been portrayed throughout history in works of art symbolizing to all those aspects of woman's life. So breasts in female life are described as “life giving and life destroying”. Breast cancer existed in ancient times and reference to this disease can be found dating back as 3000 BC, in an Egyptian papyrus. Aim of Study: The Aim of this study is to compare between batwing mammoplasty and inferiorly based wise pattern therapeutic mammoplasty in management of upper pole breast tumors regarding cosmetic results, oncological outcomes, rate of complications and degree of satisfaction of the patients. Patients and Methods: Design: Study group: This study was conducted in Department of General Surgery Ain Shams University Hospitals, this is a prospective comparative study. The study included 40 women diagnosed with upper pole breast cancer. This study was done in Breast Surgery Unit, General Surgery Department at Ain Shams from July 1 st 2019 to July 1 st 2020. Sampling Method: Random controlled sampling study,after approval of the Ethical Committee, and informed consents were obtained from these patients they were enrolled in the study. Results: Our study includes 40 female patients were randomly categorized into 2 groups. Group A included patients who had inferiority based wise pattern mammoplasty (20 patients), while Group B included patients who had batwing mammoplasty (20 patients). Conclusion: In this study, we concluded that: Both tech-niques batwing mammoplasty and wise pattern therapeutic mammoplasty are valid options for upper pole breast tumors. Wise pattern therapeutic mammoplasty remains aesthetically superior; however, batwing mammoplasty is an easy, simple technique with acceptable results to patients. Recommendations: From this study, we could recommend: The decision of which surgical approach to be used for the oncoplastic procedure is heavily based on patient and tumor characteristics; the pre-operative evaluation should include examination for degree of ptosis, overall skin quality, evidence of prior radiation, and overall breast size; successful oncoplastic procedure begins with selecting the appropriate operation for a given patient, which takes into account a patient's unique breast anatomy (e.g., breast shape and degree of ptosis) and good understanding of tumor location and extent, as well as appreciation of the patient's goals; Mastectomy with recon-struction may provide a more aesthetically pleasing result than breast conservation surgery in the small to moderate-breasted woman; larger breasted women have more options available for reconstruction, whether it is local tissue rear-rangement, local or regional flaps, or reduction mammo-plasty/mastopexy; Batwing mammoplasty procedure achieve optimal results (i.e., breast contour and nipple projection) in patients with larger breast volume and a mild to moderate degree of breast ptosis; more studies on a large scale should be performed to assess the results of batwing mammoplasty and wise pattern therapeutic mammoplasty regarding compli-cation and cosmetic outcome for management of upper pole breast tumours.
Breast conservation surgery (BCS)
The nipple-areola complex (NAC)
Oncoplastic surgery (OPS)
2021
06
01
569
584
https://mjcu.journals.ekb.eg/article_167850_067fa686205fa8e8053559e8c6a2f4cd.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Diagnostic Value of Contrast Enhanced Mammography in Detection of Cancer Breast
AHMED A. FAYAD, M.Sc.;
MOHAMED T. ABDELHAKK, M.D.
HALA M.
MAGHRABY, M.D.
Abstract Background: Breast cancer in women is a major public health problem throughout the world. It is the most common cancer among women both in developed and developing countries. Aim of Study: This study was undertaken to assess the diagnostic value of contrast enhanced mammography in detection of cancer breast.. Material and Methods: During the period from December 2015 to January 2017, 129 cases with 194 breast lesions in a prospective study presenting with various suspicious or equivocal lesions on mammography that underwent CEDM evaluation to test its diagnostic performance in the final diagnosis using the histopathology results as the gold standard of reference. The study includes 9 patients with past history of breast operations. Descriptive statisticswere used to analyze the data. Results: There were 129 females (the ages ranged from 25-88 years with a mean 50 years) with 194 lesions. Of these lesions 162 (83.5%) are malignant and 32 (16.5%) are benign. The study demonstrated contrast enhancement in 91.9% of the malignant and 41% of the benign lesions. Contrast en-hancement was observed in 136 malignant lesions. 22 (14.9%) lesions of malignant lesions took homogenous enhancement and 114 (77%) lesions took heterogeneous enhancement. In our study the margin of mass enhancing lesions showed ill-defined and speculated margins were significantly higher in malignant lesions. Conclusion: The use of dual energy contrast enhanced mammography technique can significantly improve the diag-nostic quality and cancer detection rate.
CEDM (contrast enhanced digital mammography)
2021
06
01
585
590
https://mjcu.journals.ekb.eg/article_167854_3f73edeed50ff46f1c952891deb35ada.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Effect of Laser Acupuncture on the Power of Lower Limb Muscles in Children with Spastic Cerebral Palsy
SAHAR M.A. HASSANEIN, Ph.D., M.D.;
EITEDAL M. DAOUD, Ph.D.
DALIA M.E. EL MIKKAWY, M.D.;
NASHWA K.A. EBADA, M.Sc.
Abstract Background: Cerebral palsy (CP) is defined asneurode-velopmental disorder that occurs due to disturbance in the development of the central nervous system. Laser acupuncture is a technique with minimal side effects and safe for chil-drenand can be used as an alternative line of treatment in several chronic pediatric diseases. Aim of Study: To assess the efficacy of using a six weeks course of laser acupuncture on muscle strength in children with diplegic or quadriplegic cerebral palsy. Patients and Methods: A randomized controlled trial; that was conducted in the neuropediatric clinic of the National Research Centre, Egypt and Outpatient Clinic of Ain Shams Children Hospital from 2018 to February 2020. It included 40 children with spastic CP. They were randomly assigned to two equal groups (n=20), laser acupuncture group and control group. Both groups received physiotherapy for successive 6 weeks; while only the study group also received low-level laser 650nm with 50mW powers that was applied at each acupoint for 30s giving an energy density of 1.8J/cm2). Results: Power of hip flexors and knee extensors were significantly increased in laser acupuncture group compared to the control group, p < 0.001. Conclusion: Laser acupuncture has a beneficial effect on hip flexors and knee extensors muscles strength compared with the control group in children with spastic cerebral palsy.
Laser
Acupuncture
Cerebral palsy
Muscle power
lower limb
2021
06
01
591
595
https://mjcu.journals.ekb.eg/article_167857_d5c930d9f83a24ac2d829aa3877931ee.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Role of Ultrasound Guided IVC-CI versus Central Venous Pressure in Assessment of Critically Ill Patients
RASHEDA
AZZAM, M.D.
Abstract Background: Both hypovolemia and volume over load increase the morbidity and mortality of patients. So evaluation of intravascular volume status is the first important step in patients with signs of shock. Use of non invasive method as Inferior Vena Cava (IVC) measurements is one of methods to avoid complications of invasive procedure as central venous pressure monitoring. Aim of Study: This study aimed to provide a useful guide for noninvasive intravascular volume status (as diagnosed and manage) and to evaluating the correlation between Inferior Vena Cava-Collapsibility Index (IVC-CI) measured with ultrasonography versus central venous pressure. Patients and Methods: This study was a prospective observation study that was conducted on forty critically ill patients of both sexes, aging >!21 years old of ASA (III & IV) with signs of shock, admitted in the ICU at Al-Zahraa Uni-versity Hospitals during the last two year (October 2018 till October 2020), were enrolled in the non probability consecutive sampling after approval of the Al-Azhar University Ethical Committee and written informed consent from the patient or the 1st degree relatives in case of comatosed patient. After were screened for signs of shock, hemodynamic parameters were monitored continuously then 500ml of Nacl 0.9% was administered in 15 minutes and clinical response was observed with measures taken by using ultrasound. Then the patients were divided into responder and non responder. Results: In our study there was 24 patients of 40 patients (60%) responded to volume resuscitation. While 16 patients of 40 patients (40%) did not respond to volume resuscitation regimen and then blood pressure improved only after intro-duction of vasopressor as regarding to demographic data, there was no significant difference between two groups, as regarding to heart rate, MAP, and central venous pressure was no significant difference between two groups. In responder group there was strongly correlated that was highly significant of CVP and IVC-CI, in non responder group, there was no correlation between CVP and IVP-CI throughout the study. Conclusion: Inferior vena cava collapsibility index as-sessment is relatively safe option and sensitive at least when compared to measuring CVP.
Central venous pressure
Inferior vena cava-collapsibility index (IVC-CI)
2021
06
01
597
602
https://mjcu.journals.ekb.eg/article_167859_bb0a375daf01c4ee8413911ac4b50ece.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Intraperitoneal Local Instillation of Levo-Bupivacaine versus Magnesium Sulfate versus Levobupivacaine Plus Magnesium Sulfate for Postoperative Pain Relief after Laparoscopic Sleeve Gastrectomy: Prospective Randomized Clinical Trial
ZAKARIA A. MUSTAFA, M.D.;
RANDA A. SHOKRY, M.D.
YASIR A. ALBASIONY, M.D.;
MAHMOUD A.A. AHMED, M.Sc.
Abstract Background: Laparoscopic sleeve gastrectomy is the gold standard option for the management of morbid obesity, it is a less invasive procedure with better cosmetic results and shorter operative time and hospital stay. Moreover, the current body of evidence shows that laparoscopic interventions are generally associated with less post-operative pain and analgesic requirements. Aim of Study: To compare the efficacy and safety of intraperitoneal levobupivacaine, and/or magnesium sulphate in different combinations for post-operative pain relief in patients undergoing laparoscopic sleeve gastrectomy. Methods: This is double blind prospective randomized clinical trial set at Ain Shams University Hospitals over a period of 7 months from February to September 2020 on 60 patients who were scheduled to undergo laparoscopic sleeve gastrectomy at Ain Shams University Hospitals. 60 patients were divided into three groups: Group A included patients received intraperitoneal instillation of 30ml of 0.25% Lev-obupivacaine alone, group B included patients received intra-peritoneal instillation of 30ml Magnesium Sulphate 10% alone and Group C included patients received intraperitoneal instil-lation of 15ml Magnesium Sulfate 10% plus 15ml of 0.25% Levobupivacaine to a total volume of 30ml. Results: The average Time to 1st dose of post-operative analgesia demand was also the longest in LevMg group compared to Mg group and Lev group (8.75±4.51 hours compared to 1.40±0.50 hours and 4.95±1.76 hours respectively) which was also highly significant. When total analgesia consumption in 24 hours was analysed, LevMg group had 35.00±26.66mg, Mg group had 136.50±19.27mg and Lev group 87.00±33.73 mg of Pethidine consumption which was highly significant Bupivacaine group had mild tomoderate pain and most of the patients in bupivacaineplus magnesium sulphate group had mild pain in first 24 hours of surgery. Conclusion: Intraperitoneal combination of levobuivacaine and maghnesium sulphate is more effective than levobupiavacaine or maghnesium sulphae alone for post-operative pain after laparscopic sleeve gastrectomy.
Levo-Bupivacaine
Levobupivacaine
Laparo-scopic Sleeve Gastrectomy
magnesium sulfate
2021
06
01
603
610
https://mjcu.journals.ekb.eg/article_167861_1eef05f0ea2892c3e03cfac0b4d316de.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Comparative Study between Medial Rectus Muscle Resection versus Plication When Coupled with Lateral Rectus Muscle Recession in Treatment of Exotropia
AHMED A. ELBARAWY, M.D.;
ABDALLA EL AMIN, M.D.
AMR M. MOHAMED, M.Sc.;
AHMED F. GABR, M.D.
Abstract Background: There are many reasons to perform a stra-bismus surgery, either to provide binocular single vision, improve cosmosis, restore normal eye contact and/or enhance the quality of life. Aim of Study: The purpose of this study is to compare between medial rectus muscle plication versus resection when coupled with lateral rectus recession as regard efficacy and possible complications in treatment of exotropia. Patients and Methods: This study was carried out in Ophthalmology Department at Aswan University Hospital between 2019 and 2020 on 40 patients with exotropia. The first 20 pateints were operated by the plication procedure, while, the other 20 patients were operated by the resection procedure. This study was a randomized controlled study. Results: Plication technique was comparable to resection technique as there were no significant differences as regard post-operative results, but plication technique could be safer in prevention of lost muscle and anterior segment ischemia. Also, plication technique was of shorter operation time. Conclusion: MR muscle plication is an alternative easier, safer and faster technique to resection when coupled with lateral rectus recession in treatment of exotropia.
Strabismus
plication
resection
Recession
2021
06
01
611
617
https://mjcu.journals.ekb.eg/article_167863_1a25ca25f3e116749ed38c9f33d26aa4.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Role of 3D Ultrasound for Assessment of Fetal Lungs
LOBNA S. IBRAHEM, M.Sc.;
SAFAA K. MOHAMED, M.D.
NERMEEN N.
KERIAKOS, M.D.
Abstract Background: Fetal lung maturity is vital to the survival rate of neonates, and is a determinant of extra uterine life. Neonatal respiratory distress syndrome and associated com-plications account for 28% of neonatal deaths. Although the wide use of glucocorticoids has decreased the incidence of Neonatal respiratory distress syndrome, approximately 10% of neonates still develop the syndrome. Aim of Study: To study the role of 3D ultrasound for assessment of fetal lungs. Patients and Methods: A total of 50 pregnant women 34- 40 weeks gestation after a complication-free normal course of pregnancy were enrolled in the study. They were classified into 2 groups as follows: 1. Group A: (n=25) women 34-37 weeks gestation. 2. Group B: (n=25) women 37-40 weeks gestation. All the included women were subjected to: Full history taken. Ultrasound examination to confirm GA, assess Amniotic Fluid Index (AFI) and to exclude fetal anomalies. 3D ultrasound was carried out to asses fetal lung volume. After child birth, APGAR score at (1, 5 and 10min) was assessed together with occurrence of RDS and the further need for neonatal ICU admission and respiratory support measurements. Results: The mean value of fetal lung volume was signif-icantly increased in term group (52.96±4.91) when compared to preterm group (44.08±6.43) (p=0.001). In the term group the percentage of neonates which did not experience Respira-tory Distress Syndrome (RDS) was 60% compared to 24% in the preterm group (p=0.001). In the preterm group the per-centage of admitted neonates in the Intensive Care Unit (ICU) was statistically increased (68%) when compared to the term group (54%) (p=0.047). The percentage of women in the preterm group received prenatal steroids 36% was statistically higher than those in the term group 24% (p=0.047). In the present study, fetal lung volume was positively correlating with gestational age (r=0.531; p-value=0.001). In the present study, in the preterm group RDS was negatively correlated with steroids (r=–0.304; p-value=0.032). Conclusion: Ultrasound indices, including fetal lung volume may serve as useful alternatives to amniotic fluid phospholipids in analyzing fetal lung maturity. Fetal lung volume might be an accurate non-invasive predictor for the occurrence of neonatal RDS among preterm fetuses in whom the risk of RDS development deserve fetal lung maturity testing.
3D ultrasound
Fetal lungs
2021
06
01
619
625
https://mjcu.journals.ekb.eg/article_167864_f2a4cbf610eb5d1e113270abbbf97c9b.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Immediate Effect of Neurodynamic Tensioner Versus Proprioceptive Neuromuscular Facilitation Stretch on Subjects with Short Hamstring Syndrome
SAFAA M. SADEK, M.Sc.;
RAGIA M. KAMEL, Ph.D.
MARWA Sh.
SALEH, Ph.D.
Abstract Background: Decreased flexibility of Hamstrings has a negative impact on the posture of lumbo-pelvic region and may serve as a cause of low back pain. It is also a major contributing factor for lumbar spine disorders, hamstring strains and other sports related injuries. Aim of Study: Tocompare the effects of (NT) Neurody-namic Tensioner and (PNF) hold-relax stretching on hamstring flexibility in order toidentify the most effective intervention for short hamstring syndrome. Material and Methods: Present study conducted as Pre-test - Post-test Experimental study. Participants: Forty subjects with short hamstring syndrome participated in this study. Subjects were subdivided into two matched groups; each group consisted of twenty subjects, group A who received neural tensioner in slump position; and group B who received the PNF (hold-relax) stretching. Outcome Measure: Knee extension angle (KEA) in degrees was measured using the Active Knee Extension (AKE) test with using a digital goniometer. Results: There was no significant difference in the KEA between group A and B pretreatment (p=0.75). There was no significant difference in the KEA between group A and B post treatment (p=0.38). Conclusions: Neurodynamic tensioner and PNF (hold-relax) stretching are equally effective in increasing hamstring flexibility immediately in subjects with short hamstring syndrome.
Hamstring flexibility
Neurodynamic tensioner
PNF
Active knee extension test
2021
06
01
627
634
https://mjcu.journals.ekb.eg/article_167867_432d99ca1cbceb119fa92824b0459095.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Timing of Parathyroid Hormone Measurement as an Early Predictor of Postoperative Hypocalcemia Post Total Thyroidectomy: A Prospective Study
AYMAN A. ABDRABOH, M.D.;
MAHMOUD S. FARAHAT, M.D.
NABIL A. AL NAGAR, M.Sc.;
AHMED F. AMER, M.D.
Abstract Background: Serum intact parathyroid hormone (iPTH) level is an early marker of post-thyroidectomy hypocalcemia. However, lack of methodological standardization to define timing and cut-off points of iPTH measurement limit its clinical applicability. Here, we evaluated the relationship between two distinct postoperative time sampling and iPTH accuracy on predicting hypocalcemia. Aim of Study: This study was aimed to evaluate the accuracy of iPTH measured after total thyroidectomy to predict postoperative hypocalcemia and to identify patients at risk of postoperative hypocalcaemia who require supplementation treatment, and those not at risk who can be safely discharged without any supplementation treatment. Moreover, combining postoperative PTH and serum calcium levels could result in an accurate prediction of the risk of postoperative hypocal-caemia. Patients and Methods: iPTH was measured within 24h after surgery (iPTH 24h) and on the morning of the 3rd postoperative day (iPTH 3rd PO). Hypocalcemia was defined by levels of total calcium corrected by serum albumin £8.0mg/dL and/or by the presence of symptoms or signs. The most accurate iPTH cut-off point for hypocalcemia prediction was established from a ROC curve comparing both time-points. Results: The study included 40 patients. The mean age was 46.23±9.03 years, 34 were women (85%) and all patients underwent total thyroidectomy. Hypocalcemia occurred in 8 patients (20%), of whom 5 were symptomatic. Lower levels of iPTH 24h and iPTH 3rd PO were associated with postop-erative hypocalcaemia (p < 0.05). Using the ROC curve, the optimal cut-off points were 14.8pg/mL and 14pg/mL for iPTH 24h and iPTH 3rd PO, respectively. The comparison of the AUC showed no significant difference between these two points of evaluation with 98% accuracy for both time points. Conclusions: Serum iPTH levels measured within 24h or on the 3rd morning after surgery are predictors of postoperative hypocalcemia. Notably, both time-points have the same accuracy to predict postoperative hypocalcemia (with different cutoff points).
Hypoparathyroidism
Thyroidectomy
Hypoc-alcemia
Parathyroid Hormone
2021
06
01
635
644
https://mjcu.journals.ekb.eg/article_167869_d94e94c8a6d96a0d1193a9737bd7388a.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Autistic Children Eating Patterns & Feeding Problems: Parents' Perspectives, Awareness, and Attitude Towards Nutrition Education Programs
MONA M.
ELSHAFIE ELNAJJAR, Ph.D.
Abstract Background: Recent studies have reported that different nutritional approaches have helped alleviate the severity of Autism Spectrum Disorder (ASD) symptoms. Parents and caretakers are not always aware of the nutritional needs of autistic children, and not many awareness programs are available. Aim of Study: The current study assesses autistic children eating patterns and feeding problems encountered by parents during mealtimes, and parents awareness and attitude towards nutritional educational programs for ASD as well. Material and Methods: The study design is cross-sectional, was conducted in 2019 at local rehabilitation centers for Autistic children, Special Education and Rehabilitation Or-ganization (SERO) in Egypt, 135 parents of ASD children (<15 years) took part in the study. Face-to-face interview using questionnaires was used to gather data. The questionnaire collected socio-demographic data, health, nutritional status, what problems are faced by parents during feeding, and what limitations are faced for getting information related to feeding. The attitude towards nutritional education programs is also assessed using the questionnaire. Statistical analysis of the data is done using SPSS software. Results: The results of study sample show that there are inapproprite nutritional practices which have harmful effects on the health status, on the other hand there are healthy nutritional practices which has good effect on the health status of Autistic Children that will improve health status for them. It was found that 50% of the participants' children faced problems during feeding. The majority of the participants lack knowledge in dealing with the feeding problems faced. Due to a lack of awareness programs, 62% of the total partic-ipants never attended any awareness programs, and the com-mon source for getting information was the internet for 83.70% of participants. The majority of participants demonstrated a positive attitude towards awareness programs in regards to feeding problems. Conclusions and Implications: More nutrition educational programs need to be organized to increase awareness among the parents to improve the nutritional status of autistic children.
autism
Feeding problems
food frequency
Nutrition educational programs
2021
06
01
645
653
https://mjcu.journals.ekb.eg/article_167871_a13a7bdd47372d5d48205ee32235c886.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Effect of Negative Pressure Therapy versus Polarized Light Therapy on Chronic Wound Healing
RANA M.M. ELATTAR, M.Sc.;
INTSAR S. WAKED, Ph.D.
MOHAMED B.I. BAYOUMI, Ph.D.;
ASHRAF E.M. ELSEBAIE, M.D.
Abstract Background: Chronic wounds are wounds that have failed to proceed through the normal process of healing. There are varying etiologies of chronic wounds, which all create a burden upon the health care system. Aim of Study: The aim of this study was to investigate the difference in the effect between negative pressure therapy and polarized light therapy on chronic wound healing. Patients and Methods: Thirty patients were diagnosed by a physician as chronic wound patients (grade 2 and 3). Their age ranged from 45 to 65 years. Patientswere selected from Cairo University Hospitals. They were distributed randomly into two groups (A, B) equal in numbers. Group A received negative pressure therapy daily with dressings changes 3 times a week with the traditional medical treatment for 6 weeks. Group B received polarized light therapy for 10min 3 times aweek with the traditional medical treatment for 6 weeks. Wound surface area and wound volume were assessed by tracing method and saline respectively pretreatment, 3 weeks and 6 weeks after treatment.The study was carried out from July 2020 to October 2020. Results: There were no significant difference in wound surface area and wound volume between groups pre-treatment (p>0.05). Comparison between both groups post-treatment revealed a non-significant difference in wound surface area and wound volume at post I (p>0.05); however, there were a significant decrease in wound surface area (p=0.02) and wound volume (p=0.01) of group A compared with that of group B at post II. Conclusion: These results suggested that negative pressure therapy was more effective than polarized light therapy in reducing surface area and wound volume of chronic wound.
Chronic wound
Wound healing
Negative pressure therapy
Polarized light therapy
2021
06
01
655
660
https://mjcu.journals.ekb.eg/article_167872_f7a5cb388c8dc7fa260b0eff4b3ccf5b.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Evaluation of Role of Magnetic Resonance Imaging in Detection and Characterization of Soft Tissue Masses of the Hand and Wrist
SAHAR M. EL GAAFARY, M.D.;
SUSAN A.A. ABDUL RAHIM, M.D.
HYTHEM H.S.
AHMED ALI, M.Sc.
Abstract Background: The wrist and hand joints are complex structures with an extensive differential diagnosis for a pre-senting mass. However, the vast majority of wrist and hand masses are benign. Magnetic Resonance Imaging (MRI) by virtue of its ability to provide detailed soft tissue characteri-zation is the preferred method of imaging the problematic soft tissue masses. Aim of Study: To evaluate the role of MRI in diagnosis of the most commonly encountered soft tissue masses of the wrist and hand, describing their main features; specifically the signal characteristics and location that helps to differentiate them. Methods: This cross section study included 42 patients (22 females and 20 males), their ages range between 1 year and 79 years, with mean age of 32.24 year. The study was performed in Radiology Department El-Demerdash Hospital between March 2018 and September 2019. Results: Benign and malignant lesions represented (97.6%) and (2.4%) respectively of the encountered lesions. The most commonly found lesions were ganglia (33.3%). The most frequently seen solid tumors, included Giant Cell Tumor of the Tendon Sheath (GCTTS) (9.5%), benign Nerve Sheath Tumors (NST) (4.8%), lipoma (2.4%), hemangioma (4.8%)/ vascular malformation (9.5%), fibroma of the nerve (4.8%) and malignant lesions (2.4%). Joint and soft tissue infection were encountered in (2.4%) of cases. A specific diagnosis was made, or strongly suspected, from the MRI features found in certain conditions like ganglion, hemangioma, arteriovenous malformation, giant cell tumor of the tendon sheath, lipoma, fibroma, and soft tissue infections. MR imaging of the wrist and hand provides a wealth of information regarding the status of and the relationship of the osseous and soft tissue compo-nents, both of which are necessary to confirm the clinical diagnosis and manage the patient in the most efficient way possible. Conclusion: Magnetic resonance imaging is the imaging method of choice for evaluating the presence and extent of soft tissue masses. It is particularly useful for assessing masses in the wrist and hand, where lesions are predominantly benign.By noting the signal characteristics and determining the lesion location, a specific diagnosis of the mass can often be made. unfortunately, when lesion doesn't exhibit typical features, differentiation from malignancy can't be categorically made.
Magnetic Resonance Imaging
Soft tissue masses
2021
06
01
661
671
https://mjcu.journals.ekb.eg/article_167873_a33ef203229cb035617036d874aa38ba.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Role of Plasma Connective Tissue Growth Factor Levels in Assessment of Pulmonary Arterial Hypertension in Children with Congenital Heart Disease
WALEED M. EL GENDY, M.D.;
IMAN M. EL SAYED, M.D.
MUHAMMAD M.
AMIN, M.Sc.
Abstract Background: To investigate plasma Connective Tissue Growth Factor (CTGF) levels in Pulmonary Arterial Hyper-tension (PAH) associated with Congenital Heart Disease (PAH-CHD) in children and the relationships of CTGF with hemodynamic parameters. Plasma CTGF levels were calculated in 30 children with PAH-CHD and 30 health volunteers, using the subtraction method. Aim of Study: To assess plasma Connective Tissue Growth Factor (CTGF) levels in children with CHD and study its role in assessment of PAH that can be promising diagnostic and prognostic biomarkers for PAH in children with CHD. Patients and Methods: Our study was conducted in Pedi-atric Cardiology Clinic and Cardiology Catheter Laboratory of Ain Shams University Pediatric Hospital, in the period from Jan. 2019 to May 2020, including 30 patient and 30 healthy controls of matched age and sex. Results: The patients with PAH, 17 were acyanotic and 13 were cyanotic. The health control group and patient groups did not differ significantly in terms of age, gender and BSA (p>0.05). Height, weight and BMI were significantly lower in PAH-CHD group compared with the HCG (p < 0.05), while no difference was found between PAH-CHD group (p>0.05). In addition, CTGF levels were higher in PAH-CHD group than health control group. Depicts that, PAH-CHD group had higher PASP, PADP, RVSP, mPAP, Qp, Rp and Rp/Rs (p < 0.01). Conclusion: Plasma CTGF levels could be a promising diagnostic biomarker for PAH-CHD in children.
Pulmonary arterial hypertension
Congenital heart disease
2021
06
01
673
678
https://mjcu.journals.ekb.eg/article_167874_a554506b8229449fb6cb2a14e5c8c443.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
How to Improve the Outcome of Charcot Foot: Results of Five Years Follow-up Prospective Study
MOHAMAD MOTAWEA, M.D.;
FADY KYRILLOS, M.D.
AHMED HANAFY, M.D.;
AHMED ALBEHAIRY, M.Sc.
Abstract Background: Egypt is among the world's top 10 countries in terms of the highest number of people with diabetes. Delayed presentation and lack of appropriate foot care could account for different outcomes of Charcot-foot. Aim of Study: Study the impact of nullification of the suggested risk factors on the outcome of Charcot-foot. Patients and Methods: We did a prospective analysis of the impact of compliance with the nullified suggested risk factors on both feet as compliance with 1- Wearing the removable-cast-walkers, 2- The regular follow-up visits, 3- Nullified leg-length discrepancy induced by the removable-cast-walker, and 4- Slowing of the gait speed (24 steps ±3/min). 43 patients presented ³5 years ago with unilateral chronic Charcot and normalcontralateral foot were included and subdivided into (Group-A) compliant with all nullified risk factors and (Group-B) non-compliant with ³1 of the risk factors, of matched age, sex, BMI, HbA1c and diabetes duration. Both feet are then examined for any complications that happened since January/2010 till February/2016. Results: Our results showed statistically significant dif-ference regarding the complications happened in the Charcot-foot, 11.1% (n=2) vs. 44% (n=11) and in the contralateral foot, 16.7% (n=3) vs. 48% (n=12) in group A vs group B respectively. Adherence to nullification of the suggested risk factors decreases the occurrence of complications by >6 folds in the Charcot-foot (odds ratio 6.3, p=0.03) and >4 folds in the contralateral foot (odds ratio 4.6, p=0.04). Conclusion: Nullification of leg-length-discrepancy, slowing of the gait speed, compliance with the removable-cast-walker and regular follow-up visits greatly improved the outcome of Charcot foot in our foot clinic.
Gait speed
Leg length discrepancy
Charcot
Contralateral foot
Removable cast walker
2021
06
01
679
684
https://mjcu.journals.ekb.eg/article_167878_9e561fa20f7bf22b4b82b09dbbac82e5.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Systemic Recombinant Tissue Plasminogen Activator for Treatment of Acute Ischemic Cerebral Stroke: A Systematic Review
AHMED N. ELSHAER, M.D.;
HANAA A. EL-GENDY, M.D.
AHMED W. EZZAT, M.D.;
HEBA A. ZALAM, M.Sc.
Abstract Background: Stroke is ranked as the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. Not only does the burden of stroke lie in the high mortality but the high morbidity also results in up to 50% of survivors being chronically disabled. Aim of Study: To evaluate the efficacy of using recom-binant tissue plasminogen activator in treatment of acute ischemic cerebral stroke showing its effect on morbidity and mortality. Material and Methods: In this study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till April 2020. The search retrieved 1806 unique records. We then retained 54 potentially eligible records for full-texts screening. Finally, 13 studies (No. of patients =7322 patients) were included. Results: The overall effect showed that rtPA significantly increased the chance of being alive independent (mRS0-2) [OR=1.21 95% CI (1.05, 1.41); p=0.01]. Also increased the favorable outcomes (mRS 0-1) [OR=1.34 95% CI (1.12-1.60); p=0.001]. The risk of sICH increased [OR=3.93 95% CI (2.44, 6.35); p=0.00001] and the overall mortality showed no differ-ence [OR=1.11 95% CI (0.90, 1.38); p=0.01]. The pooled studies showed no significant heterogeneity. Conclusion: The evidence indicates that intravenous rt-PA increased the proportion of patients who were alive-with favorable outcome and alive and independent at final-follow-up. This benefit occurred despite an increase in the-number of early symptomatic intracranial hemorrhages an-dearly deaths. The overall mortality at the end of follow-up is not significantly increased.
tissue plasminogen activator
Acute ischemic cerebral stroke
2021
06
01
685
694
https://mjcu.journals.ekb.eg/article_167879_cf88e980f0ece1c81db8df011d3d5e11.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Serum Uric Acid Level and Inflammation in Obese Medical Students at Ain Shams University
HEBATALLAH S. ALY, M.D.;
REEM M. SALLAM, M.D.
MARIAN M.S.
ROUSHDY, M.D.
Abstract Background: Overweight and obesity occur when excess fat accumulation increases risk to health, leading to expression of co-morbid diseases occur at different thresholds. That's why obesity is now recognized as a chronic or non-communicable disease. Aim of Study: To assess serum uric acid and diet contrib-uting in its increased concentration level in relation to inflam-mation in a subsample of obese medical students as compared to normal-weight medical students in Faculty of Medicine Ain Shams University. Subjects and Methods: The current study is a case control study of 63 students among 1220 Ain Shams medical students. Our study group was divided into two groups. Group 1 included 30 students with BMI between 18.5-24.9Kg/m2. Group 2 included 33 students with BMI >!30Kg/m2. Results: There was significant difference between the two groups in weight, waist circumference and waist hip ratio, but not for height. As regards CRP serum level, the obese group showed significant increase in serum level. In the same time there was a significant positive correlation between the CRP serum level and BMI, WC and WHR in both groups. On the other hand, protein intake was significantly higher in obese group than normal weight group, as a part of increased caloric intake. When comparing serum uric acid level in the two groups there was a statistically significant difference, and on searching for a relation between the serum uric acid and BMI, WC, CRP and protein intake serum level, a positive correlation was found. Conclusion: Serum UA level is a crucial biomarker, it could induce inflammation and hence increases adiposity or its increase results from increased obesity. Moreover, increased serum uric acid is correlated to increased protein intake in obese individuals with increased total caloric intake specially protein content.
Uric acid
Protein intake
CRP
Inflammation
obese
Medical students
2021
06
01
695
700
https://mjcu.journals.ekb.eg/article_167912_eeafe5635b28b1e55e814ba7157a5277.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Decompressive Craniectomy in Patients with Malignant Middle Cerebral Artery Infarction: Prognostic Factors and Timing Dilemma
AYMAN M. ISMAIL, M.D.;
FATEN FAWZY MOHAMED, M.D.
MONA M.
AMER, M.D.
Abstract Background: About 10 percent of ischemic strokes are defined as a malignant one due to associated massive brain edema which is severe enough to produce elevated intracranial pressure and brain herniation. Decompressive Craniectomy (DC) with duraplasty is a surgical technique that involves the creation of extra roomy space and incision of the tight dural covering the brain allowing swollen brain tissue to herniate outwards to reduce the Intracranial Pressure (ICP). Aim of Study: This study aims to share the experience of performing decompressive craniectomy in the treatment of malignant Middle Cerebral Artery Infarction (MMCAI) >48 hours after stroke with an analysis of the results and prognostic factors. Patients and Methods: From January 2016 to June 2018, we performed a decompressive craniectomy in eleven patients with massive middle cerebral artery infarction. Retrospectively we reviewed the clinical and radiological data, Glasgow coma scale at admission, pre and post-operatively. Serial Computed Tomography (CT) with measurement of midline shift pre and post-operatively. Patients were evaluated according to the following factors: Age, sex, the time between admission and surgery, the time between deterioration and surgery, the pre and post-operative Glasgow coma scale, pre and post-operative midline shift on CT scan, dominancy, and Glasgow outcome scale. Results: Eleven patients (11) have been operated on by decompressive hemicraniectomy and duroplasty, there were no significant changes in outcome in relation to the admission GCS, GCS (p=0.2599) or in GCS (p=0.3713), but there was a significant correlation between the pre-operative GCS and outcome and decompressive craniectomy leads to highly significant relieve of the midline shift (p < 0.000). No significant correlation was detected between the time interval elapsed between admission and the time surgery and patient outcome (p=0.3032), but there was also a significant correlation between the time interval between patient deterioration and time of decompressive craniectomy and patient outcome (p=0.92161). Conclusion: Very strict close observation of patients with Malignant Middle Cerebral Artery (MMCA) infarction in the Neuro ICU is highly recommended and surgery should be done as early as possible before the clinical deterioration of the brain herniation for better benefit. Decompressive craniec-tomy could be a life-saving procedure for large hemispheric infarction but postoperative morbidity and quality of life are the main challenges. Although early surgery is recommended by many studies but still DC even after 48 hours may be a life-saving procedure for some patients especially those operated on within a small time window once the clinical deterioration has happened but the post-operative morbidity and quality of life are the main challenges.
middle cerebral artery
edema
Decompressive craniectomy
2021
06
01
701
707
https://mjcu.journals.ekb.eg/article_167913_7a5d7f4783ab29f3b2b53db9e84bf922.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Vitamin D Levels in Female Depressive Psychotic Patients
DALIA R. IBRAHIM, Ph.D.*
EMAN M. MAHMOUD, Ph.D.
Abstract Background: Vitamin D is a neurosteroid hormone of a central role in CNS development and function and its insuffi-ciency is associated with cognitive impairments. Major De-pression Disorder (MDD) is a mental disorder that is affected by diet and nutritional factors. Aim of Study: The present study was carried out to assess the levels of vitamin D in depressive psychotic female patients and to compare its levels with the control group. Subjects and Methods: Eighty female subjects participated in this study, 40 inpatients in Abou Al-Azayem Psychiatric Hospital, Cairo, Egypt, suffering from major depressive disorder, and 40 healthy control volunteers. Vitamin D con-centration, Thyroid stimulating hormone (TSH), Aspartate Aminotransferase (AST), alanine aminotransferase (ALT), urea, creatinine and fasting glucose were evaluated in serum. Results: The results showed that vitamin D levels were significantly lower in the depressive psychotic group compared to the control group. Meanwhile, there were significant increases in urea concentrations in the depressive group compared to the control one. The two groups (depressive psychotic and control) on the other hand, showed insignificant changes in TSH, AST, ALT, creatinine and fasting glucose levels. Conclusion: Depressive psychotic patients suffered from vitamin D deficiency and insufficiency therefore, vitamin D supplementation maybe effective in the treatment of depression and lowering the depressive symptoms.
Vitamin D
Psychosis
major depressive disorder
2021
06
01
709
714
https://mjcu.journals.ekb.eg/article_167915_d291a0350d0da71826a6d789a3fc5c02.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Ligation versus Clipping of the Appendicular Stump in Laparoscopic Appendectomy
AHMED A. DARWISH, M.D.;
IBRAHIM M. ABDEL MAKSOUD, M.D.
MOHAMED S.F.
ZAEMA, M.Sc.
Abstract Background: Appendectomy is the most common surgical procedure performed in general surgery. For almost a century, open appendectomy, first described by Charles McBurney in 1889, has remained the gold standard treatment for acute appendicitis. The introduction of laparoscopic surgery has dramatically changed the field of surgery and laparoscopic surgery has been widely used as a minimally invasive surgery. Aim of Study: Comparative evaluation of intra-corporeal ligation versus titanium clip application as methods of securing the appendicular stump. As regard safety, simplicity, compe-tence, surgical technique, operative time, hospital stay and post-operative morbidity. Patients and Methods: This study was conducted to evaluate the results of the Intracorporeal ligation versus Titanium clips application in securing the appendicular stump in regarding operative time, operative findings, post-operative complications, hospital stay and return of the patients to their normal daily activities. Results: The overall post-operative complications were different in the 2 group. The incidence of wound infection was less in clips group (0% versus 10%). The mean hospital stay was shorter in clips group patients than ligation group patients (13.45 versus 18.95 hours). The mean time to return to normal activities was shorter in titanium clips patients (5.45 days versus 6.30 days). The use of laparoscope in suspected appendicitis is better than the open method especially in equivocal cases to reach an exact diagnosis. We must not hesitate to convert laparoscopic appendectomy to open appen-dectomy for the sake and safety of the patient. Conclusion: Both methods of intracorporeal ligation and clip application are cost effective in securing the appendicular stump. Titanium clip application is more easy to the surgeon, more time saving during the operation and less post-operative stay in the hospital. The only limitation of the clip application is the wider diameter of the base of the appendix beyond the large titanium clip in these cases intra-corporeal ligation is a safe and cheap alternative.
Laparoscopic appendectomy
ulcerative colitis
ligation
clipping
2021
06
01
715
722
https://mjcu.journals.ekb.eg/article_167916_a32f3d89e92125c902d531d81ce59f33.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Immunogenic Study for CX3CR1 Molecule in Rheumatoid Arthritis Patients
MOHAMED F. ELSHAL, M.D.*
SALAMA M. EL SHINNAWY, M.D.
AHMED S.
HASABELNABY, M.Sc.
Abstract Background: CX3C Chemokine Receptor 1 (CX3CR1) is a chemokine receptor which interact with the pro-inflammatory chemokine fractalkine and participates in the pathology of inflammatory arthritis. Aim of Study: This study aimed to evaluate the variations of CX3CR1 in rheumatoid arthritis. Subjects and Methods: A case-control study involved 50 male and female Rheumatoid Arthritis (RA) cases and 25 healthy controls. Disease activity, Anti-Cyclic Citrullinated Peptide (Anti-CCP), Erythrocyte Sedimentation Rates (ESR), Rheumatoid Factor (RF), C-Reactive Protein (CRP) were evaluated as well as assessment of the variations in CX3CR1 by Flowcytometric studies or Polymerases Chain Reactions (PCR). Results: A significant link was detected between RA and CX3CR1 (p=0.0001) with three types of genotyping detected using high resolution melting PCR as; AA constituted the highest percentage in cases (28%) compared to controls (20%), AG was detected in 21 cases (42%) and not detected in controls (0%) and GG was detected in 15 cases (30%) versus 20 controls (80%). Also, cases showed significant increase in median flow than the control (4.8 vs. 1.26 respectively) (p=.0001). A significant positive association was detected between the flowcytometry and C-reactive protein, erythrocyte sedimentation rates rheumatoid factor, Anti-CCP and the number of affected joints. Conclusion: CX3CR1 is a valuable biomarker of RA activity with a significant role in the local joint inflammatory reaction sparing other body parts.
activity
CX3CR1
Rheumatoid
severity
2021
06
01
723
730
https://mjcu.journals.ekb.eg/article_167917_4977fbe88677814fe26e7250bdc6c912.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Stepwise Devascularization and Resection of the Placenta with Adherent Uterine Wall. A New Effective Applicable Technique to Preserve the Uterus in Morbidly Adherent Placenta: Case Series
AHMED A. KHALIFA, M.Sc.;
MAGDY M. AMEEN, M.D.
MOHAMMED S. ISMAIEL, M.Sc.;
YOUSEF S. YOUSEF, M.Sc.
MOSTAFA MAHMOUD, M.Sc.;
OMAR M. FAHMY, M.Sc.
MARIAM M.
ELSHAMANDY, M.B.B.cH.
Abstract Background: Morbidly adherent placenta is considered one of the most life-threatening obstetric complications and may cause severe intra operative bleeding requiring massive blood transfusion. The challenge is how to preserve the uterus with less complications? Aim of Study: This study aimed to present an alternative applicable surgical technique to save the uterus in cases with MAP by application of stepwise devascularization and resection of the placenta with adherent uterine wall. Material and Methods: It is a retrospective study in which 75 patients with morbidly adherent placenta, who delivered by cesarean section, were selected. Bilateral uterine artery ligation was done after downward dissection of the bladder, followed by upper uterine segment incision, downward step-wise clamping and resection of the whole lower uterine segment with adherent placenta till the cervix by vertical and transverse clamps. Finally reconstruction of the uterus was done. The amount of blood loss, operative time, post-operative hospital stay and operative complications were analyzed. Results: In all cases the placenta was adherent to the lower uterine segment and involving the posterior wall of the bladder in four cases. In all cases the mean estimated blood loss was 1156.3±403.2mL, the mean operative time was 76.3 ±24.5min, and the mean post-operative hospital stay was 3.8± 1.6 days. The four cases, in which the placenta was invading the bladder wall, underwent bladder repair due to bladder injury during dissection. In all cases, the uterus had been preserved. No other intra operative complications were reported. Conclusion: Stepwise devascularization and resection of the placenta with adherent uterine wall is an effective and applicable technique to preserve the uterus in patients with morbidly adherent placenta with excellent operative results, less blood loss, blood transfusion was needed in limited cases.
morbidly adherent placenta
Placenta percereta-caserean hysterectomy
2021
06
01
731
735
https://mjcu.journals.ekb.eg/article_167918_ae4786d714e1a53e4aec99550f7a6083.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Validity and Reliability of Posture Screen Mobile Application in Adolescent Idiopathic Scoliosis
NASR A.A. OTHMAN, Ph.D.;
AHMED S.A. ASKER, M.Sc.
SALWA F. ABD ELMAGEED, Ph.D.;
NAGY A. SABET, M.D.
Abstract Background: Idiopathic scoliosis is a three-dimensional deformity of the growing spine, affecting 2%-3% of adoles-cents. Curve detection before skeletal maturation gives a good opportunity for early treatment or prevention of curve pro-gression. Aim of Study: To investigate validity and reliability (intra-rater) of posture screen mobile (PSM) application in Adolescent idiopathic scoliosis (AIS). Material and Methods: Forty-one subjects (28 females & 13 males) with idiopathic scoliosis (30 thoracolumbar & 11 lumbar) participated in this study. Their mean ± SD for age, weight, height, and BMI were 17 (±1.2) years, 65.97 (±9.16) kg, 168.6 (± 6.4) cm and 23.1 (±2.04) kg/m2 respec-tively. Cobb's angles for each patient were predetermined by the radiologist before participating in this study. Each patient was clinically scanned by using two cameras (mobile phone & IPad) from four views (anterior, posterior, right lateral, left lateral). Following digitization, the application calculates the translations and angulations of different spinal segments. Results: Moderate positive significant correlation for T1- T4 (r=0.4, p=0.009), and strong positive significant correlation for T4-T8, T8-T12, T12-L3 and L3-PSIS (r=0.82 to 0.89), p=0.0001) were found between Cobb's angle and spinal segment angulation measured by posture screen mobile. On the other hand moderate positive significant correlation for T1-T4 (r=0.6, p=0.009), and strong positive significant cor-relation for T4-T8, T8-T12, T12-L3 and L3-PSIS (r=0.8-0.9), p=0.0001) were found between Cobb's angle and segment translation that measured by posture screen mobile.Intra-rater reliability of the Posture screen mobile suggested excellent agreement for spinal segment angulation (ICC: 0.99) and spinal segments translation (ICC: 0.92-0.97). Conclusion: PSM application is valid and reliable in screening posture deviations for patients with idiopathic scoliosis. It is an easy, quick, safe, affordable, user-friendly, low-cost screening method, and noninvasive for clients and patients.
Scoliosis
Cobb's angle
Posture screen mobile
2021
06
01
737
743
https://mjcu.journals.ekb.eg/article_167919_e6716837435629af189b912bae6bcb18.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Association of Triglyceride Glucose Index and Risk of Cardiovascular Disease in Female Health Colleges
DARA
AL-DISI, Ph.D.
Abstract Background: Cardiovascular disease (CVD) is projected to be responsible for millions of deaths worldwide annually, including Saudi Arabia. CVD risk factors are highly prevalent, particularly among women in Saudi Arabia. Early awareness and treatment of cardiovascular signs before a CVD event occurs are therefore critical. Increased triglycerides and fasting glucose levels are two important risks for CVD, and the triglyceride glucose (TyG) index has been proved to predict CVD in many studies. Aim of Study: This study aims to examine the association of TyG-index and risk of cardiovascular disease in female health colleges to identify individuals at risk of developing CVD events. Methods: A total of 128 females from female health colleges in Riyadh participated in this cross-sectional study. Glucose and lipid profile parameters along with anthropometric and central obesity parameters were measured. The TyG index and the association between the TyG index and anthropometric and lipid profile parameters using the Spearman correlation coefficient were calculated. ROC analysis was used to detect long-term cardiovascular risk among women by using the TyG index against standard Framingham and ASVCVD risk scores. Results: This study identified that TyG-index was associ-ated with BMI and waist circumference, which are well-established anthropometric risk factors for CVD progression, along with total-cholesterol. A significant positive but weak association between TyG index and Framingham risk scores and lifetime ASCVD score was found. However, the TyG index may not be independently used to identify the people at risk of developing CVD as observed by the low area under the curves (AUC) scores using standard Framingham risk scores and ASCVD risk scores as gold standards. Conclusion: In conclusion, the positive correlation between TyG index and anthropometric indices and total cholesterol, which are known cardiovascular risks, suggests that the TyG index might be a useful indicator for early identification of CVD in conjunction with other established instruments, such as Farmington and lifetime ASCVD risk scores.
TyG index
Insulin Resistance
CVD
Saudi women
2021
06
01
745
751
https://mjcu.journals.ekb.eg/article_167923_2e9eb9325ab3baaa7ecabb8275ffd9bd.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Aquatic versus Land-Based Exercise in Treatment of Chronic Mechanical Low Back Pain
HEND M.T. NASAR, M.Sc.;
RAGIA M. KAMEL, Ph.D.
NABIL M.
ABEDL-AAL, Ph.D.
Abstract Background: Mechanical Low Back Pain (MLBP) is a major cause of illness and disability, especially in people of working age. Aim of Study: The study was conducted to compare be-tween the effect of aquatic exercise and land-based exercises on pain level, functional disability and lumbar Range of Motion (ROM) in subjects with Chronic Mechanical Low Back Pain (CMLBP). Material and Methods: Sixty patients with chronic me-chanical low back pain of both gender participated in the study: 17 male and 43 female between 25 and 40 years old. They were divided randomly and equally into two groups: A study group (A), in which patients received land based exercise program; and study group (B), in which patients received aquatic exercise program. Both groups received the treatment program for 50min, three times per week, for one month assessment of patients in each group for pain level, functional disability and lumbar range of motion before and after treatment. Results: There were statistically significant differences in all outcome measures in favor of the water exercises group (p < 0.001). In land exercise group, there were statistically significant differences regarding pain intensity, oswestry disability index, and lumbar flexion (p < 0.0001), except for extension, right and left side bending range of motion outcomes (p>0.05). However, there were statistically significant differ-ences regarding all outcome measure in water exercise group (p < 0.0001) when comparing the pre-treatment with post-treatment results. Conclusion: Aquatic therapy is effective in decreasing pain severity, level of functional disability and improved lumbar range of motion in patient with chronic mechanical low back pain than land-based exercise.
Low back pain
range of motion
Disability
Hydrotherapy
exercise
2021
06
01
753
760
https://mjcu.journals.ekb.eg/article_168009_5ea2d2a882453b34c8d73844473bfbb4.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Assessment of the Effect of Concomitant Use of Sodium Benzoate and Fructose on the Liver Structure and Function in Young Albino Rats
SHIMAA MOHAMMAD YOUSEF, M.D.;
HOREYA ERFAN, M.D.
MOHAMED A. ZAYED; M.D.;
KARIMA EL-SAYED, M.D.
Abstract Background: Sodium benzoate (SB) is incorporated in many food and pharmacological manufacturing as a preserv-ative. Fructose (FR) is used a as substitute for sugar in many food products. Aim of Study: To test the cumulative effect of the combined daily use of SB and FR on rats' liver. Material and Methods: Twenty-four young male rats were assigned into four groups: 1- Control group; 2- SB group; 15mg/kg/day; 3- FR group; 10ml of 10% fructose/day; and 4- Combined SB +FR group. The rats were followed-up for 28 days. At day 28, animals were sacrificed and blood samples were drawn for liver enzymes analysis. The livers of the rats were divided into two parts; a part for freezing for homoge-nization and hydrogen peroxide analysis and the other for histopathological assessment. Results: The liver enzymes showed insignificant changes compared to the control group. The H2O2 was significantly elevated in SB and SB + FR groups. The liver architecture was negatively affected as detected by hematoxylin and Eosin, periodic acid Schiff and proliferating cells antigen stains. Conclusion: The combined use of SB and FR lead to detrimental effects on the liver function and structure. This in turn warrant cautious use of these substances and raise questions about the safety of using them in a combination on daily basis.
sodium benzoate
E211
Fructose
Liver
H2O2
2021
06
01
761
767
https://mjcu.journals.ekb.eg/article_168010_0f3b6615bfc40b407b2e23da39540767.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Algorithm for Management of Low Back Pain and Sciatica
IHAB HOSNY, M.D.;
MAHMOUD MASOUD, M.Sc.
SATISHCHANDRA GORE, M.S.
FABMISS
Abstract Background: Low back pain and sciatica are one of the most common complaints that face clinicians in spine outpa-tient clinics. The process of examination and reaching a diagnosis is not always easy. Planning treatment that suits each case needs a surgeon that has the knowledge and tools to tackle the different diagnosis. Introduction of new concepts about low back pain and sciatica with improved clinical examination findings that will lead to more accurate clinical diagnosis. Using the algorithm will reach to a diagnosis that needs imaging only for confir-mation. Aim of Study: This algorithm aims at simplifying diagnosis and management of low back pain and sciatica putting in mind treatment options including endoscopic techniques. Patients and Methods: Four hundred patients were includ-ed in the study; they were examined according to the algorithm in the outpatient clinic of Al-Helmya Military Hospital during the period from January 2020 to December 2020. Results: The diagnosis reached by using the algorithm coincided with the MRI findings in 93% of cases and the success rate of the treatment methods used was 89%. Conclusion: Using a systematic approach to diagnosis and reaching a treatment plan has proved successful in the management of low back pain and sciatica.
Low back pain
Sciatica
Algorithm
Spine endoscopy
2021
06
01
769
775
https://mjcu.journals.ekb.eg/article_168011_77791e670199e4bc264d64a2ac2c5d26.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Management of Occult Breast Carcinoma: A Meta-Analysis Study
OSAMA A. AL-ATRASH, M.D.;
KARIM FAHMY, M.D.
AHMED S.
EL-SAYED ABD EL-RAOUF, M.Sc.
Abstract Background: Breast cancer is the commonest primary neoplasm affecting females in Egypt, it is considered the third leading cause of cancer related deaths in Egypt, it has been established during past decades, that surgery, radiotherapy and chemotherapy are corner stones in treatment of breast cancer. Aim of Study: Is to locate relevant studies comparing different lines of management most commonly used in treat-ment of occult breast cancer that are published till now, revising all these studies, and designing a meta-analysis study to assess the overall result and to highlight the different lines of management of occult breast cancer and to assess recurrence rate and prognosis. Material and Methods: In this meta-analysis, we system-atically investigated the present therapeutic options in patients diagnosed with OBC, targeting a definition of the surgical approach associated with best surgical and recurrence out-comes. 10 studies were eligible for inclusion in our meta-analysis, all were published in the period from inception till 2020, revising all these data, none the less designing meta-analysis study to evaluate the overall result and to highpoint the different surgical approaches in management of occult breast cancer and to evaluate recurrence rate and prognosis. Results: A total of 837 patients were included in meta-analysis, with median age 54 years range from 44 to 59.3 years old with median follow-up period 67.7 months, compared to other meta-analysis conducted by Macedo et al., had seven studies included with total number of 241 patients eligible for analysis, median age were 55 years ranged between 50- 59 years old. Conclusion: There was no statistically difference between BCS + ALND and Mastectomy + ALND surgical approaches in terms of recurrence including loco regional and distant also there was difference in survival (OS and DFS) between BCS + ALND and Mastectomy + ALND surgical approaches.
Occult Breast Carcinoma
breast cancer
2021
06
01
777
786
https://mjcu.journals.ekb.eg/article_168012_de0add162a0c34408bcb4d5c2f2d40c3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Coronary Artery Bifurcation Angle Degree; Bifurcation Lesion Development and the Prognostic Impact
AHMED GAAFAR, M.D.;
ALAA MOHAMMED, M.Sc.
MOUSTAFA
ABDEL KAWI, M.D.
Abstract Background: Coronary artery bifurcation lesion is one of the challenges in coronary arteries revascularization. Hemo-dynamic factors, as bifurcation angle is widely recognized for its involvement in atherosclerotic plaque formation. Aim of Work: Our aim of this study was to detect the effect of coronary artery bifurcation angle degree on the development of bifurcation atherosclerosis using Computed Tomography Coronary Angiography [CTCA] and its prognos-tic impact. Patients and Methods: The study was included 221 patients having low and intermediate pretest probability for Coronary Artery Disease [CAD]. Coronary arteries were investigated with CTCA for detection of bifurcation lesions, assessment of bifurcation angle and bifurcation lesion type, then 1 year follow-up period for Acute Coronary Syndrome (ACS). Results: 138 patients were males (62%) and 83 were females (38%). The meanage group was 55.7±9.8 years old. Bifurcation lesions were higher at LAD-LCx (125 patients, 56.5%) than at LAD-major diagonal (104 patients, 47%), than at LCx-OM (56 patients, 25%) (p-value <0.0001). At LAD-LCx sites there were higher bifurcation angles in patients with atherosclerotic bifurcation lesions than patients without bifurcation lesions (77.32º±18.1º vs. 62.24º±18.2º, p-value 0.001), while there was no statistically significant difference as regard bifurcation angels at LAD-diagonal and LCx-OM bifurcation sites. There was no relation between bifurcation angle and type of atherosclerotic plaque at the three studied bifurcation sites. Patients with wider bifurcation angels regardless lesions severity or management protocol had higher rates of ACS. Conclusion: A strong relation between LM bifurcation angel and the development of atherosclerotic lesions was noted, where wider bifurcation angles are more prone for atherosclerotic lesions, and more prone to develop ACS.
CT coronary angiography
CAD
Bifurcation lesion
Bifurcation angel
ACS
Plaque type
2021
06
01
787
796
https://mjcu.journals.ekb.eg/article_168013_dcf07738a395e3c10903dc1dd358c095.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Protective Effect of Obestatin on Testicular Ischemia/Reperfusion Injury in Rats
NADINE A. RAAFAT, M.D.;
SUZAN M.M. MOURSI, M.D.
WESSAM M.R.
ASHOUR, M.D.
Abstract Background: Testicular torsion (the most common cause of testicular ischemia) is one of the urologic emergencies occurring frequently in neonatal and adolescent period. Al-though reperfusion of the testis is the key treatment after ischemia, it enhanced the formation of reactive oxygen species (ROS) that result in testicular damage and cell apoptosis. The effect of obestatin on testicular ischemia-reperfusion injury has not been evaluated previously. Aim of Study: This study was delineated to investigate the potential protective effect of obestatin on testicular ischemia/reperfusion (I/R) injury in rats. Material and Methods: 30 healthy adult male albino rats weighting 194-217g were involved and divided into 3 equal groups, group (I): Sham operated control group, group (II): Testicular ischemia reperfusion (I/R) group and group (III): Obestatin treated ischemia reperfusion (I/R-obestatin) group; received obestatin (100mg/kg) intravenously 15min before the testicular detorsion (reperfusion). Serum testosterone level was measured and orchiectomy was performed 6 hours after testicular detorsion and examined histopathologically and immunohistochemically for evaluation of pro-apoptotic Bax and anti-apoptotic Bcl-2 proteins expression. Testicular malondialdehyde (MDA), interleukin-1b (IL-1b) and tumor necrosis factor-a (TNF-a) levels and superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), caspase-8 and caspase-3 activities were also evaluated. Results: This study demonstrated that administration of obestatin prior to detorsion significantly increased the reduced serum testosterone level and attenuated the testicular tissue damage observed in I/R group. It also reversed the increased MDA, TNF-a and IL-1b levels and significantly enhanced the antioxidant enzymes activities in the ipsilateral I/R testis. Moreover, it improved the significant high levels of caspase-8 and caspase-3 and alleviated the increased Bax and the reduced Bcl-2 proteins expressions noticed in I/R testis. Conclusion: Obestatin has a protective effect against testicular I/R injury which can be attributed to its anti-oxidant, anti-inflammatory and anti-apoptotic properties.
Obestatin
Reperfusion injury
testis
Oxidative Stress
2021
06
01
797
805
https://mjcu.journals.ekb.eg/article_168014_68b7aac2b536bb5a993c0a45b8e5d50e.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Evaluation of Pre-miRNA-146a rs2910164 Variations and sCD40 Ligand in Egyptian Patients with Rheumatoid Arthritis
FATMA H. ABDELRAOUF, M.D.;
HOIYDA A. ABDEL RASOL, M.D.
WALAA G. HOZAYEN, M.D.;
HANAN HUSSEIN, M.D.
ENGY EL KHATEEB, M.D.;
WALID BAKEER, M.D.
GOMAA ABDEL RAZEK, M.D.;
WAEL M. ABDEL KHALEK, M.D.
HEND H.
TAMIM, M.D.
Abstract Background: Patients with Rheumatoid Arthritis (RA) are at greater risk of developing Cardiovascular (CV) events with higher rate of subsequent mortality. MicroRNAs (miR-NAs) such as MiR-146a are thought to have an important role in the pathogenesis of RA. CD40-CD40L interaction is poten-tially involved in atherogenesis and plaque rupture in RA, it can be a risk factor in development of accelerated vascular complications in RA patients. Aim of Work: Our aim is to evaluate the level of sCD40L, investigate the genetic variations (polymorphisms) in pre-miRNA-146a rs2910164 in a cohort of Egyptian RA patients and detect their possible relation to CV risk in RA. Methods: 108 RA patients were enrolled in our study and were divided into 2 groups according to presence and absence of CV risk along with 49 controls. Genotyping of pre-microRNA-146a rs2910164 polymorphism was done by Taq-Man real-time PCR and serum sCD40L levels were measured using human soluble CD40L ELISA assay. Results: sCD40L concentration was significantly lower in RA patients without CV risk and RA patients with CV risk when compared to control group (p < 0.001), but there was no statistically significant difference when comparing both patients' groups (p=0.5). The genotype and allele frequencies of pre-microRNA-146a rs2910164 did not show a statistically significant difference between the studied groups. When comparing RA group without CV risk, RA group with CV risk and control group, GG genotype was 41.8%, 39.6% and 32.7%, GC was 40%, 49.1% and 51% and CC was 18.2%, 11.3% and 16.3%, respectively. G allele frequency in RA without CV risk group, RA with CV risk group and control group was 35.2%, 35.2% and 29.5% and C allele frequency was 34.7%, 31.4% and 33.9%, respectively. Conclusion: Pre-miRNA-146a rs2910164 gene variations were not associated with RA and does not increase the sus-ceptibility to cardiovascular disease. Low serum levels of sCD40L were detected in RA patients irrespective of the presence of cardiovascular risk. Evaluating sCD40L in patients not receiving any treatment and comparing them with post-treatment levels is recommended.
Rheumatoid Arthritis
sCD40L
Pre-miRNA-146a
rs2910164
Real-Time PCR
ELISA
2021
06
01
807
815
https://mjcu.journals.ekb.eg/article_168015_7f7933a819537d584687f1380b6b3041.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Prevalence Evaluation of Salivary Glucose and Total Proteins Levels in Children with Type I Diabetes
SANYA ABD EL HALIM FAHMY, M.D.;
SOHEIR MAKLED, M.D.
NERMEEN M.F.
HAIDER, M.D.
Abstract Background: Glucose can be found in normal indivduals saliva; however, its secretion mechanism is still not clear. Increased glucose content in salivary secretion was reported in diabetic patients by many authors as the salivary glands filter the blood glucose. Aim of Study: The aim of this study was todetermine whether salivary glucose protein levels could be used as a noninvasive tool for diagnosis and glycemic control of type -1 diabetes in children. Material and Methods: 200 patients with type 1 DM, their ages range from 5 to 18 years old randomly assigned into 2 groups: Control and study groups. Group 1: 100 child with type 1DM according to American Diabetes Association 2015. Group 2: (Control group) 100 child apparently healthy with the same age and sex matched children. Fasting blood glucose, Glycosylated Hb (HbA1c), Salivary glucose and Salivary total proteins were measured. Results: There was a significant difference between the two groups in glucose level measured by glucose level con-centration in saliva which is higher in diabetic patients. Conclusion: The present study confirmed that salivary glucose protein levels could be used as a noninvasive and non expensive tool for diagnosis and glycemic control of type -1 diabetes in children.
Type-1 diabetes
Salivary glucose
serum glucose
Salivary proteins
HbA1c
2021
06
01
817
823
https://mjcu.journals.ekb.eg/article_168016_f2a2de6fe43d649731daa676e59f43aa.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Impact of Covid 19 Pandemic on Surgical Outcomes, A Single Center Experience
ZAHRAA FUTOOH, M.D.;
NEHAL FAROUK, M.D.
DALIA
GAD, M.D.
Abstract Background: Covid 19 is global pandemic that affected millions of people worldwide causing extreme limitations in hospital admission for non-emergency surgical diseases. Aim of Study: To assess the effect of Covid 19 infection on surgerical outcomes (surgery related complications, ICU admission and mortality rates. Patients and Methods: Data of all patients admitted to Al-Zahraa University Hospital in the Departments of General, Vascular, and Pediatric Surgeries was collected regarding age, sex, type of operation, associated risk factors, infection by Covid 19, surgery related complications, ICU admission, mortality, also postponed patients. Results: Of 784 patients in three departments 54 patients were infected with Covid 19 (6.88%), significant increase in surgery related morbidity in Covid infected patients with a p-value <0.001 more at vascular and pediatric patients in comparison to general surgery patients with p-value 0.045, respectively. Also significant increase in ICU admission, need for respiratory aid and mortality rate with p 0.044, this increased risk is more with presence of ischemic heart disease IHD p=0.014 , 0.07 respectively and congenital heart disease p=0.018. Conclusion: Covid 19 affects surgical patients by great restriction of elective procedures, delayed scheduling even worse surgical outcomes
COVID-19
surgical outcomes
Surgery related complication
2021
06
01
825
832
https://mjcu.journals.ekb.eg/article_168020_ffca0bc5cd73f4d1b66a68b47c582e52.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Rate of Recurrence of Internal Rotation Contracture after Latissimus Dorsi Transfer and Subscapularis Sliding in Obstetric Brachial Plexus Palsy
MOHAMED A. AMIN, M.Sc.;
HISHAM ABDEL GHANI, M.D.
MOSTAFA MAHMOUD, M.D.;
MOHAMED ABDEL WAHED KOTB, M.D.
Abstract Background: Internal rotation contracture is the most common complication of obstetric brachial plexus palsy, tendon transfer is used to treat limited shoulder abduction and external rotation. Aim of Study: In our study we observe the incidence of recurrency of internal rotation contracture after lattissmus dorsi transfer and Subscapularis sliding. Patients and Methods: We conducted a randomized trail study over 20 patients with internal rotation contracture due to obstetric brachial plexus palsy. From 2015 to 2017 in Abo El Resh Hospital. We done subscapularis sliding combined with latissimus dorsi transfer for. The mean age at the time of operation was 2 years. We used modified gilbert score to asset shoulder function pre and postoperative. Results: All patient after surgery shows marked improve-ment of shoulder abduction and external rotation. We had recurrence of internal rotation contracture in 4 patients. Conclusion: After subscapularis sliding with latissimus dorsi transfer it is preferable to keep in close follow-up of the patient and continuous physiotherapy to prevent recurrence of internal rotation contracture.
Obstetric Brachial Plexus Palsy
Internal rotation contracture
Latissimus dorsi
2021
06
01
833
837
https://mjcu.journals.ekb.eg/article_168021_f5cce423926c2915d4216def7174cba9.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Evaluation of Endoscopic Thoracic Sympathectomy at T2 and T3 Ganglion Level for Primary Hyperhidrosis
HODA A. YOUSSEF, M.D.;
RASHA A. ABD ELGHANY, M.D.
MOHAMMED Sh.
ZARAD, M.D.
Abstract Background: Primary hyperhidrosis is a benign and idio-pathic sympathetic disorder characterized by excessive sweet-ing with no apparent underlying cause and is aggravated during periods of stress and anxiety with a prevalence of 0.6- 2.8% of population. Aim of Study: To compare the effectiveness of thoracic endoscopic sympathectomy either at T2 and T3 regarding the patient's satisfaction, compensatory hyperhidrosis and post-operative complications. Patients and Methods: Forty patients between 13 and 30 years old with primary hyperhidrosis undergoing endoscopic thoracic sympathectomy were divided into two equal groups, the group I: T2 (20 patients) endoscopic thoracic sympathec-tomy at T2 ganglion level and group II (20 patients) at T3 ganglion level. Results: All patients in both groups had an immediate improvement after the operation with dry hands and 100% satisfaction. In group I with axillary hyperhidrosis only one patient (33.3%) had axillary dryness While in group II: Three patients (75%) had axillary dryness. In group I: Two patients (40%) had planter dryness while in group II: Three patients (75%) had planter dryness. 12 patients (60%) were complicated by compensatory sweating in group I, and eight patients (40%) in group II (in back, buttock and thigh), the difference was found statistically non-significant. Conclusion: Sympathectomy at the T2 or T3 levels pro-vided adequate long-term treatment for palmar hyperhidrosis in terms of initial surgery results, complications, and patient satisfaction. The most frequent complication was compensatory hyperhidrosis. Because of the lower severity of compensatory hyperhidrosis, we prefer the T3 level for treating palmar hyperhidrosis.
Palmar hyperhidrosis
Sympathectomy
Com-pensatory hyperhidrosis
2021
06
01
839
844
https://mjcu.journals.ekb.eg/article_168022_5936bea445cc5eebca34902407d3e45d.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Assessment of Correction of Female Stress Urinary Incontinence with Trans Obturator Tape; Traditional versus Tailored
AHMED A. EL GAMMAL, M.Sc.;
SAYEDA E. ALY, M.D.
SALAH E.
SHEBL, M.D.
Abstract Background: Female genuine stress urinary incontinence (SUI) affects a great number of females, with important social and economic consequences. SUI is more frequent after several deliveries, after menopause as a result of changes in the urethral support or the sphincter mechanism. Aim of Study: To compare traditional tension free trans-obturator tape (TOT) and surgeon tailored mesh (STM) in treatment of female stress urinary incontinence as regard of safety, efficacy, side effects, cost, and follow-up. Patients and Method: Prospective randomized study was done on sixty three female patients were suffered SUI with determining of eligibility of the study as shown in COSORT flow chart Fig. (1) at Al Zahraa University Hospital, Al Azhar University from December 2016 to April 2019. All patients subjected to full history, general, and local examination (cases of cystocele, rectocele, or previous vaginal surgeries were excluded). Cystometrogram (CMG) was done for exclusion of uninhibited detrusor contractions, small bladder capacity (<250 CC), impaired bladder sensation, or impaired detrusor compliance. Patients with Significant Post voiding residual urine (>100 CC) assessed by ultrasonography were excluded from this study. All patients requested surgical treatment and provided informed written consent, and the study was approved by the ethical committee. With follow-up for six month post-operatively. Results: Depending on subjective criteria obtained from the Patric questionnaire, and objective criteria from physical examination.As regards traditional tape group, 13 patients (43.33%) were cured; two patients (6.67%) improved with no failed cases and STM group 14 patients (46.67%) were cured; one patient (3.33 %) improved with no failed cases (p-value 0.542, Pearson Chi-Square test). Conclusions: TOT (outside in technique) using both STM and traditional tape are minimally invasive techniques and are equally effective and safe in treatment of pure female SUI, with short hospital stay which reduces the cost of surgery. Both techniques could be used in treatment of pure SUI with good outcome. This technique is more economical due to the cheap ordinary polypropylene mesh. So, it should be considered as a low-cost alternative to the available commercial kits in the treatment of female SUI, mainly for public health systems with few financial resources.
Female stress urinary incontinence
Surgeon-tailored mesh
Polypropylene mesh
TVT-O
TOT
cost
2021
06
01
845
850
https://mjcu.journals.ekb.eg/article_168025_d65be112f3b9a9c65f669a9d62834eaa.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Improvement of Shoulder Function after Teres Major Transfer and Subscapularis Sliding in Obstetric Brachial Plexus Palsy
MOHAMED A. AMIN, M.Sc.;
HISHAM ABDEL GHANI, M.D.
MOSTAFA MAHMOUD, M.D.;
MOHAMED ABDEL WAHED KOTB, M.D.
Abstract Background: Obstetrical brachial plexus injury occurs as a result of forceful traction of the upper extremity for a long period of time during delivery and/or compression injury. Which result in internal rotation contracture of the shoulder and loss of external rotation. which may benefit from release of the contracture, tendon transfers. Aim of Study: This study we do teres major transfer and subscapularis sliding and measure shoulder function improve-ment. Patients and Methods: We conducted a randomized trail study over 20 patients with internal rotation contracture due to obstetric brachial plexus palsy. From 2015 to 2017 in Abo El Resh Hospital. We done subscapularis sliding combined with Teres major transfer for. The mean age at the time of operation was 2 years. We used modified gilbert score to asset shoulder function pre and postoperative. Results: All patient after surgery show marked improve-ment of shoulder abduction and external rotation. Severe external rotation contracture occurred in 3 patients. Conclusion: After subscapularis sliding with teres major transfer have perfect result in improving of shoulder function with increase the risk of external rotation contracture after transfer.
Obstetric Brachial Plexus Palsy
Internal rotation contracture
Teres major
External contracture
2021
06
01
851
856
https://mjcu.journals.ekb.eg/article_168026_6249d9a3f5166a096cfe1c68f960e620.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Case Report: Rectal Prolapse with Incarcerated Retroverted Gravid Uterus
AHMED A. KHALIFA, M.Sc.;
MOHAMED S. IBRAHIM, M.D.
MAMDOUH ELSEMARY AID, M.D.;
AHMED A. KENAWY, M.Sc.
MARIAM M.
ELSHAMANDY, M.B.B.cH.
Abstract Background: The prevalence of combined incarcerated gravid uterus with rectal prolapse is extremely rare condition and only two case have been reported before. Aim of Study: This study aimed to report a third case report of incarcerated gravid uterus within rectal prolapse to raise awareness of its diagnosis and management. Patient and Methods: Case: A case of 33 year old lady with prolapsed incarcerated gravid uterus (gestational age about 12 weeks) in a rectal prolapse and managed by successful manual reduction under anesthesia followed by rectal cerclage. The pregnancy passed without complications and ended by giving a healthy girl. Conclusion: Incarcerated retrovertd gravid uterus within rectal prolapse is a very rare case, so the obstetricians should be aware of its risk. Gentle manual reduction under anesthesia is an effective procedure with limited complications.
Gravid uterus
Retroversion
Rectal prolapse
Incarceration
2021
06
01
857
860
https://mjcu.journals.ekb.eg/article_168027_ff89137c59e28f6a9c2641e730322f07.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Key Role of Packing Technique for Successful Endoscopic Repair of CSF Rhinorhea
WAEL
A. ALZAMIL, M.D.
Abstract Background: Spontaneous CSF leaks are rare, their diag-nosis is often delayed, and they can precipitate meningitis. Craniotomy and intracranial approach is the historical "gold standard" repair for these leaks [1]. Anendonasal endoscopic approach offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success [2]. Recurrence of these leaks is not uncommon. One of the most important factors of this recur-rence is inadequate support of the flaps or grafts or loose cooptation of raw surfaces which may be unable to resist the normotensive CSF leak. Maintaining adequate continuous low grade pressure intraoperativelyand two weeks post-operatively may optimize the best chance for raw areas to heal properly with minimal recurrence. Aim of Study: The aim of this study is to identify and discuss the pivotal role of intraoperative packing and its technique to obtain a successful repair of CSF rhinorrhea. Patients and Methods: A prospective randomized study conducted on 14 patients suffering spontaneous CSF rhinor-rhea, from March 2018 to April 2020 in Hearing and Speech Institute. The 14 patients have been divided into two equal groups 7 patients each, group A and group B. In group A, traditional nasal packing was done, whoever, in group B, the special packing was done in the form two packs, the first pack over the grafted area was two layered composed of 1mm thickness silasticsheet over the graft and raw area and a piece of Merocel 1 by 1.5cmms supporting the silastic sheet. The second pack was placed in the nasal cavity. The first pack has been changed weekly to two or three weeks then removed finally. Results: All patients were doing well throughout the follow-up period. In group A, there was recurrence in fourpa-tients, two after six months and two after one year. In group B there was one recurrence after one year of follow-up.Abstract Background: Spontaneous CSF leaks are rare, their diag-nosis is often delayed, and they can precipitate meningitis. Craniotomy and intracranial approach is the historical "gold standard" repair for these leaks [1]. Anendonasal endoscopic approach offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success [2]. Recurrence of these leaks is not uncommon. One of the most important factors of this recur-rence is inadequate support of the flaps or grafts or loose cooptation of raw surfaces which may be unable to resist the normotensive CSF leak. Maintaining adequate continuous low grade pressure intraoperativelyand two weeks post-operatively may optimize the best chance for raw areas to heal properly with minimal recurrence. Aim of Study: The aim of this study is to identify and discuss the pivotal role of intraoperative packing and its technique to obtain a successful repair of CSF rhinorrhea. Patients and Methods: A prospective randomized study conducted on 14 patients suffering spontaneous CSF rhinor-rhea, from March 2018 to April 2020 in Hearing and Speech Institute. The 14 patients have been divided into two equal groups 7 patients each, group A and group B. In group A, traditional nasal packing was done, whoever, in group B, the special packing was done in the form two packs, the first pack over the grafted area was two layered composed of 1mm thickness silasticsheet over the graft and raw area and a piece of Merocel 1 by 1.5cmms supporting the silastic sheet. The second pack was placed in the nasal cavity. The first pack has been changed weekly to two or three weeks then removed finally. Results: All patients were doing well throughout the follow-up period. In group A, there was recurrence in fourpa-tients, two after six months and two after one year. In group B there was one recurrence after one year of follow-up.
CSF rhinorrhea packing
Potential energy pack
2021
06
01
861
866
https://mjcu.journals.ekb.eg/article_184485_e43d845486f25db091e52b5ca9d01f45.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Bilateral Reinforced Arm Swing Versus Single Arm Restraining on Affected Single Limb Support Time in Stroke Patients
JASMINE M. MAHMOUD, M.Sc.;
EMAN S. FAYEZ, Ph.D.
SANDRAA M. AHMED, M.D.;
MAHMOUD Y. EL-ZANATY, Ph.D.
Abstract Background: Stroke is one of the major leading causes of morbidity and mortality worldwide. Hemiparesis is one among the major impairments after stroke. It significantly affects gait performance. Patients use less affected side over the affected side. This differentiated the transverse rotation of trunk and pelvis. Some researchers found that arm sling has positive effects in enhancing gait patterns especially during gait training sessions in hemiparetic patients who have excessive motion of COG. Some studies suggested that pow-erful swing of upper extremities instead of natural movement is more helpful for improving weight shifting of the trunk, and gait kinematics. However, the upper limb swing function during walking has not yet been clarified, and still subject of debate. Aim of Study: To compare between effect of bilateral reinforced arm swing versus single arm restraining on the affected single limb support time in chronic hemiparetic stroke patients to take it into our consideration during gait rehabili-tation after stroke. Patients and Methods: Thirty male patients with chronic stroke with an average age of 54.96±4.5 years participated in this study. All patients performed overground 10-MWT without any assistive devices over a 15-m walkway at self-selected speed in 3 different conditions: Normal arm swing, affected arm restraining using arm sling and bilateral reinforced arm swing randomly for 3 trails each to calculate average walking speed. The same speed calculated was set on the treadmill of Biodex Gait Trainer 2TM system in meter per second (m/sec.) subjects performed a 3-minute walk under each of the previous conditions randomly with time interval 20 minutes between tests for recording of average time on affected side during gait cycle. Results: The mean difference in time on the affected side between normal and sling conditions was –0.37%. There was no significant difference in time on the affected side between normal and sling arm condition (p=1). The mean difference in time on the affected side between normal and powerful conditions was –3.2%. There was a significant increase in time on the affected side in powerful compared with normal arm swing condition (p=0.04). The mean difference in time of the affected side between sling and powerful conditions was –2.83%. There was a significant increase in time on the affected side in powerful compared with sling arm condition (p=0.1). Conclusion: The results suggest that powerful arm swing significantly increased the percent of weight bearing on affected side in chronic hemiparetic stroke patients. Hence, it is recommended to motivate the patient to swing his arm powerfully as much as he can during gait training sessions.
stroke
Hemiplegia
Gait
Arm swing
Arm sling
2021
06
01
867
872
https://mjcu.journals.ekb.eg/article_184486_6e4583e6ca9b9f90f6aa03a624919497.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Comparative Study between CT and MRI in Assessment of Laryngeal Cartilage Invasion in Laryngeal Carcinoma
SHAIMA F. ELKHOLY, M.D.;
MOHAMED A. KANDEEL, M.Sc.
MO'MEN A. AMEEN HAMELA, M.D.;
RAMY E. IBRAHIM ASAAD, M.D.
Abstract Background: Laryngeal cancer comprises 2 to 5% of all malignant diseases diagnosed annually worldwide. Cartilage invasion by the laryngeal cancer is of great importance through the staging of laryngeal carcinoma according to TNM classi-fication and has a great impact on management plan. There is a scarcity in the published literature regarding the comparison between MRI and CT for assessment of cartilage involvement. Aim of Study: To assess the validity of MRI and to compare this with CT findings in predicting inner and outer thyroid cartilage laminae invasion in patients with laryngeal carcinoma. Patients and Methods: The present study was an obser-vational analytical study that was carried out from January 2018 to June 2019 at the Radiology Department of Faculty of Medicine, Cairo University. A total of 30 patients with laryngeal carcinoma were included. CT and MRI was done for all patients. Results: There was a good agreement between readers in CT interpretation in term of inner lamina involvement (K=0.78) and very good agreement in term of outer lamina involvement (K=0.87). While in MRI interpretation, there was a very good agreement between readers in term of inner lamina involvement (K=0.83) and outer lamina involvement (K=0.92). However higher accuracy & confidence levels were found on interpre-tation of both CT and MRI together. We found a higher interobserver agreement between interpretation of CT and MRI together (K=1.00). Conclusion: MRI showed high validity and precision in detecting inner and outer thyroid lamina invasion by laryngeal caner than CT scan. We found that the combination of CT and MRI together was associated with more accuracy and confidence level for the readers.
Cartilage invasion
laryngeal carcinoma
TNM staging
MRI
CT
2021
06
01
873
880
https://mjcu.journals.ekb.eg/article_184488_b6ab4729a1d5e5029b993ed4379f0106.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Percutaneous Transforaminal Endoscopic Lumbar Discectomy in Obese Patients
IHAB A.M. HOSNY, M.D.;
MOHAMED K. ISMAIL, M.D.
Abstract Background: Obese patients are at higher risk of compli-cations after spinal surgery such as slower wound healing and increased infection rates. Percutaneous Endoscopic Lumbar Discectomy (PELD) has advantages over conventional micro-discectomy because it decreases perioperative complications and increases favorable clinical outcomes. Aim of Study: The aim of this study is to evaluate the clinical outcomes of PELD in obese patients as compared to patients who have a normal body mass index. Patients and Methods: Obesity is defined as a Body Mass Index (BMI) of more than 30kg/m2. Our study included 32 obese patients and 35 normal BMI patients treated by PELD for radiating pain caused by a single-level lumbar disc herni-ation. Clinical and functional outcomes using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) and follow-up was done at 2 weeks, 1, 2, 6 and 12 months post-operatively. All surgeries were done by the same surgeon. Results: Overall clinical and functional outcomes were improved during post-operative follow-up evaluation. There were no immediate perioperative complications, such as infection or durotomy in both groups. In the obese group, two patients had late re-herniation, of these, 1 patients had tolerable pain and showed good recovery with conservative treatment; 1 patient underwent another PELD surgery. In control group, there was one early reherniations which occurred within a months after PELD, which patient underwent conventional microdiscectomy. Conclusion: PELD is an effective, safe, and minimally invasive technique for obese patients. The PELD decreases the post-operative morbidity and allows for faster mobility and rehabilitation. The results were comparable to patients with normal body mass index.
Transformational
Endoscopic
Discectomy
Obesity
2021
06
01
881
887
https://mjcu.journals.ekb.eg/article_184489_994163559126f94ea2f68082ca4d228f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Value of C-Reactive Protein as a Predictor of Vasospasm and Poor Outcome in Spontaneous Subarachnoid Hemorrhage
MOHAMED ELMALLAWANY, M.D.;
AHMED ATTIA, M.Sc.
AHMED EL-FIKI, M.D.;
MOHAMED TAREK EL FAR, M.D.
AHMED
ZATER, M.D.
Abstract Background: Rupture of an intracranial aneurysm carries a high risk of disability or death. Cerebral vasospasm remains the most troublesome complication of acute Subarachinoid-haemorraghe (SAH). Activation of the systemic immune response, manifested by increased levels of circulating cy-tokines, is believed to have a significant role in the pathogenesis of cerebrovascular vasospasm. Aim of Study: The aim of this study is to correlatebetween level of CRP and incidence of vasospasm in spontaneous S.A.H, and being an independent predictor for prognosis. Patients and Methods: Cross sectional study with stratified random sample of 30 patients who admitted in Intensive Care Unit, Neurosurgery Department, Emergency and Trauma Unit at Kasr Al-Ainy, Cairo University Hospitals, from September 2018 till April 2019 diagnosed with spontaneous Subarachnoid hemorrhage and screened for CRP. Results: Out of the 30 included in the study 10 patients (33.3%) diagnosed to have anterior communicating artery aneurysm; 2 patients (6.7%) have basilar tip aneurysm, 2 patients (6.7%) have posterior communicating artery aneurysm, 2 patients (6.7%) have posterior cerebral aneurysm, and 1 patient (1.9%) have middle cerebral artery aneurysm, 2 patient have AVM, 11 patient have no underlying pathology in the conventional 4 vessels angiography. Overall age ranged from 21 years to 80 years with a mean age 53.19 patients (63.3%) were males and 11 patients (36.7%) were females. Out from 30 patients, 14 patients (46.7%) had vasospasm, and 16 (53.3%) patients didn't have vasospasm, out of 14 patients who developed vasospasm, 13 patients (92%) initially had high serum CRP level above 50mg/L, and all patient who had rising CRP level (double to triple folds) had poor outcome. Conclusion: Vasospasm is a serious event complicating spontaneous aneurysmal subarachnoid hemorrhage, it could be diagnosed clinically or radiologically, serum CRP level is an indicator of cerebral vasospasm following aneurysmal subarachnoid hemorrhage and rising serum CRP level is an independent predictor for poor outcome.
Spontaneous Subarachnoid hemorrhage
Cere- bral vasospasm - C-reactive protein
2021
06
01
889
896
https://mjcu.journals.ekb.eg/article_184493_0d43d7155295caab457a25b223559abd.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Phonological Short-Term Memory Impairment in Children with Down Syndrome
EMAN F. EL-WAKIL, M.D.;
RASHA M. SHOEIB, M.D.
YOSSRA A.N. SALLAM, M.D.;
MAHA H. BOSHNAQ, M.D.
Abstract Background: Children with Down Syndrome commonly suffer from phonological and other language disorders which have been partly attributed to underlying deficit in phonological short term memory. Its evaluation was previously confined to non word repetition and/or forward digit span tasks. Aim of Study: To assess phonological short term memory in children with Down Syndrome with mild degree of intel-lectual disability in comparison with non syndromic children with mild degree of intellectual disability to find out any possible correlation between Down Syndrome and phonolog-ical short term memory deficits through comprehensive eval-uation. Subjects and Methods: This case control study has been conducted on 40 children (20 Down Syndrome children with mild degree of intellectual disability, 20 non syndromic children with mild degree of intellectual disability with matched mental age). All of them underwent psychometric evaluation, audiological evaluation, language evaluation using Arabic version of Modified Preschool Language Scale-4th edition (PLS-4), and Arabic version of Phonological Short Term Memory Test (PSTM). Results: Down Syndrome group scored significantly lower than non syndromic children with mild degree of intellectual disability in all items of phonological short term memory test; digit span, syllable repetition, non sense word repetition, dissimilar word set recall, similar word set recall, total score (p-value 0.000, 0.001, 0.004, 0.000, 0.000, 0.000 respectively) and language test; expressive abilities was lower in Down syndrome children (p-value 0.002) but both groups were equal in their receptive abilities (p-value 0.054). Conclusion: Children with Down Syndrome scored below expected for phonological short term memory and their pho-nological store was extensively impaired.
Down syndrome
Intellectual Disability
Pho-nological short term memory
Phonological store
Language disorders
2021
06
01
897
902
https://mjcu.journals.ekb.eg/article_184497_51813430c9025f63dc0096a9887ad9d8.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Brain MRI Abnormalities in Children with Wilson's Disease: Is it Indicator for Liver Transplantation?
HOSAM-ELDIN M. BASIOUNY, M.D.;
HANAA A. EL-ARABY, M.D.
HAZEM OMER, M.D.;
EMAN Z. SEDEEK, M.D.
Abstract Background: Wilson's Disease (WD) is an autosomal recessive disorder of copper metabolism with a prevalence of about 1in 30000 people.It's more common with parental consanguinity. The adenosine triphosphate 7B (ATP7B) gene, coding the copper transporting P-type ATPase has been reported to have 380 variants. Copper leads to tissue damage by accumulating in many organs includingmainly the liver and brain. Neurological manifestations of WD are ascribed toab-normal deposition of copper in brain tissues, especially deep gray matter (basal ganglia and thalamus) and subcortical white matter. Wilson's disease can present clinically by liver disease, neurological disorderor psychiatric illness. In childhood, hepatic manifestations predominate with ahighly variable spectrum ranging from self-limiting hepatitis to fulminanthe-patic failure. Aim of Study: The aim of this study was to detect brain changes by magnetic resonance imaging in children with Wilson's disease and their correlation with clinical and bio-chemical findings. Patients and Methods: This study included 70 patients. 35 patients with WD and 35 patients with other Chronic Liver Disease (CLD) as control. WD group involved 20 males and 15 females. Their mean age was (12.73±2.86) year. Control group included 35 patients with CLD (20 with Autoimmune Hepatitis (AIH), two with sclerosing cholangitis and 13 with chronic HCV. Results: Among WD group, we reported 15 patients (42.8%) had abnormal MRI. T1 weighted images showed bilateral symmetrical hyperintensity signal of globuspallidus in two patients (5.7%), hypointensity signal of left globuspal-lidus in one patient (2.8%) and bilateral symmetrical hyper-intensity in thalami in one patient (2.8%). T2 and FLAIR hyperintensity signals mainly involving basal ganglia were present in 11 patients (31.4%). Ventricular system was affected in two patients (5.7%), it was prominent in one patient and the other patient had hydrocephalus. Patients were followed-up over a period of 6-18 months and we reported that three WD patients (20%) from those who had abnormal MRI deteriorated rapidly and were candidates for LT, while none of other patients needed LT. Conclusions: Bilateral symmetrical hyperintense signals in T2 weighted and FLAIR images mainly involving basal ganglia are specific for WD and represent CNS involvement of WD. Abnormal MRI may be a bad prognostic factor as 20% from abnormal MRI WD subgroup deteriorated rapidly and were candidates for LT.
Wilson's disease
Chronic liver disease
Autoimmune hepatitis
Alanine transaminase
Aspartate transaminase
MRI
LT
HCV
2021
06
01
903
910
https://mjcu.journals.ekb.eg/article_184501_53fea9a4768afb9cbdb7514b3488582f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Review Article Drug Impairment and Liver Disease
SAHAR ATREES, Ph.D.;
SAHAR ATREES, Ph.D.
Abstract Abstract: Liver disease is a major cause of morbidity and mortality and is rated as one of the top 5 commonest causes of premature death in the world. However, not all liver problems are related to an underlying liver disease. Many patients have liver dysfunction which may be secondary to drug therapy, infections or sepsis, gallstones or trauma. The liver helps purify the blood by changing potentially harmful chemicals into harmless ones, the sources of these chemicals can be outside the body, such as medications, or alcohol, or inside body, as ammonia and bilirubin. When drug injure the liver and disrupt its normal function, symptoms, signs. These drugs which called drug induced liver disease (DILI), leads to abnormal blood tests of liver disease, and also liver failure. Liver failure occurs when large parts of the liver become damaged beyond repair, and the liver is no longer able to function, drug-induced liver injury (DILI), is the 4th most important cause of liver disease in western countries, the incidence of DILI is between 1/10000 and 1/100000 patients-years. Aim of Study: Review the evidence regarding fundamental pharmacokinetics alterations caused by the liver disease as well as the potential foe liver toxicity with DILI. Analysis of the evidence of DILI and severe liver injury leading to death will be the aim, finally, provide recommendation and directions regarding drugs and how to minimize the risk of liver toxicity.
Drug
liver disease
2021
06
01
911
917
https://mjcu.journals.ekb.eg/article_184505_e271fe292df8824d40e0f7db9be16ad1.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Complications of Anterior Cervical Discectomy with Interbody Fusion or Arthroplasty
SAMY MOUSSA SELIM, M.D.;
TOHAMI HASSAN, M.D.
REDA
ALI SHETA, M.D.
Abstract Background: Anterior cervical discectomy with fusion or arthroplasty is a common procedure and has been associated with satisfactory outcomes. However, the incidence of com-plications, although uncommon, needs to be taken into con-sideration. Aim of Study: Our aim is to raise awareness on anterior cervical disc procedures associated complications, their pro-phylactic measures proper management. Patients and Methods: Our prospective study conducted on 156 patients; 99 males (63.5%) and 57 females (36.5%); their age range was 26 to 65 years (mean, 45.2; SD, 12.5). The study started from January 2014 to December 2019. The follow-up was for at least 1 year, and we evaluated the clinical and radiographic signs of complications. Results: Thirteen patients (8.3%) had transient dysphagia and three patients (1.9%) had adjacent segment syndrome. two patients (1.3%) each had a post-operative hematoma and a dural tear, and two of fusion (1.4%) cases had pseudoarthro-sis. One patient (0.6%) each had an esophageal injury, Recur-rent laryngeal nerve palsy, post-operative weakness, Horner syndrome, wound infection, and slippage of artificial disc prosthesis. Conclusion: Punctilious knowledge and early recognition of the anterior cervical disc surgery-segment syndrome, hematoma, and pseudoarthrosis were the most common com-plications in our study, and their incidence relatively increases in multiple level cases associated with comorbidity. Appropriate management was done in the most majority of our cases with good functional outcomes.
Anterior cervical spine surgery
Complications
Outcome
anterior cervical discectomy
In-terbody fusion
Arthroplasty
2021
06
01
927
934
https://mjcu.journals.ekb.eg/article_184515_7b1cd862197bbc07d956548fde9a9d01.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Popularity of Herbal Medicine
HADI ALNAJJAR, Ph.D.;
HUSSAM ALKOOT, M.Sc.
MARIAM
ALHUSSAINI, Ph.D.
Abstract Background: Herbal remedies play a major roll in the folcloric nature of Kuwaity community. Old remedies and priscriptions are passed down through genirations. You may find dry opium capsules in some household chest of medicine that is ued for insomnia despite its illigality. There is no clear bounderies between legal herbal products both as crud or as packaged pharmaceutical products verses the ordinary so called chemical products. The WHO herbal Act of 1986, in which I was the repre-sentative of Kuwait was an attempt to set guidelines defining herbal products and the laws of import and export of such drugs. Aim of Study: As an attempt to obtaine feedback from our community about the popularity of such systems of treatments, this study aims to identify the popularity of herbal remedies compared to chemical remedies for future legistlative acts. Matrial and Methods: The study was carried out amongst students at the College of Health Sciences in the State of Kuwait. The effect of the variables of specialization and gender was measured. This study adopts the descriptive approach and data have been collected through a questionnaire applied to the sample of the study of male and female students at the College of Health Sciences. Results: The study's results show that there are statistically significant differences (0.05) among the responses of the study sample's individuals regarding the following domains: Herbal (HB), Orthodox (OR), legislation, and general infor-mation due to the variable of gender in favor of females while there are no differences regarding the domain of supplemental and beauty products. Additionally, the results indicate that there are statistically significant differences regarding the following domains: Herbal (HB) and Orthodox (OR) due to the variable of specialization while there are no differences regarding the domain of supplemental and beauty products, legislation, and general information. Concllusion: The results display that most of the sample's individuals prefer and recommend using herbal remedies, and that they like beauty cosmetics made of herbal drugs. Also, most of the sample's individuals believe in the importance of having centers that provide herbal treatment in Kuwait stating that a great number of patients in Kuwait have no knowledge about these centers. Furthermore, some of the study sample's individuals believe that it is important to use chemical remedies in the acute cases and that both herbal and chemical remedies complement each other.
Herbal medicine
Ortodox
Popularity
Pref-erence
Beauty products
2021
06
01
935
943
https://mjcu.journals.ekb.eg/article_184520_e45a06c645be6e599fc61cd74d7c5084.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Incidence, Risk Factors and Pregnant Outcomes of Premature Rupture of Membranes: A Cross Section Study
MOHAMED
EL-HUSSENY RADWAN, M.D.
Abstract Background: Premature births are responsible for 27.0 per cent of annual child deaths globally, 70.0 per cent of prenatal mortality in developed countries and 50.0 per cent of neurological disorders. Obstetric risk factors include: Cer-vical incompetence, multiple gestation, limited birth cycles, history of abortion, premature membrane breakup, and prior preterm labour. In the meantime, pregnancy conditions such as respiratory disorders and hypertension are the most common direct causes of preterm birth. Bleeding during labour, poly-hydramnios or oligohydramnios, foetal abnormalities including, in particular, numerous organ systems and central nervous system abnormalities. Aim of Study: The purpose of this research was to measure the prevalence rate of PPROM among pregnant women in order to identify risk factors associated with PROM and fetal/neonatal outcomes. Patients and Methods: Is to calculate the incidence rate of PPROM among pregnant women attending Zagazig Uni-versity hospital, and to identify the fetal/neonatal outcome and potential factors associated with poor fetal/neonatal outcome.This is a cross-section study, performed at the ER Department of Zagazig University Hospitals for Vaginal Delivery, from July 2020 to January 2021, of 138 women with premature membrane abduction. Result: Risk factors for cases were 30 with no risk factor (21.7%), 16 with prior PROM (11.6%), 12 with multi-pregnancy (8.7%), 24 with Antepartum (17.4%). There was a statistically meaningful disparity between the outcomes of the infants in relation to the risk factors of the mothers. In the cases of the infants of strong APGAR there was a latent period of 8.89 (±6.64 SD) for cases where the infants required an O2 incubator there was a latent period of 9.73 (±5.69 SD). There was no statistically significant difference between the outcomes of the infants in relation to the latent period. Conclusion: From this study, it can be inferred that low socio-economic, younger, illiterate partitioning women have been shown to cause a rise in PPROM. Such hazards may impact both maternal and neonatal outcomes such as infection, maternal pain, foetal distress, increased surgical delivery, and the need for neonatal intensive care in more than 50 per cent of neonates.
rupture of membranes
Incidence
risk factors
Premature
2021
06
01
945
951
https://mjcu.journals.ekb.eg/article_184522_47d3a8da89d23741f6ee00372cdf7566.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
A Double-Blind, Randomized, Placebo-Controlled Study on the Evaluation of the Efficacy of Vaginal Misoprostol Plus Intramuscular Diclofenac Sodium in to Ease Insertion of Intra Uterine Contraceptive Device in Stenosis Cervix
MOHAMED
EL-HUSSENY RADWAN, M.D.
Abstract Background: Intrauterine contraceptives (IUCs) are one of the most powerful contraceptives. The most popular versions used worldwide are the Cut 380A vice (Cu-IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS). Both forms are safe, cost-effective in the long run. Aim of Study: The aim of this study was to evaluate the efficacy of combination of vaginal misoprostol with intramus-cular diclofenac sodium in decreasing pain and facilitating IUD insertion in women with cervical stenosis. Patients and Methods: The patients were randomized to four groups (32 patient each) using simple randomization (closed envelop) and classified into: The first group (Misopr-ostol Group): Includes 32 patients who received two tablets (400mg) of misoprostol in the posterior fornix of the vagina 2 hours before IUD insertion. The second group (Diclofenac Group): Includes 32 patients who received diclofenac sodium 75mg ampule intramusculary 2 hours before IUD insertion. The third group (Misoprostol Diclofenac Group): Includes 32 patients who received two tablets (400mg) of misoprostol in the posterior fornix of the vagina and diclofenac sodium 75mg ampule intramusculary 2 hours before IUD insertion. The fourth group (placebo Group): Includes 32 patients who received placebo. Result: Misoprostol group and misoprostol diclofenac group showed a significant higher number of easy IUD inser-tion, and misoprostol diclofenac group showed a significant lower extremely difficult insertion in comparison to other groups. There was statistically significant difference between misoprostol diclofenac and placebo groups as regard pain. Conclusion: The administration of vaginal misoprostol and intramuscular diclofenac sodium before IUCD insertion in women with cervical stenosis facilitate the IUCD insertion, decrease failure of insertion and reduce pain sensation during IUCD insertion.
IUCD
misoprostol
Diclofenac sodium sten-sosed Cervix
2021
06
01
953
960
https://mjcu.journals.ekb.eg/article_184523_3ef461496a6c6defec4c3c35d4d0339f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Helicobacter Pylori Tailored Treatment in Children: Tissue Culture and Sensitivity Based
BEHAIRY E. BEHAIRY, M.D.;
NERMIN M. ADAWY, M.D.
TAWFIK M. ABD ELMOTALEB, M.D.;
DALIA H. ABDULLAH ZAYED, M.D.
HOSAM-ELDIN
M. BASIOUNY, M.D.
Abstract Background: Helicobacter pylori (H. pylori) is one of the most common chronic bacterial infections in the world, and it is currently estimated that approximately half of the world's population is infected with the bacterium. The correct diagnosis and effective treatment of H. pylori gastric infection are essential in controlling this condition. The available diagnostic methods have advantages and limitations related to factors such as age of patients, technical difficulty level, costs and extensive accessibility in hospitals. The eradication therapy of H. pylori infection is still a challenge for gastroenterologists. One of the main causes of failure in H. pylori eradication is antibiotic resistance. Biopsy cultures are the most widely used methods among the antimicrobial susceptibility tests. Aim of Study: The aim of this work was to determine the proper regiment of H. Pylori treatment according to gastro-duodenal tissue culture and antibiotic sensitivity. Patients and Methods: This study included 50 patients with Helicobacter Pylori Ag positive stools and positive occult blood in stool. Their age ranged from 1.5 to 17 years old, 60% of them were female. 37 patients showed positive gastric and duodenal cultures and received treatment according to results of cultures. Results: Antibiotic sensitivity of gastric culture shows that Levofloxacin had the highest antibiotic sensitivity (93.5%), followed by clarithromycin and amoxicillin in (77%) and (67.7%) respectively. But, 100% of cases were resistant to the Metronidazole. In duodenal culture, Levofloxacin had the highest antibiotic sensitivity (96.4%), followed by, clarithro-mycin and amoxicillin in (71.4%) for each. But, 100% of cases were resistant to the Metronidazole. All patientsreceived PPI and Levofloxacin, while about 59% and 30% of patients received Amoxacillin and Clarithromycin respectively. Conclusion: Treatment of Helicobacter Pylori should be tailored according to tissue culture and sensitivity.
Helicobacter pylori
Levofloxacin
Clarithro-mycin
amoxicillin
Gastric cultures
Duodenal cultures
2021
06
01
961
966
https://mjcu.journals.ekb.eg/article_184524_72d5511ed0fe9fbf3dd2d0985496e574.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Safety, Efficacy and Acute Angiographic Outcome of the New Everolimus Eluting Stent with Correlation to Short-Term Clinical Follow-up in Patient with Acute Coronary Syndrome
MOHAMED IMAM, M.D.;
SOLIMAN GHARIB, M.D.
MOHAMED ABDELGHANY, M.D.;
HOSSAM ELHOSSARY, M.D.
Abstract Background: Drug-eluting stents are used in 80%. To 90% of revascularization procedures in the United States. Everolimus embedded in a durable polymer on a cobalt chromium Stent has shown superiority compared with Bare Metal Stents (BMS), and paclitaxel eluting stent for reduction of both late loss and binary restenosis. Aim of Study: To study the safety, efficacy and acute angiographic outcome of the new Everolimus Eluting Stent in correlation with short-term clinical follow-up in patient with Acute Coronary Syndrome (ACS). Patients and Methods: A prospective study in which ninety-five patients with (ACS), Scheduled for PCI in the cardiac catheterization laboratory in Cairo University Hospitals or NHI, using Everolimus DES, were enrolled from Jan. 2009 to June 2009. Their clinical, angiographic, interventional and follow-up data were collected and analyzed. Results: Acute success was achieved in all the cases with no device failure, after six month of follow-up, patients (94.5%) had expressed no events or chest pain, 1 patient had stable angina and refused to redo the coronary angiography, 3 patients had redo the coronary angiography due to recurrent chest pain (two of them had redo PCI in remote vessel and the other had no significant lesion), and 1 patient died because of retroperitoneal hematoma. Conclusion: The everolimus eluting stent are a safe type of drug eluting stent in clinical Practice with favorable short term outcomes in patients with acute coronary syndromes.
Everolimus eluting stent
Acute coronary syn-drome
2021
06
01
967
974
https://mjcu.journals.ekb.eg/article_184525_d831dd68f7170890b395c9c84629146c.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Magnesium Sulfate as an Adjuvant in Ultrasound Guided Stellate Ganglion Block for Post Mastectomy Pain Syndrome
GHADA F. AL-RAHMAWY, M.D.;
ENAS A. ABD AL-MOTELEB, M.D.
MONA G. EL-EBEIDY, M.D.;
MOHAMED A. HAFEZ, M.Sc.
Abstract Background: Cancer breast is the most common cancer in women and 2nd most common cancer overall. Post-Mastectomy Pain Syndrome (PMPS) is a term used to describe chronic pain following both partial mastectomy or mastectomy. It is one of many post-surgical persistent pain syndromes. Studies estimate that PMPS develops in about 25% to 60% of women leading to disability, psychological distress, and diminished quality of life. Aim of Study: The aim of the study was to compare analgesic efficacy and duration of stellate ganglion block when using both dexamethasone and magnesium sulfate with the local anesthetic lidocaine in comparison to using dexam-ethasone alone with lidocaine in cases of post mastectomy pain syndrome. Patients and Methods: Current double-blind study was conducted from September 2019 to September 2020 at outpa-tient pain clinic in Oncology Center Mansoura University (OCMU). Fifty female patients between age of 20 and 60 years, ASA physical status I and II underwent breast surgery. The patients were randomly assigned by computer generated sequence of random numbers method according to the drugs used into 2 equal groups, each group consisted of 25 patients, one group had received Dexamethasone and Lidocaine (group D) and the other group had received Magnesium, Dexameth-asone, and Lidocaine (group DM). After block, pain score was obtained using Visual Analog Scale (VAS). The shoulder movements were measured using goniometry. The skin tem-perature of the ipsilateral arm to the block was also measured. Results: After block, pain score was obtained using Visual Analog Scale (VAS). The shoulder movements were measured using goniometry. The skin temperature of the ipsilateral arm to the block was measured, the different types of shoulder movements were significantly better after injection of SGB in both groups compared to before injection. DM group showed longer analgesic duration and lower VAS score with less analgesia needed compared to D group. Conclusion: Adding magnesium sulfate to lidocaine and dexamethasone for ultrasound guided stellate ganglion block in cases of post mastectomy pain syndrome increases the time to first request of analgesia, decreases VAS values and the total amount of analgesia needed in the follow-up.
Post mastectomy pain syndrome
Stellate ganglion block
visual analogue scale
Post breast surgery pain syndrome
2021
06
01
975
985
https://mjcu.journals.ekb.eg/article_184526_34ed5228c8c866580c7ce9f5bda25b3b.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Study of Glypican-3 in Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma
ASHRAF G. DALA, M.D.;
EL-SAYED S. ABO EL-NOUR, M.D.
ABD ALLAH H. ARAKEEB, M.Sc.;
AHMED EZZ EL-ARAB ABD EL-ALIM, M.D.
Abstract Background: Early diagnosis and treatment of HCC can greatly improve the efficiency of treatment and extend patient life. Aim of Study: To investigate the expression of serum Glypican-3 (GPC3) in patients with Hepatocellular Carcinoma (HCC) and determine its efficacy as a screening test in early detection of HCC. Patients and Methods: This case control study involved 30 HCC patients, 30 liver cirrhotic patients and 20 healthy controls. This study had been approved by local institutional research board in Menoufia Faculty of Medicine. All subjects participated in the study voluntarily and written informed consent was obtained from each participant. Clinical exami-nation, abdominal ultrasonography and triphasic Computed Tomography (CT) for focal lesion were performed. Liver function tests were performed using clinical auto-analyzer, serum a-Fetoprotein (AFP) was measured using Enzyme-linked Immune-Sorbent Assay (ELISA) method and GPC3 was determined by ELISA kit for GPC3. Data were collected and statistically analyzed. Results: GPC3 was highly significant higher in HCC group than cirrhotic and control groups. There was highly positive significant correlation between GPC3 and child score, size of focal lesions and number of focal lesions. The sensitivity of GPC3 in diagnosis of HCC was (68.5%) and the specificity was (83.3%) at cut off point (58.2ng/ml) that elicited from the Receiver Operator Characteristic (ROC) curve with very good Area Under Curve (AUC) (0.814), whereas that the sensitivity of AFP was (66.7%) and the specificity was (66.7%) at cut off point (380ng/ml) that elicited from the ROC curve with very good AUC (0.679). Conclusion: GPC3 is highly associated with HCC and is more sensitive than AFP for early detection of HCC.
Alpha -fetoprotein
Enzyme-linked immune-sorbent assay
Glypican-3
Hepatocellular carcinoma
2021
06
01
987
994
https://mjcu.journals.ekb.eg/article_184527_73532f1e7d7e31e7fd5399d4dbef1255.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Effect of High Intensity Interval Training versus Circuit Weight Training on Glycated Hemoglobin in Type 2 Diabetic Patients
RANA A. ABD EL-FATTAH, M.Sc.;
NAGWA M. HAMED, Ph.D.
ABEER A. ABD EL-HAMEED, Ph.D.;
HEBA A. ABD EL-GHAFAR, Ph.D.
LAILA
A. RASHED, M.D.
Abstract Background: Diabetes is a fast-grwoing health problem in Egypt with a significant impact on morbidity, mortality, and health care resources. While increasing physical activity is an essential component of all effective lifestyle-based trials for the prevention of type 2 DM. Aim of Study: To compare between high intensity interval training and circuit weight training on type 2 DM. Material and Methods: Sixty participants had participated in this study. Their ages ranged from forty to fifty years men were selected from Manshyet El-Bakry Hospital. Group (A): Consisted of 30 patients received high intensity interval training program 3 sessions/week for 12 weeks training consisted of interval at high intensity training (85-90% of HRmax) and recovery at (50-70% of HRmax). Group (B): Thirty men participated in this group, received circuit weight training exercises performed for 3 sessions/week for 12 weeks. the resistance (weight) 30% to 40% of 1 repetition maximum for upper body and 50% to 60% for lower-body exercises. Each participant had undergone Measurments for Fasting Blood Glucose, Glycated Hemoglobin (HbA1c) and 6MWT before and after study. Results: The results of this study revealed that there was significant reduction in FBG by 17.68% and 14.18% in group A and group B respectively. While the results of HbA1c there was reduction by 20.77% and 13.37% in group A and group B. There was increase in 6MWT by 10.28% and 4.54% in group A and B respectively. (p < 0.05). Conclusion: Within the limitation of the current study it was concluded that both types of exercises significantly improve HBA1c, fasting blood glucose and 6 minute walk distance after 12 weeks of training in favour of high intensity interval training.
Diabetes mellitus
High intensity interval training
Circuit weight training
2021
06
01
995
1001
https://mjcu.journals.ekb.eg/article_184536_c2d56022cd3853819ba2709e21f72bcb.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Sub-Periosteal Shunt Valve Insertion to Overcome Shunt Exposure Risks in Predisposed Pediatric Age Group
MOHAMED ELMALLAWANY, M.D.;
AYMAN TAREK MAHMOUD, M.D.
HUSSEIN
SOFFAR, M.D.
Abstract Background: Shunting procedure still represents the backbone for the treatment of hydrocephalus. To have an exposed shunt is a nightmare every neurosurgeon wish to avoid encountering in his career. However pediatric patients with hydrocephalus are a predisposed category for this com-plication, possessing friable and delicate skin, larger head size with added skin stresses on pressure points, occasionally malnourished or premature, all of which can lead to or accel-erate the process. Objective: The aim of this study is to address the technique of the pericranial flap and the sub-pericranial shunt valve placement in the pediatric hydrocephalic patients predisposed to shunt exposure due to friable skin in an attempt to overcome this serious complication. Methods: This study was done prospectively in the Cairo University hospitals, on pediatric patients suffering from hydrocephalus including 40 patients treated between January 2018 and January 2020, having predisposing factors for shunt exposure,operated upon by the technique of elevating a pericra-nial flap and the sub-pericranial shunt valve placement. Results: Out of the 40 patient included in the study, none of the cases developed any breakdown of skin or liability for exposure, with viable and healthy skin flaps, all cases had good wound healing, most of the cases requiring shunt insertion do so in the 1st 6 monhts of age, congenital hydrocephalus (60%) was the main etiology for shunt insertion followed by post infection & post-hemorrhagic etiology, most of the cases (80%) were below weight for age, 3 cases (7.5%) of cases developed shunt malfunctioning requiring revision (2 proximal, 1 distal), 2 cases (5%) had mild superficial wound infection resolved afterward, none of the cases developed Cerebrospinal Fluid (CSF) leak. Conclusion: Sub-periosteal shunt reservoir placement is simple, easy, non-time consuming, yet was very effective in reducing the nightmare of shunt exposure & CSF leak in predisposed malnourished or premature pediatric patient, abolishing the costly and exhausting need for reoperation and shunt transfer or skin grafting and risks of CSF infection.
Subperiosteal – Shunt
prematurity – Malnour-ishement – Ventriculo -peritoneal shunt
2021
06
01
1003
1008
https://mjcu.journals.ekb.eg/article_184537_e25c043c2fab244f561ba75baa8a5359.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Evaluating the Value of the Genetic Risk Variants of Haem-Oxygenase-1, Vascular Endothelial Growth Factor and Vascular Endothelial Growth Factor Receptor-2 in Prediction of the Presence of Esophageal Varices in Patients with Liver Cirrhosis
AHMED MOUSTAFA, M.D.;
SHERIF HAMDY, M.D.
AYMAN RASHAD, M.D.;
WALAA AHMED, M.D.
AHMED NASHAAT, M.Sc.;
SAEED M. EL-NAHAAS, M.D.
Abstract Background: Current guidelines recommend screening for Esophageal Varices (EV) by Esophagogastroduodenoscopy (EGD) for all cirrhotic patients. The cost and invasive nature of endoscopic screening mean that there is an interest in developing noninvasive predictors for EV that would decrease the number of EGDs performed. The genetic factors that are involved in the development and maintenance of porto-systemic collateral circulation have been rarely investigated. Variation at the genes that encode proteins involved in the systemic and splanchnic vasodilation, which include angi-otensin-converting enzyme and endothelial/constitutive nitric oxide synthase, have been found to be involved in the EV risk among patients withcirrhosis. In cirrhosis, Vascular Endothelial Growth Factor (VEGF) receptor 2/VEGF and carbon monoxide (CO) activity are significantly increased and are closely correlated with porto-systemic collateral vasodilations. Haem-Oxygenase-1 (HO-1) is the main rate-limiting enzyme involved in CO production. Aim of Study: This study aimed at investigating the value of the genetic risk variants of HO-1, VEGF and VEGF Re-ceptor-2 (VEGFR-2) in prediction of the presence of EV in patients with liver cirrhosis. Patients and Methods: Our study included 300 Egyptian patients with liver cirrhosis, aged 18 years or older, with no history of gastrointestinal bleeding, hepatic schistosomiasis, hepatocellular carcinoma, injection sclerotherapy or band ligation for EV, surgery for portal hypertension or portal or splenic vein thrombosis by ultrasonography. Patients underwent EGD to evaluate the presence and degree of EV, fibroscan for detection of liver stiffness and genetic investigation of HO-1, VEGF and VEGFR-2. Demographic, biochemical and endoscopic data were collected. Patients were divided into Group I (no varices), Group II A (small varices), Group IIB (large varices) and Group III (100 healthy control subjects).Results: All groups were age & BMI matched, platelet count and serum albumin were significantly lower in group II B compared to groups I & II A (p-value <0.001), while serum bilirubin level was significantly higher in group II B compared to groups I & II A (p-value <0.001). TT genotype SNP of HO-1 was associated with the presence of EV, while low grade varices were more detected in patients who carry AT genotype. Other genetic risk variants of VEGF and VEGFR-2 were not helpful in the prediction of EV or in the differen-tiation between small and large varices. Conclusion: Genetic risk variants of HO-1 genotype are helpful in prediction of EV as well as in differentiation between small and large varices. Combining these genetic variants to other noninvasive parameters will be a more sensitive and specific tool to predict EV in cirrhotic patients; it may help to select patients for endoscopic screening and decrease the number of EGDs. However, further studies will be needed from the economic point of view to determine the applicability of using these noninvasive tools as predictors of varices instead of EGD.
Genetic variants
Esophageal varices
2021
06
01
1009
1016
https://mjcu.journals.ekb.eg/article_184538_71b950fca0b8e8cbbcaa03af18902cde.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Evolving Role of MRI in Assessment of Response of Hepatocellular Carcinoma Patients Post Trans-Arterial Chemoembolization: What Does the Physician Want to Know?
MOHAMED F.H. ABDALLAH, M.D.;
MOHAMED HOSNI K. ABDELMAKSOUD, M.D.
SHIMAA H.I. DESOUKY, M.D.;
MONA HASSAN, M.D.
MEDHAT
MADBOULY, M.D.
Abstract Background: In clinical practice, Transarterial Chemoem-bolization (TACE) has been widely used for the treatment of Hepatocellular Carcinoma (HCC) beyond as well as within guideline recommendations. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play critical roles for assessing treatment response of Hepatocellular Carcinoma (HCC) after locoregional therapy. Interpretation is challenging because post-treatment imaging findings depend on the type of treatment, magnitude of treatment response, time interval after treatment, and other factors. Aim of Study: To illustrate the prime role of MRI in accurate assessment and early monitoring of hepatocellular carcinoma response to treatment after transarterial chemoem-bolization. Patients and Methods: This study included 80 patients, 52 males and 28 females, patients ages ranged from 45 to 81 years with the mean age of 60 years underwent transarterial chemoembolization over a period of 23 months (Jan. 2019- Dec. 2020). All patients had liver cirrhosis related to chronic viral hepatitis. MRI was conducted at MRI unit in a private radiology centre. Results: Showed superior diagnostic performance of dynamic MRI compared to diffusion studies as dynamic MRI had a sensitivity of 90.9%, a specificity of 95.7%, PPV of 93.7%, NPV of 93.7% and overall agreement of 94% compared to 100%, 65.2%, 68%, 100% and 80% respectively of diffusion weighted imaging. The difference between the malignant residual and well-ablated groups ADC variables was statisti-cally significant p-value 0.006. Conclusion: MRI is a robust tool in detection of tumour viability after TACE of hepatocellular carcinoma and should be performed at regular time intervals. Imaging protocol should include dynamic study combined with diffusion imag-ing. DW MR imaging is a rapid promising technique for the non-invasive evaluation of tumor response after TACE par-ticularly when contrast medium administration is contraindicated. Dynamic study is the corner stone in detection of recurrent lesions.
MRI
Hepatocellular carcinoma
Chemoembol-ization
2021
06
01
1017
1024
https://mjcu.journals.ekb.eg/article_184539_aa507c23fd2b0068b70f40d206a9adeb.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Adiponectin in Type II Diabetes Mellitus
AHMAD K. MUSTAFA, M.D.;
MOHAMMED Z. ABDEL RAHMAN, M.D.
AYAT
S. YOUSEF, M.Sc.
Abstract Background: Diabetes mellitus is a chronic disorder characterized by impaired metabolism of glucose and lipids due to defect in insulin secretion or action. The association of obesity with development of type 2 diabetes may be partly mediated by altered secretion of adipokines by adipose tissues which may contribute to development of obesity. It has been reported that reduction in plasma adiponectin level may be related to the elevation of insulin resistance. Aim of Study: This study aimed to evaluate the level of adiponectin in patients with type 2 diabetes mellitus. Subjects and Methods: The current study examined sixty diabetic patients (type 2) with BMI from 30-40kg/m2 and 20 age and sex matched healthy controls with BMI from 20-25 kg/m2 . Statistical Analysis: The data were tested for normality using the Anderson-Darling test and for homogeneity variances prior to further statistical analysis. Results: Adiponectin level was significantly lower in all patients compared to controls. Lipid profile was altered in diabetic patients showing higher levels than in controls. In diabetic patients, adiponectin was significantly positively correlated with High Density Lipoprotein Cholesterol (HDL-C), while it was significantly negatively correlated with HbA1C, cholesterol, Low Density Lipoprotein Cholesterol (LDL-C), triglyceride and micro-albuminuria. Conclusion: Adiponectin plays an important role in the patho-physiology of insulin resistance, diabetes, lipid metab-olism. Reduction in adiponectin level may be related to the elevation of insulin resistance associated with diabetes milletus type II. Adiponectin represents a very important step to understand the mechanism of obesity-induced insulin resistance and atherosclerosis. In contrast to other known adipocyte-derived hormones that are generally increased in obesity, adiponectin concentrations are that serum adiponectin levels were significantly inversely correlated with cholesterol, triglycerides and HbA1c in type 2 DM patients. Decreased in obese individuals. This fact together with the promising results of experimental studies suggests the possibility that adiponectin replacement might become a new pharmacological approach to treatment of insulin resistance and/or atherosclerosis so our recommendations are monitoring of adiponectin level in diabetic patients is a good predictor of glycemic control and should used in follow-up. Insulin serum level in diabetic patients should be measured to evaluate the effect of adiponectin on insulin level.
Diabetes mellitus
Low density lipoprotein cholesterol
High density lipoprotein cholesterol
Body Mass Index
2021
06
01
1025
1028
https://mjcu.journals.ekb.eg/article_184540_6d4869a2180e8199007b8203fff8c285.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Prevalence of Periodontal Disease in a Group of Egyptian Children with Diabetes Mellitus Type 1
NERMEEN M.F. HAIDER, M.D.;
NOURHAN ABD EL WAHAB EL-DOKKI, Ph.D.
DALIA
M. MOHEB, Ph.D.
Abstract Background: Diabetes Mellitus (DM) is a serious meta-bolic syndrome with its two basic types resulting in abnormal fat, carbohydrate, and protein metabolism. Periodontal disease is considered as the sixth leading complication for individuals suffering from diabetes mellitus. Periodontal disease can be initiated, developed and progressed because of metabolic imbalances in the tissues which lower the diabetic patients resistance of diabetics to infection. Aim of Study: The aim of this study was tostudy periodontal disease experience in a group of diabetic children and the unmet treatment needs. 3 to 12 years old suffering from type 1 diabetes mellitus. Material and Methods: 91children with type 1 diabetes mellites, their ages range from 3 to 12 participated in the study with the mean time since the onset of diabetes was 5.41±3.13 years in boys and 4.88±2.29 years in girls. Results: There was a significant differencecorrelation between HbA1c and periodontitis and diabetic ketoacidosis attacks. Conclusion: Elevated blood glucose levels in patients with diabetes mellitus patients is prominently associated with periodontal disease in the form of periodontitis and xerostomia leading to high risk of ketoacidosis attacks.
Diabetes Mellites
HbA1c
Periodontitis
Xerostomia
Ketoacidosis attacks
2021
06
01
1029
1034
https://mjcu.journals.ekb.eg/article_184541_8b38cabd0690c66206967b1311348fa5.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Effect of Short Duration Isometric and Dynamic Exercises on Pain Threshold in Healthy Young Females
SAMIHA
M. ABELKADER, M.D., Ph.D.
Abstract Background: Musculoskeletal pain is a common problem encountered in medical practice. Exercise canprovidet empo-rary relief from pain. Hypoalgesia is found to occur during and after single episodes of high intensity aerobic exercise in healthy adults. However, not all individuals are willing or able to engage in high-intensity aerobic exercise. Aim of Study: To examine the character of pain threshold modulation that occurs following short-duration isometric and dynamic exercises. Material and Methods: Eighty healthy female students of College of Applied Medical Sciences, King Saud University, age ranged between 18 and 23 years participated in study. The sample was divided randomly into two equal groups; first group was tested for the effect of isometric exercise on pressure pain threshold and the second group was tested for the effect of dynamic exercise on pain threshold. Results: Results indicated that there were significant effects for both isometric and dynamic exercises on pain threshold which was found to be elevated in both exercised and non-exercise dsides after isometric and dynamic exercises and lasted for ten minutes. Conclusion: It was concluded that short duration non-exhaustive isometric and dynamic exercises was associated with hypoalgesic responses in ipsilateral and contralateral sides in healthy young females.
Isometric exercise
Dynamic exercise
Pain threshold
2021
06
01
1035
1039
https://mjcu.journals.ekb.eg/article_184542_1a3bcf4fbd755e2b2c5e88c707c63ae8.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Puzzling Technique for Fixation of Cranioplasty Flaps
OMAR Y. ABDALLA, M.D.;
AHMED S. FIKI, M.D.
Abstract Background: Cranioplasty, defined as the surgical repair of a defect in the cranium, has undergone many revolutions over time to improve patient prognosis. Cranioplasty offers cosmetic and protective benefits for patients with cranial defects. Aim of Study: A new method for the fixation of poly-methyl methacrylate (PMMA) cranioplasty flap is described, and the results of the technique were reported. Patients and Methods: Eighteen patients with cranial defects are included in the study. Patients were followed-up by clinical examination and periodic radiographic studies for a minimum of 6 months (range 6 to 12 months). Cosmetic appearance and solid fixation of the cranioplasty flap were evaluated. Results: Cosmetically good solid cranioplasty flaps oc-curred in all patients. There was no occurrence of infection or implant extrusion in any of the patients. Conclusion: This technique appears to be a simple, safe, economic and efficient method for PMMA cranioplasty flap fixation in reconstruction of significant cranial defects.
Cranioplasty
Poly-methyl methacrylate
Fix-ation
Cosmetic
2021
06
01
1041
1044
https://mjcu.journals.ekb.eg/article_184543_0eda900b5dc1a2618e761d42ce9713f4.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Human Cathelicidin in Tinea Versicolor and Tinea Circinata
AMR A. RATEB, M.D.;
AMR A. RATEB, M.D.
FAISAL NOUR EL DIN, M.D.;
RANA ABD ELAZEEM HAMMAD, M.Sc.
KHALDA S. MOHAMED, M.D.;
DINA M. SALAMA, M.D.
Abstract Background: Fungal skin infections such as superficial tinea and pityriasis versicolor are very common and affect people all over the world. Recent research suggests that certain antimicrobial peptides can also play a role in the body's natural defense against fungal infection. Aim of Study: The aim of this research is to look at the tissue expression of Cathelicidin mRNA in tinea versicolor and tinea circinata skin lesions to learn more about its function in fungal infection pathogenesis. Patients and Methods: Twenty patients with tinea versi-color, twenty with tinea circinata, and twenty controls partic-ipated in this case-control study. A punch skin biopsy was obtained from the patient's lesional and non-lesional skin, as well as the control's normal skin, for real time PCR (RT-PCR) gene expression of cathelicidin mRNA. Results: Cathelicidin was upregulated in lesional areas of tinea versicolor and tinea circinata in comparison to non lesional areas of tinea versicolor, tinea circinata and control. These results reached a statistical significance for mRNA cathelicidin in both diseases (p-value <0.001). Conclusion: The results back up the theory that antimi-crobial peptides like Cathelicidin can help defend the skin from dermatophytes and M.furfur.
Cathelicidin
Tinea circinata
Tinea Versicolor
2021
06
01
1045
1049
https://mjcu.journals.ekb.eg/article_184544_5d716459d604ff7260f459df6aff157c.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Ulnar-Sided Traumatic Wrist Pain. High Resolution Ultrasound Effectiveness versus MRI Assessment and Accuracy
HEBA KAMAL, M.D.;
NEVIEN EL-LEITHY, M.D.
Abstract Background: This work was conducted to assess the effectiveness of high resolution Ultrasonography (USG) compared with Magnetic Resonance Imaging (MRI) in inves-tigating causes of ulnar sided wrist pain in traumatic patients, as this entity represents a diagnostic dilemma, owing to the anatomical complexity and small sized structures, as well as diversity of causes. Imaging plays an important role in guiding the diagnosis and minimizing unwanted surgical interventions. Aim of Study: To evaluate the diagnostic performance of both ultrasonography and MRI in ulnar sided wrist pain, high-lightening both the strengths and weaknesses of these two imaging modalities. Patients and Methods: This study included fifty patients presenting with ulnar sided wrist pain. MRI and Ultrasonog-raphy were done in all patients. Results: Out of 50 patients, 30 males (60%) and 20 females (40%), age ranging 23-65 years, were included in this study. A comparative analysis was done using MRI versus USG findings. The sensitivity, specificity, and accuracy of USG for Scapho-lunate ligament injury were 45.5%, 100%, 88% respectively, as MRI was positive in 11 cases, while USG only diagnosed 5 cases. The sensitivity, specificity, and accuracy for Triangular Fibrocartilage (TFCC) tear, were 64.71%, 90.91% and 82% respectively, as MRI was positive in 17 cases, while USG diagnosed 14 cases. For Extensor Carpi Ulnaris (ECU) injury, were 100%, 89.1% and 92% respectively, as MRI was positive in 13 cases, while USG diagnosed 17 cases. For extensor carpi ulnaris tendon sublux-ation, were 100%, 100% and 100% respectively, as both modalities were successful in diagnosing the same three cases, for ganglion cysts, were 100%, 100% and 100% respectively. For trabecular bone edema, MRI was positive in 24 cases, and for distal radioulnar joint instability MRI was positive in 9 cases, which were not diagnosed by USG, with lack of agreement between both modalities. Conclusion: Both magnetic resonance imaging and mus-culoskeletal ultrasound are essential and complement each other in the evaluation of causes of ulnar sided wrist pain in trauma patients. Musculoskeletal ultrasound is highly recom-mended for the examination of tendon injuries, while MRI is more efficient and suitable for assessing deeper structures, such as bone or ligaments.
Ultrasonography (USG)
Magnetic resonance imaging (MRI)
Ulnar sided wrist pain
2021
06
01
1051
1061
https://mjcu.journals.ekb.eg/article_184545_cf3a58972a835659f442cb4af603cda3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Ultrasound Characterization of a Solitary Thyroid Nodule According to British Thyroid Association (BTA) - Derived Criteria: A Simple Test of Reliability on a Small Cohort
LAMYA A. EISSA, M.D.;
NOORALDEEN ALSAMAHI, M.S.
MOHAMED SAMY BARAKAT, M.D.;
DINA ABDALLAH, M.D.
MUHAMMED
MAHMOUD EL-SHAFEI, M.D.
Abstract Background: US-based thyroid imaging lexicons have been widely used in clinical practice for identification of FNAC-eligible thyroid nodules. A “U”-classification (BTA) was introduced in 2014 with intense researches conducted in last five years trying to test its feasibility and reliability in stratification of US thyroid nodules. Material and Methods: Prospective single-center uni-departmental study aimed at selection of only “solitary” nodules with image-analysis of US features of suspicious and non-suspicious nodules and ascribing each nodule a “U”-class in view of lexicon-provided user-friendly graphic references. Results: A small cohort, of 37 solitary nodules, was selected out of a total of 150 with comparison to FNAC aspiration cytology result according to pathology Bethesda staging. The correlation of each “U” class was compared to pathology (fine needle aspirates) and revealed very good statistical significance. Conclusion: The study suggests that a BTA (The “U”- classification) is a simple reliable test that can be feasibly practiced to select FNAC-eligible nodule amongst multi-nodular glands.
Ultrasound characterization
British Thyroid Association (BTA)
Solitary Thyroid
2021
06
01
1063
1077
https://mjcu.journals.ekb.eg/article_184546_b8cddefed590638d4b2bf1751aadef84.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
CD4 CD25 T Cells in Children with Recent Onset Type 1 Diabetes
MARWA FATHY, M.Sc.;
IBRAHIM IBRAHIM M. EL ARABY, M.D.
NANCY M. EL GUINDY, M.D.;
GHADA M. ANWAR, M.D.
Abstract Background: Type 1 diabetes (T1D) results from T-cell-mediated autoimmune destruction of the insulin-producing pancreatic islet Beta cells. This breakdown of immunological self-tolerance results in auto reactivity to islet self-antigens. This requires genetic susceptibility as well as environmental factors (gene environmental interaction). It is believed that numerical and functional balance between killer cells (CD4+ and CD8+) and regulatory T-cells in the pancreatic infiltrate determines the extent of Beta cell destruction. Aim of Study: To study the number and function of Treg CD4+ CD25+ T-cells in infants and children with recent onset type 1 diabetes and to compare the results with the Treg CD4+ CD25+ T-cells in the siblings of the diabetic child and control subjects. Patients and Methods: This study was performed on60 patients meeting the diagnostic criteria of type I diabetes, together with 20 children of their non diabetic siblings were recruited at the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU) at Cairo University Children’s Hospital in the period from December 2011 to October 2012. In addition to 20 children with age and sex-matched, none of whom had either a personal or family history of diabetes or other autoim-mune pathologies as control were included in the study. Results: Show no statistically significant relation of CD4 CD25 T-lymphocytes to age, anthropometric measures (weight & height), laboratory data including HBA1C, lipid profile or thyroid function tests, the insulin dose and the severity of the case presentation (whether classic onset or DKA). Also there was no statistically significant difference between the 3 groups (diabetic – non diabetic siblings – controls) regarding CD4CD25 T- lymphocytes levels by the one-way ANOVA test. Conclusion: The sensitivity of CD4 CD25 T-lymphocytes in case of type 1 diabetes was 60% and the specificity was 47%. The PPV (positive predictive value) and the NPV (neg-ative predictive value) were 55% and 67% respectively. Such results conclude that CD4 CD25 T-lymphocytes cannot be taken as a valid marker in case of type I diabetes.
CD4+ CD25+ T Cells
Recent onset Type 1 diabetes
2021
06
01
1079
1087
https://mjcu.journals.ekb.eg/article_184547_b2c6351e79be0c1adf226b10c40be869.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Effect of Cyclosporin - A on the Lung of Adult Male Albino Rats and The Possible Protective Role of Vitamin E
HALA H.M. MOSSALAM, M.D.;
ASMAA F. YOUSUF, M.D.
Abstract Background: Cyclosporine A (Cs A) is an immunosup-pressive agent which used in treatment of various autoimmune diseases. Aim of Study: Evaluation of the effect of cyclosporin-A administration on the histological structure on the lung in adult male rat and the protective role of vitamin E. Material and Methods: Forty adult male albino rats were divided equally into four groups. Group 1 received distilled water, Group 2 received oral daily dose of cyclosporine A (10mg/kg/body weight) for 4 weeks, Group 3 (a co-treated group) received oral daily dose of vitamin E (200mg/kg/body weight) simultaneously with cyclosporine A (10mg/kg/body weight) for 4 weeks, and Group 4 (a pre-treated group) received oral daily dose of vitamin E (200mg/kg) 2 hours prior to treatment with cyclosporine A (10mg/kg body weight) for 4 weeks. Lung specimens were taken out and processed for histopathological examination and for assessment of lung tissue levels of oxidative stress markers (MDA, SOD, GSH, and CAT). Results: Histopathological examination using light and electron microscope revealed that cyclosporine-A induced deleterious histopathological changes in the lungs of adult male albino rats. Focal destruction of alveolar walls, formation of emphysematous air spaces, distortion of the interalveolar septa, peri-bronchial inflammatory cell infiltration and con-gestion with fibrosis. Pneumocytes type I showed an irregular nucleus. Pneumocytes type II revealed irregular pyknotic nuclei, numerous vacuolated or empty lamellar bodies with loss of their lamellar arrangement, and distorted surface microvilli. There was significant increase in lung malondial-dehyde (MDA) level, with significant decrease in lung super-oxide dismutase (SOD), glutathione peroxidase (GSH), and catalase (CAT). Vitamin E either with or before receiving cyclosporin-A reduced lung affection with improved level of oxidative markers in the lung homogenates. Conclusion: Vitamin E reduced cyclosporin-A lung affec-tion with improved level of oxidative markers in the lung homogenates.
Cyclosporine A
Oxidative Stress
lung
Vitamin E
2021
06
01
1089
1096
https://mjcu.journals.ekb.eg/article_184548_c22d41e792bca494ae40b7228c5c5e2a.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Effect of Smart Phone Use on Handgrip Strength and Fatigue in Female College Students
SAMIHA
M. ABELKADER, Ph.D.
Abstract Background: Smart phone is a device that combines mobile and cellular functions in one unit. Many smart phone users spend hours on the irphones every day that require esprolonged grips, repetitive motion on small buttons and awkwardwrist movement leading to hand, wrist and arm ailments. Aim of Study: To investigate the effect of smartphone overuse on handgrip strength. Material and Methods: One hundred and eighty-eight female college students of King Saud University were included in the study. The study was conducted between June 2016 and December 2018. They were divided into two groups: Smartphone users (n=103) and non-smartphone users (n=85), between the agerange, 18-25 years, were included. Their handgrip strength was measured usinga handheld dynamometer. Participants performed three maximum at tempts for each measurement, and the average value of three trials was taken. A few seconds of rest were given between each trial tominimize fatigue. We analyzed the difference between the groups using paired t-test. Results: No significant difference was found between theright and left hand's grip strengthson both groups (p>0.05). The fatigue evalues were also not significantly different (p>0.05). The significance level was set at p£0.05. Conclusion: High-frequency smartphone use did not affect the grip strength in female college students.
Grip strength
smartphone
Overuse
2021
06
01
1097
1100
https://mjcu.journals.ekb.eg/article_184549_716bb1d2eb894fd7822c1d51e41c89c6.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Acute Coronary Syndrome with Normal or Near-Normal Coronary Angiography:Prevalence and Clinical Outcomes among Yemeni Patients
KHADIGA SHAFIQ AMAN, M.D.;
AHMED SALEM ALHAITHMI, M.D.
MOHAMED
BEN MOHAMED ALSAADI, M.D.
Abstract Background: Nonobstructive acute coronary syndrome or acute coronary syndrome with normal or near-normal coronary angiography (ACSNONCA) occurs in 10% to 25% of patients undergoing coronary angiography and in up to 6% of patients with troponin-positive ACS. Prevalence of ACSN-NOCA and its clinical outcomes were not discussed in previous studies in Yemen. Aim of Study: Our study aimed to compare demographic and clinical findings and prognosis in patients who have ACS with stenosis <50% (Group I) with patients who have ACS with critical obstructive disease, requiring percutaneous coronary intervention (Group II). Patients and Methods: The total population (n=327) was divided according to the angiographic findings into: Group I (stenosis <50%) with 114 patients (14.8%) and Group II (stenosis >50%) with 213 patients (27.6%). During the period January 2010 through September 2015, patients were admitted at Algamhoria Teaching Hospital, Aden and undergone cardiac catheterization in Cardiac Surgery Center at Althawra Hospital, Sana'a. Results: Group I Patients (stenosis <50%) were signifi-cantly younger were more likely to be female, younger, with fewer risk factors, compared to Group I Patients. We isolated and defined two subgroups within Group I: Group IA: Patients with normal angiograms (n=60, 52.6%) and Group IB patients with stenosis of 20-50% (n=54, 47.4%). Patients with stenosis of 20%-50% were relatively older males, with an increasing frequency of nondiabetic, with a history of chronic heavy chewing and with a worse prognosis, during long-term eval-uation. Follow-up data revealed that myocardial infarction was found in 1.8% of Group IA and in 5.2% of Group IB patients. Follow-up revealed no deaths in Group IA patients and two cardiac deaths (3.7%) in Group IB patients. Conclusions: Prognosis of patients with nonobstructive stenosis was significantly better than that of patients with critical obstructive stenosis. However, patients with stenosis of 20-50% had a worse prognosis than did those with normal coronary arteries.
Acute Coronary Syndrome
Normal or near-normal coronary angiography
2021
06
01
1101
1110
https://mjcu.journals.ekb.eg/article_184550_6398c199d153480b6b8f947b5797fb13.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Operative and Non-Operative Management of Blunt Liver Trauma: Our Experience
MOHAMED H. ZAID, M.D;
MOHEB S. ESKANDAROS, M.D.
AHMED
A. DARWISH, M.D.v
Abstract Background: In recent years, there is a success of Non-operative management of blunt liver trauma. Aim of Study: The aim of our study is to discuss our experience in Operative and Non-Operative management of Blunt liver Trauma. Patients and Methods: A prospective cohort enrolled twenty-seven patients with blunt liver trauma admitted to our hepato-biliary unit were managed with non-operative conservative management, Angioembolization or operative intervention. Results: The patients mean age was 31.1±7.51 years. Two (7.4%) patients were diabetic, three (11.1%) were hypertensive. Twenty-two (81.5%) patients Glasgow coma score >10. Twenty (74%) patients were managed Non-operatively. Nineteen (95%) patients had successful Non-operative management but one patient (5%)patient needed delayed operation. Seven (25.9%) patients were managed operatively. The most com-monly associated injury was chest (59.2%), head (33.3%), spleen (11.1 %) and kidney (3.7%). Liver related complications included biloma & pseudo-aneurysm. The overall mortality was (7.4%). Conclusion: NOM of blunt liver injuries in haemodynam-ically stable patients is safe and feasible. Haemodynamic instability, generalized peritonitis during resuscitation or associated intra-abdominal organ injuries requires early surgical intervention. Liver related complications contribute to failure of NOM. Associated extra-abdominal and intra-abdominal injuries do not interfere with non-operative management.v
Liver Trauma
Non-operative management
Operative management.v
2021
06
01
1111
1117
https://mjcu.journals.ekb.eg/article_184998_5394fd8a685eaec6baa8a420b58312c1.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Point Shear Wave Elastography (pSWE) for Evaluating Relation between Laboratory Renal Function Deterioration in Chronic Kidney Disease (CKD) and Degree of Renal StiffnessPoint Shear Wave Elastography (pSWE) for Evaluating Relation between Laboratory Renal Function Deterioration in Chronic Kidney Disease (CKD) and Degree of Renal Stiffness
DALIA SALAH EL-DEEN ANWAR, M.D.;
ENGY FATHY TANTAWY, M.D.
Abstract Aim of Work: To evaluate the role of point shear wave elastography (pSWE) in detecting degree of renal fibrosis and correlating it to deterioration of renal function in chronic kidney disease patients. Background: Chronic kidney disease (CKD) is diagnosed by either of the following lasting for more than 3 months: Decrease of glomerular filtration rate (GFR) less than 60ml/min/1.73m2 which is the best index of kidney function, or presence of markers for kidney damage as albuminuria. Renal fibrosis is nearly the ultimate common pathway for all CKD. The main method in clinical use for the assessment of renal fibrosis is the renal biopsy which is known for its considerable disadvantages like its invasive nature, with a risk of further complications, high cost, inter-observer varia-bility, and sampling error. Shear wave elastography (SWE) is one of the promising techniques that allow non-invasive estimation of tissue stiffness. Material and Methods: This study was performed at the Radiodiagnosis Department, Zagazig University. We examined 42CKD patients who underwent pSWEas well as laboratory detection of Estimated glomerular filtration rate (eGFR). Patients were classified according to GFR into fivestages: Into stage 1 (eGFR ³90), stage 2 (eGFR 60-89), stage 3 (eGFR 30-59), stage 4 (eGFR 15-29), and stage 5 (eGFR <15). All analyses were done using the Statistical Package for theSocial Sciences 20.0 software. Results: The mean value of SWE (kPa) in CBD patients (5.44±1.4). The mean SWE values in the CKD stages were 3.65±0.9, 4.5±1.2, 5.8±0.5, 5.3±1.1, 6.6±0.9 kPa in stages 1,2,3,4, and 5 respectively. There was no significant difference between CKD stages except between stage 1 vs. 5 and stage 2 vs. 5.Only age showed a significant correlation with SWE in CKD patients (r=0.453; p=0.039). The laboratory investi-gationrevealed that 6 patients stage I (110±26.5), 8 patients stage II (71.5±1), 8 patients stage III (45.5±8.3), 6 patients stage IV (23±6.2) and 14 patients stage V (8.3±2.8). The cut-off value for predicting CKD was 4.05 kPa with 85.70% sensitivity and 90.5% specificity, while for predicting kidney fibrosis it was 4.45 kPa with 93.3% sensitivity and 83.3% specificity. Conclusion: Our results suggest that SWE can distinguish between normal subjects and patients with CKD. It also can detect renal fibrosis but cannot correlate with different CKD stages detected by GFR.
Chronic Kidney Disease
Shear wave elastography
laboratory
fibrosis
2021
06
01
1119
1128
https://mjcu.journals.ekb.eg/article_184999_8198875205c60c5d731193e6d6d4e0f9.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Effects of Moringa Oleifera Seeds Aqueous Extract on Type-II Diabetic Nephropathy in Adult Male Albino Rat
NAGEH M. GABR, M.D.;
AL-BAYUOMI A. FOUDA, M.D.v
Abstract Background: Because of the potential antioxidant, anti-inflammatory, and immune-modulating properties of Moringa oleifera,there is an increased interest in its potential capacity in the prevention and control of diabetes mellitus and lipids peroxidation. Aim of Study: Evaluating the potential antidiabetic efficacy and protective activities of aqueous extract of Moringa oleifera seeds in alloxan-induced diabetic nephropathy. Material and Methods: This experimental study wasstarted in September and ended at November, 2020. It wasperformed at Medical Physiology Department, Al-Azhar Faculty of Medicine, Cairo. Fifty adult male albino rats of a local strain were distributed randomly into 5 equal groups: Normal control group, control group received aqueous extract of Moringa seeds (500ml/kg body weight orally for 10 weeks), diabetic control group received a single dose of alloxan (140mg/kg body weight intraperitoneally), diabetic group received aqueous extract of Moringa seeds (500ml/kg body weight orally 10 weeks), and diabetic group received Moringa seeds aqueous extract before and after induction of diabetes in the same pervious doses. Results: Alloxan-induced diabetes mellitus was associated with significant higher levels of serum glucose, glycosylated hemoglobin (HbA1c), and lowered level of insulin as compared to the control normal group. It was also associated with histopathological changes of renal tissues and impaired renal function in the form of significant elevations of serum K+, Na+, creatinine, urea and uric acid levels as compared to the control normal group. Also, there were significant disturbance of lipid peroxidation represented by MDA Level and significant decrease in SOD level as compared to the control normal group. Moringa oleifera seeds aqueous extract showed signif-icant lower levels of serum glucose, HbA1c and elevated level of insulin as compared with the diabetic rats. It was also associated with histological regeneration of damaged renal tissues and restoration of renal function in the form of signif-icant decrease of serum K+, Na+, creatinine, urea and uric acid levels as compared to the diabetic group. Also, there were significant amelioration of lipid peroxidation represented by significant decrease of MDA level, and significant increase of SOD level as compared to the control normal group. These results were prominent in pretreated group with Moringa seeds aqueous extract. Conclusion: Moringa oleifera improved glycemic and lipidemic disturbances as well as have potent protective and regenerative effects for the kidney.
Moringa oleifera
alloxan
Diabetes mellitus
Nephropathy
2021
06
01
1129
1139
https://mjcu.journals.ekb.eg/article_185000_5d43d9cf663a1a7ec0ea96f5f6ea3c2f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Human b-2 Defensin in Tinea Versicolor and Tinea Circinata
AMR A. RATEB, M.D.;
AMIRA M. EL TAWDY, M.D.
FAISAL NOUR EL DIN, M.D.;
RANA ABD ELAZEEM HAMMAD, M.Sc.
KHALDA S. MOHAMED, M.D.;
DINA M. SALAMA, M.D.
Abstract Background: Both superficial tinea and pityriasis versicolor are very popular fungal skin infections that affect people all over the world. Recent research suggests that certain antimi-crobial peptides can also play a role in the body's natural defense against fungal infection. Aim of Study: The purpose of the current research would be to investigate the tissue expression of b2-defensin mRNA in lesions of tinea versicolor and lesions of tinea circinata and hence studying its role in fungal infection pathogenesis. Patients and Methods: Twenty patients with tinea versi-color, twenty with tinea circinata, and twenty controls were included in this case control study. For real-time PCR (RT-PCR) gene expression of b2-defensin mRNA, a punch skin biopsy was obtained from the patient's lesional and non-lesional skin, as well as normal skin from a control. Results: b2 defensin was upregulated in lesional areas of tinea versicolor and tinea circinata in comparison to non lesional areas of tinea versicolor, tinea circinata and control. These results reached a statistical significance for mRNA b2 defensin in tinea versicolor and tinea circinata (p-value <0.014). Conclusion: The results back up the theory that antimi-crobial peptides (b2-Defensin) may help the skin fight der-matophytes and M. furfur.
b2-defensin
Tinea circinata
Tinea Versicolor
2021
06
01
1141
1145
https://mjcu.journals.ekb.eg/article_185001_d4e762fc5977eb4480d4f9878ccad6be.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Parasitological Studies on Trichomonus Vaginalis on Female Patients Presented with Vaginal Discharge at Aswan University Hospital
AHMED K. DYAB, M.D.;
HANY A. FAROUK, M.D.
MOHAMMED F. MOHAMMED, M.Sc.;
TASNEEM M. HASSAN, M.D.
Abstract Background: Trichomonas vaginalis (T.vaginalis) is one of the most common parasitic non viral Sexually Transmitted Infections (STI) in the world. The World Health Organization (WHO) has estimated that 160 million trichomoniasis cases are acquired annually worldwide [1]. Aim of Study: Evaluate different direct laboratory methods used in diagnosis of vaginal trichomoniasis. Material and Methods: The cross sectional study was carried out on 200 female patients, suffering from vaginal discharge, aged between 20-50 years old. Two vaginal swabs were taken from every patient after taking a concent. All the samples were examined by wet mount, stained by Giemsa, rapid test and Culture on modified Diamond's medium and ELIZA. Results: This study showed that ELIZA is the gold stan-dered among diagnostic techniques as it detected T. vaginalis in 15% of suspected patients followed by 13.5% by culture, then 12.5% by rapid test and lastly wet mount which detected only 5% of cases. ELIZA and Culture gave the highest sensi-tivity, specificity, accuracy, NPV and PPV followed by rapid test. The least sensitive was wet mount. The least specific was Giemsa stain. Conclusion: The study showed that wet mount method is simple and cheap. Wet mount microscopy is the preferred option for prompt diagnosis of trichomoniasis. It is proved that rapid test is relatively simple to carry out, shows reasonable sensitivity and culture remains the most accurate single method for detecting the presence of T. vaginalis in patient samples. and Diamond's medium is a suitable culture method and is considered as the gold standard of diagnosis of trichomoniasis.
Trichomonas
Vaginalis rapid test vaginal discharge
ELIZA
Diamond’s medium
Aswan
2021
06
01
1147
1154
https://mjcu.journals.ekb.eg/article_185002_0543f0278b93626a4e2e6dc7f95c0f79.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Post-Operative Use of Dopamine Agonist in Management of Remaining Nonfunctioning Pituitary Adenoma
AHMED
ADEL AYAD, M.D.
Abstract Background: Complete tumor elimination via transsphe-noidal surgical operation is frequently hard for large non-functioning pituitary adenomas (NFPAs). A confirmed medical treating might be beneficial for their managing. Aim of Study: To investigate the effectiveness of dopamine agonist medication in decreasing or avoiding the re-growing of NFPA after ward surgical operation. Patients and Methods: This was a prospective, randomized, clinical trial done in Al-Azhar University Hospitals was conducted on 20 patients experienced primary transsphenoidal surgical operation for pituitary adenoma management, the study was carried out through a period of 12 months from March 2020 to March 2021. Results: Tumour reduction rate of remaining cancer mass was significantly higher in medically-treated group, while tumour growing rate of remaining tumour mass was signifi-cantly elevated in controls. Conclusion: Cabergoline (dopamine agonist was an ef-fective medication for the treatment of remaining NFPA, and its usage was accompanying with an elevated tumour shrink-agerates.
Dopamine Agonists (DA)
Non-Functioning Pituitary Adenoma (NFPA)
2021
06
01
1155
1162
https://mjcu.journals.ekb.eg/article_185003_fb3e24bddea50ba6150d70f2b0787961.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Laparoscopic Three-Port Sleeve Gastrectomy: Description of the Technique and Preliminary Results
HOSAM B. BARAKAT, M.D.;
ALHASSAN M. HASSAN, M.D.
SHERIF M. ELGARF, M.D.;
GAMAL I. MOUSSA, M.D.
TAMER
M. ELMAHDY, M.D.
Abstract Background: Up till now, there is no standardized tech-nique for performing Laparoscopic sleeve gastrectomy (LSG). Aim of Study: The aim of this study was to assess the feasibility of LSG by means of three port technique and reporting short term results. Patients and Methods: This was a prospective study donefrom February to December 2019. Twenty-eight morbidly obese patients (18 females and 10 males) were included. Mean age of 31.03±8.89 years, mean preoperative body mass index of 44.38±5.32kg/m2. This study discussed the patients' demo-graphics, operative technique, operative records, post-operative outcomes concerning excess weight loss, comorbiditiesreso-lution, complication rates, pain assessment and patients' scars satisfaction. Follow-up was done at 10 day, 1, 3, 6, and 12 months. Results: All procedures were completed laparoscopically. Mean operative time was 58.46±18.61 minutes. The mean hospital stay was 1.25±0.75 day. The %EWL was 23.91%, 40.22%, 55.69%, and 69.65% at 1, 3, 6, and 12 months, respectively. Within a 6 to 12 month postoperatively, 50% of patients with hypertension (AHT) presented with significant improvement, all diabetic patients described resolution or significant improvement and 62.5% of patients with arthralgia had improved. Conclusions: Three ports LSG is feasible without need for liver retractor port insertion, safe, effective, with short hospital stay and good cosmetic results.
Laparoscopic Sleeve
Three port
weight loss
2021
06
01
1163
1169
https://mjcu.journals.ekb.eg/article_185004_c80bc636eb6d9aaf623a0fc9edd24f8f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Local Versus Systemic Use of Tranexamic Acid in Elective Cesarean Section
KAREEM A. ABDULLATIF HASSAN, M.Sc.;
MOHAMED A. ELNEGERI, M.D.
MAHER
SHAMS ELDIN HASSAN, M.D.
Abstract Background: Obstetric hemorrhage remains one of the major determinants of maternal death in both developed and developing countries. Because of its weight as a leading cause of maternal mortality and morbidity. Hemostatic drugs are not usually used as first-line treatment in post-partum hemor-rhage (PPH). It was authenticated that extensive tissue injury can direct the hemostatic equilibrium toward increased fibri-nolysis, leading to coagulopathy and bleeding. Antifibrinolytic drugs, named tranexamic acid (TXA) have been recognized to decrease blood loss and transfusion needs in various elective surgeries. Aim of Study: Evaluating the role of adjunctive IV Tran-examic acid versus topical Tranexamic acid infusion of the placental bed to prevent the postpartum hemorrhage. Patients and Method: It was a randomized clinical trial that extended from January 2019 to January 2020 and was done at Mansoura University Hospital, Obstetrics and Gyne-cology Department and it included a total of 164 pregnant subjects planning for cesarean section who were randomly divided into two groups; the initial group included cases who were subjected to local tranexamic acid administration (2gm), and the other one included cases who were commenced on the intravenous form (1gm). Before operation, all subjects were subjected to complete history taking, fulllaboratory investigations, detailed obstetric examination, and pelviab-dominal ultrasound. Cesarean section was performed in all cases using the standard procedure. Results: The mean age of the included cases was 35.3 and 33.89 years in the local and systemic groups respectively. There was no significant difference between the two groups regarding parity, number of gestations, the indication of cesarean section and the mean operative time. Blood loss was significantly increased in the systemic group versus local group (p < 0.001), hemoglobin levels showed significant de-crease in the systemic group. The change in both hemoglobin and hematocrit levels was significantly higher in the systemic group (p < 0.001). Conclusion: It is apparent that topical administration of TXA is associated with more effective to decrease blood lossv and causes less change in hematological parameters compared to its intravenous administration.
Postpartum Hemorrhage
Tranexamic acid
Maternal Mortality
2021
06
01
1171
1180
https://mjcu.journals.ekb.eg/article_185005_8ce7467c755f999b2ada49115f3e727d.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Recent Trends in Management of Thalamic Tumours in Pediatric Age Group
MOHAMMED H. NAYEL, M.D.;
IBRAHIM M. IBRAHIM, M.D.
MOHAMMED A. ELBELTAGY, M.D.;
AHMED S. ABDELMONEAM, M.D.
AHMEDv
R. ISMAIL, M.D.
Abstract Background: Tumors of the thalamic origin represent about 2-5% of pediatric brain tumors. They are considered a challenging subset of brain tumors to both neurosurgeons and radiotherapists due to their critical anatomical position and the proximity of functionally significant structures especially in children. Aim of Study: Is to present the authors' experience in the management of 33 cases of pediatric thalamic brain tumors. Patients and Methods: Medical records of 33 pediatric patients with thalamic brain tumors admitted to CCHE during the period from July, 2007 till December, 2014 have been reviewed as regard surgical inter-ference, chemotherapy and radiation therapy in relevance to different histo-pathological subtypes, tumor size, patients' age and patients' presenting symptoms. Conclusion: Pediatric thalamic brain tumors are highly challenging tumors with significant level of morbidity and mortality that require integrated analysis of further studies to achieve better outcome.
Thalamic tumours
Pediatric age group
2021
06
01
1181
1188
https://mjcu.journals.ekb.eg/article_185006_e41e5330374b45d0a537e58fad5ae17f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Complications of Peek Cage Following Single Level Anterior Cervical Discectomy and Fusion
MO'MEN A. ELWAN, M.D.;
AHMED ZOHDI, M.D.
MOHAMED HAFEZ, M.D.;
HAZEM MOSTAFA, M.D.
Abstract Background: Prospective study of complications related to PEEK cage in fusion following single level anterior cervical discectomy. Aim of Study: To assess the complications related to PEEK cage following single level anterior cervical discectomy and fusion. Patients and Methods: A total of 127 case have been operated, 12 of them developed complications after using PEEK cage after anterior cervical discectomy and fusion. Follow-up at Cairo University Hospital between 2011 to 2013. Outcome assessment was done using visual analogue score (VAS), forearm pain, neck pain as well as neurological assess-ment and radiological follow-up with cervical X-rays. Results: 12 patients from a total of 127 patients following single level anterior cervical discectomy and fusion using PEEK cage had cage related complications. Follow-up ranged from 12 to 27 months, with a mean follow-up of 15 month. There were five cases of cage migration, three cases with subsidence, two cases with adjacent level degeneration, one case with kyphotic deformity and one case pseudoarthrosis. Conclusion: Use of PEEK cage in cervical fusion following single level Anterior Cervical Discectomy is widely used and provide satisfactory results. Complications related to PEEK cage use is relatively low and avoidable through careful attention to technically steps in graft site and choosing an appropriate sized cage.
PEEK
anterior cervical discectomy
fusion
2021
06
01
1189
1194
https://mjcu.journals.ekb.eg/article_185007_b445b62e65afb1537f338322d4ff867a.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester
OMLSAED M. ALMAHABRISH, M.B.B.Ch.;
MOHAMED S. ABDELHAFEZ, Ph.D.
MOHAMED E. TAMAN, Ph.D.;
NASSER M.S. ALLAKANY, Ph.D.
Abstract Background: Manual vacuum aspiration (MVA) is a safe and effective technology for the treatment of missed miscar-riage but it is not widely available and affordable in rural areas particularly in low resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of missed miscarriage. Aim of Study: The purpose of this study was to compare the effectiveness, patient satisfaction and hematocrit drop of misoprostol versus MVA to understand the potential role of misoprostol as a first line for treatment of first trimester missed miscarriage. Patients and Methods: A Randomized Controlled Trial was conducted from January 2020 to January 2021 at Mansoura University Maternity Hospital. Included 70 participants were randomized to treatment with either MVA or 800µg vaginal misoprostol. The main outcome measures assessed at 1 week follow up were complete uterine evacuation, patient's accept-ability and satisfaction. Results: There is no statistically significant difference between studied groups regarding success rate and mean patient satisfaction score immediately and after one week, 82.9% of misoprostol group and 94.3% of MVA group suc-cesses. The mean hemoglobin and hematocrit after treatment illustrated statistically significant lower mean value among misoprostol group than MVA group (10.07 & 10.91, respec-tively for Hb) and (30.75 & 33, respectively for hematocrit value). Hemoglobin drop for both groups illustrated no statis-tically significant difference between studied groups. There is statistically significant negative correlation between en-dometrial thickness/mm and satisfaction after one week among both group. Conclusion: Both misoprostol and MVA had high rates of satisfaction and complete uterine evacuation, which could ultimately reduce maternal complications from abortion. Medical treatment is as effective as surgical treatment of first trimester missed miscarriages. Recommendations: Although misoprostol is a very effec-tive drug, the health care professional should have thorough knowledge of the dose, side effects, complications and contraindications before prescribing it. More studies with larger sample size are needed to elucidate the optimal method for missed miscarriage management and patient satisfaction.
misoprostol
Manual vacuum aspiration
First trimester missed miscarriage
2021
06
01
1195
1200
https://mjcu.journals.ekb.eg/article_185010_49d747ac7419857ca3e794314bcf9c10.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Axillary Lymph Node Dissection versus Axillary Radiation in Patients with Positive Sentinel Lymph Node Biopsy in Early Breast Cancer
HEBA THARWAT ABD EL AZIZ, M.D.;
EL-SAYED M. ABD-ELWAHAB, M.D.
HANY
A. EL HADY, M.D.
Abstract Background: Patients with cancer detected in a sentinel lymph node biopsy have under gone axillary lymph node dissection (ALND), which is an effective but invasive surgical procedure associated with adverse side effects, such as lymph-edema and difficulty moving the arm. Axillary radiation delivers outcomes that are similar to axillary lymph node dissection and with fewer side effects. Aim of Study: To define which patient may benefit from axillary dissection and who may benefit from axillary radiation without the hazards of axillary dissection in Patients with positive sentinel lymph node biopsy in early breast cancer patients. Patients and Methods: The 150 female patients with suc-cessful lymphatic mapping for early breast cancer T1 and T2, who were clinically node-negative,were randomly assigned prior to SLNB to receive either ALND(n=75) or axillary radiotherapy (n=75). The first 75 patients who were positive for SLNB were eligible for ALND (standard level I and II clearance) and the second consecutive positive 75 patients of the study were eligible for axillary radiotherapy. Results: Lymphedema rates were (2.6%) in the axillary dissection group and no arm edema in the axillary radiotherapy group. Long thoracic nerve injury rates were (2%) in the axillary dissection group and no nerve injury in the axillary radiation group, although no other nerve or vascular injuries were reported within two groups. Five year axillary recurrence rates (0.7% ALND vs 0.2% axillary radiotherapy). Most patients received adjuvant chemotherapy (68.6%) and/or endocrine therapy (31.4%) 47. Conclusion: Axillary radiation in patients with sentinel lymph node biopsy positive in early breast cancer may be considered as a standard therapy instead of axillary lymph node dissection.
Early breast cancer
sentinel lymph node biopsy
Axillary clearance
Axillary radiotherapy
2021
06
01
1201
1206
https://mjcu.journals.ekb.eg/article_185019_918a7d9e455aba7b95cc8903d02166aa.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Management of Thalamic Low Grade Tumours in Pediatric Age Group
MOHAMMED H. NAYEL, M.D.;
IBRAHIM M. IBRAHIM, M.D.
MOHAMMED A. ELBELTAGY, M.D.;
AHMED S. ABDELMONEAM, M.D.
AHMED
R. ISMAIL, M.D.
Abstract Background: Most of thalamic tumors are low grade. They have critical anatomical position especially in children's due to adjacent to important structures. The Aim Study: Is to present the authors' experience in the management of 24 cases of pediatric thalamic low grade tumors. Patients and Methods: Medical records of 24 pediatric patients with thalamic brain tumors admitted to Children Cancer Hospital during the period from July, 2007 till Decem-ber, 2014 have been reviewed as regard surgical interference, and chemo-therapy in relevance to tumor size, patients' age, different histopathological subtypes, and patients' presenting symptoms. Conclusion: Most of thalamic brain tumors are low grade tumors with significant level of morbidity and mortality that require integrated analysis of further studies to achieve better outcome.
Thalamic tumours
Low grade tumor
Pediatric age group
2021
06
01
1207
1213
https://mjcu.journals.ekb.eg/article_185021_a09bf912bc3ce3a9c1c7ed3a2ff070fe.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
CT Chest Findings in 100 Patients with COVID-19 Pneumonia in Egypt
NEVEEN SEIF AL-ISLAM SHAKER, M.D.;
ALY ALY ALBARBARY, M.D.
Abstract Background: Coronavirus disease 2019 (COVID-19) cases are represented by variable spectrum of CT chest findings despite their clinical symptoms. Aim of Study: Is to detect the CT findings despite different clinical presentation and standardize the COVID-19 lung assessment by non-enhanced chest CT. Material and Methods: This was a descriptive study done at Radio-diagnosis Department at Tanta University. Patient underwent chest CT scan. The diagnoses of the cases was initially based on the criteria published by WHO on January 20202. Two radiologists reviewed the CT findings. 100 patients underwent chest CT scans March 29,2020 and September 30th, 2020, were descriptive enrolled. The cohort included 50 (50%) men and 50 (50%) women with a mean age of 46.29±13.21. The symptomatic patients were 62 (62%) & the asymptomatic were 38 (38%). The symptoms include fever, cough, ageusia & anosmia, the most predominant complaint were ageusia & anosmia as 45 patients (79) suffered from. The asymptomatic cases were in close contact with proved COVID patients or had suspicious laboratory findings Results: All cases underwent CT study five cases (%%) were normal, 35 (35%) show consolidation, 89 (89%) show ground glass opacification, 35 (35%) with combined consol-idation & ground glass opacification. 5 cases show other nonspecific findings. 72 cases show bilateral consolidation while only 17 cases with unilateral distribution. Conclusion: Pneumonia in COVID-19 cases usually manifests as bilateral, subpleural, ground-glass opacities with air bronchograms with ill-defined margins on chest CT. Even in asymptomatic cases, abnormal findings of chest CT may occur.
COVID
CT chest
Ground glass opacification
Consolidation
2021
06
01
1215
1221
https://mjcu.journals.ekb.eg/article_185024_fe16e25f1ef70ce7609d744db9a77d7a.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
A Novel Angiographic Index Can Independently Predict 1-Year Cardiovascular Outcomes after Anterior ST-Elevation Myocardial Infarction
ISMAIL M. IBRAHIM, M.D.;
MOHAMED TAHA ELSAID, M.Sc.
MAHMOUD ABDELAZIZ, M.D.;
MOHAMED I. ALAWADI, M.D.
AHMED
EL ZAYAT, M.D.
Abstract Background: In ST-elevation myocardial infarction (STE-MI), the association between either the grade or location of coronary thrombi with major adverse cardiovascular events (MACE) is controversial. Aim of Study: We created a novel index “thrombus score” through multiplying the TIMI thrombus grade by a segment weighing factor adopted from Gensini score. We hypothesized this thrombus score can better reflect the prognostic relevance of coronary thrombi. Patients and Methods: We prospectively studied 364 consecutive patients with anterior STEMI treated by primary percutaneous coronary intervention (PCI). Patients were followed-up for major adverse cardiovascular events (MACE) defined as the composite of repeated myocardial infarction, target vessel revascularization, stent thrombosis, stroke; and all-cause mortality. Results: 47 (12.9%) patients developed MACE. In the MACE group, percentage of female patients (p=0.004), base-line and peak HsTnT (<0.001; each), thrombus score (p < 0.001) were significantly higher. Conversely, LVEF at discharge was significantly lower in the MACE group (p=0.02). Using Cox regression analysis, only thrombus score (p < 0.001) and LVEF (p=0.01) were found as independent predictors of MACE. By ROC curve analysis, thrombus score at a cutoff value of >!7.5 was associated with MACE at 1 year with a sensitivity of 85% and specificity of 90% (AUC: 0.87, 95% CI: 0.83-0.93, p < 0.001). Conclusion: In STEMI patients treated with primary PCI, the novel angiographic “thrombus score” was the strongest independent predictor of MACE during the first year. Further studies are recommended to better understand and validate this novel score.
myocardial infarction
Primary percutaneous coronary intervention
Major adverse cardiovas-cular events
MACE
Thrombus score
2021
06
01
1221
1228
https://mjcu.journals.ekb.eg/article_185025_b6c3d26698fa4d5e2c514d3e788418f7.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Comparative Study between Fusion and Non-Fusion Techniques in Anterior Cervical Discectomy: Bone Cement Versus Cervical Cage
AHMED ZOHDI, M.D.;
MOHAMED HAFEZ, M.D.
HAZEM MOSTAFA, M.D.;
MO'MEN AHMED ELWAN, M.D.
Abstract Background: A prospective comparative study between fusion and non-fusion techniques in anterior cervical discec-tomy (ACD) evaluating the results achieved using polymeth-ylmethacrylate (PMMA) as a non-fusion and cervical cage (PEEK) as a fusion following single level ACD. Patients and Methods: A total of 40 patients, divided in to two groups of 20 patients each, group (A); having PMMA used for disc replacement and group (B) cervical (PEEK) cage placement after ACD. Results: Of both groups are evaluated regarding: (1) Clinical outcome according to Odom's criteria (2) Radiological outcome and inter body fusion, (3) Simplicity and postoperative morbidity of each procedure and (4) Complications related to each technique. Patients were followed up for a mean period of 10 months. Group (A) presented excellent and good clinical outcome in 85% at 6 months and 90% at 12 months. Radio-logical none fusion was noticed in 80% of patients and partial fusion occurred in 20% of cases at 12 months postoperative interval cage migration in 5% (one patient) into adjacent vertebral bodies which needed surgical removal and replaced by cage after causing partial collapse of the disc space height. No other graft related complications, progressive deformity or instability were reported. Group (B) achieved 90% excellent and good clinical outcome at 6 and 12 months respectively. Fusion rate of 85% at 6 months and increased to 95% at 12 months. No other cage related complications were reported. Conclusion: Clinical outcome in both group is related to the surgical decompression technique and preoperative neu-rological status of the patients e.g. cervical spondylotic myelopathy (CSM), cervical spondylotic radiculopathy (CSR) or both than to the use of either disc replacement by fusion (PEEK) cage or non fusion by bone cement (PMMA). The use of interbody fusion cage is preferred owing to their ability to function as load-sharing devices and to adequately fix the spine and increase segmental stiffness thus achieve acceptable fusion rate and low complication when compared with PMMA graft.
cervical cage
PEEK
Polymethylmethacrylate
anterior cervical discectomy
Cervical spond-ylotic myelopathy
Cervical spondylotic radicu-lopathy
2021
06
01
1229
1238
https://mjcu.journals.ekb.eg/article_185027_9f41413834271f3e94b21786d6d8f593.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Can Ultrasound Replace CT in Peripheral Lung Biopsy Guidance: A Comparative Study
MUHAMMAD K. ALSHALLOFY, M.Sc.;
MANAL F. KHALID, M.D.
EMAM M. ABO SEIF, M.D.;
AMR M. ZAYED, M.D.
Abstract Background: Selecting the most effective guidance method for peripheral lung biopsy is a priority for interventional radiologists. The clinical trials comparing efficacy and safety of ultrasound (US) and computerized tomography (CT) as biopsy-guiding modalities for peripheral lung biopsy tech-niques are limited in the literature, and most of them are retrospective. Aim of Study: To compare the efficacy and safety of biopsy guided by US versus CT for lung lesions with pleural contact. Patients and Methods: This is a prospective comparative study; included 40 patients underwent image-guided biopsy at Nasser Institute Hospital, Cairo, Egypt. From June 2018 to May 2020. Lesion size, location, length of pleural contact, number of needle passes, and number of tissues cores, proce-dure times, complications, and histopathology reports were documented for each biopsy. Statistical analysis using Fisher's exact test and t-test, (Alfa-point=0.05). Results: US-guided group had significantly fewer com-plications; 15% (3/20) versus 40% (8/20) for CT-guided group; (p=0.036). Fewer number of needles passes were required for US-guided biopsies (mean, 2.7 passes ±0.8 (SD) than for CT-guided biopsies (mean, 3.4 passes ±1.2 (SD); p=0.04). Proce-dural times were significantly shorter in the US-guidance group, with a mean procedure time of 6.3 minutes ±2.2 (SD) compared to 21.8 minutes ±5.7 (SD) for CT-guided biopsies; (p=0.0001). Conclusion: US guidance should be thought of as a primary tool for guidance of peripheral lung lesions' biopsy, because it is superior to CT in safety and time-saving with comparable accuracy.
US-guidance
CT-guidance
Peripheral lung lesions
2021
06
01
1239
1244
https://mjcu.journals.ekb.eg/article_185029_5de1bce9f661574f4725d8558a6d1e70.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Added Metformin to Systematic Neoadjuvant Chemotherapy in Breast Cancer Patients: Randomized Study from Egypt
SOHA AHMED, M.D., MBA;
AHMED SAID, M.Sc.
ANWAR A. ELSHENAWY, M.D.;
DINA M. MORSI, M.Sc.
MOHAMED ABDEEN, M.D.;
MOHAMED ABDELRAHMAN, M.D.
Abstract Background: Rational of the neoadjuvant chemotherapy can significantly decrease the size and stage of tumor for breast carcinoma. Studies have demonstrated that there is a greater long-term outcome in patients who reach pathological complete response (pCR) following neoadjuvant therapy. Metformin, a biguanide agent, is used as first-line therapy for the treatment of type II Diabetes. The studies reported that diabetic patients with metformin-administered breast cancer and neoadjuvant chemotherapy had a higher pCR rate than diabetics without Metformin. Aim of Study: To assess the efficacy of incorporating Metformin to standard neoadjuvant chemotherapy in breast cancer patients to increase the rate of pathological complete response (pCR). Patients and Methods: From 1/7/2016 to 1/9/2019, a total of 50 patients were enrolled in the study. Breast cancer patients were equally randomized to receive either standard neoadjuvant AC-Paclitaxel or a similar regimen plus Metformin 500mg twice daily until the time of surgery. For reaction & toxicity, patients were evaluated. Results: Concerning all clinical-pathological variables & biological subtypes, there was no statistically significant difference between both arms. Complete clinical remissions were achieved in 19 patients (76%) and 15 patients (60%) respectively for the investigated group and standard group (p-value 0.4). In the investigated group, 19 patients (76%) were referred to have modified radical mastectomy (MRM) and 6 patients (24%) were referred to have complete breast surgical resection (CBS), while in the standard group, 23 patients (92%) were referred to MRM and 2 patients (8%) were referred to CBS. There was no statistically significant difference between the two types of surgery in the two groups (p-value 0.247). The primary endpoint was the pCR rate in the axilla and breast post operatively. Statistical analysis showed certain trend toward higher rate of pCR with the addition of Metforminin the investigated group compared to the standard group (p-value: 0.08). Uni-variate analysis showed significant correlation with pCR in the 2 groups as regard ER and HER-2/neu positivity, (p-value 0.004).The Median DFS at 2 years in our study was 93.25%. Kaplan-Meier survival curves' analysis showed no significant difference between both groups with a DFS of 91.25% in the investigated group arm, and 96.25% in the standard group. Conclusion: The addition of metformin to neoadjuvant chemotherapy has a nearby significant impact on pathological complete response (PCR)in female patients with advanced breast cancer with no significant increased toxicity. Further studiesare recommended to highlight the effect of adding metformin to standard neoadjuvant chemotherapy in ER and/or HER2 positive breast cancer patients.
breast cancer
neo-adjuvant
Metformin
Pathological complete response
2021
06
01
1245
1253
https://mjcu.journals.ekb.eg/article_185030_90a08b6a51f262b96892b6a77aecfa73.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Role of HRCT in Evaluation of Thoracic Manifestations of Collagen Vascular Diseases
YOUSSRIAH Y. SABRI, M.D.;
MAI B. IBRAHIM, M.D.
REEM H. ABD-AL LATIF, M.D.;
MAHA M. HUSSEIN, M.Sc.
Abstract Background: High-resolution computed tomography has proven to play a basic role in the detection and characterization of various pulmonary lesions (interstitial, small air way disease etc.) in patients with collagen vascular diseases. Accurate HRCT detection of pulmonary involvement in collagen vascular disease has important therapeutic and prognostic implications. Aim of Study: The aim of this study is to evaluate role of HRCT in diagnosis of thoracic manifestation of collagen vascular diseases. Patients and Methods: 100 patients diagnosed as collagen vascular disease were referred to Radiology Department in Faculty of Medicine, Cairo University for HRCT of the chest. Results: Interstial lung disease was seen in 48 patients (48%), while 31 patients (31%) showed signs of small airway disease. Conclusion: HRCT is fundamental for evaluation of all thoracic manifestation of collagen vascular diseases.
HRCT
Collagen vascular diseases (CVD)
2021
06
01
1255
1262
https://mjcu.journals.ekb.eg/article_185032_d3d641977b56b3776750ec0b7f6fe8df.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Characterization of Hepatic Focal Lesions by Diffusion Tensor Imaging and How Far it Can Predict Post-Treatment Response?
NEHAD M.S. FOUDA, M.D.;
KARIM M. ABDELHAMID, M.Sc.
NEHAL
THARWAT, M.D.
Abstract Background: Liver diseases have been known to be a major health problem principally because of their world-wide distribution. Focal liver disease is a common diagnostic problem referred to radiologists for evaluation owing to its nonspecific clinical presentation and marked interobserver variation on clinical examination. Aim of Study: The purpose of this study is to evaluate the role of diffusion tensor imaging in characterization of hepatic focal lesions and its value in post-treatment response. Patients and Methods: This prospective study included 30 patients previously diagnosed to have hepatic focal lesions (HFLs) by their characteristic triphasic computed tomography (CT), dynamic magnetic resonance imaging (MRI) features and/or biopsy. The study included 43 lesions in 30 patients (16 benign lesions, 23 malignant lesions, and 4 treated malig-nant lesions). MRI with diffusion tensor imaging (DTI) was performed for all patients. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were evaluated for all lesions. Results: There was a statistically significant difference in ADC values between the benign and malignant lesions (p < 0.001) and between the treated malignant and untreated malignant lesions (p=0.002). There was a statistically signif-icant difference in FA values between the benign and malignant lesions (p < 0.001) and between the treated malignant and untreated malignant lesions (p=0.004). The best cut-off ADC value to differentiate between benign and malignant lesions respectively was >1.42x 10-3 mm2/s with 95.7% sensitivity and 82.8% specificity. The best cut-off ADC value to differ-entiate between treated malignant and malignant lesions respectively was >1.65x 10-3 mm2/s with 97.8% sensitivity and 95.7% specificity. The best cut-off FA value to differentiate between malignant and benign lesions respectively was >0.29 with 95% sensitivity and 70% specificity. The best cut-off FA value to differentiate between treated malignant and untreated malignant lesions respectively was <0.297 with 100% sensitivity and 69.2% specificity. Conclusion: Diffusion tensor imaging is an evolving technique that can be used to characterize different hepatic focal lesions either benign or malignant with significant additive value to dynamic contrast enhanced MRI examination. It can also be used to monitor treatment response.
Diffusion tensor imaging
hepatic focal lesions
benign
malignant
2021
06
01
1263
1273
https://mjcu.journals.ekb.eg/article_185034_0f2574de107c7d7dbc759709df13a4b2.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Efficacy of Low Dose Computed Tomography Using Adaptive Statistical Iterative Reconstruction in Lung Cancer Screening
SABRY ALAM EL-DIN M. EL-MOGY, M.D.;
MOHAMMAD Kh. EL-BADRAWY, M.D.
NEHAL E. EL-EMAM, M.Sc.;
NEHAL THARWAT, M.D.
Abstract Background: Lung cancer is the most common malignant tumor and the leading cause of cancer-related deaths all over the world. Early detection and treatment are important to increase survival rate. Therefore, screening of lung cancer should target those individuals at high risk. Aim of Study: To detect the efficacy of low dose computed tomography (LDCT) of the chest with adaptive statistical iterative reconstruction (ASIR) algorithmas a screening method in diagnosing early stages of lung cancer and thus decrease the disease related morbidity and mortality as itminimizes exposure to ionizing radiation while maintaining sufficient image quality. Material and Methods: Ninety-six high risk cases (current smokers or ex-smokers), 94 males and 2 females, withage range from 50-78 yearswere included in this study. All cases underwent CT of the chest using low dose protocol with-ASIR algorithm with different blending levels of reconstruction (40%, 60%) for lung cancer screening. All images were interpreted using the International Early Lung Cancer Action Program (I-ELCAP) diagnostic protocol for lung nodule diagnosis and management. Results: From 96 cases included in the study, 82 cases had normal chest CT and 14 cases showed abnormal findings in chest CT (4 of them showed nodular lung lesions and the other 10 cases showed other findings related to smoking as bullae, bronchial wall thickening, emphysema, honey combing and bronchiectasis). Among the 6 nodules detected in the 4 cases, one nodule was >!15mm, and 5 nodules were <15mm. According to I-ELCAP diagnostic protocol, one nodule was considered positive and 5 nodules were considered semi-positive. LDCT chest using ASIR algorithm for lung cancer screening revealed high sensitivity and specificity for detecting lesions at cut off point size 6 mm (84.9% and 100% respec-tively). The area under receiver operating characteristic (ROC) curve for prediction of nodule with cutoff point size 6mm was 0.938 with 95% confidence interval (0.887-0.990). Conclusion: LDCT of the chest using ASIR algorithm is a promising and efficient tool for lung cancer screening with significant minimization of ionizing radiation exposure as well as preserved optimum image quality.
Lung Cancer
Chest CT
Low dose
Asir
2021
06
01
1275
1281
https://mjcu.journals.ekb.eg/article_185035_56dbd456e1e6f5ec3016369f8663d7d6.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Chemical Dorsal Rhizotomy in Lung Cancer Pain
AHMED F. AHMED, M.Sc.;
RAAFAT R. MAHFOUZ, M.D.
EMAD GERGES SALEH, M.D.;
SOMAYA A. EL SHEIKH, M.D.
MOHGA
A. SAMY, M.D.
Abstract Background: Lung cancer is one of most common malig-nancies worldwide. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer. Many therapeutic modalities proposed to provide pain relief in those patients. Aim of Study: The aim of this study was to assess the safety and effectiveness chemical dorsal rhizotomy (phenol) in treatment of chronic malignant thoracic pain. Patients and Methods: This prospective interventional study included 30 patients with lung cancer pain. The patients received chemical phenol in dorsal rhizotomy corresponding to related pain dermatome at National Cancer Institute during the period from 1st of January 2015 to end of December 2018. Results: Visual analog scale, quality-of-life and quality of sleep scores were improved significantat Day 1, 1 week, 1m and 3m as compared to pre block. As regards complication, one case had dorsal back pain, and three cases had numbness. Conclusions: Chemical rhizotomyleads to pain relief on short and long term but has concerns in safety profile.
Chemical rhizotomy
Lung Cancer
Chronic pain
2021
06
01
1283
1288
https://mjcu.journals.ekb.eg/article_185037_3432f995c88dac50ea06f152afa24b53.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
The Value of Ultrasound Elastography in Evaluating Inflammatory Breast Lesions
BASMA M. ALKALAAWY, M.D.;
SOHA T. HAMED, M.D.
NOHA M. ELSAYED AHMED, M.Sc.;
DALIA S. ELMESIDY, M.D.
Abstract Background: Differentiating benign from malignant breast inflammatory conditions is crucial because they have totally different prognosis and management. Ultrasound Elastography can be used as a noninvasive tool for assessing inflammatory breast lesions. Strain Elastography can help pickup malignant inflammatory breast lesions and subsequently guide biopsy, while ruling out benign inflammatory lesions and sparing the patient unnecessary procedures. Aim of Study: Assess the diagnostic performance of strain ultrasound elastography added to the conventional B-mode ultrasound in evaluating inflammatory breast lesions. Patients and Methods: This study includes 33 female patients presenting with mastitis in the time period from September 2018 to October 2019. All breast lesions were assessed by Conventional B-mode ultrasound and Strain Elastography. Qualitative color-coded E-scoring and Semi-quantitative SR (strain ratio) evaluation of the sonoelasto-graphic images were performed. The results were compared to histopathologic diagnoses or follow-up for 2 weeks after antibiotic therapy, serving as reference standard. Sensitivity, specificity, positive predictive values (PPV), negative predictive value (NPV) and total accuracy were calculated for conventional B-mode ultrasound, and Strain elastography separately and then combined together. Statistical analysis was done using IBM© SPSS© Statistics version 22 (IBM© Corp., Armonk, NY, USA). Kappa test tests were two-tailed. A p-value <0.05 was considered signif-icant. Results: Combined US and Elastography yielded the highest accuracy (96.2%) and Specificity (96%). E-score qualitative elastography yielded better accuracy (90.9%) and Specificity (90.3%) than Strain ratio, semiquantitative elas-tography.
Inflammatory breast lesions
Ultrasound
Elastography
2021
06
01
1289
1297
https://mjcu.journals.ekb.eg/article_185039_0d399ffcc935f0ea9bacd7516549370d.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Thermal Radiofrequency in Lung Cancer Pain
AHMED F. AHMED, M.Sc.;
RAAFAT R. MAHFOUZ, M.D.
EMAD G. SALEH, M.D.;
SOMAYA A. EL SHEIKH, M.D.
MOHGA
A. SAMY, M.D.
Abstract Background: Lung cancer is one of most common malig-nancies worldwide. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer. Many therapeutic modalities proposed to provide pain relief in those patients. The aim of this study was to assess of the safety and effec-tiveness of Thermal Radio Frequency (TRF) of Dorsal root ganglion in treatment of chronic malignant thoracic pain. Aim of Study: Was to assess of the safety and effectiveness of Thermal Radio Frequency (TRF) of Dorsal root ganglion in treatment of chronic malignant thoracic pain. Patients and Methods: This prospective interventional study included 30 patients with lung cancer pain. The patients received TRF of Dorsal root ganglion corresponding to related pain dermatome at national cancer institute during the period from 1st of January 2015 to end of December 2018. Results: Visual analog scale, quality-of-life and quality of sleep scores were improved significant at Day 1, 1 week, 1m and 3m as compared to pre block. On assessment of post-operative complication four cases had dorsal back pain and two cases had neuritis. Conclusions: TRF leads to pain relief on long term but with minimal concerns in safety profile.
Thermal radiofrequency
Lung Cancer
Chronic pain
2021
06
01
1299
1306
https://mjcu.journals.ekb.eg/article_185040_edb751c43b84b426a6618e4b7e3f65c6.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Influence of IL28B of Donors and Recipients on Liver Transplantation Due to End Stage HCV Related Liver Disease
AYMAN YOUSRY, M.D.;
MOHAMAD S. ABDEL AZIZ, M.D.
OLFAT G. SHAKER, M.D.;
DALIA A. OMRAN, M.D.
MOHAMED
S. EL NEKLAWI, M.Sc.
Abstract Background: Recent studies have described a major impact of the IL28B gene polymorphism on graft survival post liver transplantation. Our study aims to investigate the impact of IL28B of donors and recipients on the natural course and outcome of liver transplantation due to end stage HCV related liver disease. Aim of Study: This study aims to investigate SNP of IL28B gene in Egyptian patients with end stage HCV related liver disease. Correlating the prevalence of IL-28b-alleles with patient and graft survival and with the progression of fibrosis for HCV-induced (graft) liver disease after liver transplantation. Also to correlate IL28B genotype with the outcome after liver transplantation. Patients and Methods: Donor and recipient IL28B rs12979860C>T single nucleotide genotype was determined in 24 patients who had undergone LT for HCV-induced end stage liver disease and received regular follow-up evaluations for two years post liver transplantation. Results: We found that the CC genotype frequency was reduced among patients with HCV related end stage liver disease while, in contrast, the frequency of CT & TT increased. No association was noted between IL 28B polymorphism of donors and recipients regarding fibrosis progression or patient and graft survival, as well as liver outcomes. Conclusions: No impact of IL 28B polymorphism on fibrosis progression, liver outcomes or patient and graft survival.
IL28B
Gene polymorphism
Liver transplan- tation
fibrosis
graft survival
2021
06
01
1307
1316
https://mjcu.journals.ekb.eg/article_185041_cae9fff9558c55653374fc8c2031fc26.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Impact of COVID-19 Pandemic on Physical Activity and Spinal Pain in a Group of Apparently Healthy Egyptians: A Cross Sectional Study
AHMED KOHEIL, M.D.;
DALIA DORGHAM, M.D.
WAEL NAZIM, M.D.;
DOAA H.S. ATTIA, M.D.
Abstract Background: Spinal pain is a frequent health problem. Sedentary lifestyle and lack of physical activity PA had been widely pointed out as a risk factor for LBP. Since the end of 2019, the world has been facing the COVID-19 pandemic, this resulted in change of lifestyle and PA performed by lots of people. Aim of Study: To detect change in PA before and after COVID-19 pandemic and its relation to LBP, cervical pain, nonspecific bodily pains or fatigue. Patients and Methods: The current study included 146 apparently healthy participants whom were asked to answer the validated Arabic version of International Physical Assess-ment Questionnaire IPAQ to assess PA before and after COV-ID-19 pandemic. Participants also answered questions to assess new onset of symptoms and/or increased symptoms in terms of LBP, nonspecific bodily pains or fatigue. Results: Participants were divided into two groups based on the presence of spinal pain, joint pains, bodily pains and fatigue: Worsened group who developed the symptom after COVID-19 pandemic or had worsening of an old symptom after the pandemic, and stable group who had no symptoms after the pandemic or had an old symptom that did not increase after the pandemic. There was significant change in high intensity PA after the pandemic (p < 0.001). Participants who experienced spinal pains had significantly practiced walking (p=0.002) and moderate intensity activities (p=0.038) before the pandemic. There was significant correlation between performing high intensity PA during COVID-19 pandemic and stable spinal pain, nonspecific bodily pains and fatigue (p=0.021, p=0.025, p=0.046) respectively. Individuals who experienced worsening in spinal pains, nonspecific bodily pains or fatigue had significant change in moderate intensity activity days (p=0.049) and duration (p=0.022) after the pandemic. Conclusion: The changes in moderate intensity PA is related to spinal pain, nonspecific body pain and fatigue.
Physical activity
COVID-19
Sport
LBP
2021
06
01
1317
1323
https://mjcu.journals.ekb.eg/article_185042_10c4061c42e54474bfcc3d7b02c20e82.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
CD96 as a Leukemic Stem Cell Marker in Acute Myeloid Leukemia Patients: Relation to Remission Induction Chemotherapy
MOHAMED A. FATEEN, M.D.;
RASHA RAWI, M.D.
HEBA E. ABD EL-RAHMAN, M.Sc.;
SAHAR K. HUSSEIN, M.D.
Abstract Background: Leukemic stem cells (LSCs) play a crucial role in chemotherapy resistance in acute myeloid leukemia (AML), the classical LSCs phenotype is CD34+/CD38-. Successful eradication of LSCs requires combination of different strategies including targeting LSC specific surface molecules. Aim of Study: To investigate the role of CD96, as a stem cell marker, in AML and its relation to induction therapy outcome. Material and Methods: The current study was conducted on 50 patients with de-novo AML, in addition to 20 controls. Using multicolor flow cytometry, we analyzed the expression of CD96, a potential marker for LSCs among CD34+/CD38- cell population in AML patients at initial diagnosis and correlate it to the response of induction therapy. Results: Percentage of CD96 among CD34+/CD38- was significantly higher in AML patients compared to control group (p < 0.001). However, no statistical significant difference was observed between complete remission (CR) and non-remission (NCR) groups. Also the correlation studies of LSC markers with laboratory findings revealed no significant correlation. Conclusions: CD96 expression among CD34+/CD38- cells may be used as a useful marker for detection of LSCs in AML patients. However its expression is not correlated to post induction therapy outcome.
Acute myeloid leukemia (AML)
Leukemic stem cell (LSC)
CD96
Induction therapy
2021
06
01
1325
1331
https://mjcu.journals.ekb.eg/article_185043_7f082597878bd14159cfac709aad275f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Impact of IL28B Polymorphism on the Response to Treatment of Hepatitis C with Interferon Based Therapy or Direct Acting Antivirals
AYMAN YOUSRY, M.D.;
MOHAMAD S. ABDEL AZIZ, M.D.
OLFAT G. SHAKER, M.D.;
DALIA A. OMRAN, M.D.
MOHAMED
S. EL NEKLAWI, M.Sc.
Abstract Background: A major impact of the IL28B gene polymor-phism on the response to antiviral therapy in chronic hepatitis C have been described recently by a lot of studies. This study aims to scrutinize the impact of IL28B genotypes of donors and recipients on the response to treatment with INF based therapy or DAA among patients that underwent liver trans-plantation. Aim of Study: This study aims to correlate IL28B genotype of donors and recipients for patients that had undergone liver transplantation with the response to INF based therapy, and the response to Direct Acting Antivirals (DAA). Patients and Methods: Donor and recipient IL28B geno-typing by PCR was done for 24 patients who experienced LT for HCV-induced end stage liver disease with established standard follow up evaluations post liver transplant for two years. Pegylated interferon-a (PEG-IFN-a) and ribavirin were received by 10 of the patients and direct acting antiviral (DAA) agents were offered to the remaining 14 patients. Results: We found that there was no impact of IL 28B polymorphism on the response to anti viral treatment (AVT) by (DAA) agents, as all different IL 28B genotypes and different recipient/donor patterns eventually achieved SVR even in cases with two unfavorable non-CC genotypes in both recipients and donors. We also found that the donor rs 12979860 CC genotype was strongly associated with the success of PEG-IFN-a and ribavirin treatment of recurrent hepatitis C. Conclusions: In the era of DAAs, it seems likely that it will be possible to overcome the effect of IL28B polymorphism with DAAs combinations.
Antiviral therapy
Chronic hepatitis C
DAA
single nucleotide polymorphisms
INF based therapy
2021
06
01
1333
1340
https://mjcu.journals.ekb.eg/article_185044_6f04fca8b17b5b6763e207b893ae5522.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
June
Review Article: Autoimmunity and Pathogenesis of Type 1 Diabetes
MARWA FATHY, M.Sc.;
IBRAHIM I.M. EL ARABY, M.D.
NANCY M. EL GUINDY, M.D.;
GHADA M. ANWAR, M.D.
Abstract Type 1A diabetes mellitus results from autoimmune de-struction of the insulin-producing beta cells in the islets of Langerhans. This process occurs in genetically susceptible subjects, is probably triggered by one or more environmental agents, and usually progresses over many months or years during which the subject is asymptomatic and euglycemic. Thus, genetic markers for type 1A diabetes are present from birth, immune markers are detectable after the onset of the autoimmune process, and metabolic markers can be detected with sensitive tests once enough beta cell damage has occurred, but before the onset of symptomatic hyperglycemia. This long latent period is a reflection of the large number of functioning beta cells that must be lost before hyperglycemia occurs. Type 1B diabetes mellitus refers to nonautoimmune islet destruction (Type 1B diabetes). Both genetic and environmental factors contribute to the risk of developing type 1 diabetes mellitus (T1DM). In genet-ically susceptible individuals, exposure to one or more envi-ronmental agents appears to trigger an immune response that ultimately causes destruction of the insulin-producing pancre-atic beta cells. Identification of these factors should lead to a better understanding of the pathogenesis of the disease and aid in developing strategies to prevent T1DM. They include: - Viral infections, particularly enterovirus infections. - Immunizations. - Diet, especially exposure to cow's milk at an early age. - Higher socioeconomic status. - Obesity. - Vitamin D deficiency. - Perinatal factors such as maternal age, history of preeclamp-sia, and neonatal jaundice. Low birth weight decreases the risk of developing T1DM.
Type 1 diabetes
Autoimmunity
2021
06
01
1341
1347
https://mjcu.journals.ekb.eg/article_185045_7b3f11f34de2ad25f2af1e16d3c526b5.pdf