2024-03-28T23:26:10Z
https://mjcu.journals.ekb.eg/?_action=export&rf=summon&issue=22431
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Role of Dual Energy Computed Tomography in Evaluation of Renal Stones
MOHAMED SHAWKY, M.D.;
TAHA M. TAHA, M.Sc.
TAREK F.
ABD ELLA, M.D.
Abstract Background: DECT is a new evolving technique used for in vivo prediction of renal stones chemical characterizations. Aim of Study: This study aims to assess the role of Dual Energy computed Tomography (DECT) in evaluation of renal stone compositions. Patients and Methods: This study is a prospective cohort study, it included 30 patients. Classic single energy examina-tions were done (100-120 kVp) followed by DECT performed by using a single-source dual energy with fast switching between two kilovoltages (80, 135 kVp). Results of DECT were then compared to crystallography. Results: (20 males and 10 females) with known renal stones, no age or sex predilection. The patient aged from (16) to (79) years From all the examined 37 stones, DECT predicted chemical composition of stones as 24 Ca oxalate stones, 8 uric acid stones and 5 cystine stones. DECT accurately iden-tified all uric acid stones. DECT recognized 2 stones as Ca oxalate and they were proven to be Ca phosphate by crystal-lography. DECT also failed to identify mixed compositions in 2 stones which were diagnosed as Ca oxalate and cystine stones. Statistical analysis revealed reliable agreement between DECT and crystallography with a (p-value) of >0.001 (highly significant). Conclusion: DECT was found as an effective and reliable method in pre-analysis of renal stones prior to management.
Dual Energy Computerized Tomography (DECT)
Renal stones
2021
09
01
1349
1357
https://mjcu.journals.ekb.eg/article_194942_14a715a51054a6843a27e0a82d8f67cc.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Endermologie versus Low Level Laser Therapy on Post Mastectomy Lymphedema
MONA M.A. ZIETHAR, M.Sc.;
INTSAR S. WAKED, Ph.D.
ROKAIA A. TOSON, Ph.D.;
RAGAB A.A. SHERIF, M.D.
Abstract Background: Breast cancer-related lymphedema (BCRL) is a major side effect and a complication of breast cancer surgery and radiotherapy, causing chronic lymphedema in the arm. Aim of Study: This study was conducted to compare between efficacy of Endermologie and Low Level Laser Therapy (LLLT) in treatment of post mastectomy lymphedema. Subjects and Methods: Thirty women diagnosed clinically by oncologist/physician as unilateral breast cancer with secondary upper limb lymphedema post mastectomy, they were selected from Damanhour Oncology Centre suffering from grade II lymphedema without skin changes one year post mastectomy based on tape and volumetric assessment. Their age ranged from 40 to 60 years. They were assigned randomly into two groups (A) and (B) equal in number. Group (A) received 30min Endermologie 3 times per week in addition to routine physical therapy program (manual lymphatic drain-age, compression bandage, active range of motion and eleva-tion), hygiene and skin carefor 6 weeks. While, Group (B) received 20min LLLT 3 times per week in addition to routine physical therapy program (manual lymphatic drainage, com-pression bandage, active range of motion and elevation), hygiene and skin care for 6 weeks. Upper limb lymphedema was evaluated by tape and volumetric assessment before and after the intervention. Results: There was no significant difference in upper limb volume and circumference between both groups pre-treatment (p>0.05). Comparison between the group (A) and (B) post-treatment revealed a significant decrease in upper limb volume and circumference of the group (A) compared with that of the group (B) (p>0.05). Conclusion: These results suggested that Endermologie was more effective than LLLT in reducing limb circumference and volume in post mastectomy lymphedema.
mastectomy
Lymphedema
Endermologie
Low level laser therapy
2021
09
01
1359
1366
https://mjcu.journals.ekb.eg/article_194943_4524fb8f908de42ffd9254d9007f2027.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Changes in Ocular Higher-Order Aberrations after Corneal Collagen Cross-Linking for Keratoconus
AHMED M. MOHARAM, M.Sc.;
MOHAMED M. KHATER, M.D
HISHAM A. SAAD, M.D., F.R.C.S. (GLASG.);
KHALED A. NAGY, M.D.
Abstract Background: Keratoconus is a progressive, bilateral, and asymmetric non-inflammatory corneal ectasia. Corneal Col-lagen Cross-Linking (CXL) is the only treatment option that focused on disease pathology and increasing the biomechanical rigidity of the cornea. HOAs are part of the refractive errors which deteriorate the quality of the retinal image and they are not correctable with sphere and cylinder corrections. Since HOAs can impact visual performance and contrast sensitivity; they are considered important indices in the field of quality of vision. Aim of Study: To determine changes in ocular higher order aberrations (HOAs) after Corneal Collagen Cross Linking (CXL) for Keratoconus (KC). Patients and Methods: This study was conducted between April 2018 and March 2019 comprising 30 keratoconic eyes of 19 patients. Patients were treated with epithelium-off CXL and evaluated at the baseline, 3 and 6 months after the proce-dure. The ocular HOAs were measured and analyzed using Zywave II Aberrometer. Results: There was statistically significant improvement in Best Spectacle-Corrected Visual Acuity between the pre-operative and 6-month evaluations (p < 0.05). HOAs at 6mm were statistically significantly reduced at 6 months. Conclusion: CXL is effective in improving HOA param-eters in eyes with KC. changes in HOAs at 6mm were signif-icantly and strongly associated with the post-operative changes in BSCVA.
cornea
Collagen Cross-Linking
Keratoconus
Wavefront
HOAs
2021
09
01
1367
1371
https://mjcu.journals.ekb.eg/article_194944_b96dfa8935b98431a945105e9847a841.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Value of Pelvic Magnetic Resonance Imaging in Local Staging of Rectal Cancer
MOUSTAFA E. RADWAN, M.D.;
EHAB M. ABDELRAHEEM, M.D.
ABD EL KARIM ABD ALLAH, M.D.;
AFAF HASAN, M.D.
MOHAMMAD EL OSSEILY, M.D.;
EHAB MOUSA, M.D.
Abstract Background: The prognosis for patients with rectal cancer is closely related to the stage of the disease at the time of diagnosis. Currently, rectal Magnetic Resonance Imaging (MRI) is the most encouraging imaging modality for local staging of rectal cancer. Aim of Sudy: This study aimed to evaluate the role of pelvic MRI in staging of the rectal cancer for management decision. Patients and Methods: This prospective study included 30 patients who proved to have rectal cancer by clinical and histopathological studies. Pelvic MRI was accomplished for all patients according to the following protocol: Sagittal T2WI; Axial T2WI; Axial T 1 SPIR; Axial T 1 WI; and Coronal T2 TSE. T staging and N staging were performed for the lesions. Results: Thirty patients were included in this study, 21 males and 9 females with their ages range between 19 and 80 years (mean=43 years). MRI defined the location of the tumor in the upper third (2 cases), 6 cases at the middle third and in 21 cases at the lower third of the rectum. T staging: No lesions were staged as T1, one case was staged as T2, twenty-three lesions were diagnosed as T3; five cases were diagnosed to have T4 lesion (local infiltration) involving; prostate (4 cases) and infiltrating the skin and penile root in another case. The operative findings confirmed MRI data in those cases. One case was staged as T0 stage following proctoscopic resection of rectal polyp and proved to be rectal carcinoma (villous carcinoma). The sensitivity of MRI was identical to (100%) operative and histopathological assessment in all T stages from (T 1 to T4). N staging: The N stage was interpreted according to the TNM classification, any enlarged node in this study was suspected to be positive for metastatic deposits. Conclusions: Pelvic MRI provides high resolution images of the entire mesorectum allowing for an accurate staging of rectal cancer. It offers multiplannar capabilities with high resolution, non-invasive however it is relatively a costly examination. It is of high value in building up the best therapy strategy for cancer rectum patients.
Cancer rectum
Pelvic MRI
Local staging
2021
09
01
1373
1380
https://mjcu.journals.ekb.eg/article_194945_d6d74c21bae97fbc7a15b7e37e949b73.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
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: Was 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
09
01
1381
1387
https://mjcu.journals.ekb.eg/article_194946_3acca2486cfad3e80a537bce3c23d298.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Impact of Initial Thrombocytopenia on Short and Midterm Outcomes in Patients with Acute Coronary Syndromes Who Underwent Percutaneous Coronary Intervention
SHERIF W. AYAD, M.D.;
MOHAMED A. SADAKA, M.D.
MOHAMED A. SOBHY, M.D.;
OLA S. NOUR ELDIN, M.Sc.
Abstract Background: Acute Coronary Syndromes (ACS) patients with thrombocytopenia are challenging in their management as they carry high bleeding and thrombotic risks. Aim of Study: In this study we aimed to assess the impact of thrombocytopenia on ACS patients. Patients and Methods: We collected data of 608 ACS patients who presented to our hospital during the year 2017. Patients were divided into 2 groups according to the presence of initial thrombocytopenia: Group 1 with initial thrombocy-topenia (n=123) and group 2 without initial thrombocytopenia (n=485). Platelet count less than or equal 150.000/ml was used to define thrombocytopenia. Endpoints were in-hospital and 6 months Major Adverse Cardiovascular and Cerebrov-ascular Events (MACCE). Results: Group 1 patients were significantly older and, more likely with a history of acute coronary syndrome (38.2% versus 26.7%, p=0.049), and more likely to present as non ST elevation myocardial infarction (39% versus 26.7%, p=0.037). In hospital outcome showed significantly higher risk of cumulative MACCE in group 1 patients (12.2% versus 2.3%, p=0.002) and a similar result was found after at least 6 months follow-up (19.3% versus 9.6%, p=0.041). Both groups had similar incidence of bleeding and heart failure. Group 1 patients had significantly higher incidence of in hospital MACCE (p=0.038), but this was not significant after 6 months follow-up. Conclusions: ACS patients with mild thrombocytopenia had similar bleeding risk in comparison to patients with normal count during the hospital stay and after 6 months of follow-up, higher risk of in hospital MACCE and so they should be managed as patients with normal platelet counts.
Acute coronary syndromes
thrombocytopenia
percutaneous coronary intervention
2021
09
01
1389
1397
https://mjcu.journals.ekb.eg/article_194947_604c2359add6298e6d6d8c0d0757aa29.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Assessment of Imaging Findings in Inflammatory Breast Disease by Ultrasound
SAHAR M. EL-FEKY, M.D.;
HEBA ALLAH M.Y. EL-NAGGAR, M.D.
NOURHAN N.S.
DEGHIDY, M.Sc.
Abstract Background: Inflammatory breast disorders include a wide array of underlying causes, ranging from common benign infection, noninfectious inflammation and inflammation resulting from underlying breast malignancy. Mastitis refers to inflammation of the breast parenchyma, often presenting with pain, heat and redness that may be a debilitating illness with prolonged morbidity. It may also present with a wide array of other nonspecific symptoms, which may lead to delayed diagnosis and inappropriate treatment. Aim of Study: To discuss imaging findings in inflammatory breast disease by ultrasound. Patients and Methods: This was a prospective study which was carried out at Ain Shams University Hospitals; the study was conducted on 100 women with inflammatory breast diseases referred to the Radiology Department and Surgical Outpatient's Clinics. Results: Echogenic edematous fat lobules of the studied group show that; 30 (30.0%) were negative and 70 (70%) were positive, interstitial edema; 24 (24.0%) were negative and 76 (76%) were positive, defined collections; 68 (68.0%) were negative and 32 (32%) were positive. Lymph node enlargement; 54 (54.0%) were negative and 46 (46.0%) were positive. There was lymph node enlargement for only 45 (31 cases show reactive lymph nodes oval in shape with preserved shape and hilum and 14 cases show suspicious lymph nodes with cortical thickening and eccentric hilum). Follow-up by u/s and histopathology of the studied group show that 93 (93.0%) were resolved and 7 (7.0%) were IDC by histopathology. Conclusion: Ultrasound plays a fundamental role in the diagnostic work up of mastitis patients. An ideal ultrasound should ensure an accurate diagnosis, guide for interventional procedures whenever necessary and should be used to monitor adequate management by short term follow-up studies along the course of therapy.
Inflammatory breast disease
Assessment of imaging findings
Ultrasound
2021
09
01
1399
1408
https://mjcu.journals.ekb.eg/article_194948_06ce7eeabc0685d491b49d99602919fd.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Relation between Acne Vulgaris and Metabolic Syndrome in Males
ESSAM NADA, M.D.;
SEREEN ABD EL HALEEM MOHAMED, M.Sc.
SOHA
ABOELDAHAB, M.D.
Abstract Background: Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adoles-cents. Metabolic Syndrome (MetS) is a multiplex syndrome and has been reported to be associated with many dermatologic diseases, such as acne vulgaris. Aim of Study: Study the prevalence of MetS in post-adolescent male patients with AV (aged >!20 years), and assess the relation between MetS and severity of AV in these patients. Patients and Methods: A randomized case control study was conducted on 52 post adolescent male patients with acne and 52 patients (age and sex matched) as control. All patients were subjected to clinical assessment including: Evaluation of MetS components: (Body Mass Index (BMI) calculation: [Weight (kg) / height (m)2] & waist circumference) and estimation of biochemical parameters (fasting serum triglyc-erides, HDL and fasting blood glucose). Dermatological evaluation was done for assessment of acne severity. Results: MetS prevalence was statistically significant higher in AV patients (19.2%) compared to controls (5.8%). (x2=4.37, p=0.037). There was a statistical significant relation between AV and risk of developing MetS as odds ratio was 3.9 (1.003 to 15.07), p=0.049. There was statisti-cally insignificant relation between the severity of AV and MetS prevalence. Conclusion: MetS prevalence was higher in AV patients than in control and was more common in patients with severe acne. There was a statistical significant relation between AV and risk of developing MetS.
Acne
Metabolic syndrome
hyperinsulinemia
Body Mass Index
2021
09
01
1409
1415
https://mjcu.journals.ekb.eg/article_194949_681966cb11d51537377406e551735bd3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Asymptomatic Charcot Foot in Longstanding Diabetes
MOHAMED E. EL-SHINAWI, M.D.;
NADER M. HAMADA, M.D.
ABDEL RAHMAN
M. ABDEL RAHMAN, M.Sc.
Abstract Background: Charcot foot is a longstanding complication of Diabetes Mellitus (DM) and the incidence of undiagnosed Charcot disease among diabetic patients ranges from 0.4% to 13%. Aim of Study: This study aimstodiagnose preclinical Charcot disease in longstanding diabetic patients. Patients and Methods: Aprospective study was carried out on 50 patients with longstanding diabetes. Full history was taken, laboratory and radiological investigations were performed. Results: 52% of patients were found to have positive findings for Charcot disease. Positive findings on X-ray were found to be significantly related with age, HbA1C, DM duration and body mass index. Conclusion: Patients with long standing diabetes mellitus with no obvious deformity or foot ulcerations should be screened for Charcot foot X-ray findings and should be advised about proper glycemic control, avoiding minor trauma and seeking medical advice once early clinical signs of Charcot foot appear.
Charcot foot
Long standing diabetes
X-ray
2021
09
01
1417
1425
https://mjcu.journals.ekb.eg/article_194950_ddd62a398d1f433e3ded05ee214a7e1c.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Meta-Analysis for Comparison between Antireflux Surgery With or Without Endoscopic Management of Barrett's Esophagus
KHALED A. EL FIKY, M.D.;
MOHAMED MAHFOUZ MOHAMED, M.D.
AHMED Y. EL RIFAI, M.D.;
KHALED M. ELAMIR ABDO, M. Sc.
Abstract Background: In patients with BE, anti-reflux surgery aims to sustainable control reflux symptoms and heal reflux induced esophageal mucosal inflammation and prevent progression of BE to adenocarcinoma. Endoscopic resection of visible lesions if any, followed by ablation of the rest of the BE epithelium is the current standard of care for management of BE with confirmed dysplasia. Although the current literature describes multiple endoscopic and anti-reflux techniques for the management of BE, there is no published evidence on the efficacy of anti-reflux surgery followed by endoscopic man-agement on the outcomes of BE. Aim of Study: The objective of this study was to compare between anti-reflux surgery with or without endoscopic man-agement of BE. Patients and Methods: In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The search retrieved 2089 unique records. We then retained 57 potentially eligible records for full-texts screening. Finally, 6 studies were included. Results: In the present systematic review and meta-analysis, five studies reported the rates of recurrence. The overall effect estimates showed the rate of recurrence was 5.7% (95% CI 1.2-10.2%). In the present systematic review and meta-analysis, five studies reported the overall complica-tions rate. The overall effect estimates showed the overall complications rate was 7.3% (95% CI 4.1-10.6%), mainly stricture and perforation. Conclusion: Endoscopic procedures after anti-reflux surgery is a safe modality, with high rate of success in complete eradication of BE in symptomatic GERD patients, especially those with severe anatomical impairment in distal esophageal segment. As a concurrent procedure, endoscopic procedures may be beneficial in the terms of reducing the early recurrence rates, which seems to be important issue during the manage-ment of BE. By doing synchronous endoscopic procedures and fundoplication, one might observe a true anatomy of esophagogastric junction in its entirety and might be able to truly observe the distal extent of columnar esophagus.
Antireflux surgery
Endoscopic Management
Barrett's esophagus
2021
09
01
1427
1436
https://mjcu.journals.ekb.eg/article_194951_41775f8276f05353f79b7d3089ac9e4f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Electro-Acupuncture versus Therapeutic Ultrasound on Coccydynia after Delivery
HEBA F. HAMADTO, M.Sc.;
MAGDA S. MORSY, Ph.D.
MOHAMED F.
ABO EL ENEEN, M.D.
Abstract Background: Coccydynia is pain and inflammation of the coccyx or tailbone. Therapeutic ultrasound and electro-acupuncture are safe and effective methods for reducing chronic coccyx pain. Aim of Study: This study was conducted to determine if therapeutic ultrasound have more effect than electroacupunc-ture on coccyx pain after delivery at young female. Subjects and Methods: Thirty primi and multiparous women suffering from coccydynia were participated in this study. They were selected rondomely from the out patient clinic of gynacology and obstetric in Al-Qasr El-Einy Hospital to share in this study, their ages were ranged from 25 to 35 years old and their body mass index (BMI) were not exceed 30kg/m2. The participants were assigned into two groups of equal numbers: Group (A) received continuous ultrasound of frequency 1MHZ and intensity 1.5W/cm2 for 5 minutes/ session, 3 times per week for 4 weeks on painful area of coccyx, while group (B) received electro acupuncture for 20 minutes, 3 times per week for 4weeks. Assessment of pain level in each group was done by using visual analogue scale and plasma cortisol level in the blood at the beginning of the study and at the end of the treatment course. Results: The results of this study revealed that there was statistically significant improvement in VAS and plasma cortisol level in group (A) than in group (B). Conclusion: Therapeutic ultrasound are more effective than electro-acupuncure treatment in alleviating pain in women suffering from coccydynia after delivery.
coccydynia
therapeutic ultrasound
Electroa-cupuncture
Serum cortisol
visual analogue scale
2021
09
01
1437
1443
https://mjcu.journals.ekb.eg/article_194952_e5ea6bebc73f181d269b9ec336799994.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Opposite Clear Corneal Incision (CCI) on Corneal Higher-Order Aberrations after Phacoemulsification
HANY M. EL IBIARY, M.D.;
RAFAAT A. REHAAN, M.D.
TAREK M. ABD AL-AZIZ, M.D.;
HATEM A.A. GAMAL ELDIN, M.Sc.
Abstract Background: Nowadays, care of a cataractous patient greatly exceeds surgical removal of the opacified lens. In a step foreword to welfare of the elderly, phacoemulsification can perform as a refractive tool, addressing both spherical and astigmatic refractive errors. Aim of Study: The aim of that work was to evaluate safety and effectiveness of OCCIs, as an innovative procedure for correction of corneal astigmatism, during phacoemulsification. Patients and Methods: The study assessed 64 patients, who underwent phacoemulsification. Pre-operative and post-operative corneal topography was done, documented and statistically analyzed for each patient. Results: The study revealed a decrease of pre-operative corneal astigmatism from a pre-operative mean of –1.78D to a post-operative mean of 1.09D in OCCI group and a decrease of pre-operative corneal astigmatism from a pre-operative mean of –1.71D to a postoperative mean of 1.29D in single incision group. Conclusion: The present study revealed that OCCIs with appropriate pre-operative corneal topography represent a real advance in the applications of refractive lenticular surgery. OCCIs provide an innovative technique for managing pre-operative, regular, corneal astigmatism. This is simple, easy to learn technique, with no extra instrumentation. The OCCIs in this study was safe, with no wound related complications. However, OCCIs require careful early post-operative care, due to their penetrating nature. Once the wounds are sealed, risk of further complications approaches zero. Further studies on that technique, employing different incision architecture are required to help development of nomograms correlating the incision length, width, age of the patient, and the amount of pre-operative corneal astigmatism to be corrected.
Opposite clear corneal incision
Corneal higher-order aberrations
Phacoemulsification
2021
09
01
1445
1452
https://mjcu.journals.ekb.eg/article_194953_44a278830e59d284706c5abcd58555f0.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Ocular Parameter Changes in Pediatric Patients with Nephrotic Syndrome
WESAM E. AFIFI, M.D.;
AHMED A. TABL, M.D.
MAHMOUD A. ABD EL MOHSEN, M.Sc.;
MOHAMED S. SLEEM, M.D.
Abstract Background: Nephrotic syndrome has a relapsing nature that necessitates prolonged use of steroids and other immu-nosuppressive drugs. Systemic steroid administration is asso-ciated with multiple ocular side effects. This study was conducted to report various ocular manifestations in pediatric patients with nephrotic syndrome. Aim Study: The aim of our study is to report various ocular manifestations in children with idiopathic nephrotic-syndrome. Patients and Methods: This cross-sectional case control study included 100 cases diagnosed with nephrotic syndrome and 50 healthy controls. All subjects were subjected to detailed history taking, general examination, and laboratory investiga-tions. Also, comprehensive ophthalmological examination (including visual acuity, slit lamp microscopy, intraocular pressure measurement, and fundus examination) were per-formed. Results: Unaided visual acuity was significantly increased in cases compared to controls, and that was evident in both right and left eyes. IOP was significantly elevated in cases compared to controls (p < 0.001). Cataract was detected in 4 cases (4%). Right eye fundus examination revealed abnormal-ities in 12 cases (12%). The mean duration of disease in our study was 2.22 years (range, 6 months-9 years). Disease duration had no significant association with neither of IOP, cataract, nor fundus examination (p>0.05). Conclusion: There is an increased incidence of ocular complications in pediatric cases with nephrotic syndrome. It is recommended that these cases should have regular ophthal-mological examination for early detection of these compli-cations.
nephrotic syndrome
steroids
Ocular side effects
2021
09
01
1453
1458
https://mjcu.journals.ekb.eg/article_194954_d39c866cbd8384ba8dfc9fc92cb8afee.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Added Value of Susceptibility Weighted Imaging (SWI) in Diagnosis of Multiple Sclerosis (MS)
RANIA A. ANAN, M.Sc.;
MOHAMED A. EL-ADALANY, M.D.
TAMER M. BELAL, M.D.;
SABRY A. EL-MOGY, M.D.
Abstract Background: There are a number of challenges in MS clinical practice, including the limitations of conventional MRI techniques in the diagnosis, subtyping, predicting disease course, and monitoring of people suffering from MS. Suscep-tibility Weighted Imaging (SWI) is a relatively new MR sequence that has the ability for simultaneous visualization of hyperintense MS lesions and their central veins. Aim of Study: To assess the role of MR susceptibility weighted imaging in comparison with T2 and FLAIR sequences in evaluation of MS lesions. Patients and Methods: In this prospective study, 30 patients with clinical diagnosis of MS were enrolled. All patients were undergone brain MRI consisting T2W, FLAIR and SWI se-quences. All sequences were analyzed for the presence and number of MS plaques. Moreover, the detection of central veins in MS plaques were assessed by SWI. Results: Our study included 30 MS patients: 5 patients (16.7%) had disease duration more than 5 years and 15 patients (83.3%) with disease duration less than 5 years. All obtained sequences showed fewer number of plaques as the disease duration was less (p < 0.05). SWI has also the ability of detection central vein in MS plaques. Conclusion: SWI is an additional sequence, that together to conventional MRI sequences, helps to characterize the white matter lesions detected in multiple sclerosis diagnosis with superiority of detecting central veins which improves the understanding of the MS pathogenesis.
Central vein sign
Multiple sclerosis
Suscep-tibility weighted imaging
2021
09
01
1459
1462
https://mjcu.journals.ekb.eg/article_194955_bdfcf7ff79b6fd484c6de53b68df5fb3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Association between Abdominal Wall Fat Index (AFI) on Ultrasonography with Carotid Intima Media Thickness (CIMT) and Lipid Profile
JOSEPH K. HALIM, M.Sc.;
AHMED M. MONIB, M.D.
MARWA ELSAYED
ABDELRAHMAN, M.D.
Abstract Background: Many international organizations have rec-ognized obesity as a chronic disease, with significant contri-bution to the global mortality and morbidity. Besides, obese patients are at higher risk of death than non-obese individuals. Obesity is a major driver for disability, early retirement, and psychological disorders as well. Abdominal wall fat index (AFI) is a widely utilized sonographic measure for regional fat accumulation; it is calculated as a ratio of the highest to lowest preperitoneal and subcutaneous fat thicknesses, respectively. Carotid Intima Media Thickness (CIMT) is a well-established marker for early atherosclerosis. In this study we investigated the relationship between abdominal wall fat index (AFI) and Carotid Intima Thickness (CIMT) with lipid profile among overweight and obese patients. Aim of Study: Investigating the relationship between abdominal wall fat index (AFI) and Carotid Intima Media Thickness (CIMT) as measured by ultrasonography with lipid profile among overweight and obese patients. Patients and Methods: We conducted a cross-sectional study on 60 adult participants ranging from 22 to 66 years old of both genders. The patients were divided into three groups according to the AFI value into: Group I (AFI <0.7), group II (AFI <1.4), and group III (AFI ³1.4). AFI and CIMT measured using ultrasonography and lipid profile was obtained. Results: Participants in group III (mean=53.7±11.0 years old) were significantly older than other studied groups; and were more likely to be hypertensive and diabetic. There was a statistically significant difference between studied groups regarding body mass index (BMI; p=0.001), the highest level was among group III (mean BMI=34.1±5.8Kg/m2). There were positive correlations between lipid profile parameters and the AFI. Furthermore, there was a statistically significant difference between groups regarding CIMT (p=0.001). CIMT was the highest among group III (mean of 1.4±0.3mm), followed by group II (mean of 1.2±0.3mm), and group I (mean of 0.7±0.3mm).CIMT was positively correlated with AFI (r=0.747, p=0.001). BMI was highest among group III (mean of 34.1±5.8), followed by group II (mean of 30.3±4.0), and group I (mean of 25.0±2.2) BMI was positively correlated with AFI (p=0.001). Conclusions: AFI has a significant positive correlation with CIMT and preperitoneal fat thickness. AFI can be a useful marker in evaluating and predicting disorders of me-tabolism, circulation and atherosclerosis.
Abdominal wall fat index
Carotid Intima Media Thickness
Obesity
2021
09
01
1463
1470
https://mjcu.journals.ekb.eg/article_194956_9f28b4e895302015839224b63ca733e2.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Impact of Psychological Rehabilitation on Healing of Burn Patients
DALIA M. MEFREH ELSAKA, M.D.;
AYMAN A. ELHDAD, M.D.
AHMED S. ELGAMAL, M.D.;
MEDHAT S. HASAN, M.D.
MOHAMED MAGDY
MOHAMED MOWAFY, M.Sc.
Abstract Background: Psycological distress among people who have sustained burns is common. The time taken for burn wounds to heal can not be fully explained by physical factors such as burn type, wound size and depth only. Clinicians should not ignore the importance of psycological influences on the wound healing process and also give consideration to the potential for psycological rehabilitation to lessen patient's distress and improve wound healing outcomes. Aim of Study: The aim is assessment of psychiatric status of burn patients during hospitalization, determination of psycological intervention methods and observation of impact of psycological rehabilitation on healing of burn patients. Patients and Methods: The present non-randomized, prospective, cohort study was conducted on 40 patients with partial or full-thickness burns that attended Burn Unit of Plastic Surgery Department, Menoufia University Hospital between January and December 2019. Approval of the ethical committee and written informed consent from all participants was obtained. Results: In the present study, in the pre-intervention period, we found that 35% of the patients had mild-to-moderate anxiety and most of the patients had scaled burn (55%) and the mean burn surface area was 18.45±8.51%. The majority of the patients had mixed burn degree (57.5%). Conclusion: Psychological interventions appear to effec-tively reduce burn patient psychological morbidities. We demonstrated that psychological interventions significantly reduce the risk of depression, anxiety, and hospital stay compared to usual care. These findings are very important as it confirms the promising role of psychological interventions in burn patients. Nevertheless, further studies with rigorous design, large sample size and multiregional cooperation are required.
Acute stress disorder
Burn model system
Post-traumatic stress disorder
Total body surface area
Beck depression inventory-II
2021
09
01
1471
1479
https://mjcu.journals.ekb.eg/article_194957_cc0352bba7d85de90c8e8a64894adcbb.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Cardiac Affection in Pediatric CKD Patients in Relation to Hyperuricemia and its Treatment
IHAB Z. EL-HAKIM, M.D.;
EMAN M. ELSAYED, M.D.
MOHAMED N. EL-SHARAWI, M.D.;
AYAAT A. MASRY, M.Sc.
Abstract Background: The prevalence of hyperuricemia in CKD pediatric patients increases in parallel with the estimated glomerular filtration rate (eGFR) decline, which is present in 40% to 60% of patients with CKD stages 1 to 3 and in 70% of patients with CKD stage 4, in this study, we aimed to study the prevalence of hyperuricemia among CKD paediatric patients in stages 2,3,4 and its effect on cardiac indices, and effect of allopurinol treatment on cardiac indices. Aim of Study: The Prevalence of hyperuricemia among CKD paediatric patients and its effect on cardiac indices. The impact of treatment with allopurinol for 6 months in hyperu-ricemic CKD pediatric patients on cardiac indices. Patients and Methods: A prospective cohort study was conducted on 78 CKD pediatric patients in stages 2,3,4, recruited from nephrology clinic Ain Shams University Hos-pital during the period from December 2019 to February 2020. Results: There were highly statistically significant negative correlation between serum uric acid level and GFR with p-value >0.001 and there were a highly significant relation between the level of uric acid and CKD stage with p-value >0.001, and there were a highly significant diffirane in cardiac indices before and after the treatment. There was a highly significant relationship between the level of uric acid before and after allopurinol treatment which showing the effectiveness of the drug for decreasing the uric acid level in the blood and it’s effect on the kidney and cardiovascular systeme. Conclusion: 6 months administration of allopurinol treat-ment in hyperuriamic CKD pediatric patients in stages 2,3,4 resulted in improving the laboratory data of (uric acid level, serum creatinine, GFR) and showing a significant effect on cardiac indices (LV structure, systolic and diastolic function).
Cardiac affection
Pediatric CKD patients
Hyperuricemia
Treatment
2021
09
01
1481
1487
https://mjcu.journals.ekb.eg/article_194958_765d2160a23389cee5874dabe33306ef.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Ventilatory Function Response to Upper Versus Lower Limbs Aerobic Training in Elderly Men
HADEER KAMAL, M.Sc.;
AZZA ABDELAZIZ, Ph.D.
YOUSSEF MOHAMMED, M.D.;
MARWA M. ELSAYED, Ph.D.
Abstract Background: Ventilatory function and aerobic capacity each decline by ~40%, with aging leading to ventilatory limitation, dyspnea, exercise intolerance, which affected by performance of upper and lower limbs, so it is important in the elderly to use aerobic training to improve ventilatory function, by training upper limbs as well as lower limbs which not investigated previously. Aim of Study: To compare between the impact of upper versus lower limbs training on ventilatory function in elderly men. Material and Methods: Eligible 40 elderly men their age ranged from (60-65) years old, body mass index (BMI) ranged from 25 to 34.9kg/m2 participants were recruited from the Outpatient Clinic of Faculty of Physical Therapy, Cairo University, Egypt. Patients were divided into two groups equal in number; the group (A) performed upper limbs training by arm ergometer, while the group (B) performed lower limbs training by cycle ergometer for three times per a week for 12 weeks. Ventilatory function included (Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio) were evaluated pre and post intervention for 12 weeks (36 sessions). Results: After 12 weeks of intervention, both groups demonstrated significant increase of FEV 1 and FVC (p < 0.05), by contrast there was no significant difference was observed in the mean of FEV1/FVC ratio between pre and post-intervention (p>0.05) in both groups. Conclusion: The results demonstrated that moderate intensity aerobic exercise using both arm ergometer and cycle ergometer has equally effect on improvement of the ventilatory function of elderly men.so we recommended aerobic training of upper limbs as an integral intervention in pulmonary rehabilitation program of elderly subjects.
Elderly men
Ventilatory function
Arm ergom-eter
Cycle ergometer
2021
09
01
1489
1495
https://mjcu.journals.ekb.eg/article_194959_b75dad5be6b9357dd157467aa6a53ed5.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
The Role of Diffusion Weighted MRI in Differentiation of Intra-Axial Cystic Brain Lesions
YASSER ABD EL AZIM, M.D.;
EMAN A. FOUAD DARWISH, M.D.
AMNA A.
HAYDER, M.Sc.
Abstract Background: Intracranial cystic lesions are unnatural cavities in which the continuity of the brain parenchyma is disrupted because of different pathologies such as infections and tumors containing proteinaceous fluid and/or cellu-lar/necrotic materials. Aim of Study: The purpose of this study is to investigate the value of DWI in differentiation of the common intracranial intra-axial cystic/necrotic lesions. Patients and Methods: This is a descriptive study, con-ducted from July 2019 till February 2021. It is included twenty-four adult patients of either sex with a cystic/necrotic intra-axial brain lesion with variable perifocal edema and rim enhancement on post-contrast study at MRI unit, radiology department, Ain Shams University (ASU) Hospital. All exam-inations carried out after signing the informed consent by the patient himself or his guardian if the patient is incapacitated by any means. Results: The inflammatory lesions, the wall ADC values were not uniform. We found the lowest ADC value in contrast enhanced part of the pyogenic abscess 0.922x10-3 mm2/s and the highest ADC wall value 1.529x10-3 mm2/s found in toxoplasmosis abscess. There was a significant difference in the wall ADC values of metastatic lesions mean ADC of contrast enhanced part was 1.32±0.18x10-3 mm2/s and 0.80 ±0.13x10-3 mm2/s found in PCNSL, with a cut off value, sensitivity, specificity, positive predictive value (PPV) negative predictive value (NPV) and p-value of: 1.035, 100%, 100%, 100%, 100% and 0.007 respectively. The mean ADC value of the surrounding edema in our study were measured 1.40 ±0.11x10-3 mm2/s for abscess group and 1.59±0.31x10-3 mm2/s for malignant group with insignificant p-value of 0.201. Conclusion: Further more MR techniques may be used for discrimination brain abscess from cystic or necrotic tumors, as diffusion tensor imaging (DTI), MR spectroscopy and perfusion weighted imaging as well as positron emission tomography computed tomography (PET-CT) may be helpful. The use of these additional techniques will help to improve the accuracy of MR in differentiating brain abscess from cystic or necrotic tumors.
Diffusion Weighted MRI
differentiation
Intra-axial cystic
Brain Lesions
2021
09
01
1497
1508
https://mjcu.journals.ekb.eg/article_194960_76d2293e850a126ed02685c720d4713d.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Role of Adding Diffusion-Weighted MR Imaging to Conventional MR Imaging in Evaluation of Ovarian Masses
OMNIA A. KAMAL, M.D.;
MONA A. ABDELWAHED, M.D.
ESRAA O.
FETOUH, M.Sc.
Abstract Background: Ovarian cancer is a leading cause of death among gynecological malignancies and the fifth most common cause of cancer deaths in women. Aim of Study: To determine whether the addition of DW sequences to a conventional MR imaging protocol can help in the prediction of the nature of suspicious ovarian masses which are detected previously by conventional ultrasound. Patients and Methods: Thirty-five female patients with initial undetermined ovarian lesions were included in this study during the period from December 2019 to September 2020. Women who present with an ovarian mass on previous US examination and were referred to the Radiology Department of Alexandria Main University Hospital and Radiology De-partment of Ain Shams University Hospitals for further assessment and characterization by MRI imaging with adding DW-MR imaging Sequence. Results: In the current study, the mean patient age was 41.00±13.37 years. 17 (48.57%) of 35 ovarian masses were benign, and 12 (34.29%) were malignant, and 6 (17.14%) were borderline. Diffusion-weighted MRI findings of the different histopathological types showed restricted diffusion in 83.3% of borderline lesions and 91.7% of malignant lesions while only 17.6% of benign lesions showed restriction diffusion with a statistically significant difference at p-value 0.025*. DWI had shown 91.7% sensitivity and low specificity 82.4%. Combined DWI and conventional MRI sequences had the highest accuracy 93.1%, and sensitivity at 95.3%. Conclusion: Our results concluded that the DWI can help and increase the confidence of MRI in assessment or exclude potential malignancy in ovarian masses.
Ovarian mass
MRI
Diffusion-weighted
ADC
2021
09
01
1509
1523
https://mjcu.journals.ekb.eg/article_194961_ade27885bbbf42eee0f33ec85e964cf3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Role of Diffusion Weighted MRI in Characterization of Musculoskeletal Soft Tissue Tumors
HANA H. NASSEF, M.D.;
AHMED M. BASSIOUNY, M.D.
MAHA A.
QASSIM, M.Sc.
Abstract Background: Magnetic Resonance Imaging is the method of choice for the diagnostic work-up of soft tissue tumors. It is the modality of choice to evaluate such masses, because of its excellent soft tissue contrast. Aim of Study: To assess the efficacy of Diffusion weighted MRI in characterization of musculoskeletal soft tissue tumors. Patients and Methods: The current study enrolled 20 patients (11 female and 9 male) with musculoskeletal STTs with mean age was 41.08±11.54 year. The most frequent affected site with the swelling was the thigh (48%) followed by the arm (20%). Four (16%) patients suffered from leg swelling while three (12%) patients had shoulder swelling. Our results revealed that malignant musculoskeletal soft tissue masses had significantly lower ADC value in comparison to those with benign masses (0.70±0.09 vs. 1.58±0.52x10-3m2/s; p < 0.001). Results: Patients with malignant lesions had significantly lower ADC value in comparison to those with benign lesions (0.70±0.09 vs. 1.58±0.52 (103mm2/s). Myxoma had the highest ADC value that was 2.44 (103mm2/s) while sarcoma had lowest value that was 0.54±0.03 (103mm2/s). It was noticed that MRI had 100% sensitivity and 81.8% specificity for diagnosis of malignant musculoskeletal soft tissue masses with overall accuracy was 92% and area under curve was 0.91 at cut off value was <1.14 (103mm2/s). Based on final diag-nosis; MRI was successful in diagnosis of all cases with malignant musculoskeletal soft tissue masses but as the same time, MRI falsely diagnosed two cases with benign nature to be malignant. Those two cases were finally diagnosed to be lipoma. Conclusion: Based on the current study, DWI-MRI con-sidered the method of choice for the characterization of muscul oskel etal STTs; however, DW-MRI with ADC mapping is a rapidly, valuable, non-invasive, non-contrast tool for reliably differentiating between benign and malignant STTs. It's recommended to perform such study in large sample of patients and in more centers to confirm the great values of DWI-MRI in evaluation of such lesions.
Diffusion Weighted MRI
Musculoskeletal soft tissue tumors
2021
09
01
1525
1532
https://mjcu.journals.ekb.eg/article_194962_6fa3faac1c06c7bf408cb17876ca52d1.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Role of Apparent Diffusion Coefficient (ADC) Mapping in Assessment of Therapeutic Response of Hepatocellular Carcinoma Post Trans-Catheter Arterial Chemoembolization
MONA A.S.M. ABO ELENIN, M.Sc.;
ZENAT A. EL SABBAGH, M.D.
MOHAMED M.M.
ABDEL AZIZ, M.D.
Abstract Background: Trans-arterial chemoembolization (TACE) is widely used as an interventional procedure in treatment of HCCs. ADC value can be used in evaluating its efficacy in order to rule out or in residual tumor tissue. Aim of Study: To assess the role of DWI and ADC value in evaluating HCCs post TACE. Patients and Methods: A retrospective analytical study on 25 patients with hepatocellular carcinoma (HCC); to assess therapeutic response of (HCC) cases after TACE by ADC mapping MRI technique in comparison to dynamic contrast study (DCE-MRI), to evaluate its accuracy, sensitivity and specificity in detecting treatment response/residual tumor. Results: Comparative study between the 2 groups revealed; highly significant increase in ADC value, in active group; compared to inactive group; with highly significant statistical difference (p < 0.01). Comparative study between DCE-MRI and DWI/ADC assessments revealed; non-significant differ-ence in sensitivity, specificity, PPV and NPV in HCC patients; with non-significant difference (p>0.05). Spearman's correla-tion analysis shows that; AFP level had a highly significant negative correlation with ADC value; with highly significant statistical difference (p < 0.01). By using ROC-curve analysis, DWI/ADC value at a cutoff point (91.33) detected patients with residual active lesions, with good accuracy (84%), sensitivity 84% and specificity 83% (p=0.0001). Conclusion: ADC maps can be used as a quantitative value to differentiate between active and inactive tumors and in monitoring response to treatment in oncological patients.
ADC
Hepatocellular carcinoma
TACE
DWI
MRI
2021
09
01
1533
1541
https://mjcu.journals.ekb.eg/article_194963_3e40ebd08a2c80cd02696f76812da3fd.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Optical Coherence Tomography and Optical Coherence Tomography Angiography Findings in Amblyopic Patients
MARWA S.M. IBRAHIM, M.Sc.;
AZZA M.A. SAID, M.D.
MAHMOUD A. EL SAMKARY, M.D.;
ISLAM A.M. SOLIMAN, M.D.
Abstract Background: Amblyopia is a unilateral or bilateral decrease of visual acuity caused by deprivation of pattern vision or abnormal binocular interaction, for which no cause can be detected by physical examination of the eye and which in some cases, can be reversed by therapeutic measures. Aim of Study: To examine amblyopic eyes in a comparative study with age matched controls to detect possible changes in macular, Ganglion cell layer (GCL), choroid, peripapillary retinal nerve fiber layer (RNFL) measurements using optical coherence tomography (OCT), and foveal avascular zone (FAZ) area using optical coherence tomography angiography (OCTA). Patients and Methods: A case control observational study. Forty eyes of forty participants divided into 4 groups. 30 patients with unilateral amblyopia due to strabismus, ani-sometropia and sensory deprivation (each group included 10 patients) compared with 10 controls. OCT & OCTA were done using (Heidelberg Engineering, OCT spectralis, Germany). Results: As regard mean GCL thickness and FAZ area in superficial capillary plexus (SCP) and deep capillary plexus (DCP), there was no statistically significant difference between patients' groups and control group. Also there was no statisti-cally significant difference in RNFL thickness between am-blyopic groups and control group except nasal quadrant in strabismic and sensory deprivative groups, there was statisti-cally significant difference. For sub-foveal thickness there was statistically significant difference in strabismic, anisome-tropic groups, but no significant difference in sensory depriv-ative group. Conclusion: Patients with unilateral amblyopia were prone to have a higher central macular thickness in sensory depriv-ative group only, with no difference in thickness regarding other groups, and thinner nasal quadrant RNFL thickness in strabismic and sensory deprivative groups only, when compared to control eyes.
Optical Coherence Tomography
Optical coher-ence tomography angiography
ganglion cell layer
Retinal nerve fiber layer
Superficial capillary plexus
deep capillary plexus
2021
09
01
1543
1554
https://mjcu.journals.ekb.eg/article_194964_8af7066a7bb848796a65a6d168b67ef8.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Comparative Study between Anterior and Lateral Approaches of Laparoscopic Splenectomy
HISHAM OMRAN, M.D.;
MAHMOUD A. EL-SHAFEI, M.D.
MARK M. LABIB, M.Sc.;
HOSSAM S. ABD EL-RAHIM, M.D.
Abstract Background: The primary basis of treatment for ITP and many hematological disorders was splenectomy. There are many approaches and techniques that have evolved for splenec-tomy. Reports of laparoscopic splenectomy began appearing in the literature in 1991 and 1992. Over time it has become the standard for elective splenectomy for both benign and malignant indications although open splenectomy remains perfectly acceptable for all indications as well. Laparoscopic splenectomy developed many techniques and approaches through last years, examples of these are anterior approach laparoscopic splenectomy, lateral approach laparoscopic splenectomy, single port laparoscopic splenectomy, hand assisted laparoscopic splenectomy (HALS). Aim of Study: The goal of this study is to compare lapar-oscopic splenectomy anterior and lateral approaches, including operative time, blood loss, surgical complications, conversion to open surgery, postoperative morbidity, postoperative length of stay, number of trocars used and blood transfusion require-ments in each approach. Materials and Methods: The present study was a rand-omized controlled prospective study with 40 patients. Indicated for splenectomy at El-Demerdash Hospital between 2018 and 2020, splenectomy was done by the same surgical team. The 40 cases in our sample were obtained from Ambulatory Clinics in University Hospitals in Ain-Shams. The closed envelope system split the patients into two classes: Group 1 including 20 patients underwent laparoscopic splenectomy using anterior approach, group 2 including 20 patients underwent laparoscopic splenectomy using lateral approach. The inclusion criteria were all adult patients indicated for surgery, fit for anesthesia and consented to participate in the study, aged between 18 to 60 years with a diagnosis of: Hematological disorder (Idio-pathic thrombocytopenic purpura ITP, Thrombotic Thrombo-cytopenic Purpura TTP, chronic hemolytic anemia except sickle cell disease), hydatid cyst, splenic tumor; as lymphoma, felty syndrome and sarcoidosis. We excluded patients with bleeding tendency due to causes other than ITP, patients with previous upper laparotomies, patients with generalized diseases that contra-indicates laparoscopic maneuvers, patients with huge splenomegaly with longitudinal axis more than 20cm and pregnancy.Results: In the present study; there were statistically important ties between the types of approach used and both operative time and number of ports., we found that the lateral approach had a shorter operative time; as well as, the number of ports was less in lateral approach. On the contrary there was no statistically significant difference between two types of approach in terms of age, body mass index (BMI), gender, indication of surgery, complete blood count (CBC) findings, spleen size, blood loss, vascular or visceral injury, conversion to open surgery, hospital stay and post-operative complications (chest infection, wound infection, pancreatic leak and acute gastric dilatation). Conclusion: We find that for laparoscopic splenectomy, the lateral approach has a greater intraoperative benefit than the anterior approach. The lateral solution was connected to much shorter operative times and a smaller number of ports.
Anterior
Lateral approaches
Laparoscopic Splenectomy
Idiopathic thrombocytopenic pur-pura
2021
09
01
1555
1567
https://mjcu.journals.ekb.eg/article_194965_400e8e99189a3497d6e88be8ce66353e.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Seroprevalence of Anti-SARS-CoV- 2 Antibodies among Health Care Workers: Kasr Al Ainy Screening Study
HALA FARAWELA, M.D.;
MAI M. SHERIF, M.D.
MONA S. HAMDY, M.D.;
HALA SALAH, M.D.
AHMED A. TAHA, M.D.;
REEM J. FARID, M.D.
RANIA H. KHALIFA, M.D.;
MARIAM O.F. HANNA, M.D.
DINA M.R. BAHGAT, M.D.;
RASHA M.H. SHAHIN, M.D.
HEBA M. SELIM, M.D.;
ENGY EL KHATEEB, M.D.
NERMINE M. RIAD, M.D.;
FATMA H. ABDELRAOUF, M.D.
HEND H. TAMIM, M.D.;
HISHAM EL MINAWI, M.D.
NOHA M.H.
SHAHEEN, M.D.
Abstract Background: Egypt is affected by the COVID-19 pandemic in all aspects of life: Health, economy and socially. Serological survey for SARS-CoV-2 antibodies is a valuable method to assess the extent of spread of the pandemic especially in healthcare workers (HCW), and to detect asymptomatic cases. Aim of Study: This research aims at proving the usefulness of SARS-CoV-2 antibody detection to identify and isolate infected individuals among HCW. Results may be employed as a surrogate to economize the use of RT-PCR evaluation and to make executive decision limiting viral spread among medical personnel in Kasr Al Ainy hospitals. Material and Methods: This cross-sectional survey study has included 897 HCW from multiple frontline and susceptible services within Kasr Al Ainy, Cairo University Hospitals. HCW were subjected to wide screening to study the presence of SARS-CoV-2 specific antibody responses (IgG and IgM) by Electro-chemiluminescence immunoassay tests and Lateral Flow Immunochromatographic assay (Rapid detection test) kits. Results: Our screening program has revealed 105 positive cases which accounts for 11.7% of the screened group. Of those, 33 (31.4%) were symptomatic and 72 (68.6%) were asymptomatic. Conclusion: The use of COVID-19 antibody testing for HCW can provide crucial information that might prevent further propagation of infection among HCW and their patients. Further research is warranted to provide evidence related to wide implementation of screening programs for HCW and to provide clear guidelines related to specifics of such programs.
SARS-CoV-2 antibody
Healthcare workers
Electro-chemiluminescence immunoassay
Rapid detection test
RT-PCR
Egypt
2021
09
01
1569
1574
https://mjcu.journals.ekb.eg/article_194966_cc39599580d020d9dfdcf6b3f91df145.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Value of Triplicated Inferior Pedicle Breast Reduction in Improving Cosmetic Outcome in Upper Outer Quadrant Breast Cancer Patients
SAMY A. ABD EL RAHMAN, M.D.;
AHMED G. OSMAN, M.D.
AHMED M. GAD, M.D.;
MOHAMED R.M. ABO SHADY, M.Sc.
KAMAL M.K.
ELSAID, M.D.
Abstract Background: Breast is the true mirror of femininity. Breast cancer is one of the diseases that affect the psychological state of women, not only because of the complications it entails, but also because of the negative impact of treatment on women psychologically and physically. Aim of Study: The aim of this work is to assess the effect of triplicated inferior pedicle technique on improving cosmetic outcome in patients with breast cancer in upper outer quadrant. Patients and Methods: This study conducted at Ain Shams University hospitals, starting January 2020 till May 2020 with follow up 6 months.The study include 15 patients from 30- 50 year. This prospective study started with 15 Female patients with breast cancer in upper outer quadrant or upper pole lesion. During the period of the study at Ain-Shams University Hospitals. The data was collected and presented as followed in several tables and figures. Results: In our study the mean value of immediate post-operative SN-N was 21cm. After 6 months the mean value of postoperative SN-N was 21.5cm. In the current study the mean value of preoperative inframammary fold- nipple distance (IMF-N) was 17.27cm. In our study mean value of immediate postoperative IMF-N was 7.33cm, and After 6 months the mean value of postoperative IMF-N was 8cm. So, triplicated inferior pedicle is to obtain the benefits and avoid the most annoying complication and maintain the shape of breast after breast reduction without significant difference in postoperative complications. Conclusion: Breast reduction is a procedure, which has evolved tremendously over the years due to the continuous and ongoing quest to achieve the objective of reducing the breast size, improving breast shape and relocating the nipple areola complex, while minimizing scars and also preserving lactation and innervation to the nipple-areola complex.
Triplicated inferior pedicle breast
cosmetic outcome
Upper outer quadrant breast cancer patients
2021
09
01
1575
1583
https://mjcu.journals.ekb.eg/article_194974_14dd959c2a0a36ca4276428a3edf63ff.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Different Modalities of Flap Coverage of Achilles Tendon Region Defects: Functional and Aesthetic Outcomes
TAHER M. ELGHAZALY, M.B.B.Ch.;
TAREK F. KESHK, M.D.
MOHARAM A. MOHAMED, M.D.;
AHMED A. TAALAB, M.D.
Abstract Background: In the decision-making process toward covering various Achilles' tendon region, knowledge about patient related outcomes after surgery and rehabilitation is important. Therefore, we aimed to present an overview of outcomes and select the most appropriate flaps used for covering soft tissue defects over Achilles' tendon region. Aim of Study: Study aimed to analyse and determine the suitable reconstructive surgical options for Achilles' tendon coverage and to evaluate the clinical, functional and aesthetic outcomes. Patients and Methods: Between September 2017 and December 2019, 25 patients with skin loss over Achilles' tendon region were admitted to Menoufia University Hospital and Shebin-Elkom Teaching Hospital. The soft tissue defects ranged from 3x2 to 16x12 cm. Six types of flaps were used for the coverage of concomitant skin defects. Results: There was no complete flap loss and all flaps survived. Lateral supra malleolar flap (28%) was used in seven patients, distally based peroneus brevis muscle flap (16%) in four patients, posterior tibial artery perforator flap (24%) in six patients, peroneal artery perforator flap (4%) in one patient, reversed sural artery flap (24%) in six patients, and free latissimus dorsi musculocutaneous flap (4%) in one patient. Two patients were subjected to debridement and covered with split thickness skin graft (STSG). One patient suffered from chronic ulcer formation which was covered with lateral supra malleolar artery flap. The algorithm of one-stage reconstruction was established, according to the defect size of skin. Conclusion: Perforator flaps, lateral supra malleolar artery flap, and the distally based peroneus brevis muscle flap were a suitable option for coverage of small to intermediate sized defects; reversed sural artery flap is best for coverage of moderate to large size defects and free flaps are the best choices for complex wide reconstructions.
Achilles' tendon
Coverage
soft tissue defects
Flaps
2021
09
01
1585
1594
https://mjcu.journals.ekb.eg/article_194975_9b98d82f71f8a6ae0c3a7c94f836b2d8.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Pilates Exercises on Kidney Functions in Patients with Hypertension
ZEINAB E. IBRAHIM, M.Sc.;
NESREEN G. ELNAHASS, Ph.D.
Abstract Background: The Pilates method is a conditioning program in hypertensive patients of the body and mind that is gaining in popularity and acceptance worldwide. Aim of Study: To determine the response of kidney func-tions after pilates exercise in patients with hypertension. Material and Methods: Fifty Patients of both sexes were recruited from El-Santa Central Hospital, their ages ranged from 40 to 50 years. All of them suffered from hypertension form 5-10 years ago moderate stage systolic (160-179mmHg) diastolic (100-109mmHg) to severe stage systolic (180-209 mmHg) diastolic (110- 1 19mmHg) according to Joint National Committee (JNC-V) classification. The study was pre-post study, were all the patients performed 5 pilates exercises per session for 3 sessions per week for a whole study duration of 8 weeks we measure kidney function tests (urea-creatinine) and blood pressure (systolic and diastolic). Results: The statistical analysis by paired t-test revealed that there was significant difference (p=0.00 1; p < 0.05) between pre- and post-systolic blood pressure within study group, the mean values of pre- and post-diastolic blood pressure were 100±8.32 and 95±8.02, respectively, with improvement per-centage 5.00%. The statistical analysis by paired t-test revealed that there was significant difference (p=0.00 1; p < 0.05) between pre- and post-diastolic blood pressure within study group, the mean values of pre- and post-creatinine were 1.76±1.12 and 1.69±1.10, respectively, with improvement percentage 3.98%. The statistical analysis by paired t-test revealed that there was no significant difference (p=0.083; p>0.05) between pre- and post-creatinine within study group, The mean values of pre-and post-urea were 61.09±6.40 and 58.93±6.31, respectively, with improvement percentage 3.54%. The statistical analysis by paired t-test revealed that there was no significant difference (p=0.068; p>0.05) between pre- and post-urea within study group. Conclusion: Pilates exercises have a statistically significant effect on blood pressure but not on kidney functions in patients with hypertension.
Pilates exercises
Hypertension
Kidney func-tions
2021
09
01
1595
1601
https://mjcu.journals.ekb.eg/article_194976_42b7bc378d73de890ab6ab9919023415.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Iron Deficiency Anemia in Children and Adolescents with Type I Diabetes, Is it a Real Problem?
ASMAA A. SOLIMAN, M.D.;
SAFINAZ A. ELHABASHY, M.D.
RASHA A. THABET, M.D.;
NOURAN Y. SALAH EL DIN, M.B.B.Ch.
Abstract Background: Iron deficiency anemia (IDA) in children with type I diabetes (T1D) represents a significant burden. Aim of Study: To asses iron status in children and adoles-cent with T1D of and to correlate it with glycemic control and diabetic vascular complications. Patients and Methods: Two hundred children with T1D recruited from Pediatrics and Adolescent Diabetes Unit (PADU), Ain Shams University in the period from December 2019 to July 2020. They were 123 males (61.5%) and 77 females (38.5%) aged 10.97±3.93 years (Range: 2-18 years). History taking, fundus examination and general examination were done stressing on anthropometric measurements. Labo-ratory evaluation including complete blood count, glycosylated haemoglobin (HbA1c), urinary albumin/creatinine ratio (ACR), lipid profile and patients with microcytic hypochromic anaemia underwent Serum iron, total iron-binding capacity (TIBC), serum ferritin, Hepcidin, Anti-tissue transglutaminase (IgA), Occult blood in stool and H-pylori antigen in stool. Results: Seventy two of diabetic children were anemic (36%) and fifty one had IDA (25.5). IDA was more prevalent in males. Children with T1D and IDA experienced more clinically significant hypoglycemic attacks, more DKA attacks, high fatigue severity scale and history of menorrhagia. Low body weight, low BMI, low mean corpuscular volume (MCV), high TIBC and low hepcidin level were present in diabetic children with IDA. They also had high HbA1c, neuropathy, high triglycerides and high level of low density lipoprotein (LDL cholesterol). Conclusions: IDA is a significant morbidity among chil-dren with T1D and it should be screened. Serum hepcidin levels are significantly associated with iron status in children, and could be useful indicators of ID.
iron deficiency anemia
children
Adolescents
type I diabetes
Is it a Real Problem?
2021
09
01
1603
1619
https://mjcu.journals.ekb.eg/article_194977_d40766e21e48b472e55ea71635838761.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Percutaneous Transforaminal Endoscopic Lumbar Discectomy in Adolescents
IHAB A.M.
HOSNY, M.D.
Abstract Background: Lumbar disc herniation in adolescents is relatively rare but poses a serious problem to the patient and the parents. Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) has several advantages over conventional surgeries 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 PTELD in adolescent patients. Patients and Methods: Adolecence is defined as any person whose age is between 10 and 19 years. This was a retrospective study which included 14 patients aged between 15 and 19 years treated by PTELD for low back pain and sciatica. Clinical and functional outcomes were evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI) and follow-up at 2 weeks, 1, 2, 6 and 12 months postoperatively. Final results were assessed using the modified MacNab score. All surgeries were done by the same surgeon. Results: Overall there was improvement of clinical and functional outcomes during the postoperative follow-up eval-uation. There were no immediate perioperative complications, such as infection, nerve injury or dural tears but only two patients developed dysathesia and were treated medically. There was no recurrence of herniations as the patients followed a strict postoperative rehabilitation program. Conclusion: PTELD is a minimally invasive technique which is effective and safe for adolescent patients. PTELD decreases the post-operative morbidity and permits faster mobility and rehabilitation.
Transformational
Endoscopic
Discectomy
Adolescents
Lumbar Disc Herniation
2021
09
01
1621
1627
https://mjcu.journals.ekb.eg/article_194978_28770472d9c033ee718b58c39265bd68.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Safety and Effectiveness of Total versus Subtotal Thyroidectomy in Management of Simple Multinodular Goiter
ABDELRAHMAN M. ELGHANDOUR, M.D.;
OSAMA F. MOHAMED, M.D.
MOHAMED M.
TAHER KAMAL EID, M.Sc.
Abstract Background: Disorders of the thyroid gland constitute the second most common endocrine disease following diabetes mellitus. The prevalence of nodular goiter and thyroid auton-omy is increased in regions with chronic Iodine Deficiency (ID). It has been documented that the thyroid gland adjusts to ID in the early stages by diffuse hyperplasia, while chronic exposure to ID results in nodular hyperplasia, increased colloid content and increased height of the follicular cells. Aim of Study: To compare between total and subtotal thyroidectomy in management of Multinodular Goiter as regard safety and effectiveness and post-operative complica-tions like: Hypocalcaemia, recurrent laryngeal nerve injury and hypoparathyroidism. Material and Methods: This prospective study was done at Ain Shams University Hospitals and Banha teaching hospital during the period between March and September 2019. This study included 40 cases of SMNG. Their age was between 30 to 45 years, consent was taken from each patient pre-operatively. Agreement of ethical committee was done. Results: Our study showed the advantages of total thy-roidectomy include adequate eradication of the disease, prevention of recurrent goiter and avoidance of the need for completion surgery in case of occult malignancy, but it is associated with higher morbidity (postoperative thyroidectomy complications: RLN palsy and hypoparathyroidism) and the need for lifelong replacement therapy (L-thyroxin supplemen-tation). Conclusion: In MNG, there are a high percentage of cases with disease involving the entire gland; many areas of appar-ently healthy tissue are found to be microscopically involved with variable grade of chronic lymphocytic thyroiditis or follicular hyperplasia or even lobular dysplasia with tendency to form nodules. These signs of disease of this organ tend to recurrence if not treated.
Iodine Deficiency
Total Thyroidectomy
Bilateral subtotal thyroidectomy
2021
09
01
1629
1638
https://mjcu.journals.ekb.eg/article_194979_e37b5e439c41574a2fbf3a799c0af395.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Total Thyroidectomy versus Total Thyroidectomy with Prophylactic Central Compartment Neck Dissection in Early Papillary Thyroid Cancer
AYMAN A. ABD-RABHOU, M.D.;
HESHAM M.A. OMRAN, M.D.
HOSSAM S. ABDELRAHIM, M.D.,M.R.C.S.;
MAHMOUD I. SEDIK, M.Sc.
Abstract Background: Thyroid cancer has the highest increase in incidence rate among all cancers, and this is largely but not full attributed to the increased detection of subclinical papillary carcinomas, the high incidence of occult nodal metastasis in PTC, advocating prophylactic central compartment neck dissection (pCCND) for the initial management of these tumors is, in theory, the ideal thing to do. Nevertheless, the role of pCCND in the management of PTC remains contro-versial regarding its benefits and risks. Aim of Study: The aim of this study is to compare between total thyroidectomy with or without prophylactic central compartment neck dissection in case of papillary thyroid cancer with clinically negative cervical LN metastasis, focusing mainly on the rate of complications and the risk of recurrence of the disease. Patients and Methods: This is a retrospective comparative study was conducted in the Department of Endocrine Surgery Unit, Ain Shams University hospitals and Shefa Elorman hospital, the study included 40 cases diagnosed with papillary thyroid cancer with clinical negative LNs, operated between March 2013 and March 2018. Sampling Method: we collected 40 cases of papillary thyroid cancer with clinical negative LNs operated in the department of endocrine surgery unit, Ain Shams University hospitals and Shefa Elorman hospital, between March 2013 and March 2018, 20 of them (group 1) underwent total thy-roidectomy and 20 cases (group 2) underwent total thyroid-ectomy and prophylactic central compartment neck dissection. Results: Females to male ratio was 17:3 in both groups with no statistical significant difference (p=1), the mean age of the participants in group (1) was 39.5±10.1 years while in group (2) was 37.5±7.4, with no statistical significant difference between both groups (p= 0.742), the mean operative time in group (1) patients was (122.1±19.1 min.) while in group (2) patients was (182.2±15.3 min.) with statistically significant relationship, only one case 5% in group (2) patients suffered hoarseness of voice.5% of group (1) patients and 10% of group (2) patients suffered from transient hypocalcemia, one patient (5%) in group (1) patients had recurrence and 4 patients (20%) of group (2) patients suffered from recurrence. Conclusion: Total thyroidectomy with prophylactic central LN dissection done in cases suffering from PTC with clinically negative cervical LNs increase operative time and post-operative hospital stay in comparison to total thyroidectomy with no statistical difference as regard to surgical complications and post-operative recurrence especially with presence of post-operative radioactive ablation.
Papillary thyroid carcinoma
Prophylactic central compartment neck dissection
Total thy-roidectomy
2021
09
01
1639
1649
https://mjcu.journals.ekb.eg/article_194980_27234c001d465e16be821379b9da23d9.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Evaluation of the Relationship between Retinal Nerve Fibres Layer (RNFL) Thickness in Myopia versus Hypermetropia
NEGM ELDIN H. ABD ALLAH, M.D.;
LAMIA S. ELEWA, M.D.
HAZEM M.O. MOHAMED RASHED, M.D.
ALSHIMAA A.S. ELSROUGY, M.Sc.
Abstract Background: OCT has evolved over the past decade as one of the most important ancillary tests in ophthalmic practice. OCT makes it possible to obtain noninvasive, rapid, objective, high-resolution, cross-sectional imaging of the retina, the (RNFL) and the optic nerve head and also permits direct, real-time imaging of ocular pathology that previously could not be visualized using traditional methods. Aim of Study: The purpose of this study is to evaluate the relationship between retinal nerve fiber layer thickness (RNFL) in myopia versus hypermetropia. Patients and Methods: A comparative study included a total of 68 eyes divided into 45 eyes with errors of refraction and 23 emmetropic eyes in the period from March 2020 to September 2020 (Myopic eyes above -4 D, hypermetropic eyes above +4D). Results: The results found in our study showed that there was statistically significant difference in RNFL thickness between myopic eyes, hypermetropic eyes in comparison to emmetropic eyes. RNFL thickness decreases in myopic eyes in the whole thickness and in all quadrants except in temporal quadrant, while RNFL thickness increases in hypermetropic eyes in the whole thickness and in all quadrants except in temporal quadrant. Conclusion: Our study is comparing the peripapillary RNFL thicknesses of myopic eyes versus hyperopic eyes. We have shown that peripapillary RNFL thickness differed with refractive status of the eye being thinner in myopic eyes and thicker in hyperopic eyes.
Retinal nerve fibres layer
Myopia
Hyper-metropia
2021
09
01
1651
1658
https://mjcu.journals.ekb.eg/article_194981_6873e60d09492d03fe34d72d3f77f4ee.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method
MAHMOUD S. FARAHT, M.D.;
HAITHAM M. ELMALEH, M.D.
WALEED M. ABDELGHANI HASSAN, M.Sc.;
HOSSAM S. ABDELRAHIM, M.D.
Abstract Background: Laparoscopic cholecystectomy is the most frequent operation nowadays for gallbladder stones. It is associated with faster recovery and shorter hospital stay. On the wide use of laparoscopic cholecystectomy, various com-plications appeared. This made researches work on studies to predict the difficulty of laparoscopic cholecystectomy through different scoring system. This study validates the usage of a scoring system for preoperative prediction of intraoperative difficulties of lapar-oscopic cholecystectomy that may help the patient as well as surgeon in being better prepared for intraoperative challenges. Gallbladder-related disease is one of the common surgical elective and emergency indications. Laparoscopic cholecys-tectomy (LC) is the gold standard nowadays for gallbladder removal. The frequency of complications associated with laparo-scopic cholecystectomy varies from 0.5-6%. Complications of cholecystectomy include iatrogenic perforation of gallblad-der with spilt gallstones that is considered the most common, bile duct injury, bile leaks, bleeding and bowel injury. Con-version rate was about 5% of all laparoscopic cholecystecto-mies. Many risk factors have been found to be associated with difficult laparoscopic cholecytectomy. These result in part from patient selection, surgical inexperience, and the technical constraints that are inherent to the minimally invasive approach. Scoring proposed by Randhawa and Pujahari in 2008 is the most used currently. They found its statistically and clinically good test for predicting outcome in LC. This score had positive predictive value of 88.8% and 92.2% for easy and difficult. One of the unique features in this score is the inclusion of palpable Gallbladder that was not reported earlier. But there was no correlation of score and conversion in this study as all cases of conversion were due to anomalous ducts that could have been predicted by MRCP. It included various clinical and ultrasonographic parameters. Aim of Study: To validate a risk score based on the patient's history, physical examination and abdominal ultrasonography parameters for preoperative prediction of difficult laparoscopic cholecystectomy. Patients and Methods: Our study included 30 patients underwent laparoscopic cholecystectomy in Ain Shams Hos-pital and Alamria Hospital. Results: In our study, males were more predominant than females (73.3% vs 26.7%) with mean age of (40.23±13.64) years. Our patients had mean BMI of (28.43±4.03) kg/m2 with most of them were obese (63.3%). Intra operative diffi-culty showed significant relation with sex and BMI. 13.3% of patients had leukocytosis and all our patients had normal alkaline phosphatase. 56.7% of the study patients were presented with previous acute attacks, 20% presented with fever, 6.7% had palpable GB and 33.3% had abdominal scar. Intra operative difficulty showed significant relation with previous acute attack, abdominal scar and GB wall thickness. We found that preoperative scoring had a sensitivity of 89.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 84.6%, diagnostic accuracy of 93.3%, and Kappa agreement of 0.862 compared to the intraoperative scoring system. Conclusion: We strongly recommend using the preoper-ative scoring system for predicting the degree of difficulty for laparoscopic cholecystectomy.
Difficult cholecystectomy
Acute Cholecystitis
Lap cholecystectomy
2021
09
01
1659
1667
https://mjcu.journals.ekb.eg/article_194983_82c8beb33fa0d2f999fbf1f59e864a09.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Ultrasound Guided Percutaneous Tracheostomy versus Conventional Tracheostomy: Technique and Outcome
NAGLAA M. ALY, M.D.;
HEBA A. LABIB AHMED, M.D.
WAEL A. MOHAMED, M.D.;
AHMED Y.A. ELBATSH, M.Sc.
Abstract Background: In the 21st century, the majority of trache-ostomies are now inserted by the intensivists in the intensive care unit (ICU). It is one of the most frequent procedures performed in critically ill patients. It has been advocated for those requiring prolonged mechanical ventilation because it facilitates weaning by decreasing the work of breathing, decreases the requirement for sedation and may allow for earlier patient mobilization, feeding and physical and occu-pational therapy. Aim of Study: To evaluate ultrasound guided percutaneous tracheostomy and conventional tracheostomy in critically ill patients regarding effect on outcome (weaning from mechanical ventilation and ICU stay), duration of the technique, success rate and to evaluate incidence of perioperative, early and late complications. Patients and Methods: Our study is a randomized con-trolled clinical trial conducted on 40 critically ill patients admitted to the Intensive Care Unit at Ain Shams University Hospitals, from the period from September 2020 until March 2021 they were intubated and mechanically ventilated and required elective percutaneous dilatational tracheotomy. Results: US-guided group showed fewer procedural com-plications compared to conventional group. We had faced procedural complications in conventional group in form of 2 (10%) of patients suffer from hypoxemia, Pneumothorax, decannulation and post. Tracheal wall injury. 3 (15%) of patients had transient hypotension and false passage. And 5 (25%) cases of perforation of ETT cuff during insertion, one case (5%) of subcutaneous emphysema and 7 (35%) cases of minor bleeding compered to three cases of minor bleeding in US-guided group, one case of decannulation and three case of transient hypotension. No early complications were detected in both study groups; except one case of tube obstruction or displacement in conventional group. According to late com-plications our analysis illustrates decrease in late complication in US-guided group 2 (10%) versus 4 (20%) in conventional group. In US-guided group only two cases of Stoma site infection resolved by antibiotic and local care. In conventional group there were two case of Tracheoesophageal fistula, one case of Stoma site infection and one case of Tracheoinnominate fistula. Conclusion: Percutaneous dilatational tracheostomy could be a safer procedure when performed by using peri- and preoperative US assistance. The use of US guidance for percutaneous dilatational tracheostomy could reduce the complication rates of the procedure. The ultrasound-guided percutaneous dilatational tracheostomy seems to reduce the late and early complications when compared to the anatomical landmark guided Percutaneous dilatational tracheostomy. Pre-procedural US-guided percutaneous dilatational tracheostomy can be considered as a reliable tool to increase safety and improve outcomes of elective tracheostomy.
Intensive Care Unit
Balloon dilation tracheostomy
Before christ
2021
09
01
1669
1678
https://mjcu.journals.ekb.eg/article_194984_72e26dbb4876b5e86dda65fa71b24106.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Evaluation of Laparoscopic Ventral Mesh Rectopexy in Complete Rectal Prolapse
AHMED M. NAFEI, M.D.;
YASSER M. ABDELSAMEE, M.D.
MUSTAFA
M. ABDO, M.Sc.
Abstract Background: Complete rectal prolapse is a condition that greatly impairs the quality of life. Treatment in adults is essentially surgical but the optimum method is still a chal-lenging clinical problem in colorectal surgery. The literature offers abundant publications and there have been turns and twists in the evolution of surgical techniques for treatment of this condition. Aim of Study: To evaluate the outcome of laparoscopic ventral mesh rectopexy as a procedure for repair of complete rectal prolapse in terms of recurrence rate and post-operative improvement of faecal incontinence and constipation. Periop-erative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. Patients and Methods: This was a retrospective cohort study conducted on 20 patients with complete rectal prolapse underwent laparoscopic ventral mesh rectopexy admitted from colo-rectal unit clinic of Ain Shams University hospital in the period from January 2017 to December 2018, were eval-uated in the present study. Results: Twenty patients 13 females (65%) and 7 males (35%) with median age of 47.7. Wexner constipation score improved significantly from the preoperative value of median (IQR) 6.5 (range, 2-19) to 6 (range, 2-12) (p-value <0.001). In patients presenting with faecal incontinence (FI), significant improvement in post-operative wexner (Cleveland clinic incontinence score) (CCIS) from median (IQR) 14.5 (range 0-20) to 0 (range, 0-16) (p-value <0.001). Three cases (15%) of complete rectal prolapse recurrence were reported within 18 months follow-up. Conclusion: Despite a multitude of existing operative techniques for correction of rectal prolapse, we believe that laparoscopic ventral mesh rectopexy has obtained good results in terms of functional outcome of the abdominal procedures with low recurrence rate and significant improvement in constipation and faecal incontinence, offering the advantages of anterolateral mobilization, mesh repair and of a laparoscopic approach compared to an open one.
Laparoscopic ventral mesh rectopexy
Complete rectal prolapse
2021
09
01
1679
1685
https://mjcu.journals.ekb.eg/article_195994_4c8c9a9a62adc635889946af12fe1d52.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
A Single Centre Retrospevtive Evaluation of Colorectal Cancer Resection at Nasser Institute Hospital
AMR A. HAMED, M.Sc.;
MOHAMMAD A. NADA, M.D.
EHAB H. ABD EL-WAHAB, M.D.;
IBRAHIM M. ABD EL-MAKSOOD, M.D.
Abstract Background: Several studies compared right to left sided colon cancers, the conclusion was that right-sided tumors carry a worse prognosis than left-sided ones, and even some authors went more in considering them two distinct tumors that should be treated in a different manner. Aim of Study: The aim of this study was to delineate colorectal cancer age and sex distribution, pathologic pattern at time of resection of cases admitted to Nasser Institute Hospital in the period between Jan. 2018 and Dec. 2019. Patients and Methods: This is a retrospective study con-ducted at histopathology department of Ain Shams University hospital by collecting the data from histopathological reports of 114 patients who underwent surgical resection of colorectal cancers in colorectal unit in Nasser Institute Hospital during the period from Jan. 2018 to Dec. 2019. Results: This study included 86 patients who underwent any type of colorectal resection for their malignant lesion and underwent pathological assessment for their excised specimens in Nasser Institute Hospital in the period between January 2018 and December 2019. Totally 114 patients underwent colorectal resections in this period, Benign tumors were found in 28 patients out of 114 (25%), while malignant tumors were found in 86 out of 114 (75%).
Colorectal cancer resection
2021
09
01
1687
1698
https://mjcu.journals.ekb.eg/article_195996_e0766adada4c512dbdddc132d3726b31.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Deep Breathing on Functional Capacity among Healthcare Workers Wearing FFP2/N95 Filtering Facepiece Respirators
SHIMAA T.M. TAHA, M.Sc.*;
ZAHRA M.H. SERRY, Ph.D.*
EMAD M.I. TAHA, Ph.D.;
YOUSSEF M.A. SOLIMAN, M.D.
Abstract Background: The novel 2019 coronavirus disease (COV-ID-19) pandemic is putting the world at risk due to the spread of virus-infected respiration droplets. Healthcare workers (HCWs) wear N95 respirators to avoid this infection but Wearing it invokes several physiologic implications with prolonged use. Aim of Study: The aim of this study was to measure the effect of deep breathing on functional capacity among health-care workers wearing FFP2/N95 filtering facepiece respirators. Subjects and Methods: Sixty HCWs (14 males and 46 females) wearing FFP2/N95 filtering facepiece respirators, their age ranged from (25-35) years old and body mass index (BMI) less than 30 kg /m2. participants were recruited from intensive care unit department and inpatient clinics, Cairo University Hospitals, Egypt. Participants were assigned into two groups equal in number; the group (A) (22 females & 8 men) performed deep breathing training by incentive spirom-eter (IS) daily for 6 weeks, while the group (B) (24 females & 6 men) was the control group. Both groups were wearing the respirator for 4-8h/day. Data obtained regarding six-minute walk test (6MWT) at the beginning of the study and after 6 weeks for both groups. Parameters were evaluated include heart rate (HR), oxygen saturation (SPO2), modified borg dyspnea scale (MBS) and six-minute walking distance (6MWD) without wearing N95 mask, while wearing N95 mask from 2 hours Pre training and while wearing N95 mask from 2 hours Post training after 6 weeks also breath holding time (BHT) was measured at the beginning and the end of the study. Results: After 6 weeks of training, there was no significant difference between groups in HR, O2 saturation and 6MWD at Pre training without mask and at Pre training with mask (p>0.05). However, there was a significant decrease in resting HR, HR after 6MWT, resting MBS and MBS after 6MWT at Post training with mask of study group compared with that of control group (p < 0.001). There was a significant increase in resting O2 saturation, O2 saturation after 6MWT and 6MWD at Post training with mask of study group compared with that of control group (p < 0.01). There was a significant increase in the BHT of study group compared with that of control group Post training (p < 0.001).Conclusion: The results demonstrated that deep breathing training improve functional capacity among healthcare workers wearing FFP2/N95 filtering facepiece respirators.
Deep breathing
Functional capacity
FFP2/N95 filtering facepiece respirators
2021
09
01
1699
1706
https://mjcu.journals.ekb.eg/article_195997_90f2f5f7cca77657b37692da850f6cfe.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Presepsin versus Procalcitonin as Diagnostic and Prognostic Markers in Sepsis
GALAL ADEL EL KADY, M.D.;
AYMAN AHMED ABD EL LATIF, M.D.
HALA SALAH EL DIN EL OZAIRY, M.D.,
AHMED NABIL AHMED ELSEKNEDY, M.Sc.
Abstract Background: Sepsis is a type of systematic inflammatory response syndrome caused by invasion of pathogens or con-ditional pathogenic bacteria into the blood circulation. Aim of Study: To evaluate the value of the presepsin in early diagnosis of sepsis in comparison with procalcitonin (PCT) and assess prognostic significance of presepsin in sepsis evaluation in relation with PCT. Patients and Methods: A prospective cohort study was conducted on 62 adult critically ill patients with sepsis and its related syndromes who were admitted to Ain Shams Uni-versity hospital general intensive Critical Care Unite, from November 2017 to February 2018. Serum level of presepsin and procalcitonin were measured on admission, 24 and 72 hours after admission. Results: There was positive significant correlation between procalcitonin and APACHE II score started from day 0 with p-value 0.011 and started to show strong direct correlation till day 3. Also, there was positive linear significant correlation between procalcitonin and values of SOFA score started from day 1 with p-value 0.005 and started to show strong direct correlation till day 3 with p-value 0.0001. While, there was significant correlation between presepsin and value of APACHE II score at day 0 with p-value 0.006 then insignificant correlation at day1 and started to show strong direct correlation at 3rd day with p-value 0.0001. Also, there was positive linear significant correlation between presepsin and values of SOFA score started from day 0 with p-value 0.035 and started to show strong direct correlation till day 3 with p-value 0.0001. Conclusion: Presepsin cannot differentiate between sepsis and non-infective SIRS since admission; it can predict severity, prognosis and patient outcome. The accuracy of presepsin in this context was seen by our results to be superior to PCT.
CD14
presepsin
Procalcitonin
prognostic
Sepsis
2021
09
01
1707
1714
https://mjcu.journals.ekb.eg/article_195998_0f1f6d0decd30fbc335100eb8e5c6a05.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Efficacy of Low Level Laser Therapy on De Quervain's Tenosynovitis after Delivery
DARIEN A. ELSAWY, M.Sc.;
MAGDA S. MORSY, Ph.D.
MOHAMED F.
ABO EL ENIN, Ph.D.
Abstract Background: De Quervain's Tenosynovitis is painful stenosing tenosynovitis of the first dorsal compartment of the wrist that affecting daily physical functions and baby care. So, it is necessary to decrease pain in De Quervain's tenosyn-ovitis. Aim of Study: To investigate the efficacy of Low level laser therapy on de Quervain's tenosynovitis after delivery. Subjects and Methods: This study was carried upon 30 women suffering from de Quervain's Tenosynovitis after delivery. Their age ranged from 25 to 35 years old and their BMI was less than 30kg/m2. They were selected from Alsho-hadaa hospital- Al Monofia. The participants were randomly distributed in two groups equal in number. Study group (A) consisted of 15 women who received low level laser therapy (Wave length: 830nm, Energy density: 20J/cm2, Power: 30- 40, Contanous out put of 100%, Irradiation rate: 1min for each tender point , Beam diameter: 4mm) on the tender points of her dominant hand and then performed exercise program for 30 minutes, 3 times per week for 4 weeks. Additionally to this she adviced to wear thumb spica splint while patients of Control group (B) received exercise program for 30 minutes, 3 times per week every other day for four weeks. Additionally to this she adviced to wear thumb spica splint. All participants were evaluated by visual analogue scale, serum cortisol levels before and after treatment. Results: At the end of the treatment course, percentage of improvement in VAS and plasma cortisol levels was sig-nificantly high in the study group compared to the control group which means that low level laser therapy was effective in alleviating pain in women suffering from de Quervain's tenosynovitis after delivery. Conclusions: Low level laser therapy has beneficial effects in alleviating pain in women suffering from de Quervain's tenosynovitis after delivery.
De Quervain's tenosynovitis
Low level laser therapy
visual analogue scale
Cortisol level
2021
09
01
1715
1719
https://mjcu.journals.ekb.eg/article_197223_318c3c63217ce468c52e52c3ca22700b.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Evaluation of the Effects of Abdominal Liposuction in Improving Metabolic Parameters in Recently Diagnosed Non Complicated Type 2 Diabetes
AWAD H. ELKAYAL, M.D.;
BARAKAT ABDELREHEEM MAHMOUD, M.D.
AHMED M.A.
ANANY, M.Sc.
Abstract Background: Diabetes Mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglyc-emia accompanied by greater or lesser impairment in the metabolism of carbohydrates, lipids and proteins. DM is probably one of the oldest diseases known to man. It was first reported in Egyptian manuscript about 3000 years ago. In 1936, the distinction between type 1 and type 2 DM was clearly made. Type 2 DM was first described as a component of metabolic syndrome in 1988. The origin and etiology of DM can vary greatly but always include defects in either insulin secretion or response or in both at some point in the course of disease. Obesity is associated with an increased risk of premature death and significantly increases the risk of developing type 2 diabetes mellitus, hypertension, coronary heart disease. Dyslipidaemia is a silent pandemic affecting millions of people around the world. There is controversy of the possible benefit of liposuction or abdominoplasty in the metabolism of glucose or cholesterol. Liposuction was the second most frequently performed aesthetic operation in 2013. As with any surgery liposuction carries risks, however, in recent years, improved techniques have made liposuction safer, easier, and less painful. Thus, any intervention that immediately decreases adiposity and is relatively safe could be a viable method not only for aesthetic purpose but also for increasing the efficiency of insulin and improving metabolic profile, especially when combined with regular exercise and proper diet. Aim of Study: The aim of this study is to evaluate the effectiveness of abdominal liposuction in improving quality of life in newly diagnosed uncomplicated type 2 diabetic patients. Patients and Methods: This study will take place in plastic Surgery Department, Port Said general Hospital. As total number of cases satisfying inclusion criteria not exceed 6 cases the study period (During 2019-2020) the total sample 3x6=18 cases all will be included as comprehensive sample. Results: In our study, the mean FBG was 163±22mg/d1 preoperatively. At three months after surgery, it was 162±29mg/dl, but at six months after surgery, it was 147± 28mg/d1. The mean PPBG was 218±40mg/d1 preoperatively. At three months after surgery, it was 216±40mg/dl, but at six months after surgery, it was 200±34mg/d1. The mean HbAlc percentage was 8±0.8% preoperatively. At three months after surgery, it was 7.7±0.8%, but at six months after surgery, it was 7.6±0.8%. The mean triglyceride level 48 preoperatively. At three months after surgery, it was 162±41, but at six months after surgery, it was 159±49. The mean cholesterol was 207 ±42 preoperatively. At three months after surgery, it was 197 ±52, but at six months after surgery, it was 189±41. The HOMA-IR was 3±0.7 preoperatively. At three months after surgery, it was 2.8±0.7, but at six months after surgery, it was 2.8±0.7. All the laboratory investigations change over time among the studied patients were not statistically significant. Conclusion: So, we can conclude that large volume ab-dominal liposuction should not, by itself, be considered a clinical therapy for type 2 diabetes mellitus. Aspiration of large amounts of subcutaneous abdominal fat in diabetic patients, despite having cosmetic benefits, It does not signif-icantly improve insulin sensitivity through altering serum levels of obesity markers. Therefore, the procedure is safe and may could successfully help diabetic subjects to reduce their potential metabolic risks. Therefore, abdominal Liposuc-tion is effective scarless operation for subcutaneous adipose fatty tissue reduction.
liposuction
Newly diagnosed type 2 diabetes
2021
09
01
1721
1730
https://mjcu.journals.ekb.eg/article_197224_964351458171b47032a80365c1860ff1.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Task-Oriented Training on Upper Extremity Function for Patients with Spinal Cord and Traumatic Brain Injuries: Systematic Review
MOHAMED A. HASSANIN, M.Sc.;
MAYA G. ALY, Ph.D.
GEHAN M.
AHMED, Ph.D.
Abstract Background: Tetraplegia that results from cervical injury is the most frequent neurologic category after spinal cord injury (SCI) and causes substantial disability. Traumatic Brain injury (TBI) is a shock or a penetrating injury to the head that disrupts the brain function leading to various impairments including upper limb dysfunction. Improving arm and hand function after these injuries is a major priority of rehabilitation due to its reflect on mobility, independency and quality of life. Advances of treatment approaches and technology have been introduced in research work; one of these approaches is task-oriented training (TOT). Aim of Study: This systematic review aims to find out the evidence on the effectiveness of TOT to improve the upper limb functions among patients with SCI and TBI. Material and Methods: This systematic review performed using the PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro) and the Egyptian Knowledge Bank (EKB) search engines and the associated keywords. The methodological quality assessment was done by two reviewers using PEDro scale. Random effect model and standardized mean differences were used for meta-analyses. Results: The search identified 8,424 records, of which only two trials were selected as eligible. Quality appraisal revealed the trials were of good or fair quality. Conclusion: This systematic review suggests moderate level of evidence for non-significant effect of Task-oriented training in improving upper limb function and hand dexterity in patients with spinal cord injuries and further primary research is recommended for both SCI and TBI.
spinal cord injuries
Traumatic brain injuries
Task-oriented
Upper extremity
Hand
2021
09
01
1731
1738
https://mjcu.journals.ekb.eg/article_197227_1a27cc9c2c138eb087f36d7ae22083ca.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Role of Focused Ultrasound in Preservation of Lateral Group of Axillary Lymph Nodes in Patients with Breast Cancer
FAWZY SALAH FAWZY, M.D.;
AHMED KHALIL, M.D.
MOHAMED H.
ZAID, M.D.
Abstract Background: Breast cancer-related lymphedema of the upper extremity is a fearful annoying complication for axillary clearance in breast cancer survivors. Preservation of upper extremity lymph nodes could help in reduction of incidence of the patients complaining of post axillary clearance lymph-edema. Aim of Study: To evaluate the role of focused ultrasound on lateral group of axillary lymph nodes in evaluation of clinically palpable axillary lymph nodes thus sparing the non-suspicious lateral group by ultrasound and prevention of upcoming lymphedema. Patients and Methods: This prospective study was con-ducted on fifty patients with T1 and T2 breast cancer and pathological axillary lymph nodes by ultrasound. They were scheduled for either conservative breast surgery or modified radical mastectomy with axillary clearance. Lateral group of axillary lymph nodes were divided preoperatively by focused axillary ultrasound into 2 groups. Group A included non-suspicious lateral axillary lymph nodes while group B included suspicious lateral axillary lymph nodes. During axillary dissection, the lateral group of axillary nodes (lying lateral to the thoracodorsal pedicle) was sent separately for histopatho-logical assessment (paraffin). Results: In Group A, 40 patients had a free lateral group by focused axillary US. By postoperative histopathology examination, 37 of them were confirmed free and only 3 cases proved to have metastatic deposits. While in group B, 10 patients had suspicious lateral group by focused axillary US. By postoperative histopathological examination, 8 of them had metastatic deposits and only 2 cases were free of the lateral group. So we concluded that the sensitivity of focused ultrasound of lateral group of axillary lymph nodes was 72.73%, the specificity was 94.87% and the accuracy was 90% in patients who had already suspicious lymph nodes by axillary US. Conclusion: Focused ultrasound of lateral group of axillary lymph nodes has moderate sensitivity, high specificity and accuracy. Sparing of free lateral group in patients with breast cancer could be a helpful surgical procedure aiming to reduc-tion of the rate of upper extremity lymphedema.
breast cancer
Lateral group of axillary lymph nodes
Arm lymphedema
Axillary ultrasound
2021
09
01
1739
1744
https://mjcu.journals.ekb.eg/article_197228_ba7e4300880ee42297508a4675206d63.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Assessment of Injuries of Tempo ro-Mandibular Joint by MRI
SAMEH M. ABDELWAHAB, M.D.;
MENNAT ALLAH H. SHALABY, M.D.
MAGED A.
ABDULLAH BAHATHEQ, M.Sc.
Abstract Background: The use of magnetic resonance imaging (MRI) in the assessment of temporomandibular joint (TMJ) injuries has been a mainstay. Since it can non-invasively showing major regional anatomic structures and revealing the presence of joint effusion and bone marrow signal-intensity abnormalities. Aim of Study: To elucidate the role of MRI in the diagnosis of TMJ injuries and for which extent MRI is able to detect its abnormalities. Patients and Methods: A total of 43 patients with TMJ injuries were included in the study. A 1.5 tesla MRI machine is used to assess the TMJs. The position of the disc, its configuration, the presence or absence of joint effusion, osteoarthritis, and the morphology of the mandibular condyle were all evaluated. Results: The clinical symptoms of the patients there were higher of symptoms in sensation of pain (86%); followed by limited mouth opening (44.2%). The patients anterior disc dislocation with reduction was higher value was found in patients' injuries of temporomandibular joint 17 patients (39.5%) with p-value
Temporomandibular Joint Disorders
Magnetic Resonance Imaging
disc displacement
internal derangement
Joint effusion
2021
09
01
1763
1768
https://mjcu.journals.ekb.eg/article_197230_70c27ac48ba300bf5c19f6ab86c34643.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Evaluation of Postoperative Complications after Laparoscopic Sleeve Gastrectomy with Omentopexy versus Conventional Laparoscopic Sleeve Gastrectomy
MOHAMED H. ZAID, M.D.;
KARIM FAHMY, M.D.
AHMED G. OSMAN, M.D.;
AHMED KHALIL, M.D.
Abstract Background: Laparoscopic sleeve gastrecomy is the most popular bariatric procedure with good outcome and acceptable complications (bleeding, leakage, stenosis or twist). Aim of Study: To evaluate the role of omentopexy rein-forcement of staple line in reducing postoperative leakage, bleeding and gastric twist. Patients and Methods: This is a prospective cohort study conducted at Ain-Shams University Hospitals, in the period From May 2017 to November 2020. Four hundred morbid obese patients were recruited for this study. Ethical approval was obtained from the Ethical Committee of Ain Shams University Hospitals, and informed written consents were obtained from all patients. Results: Our study included 200 patients who underwent Laparoscopic sleeve gastrectomy, one hundred patients un-derwent LSG without omentopexty (group A) and the other one hundred patients underwent LSG with omentopexy (group B). As regards the age, group A (control group) mean age of 35.74±7.88 while group B (omentopexy group) mean age of 35.6±7.85. The mean BMI 40.95±5.25 in group A while 40.94±5.02 in group B. Three cases of group A (1.5%) while group B had no cases of postoperative leakage with p-value is 0.24. Two cases of group A had postoperative bleeding (1%) while it did not happen in group B with P value is 0.499. Gastric twist had happened in only 1 case of group A (0.5%) while did not happen in any cases of group B, P value is 1. The mean operative time in group A 46.08±10.95 minutes, while 67.49±9.19 minutes in group B with p-value 0.00. Conclusion: LSG with omentopexy reduce rate of post-operative complications (bleeding, leakage and gastric twist) but need longer time than conventional LSG.
Laparoscopic sleeve gastrectomy
Omentopexy
2021
09
01
1745
1751
https://mjcu.journals.ekb.eg/article_197249_c4f6ef85e5876135eca24c41ee38f445.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Mulligan Bent Leg Raise Technique on Hamestring Shortening Following Lower Limb Burn
HISHAM M.O. ABO ELSOUD, M.Sc.;
HANY M. ELGOHARY, Ph.D.
AMR A.M. ABOUZID, M.D.;
INTSAR S. WAKED, Ph.D.
Abstract Background: Globally, burns are a serious public health problem and Knee post burn scar flexion contractures, makes up 22% of large joint contractures. Stretching is effective method to improve muscle length and mulligan bent leg raise is a modification of straight leg raise which increase hamstring flexibility and length. Aim of Study: This study has been conducted to evaluate the effect of the mulligan bent leg raise technique on elongation of hamstring muscle and the reflection of that on some quan-titative gait parameters and the range of motion (ROM) of knee extension. Patients and Methods: Thirty male patients between 30- 50 years were participated in this study, with a second-degree posterior leg burn and a total body surface area of 15-20%. They were divided randomly into two equal groups, study group (A), 15 patients received mulligan bent leg raise technique plus the traditional physical therapy program and control group (B), 15 patients received only the same traditional physical therapy program. Measurements were recorded before treatment and after third, sixth and eighth week of treatment (session for 30 minutes, 5 days/week for a total period of 2 months). A 16-meter walkway and tape measure were used to measure the quantitative gait parameters, while manual goniometer was used for measuring ROM of knee flexion. patients were exam-ined at the outpatient clinic of Cairo University during the period from December 2020 to February 2021. Results: There was a significant decrease in knee flexion ROM and step width and a significant increase in step length and stride length of the study group (group A) at post I, post II and post III compared with that of the control group (group B) (p < 0.001). Conclusion: It is concluded that the mulligan bent leg raise technique is effective in elongating the hamstring muscle as reflected by the improved gait parameters as well as the ROM of knee extension.
Mulligan bent leg raise
Shortening
Hamstring
Burn
2021
09
01
1753
1761
https://mjcu.journals.ekb.eg/article_197251_5b2d5385460a3faeb2f70dca2bbf02a1.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
MRI and MRCP in the Evaluation of Pediatric Pancreatico-Biliary Diseases
MAHA A. ELSHINNAWY, M.D.;
SHROUK M. AWADALLAH, M.D.
TASNEEM A.
ABD ELMAJEED, M.Sc.
Abstract Background: This study aimed to determine of the diag-nostic benefit of MRCP as a noninvasive method to evaluate the pancreatico-biliary disorders in pediatric age group. Aim of Study: Is to evaluate the role of MRCP in the diagnosis of pancreatico-biliary disease in pediatric age group. Patients and Methods: The study retrospectively enrolled 25 patients undergoing MRCP for suspected pancreatico-biliary abnormalities. MRCP findings were compared with other imaging modalities, ERCP or operative findings. Results: MRCP had overall sensitivity, specificity, and diagnostic accuracy of 100%, 100% and 88% respectively in detecting the etiology of pancreatico-biliary diseases in our patients. Positive predictive value was 88% while the negative predictive value was 100%. Conclusion: In conclusion, based on own experience, MRCP is a fast, non-invasive method for diagnosing pancre-atico-biliary disorders in children with high diagnostic accu-racy, sensitivity and specificity. MRCP doesn't involve the use of ionizing radiation which is suitable for children. Thus, MRCP ought to be the standard diagnostic procedure in the future.
MRCP
Pancreatico-biliary diseases
Pediatric
Jaundice
ERCP
2021
09
01
1769
1776
https://mjcu.journals.ekb.eg/article_197252_7d60cda3e6d9301eeffa70ac5af0ed53.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Physical Therapy Modalities in Children with Thalassemia and Sickle Cell Disease: Narrative Review
ASMAA O. SAYED, Ph.D.;
AHMED S. AWAD, Ph.D.
DUAA SALEH
SOLIMAN MOHAMED, M.Sc.
Abstract Background: Physical therapy is playing an important role in enhancing and promoting health related quality of life in children with thalassemia and sickle cell disease by de-creasing the associated disease symptoms as pain, anxiety, depression and fatigue and enhancing the cardiopulmonary system, bone mass index, ferritin and serum levels by using different physical therapy modalities as exercise training, Yoga, Massage therapy, transcutaneous electrical nerve stim-ulation (TENS), spirometer and vibration therapy. Aim of Study: To identify the effectiveness of using physical therapy modalities in children with thalassemia and sickle cell disease. Subjects and Methods: This review included Children with thalassemia and sickle cell disease aged between 6 to 18 years, receive different physical therapy modalities. Design: A search of electronic databases that included, PubMed, Physical therapy Evidence Database, Google scholar, Science Direct and Cochrane was searched since ever till December 2019 using the following keywords: 'Physical therapy modalities', 'thalassemia', 'exercise training', 'sickle cell disease', 'breathing exercise', 'health related quality of life', 'transcutaneous electrical nerve stimulation' and 'children'. Results: Twelve articles that were retrieved met the inclusion criteria. Conclusion: From clinical point of view using physical therapy modalities can promote quality of life in children suffering from thalassemia and from sickle cell disease but furthermore studies are needed to help the researchers and the patients.
thalassemia
Sickle cell disease
Physical therapy modalities
children
Health related quality of life
Exercise training
Breathing exercise
Transcutaneouselectrical nerve stimu-lation
2021
09
01
1777
1789
https://mjcu.journals.ekb.eg/article_197255_388c32b219cfcd49af986f7efb311395.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Diagnostic Algorithm for Proper Selection of Patients Undergoing Endoscopic Dacryocysto rhino stomy
WAEL A. ALZAMIL, M.D.;
MOHAMMAD A. ALZAMIL, M.Sc.
Abstract Background: Increased lacrimation or tearing is considered a symptom of a large number of pathologies and differential diagnoses. It may be due to increased lacrimal outflow as a result of infection, allergy, and trauma, or may be due to defective drainage function of the lacrimal system resulting in epiphora (1). Defective drainage function may be due to obstruction or stenosis at any level of the drainage system, or may be due to week apposition of the lacrimal puncti on the eye globe like patients with ectropion due to scarring or muscle weakness in which the lid gets outwards eversion, a condition that is called ectropion. This condition can be caused by various etiologies, the most important of which are tractional by scarring or paretic by facial paralysis or senile atrophy (2). So proper identification of the nature of tearing (lacrimation or epiphora) and the level of obstructed drainage is of para-mount importance to target our management or surgical approach and to obtain higher success rates, less failures and minimal recurrences (3). Depending upon the level of the obstruction, specific surgical procedures were used. These may include any of the following procedures, punctual dila-tation, punctoplasty, Canalicular reconstruction, Canaliculo-dacryocystorhinostomy, Close dacryointubation, dacryo-cystorhinostomy (External and Endoscopic), Conjunctivo dacryocystorhinostomy and Dacryocystectomy etc (4). Endo-scopic dacryocystorhinostomy is considered an effective and safe approach addressing obstructive etiology of epiphora other than punctual pathologies (5). So proper preoperative diagnostic work at various levels (history, examination and investigations) is essential for successful management. Aim of Study: 1- The first aim of our study is to construct a diagnostic algorithm and management plan for patients with obstructive lacrimal pathology and epiphora. 2- To evaluate this Algorithm as regards the surgical outcome of endoscopic dacryocystorhinostomy. Patients and Methods: A prospective, study conducted from September 2015 to December 2020 on 20 patients suffering increased lacrimation. Patients have been subjected to special stepwise diagnostic algorithm and classified into three main groups A, B and C according to the pathology and treatment plan. Group A of 11 patients suffering retro-punctual obstruction managed by endoscopic dacryocystorhinostomy while 5 patients in group B suffering punctual etiology (ob-struction and diversion or malposition) and 4 patients in group C suffering increased lacrimation rather than obstruction have been fulfilled the exclusion criteria and referred for proper ophthalmological management. Results: In group A, 11 patients undergone the diagnostic algorithm and fulfilled the inclusion criteria of retro-punctual obstruction of the lacrimal drainage system. Patients in group A have been managed by endoscopic dacryocystorhinostomy except one infant patient. They were doing well throughout the follow up period (4-6 months). In the 10 operated patients and before silicon tube removal, 7 patients reported complete improvement of epiphora, 2 patients reported decreased epiphora and 1 patient has no change of epiphora. After stent removal all operated patients of group A (10) reported complete improvement of epiphora with no recurrence after 6 months. 5 Patients in group B suffering punctual etiology (obstruction and diversion) and 4 patients suffering increased lacrimation rather than obstruction have been referred for ophthalmologist and managed accordingly. They were doing well except two patients in group B suffering punctual stenosis and obstruction who needed repeated dilatations and one patient reported to be indicated for punctoplasty. Conclusion: Application and following the diagnostic Algorithm steps and adhering to it have markedly improved patient selection and the final outcome of endoscopic dacry-ocystorhinostomy and effectively referred non obstructive or punctual patients for proper ophthalmologic management to avoid non indicated endoscopic dacryocystorhinostomy and treatment failure.
Indicated dacryocystorhinostomy
Diagnostic Algorithm for DCR
2021
09
01
1791
1801
https://mjcu.journals.ekb.eg/article_197275_68385fdeb9abae1f09740bd980f8eb72.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Dominant versus Non-Dominant Unilateral Bag Carrying on Upper Trapezius Fatigue, Strength and Shoulder Function
DINA MAGDY, M.Sc.;
WADIDA HASSAN, Ph.D.
MARY
NASSIF, Ph.D.
Abstract Background: In today's society, women have a lot of tasks at work, study, family, social events and this coupled with the use of large and heavy shoulder bags put them at a particular risk of injuries in the shoulder complex. Aim of Study: This study aimed to compare between carrying a unilateral shoulder bag on the dominant versus non-dominant side on upper trapezius muscle fatigue, strength and shoulder function. Subjects and Methods: One hundred and twenty healthy females right handed with age ranging from 20-59 were randomly assigned into 2 equal blocked groups. The outcome measures included, upper trapezius fatigue & strength (via hand-held dynamometer) as well as shoulder function (via simple shoulder test). Both groups walked on a treadmill for 5 minutes with speed 1.1m/s (group A) was carried the bag on the dominant side & (group B) was carried the bag on the non-dominant side. The outcome measures were collected pre & post-test for the dominant side (group A) & the non-dominant side (group B). Results: The results of this study revealed that there were no significant differences in terms of fatigue & function between pre & post measurments, but there was a significant difference in upper trapezius muscle strength for both groups. However, there were no significant differences between the dominant & non-dominant sides in terms of fatigue, strength & function. Conclusion: Our results revealed that there were no significant differences when carrying a shoulder bag on the dominant & non-dominant side on upper trapezius fatigue, strength & shoulder function.
Healthy females
Upper trapezius fatigue
Strength
Shoulder function
2021
09
01
1803
1808
https://mjcu.journals.ekb.eg/article_197277_b1cfac55bb595fcbf720365f119ff28c.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Evaluation of the Role of Vitamin C in Protection Against Topiramate Induced Nephrotoxicity in Adult Male Albino Rats
Abstract Background: Topiramate is a drug used to treat seizures in patients with epilepsy, however, kidney damage may result after its long-term use. The mechanisms of damage are variable and can affects all renal cellular components. Aim of Study: Treatment with an antioxidant, such as vitamin C, may help prevent this renal damage. In this study, we used histological, ultrastructural, and biochemical ap-proaches to detect the renal affection caused by topiramate treatment and to evaluate the role of vitamin C in protection against topiramate-induced nephrotoxicity. Material and Methods: Forty adult male albino rats treated daily for six weeks and divided equally to four groups: Group I (control group), group II supplemented orally with vitamin C (10mg/kg/day), group III treated orally with topiramate (100mg/kg/day), and group IV received vitamin C (10mg/ kg/day) 2 hours prior to topiramate (100mg/kg/day) treatment. Results: Examination of the kidney tissue of group III showed distortion of the renal glomeruli and tubules. In addition, topiramate significantly elevated the levels of serum urea, creatinine, lipocalin, indoxyl sulphate, and tissue malond-ialdehyde (MDA), and caused significant reduction in tissue superoxide dismutase (SOD) and catalase (CAT). However, group IV showed improvement in the renal glomeruli and tubules with significant improvement in serum urea, creatinine, lipocalin, indoxyl sulphate and tissue oxidative stress markers. Conclusion: The data presented in this work shows that topiramate may be a toxic therapeutic agent however, vitamin C supplementation may aid in protection against topiramate-induced nephrotoxicity.
Topiramate – Vitamin C
Renal – Transmission electron microscope
2021
09
01
1809
1817
https://mjcu.journals.ekb.eg/article_203254_00d93f5ff75f6b75fa99e819c4797da0.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Assessment of the Transoral Maxillectomy
MOHAMMAD W. EL-ANWAR, M.D.;
MAGDY A. SAYED EL-AHL, M.D.
HAZEM S. AMER, M.D.;
MOHAMED A. AL SHAWADFY, M.D.
Abstract Background: Head and neck cancer accounts for 17% of all cancer cases and could affect functions such as swallowing, phonation, breathing, aesthetics and the individual's quality of life. Aim of Study: To assess the transoral approach for maxil-lectomy in selected cases of cancer maxilla. Patients and Methods: The study included patients who were diagnosed to have maxillary carcinoma after the endo-scopic biopsy. The transoral approach was used for maxillec-tomy in all cases. Then, the patients were followed-up for 5 years. Results: Within the included eleven patients with maxillary squamous cell carcinoma, transoral maxillectomy could be performed without the need for any skin incision. No uncon-trollable epistaxis, orbital injury, septal perforation, postop-erative fistula, skin necrosis, vestibular stenosis or granulation was observed. Recurrence of the tumor was detected in one case only (9.1%) throughout the follow-up. Conclusion: The transoal approach for maxillectomy can be considered as a reliable and safe approach for selected cases of cancer maxilla. So, it should be incorporated into the oncological and maxillofacial surgeon's surgical armamentar-ium to avoid external incisions.
Transoral maxillectomy
Maxillectomy
Maxil-lary sinus
Cancer maxilla
2021
09
01
1819
1823
https://mjcu.journals.ekb.eg/article_203256_ff4202ee315806e1efb0882e3750ee3b.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
YKL-40 as a New Biomarker in Asthmatic Children and Asthmatic Exacerbation. Its Role and Correlations with Eosinophil's Percentage and Serum IgE Level
MAHMOUD M. ZAHRAN, M.D.;
EHAB IBRAHIM I. SOROUR, M.D.
HESHAM
S.M. ELBAZ, M.D.
Abstract Background: YKL-40 is a member of the mammalian chitinase like protein class of 40 Kda (kilo Dalton) heparin binding glycoprotein. Its name is derived from the protein's molecular weight and three N-terminus amino acids (tyrosine [y], lysine [k] and leucine [l]). YKL-40 is secreted by various cell-types including macrophages, chondrocytes, and some types of cancer cells. The exact physiological role of YKL-40 is not known, but it has been implicated in cell development, inflammatory disease such as asthmaand cancer progression. Aim of Study: This study was to investigate whether serum YKL-40 were increased in Asthmatic children and identify its correlation with acute exacerbation, total IgE, blood Eosinophil percentage (EO%) and Pulmonary Function (PF). We measured serum YKL-40 levels, EO%, and serum IgE in 30 children with Asthma as well as in 20 apparently healthy controls from the communities surrounding AL-Salama Hospital, EL-Khobar district, Saudi Arabia. Pulmonary Func-tion (PF) of Asthmaticpatients was also measured. Patients and Methods: Our data showed that the serum YKL-40 was significantly elevated in patients with Asthma (77.66ng/mL) compared with control (55.16ng/mL) (p=0.001) and when Asthma patients were stratified, serumYKL-40 levels in exacerbation group were significantly higher (83.72ng/ mL) than those in stable Asthmatic group (77.66ng/mL) (p=0.043). Results: In addition, serum YKL-40 was correlated posi-tively with the level of IgE (with r=0.298 and p=0.018) and EO% (with r=0.272 and p=0.032) but negatively correlated to pulmonary functions as Forced Expiratory Volumein 1st second (FEV1) (with r=–0.044 and p=0.0001). Thus, we conclude that YKL-40 is found significantly high in the serum of asthmatic childrenand its level correlates with exacerbation attacks, indicating that high levels of serum YKL-40 may be biological characteristic of the asthma exac-erbation. Conclusion: In our study, we conclude that serum YKL-40 level are increased in asthmatic children patients and its level correlates with exacerbation attacks indicating that YKL-40 may be either a cause or a new biomarker for asthma and its disease severity.
YKL-40
Asthmatic Children
Astmatic excer-bation
Serum IgE level
2021
09
01
1825
1831
https://mjcu.journals.ekb.eg/article_203258_549d67e94119219530b5067575a1f87e.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
The Outcome of Surgical Excision of Giant Supratentorial Brain Tumors in Pediatrics: A Study of Consecutive 70 Cases at our Institute
AHMED H. ASHRY, M.D.;
AYMAN TAREK MAHMOUD, M.D.
HASHEM
M. ABOUL-ELA, M.D.
Abstract Background: Surgery of giant supratentorial pediatric brain tumors (GSPBT) is challenging. Diagnosis may be misled by the inconspicuous symptoms and signs. Surgery is difficult due to the propensity for severe hemorrhage which is risky in this age group. Aim of Study: We discuss the surgical management of GSPBT with emphasis on how to reach maximal safe resection and different surgical strategies to improve the outcome. Patients and Methods: All Patients with GSPBT under-going elective surgery were included of age 3 months to 12 years. Giant tumors were defined by being larger than 5cm. General anesthesia was performed by neuroanesthesiologists. Various tools and instruments were used such as Cavitating ultrasonic aspirator, microscope and endoscope. Blood trans-fusion was performed as early as possible to replace losses. Extent of removal was assessed from CT or MRI scans. Results: This study included 70 children operated for GSPBT. There were 47 males (67.1%) and 23 females (32.9%). The age ranged from 3 to 144 months with a mean age of 56.3 months. The commonest presenting symptoms were those of raised intracranial pressure (ICP) in 61 cases (87.1%). Gross total resection was achieved in 57 patients (81.4%), debulking up to 80% in 3 patients (4.3%), debulking up to 50% in 1 patient (1.3%) and partial resection less than 50% in 9 patients (12.9%). The amount of blood transfusion ranged from 5 to 300ml/kg with a mean amount of 39.4ml/kg. PNET was the most common pathological diagnosis. Two cases required interruption of the procedure due to massive bleeding causing hypotension (2.9%). There were no complications due to massive blood transfusion. There were no cases of mortality. Conclusion: GSPBT can be totally resected with a good outcome. This needs a team approach including a good an-esthesia team and proper postoperative care. Surgical tech-niques including sub-pial technique, endo scope- assisted microsurgery, and the CUSA may help accomplish this target.
Giant
Supratentorial
Pediatric
brain tumors
Surgery
2021
09
01
1833
1837
https://mjcu.journals.ekb.eg/article_203259_f885e027973d9091d1ca8872f2e30363.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Endoscopy Challenges During the SARS-CoV- 2 Pandemic: A Single-Center Experience from Cairo University Hospital-Egypt
MOHAMED B. HASHEM, M.D.;
HEDY A. BADARY, M.D.
ISMAIL ANWAR, M.D.;
SHERIF HAMDY, M.D.
MOHAMMAD S. ABDELBARY, M.D.;
IMAN HAMZA, M.D.
Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on the daily practice of gastrointestinal endoscopy all over the world. Most endoscopy units had to undergo major adjustments including reducing the numbers of personnel, trainees and postponing a large proportion of endoscopic procedures. We hereby report the daily experience from 15th of March to 15th of July 2020 of Kasr Al Ainy Cairo University Hospital Endoscopy unit during the COVID-19 pandemic pre-peak and peak phases in Egypt. Aim of Study: To study the implications of COVID-19 on the endoscopy unit daily practice and exhibiting the precautions adopted to minimize the risk of exposure to infection. Patients and Methods: We retrospectively analysed the number of procedures done during the peak of the 1st wave of COVID-19 pandemic in Egypt as well as precautions used in the endoscopy setting and a comparison was made with the number of procedures done over the previous 4 months and during the same period in 2019. Results: During the lockdown, upper endoscopies and colonoscopies accounted for the major differences in number of procedures in comparison to the previous four months prior to the lockdown. On the other hand, the rate of endoscopic biliary drainage did not differ significantly. Conclusion: During the global COVID-19 pandemic, reorganization of the workflow and the service provided by Kasr Al-Ainy Cairo University hospital endoscopy unit was deemed necessary. Through implementation of strategies aiming at proper patient selection and risk assessment, effi-ciently reducing the number of working staff, putting off training programs, and applying strict infection control meas-ures, we were able to safely traverse the peak phase of the pandemic in Egypt.
Endoscopy
COVID-19
Cairo University
2021
09
01
1839
1842
https://mjcu.journals.ekb.eg/article_203260_34a6051a67b209555ac7f7d8a42c1cfc.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Comparative Study between Intrathecal Dexmedetomidine and Intrathecal Magnesium Sulfate for the Prevention of Post-Spinal Anesthesia Shivering in Lower Limb Orthopedic Surgeries: A Randomized Controlled Trial
GIHAN SEIF-ELNASR MOHAMED, M.D.;
FADY ADIB ABD ELMALEK, M.D.
FAROUK KAMAL, M.D.;
ASMAA M. SAAD ABD EL-HAFIZ, M.Sc.
Abstract Background: Shivering is a common and unpleasant perioperative event following general as well as neuraxial anesthesia. It has been reported in 40-70% of regionally anesthetized patients. Shivering is a physiological compensa-tory response to core hypothermia precipitated by anesthetic induced thermoregulatory impairment, exposure to a cool environment, infusion of unwarmed fluids and evaporation from exposed surfaces. However, some shivering like tremors is not thermoregulatory. Aim of Study: To compare the efficacy of intrathecal dexmedetomidine versus intrathecal magnesium sulphate when added to hyperbaric bupivacaine for reducing the severity and incidence of post-spinal shivering in lower limb orthopedic surgeries. Patients and Methods: We compared the efficacy of intrathecal dexmedetomidine versus intrathecal magnesium sulphate for reducing the severity and incidence of post-spinal shivering in lower limb orthopedic surgeries. This study was a randomized controlled trial, 105 adult patients (ASA I-II) of both sexes, aged 18-45 years, were scheduled for lower limb orthopedic surgeries in Ain Shams University Hospitals. Patients were randomly allocated into three equal groups; each group consists of 35 patients and had spinal anesthesia with one of the following mixture: - In group A, spinal anesthesia was performed with 3.5ml of 0.5% hyperbaric bupivacaine (17.5mg), plus 5µg dexme-detomidine in 0.5ml normal saline. - In group B, 3.5ml of 0.5% hyperbaric bupivacaine (17.5mg), plus 25mg MgSO4 in 0.5ml normal saline was injected intrathecally. - In group C, 3.5ml of 0.5% hyperbaric bupivacaine (17.5mg), plus 0.5ml of normal saline was injected intrathecally. Results: Our results showed that all patients in the three groups were comparable regarding demographic data (includ-ing age, sex, weight and height) and intraoperative hemody-namics (SBP, DBP and HR). Regarding temperature, though difference in decreased core temperature was clinically insig-nificant, there was statistical significant difference between the three groups at almost all times as temperature at dexme-detomidine group was higher than magnesium group but the temperature at controlled group was lower than other two groups. Regarding shivering, we found that C group showed statistically significant higher number of total patients who developed shivering than B group and A group. 9 patients (25.7%) in dexmedetomidine group (group A), 12 patients (34.3%) in magnesium sulfate group (group B), and 20 patients (57.1%) in control group (group C). Conclusion: Our study viewed that intrathecal adminis-tration of dexmedetomidine or magnesium sulphate as adjuvant to heavy bupivacaine in spinal anesthesia, reduced incidence and severity of shivering in patients presented for lower limb orthopedic surgery with non-significant difference among both adjuvants.
post-anesthetic care unit
Intrathecal dexme-detomidine
Intrathecal magnesium sulfate
2021
09
01
1843
1853
https://mjcu.journals.ekb.eg/article_203262_8fa6d41a080e8164c79bc76e3d7460b9.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Resistive Exercise versus Acupressure on Blood Glucose Level in Type 2 Diabetes
AMANY Y. AHMED, M.Sc.;
AKRAM A. SAYED, Ph.D.
NAGI L. NASIF, Ph.D.;
ABO EL NAGA EL HAGAGY, M.D.
Abstract Background: Type 2 diabetes has become a major global public health concern characterized by dysregulation of carbohydrate, lipid and protein metabolism, and results from impaired insulin secretion, insulin resistance or a combination of both Abstract: Acupressure lowers the blood glucose level through a massage at the point of the meridian, which can trigger the calming and uplifting response in the body, Resistive exercise is often recommended for patients with type 2 diabetes to improve physical conditioning and glycemic control. Aim of Study: The current study was conducted to compare between: Effect of resistive exercise and Acupressure on blood glucose level in type 2 diabetes. Subjects and Methods: Sixty patients (34 male 26 female) with type 2 diabetes participated in this study their age ranging from 35 to 60 years. They were selected from outpatient clinic in Internal Medicine, Luxor General Hospital. Group A: Received acupressure therapy (AT on point (Sp-6) which found atone palm width above the tip of inner ankle bone on the back of the shinbone, 3 minutes and repeated 3 times per session on both legs for three times per week for 12 weeks, in addition to hypoglycemic drugs. Group B: Received resistive exercise using dumbbell and sandbag, intensity of exercise for each muscle group determined after assessment of ten repetition maximum (10RM) 40% to 60% of 1RM (1 set 10 repetitions) used for 30 minute 3 time per week for 12 week beside their medication. 10RM reevaluated every 2 week and after 2 week load increase to 2 set 10 repetitions. Method of evaluation was measurement of random blood glucose level measured before starting and after each session glycosylated hemoglobin (HbA1c) fasting blood glucose level, 2 hour post prandial and glucose level and insulin level measured before starting and after end of program. Results: There was a significant decrease in randomized blood glucose, fasting blood glucose and increase in insulin level with no significant differences in HA 1 C and 2 hour post prandial in acupressure group when compared with resistive exercise group. Conclusion: Acupressure is more effective than resistive exercise as a complementary alternative medicine & can be helpful in reducing blood glucose level and increasing insulin levels in type 2 diabetic patients.
Acupressure
Diabetes mellitus
Resistive exercise training
2021
09
01
1855
1862
https://mjcu.journals.ekb.eg/article_203295_e11e4deb6d23a445963d14ee179418bf.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Backward Treadmill Training on Genurecurvatum in Cerebral Palsied Children
RAMY A. KHIDR, M.Sc.;
HEBATALLAH M. KAMAL, Ph.D.
AMIRA E. EL BAGALATY, Ph.D.;
HASSAN M. EL BARBARY, M.D.
Abstract Background: Cerebral palsy (CP) is described as a group of disorders of the development of movement and posture, causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Many patients with CP walk with a knee recurvatum pattern. A recurvatum gait can also be quite disabling and has been reported to cause proximal tibial deformity. Knee recur-vatum has been described to occur in 8% to 40% of patients with CP. Aim of Study: To determine effect of backward treadmill training on genurecurvatum in cerebral palsied children. Subjects: Thirty ambulant cerebral palsied children were selected by simple random way for this study from outpatient clinic of Al Shohadaa Central Hospital. Their ages ranged from 4-8 years. Their knee hyperextension ranged from 10 to 20 degrees in X-ray. No other knee deformities, surgical intervention or fractures. They were assigned randomly into two groups equal in number, each group consisted of 15 children; Group A: They received backward treadmill gait training exercise for thirty minutes for three times per week over three successive months with a specifically designed physical therapy program for one hour for each child, three times weekly, over three months. Group B: They received only the same designed physical therapy program given to group A. Material and Methods: All children's baseline data (radi-ological evaluation) were collected before and after treatments. Results: There was a statistically high significant decrease in the mean value of knee joint angle of both groups (A and B) where (p-value <0.0001) measured by X ray and this high significant reduction is in favor of group (A). Conclusion: This article shows that backward treadmill training with a specifically designed physical therapy program considered to be a safe, easy to use and very effective physical therapy program on genurecurvatum in cerebral palsied children.
Treadmill
Backward walking
Genurecurvatum
Cerebral palsy
2021
09
01
1863
1868
https://mjcu.journals.ekb.eg/article_203296_6e1c20707ad93fd8c63838d45380afb3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Difference between Neurodynamic Mobilization and Stretching Exercises for Chronic Discogenic Sciatica
HAYTHAM I. MORSI, M.Sc.;
BASSEM G.D. EL NAHASS, Ph.D.
MONA
M. IBRAHIM, Ph.D.
Abstract Background: Sciatica has noxious symptoms and critical functional disabilities, which disturbs people lives. Physio-therapy modalities play the most important role in the con-servative management of sciatica. Aim of Study: To compare the effectiveness of the slider, tensioner neurodynamic mobilization techniques and stretching exercises on pain intensity, range of motion (ROM) of ankle dorsiflexion, and functional disability in patients with chronic discogenic sciatica. Patients and Methods: Thirty-six patients with unilateral chronic discogenic sciatica from both sexes, their ages ranged from 21-50 years, were randomly allocated into three equal groups. Group (A) received slider neurodynamic mobilization technique only, while group (B) received tensioner neurody-namic mobilization technique only, and group (C) received stretching exercises of back extensors, hamstrings and gas-trocnemius muscles only. In addition to ergonomic advice given to all the three groups. Treatment was given three days per week for two consecutive weeks. The outcome measures were assessed pre and post treatment. Pain intensity was measured using visual analogue scale. ROM of ankle dorsi-flexion was measured using the universal goniometer. Func-tional disability was measured using the Oswestry disability index. Results: There were found significant differences in both; the slider and tensioner neurodynamic mobilization techniques as compared to stretching exercises in pain intensity and functional disability. There were found no significant differ-ences between the three groups in ankle dorsiflexion ROM. Conclusion: Slider and tensioner neurodynamic mobili-zation techniques are more effective than stretching exercises in terms of reducing pain intensity and improving functional disability without significant differences between them in improving ankle dorsiflexion ROM.
Slider
Tensioner neurodynamic mobilization
stretching exercises
Sciatica
2021
09
01
1869
1876
https://mjcu.journals.ekb.eg/article_203297_55dcd9ca21d8b338046026aca0d5c341.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Pilates Exercises on Abdominal Muscle Strength in Post Menopausal Women
NAHLA M. SHAKER, M.Sc.;
SOHEIR MAHMOUD ELKOSERY, Ph.D.
HAZEM S. EL ASHMAWY, M.D.;
AFAF M. MAHMOUD BOTLA, Ph.D.
Abstract Background: Menopause is the time that marks end of woman's menstrual cycle, occurring on average around 51 years of age. It associated with decline in estrogen level which lead to increase central obesity as well as decrease muscle strength and endurance. Pilate exercises belong to a group of so-called body mind exercises which improve mental and physical status, increasing muscle strength and flexibility. Aim of Study: This study aimed to see the impact of Pilates exercise on abdominal muscle strength in post-menopausal women. Subjects and Methods: Thirty post-menopausal women complaining from belly abdomen were selected randomly from out-patient clinic of faculty of physical therapy to participate in this, their age ranged from 50-60 years, their BMI not exceed 35Kg/m2, all of them had number of parities ranged from 2-4 times, their menstrual cycle had stopped at least one year ago. Subjects were subdivided randomly into two groups each with fifteen participants, group A practiced selected exercise program that include (static abdominal, pelvic rocking and postural correction exercises) for 20min/session twice per week for 12 weeks and group B performed the same program as for group A plus Pilates exercises for another 60min. Outcome to be studied in this research was abdominal muscle strength (peak torque, total work and average power) using Isokinetic dynamometer. Results: There was a significant increase in peak torque, total work and average power in abdominal muscles in group B who perform Pilates exercise rather than group A (p>0.001) Conclusion: Pilates exercise is an effective modality to increase abdominal muscle strength in post-menopausal women
Menopause
Pilates exercise
Isokinetic dy-namometer
2021
09
01
1877
1882
https://mjcu.journals.ekb.eg/article_203298_3df0c7514d3049149d80ef368b0bacc6.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Selected Exercise Program on Quality of Life in Stroke Patients
MAI M. GAMAL, M.Sc.;
GEHAN M. AHMED, Ph.D.;
AMIRA M. ABDEL RAHMAN, M.D.;
RANIA M. TAWFIK, Ph.D.
MAHMOUD
Y. ELZANATY, Ph.D.
Abstract Background: Stroke is one of the leading causes of death and long-term disability worldwide. Aim of Study: This study aimed to conduct the effect of selected exercise programe on quality of life in stroke patients. Material and Methods: Ten male patients with stroke enrolled in this study. A selected physical therapy program was provided for the selected group (GS) including: Passive Range of motion exercises for tightening muscles, Facilitation for weak muscles through: PNF technique, quick stretching. The Outcome Measures: The Arabic version of a short form dimension test (SF-36) used to assess the QOL Items of the SF-36 were divided into eight different domains. The control group was evaluated before and after intervention with a QOL questionnaire (SF36). Results: There was a revealed significant increase in physical functioning, energy/fatigue, emotional well-being, social functioning, pain and general health post treatment compared with that pretreatment. Also, there was no significant difference in role limitations due to physical health and role limitations due to emotional problem between pre and post treatment in the selected group. Conclusion: Selected physical program, significantly improves quality of life in patients with stroke.
Strokee
exercise
quality of life
2021
09
01
1883
1888
https://mjcu.journals.ekb.eg/article_203299_b55f2d7b83eb2c7dff672c698d745744.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Comparison between Effect of McConnell Tape, Kinesiology Tape and Open Knee Brace in Treatment of Patellofemoral Pain
ENGY F. ADLY, M.Sc.;
NABIL M. ABDEL-AAL, Ph.D.
ABEER A. EL YAMNY, Ph.D.;
AHMED E.M. SHAHEEN, M.D.
Abstract Background: Patellofemoral Pain Syndrome (PFPS) is the most prevalent orthopedic condition among physically active adolescents and young adults. PFPS is reported to be between 15% and 25% in young adults. Women are affected about more than twice as often as men. Aim of Study: Investigate the effect of Kinesiology taping, McConnell taping and Open knee brace beside the routine physical therapy in treatment of Patellofemoral pain syndrome (PFPS). Material and Methods: Forty-eight patients (19 males, 29 Females) with unilateral PFPS randomly assigned equally into McConnell tape (MT) group, Kinesiology tape (KT) group, and Open knee brace group (KB). All subjects received interferential therapy, patellar mobilization, quadriceps-strengthening exercise and stretching exercise beside MT or KT or KB. The patients were evaluated by electrogoniometer for knee flexion active range of motion (FAROM), Kujula questionnaire for functional activities and Visual Analogue Scale (VAS) for pain assessment. The evaluation was applied before, after 3 weeks and after 6 weeks of intervention. Results: There was no significant difference between the three groups in VAS, Kujula score and FAROM after three weeks of intervention (p>0.05). After six weeks of intervention, there was a statistical significance in VAS and in Kujula score for MT group (p < 0.05). However, there was no statistically significant difference in FAROM between three groups. There was a statistically significant improvement in VAS, Kujula score and FAROM after three weeks as well as after six weeks of intervention in all groups (p < 0.0001). Conclusion: Adding MT, KT or KB to physical therapy program might be effective in treatment patellofemoral pain, MT was more effective in improving pain and Kujula score, but not for FAROM, than other modalities.
Patellofemoral pain syndrome
McConnell tape
Kinesiology tape
Open knee brace
2021
09
01
1889
1898
https://mjcu.journals.ekb.eg/article_203300_2688ca08b16242262be306d4fe76237e.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Studying the Role of IMP3 and P53 in Detection of Dysplastic Changes in Barrett's Esophagus
GHADA A. ABD EL-FATTAH, M.D.;
RASHA M. ABDRABUH, M.D.
ALAA
KANDILL, M.D.
Abstract Background: Barrett's esophagus (BE) is an acquired metaplastic lesion with unpredictable potential for esophageal adenocarcinoma (EAC). Searching for immunohistochemical markers for predicting progression in Barrett's esophagus is of increasing interest. Aim of Study: The aim of this study is to detect early dysplastic changes in patients with BE for better management of diagnosed cases. Material and Methods: This retrospective study was carried upon 28 endoscopic biopsies of BE; 6 cases of Barrett's esophagus without dysplasia, 12 cases were Barrett's esophagus with low grade dysplasia and 10 cases with high grade dys-plasia. Cases were collected from archives of Pathology Department and Early Cancer Detection Unit (ECDU), Faculty of Medicine, Benha University during the years 2015-2020. IMP3 and P53 immunohistochemichal staining were performed and evaluated for each case. Results: IMP3 was positive with high expression in 80% of high grade dysplasia cases which was a statistically signif-icant relation between IMP3 expression and grade of dysplasia. P53 was a highly sensitive marker for early dysplastic changes, reporting 100% sensitivity to low grade dysplasia. P53 was also highly specific to high grade dysplasia (100%). IMP3 was found to be highly sensitive to high grade dysplastic changes (90%). Conclusion: Combination of both markers could be helpful in detection of early dysplastic changes in Barrett's esophagus patients who are at risk of malignancy to start a strict follow-up procedures. Both markers together could be useful in detection ofhigh grade dysplasiaand rapid intervention to prevent malignant transformation.
Barrett's esophagus
dysplasia
p53
IMP3
Immunohistochemistry
2021
09
01
1899
1906
https://mjcu.journals.ekb.eg/article_203301_bc0dbbc3c0bd911fcbafbc0d1c73cb42.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Congenital Anomalies in Neonates Admitted in Neonatal Intensive Care Units, Cairo University
ABDELRAHMAN A. ABDELRAZEK, M.D.;
SAFAA M. ABDELRAHMAN, M.D.
RANIA M.H. ELKAFASE, M.D.;
IMAN E. ABDEL MEGUID, M.D.
ZEINAB
A. EL-SAYED, M.Sc.
Abstract Background: Congenital anomalies comprise a wide range of abnormalities of body structure or function that are present at birth and are of prenatal origin. Congenital anomalies defined as structural changes that have significant medical, social or cosmetic consequences for the affected individual, and typically require medical intervention. Three to seven percent is the estimated worldwide incidence of congenital anomalies, with 295000 newborns die within 28 days of birth every year worldwide due to congenital anomalies. Aim of Study: This study aims to detect the incidence of congenital anomalies in neonates admitted in Neonatal Inten-sive Care Units, Cairo University in the year 2014 and the associated risk factors present in their parents. Patients and Methods: We retrospectively reviewed the records of neonates having congenital anomalies admitted in Neonatal Intensive Care Units, Cairo University Children Hospital over one year from January 2014 to January 2015. Our collected data include full history with pedigree, full clinical examination and investigations. Results: 1105 neonatal 's records collected from Neonatal intensive care units, Cairo University for one year, four hundred sixty five (42%) of them having congenital anomalies, with high mortality (30.5%) from congenital anomalies, consanguineous marriage represent with 28.8%. Gastrointes-tinal tract anomalies are the most common congenital anom-alies (48.6%) followed by cardiovascular system (24.3%) respiratory system (4.3%) urinary and genetic causes (1.9%), mothers have chronic illness represent (10.3%) with eight% took drug during pregnancy. Conclusion: We found that there is high incidence of congenital anomalies in our Neonatal Intensive Care Units this is mostly related to that we are tertiary referral center and also most of these cases collected from surgical unit and need surgical interference and related to high incidence of consanguineous marriage. Congenital anomalies can contribute to long-term disabil-ity, which may have significant impacts on individuals, families, health-care systems and societies. The exact causes of congenital anomalies cannot be identified so close follow-up of pregnant women is highly indicated. Some congenital anomalies can be prevented. For example, vaccination, adequate intake of folic acid or iodine during pregnancy and adequate antenatal care are keys for prevention.
Congenital anomalies
(GIT) Gastrointestinal tract
Neonates
neonatal intensive care unit (NICU)
2021
09
01
1907
1916
https://mjcu.journals.ekb.eg/article_203302_40c221eaebb41fad675d3e47ef7f7f3d.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Clinical Role of Serum Lactic Dehydrogenase Assessment in Critically Ill Pediatric Patients with Sepsis
NAHLA A. MOHAMED, Ph.D.;
EMAN R. YOUNESS, M.D.
Abstract Background: Sepsis is a systemic inflammatory disorder that may be associated with higher rate of morbidity and mortality in pediatric patients admitted to intensive care unit with sepsis. Usage of different biomarker may helpful for early identification and appropriate management of sepsis. Aim of Study: To investigated the role of serum lactic dehydrogenase (LDH) in prediction of sepsis in critical pediatric patients, and its relation with prognostic scoring systems. Patients and Methods: A prospective cohort study was conducted at El Galaa Teaching Hospital between January 2020 and December 2020. A total of 168 pediatric patients were divided into the septic group (84 critically ill patients with sepsis from the pediatric intensive care unit (PICU)] and the control group (84 stable patients admitted to the in patient word). Demographic and clinical data were collected, routine laboratory investigation including LDH on admission and after 24 hours were performed. Pediatric Risk of Mortality III (PRISM III) Sequential Organ Failure Assessment (pSOFA) were assessed. Results: The serum LDH level was significantly higher in septic than control (p=0.000) and in non-survivor than survivor group (p=0.000). Also, There was statistically significant between survivor and non-survivor as regarding length of hospital stay, pSOFA score and PRISM III score. There was statistically significant positive correlation between LDH, PRISM III (r=0.842, p < 0.001) and pSOFA (r=0.785, p < 0.001). Conclusion: The study concluded that the LDH is a useful marker in predicting of sepsis in critically ill pediatric patients especially when combined with prognostic scoring systems.
Lactate dehydrogenase
Sepsis
pediatric intensive care unit
Pediatric Risk of Mortality III
Sequential organ failure assessment
2021
09
01
1917
1927
https://mjcu.journals.ekb.eg/article_203303_05c52bde5551381b285be53c790269e4.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Current Perspectives Regarding The Effects of Muscular Exercise on Neurological Disorders: A Literature Review
MOHAMED
M. KHALIFA, M.D.
Abstract Regular physical exercise is a well-known mechanism for preventing and treating several health conditions, from the general improvement of the overall health condition and the prevention of obesity and increasing the arterial collater-alization and blood flow to the upregulation of antiinflamma-tory and antioxidant signaling cascades. The beneficial effects of regular physical exercise are far-reaching and diverse. Chronic neurological disorders are considered a significant public health concern. Given the fact that the available treat-ment modalities in most neurological conditions are not fully curative and aiming primarily at improving the quality of life and the ability to cope, with a wide side effect profile of the available medications to the high cost of other available methods as electric stimulation devices, this highlight the importance of investigating the beneficial roles of regular physical exercise, both as a preventive and a curative tool, indifferent chronic neurological diseases. This short review of the literature highlights the recent research finding and mechanisms of the beneficial effects of exercise in different chronic neurological diseases.
Current perspectives regarding
Muscular exer-cise
Neurological disorders
2021
09
01
1929
1933
https://mjcu.journals.ekb.eg/article_203306_9303f4282278f4fcadd0e06a5ab1c5a4.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Value of Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) and ADC in Evaluation of Urinary Bladder Carcinoma
MONA A.M.A. NAGI, M.D.;
HANAA A. AHMED, M.D.
DHURGHAM
HAYDER WALI, M.Sc.
Abstract Background: Urinary bladder cancer is the fourth com-monest among males and the tenth among females. It has a high recurrence rate necessitating proper initial management. MRI is a very valuable imaging tool with high tissue contrast and multi-planar imaging abilities thus allowing better tissue characterization. Aim of Study: Is to evaluate the value of diffusion weighted magnetic resonance imaging (MRI-DWI) in the diagnosis and staging of urinary bladder carcinoma, with pathological diagnosis taken as the reference. Patients and Methods: In this study, 40 patients with suspected urinary bladder masses performed pelvic MR im-aging. All patients were scheduled for variable MR sequences including T2WIs and DWIs. Results: Regarding the detection of urinary bladder car-cinoma the sensitivity, specificity, and accuracy for differen-tiating superficial from invasive tumors using T2 images alone and combined use of T2 and DW images were 62.5%, 66.7%, 63.2% and 100%, 100%, 100% respectively. Conclusion: DW-MRI is a safe, quick accurate sequence that can accurately detect and local stage urinary bladder carcinoma. In addition, DW images can predict the histological grade of the tumor decreasing the need for biopsy.
MRI (magnetic resonance imaging)
DWI (dif-fusion weighted images)
2021
09
01
1935
1943
https://mjcu.journals.ekb.eg/article_203307_061d78fbf14ed0f1cd6ac3a400725be3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Relationship between Low Back Pain and Stress Urinary Incontinance in Middle - Aged Women
HEBA A. KHEDER, M.Sc.;
MOHAMED A. AWAD, Ph.D.
MARWA E. HASANIN, Ph.D.;
AHMED M. SAEED, M.D.
Abstract Background: Low back pain (LBP) and stress urinary incontinence (SUI) are common problems in women, there are many factors that associated with the development of LBP, but there are a limited research that evaluate the relationship between LBP and SUI. Aim of Study: To determine the relationship between stress urinary Incomitance and low back pain in middle-aged women. Material and Methods: One hundred multipara women participated in this study. 50 women complained from stress urinary incontinence (diagnosed by physician) and 50 women were free from stress urinary incontinence (diagnosed by physician). They were selected from Al-Hussein University Hospital in Cairo, Al-Azhar University from November 2020 to March 2021. Their ages were ranged from 35 to 45 years old. Their body mass index was not exceeding 30kg/m2. They were multipara women. Patients with corrected SUI, previous low back surgery, spondylolisthesis and chronic low back pain were excluded from the study. They were divided ran-domly into two equal groups (A&B). Group A consisted of 50 women without SUI. Group B consisted of 50 women with SUI. Pelvic floor muscle strength was assessed by Kegel perineometer and severity of low back pain was assessed by oswestry disability index (ODI) for both groups (A&B). Results: In group (A )There was no statistical significant correlation between oswestry low back pain disability ques-tionnaire (ODI) and pelvic floor muscle strength (PFMS) (r=–0.206; p-value=0.151. While in group (B). There was a statistical significant negative correlation between oswestry low back pain disability questionnaire (ODI) and pelvic floor muscle strength (PFMS) (r=–0.281; p-value=0.048) and in all studied cases (group A + B). There was a statistical signif-icant negative correlation between oswestry low back pain disability questionnaire (ODI) and pelvic floor muscle strength (PFMS) (r=–0.419; p-value=0.001). Conclusion: Accordingly, it can be concluded that there is a positive relationship between low back pain and stress urinary incontinence and presence of stress urinary inconti-nence is predisposing factor for low back pain.
Low back pain
Stress Urinary Incontinence
Pelvic floor muscle strength
Oswestry Disability Index
Kegel perineometer
2021
09
01
1945
1949
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Effect of Whole Body Vibration on Obese Hypothyroid Postmenopausal Women
OMAR S. ABDEL-LATIF, M.Sc.;
MAGDA S. MORSY, Ph.D.
HASSAN
O. GHARIB, M.D.
Abstract Background: This study was conducted to determine the effect of whole body vibration on 30 obese hypothyroid postmenopausal women. Aim of Study: The aim of this study was to investigate the effect of whole body vibration on hypothyroidism in postmenopausal women. Material and Methods: Thirty obese postmenopausal women were participated in this study. They were referred from outpatient clinic of physical therapy department in Elshiekh Zayed Specialized Hospital. Their ages were ranged from (50-55) years old with a mean value 51.83±1.7 years and their (BMI) was ranged from (30-35) kg/m2 with a mean value 31.6±1.62kg/m2. All patients were clinically diagnosed as hypothyroidism and all of them were receiving hypothyroid medical treatment in the form of thyroxine tablets (2-3 tablets per day). All participants were randomly divided into two groups equal in number, control group (group A) and study group (group B). Patients in group (A) were treated by thy-roxine tablets described by the physician and a low caloric diet program for 8 weeks, while patients in group (B) were treated by thyroxine tablets and the same low caloric diet program as group (A) in addition to performing a whole body vibration training machine for 40 minutes, 3 sessions per week for 8 weeks. The session of WBV was consisted of 40 minutes, started with low frequency (20 HZ), then increased frequency gradually up to 100 Hz and then ended with low frequency (20 HZ). All patients in both groups (A&B) were evaluated by measuring body weight, Body mass index (BMI), Waist hip ratio (WHR), total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, TSH, FT3, FT4 before starting and after the end of the treatment program. Results: The results showed a highly significant (p-value £0.0001) decrease in body weight, Body mass index, Waist hip ratio, total cholesterol, triglycerides, low-density lipoprotein and TSH hormone with a significant (p-value £0.0001) increase in high-density lipoprotein, FT3 and FT4 after treatment in both groups. Yet, these changes were more pronounced and statistically significant in the study group when compared to the control group. Conclusion: It could be concluded that whole body vibra-tion training combined with low caloric diet program with thyroxine tablets is much better than using only a low caloric diet program with thyroxine tablets in treating obese postmen-opausal women with hypothyroidism. Thus, whole body vibration training has a great and beneficial effect on hypothy-roidism in obese postmenopausal women. It gives amazing results and noticeable changes.
Whole body vibration
hypothyroidism
Men-opause
Obesity
2021
09
01
1951
1960
https://mjcu.journals.ekb.eg/article_203327_30e6725019b66bdb1cd9d6596739e4fc.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Serum Zinc Level before and after Low Carbohydrate Diet in Male and Female Overweight and Obese Ain Shams University Medical Students
AHMED N. HASSAN, M.D.;
YASMIN M. ABOUL-ELA, M.D.
MENNATALLAH
A.A. SHETAYA, M.Sc.
Abstract Background: Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2). Aim of Study: Our study was conducted to assess serum zinc level before and after low carbohydrate diet program over 40 days. Patients and Methods: The study included 30 overweight and obese students with age range from (20-26 years) 22 females and 8 males selected randomly from Faculty of medicine Ain Shams University during 2019-2020 after ex-clusion of students with body mass index below 25kg/m2 and students with constipation, fatigue, diarrhea, heartburn, gas, nausea, vomiting, appetite changes or headache. Results: Serum zinc levels in overweight and obese students were low, most of participants have zinc deficiency which improved with the decrease of BMI after low carbohy-drate diet program this ensures that serum zinc levels affected by body weight and body mass index. Our single arm open label clinical trial showed that serum zinc level improved with decrease in body mass index among overweight and obese medical students after applying low carbohydrate diet program over the same period of time. Conclusion: Taken together the benefits of carbohydrate restriction in overweight/obese patients and the altered serum zinc levels in these patients, it was tempting to further serum zinc levels before and after low carbohydrate diet in overweight and obese youth, where to our knowledge, this is the first clinical study targeting this subject in Egypt.
zinc
Low
Carbohydrate diet
overweight
Obesity
2021
09
01
1961
1966
https://mjcu.journals.ekb.eg/article_203328_3de6f24179c70f514983fa942c7ef593.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Hyposalivation Response to Low-Level Laser in Diabetic Type 2 Patients
SAFAA S.S. SHETAWY, M.Sc.;
HANY E. OBAYA, Ph.D.
FATMA ABOELMAGD M. HAMED, Ph.D.;
AHMED M. MOSAAD, M.D.
Abstract Background: Diabetes mellitus is a chronic metabolic disorder, which usually leads to various complications. Among these complications is salivary hypofunction characterized by an abnormal reduction in saliva flow rate. Aim of Study: The aim of this study was to find out the efficacy of LLLT on hyposalivation in diabetic type 2 patients. Patients and Methods: Twenty-five diabetic type 2 patients from both sexes (16 females and 9 males) were included in the study. Their ages ranged from 40 to 55 years old. Patients were recruited from the outpatient clinic of internal medicine, Suez Canal hospital. All patients included in the study were with whole resting saliva !90.16ml/min. The study was con-ducted from August 2020 to March 2021. The salivary flow rate was measured using the 'low forced spitting' method. The collection period was 5min. The salivary flow rate (ml/min) was calculated by dividing the collected salivary amount (volume in ml) by the time of collection period (5 minutes). The salivary flow rate was measured before starting of sessions (pretreatment), after the 6th session (post I), and after the 12th session (post II) in the same procedure. Patients were assigned into one experimental group received 12 sessions (2 sessions per week for 6 weeks) of low-level laser. LLLT was performed on the major salivary glands punctually. Three points were applied extraorally to each parotid gland, two to each sub-mandibular gland, and two to each sublingual gland. A total of 14 points were applied per session. Application duration was 30 sec per point (total duration of 14 points was 420sec). Results: There was a significant increase in salivary flow rate at the post I and post II compared with pretreatment (p < 0.001). The percent of change at the post I was 118.18% and at post II was 218.18%. There was a significant increase in salivary flow rate at post II compared with post I (p < 0.001) and the percentage of increase was 45.83%. Conclusion: These results suggested that LLLT had a hopeful effective role in improving hyposalivation related to diabetic complications.
Hyposalivation
Xerostomia
Dry mouth
Low-level laser (LLL)
Type 2 diabetes mellitus
2021
09
01
1967
1971
https://mjcu.journals.ekb.eg/article_203329_163b5e36b9ed0520edafbdd29ae2e353.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Synchronous versus Asynchronous E-Learning Practical Training on Acquiring Knowladge and Skills for Pediatric Physical Therapy Students
NADA ELGHARIEB, M.Sc.;
FATEN HASSAN ABDELAZEIM, Ph.D.
Abstract Background: E-learning is the use of electronic devices to conduct teaching synchronously or asynchronously, that allow students to learn from different places especially during pandemic COVID 19. Aim of Study: This study aims to find out which form of e-learning synchronous or asynchronous practical training more effective to acquire knowledge and skills for pediatric physical therapy students. Patients and Methods: Seventy-five undergraduate (5th grade and internship) students selected randomly from different universities, students randomly allocated in two groups, thirty seven students in group A receive synchronous e-learning through zoom life session, thirty eight students in group B receive asynchronous e-learning through recorded video, students knowledge and skills assessed by online quiz designed on Google forms platform, the study carried out from December 2020 to April 2020. Result: There was a significant increase in the quiz total score of group B compared with that of group A (p=0.003) (p < 0.05). Conclusion: The result suggested that asynchronous e-learning is more effective than synchronous e-learning to acquire knowledge and skills for pediatric physical therapy students.
E-learning
Synchronous learning
Asynchro- nous learning
practical training
2021
09
01
1973
1977
https://mjcu.journals.ekb.eg/article_203330_77a09882a38376785f8eafa624923440.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Role of Ultrasonography and Magnetic Resonance Imaging (MRI) in Evaluation of the Tendons of the Wrist and Hand
WALEED A. MOUSA, M.D.;
MOHAMED S. EL-ZAWAWI, M.D.
DINA
M. BARSEEM, M.Sc.
Abstract Background: Variable abnormalities of the tendons of the wrist and hand including injury, inflammation, tumors & anatomical variants used to be evaluated with MRI as a standard modality. Owing to MRI relative limited availability and its high cost, ultrasonography (US) considered a valuable tool in assessment of wrist and hand tendons. Aim of Study: To assess the ultrasonography (US) results in comparison with MRI results which is used as gold standard in assessment of variable wrist and hand tendon abnormalities. Patients and Methods: One hundred patients with different wrist and hand complaints were enrolled in our study, 43 females and 57 males their age between 8-82 years with a median age 45 years. All patients were subjected to history taking and full clinical examination of the wrist and hand. Each patient underwent the ultrasound first before the MRI examination. Results: Near equal results were observed between US findings and MRI findings indicating that we can use both examinations to evaluate the wrist and hand tendons, and that US can be used as initial tool in assessment of the wrist and hand tendon abnormalities. According to our study, sonography exhibited 99% diagnostic accuracy for ganglion cysts, 100% for solid masses of tendon sheath & tendinosis/tenosynovitis, 97% for tendon injury & 98% for anatomical variants of the wrist and hand tendons. Conclusion: Our study demonstrated that ultrasonography and MRI are comparable and closely related as regards detec-tion of different pathological changes in hand and wrist tendons. Further studies are needed to confirm the findings in larger groups of patients and to evaluate the role of Ultra-sonography (US) in assessment of the other structures of the wrist and hand.
Wrist hand tendons
Ultrasonography - MRI
2021
09
01
1979
1990
https://mjcu.journals.ekb.eg/article_203332_31f7880616275eb9a40beba9421e1f30.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Emerging Value of Platelet-to-Hemoglobin Ratio and Monocyte-to-Hemoglobin Ratio in Assessment of Rheumatoid Arthritis Patients
NADA M. GAMAL, M.D.;
EMAN R. BADAWY, M.D.
TAMER
A. GHEITA, M.D.
Abstract Background: Rheumatoid arthritis (RA) is chronic au-toimmune disease associated with systemic inflammation that affects mainly synovial joints. Inflammation is the main reason of tissue destruction, physical disability and excess of mortality in RA. There is a need to find accurate inexpensive valuable inflammatory markers to be helpful in early diagnosis, prompt treatment and strict follow-up of RA patients. Aim of Study: To assess platelet-to-hemoglobin ratio (PHR) and monocyte-to-hemoglobin ratio (MHR) in RA patients. In addition to evaluate their associations with clinical and laboratory markers of RA disease activity and severity. Patients and Methods: The study included 175 adult RA patients and 186 age and gender healthy individuals were enrolled as control group. Disease activity score (DAS28) and RA medical records-based index of severity (RARBIS) were assessed in RA patients. PHR and MHR were measured in patients and controls. Results: They were 154 females and 21 males RA patients with a mean age of 45.43±10.5 years and disease duration of 9.3±0.47 years. PHR and MHR were significantly higher in patients (27.04±9.52, 0.03±0.02) than controls (21.58±5.6, 0.02±0.01) respectively, (p < 0.001). PHR and MHR had diag-nostic ability to discriminate RA patients from controls with sensitivity of 75%, 73.94% respectively and specificity of 53.23% in both. PHR had significant positive correlations with DAS28 (r=0.25, p=0.003), RARBIS (r=0.20, p=0.041), erythrocyte sedimentation rate (ESR) (r=0.41, p < 0.001), C-reactive protein (CRP) (r=0.4, p < 0.001) and anti-cyclic cit-rullinated peptide antibodies (anti-CCP abs) (r=0.3, p=0.001). MHR was only correlated with CRP (r=0.24, p=0.002). Mul-tivariate linear regression for the increase in PHR among RA patients revealed that ESR (b=0.100; p < 0.001, CI=0.05-0.145) and CRP (b=0.091; p=0.004, CI=0.02-0.152) were significant predictors. Conclusion: PHR and MHR were significantly increased in RA patients than controls. In addition, PHR and to lesser extent MHR were associated with RA disease activity and severity clinical as well as laboratory markers. This means they may serve as novel, inexpensive and easily obtainable inflammatory RA markers helping in evaluation and monitoring of RA patients disease activity and severity.
Platelet-to-hemoglobin ratio
Monocyte-to-hemoglobin ratio
Rheumatoid Arthritis
DAS28
RARBIS
2021
09
01
1991
1999
https://mjcu.journals.ekb.eg/article_203333_bbbb5d622f9725923e8a41f05480a324.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Comparison between Ultrasound-Guided Bilateral Ilioinguinal-Iliohypogastric Nerve Block and Ultrasound-Guided Transverses Abdominus Plane Block with the Usage Bubivacaine and Dexamethasone for Post-Cesarean Section Analgesia: A Pilot Study
REHAM MAHROUS, M.D.;
MAHMOUD ALALFY, Ph.D.
RABAB SABRY, M.D.;
NIHAL M. EL-DEMIRY, M.D.
MANAL MOUSSA, M.D.;
OMNIA MANDOUR, M.D.
Abstract Background: Post-operative pain management following cesarean section (CS) can be done using abdominal field blocks like ilioinguinal-iliohypogastric (IL-IH) nerve block and transversus abdominis plane (TAP) block. The use of adjuvants such as dexamethasone can improve the sensory block's analgesic efficacy. Aim of Study: This study aimed from this pilot study to compare ilioinguinal-iliohypogastric nerve block and trans-versus abdominus plane block regarding post-CS pain relief. Patients and Methods: Twenty parturients undergoing CS were randomized to receive ultrasound-guided bilateral either IL-IH nerve block or TAP block. For both blocks, we used 20ml of 0.25% bupivacaine + 8mg dexamethasone for each side at the end of the operation. Patients' pain intensity was recorded at 0, 4, 8, 12, 24 hours postoperatively using the visual analog scale (VAS). The total amount of nalbuphine consumed over the following 24 hours was recorded. Results: Throughout the first 24 hours, the II-IH nerves block group had decreased pain scores (Visual Analog Score). In addition, the IL-IH group showed considerably less Nalbu-phine consumption. Conclusion: IL-IH nerve block provides more effective post-CS analgesia than TAP block.
Cesarean section analgesia
Bubivacaine
dexamethasone
2021
09
01
2001
2006
https://mjcu.journals.ekb.eg/article_203334_0588a11f40e5264bf7fd5751704f99cf.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Clinical versus Instrumented Reliability of Diagnosis of Acute Compartmental Syndrome in Tibial Fractures
WESAM G. EL INANI, M.D.;
YASIR A. RADWAN, M.D.
AHMED S. MOUSTAFA, M.Sc.;
HAMADA M. ABD ELAAL, M.Sc.
Abstract Background: Acute compartment syndrome of the leg may be a devastating complication of a tibial fracture. Metic-ulous and repeated examinations of the patient who has such a fracture are needed to ensure the diagnosis of acute com-partment syndrome (ACS). A.C.S. remains challenging in many patients although the "5 Ps" of compartment syndrome; pain, pallor, paralysis, pulselessness, and paresthesia. Aim of Study: To measure intra-compartmental pressure in different compartments in the lower leg in tibial fractures and to correlate it with common clinical findings found in acute compartment syndrome in trial to early detect acute compartment syndrome and to decrease its devastating com-plications and rate of fasciotomy. Patients and Methods: This study was conducted on 100 patients referred to the Emergency department having Tibial fracture predisposed to have acute compartment syndrome by measuring intra-compartmental pressure instrumentally using stryker intra-compartmental pressure monitoring system and correlated with clinical picture and detect the percentage of patients need fasciotomy. Results: The Stryker intra compartmental monitoring system (STIC catheter) has accuracy and easy to measure intra-compartmental pressure and helps us to early detect A.C.S. in the lower leg also to decrease rate of fasciotomy and complications but it is expensive and needs proper training to use it. Conclusion: The patient who undergoes fasciotomy re-quires a physical therapy program to regain function. Postop-erative care and rehabilitation are just as important as the procedure itself.
Acute compartmental syndrome
Tibial fractures
2021
09
01
2007
2014
https://mjcu.journals.ekb.eg/article_203335_c371c39c0da8715ace3f864c6e7e8ac5.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Prevelence of Trigger Points at Lower Back among Dentists in Cairo at Maadi District by Using Algometer
MOSTAFA E. FOUAD, M.Sc.;
ABD ELRAHMAN CHABARA, Ph.D.
REDA K. ABDELRAZIK, Ph.D.;
NABIL A. MOHAMED, Ph.D.
Abstract Background: Low Back Pain (LBP) is most common symptom among dentists due to working in a standing position and prolonged stooping over a reclined or supine patients which lead to trigger points formation at lower back. Aims of Study: Localized most common level of trigger point formation among dentists at lumbosacral area and identified the possible risk factors for the development of trigger points by Algometer which eased for physical therapist to find trigger point easily and save time and effort for treatment. Subjects and Methods: This study was carried out on fifty dentists males with low back pain and their ages were ranged from 30 to 45 years, dentists have recurrent episode of pain at lower back and all dentists worked daily at hospital or in thier private clinics examinated from El-Yom El-Wahed and El-Hayaa El-Arabya Hospitals in Maadi District, Cairo Governorate. Results: L5 level was the common site of trigger points at lower back detected in 15 (48.3%) subjects followed by S1 level in 7 (22.5%) subjects and S2 level in 7 (22.5%) subjects and Trigger points at lower back was detected in L4 level in 2 (6.7%) subjects 19. Conclusion: L5 level was the common site of trigger point formation at lower back among dentists.
Back trigger points
Back pain among dentists
Algometer
2021
09
01
2015
2021
https://mjcu.journals.ekb.eg/article_203336_89a1b9fa8a15c1705dd229a369a601a9.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Operative Treatment of Scaphoid Nonunion
SHERIEF N. AMIN, M.D.;
AYMAN M. MANSOUR, M.D.
HAMADA M. ABDELAAL, M.Sc.
AHMED S. MOUSTAFA, M.Sc.
Abstract Background: Scaphoid nonunion result in a predictable pattern of wrist arthrosis. To minimize the incidence of arthrosis, the goal of treatment should be consolidation of the fracture of the scaphoid in anatomic alignment. Aim of Study: To evaluate different means of treatment of scaphoid nonunion and evaluate its clinical results. Patients and Methods: This study was conducted at EL-Helmya Military Hospital and Kasr El-Ainy Hospital during the period from 2011 to 2016 on fifty patients diagnosed as non-united fracture scaphoid and operated upon by fixation and graft if needed, then followed-up for a period of at least 18 months. Patients were 49 male and one female with an average age of 23 years. All operative management and follow-up. Results: This study proved that operative treatment of scaphoid nonunion can be summarized as follows: Grade I,II,III according to Slade and Geissler`s classification can be treated by percutaneous or open fixation by Herbert screw even if the nonunion in prox. Pole. Grade IV/V/VI we have to open volarly for waist or dorsally for prox. Pole and fixation with bone graft from iliac crest or distal radius. Conclusion: This study proves that the goal of treatment of scaphoid nonunion should be consolidation of the fracture in anatomic alignment. scaphoidnonunions with severe collapse and humpback deformity must be approached volarly with interposition of an intercalary bone graft and internal fixation. A dorsal approach to proximal scaphoid nonunions allows immediate access for removing the necrotic bone from small proximal pole nonunions and internal fixation.
Scaphoid
Osteonecrosis
fixation
bone graft
2021
09
01
2023
2033
https://mjcu.journals.ekb.eg/article_203337_6c14e7034b9b5e52c2b7d5e6f1ed0d93.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Conservative versus Radical Management of Morbidly Adherent Placenta: An Audit
MUNA A.M. ALAWIETI, M.Sc.;
EMADA. FYALA, M.D.
KHALID S. ISMAIL, M.D.;
AHMED M.M. BADAWY, M.D.
Abstract Background: Maternal and neonatal morbidity and mor-tality are associated with abnormal placentation and obstetric hemorrhage. To reduce morbidity and mortality in morbidly adherent placentas, a high index of suspicion, early antenatal diagnosis, adequate patient counselling, scheduled surgery at a well-equipped institution, and anticipation of high volume blood transfusion are the essential steps. Aim of Study: The aim of this study was to reach the best way of management of abnormal adherent placentathrough evaluation of conservative and radical management of cases ofplacenta accreta over last three years in Mansoura University Hospital. Patients and Methods: A retrospective observational study conducted in Obstetrics and Gynecology Dept. of Mansoura University Hospital. We reviewed the medical records of 250 women who diagnosed as invasive placenta from the beginning of (2017) to the end of (2019). The main aim to reach the best way of management of abnormal adherent placenta through evaluation of conservative and radical management of cases of placenta accreta over last three years in Mansoura University. Results: There was statistically significant higher median volume blood loss, packed RBCs units, fresh frozen plasma and platelet units with radical management than with conserv-ative management. Regarding maternal complications, bladder injury, ureteric injury, major vessel injury, wound infection, coagulopathy, re-admission and ICU admission were higher incidence among cases in radical group than cases with conservative management. Grade 3 was present among cases with radical management only (30.5%) while grade 1 was higher among cases with conservative management 96.9%. Conclusion: According to our study, conservative man-agement in G1 (placenta accreta) is the recommended man-agement option, well-planned cesarean hysterectomy in G3 (placenta percreta) is the only management option. While G2 (placenta increta) can be managed either radically or conserv-atively according to bleeding degree and bleeding control.
morbidly adherent placenta
Conservative
Radical
2021
09
01
2035
2041
https://mjcu.journals.ekb.eg/article_203338_ada3fcb7f6d9cf30a94816c158b92393.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Toxic Effects of Methotrexate on the Cerebellar Cortex of Adult Albino Rats and the Possible Protective Role of Vitamin C: An Electron Microscopic Study
DORREIA A.M. ZAGHlOUL, M.D.;
SALWA M. OUIES, M.D.
WAIL M. GAD EL-RAB, M.D.;
AHLAM W. MOHAMED, M.Sc.
Abstract Background: The cerebellum means the little brain which located behind the big brain. It was involvedin different functions like cognition, memory and motor activity. Meth-otrexate is anti-cancer drug widely used in chemotherapy regimens. Also, it was used as an anti-inflammatory drug. Methotrexate has serious side effects on the nervous system. Vitamin C is the most common antioxidant element; it acts as a free radical scavenger especially in the nervous tissue. Aim of Study: The aim is to identify the serious toxic effect on the fine cellular structure of the cerebellar cortex of albino rats, and to determine if vitamin C can protect against serious of methotrexate or not. Material and Methods: We used fifteen male albino rats and they were divided in to three groups. First group considered as control, the second received 10mg/kg by intraperitoneal injection as single dose weekly for four weeks. The third group received the same methotrexate dose and vitamin C as 20mg/kg through the intragastric tube every other day for four weeks. After one month of the experiments, rats were decapitated and brains were extracted and cerebella are separated and cut for different serial sagittal sections, they were processed for electron microscopic study. Results: Exposure to methotrexate resulted in pathological changes at cellular component of cerebellar cortex in the form shrinkage of Purkinje cell, karyolitic changes in granule cells and nuclear damage was viewed and photographed by the electron microscope, but when vitamin C was administrated at the same time, these changes were decreased within Purkinje and granule cells. Conclusion: Methotrexate is asharmful drug, it destroys the cortex oh cerebellum, but when vitamin C is administrated with it, it can diminish its harmful effect.
cerebellar cortex
Methotrexate
vitamin c
2021
09
01
2043
2047
https://mjcu.journals.ekb.eg/article_203339_4756274760ff6e702378af94188ca1f3.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Primary Indicators of Critical Illness in Corovavirus Disease-2019
HOUSSAM ELDIN H. ABD ELNABY, M.D.;
MOSTAFA A.R. HUSSEIN, M.D.
MOHAMMAD A.A. AMIN, M.D.;
MOHAMMAD E. ABO-GHABSHA, M.D.
Abstract Background: Many studies discussed numerous predictors of severity in Coronavirus disease-2019 (COVID-19) patients. However, very limited number of these studies concerned with finding indicators of disease progression, ICU admission and life-threatening complications in such patients. Aim of Study: To determine some of the baseline indicators that lead COVID-19 patients to develop the critically ill form of the disease. Patients and Methods: This cross sectional study was conducted during the period from January 2021 to March 2021. It included 40 patients with COVID-19 infection, proved by positive reverse trascriptase real-time PCR (rt RT-PCR) admitted to Al-Hussein and Bab Al-Sha'reia University Hos-pitals (quarantine sectors) . Studied patients were divided into two equal groups, based on the classification of the Chinese Centers of Disease Control and Prevention (CDC): (1) Severe (non-critically ill) group and (2) Critically ill group. Demo-graphic data and co-morbidities of all participants were recorded and BMI was calculated. Baseline CBC, AST, ALT, ESR, CRP, ferritin, D-dimer and HRCT chest were done for all patients. Results: Age, sex, BMI, smoking habit, CBC indices, ALT, AST and CRP did not show significant differences between severe and critically ill groups. However, ESR, D-dimer, ferritin, HRCT chest score, hypertension and diabetes mellitus showed statistically significant assosciation with the critically ill patients (p-value <0.05). HRCT chest score and hypertension were proved to be independent variables signif-icantly associated with critical illness, unlike ESR which is a dependent variable. Hypertensive patients were 40 times more likely to be critically ill compared to non-hypertensive COVID-19 patients (adjusted OR=40.238). Additionally, for every increase in HRCT chest score by one point, the odds of being critically ill among COVID-19 patients increased twice (adjusted OR=2.1). Conclusion: Hypertension and diabetes mellitus increase the risk of developing critical illness in COVID-19 patients. Elevated ESR, D-dimer, ferritin levels and the more the percentage of HRCT chest involvement are associated with critical illness as well.
Indicators
Critical illness
Coronavirus disease-2019
2021
09
01
2049
2055
https://mjcu.journals.ekb.eg/article_203340_ae3972256c4faee57139504868310e7b.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Predictors of Management Outcomes in Pathological Small Bowel Surgical Emergencies: A Prospective Study in a Busy Emergency Unit
AHMED M. HASSAN, M.D.;
AHMED NABIL, M.D.
M.R.C.S. (Eng); SAMUEL NEMR, M.Sc.;
HESHAM AMER, M.D.
AYMAN
M.A. OSMAN, M.D., M.R.C.S. (Eng)
Abstract Background: The management of pathological small bowel disorders in the emergency department is challenging, and is linked to higher morbidity and mortality rates. Aim of Study: The aim of this study was to identify the main factors that could help predict the management outcomes in pathological small bowel surgical emergencies (PSBSEs). Patients and Methods: All patients presenting with PSBSEs to the Emergency Unit over a 6-months period were prospec-tively studied. Data about patient-related, assessment-related, pathology-related, and management-related variables; 90-day morbidity; as well as mortality were all recorded. Univariate and multivariate analyses were carried out to identify the predictors of management outcomes in PSBSEs. Results: Our study included 107 patients. The most fre-quently encountered PSBSEs were obstruction and/or stran-gulation (64 cases, 59.8%). Management was operative in 88 cases (82.2%). Overall, 30 cases (28%) developed morbidity, and 7 cases (6.5%) died. In univariate analysis, 14 different factors were associated with a significantly increased risk of morbidity; whereas in multivariate analysis, only 5 factors were found to be significant predictors of 90-day morbidity. The highest odds of morbidity were associated with re-operation [Odds Ratio (OR)=11.2, 95% CI=6.7-18.3, p=0.001] and hemodynamic status [OR=9.7, 95% CI=2.8-21.5, p=0.001]. Conclusion: Constant abdominal pain at presentation, hemodynamic instability, midline surgical incision, operative time >!2 hours, and re-operation were all associated with a significantly increased risk of 90-day morbidity in patients with PSBSEs.
predictors
outcomes
Pathological small bowel emergencies
2021
09
01
2057
2067
https://mjcu.journals.ekb.eg/article_203344_e419a324085ffe079bc7a3667f45f02e.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
External Sphincter Injection of Onabotulinum-A Toxin in Treatment of Children with Bladder- Sphincteric Dyssynergia
ABOURJILA A. GAMAL ELDIN, M.D.;
AYMAN M. GABR, M.D.
AMR M. ELSOFY, M.D.;
MOHAMED FAWZY, M.D.
Abstract Background: The first application of Onabotulinum-A Toxin in urology was its injection into the urinary sphincter to treat neurogenic detrusor-sphincter dyssynergia in quadri-plegic men. Since that first report by Dyskatra et al., in 1988, the results of focal Onabotulinum-A Toxininjections into the sphincter, the bladder wall and lately into the prostate have raised the interest of the urology community in this promising new therapeutic modality. This is an evidence-based review of the current indications, techniques and outcomes of Ona-botulinum-A Toxin injections into the urethral sphincter. Aim of Study: We evaluated the effect of detrusor injection of onabotulinum-A toxin into the urethral urinary sphincter in children with bladder-external sphincter dyssynergia to decrease urethral resistance and improve voiding. Material and Methods: Prospective treatment was per-formed in 25 children 4 to 15 years old (mean age 7) with bladder-neck dyssynergia using onabotulinum-A toxin. Pre-operatively all children were evaluated by ultrasound, voiding cystourethrography, excretory urography, magnetic resonance imaging and urodynamic studies, including pressure flow, electromyography and uroflowmetry. Using a rigid pediatric endoscope and a 4Fr injection needle 50 to 100 IU onabotu-linum-A toxin was injected into the external sphincter at the 5 and 7 o'clock positions. Follow-up was 6 to 15 months. Repeat injections every 6 months were given according to the response with a maximum of 3 injections. Results: Immediately after onabotulinum-A toxin injection all except 1 patient were able to void without catheterization. No acute complications occurred. Postoperatively post-void residual urine decreased by 30%, detrusor leak point pressure decreased significantly by a mean ± SD of 66±18 vs 37±4cm H2O and uroflowmetry showed a marked increase in maximum urine flow of 7±2 vs 17.3±8ml per second. Conclusions: Urethral sphincter onabotulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.
Onabotulinum-A toxin
Nonneurogenic neuro-genic bladder
Bladder-neck dyssynergia
Blad-der-external sphincter dyssynergia
2021
09
01
2069
2073
https://mjcu.journals.ekb.eg/article_203393_fd3838e8fff6bb8ffcf1b899e74c0f36.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Surfactant Lung Lavage versus Standard Treatment for Meconium Aspiration Syndrome
TAREK K. ALSAYAD, M.D.;
EHAB I. SOROUR, M.D.
MOHAMED MOUSTAFA, M.D.;
ASHRAF ABDELKADER, M.D.
Abstract Background: To evaluate diluted surfactant lung lavage as a therapy for severe meconium aspiration syndrome. Aim of Study: The aim of this study is to evaluate the efficacy and outcome of lung lavage using diluted surfactant compared to standard protocol for treatment of meconium aspiration syndrome. Patients and Methods: This was a prospective interven-tional study involved 24 patients with severe meconium aspiration syndrome divided into two equal groups one received the standard care in the form of high frequency ventilation and the second group received pulmonary lavage using diluted surfactant in addition to the standard care. Pulmonary lavage was done using of 15ml/kg of surfactant diluted to concentra-tion of 5mg of phospholipids/1ml of 0.9% NaCl divided into four equal aliquots. Results: On comparing both groups patients managed by pulmonary lavage using diluted surfactant showed significant improvement in PCO2 and mean airway pressure occurred 6 hours after lavage while improvement in PO2, oxygenation index and arterial-alveolar oxygen gradient occurred 24 hours after lavage. The duration of mechanical ventilation, oxygen therapy and hospital stay were shorter in the surfactant group. There was no difference between both groups in the incidence of complications, need for ECMO or death. Conclusion: Surfactant lung lavage is a safe and effective therapy for severe meconium aspiration syndrome.
Meconium
Aspiration
Surfactant
Lavage
Neonates
2021
09
01
2075
2082
https://mjcu.journals.ekb.eg/article_203394_c2d1df745e1016a3374645d1a633644e.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Preemptive Midazolam Can Reduce the Glycemic Stress Response to Surgery for Type-2 Diabetics Undergoing Simple Eye Surgery
ASHRAF E. ABDALLA, M.D.;
MAHMOUD M. ELSAYED, M.D.
ABDALLA
M. ELSAYED, M.D.
Abstract Background: Estimation of percentage of change of blood glucose concentration (BGC) at 30- and 60-min after single dose of intravenous midazolam injection and at end of surgery in relation to pre-injection concentration. Aim of Study: Estimation of percentage of changes of blood glucose concentration (BGC) at 30- and 60-min after intravenous injection of single dose of midazolam and at end of surgery in relation to pre-injection BGC. Patients and Methods: 100 type-2 diabetic patients with fasting BGC of ³200mg/dl, ASA grade II or III and assigned for cataract surgery were evaluated clinically and received midazolam injection in a dose of 0. 0 1-0. 1 mg/kg, up to a total dose of 2.5mg, over two minutes or until patient was sedated and achieved Ramsy score 2 or 3. BGC was estimated before midazolam injection and at 30-min, 60-min after injection and at end of surgery. Then, patients received peribulbar and subtenon local anesthetic infiltration was performed. Results: All surgeries were conducted uneventfully within a mean operative time of 62.6±8.8 min. BGC showed progres-sive increases during surgery reaching a maximum at 60-min after injection and declined at end of surgery, but with non-significant differences between the three estimations and the pre-injection levels. Median value of percentage of increase of BGC at 60-min was significantly higher in comparison to median values of other estimations, with significantly higher percentage of increase at end of surgery than at 30-min after injection. Conclusion: Preemptive administration of midazolam for diabetic patients could control the surgery-induced hypergly-cemic effect and thus could protect patients against postoper-ative hyperglycemic complications.
midazolam
Type-2 diabetes mellitus
Surgical stress
Percentage of change
2021
09
01
2083
2088
https://mjcu.journals.ekb.eg/article_203396_122eacb1dd05f083b26f8b9020b337ca.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Left Radial versus Femoral Coronary Angiography in Post CABG Patients
MOHAMED MAKRAM, M.D.;
TAMER EL BANNA, M.D.
Abstract Background: Coronary angiography via TRA approach (TRA) has gained growing acceptance and operator preference in recent years, based on a reduction in vascular complications and mortality. Aim of Study: This study was aimed to Compare left radial versus femoral artery approach during coronary angiography in patients post CABG especially in fluoroscopy time and contrast amount. Patients and Methods: Our study was a single center, retrospective cohort study was done on 100 patients to compare procedural variables especially fluoroscopy time and contrast amount of TRA versus TFA catheterization in patients who had previously undergone CABG surgery. In the period be-tween February 2020 and February 2021, 100 patients who had previously undergone CABG surgery and had received diagnostic or interventional cardiac catheterizations at our institute were included in the study population. Results: Our results observed in Table (1) cleared that, the number of male patients in TFA access group was 35 (70%), while, the number of males in TRA group was 37 (74%). Conclusion: Our study concluded that the fluoroscopy time and contrast amount were of lower levels in the TRA access than TFA access.
CABG patients
Radial versus femoral coronary angiography
2021
09
01
2089
2092
https://mjcu.journals.ekb.eg/article_203397_c74a069d006aaf4089f68aa12e55b98f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Persistent Symptoms of Coronavirus Disease 2019 after Passing Acute Infection
Abstract Background: Although the acute symptoms of COVID-19 have been widely described, the longer-term effects are less well known because of the relatively short history of the pandemic. Theories attributed those symptoms to chronic inflammation (fatigue), sequelae of organ damage (pulmonary fibrosis and chronic kidney disease) and hospitalization and social isolation (muscle wasting and malnutrition). Aim of Study: The study aimed at determining the fre-quency of persistent post-COVID-19 symptoms among sur-vived COVID-19 patients, clarifying the relation between this frequency and the degree of disease severity and spotlighting some of the factors that might influence it. Patients and Methods: This case control study was carried out during the period from March 2021 to June 2021. It included 103 subjects from the medical staff of Bab Al-Sha'reia University Hospital and their relatives, diagnosed 13-16 weeks ago to have COVID-19 infection by positive reverse transcription real-time polymerase chain reaction (rt RT-PCR) test in their respiratory tract swabs. They were communicated either directly or through phone. Forty sex, age and body mass index (BMI) matching individuals, chosen from the medical staff of the hospital, with no history sug-gesting COVID-19 infection, tested negative for COVID-19 IgG and IgM by rapid test, served as a control group. Results: The frequency of persistent post-COVID-19 symptoms among COVID-19 survivors was 41.75%. Fatigue was the most frequently reported symptom (38.83%), followed by dyspnoea and musculoskeletal pain (25.24%). Fatigue, headache, musculoskeletal aches, cough and dyspnoea were significantly more frequent among hospitalized subjects compared with home-managed ones. Dyspnoea was the only symptom to show a significant frequency among ICU individ-uals (p-value=0.015). As well, statistically significant higher BMI and prolonged duration of hospital stay were reported among individuals managed in the ICU when compared with the ward participants. Patients with post-COVID syndrome (PCS) were significantly older than non-symptomatic individ-uals (p-value <0.0001), with higher rates of co-morbidities (p-value=0.001). Hypertension was the only co-morbidity that reported a discrete significant higher frequency among post-COVID-19 patients (p-value=0.003). Hospitalization, length of hospital stay, requiring oxygen therapy and receiving either NIV or MV were all significantly linked to the devel-oping of persistent post-COVID-19 symptoms. Conclusion: Persistent post-COVID-19 symptoms are common among COVID-19 survivors. Older patients and those with co-morbidities (especially hypertension) are more liable to have PCS. Many factors including hospital admission, longer hospital stay, the need for oxygen therapy, NIV or MV are associated with persistent post-COVID-19 symptoms.
Persistent symptoms
Coronavirus disease 2019
2021
09
01
2093
2101
https://mjcu.journals.ekb.eg/article_203432_a8faef79eae7aa90c090f6a33c332de4.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Postoperative Outcome Comparison between Manual Dilatation and Lateral Internal Anal Sphincterotomy in the Treatment of Chronic Anal Fissure
Abstract Background: In latest days, medicinal cure for chronic anal fissure has replaced surgical surgery. Internal anal sphinc-ter hypertonia is an uncomfortable disorder that affects many people. This study compared the results of surgical treatment of chronic anal fissure after lateral internal sphincterotomy with manual dilatation of anus. Aim of Study: This study was aimed to contrast the out-comes of total lateral internal anal sphincterotomy and manual dilatation of anus in terms of symptoms and postoperative complications. Patients and Methods: This randomized controlled pro-spective Cohort study was conducted on 100 patients of chronic anal fissure with pain and bleeding. They were allo-cated to manual dilatation (n=50) or to lateral internal anal sphincterotomy (n=50). Results: The mean± SD postoperative pain VAS score of MAD group is higher than LAS group after 12 hours (6.72± 0.757 vs 5.46±0.579), 24 hours (3.42±0.642 vs 2.86±0.452) and 48 hours (0.50±0.544 vs 0.46±0.542). There is a notable change in postoperative pain VAS score in between MAD and LAS groups at 12 and 24 hours (p < 0.0001). Furthermore, there is no significant change in postoperative pain VAS score between the MAD and LAS groups after 48 hours (p=0.698), Conclusion: Lateral anal sphincterotomy is better than anal dilatation in the management of chronic anal fissure in terms of early symptomatic relief, shorter hospital stay and less complication rate.
Anal sphincter
chronic anal fissure
Lateral internal anal sphincterotomy
Manual dilatation of anus
2021
09
01
2103
2108
https://mjcu.journals.ekb.eg/article_203433_66902f265b2b43b6f6f0d33696a134b7.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Cost Utility of Splenic Artery Angioembolization for High-Grade Splenic Injury
HAMADA R. ABDELKADER, M.D.;
ABDELAZIZ A. ABDELHAFEZ, M.D.
AHMED
M. ELBASIOUNY, M.D.
Abstract Background: Management of blunt spleen injuries has evolved from mandatory splenectomy to non-operative man-agement (NOM) allowing for splenic salvage, Splenic artery embolization (SAE) has been shown to be an effective treat-ment for hemodynamically stable patients with high-grade blunt splenic injury. However, there are no local estimates of how much treatment costs. Aim of Study: The aim of this study was to evaluate the cost of providing SAE to patients in the setting of blunt abdominal trauma with splenic injury and to determine if the costs of an added, preventative procedure (SAE) early in management of blunt splenic injury would be offset by added utility by avoiding splenectomy. Patients and Methods: This study was a retrospective cohort study from a tertiary institution (50 patients in King Khaled Hospital Trauma Center, Hail, KSA and 9 patients in Al Hussein University Hospital, Cairo, Egypt). A total of 59 patients were treated with embolization in this period for blunt trauma, and however 39 cases were excluded given the presence of multiple concomitant injuries. Isolated splenic injury treated with SAE were identified in 20 patients and included for final analysis. Of these 10 patients, none required subsequent splenectomy following SAE. Results: The mean total angiography costs were 1837.94± 405.368 $, the costs of post-procedure management of patients including all hospital costs prior to discharge with associated length of stay. Conclusion: Splenic embolization is a low-cost procedure for management of blunt splenic injury. The cost to provide SAE at our center was much lower than previously modelled data from overseas studies. Further research is advised to directly compare the cost of SAE and splenectomy in other countries.
Splenic artery embolization
Blunt Abdominal Trauma
Non-operative management
cost
2021
09
01
2109
2115
https://mjcu.journals.ekb.eg/article_203434_f0e47d3de69a2e725cdde357058a36f8.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Clinical Factors Associated with Intestinal Strangulating Obstruction and Recurrence in Adhesive Small Bowel Obstruction
MOHAMED
IBRAHIM SHALAMESH, M.D.
Abstract Background: Post-operative adhesions are a mutualreason of small-bowel obstructions, and up to 53 percent of cases operated on for adhesive small-bowel obstructions (ASBO) face recurrences. Our study evaluated the clinical parameters accompanied with strangulating obstructions and the risk factors with ASBO rate of recurrence. Patients and Methods: A retrospective research has been carried out by the department data-base. 80 Patients with ASBO were included in the study and followed-up from January 2016 to July 2018 at Sayed Galal University Hospital. The clinical issues a companied with strangulation of obstruc-tions and recurrences after ward treating were assessed. Results: Of the 80 involved ASBO cases, the obstructions recurred in 22 patients with a rate of recurrence was 27.5% (22/288), and 6 of those 22-patients experienced repeated surgical operation [rate of re-operation 27.3% (6/22)], whereas the other 16 cases underwent conservation treatment. The rate of recurrent of the simple ASBO group was 28.6% (19/72), and the median non-recurrence period was 12.2-mths. The rate of recurrence of the strangulating obstructing group was 37.5% (3/8), and the median non-recurrence period was 11.5- mths. The alterations among the studied groups were consid-ered as non-significant (p-value=0.241). Conclusion: Four clinical factors involving leukocytosis, tachycardia, together with CT results of thickening or swelling of the mesentery and CT displaying seroperitoneum, a com-panying with incidence of intestinal strangulations in ASBO. ASBO-cases who experienced operative intervention had a decreased rate of recurrence, but ASBO-cases with strangu-lating obstructions hadn'trise therate of recurrence in compar-ison to those of cases with simple ASBO.
Adhesive small bowel obstruction
Clinical parameter
Following-up
Intestinal strangula-tion
Recurrence
2021
09
01
2117
2123
https://mjcu.journals.ekb.eg/article_203437_7e145c0e220a27111dab07df7f36e85d.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Conservative Treatment versus Surgical Treatment in the Management of Large Invasive Lobular Carcinoma
HAMADA RASHAD ABDELKADER, M.D.;
MOHAMMED MAMDOUH ASR, M.D.
Abstract Background: The safety of breast conservation therapy (BCT) has not been demonstrated in large ILC tumors, poten-tially contributing to the higher mastectomy rates seen in ILC. Aim of Study: The aim of our study was to identify patients with of breast ILC measuring 4cm and evaluated difference in recurrence free survival (RFS) between those treated with BCT versus mastectomy. Patients and Methods: This is a retrospective study of patients treated for ILC, 60 consecutive treated women with unilateral Stage I or II invasive lobular breast carcinoma were treated with axillary dissection and either mastectomy or conservative breast therapy (n=30) or BCS (n=30), they were admitted to Surgical Oncology Department and General Surgery Department Sayed Galal University Hospital, Al-Azhar University. Results: Disease free survival after 5-years was 81.3% in BCT group and 87.2% in mastectomy group, and after 10- years was 81.3% in group BCT and 72.1% in mastectomy group. Conclusion: For patients with large size ILC, BCT provides similar tumor control as mastectomy, provided that negative margins are achieved. Our findings can be used to help patients and providers make informed choices about surgical options for ILC, which currently has a higher rate of mastectomy than that of IDC.
invasive lobular carcinoma
Large tumors
Recurrence-free survival
Breast conservation surgery
mastectomy
2021
09
01
2125
2130
https://mjcu.journals.ekb.eg/article_203440_b94cd93c47a761e944fe56ff5c2fe674.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
The Toxic Effects of Methotrexate on the Cerebellar Cortex of Adult Albino Rats and the Protective Role of Vitamin C: A Light Microscopic Study
DORREIA A.M. ZAGHlOUL, M.D.;
SALWA M. OUIES, M.D.
WAIL M. GAD EL-RAB, M.D.;
AHLAM W. MOHAMED, M.Sc.
Abstract Background: Cerebellum is the region of brain responsible for multiple motor and cognitive functions. It is formed of two cerebellar hemispheres separated by fissures. It is formed of lobes, lobules and folia; each folium is formed of cerebellar cortex and medulla. Methotrexate is anti-metabolic drug used in treatment of cancer, it has neurotoxic effect, and it produces oxidative stress in nervous tissue. Vitamin C is powerful anti-oxidant; it is a powerful free radical scavenger. Aim of Study: The aim of this work is to study the toxic effects of methotrexate and the possible protective role of vitamin C. Material and Methods: In this study, 30 rats are divided in to 3 groups (Group 1) received no treatment. (Group 2) received 10mg/kg methotrexate injected intraperitoneal once time per week foe four weeks. (Group 3) received vitamin C 20mg/kg by intragastric tube every other day for four weeks and methotrexate as same dos of group 2. At the end of experiment, rats are sacrificed and cerebella are taken and processed for light microscopic examination. Results: There are histological changes in group treated with methotrexate (2) in the form of decreased thickness of granular layer. Purkinje cells shows shrinkage in cell bodies, decrease in number, lost mono laminar organization. Molecular layer showed decreased cellularity. After administration of vitamin C, these cellular changes are decreased, molecular and granular cell layer thickness are restored. Conclusion: Methotrexate is a toxic drug, it destroys the cerebellar cortex, but when administrated with vitamin C, its toxicity is decreased.
cerebellar cortex
Methotrexate
vitamin c
2021
09
01
2131
2136
https://mjcu.journals.ekb.eg/article_203442_36897f4602219a8879cb931d5c1fcf7f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Sociodemographic and Socioeconomic Factors as Determinants for the Health Related Quality of Life of Asthmatic Children and Adolescents
EMAN E. EBRAHIM, M.D.;
LUBNA M. FAWAZ, M.D.
HWAYDA Y. ABDALLAH, M.Sc.;
SARAH ALI SALEH, M.D.
Abstract Background: Asthma is the most prevalent childhood chronic disease worldwide. Although health-related quality of life (HRQoL) in asthmatic children is known to be affected by the disease severity, sociodemographic factors and socio-economic status (SES) may also play a role. Aim of Study: To study the effect of sociodemographic and economic factors on HRQoL in asthmatic children and adolescents. Patients and Methods: This was a cross sectional study during which 370 asthmatic child/adolescent and their parents were interviewed at Chest and allergy clinic and were asked to fill El-Gilany socio-economic status (SES) scale and the arabic version of Pediatric Asthma Quality of Life Question-naire (PAQLQ) then the individual and the total scores were calculated. Results: 79.5% of the participants were children less than 12 years old, 61.9% were females, 73.5% lived in rural areas, and 89.7% were of low socioeconomic class. Regarding the sociodemographic factors, there was statistical significance between the total score of Pediatric asthma quality of life questionnaire (PAQLQ) and the patient's age, residence, parents' education & occupation (p-value <0.001). Regarding the SES, there was statistical significance between PAQLQ score and the family income and the total SES sore (p-value <0.001). Conclusion: Socio demographic and economic status can be considered independent determinants of HRQoL in asth-matic children and adolescents.
bronchial asthma
Health-Related Quality of Life
socioeconomic status
2021
09
01
2137
2142
https://mjcu.journals.ekb.eg/article_203443_4e9c9a929859daa804d3e0c493730996.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Safety and Efficacy of Sacubitril/Valsartan Early Initiation in Hospitalized Patients with Heart Failure and Reduced Ejection Fraction
MOHAMMED MOANES M. MOHY EL DIN, M.D.;
EL KAFOURY A. HAMDY, M.D.
Abstract Background: Current guidelines approved Sacubitril/ valsartan as replacement therapy to angiotensin-converting-enzyme inhibitors or angiotensin-receptor-blockers for treat-ment of heart failure patients with reduced ejection fraction. Aim of Study: The study was conducted to evaluate the safety, efficacy, and tolerability of sacubitril/valsartan (S/V) initiation in hospitalized patients. Patients and Methods: This is a Prospective observational cohort study that included 191 patients who were hospitalized due to heart failure with reduced Ejection fraction (HFrEF) from March 2019 till June 2020. Sacubitril/valsartan was initiated during hospitalization and after hemodynamic stabi-lization. The study evaluated the following: Incidence of hypotensive events, the incidence of inpatient acute kidney injury and hyperkalemia, rate of discontinuation, and change in ejection fraction (EF), Brain natriuretic peptide (BNP), and N-terminal Pro-B-type natriuretic peptide (NT-pro-BNP) from baseline and after one and three months from initiation. Results: The mean age was 60.4±12.4 years and 73.8% of patients were males. Of the studied group, 92.1 % continued to take S/V, while 3.1% stopped medicine due to symptomatic hypotension, 2.6% due to financial issues, 1% due to AKI, and 1% due to hyperkalemia. After three months, only 5.8% of the patients tolerated the maximum dose (97-103) bid. For patients who continued to take S/V, there was a significant increase in EF at one- and three-month post-initiation, 28.4% vs. 33.8% & 28.4% vs. 39.4% respectively, (p < 0.001). On the other hand, there was a significant decrease in both BNP and NT-pro-BNP, (p < 0.001). Conclusions: Early initiation of sacubitril/valsartan during hospitalization is safe and tolerable with good efficacy and minimal adverse effects. Key Messages: Most hospitalized patients due to acute decompensated heart failure and reduced ejection fraction can tolerate initiation of sacubitril/valsartan after hemodynamic stabilization guided by strict blood pressure, creatinine, and potassium level monitoring.
Heart failure with reduced ejection fraction
Angiotensin receptor
Neprilysin inhibitor
Sacubitri l/valsartan
2021
09
01
2143
2149
https://mjcu.journals.ekb.eg/article_203444_1feca7b00d9be0ef3d874c33c64e75bd.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
The Role of Sphincterotomy on the Outcome of Post Endoscopic Retrograde Cholangiopancreatography Pancreatites
AMER YEHIA MOHAMED, M.D.;
MOMAMED FAKHRY MOHAMED, M.D.
OMAR
A. MAHMOUD, M. S c.
Abstract Background: Post-Endoscopic retrograde cholangiopan-creatography [ERCP] pancreatitis is one of the most frequent and feared complications following ERCP and can lead to significant morbidity as well as occasional mortality. Endo-scopic sphincterotomy is a procedure of ERCP that is either used solely for the treatment of diseases of the papilla of Vater, such as sphincter of Oddi dysfunction or to facilitate subsequent therapeutic biliary interventions such as stone extraction or stenting and decrease the possible. Aim of Study: To evaluated the effect of sphinctrotomy in reducing or increasing post ERCP pancreatits. Patients and Methods: A prospective cohort study was conducted in General surgery, Gastro-enterology and Hepa-tology Department Faculty of Medicine, Assiut University Hospital on 100 patients aged from 15 to 70 years from both sexeligible for ERCP for extraction of common bile duct stones, treatment of papillary stenosis and facilitation of endotherapy [i.e. stent placement, tissue sampling and stricture dilation] allocated into 2 equall groups [50 patients each]; group A, in which ERCP was performed with cannulation of the common bile duct and group B in which ERCP was performed with sphincterotomy. Pre-operative assessment included full history, physical examination, serum amylase and lipase and pelvi-abdominal ultrasound. Results: There were no statistically significant differences between both groups as regarding postoperative ultrasound findings and post-operative results of laboratory investigations including: Lipase and amylase. Conclusion: Sphincterotomy can be performed safely and effectively during ERCP without fear of an increased risk of post-ERCP pancreatitis.
Endoscopic
pancreatitis
Retrograde cholan- giopancreatography
Sphincterotomy
2021
09
01
2151
2156
https://mjcu.journals.ekb.eg/article_203684_f0a141b41658d3cbb07ea4d74094f599.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
The Value of CT Imaging and Psoas Muscle Index in Grading the Severity of Sarcopenia in Liver Cirrhosis Patients and its Impact on Morbidity and Mortality
HEBA KAMAL, M.D.;
NEVIEN EL-LEITHY, M.D.
Abstract Background: Sarcopenia is a common feature of malnu-trition in patient with liver cirrhosis and is widely recognized as independent predictor of poor outcome and mortality in this setting. Aim of Study: This work was conducted to assess the severity of sarcopenia in liver cirrhosis patients, by quantifying muscle mass through CT at L3 level, measuring psoas muscle volume and cross sectional area, than correlating the results with hand grip strength as representative of functional status. Patients and Methods: This study included 101 liver cirrhosis patients and 30 controls. All enrolled subjects had abdominal computed tomographic (CT) imaging at the level of L3 to calculate Psoas muscle cross sectional area, volume, and psoas muscle index (PMI) which is the sum of both RT and LT cross sectional area/height2 (m2), also hand grip strength was calculated for all patients using hand grip dy-namometry. The severity of cirrhosis was classified according to the Child-Pugh and MELD scores. Result: This was an observational prospective study including (101 liver cirrhosis & 30 controls), the mean age was 59.67 ys±8.01, cirrhotic patients were graded into three groups according to Child scoring system. Mean CT psoas volume, psoas surface area and psoas muscle index for Child (A+B) were 25.44±6.96, 7.97±2.23 & 4.58±1.21, while for Child C, were 15.85±6.02, 5.02±1.80 & 2.96±1.00. Using the FNIH (Foundation for the national Institutes of health) cuff off of hand grip (<26kg in male and <16kg in female Psoas muscle index cut off was 4.5cm2/m2. Conclusion: Psoas muscle cross sectional area, volume and index measurements were well correlated with hand grip strength and proved to be independent prognostic factor for grading sarcopenia in cirrhotic patients.
Sarcopenia
CT
Psoas muscle
Handgrip Strength
2021
09
01
2157
2168
https://mjcu.journals.ekb.eg/article_203685_4fff0be1a006d3903ce6fe87f4a569f4.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
The Adding Role and Accuracy of Chest Ultrasound and Doppler in Peripheral Lung Lesions
YOUSSRIAH Y. SABRI, M.D.;
DINA A.A. MUHAMMED, M.D.
KHALED M. HELMI EL KAFFAS, M.D.;
HEBA ALLAH H. ASSAL, M.D.
MONA A. FOUAD HAFEZ, M.D.;
SHADY N. MASHHOUR, M.D.
Abstract Background: Chest ultrasound (US) and color Doppler sonography play important roles in the diagnosis and charac-terization of different pathologies of peripheral lung lesions, especially in the emergency setting. Aim of Study: The aim of this study is to assess the role of chest US and Doppler examination in the assessment of peripheral lung lesions in comparison with chest CT, which is the gold standard for chest diagnosis. Subjects and Methods: This cross-sectional study involved 120 patients who underwent chest CT examination, full chest US, and Doppler. Results were assessed blindly and compared with CT. Results: The main lung lesions assessed by US and Doppler were lung collapse, consolidation, interstitial lung changes, and peripheral pulmonary nodules, with the estimated sensi-tivity, specificity, positive predictive value, negative predictive value, and accuracy of detection ranging from 63.9%-76.9%, 94%-95%, 79.2%-95%, 85.9%-91.5%, and 85%-93.3% re-spectively. There was a significant correlation between US and Doppler in comparison with CT. Conclusion: Chest US proved its value as a complementary tool for the diagnosis of peripheral lung lesions, with high specificity and accuracy. This finding was enforced by Doppler, history, and clinical suspicion, although the use of CT to obtain the final diagnosis would be more applicable.
Chest Ultrasound
Chest Doppler
Chest CT
Peripheral lung lesion
2021
09
01
2169
2178
https://mjcu.journals.ekb.eg/article_203686_e738c4b2008ad071136bb9702dfcfb90.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Herbs and Supplements for Liver Toxicity: A Review on Mode of Action of Herbs and Supplements on Liver Toxicity
SAHAR S. ATREES, Ph.D.;
HEBA MOHAMMED RABIA, Ph.D.
Abstract Liver diseases is a dynamic pathological condition which can be slowed down in its initial phases without proper clinical management of fibrosis Progressive liver damage may lead to cirrhosis and ultimately to liver failure or primary liver cancer which are irreversible conditions. In order to cure fibrotic damage to liver, its early stages should be the center of attention. Some supplements and complementary and alternative medicine (CAM) deserve specific mention, because of their already recognized natural way of healing and long lasting curative effects. Dietary supplements (DS) are extensive very consumed worldwide despite unproven efficacy. the true incidence of DS-induced liver injury (DSILI) is unknown, but is probably under diagnosed duo to the general belief of safety of these products, the present review is a systematic account of some herbs and supplements on both dual effects on liver (protective: Toxic), much additional work is still needed to explore mo-lecular pathways to discover potential applications of these alternative medicines.
herbs
Supplements for liver toxicity
2021
09
01
2179
2183
https://mjcu.journals.ekb.eg/article_203687_42754aafd4792fdb6ef9b8539536b34f.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Use of Multislice CT in Evaluation of Different Grades of COVID 19 Patients in Addition to Correlation with Serum Ferritin Level: A Cross Sectional Study
MENNATALLAH ELSAYED, M.D.;
MENNATALLAH ELAGUIZY, M.D.
Abstract Background: During the worldwide COVID 19 pandemic, both labs and Computed tomography play an important role as prognostic factors for disease severity. Ferritin, the cellular protein storage for iron, is an indicator for systemic inflam-mation and computed tomography shows characteristic pul-monary changes in COVID 19 patients. Aim of Study: The target of this study is to assess the role of Ferritin and computed tomography in evaluation of mild, moderate and severe COVID 19 patients and to correlate between ferritin level, CT findings and disease severity. Patients and Methods: Between first of July till end of September 2020, 75 patients (21 males and 54 females) with PCR confirmed COVID-19 infection from Cairo, Egypt, were referred for laboratory and multislice computed tomographic assessment. Results: The most prominent radiological findings in moderate and severe cases were ground glass opacities (54.2% and 89.5%), lung nodules (54.2% and 52.6%) and reticular pattern (37.5% and 52.6%) respectively. Some imaging features like ground glass opacities, interlobular septal thickening and pleural effusion with elevated ferritin levels were shown to correlate with disease severity. Conclusion: Computed tomography and serum ferritin levels have a significant role in evaluation and assessment of severity of patients with COVID 19.
COVID 19 patients
Serum ferritin level
Multislice CT
2021
09
01
2185
2196
https://mjcu.journals.ekb.eg/article_203688_641df99c0bfd161d935b7f03154d8642.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Liver Fibrosis as a Predictive Factor of Response to Pegylated-IFN/ Ribavirin Therapy in Chronic HCV Patients
WAHID DOSS, M.D.;
MOHAMED ALI SABER, M.D.
MOHAMMAD EL-SAYED, M.D.;
AHMED EL DEEB, M.Sc.
GAMAL
ESMAT, M.D.*
Abstract Background: The stage of fibrosis is a sensitive predictor of sustained virological response to Pegylated INF/Ribavirin in chronic hepatitis C. Aim of Study: To assess the value of liver fibrosis as a predictor of SVR. Patients and Methods: This study was a retrospective controlled study and was performed on a total number of 240 patients who were treated by PEG-IFN alpha/RBV for 48 weeks and fibrosis stage was done for the all patients. Results: SVR was significant high in patients with F0 and F1 fibrosis stage. Conclusion: The fibrosis stage was a strong pretreatment predictor of response to pegylated interferon and ribavirin therapy in egyptian patients chronically infected with HCV genotype 4.
HCV-Pegylated Interferon
Liver fibrosis
2021
09
01
2197
2202
https://mjcu.journals.ekb.eg/article_203689_b511801c65787bfb42092e115b191a71.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
The Role of Sonoelastography in Diagnosis and Grading of Patients with Carpal Tunnel Syndrome
MENNATALLAH ELSAYED, M.D.;
MAHMOUD A. SABER MOHAMED, M.Sc.
LAMIA M. AFIFI, M.D.;
AHMED M. WAFAIE, M.D.
Abstract Background: Carpal tunnel syndrome is a result of median nerve compression by its surrounding anatomical structures. Ultrasonographic examination of the carpal tunnel can give information regarding the anatomical abnormalities of the median nerve and carpal tunnel contents, which may result in carpal tunnel syndrome. Pathophysiology of carpal tunnel syndrome can be evaluated through assessment of the elasticity of the carpal tunnel contents using sonoelastography. The two major applications in sonoelastography are strain elastography and shearwave elastography. Aim of Study: The purpose of this study was how to analyse the potential of the greyscale ultrasound, strain elastography and shearwave elastographing in diagnosing and grading carpal tunnel syndrome with the electrophysiological results used as the diagnostic reference. Patients and Methods: Grey scale ultrasound and sonoe-lastography analysis of the participants of this study was done to 100 wrists; 50 wrists (7 males and 43 females) regarded as cases and 50 normal wrists (38 males and 12 females) regarded as controls. Age range for cases was 24 to 75 years (mean of 46.32±14.29 SD). Age range for control group was 17 to 56 years (mean of 35.04±11.64 SD). Data was presented using mean and standard deviation for quantitative variables and frequency and percentage for qualitative ones. Comparison between groups for quantitative variables was performed using Independent sample test (if 2 groups) or One-way ANOVA with post-hoc Tukey's test for pairwise comparisons (if >2 groups). Association of ordinal and quantitative variables was performed through Spearman correlation coefficients. Receiver Operating Characteristics (ROC) curve analysis was conducted to explore the discriminant abilities of different nerve conduction measures to differentiate Carpal tunnel syndrome patients from controls, in addition to selection of the most appropriate cut-off points using the Youden Index (J). p-values less than or equal to 0.05 were considered statistically significant. Results: Sonoelastography parameters were able to diag-nose carpal tunnel syndrome with variably high accuracy, with strain ratio and Shearwave elastography being the most accurate of the investigated parameters. We suggested cut off values of 1.26 and 46.95 kPa for strain ratio and Shearwave elastography respectively for the diagnosis of carpal tunnel syndrome. The forementioned cut off values produced 100%, 98% sensitivities and 100%, 98% specificities for strain ratio and Shearwave elastography respectively. As for grading, cut off values for the examined parameters that accurately repre-sents the different grades of disease severity could not be established. Conclusion: Grey scale ultrasound and sonoelastography provided significant improvement in the diagnostic accuracy in the assessment of carpal tunnel syndrome. As for grading of the severity of carpal tunnel syndrome, we recommend the implementation of further studies with larger sample volume to yield better results.
Carpal tunnel syndrome
Grey scale ultrasound
Sonoelatography
2021
09
01
2203
2211
https://mjcu.journals.ekb.eg/article_203691_6adbbb9d918a638be3feccca14dd1e2b.pdf
The Medical Journal of Cairo University
0045-3803
0045-3803
2021
89
September
Interleukin 28b Single Nucleotide Polymorphism (rs8099917) as a Predictive Factor of Response to Pegylated-IFN/Ribavirintherapy in Chronic HCV Patients
WAHID DOSS, M.D.;
MOHAMED ALI SABER, M.D.
MOHAMMAD EL-SAYED, M.D.;
AHMED EL DEEB, M.Sc.
GAMAL
ESMAT, M.D.
Abstract Background: For Interleukin 28b Single nucleotide poly-morphism (SNP) rs8099917, the favourable T allele is asso-ciated with a higher SVR after PEG-IFN alpha/RBV therapy while the G allele is a risk factor for non-response. Aim of Study: To assess the value of Interleukin 28b (SNP) rs8099917 as a predictor of SVR. Patients and Methods: This study is a retrospective con-trolled study and was performed on a total number of 240 patients who were treated by PEG-IFN alpha/RBV for 48 weeks and (SNP) rs8099917 was done for the all patients. Results: TT genotype was more prevalent in SVR group than TG and GG genotypes. Conclusion: IL-28b single nucleotide polymorphism (SNP) rs8099917 is a strong pretreatment predictor of response to pegylated interferon and ribavirin therapy in egyptian patients chronically infected with HCV genotype 4.
HCV-Pegylated Interferon
Interleukin 28b SNP rs8099917
2021
09
01
2213
2219
https://mjcu.journals.ekb.eg/article_203692_745023ef906d6bd6c82713eb5ed66074.pdf