The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Postoperative Satisfaction in Patients Undergoing Fracture Neck Femur Fixation After Continuous Facia Iliaca Block (CFIB) Versus Continuous Lumbar Plexus Block (CLPB)1125065110.21608/mjcu.2019.50651ENMOHAMMED A. HASSAN, M.D.;HALA E. MOHAMMED, M.D.The Department of Anaesthesiology, Surgical ICU and Pain Management, Faculty of Medicine, Cairo UniversityAMR Z. MANSOUR, M.D.;MOHAMMED A. MANSOUR, M.D.The Department of Anaesthesiology, Surgical ICU and Pain Management, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: It is thought that both CFIB and CLPB can decrease the length of hospital stay, morbidity and help early ambulation in patients with fracture neck of femur.<br />Aim of the Study: To compare the postoperative analgesic efficacy and opioid spare effect of continuous ultrasound-guided lumbar plexus block and fascia iliaca compartment block in patients undergoing surgery for fractured neck of femur.<br />Material and Methods: 40 patients with fracture neck femur were randomized intone of 2 blocks, CFIB and CLPB.<br />Results: CFIB was superior to CLPB in total consumed dose of morphine, sensory and motor block for 48 hours postoperatively (p=0.006), hemodynamic stability (p<0.001), incidence of side effects (p=0.04) and patient satisfaction (p=0.06).<br />Conclusion: Single injection lumbar plexus block provides postoperative analgesia for up to 18 hours, with avoidance of troubles of continuous infusion, with lower VAS scores and good patient satisfaction. However, it is considered a difficult technique with higher rate of complications and failure. On the other hand, Continuous infusion fascia iliaca block gives better quality analgesia, for up to 48 hours, and high patient satisfaction.https://mjcu.journals.ekb.eg/article_50651_0b077cc3c98f8d606bef3360c612db9a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Radiation Induced Liver Damage in Patients with Liver Cancer13185228310.21608/mjcu.2019.52283ENSARAH A. NASSAR, M.Sc.;IMAN ABD ELHADY, M.D.The Departments of Clinical Oncology* and Physics Radiation Oncology, Faculty of Medicine, Cairo UniversityASHRAF MOUNIR, M.D.;MAHA KAMALELDIN, M.D.The Departments of Clinical Oncology* and Physics Radiation Oncology**, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Assessment of toxicity of radiation therapy and factors that influence the occurance of toxicity in patients with inoperable Hepatocellular carcinoma<br />Aim of Work: To evaluate the safety of radiation therapy using volumetric modulated arc therapy in patients with inoperable Hepatocellular carcinoma.<br />Patients and Methods: Between May 2014 and April 2016, twenty five patients with inoperable Hepatocellular carcinoma and not amenable to local ablative therapies received radiation therapy using VMAT 50.4 Gy in 28 fractions. We evaluated clinical as well as dosimetric factors related to the occurrence of RILD.<br />Results: RILD occurred in 28% of the patients and the mean volume of PTV was the only factor causing statistically significant difference in the occurrence of RILD with a mean PTV volume of 620.2cc in the RILD group versus 579.7cc in the No RILD group with a p=0.028<br />Conclusion: Lowering PTV volume contributes in the prevention of occurrence of RILD.https://mjcu.journals.ekb.eg/article_52283_2a82b6a023e62efb39bb03176f1ab441.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Study of the Effect of Sedatives on Continuous Positive Airway Pressure Titration and Short Term Therapy Compliance19255229810.21608/mjcu.2019.52298ENROFAIDA E.M. EL-GENDY, M.Sc.;HODA M. BAHR, M.D.The Departments of Chest* and Neuropsychiatry**, Faculty of Medicine, Tanta UniversityMAI A. EISSA, M.D.;AHMED Sh. MOHAMED, M.D.The Departments of Chest* and Neuropsychiatry**, Faculty of Medicine, Tanta UniversityREHAM A.AMER, M.D.The Departments of Chest* and Neuropsychiatry**, Faculty of Medicine, Tanta UniversityJournal Article20181001Background: Obstructive Sleep Apnea (OSA) is the most common form of sleep disordered breathing and represents a major public health problem. It is caused by repetitive collapse of a narrow upper airway during sleep with periodic cessation of breathing (for more than 10 seconds). These events usually result in fragmented sleep, intermittent hypoxia and lead to excessive daytime sleepiness.<br />Aim of Study: We aimed to evaluate the effect of sedatives, as a method to improve over night continuous positive airway pressure titration, short-term therapy compliance, and outcomes in patients with newly diagnosed obstructive sleep apnea.<br />Patients and Methods: 40 Subjects in this randomized, double-blind, placebo-controlled trial were divided to group I received 3mg eszopiclone and group II received placebo within 60min prior to the start of CPAP titration (at lights out) and, for 2 weeks as a combined therapy with CPAP before sleep, we compared the quality of CPAP titrations and Adher-ence to CPAP (primary outcome) during the first 4 weeks of therapy between the two groups, and evaluated improvements in symptoms (secondary outcomes) after 2 and 4 weeks of therapy.<br />Results: Eszopiclone significantly improved sleep titration quality (increased sleep efficiency, increased total sleep time, decreased total arousal index, decreased CPAP pressure, decreased AHI at the highest CPAP pressure) and significantly & rapidly improved short term compliance (% of night CPAP used, mean hours/nights CPAP used, % of nights CPAP used >4 hours) and functional and behavioral outcomes, compared with placebo group.<br />Conclusion: Nonbenzodiazepine hypnotics (eszopiclone) are safe and relatively inexpensive and have the potential to improve the quality of polysomnograms or prevent studies from needing to be repeated. A short course of nonbenzodi-azepines is a simple option that may facilitate better CPAP tolerance, improve therapeutic adherence, and reduce the rate of self-discontinuation of therapy. Good CPAP adherence lead to better functional outcomes.https://mjcu.journals.ekb.eg/article_52298_3bc83f97fa5cd759e9d7d362f7e7ea2e.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Serum Clusterin as a Diagnostic Tool for HCV Related Hepatocellular Carcinoma27325229910.21608/mjcu.2019.52299ENELHAM O. HAMED, M.D.TAMER M. ABD EL-LATEF, M.D.The Department of Clinical and Chemical Pathology, Faculty of Medicine, Sohag UniversityAHMED S. MAHMOUD, M.D.KATREN Y. FAHEM, M.Sc.The Department of Clinical and Chemical Pathology, Faculty of Medicine, Sohag UniversityJournal Article20181001Abstract<br />Background: Hepatocellular carcinoma (HCC) is consid-ered one of the major malignant tumors in the world. The number of cases increases every years and HCC almost always has a fulminant course with grave prognosis.<br />Aim of Study: Was to evaluate the clinical use of serum clusterin levels as a diagnostic tool for HCC with hepatitis C virus related cirrhosis.<br />Subjects and Methods: A total of 100 subjects, 80 patients and 20 healthy controls were enrolled in this study. Patients were divided into 2 groups; group I: (30 patients) with HCV related liver cirrhosis, group II: (50 patients) with hepatocel-lular carcinoma. Serum levels of alpha fetoprotein (AFP) and clusterin (CLU) were measured. Alpha fetoprotein based on Chemiluminescent microparticle immunoassay (CMIA). Serum CLU concentration was performed using enzyme linked immunosorbent assay technique (ELISA).<br />Results: The mean values of serum clusterin increase significantly among HCC patients than controls and cirrhotic patients. The cirrhotic patients show significant decrease than controls group. The sensitivity and specificity for clusterin was 72.5% and 92% and for AFP was 77.3% and 100%, respectively. The AUC for clusterin was 0.8 (p<0.001) com-pared with 0.9 (p<0.001) for AFP. The combined parallel approach improved the diagnostic sensitivity to 96.5%. We found positive correlation between AFP and sCLU (r=0.31 and p=0.003).<br />Conclusion: Serum CLU levels should be a useful potential biomarker for HCC diagnosis.https://mjcu.journals.ekb.eg/article_52299_af604fa14de13416d00fedc5f4b17080.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Intraoperative Assessment of Ultrasound Guided Continuous Facia Iliaca Block (CFIB) Versus Continuous Lumbar Plexus Block (CLPB) in Patients Undergoing Fracture Neck Femur Fixation33405231710.21608/mjcu.2019.52317ENMOHAMMED A. HASSAN, M.D.;HALA E. MOHAMMED, M.D.The Department of Anaesthesiology, Surgical ICU & Pain Management, Faculty of Medicine, Cairo UniversityAMR Z. MANSOUR, M.D.;MOHAMMED A. MANSOUR, M.D.The Department of Anaesthesiology, Surgical ICU & Pain Management, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: In the elderly and high risk patients, it is logic to prefer local anaesthesia rather than general anaesthesia. The fascia iliaca compartment block is an easy, available method for peri-operative analgesia in patients with painful conditions affecting the thigh, the hip joint and/or the femur. Lumbar plexus block is another form of deep blocks which is used to provide anesthesia and/or analgesia for the entire distribution of the lumbar plexus.<br />Aim of Study: Intraoperative assessment of CFIB versus CLPB.<br />Material and Methods: 40 patients with fracture neck femur were randomized intone of 2 blocks, CFIB and CLPB.<br />Results: CFIB was significantly superior to CLPB as regards shorter time for catheter insertion (CIT) (p<0.001), earlier maximum motor block (p<0.001) and earlier peak of sensory block (p=0.008), intraoperative hemodynamic stability (p<0.001) while CLPB group showed significantly rapid onset of motor and sensory block (p<0.001, p<0.001).<br />Conclusion: Continuous infusion fascia iliaca block gives better quality analgesia. It is an easy procedure that could be done in the emergency room. It is faster, safer and more applicable technique than continuous lumbar plexus block.https://mjcu.journals.ekb.eg/article_52317_ced87c681b5b304e015bd6a038f705ac.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301How Far Does Residual Liver Volume Affect Portal Pressure Gradient During Donor Hepatectomy in Living Donor Liver Transplantation41445231810.21608/mjcu.2019.52318ENAHMED H. KHALIL, M.D.,M.R.C.S.; MOHAMMED KHATTAB, M.Sc.The Department of General Surgery, Faculty of Medicine, Cairo UniversityKAREEM HOSNY, M.D.;MOSTAFA EL-SHAZLY, M.D.The Department of General Surgery, Faculty of Medicine, Cairo UniversityAYMAN SALAH ELDIN, M.D.;ADEL HOSNY, M.D.The Department of General Surgery, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Living donor liver transplantation (LDLT) is now a solution for end stage liver disease, In living donors, up to 70% of the whole liver volume can be donated. Relative portal hypertension (increase of the portal pressure after donor hepatectomy as compared to the preoperative state was ob-served. Several factors affect portal pressure gradient in LDLT, we evaluate the effect of residual liver volume (RLV) on the portal pressure gradient.<br />Aim of Study: In this study we aimed to studying the correlation between portal pressure gradient and residual liver volume after donor hepatectomy in living donor liver trans-plantation.<br />Patients and Methods: This prospective study included 30 adult living donors who underwent right hepatectomy in Liver Transplantation Unit, Faculty of Medicine, Cairo Uni-versity during the period between June 2015 to October 2016. Inclusion criteria an age group from 21 to 50 years with a residual liver volume >_ 35%. Computed Tomography volum-etry was done to all donors to calculate the graft weight recipient ratio and the residual liver volume of the donor. PVP was measured intra-operatively using wide gauge cannula preclamping and postclamping of portal vein.<br />Results: The mean portal pressure before and after clamp-ing of right portal vein was 9.9mmHg and 15.23mmHg re-spectively (p<0.001). The portal venous gradient is negatively correlated with RLV (p-value 0.029).<br />Conclusion: The study has demonstrated a significant rise in PVP post clamping of right portal vein. Also, the lower the percentage of residual liver volume the higher the changes in portal venous pressure.https://mjcu.journals.ekb.eg/article_52318_b575f4157e56fe1ff45ad656ab999978.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Clinical and Radiological Predictors of Recanalization after IV rt-PA in Patients of Acute Ischemic Stroke45525231910.21608/mjcu.2019.52319ENMOHAMED M. EL-SHENAWY, M.Sc.;EL-SAYED A. TAG EL-DIN, M.D.The Departments of Neurology* and Diagnostic Radiology**, Faculty of Medicine, Tanta UniversityAZZA A. GHALI, M.D.;RASHA L. YOUNES, M.D.The Departments of Neurology* and Diagnostic Radiology**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background and Aim: Acute Ischemic Stroke (AIS) is defined as a focal neurological deficit lasting for more than 24 hours with no cause other than that of vascular origin. Stroke is the third commonest cause of mortality after cardiac disease, cancer and the first cause of disability. Current treatment for AIS includes thrombolytic drugs such as rt-PA which dissolve occlusive blood clots and reversing the ischemia in salvageable area of the penumbra adjacent to irreversible infracted area. The purpose of this study is to assess the predictors of recanalization after treatment via rt-PA.<br />Aim of Study: Was to assess the clinical and radiological predictors of the recanalization after IV thrombolytic therapy in patients of AIS.<br />Subjects and Methods: This study was conducted in the Departments of Neuropsychiatric and Radiology, Tanta Uni-versity on 25 patients of AIS in the period between August 2016 and February 2017. They were classified into 2 groups according to the successful recanalization or not. All patients were subjected to full history taking, neurologic examination including evaluation by National Institute of Health Stroke Scale (NIHSS), laboratory investigations, neuroimaging including: Computed Tomography (CT), Transcranial Doppler Ultrasound (TCD) and CT angiography which were done with follow-up 24 hours later.<br />Results: The mean age of the group of successful recanal-ization was 62.12±13 while in the group of failed recanalization was 69.21±10. Smoking and DM were significantly higher among patients with failed recanalization while cardiac prob-lems were significantly more common in patients with suc-cessful recanalization. In addition, the recanalization was associated with significant improvement in stroke severity. Distal MCA occlusion had a better chance of recanalization via rt-PA than proximal MCA occlusion.TCD had 81.25% sensitivity and 100% specificity compared to CTA.<br />Conclusion: IV rt-PA is an effective treatment of AIS. Earlier rt-PA timing of administration and lower NIHSS were significant predictors for successful recanalization. TCD is an easy, fast and feasible tool to assess the occluded vessels with near results to CTA.https://mjcu.journals.ekb.eg/article_52319_ab0e5852c4fbb6b25cedfa215d1c3bff.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Association of Insulin Growth Factor 2 Binding Protein 2 Gene rs4402960 Polymorphism with Type 2 Diabetes Mellitus in A Sample from Egyptian Patients53585232010.21608/mjcu.2019.52320ENYASSER M. ISMAEL, M.D.;SAHAR M. FAYED, M.D.The Department of Clinical & Chemical Pathology, Faculty of Medicine, Benha University, EgyptDALIA M. ABD EL-HASSIB, M.D.;BASMA G.A. BEHAIRY, M.Sc.The Department of Clinical & Chemical Pathology, Faculty of Medicine, Benha University, EgyptJournal Article20181001Abstract<br />Background: Genetic variation at the insulin growth factor 2 binding protein 2 (IGF2BP2) gene has been associated with Type 2 Diabetes (T2DM) by genome-wide association studies.<br />Aim of Study: To assess the genetic association of insulin growth factor 2 binding protein 2 (IGF2BP2) rs4402960 polymorphism with the development of type 2 diabetes mellitus in a sample from Egyptian patients.<br />Patients and Methods: 50 subjects; 30 T2DM patients and 20 healthy controls. They were subjected to: History, clinical examination, measuring glycosylated hemoglobin, lipid profile and genotyping of IGF2BP2 (rs4402960) using Taqman-based allelic discrimination technique by Real-Time PCR.<br />Results: There was significant statistical difference re-garding allele frequency of IGF2BP2 (rs4402960) as it exhib-ited an increased T allele frequency in the diabetic group while G allele was decreased compared to controls. The allelic association analysis confirmed a significant association with T2DM [OR=7.43, p=Conclusion: IGF2BP2 rs4402960 was significantly asso-ciated with increased risk of T2DM and can be used to predict the disease in Egyptian patients, and it is recommended to do this study on a large scale to confirm this association.https://mjcu.journals.ekb.eg/article_52320_b55dbb63e1fdd3d24c310e05277aa5e9.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301A Comparative Study of Immunoglobulin (E) Levels in the Nasal Mucosa and Blood in Chronic Rhinosinusitis Patients With and Without Nasal Polyps59645232110.21608/mjcu.2019.52321ENMOHAMED S.M. KASSEM, M.Sc.;EMAD M.K. SHEHATA, M.D.The Departments of Otorhinolaryngology* and Otolaryngology**, Faculty of Medicine, Tanta UniversityHASSAN M. HEGAZY, M.D.;YASSER I. AGLAN, M.D.The Departments of Otorhinolaryngology* and Otolaryngology**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Rhinosinusitis is a significant health problem, which results in a large financial burden on the society. Chronic rhinosinusitis is a multi-factorial disease. These factors are mucociliairy impairment, (bacterial) infection, allergy, asthma, genetic factors and environmental factors. Critical analysis of the papers linking atopy as a risk factor to rhinosinusitis (chronic or acute). Immunoglobulin E (IgE) levels increase when patient exposed to common antigens (e.g., house dust, animal dander and pollen) with increased production of allergen-specific IgE.<br />Aim of Study: The aim of this work is to compare the level of IgE in the nasal mucosa and blood in chronic rhinos-inusitis patients with and without nasal polyps.<br />Patients and Methods: 60 patients, presented with Chronic rhinosinusitis with and without nasal polyps were enrolled in the study. Patients were divided into two groups: (Group I) Chronic rhinosinusitis patients with nasal polyps and (group II) Chronic rhinosinusitis patients without nasal polyps. Levels of total and local IgE were measured in two groups.<br />Results: Group I show that local IgE was high than normal but total IgE was within normal range. Group II shows that local and total IgE were within normal range.<br />Conclusions: This study suggests a higher prevalence of allergy in Chronic Rhinosinusitis patients with Nasal Polyps (CRSwNP) than Chronic Rhinosinusitis patients without Nasal Polyps (CRSsNP).https://mjcu.journals.ekb.eg/article_52321_9da494c4e7ac2bffbc1d03bfeeb630eb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Endoscopic Cauterization Versus Clipping of Sphenopalatine Artery in the Management of Intractable Posterior Epistaxis65705232210.21608/mjcu.2019.52322ENIBRAHIM T. EL-SHAMY, M.Sc.;EMAD M. SHEHATA, M.D.The Departments of Otorhinolaryngology*, Audiology** and Otolaryngology***, Faculty of Medicine, Tanta UniversityMAGDY E. SAFAN, M.D.;AHMED M. GAMEA, M.D.The Departments of Otorhinolaryngology*, Audiology** and Otolaryngology***, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Endoscopic ligation of the sphenopalatine artery is a safe, simple and effective procedure in the man-agement of refractory posterior epistaxis. Both modalities (cauterization, clipping) show good efficacy in controlling posterior epistaxis with slight advantage of clipping that it showed less post-operative complications.<br />The Aim of study: This work was to compare the efficacy of endoscopic sphenopalatine artery cauterization versus clipping in the management of intractable posterior epistaxis.<br />Patients and Methods: Forty patients were selected for this prospective study in the period between October 2016 to April 2017 at Otolaryngology Department, Tanta University Hospital complaining of recurrent epistaxis (26 males and 14 females). The patient ages ranges between 18-60 years. We selected patients who didn't have history of sinonasal trauma, tumours or bleeding disorders. Twenty patients of the study had an endoscopic sphenopalatine artery clipping, the other twenty had sphenopalatine artery cauterization. The choice between the two surgical techniques has been randomized and all patients have been operated by the same doctor.<br />Results: Among the first group who had SPA cauterization 5 patients had recurrent epistaxis in the 4th, 5th, 6th, 8th day and after 1 month respectively thus success rate among this group is 75%. Two patients in the group who had sphenopal-atine artery clipping had recurrent epistaxis in the 6th and 7th day with success rate 90%.<br />Conclusions: Both modalities (cauterization, clipping) show good efficacy in controlling posterior epistaxis with slight advantage of clipping that it showed less post-operative complications.https://mjcu.journals.ekb.eg/article_52322_ac5dc4160fc89790f6353b3f632d4848.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Histopathological and Immunohistochemical Study of the Prognostic Significance of Cox2 and CDX2 Expression in the Available Cases of Colorectal Carcinoma71805232310.21608/mjcu.2019.52323ENHEND A. EL-REFAEY, M.Sc.;ASMAA E. BEDEER, M.D.The Department of Pathology, Faculty of Medicine, Tanta UniversityHASSAN T. SHOEIR, M.D.;HUSSEIN M. GHORABA, M.D.The Department of Pathology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Colorectal cancer is the third most common cancer worldwide. In Egypt, the relative frequency of colorectal cancer is about 9-12% with high male predominance 3:1. Several proteins are associated with the development and progression of colorectal cancer including Cox2 and CDX2 proteins. However, it is still controversial whether Cox2 and CDX2 expression can be regarded as prognostic factors for colorectal cancer patients.<br />Aim of Study: The purpose of this study is to detect the immunohistochemical expression of Cox2 and CDX2 in colorectal carcinoma and correlate their expression with the available clinicopathological parameters to illustrate their prognostic role.<br />Material and Methods: Fifty cases of colorectal carcinoma in colectomy specimens were collected retrospectively. They were stained by H & E, Cox2 and CDX2 for immunohisto-chemical study. The relations between their expression and the available clinicopathological parameters were evaluated.<br />Results: Cox2 expression in colorectal carcinoma showed statistically significant relation with depth of tumor invasion, lymph node status, distant metastasis and tumor stage. CDX2 expression showed statistically significant inverse relation with histopathological grade, depth of tumor invasion, lymph node status, distant metastasis, tumor stage and vascular invasion. There was statistically significant relation between the immunohistochemical expression of Cox2 and CDX2 in colorectal carcinoma.<br />Conclusions: Expression of Cox2 and loss of CDX2 are usually related to poor outcome and metastasis in colorectal cancer.https://mjcu.journals.ekb.eg/article_52323_9fbae6843abecd182f641d54fa662caa.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Efficacy of Adding Post-Training Nordic Exercises to Hamstring Injury Prevention Program in Soccer Players81865232410.21608/mjcu.2019.52324ENHEND ADEL DORGHAM, M.Sc.;MOHSEN MOHAMED EL-SAYYAD, Ph.D.The Department of Basic Science, Faculty of Physical Therapy, Cairo UniversityAHMED EBRAHIMEL-ERIAN, Ph.D.The Department of Basic Science, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: Hamstring injuries represent about 50% of non-contact football muscle injuries, with recurrence rate 12- 33%, even with preventive procedures.<br />Aim of Study: To investigate the effect of Nordic Exercise post training for the hamstring initial injury prevention.<br />Subjects and Methods: In this randomly controlled trial study, 34 professional football players randomly assigned into two groups, 17 players in each group, with age range 21-35 years old. Group A (experimental): Subjects performed pre and post training Nordic Hamstring Exercise (NHE) while in Group B (control) they performed only the pre training NHE. The duration of therapeutic intervention in both groups was 12 weeks and was performed beside the normal warming up and cooling down.<br />Method of Evaluation: Arabic version of Australian Foot-ball association injury form was used to collect the injuries incidence for each subject in both groups.<br />Results: At the end of the therapeutic intervention, the mean of total risk time was 116.3±13.2 and 117.6±5.7 exposure hours for group A and B respectively, the experimental group showed reduction in the total number of injuries by 95% than last season, also the incidence of initial injury in group A was 92% less than which in last season while in group B it was 80% less than last season.<br />Conclusion: The pre and post NHE was more effective in reducing the initial hamstring injury rates in professional football players than the pre NHE alone.https://mjcu.journals.ekb.eg/article_52324_b67a4a8731f4ca2cc31ad1d02c26501a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Evaluation of the Results of Supermaximal Monocular Recession-Resection Operations for Large-Angle Sensory Exotropia87925232510.21608/mjcu.2019.52325ENDOAA AHMED NAIEM, M.B.B.Ch.;HEBA MOHAMMED SHAFIK, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityMOHAMMED ASHRAF EL-DESOUKY, M.D.;AHMED LOTFI ALI, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: In sensory exotropia with large distant angle (>40 PD) there is usually preference to operate on the poorly seeing eye to spare the sound eye.<br />Aim of Study: To evaluate the results of monocular super maximal recession and resection operations performed on the poorly seeing eye.<br />Patients and Methods: The study was carried out in Ophthalmology Department, Tanta University Hospital includ-ed 30 patients had large angle sensory extropia (40 to 120 PD). We underwent full history taking, and required clinical ophthalmological and general examination.<br />Operations and Follow-up: Lateral rectus recession ranged from 7 to 11mm and medial rectus resection ranged from 5 to 9mm. Postoperatively, follow-up was carried out after 1 week, 1, 3 and 6 months.<br />Results: Post operative persistently narrowed palpebral fissure was observed in 4 patients (13.3%), while transient (for 3 months) limitation of abduction was observed in 4 patients (13.3%). Postoperative orthotropia occurred in 23 cases (76.7%) while residual exotropia was observed in 7 cases. After 6 months of follow-up recurrence occurred in 20%. The operation was considered totally successful in 18 patients (60%) who were with no residual exotropia, no recurrence, no persistent palpebral fissure narrowing, and no persistently limited abduction. Our patients' satisfaction had been obtained in 26 patients (86.7%).<br />Conclusions and Recommendations: Monocular super maximal recession/resection operations on the affected eye could be a suitable decision in large angle sensory exotropia with acceptable rate of success and disfigurement and recur-rence rates. More studies are recommended on larger numbers of patients and with longer period of follow-up. Also super maximal recession/resection operations can be tried on patients with large angle sensory esotropia.https://mjcu.journals.ekb.eg/article_52325_f354eb35ce8da196f306e522767d6225.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Comparative Study of Ondansetron, Haloperidol or Midazolam in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Gynecological Operations93985232610.21608/mjcu.2019.52326ENSHERIEN Z. MOHAMMED, M.Sc.;AMR A.M. ABD AL-FATAH, M.D.The Department of Anesthesia, Damanhur National Institute of Health, Alexandria University* and The Department of Anesthesiology & Surgical Intensive Care, Faculty of Medicine, Tanta University**GHADA F. AL-BARADEY, M.D.;SALAH EL-DEEN I. AL-SHERIEF, M.D.The Department of Anesthesia, Damanhur National Institute of Health, Alexandria University* and The Department of Anesthesiology & Surgical Intensive Care, Faculty of Medicine, Tanta University**Journal Article20181001Abstract<br />Background: Post-Operative Nausea and Vomiting (PONV) is a common, undesirable effect after surgery per-formed under general anesthesia.<br />Aim of Study: The aim of this study is to compare the effect of ondansetron, haloperidol or midazolam in the pre-vention of PONV in non-smoker females undergoing laparo-scopic gynecological operations under general anesthesia.<br />Patient and Methods: This prospective randomized con-trolled study carried out in Tanta University Hospital for six months (from November 2016 to April 2017). This study included 90 nonsmoker female patients, aged between 18 and 60 years, ASA I & II, scheduled for laparoscopic gynecological operations under general anesthesia. The anesthetic technique, drugs, monitoring, and care were standardized in all the patients during the perioperative period. Patients were ran-domly allocated to one of three groups (n=30 for each group): Group I ondansetron (O) 4mg I.V ondansetron was given at the end of surgery. Group II haloperidol (H) 1mg I.V haloperi-dol was given at the end of surgery. Group III midazolam (M) 2mg I.V midazolam was given 30 minutes before the end of surgery. Dexamethasone 4mg was added to each study group after induction of anesthesia. For the first 24 hours after anesthesia, the presence or absences of nausea, vomiting or retching were recorded. Rescue antiemetic was given if the patient complains of PONV.<br />Results: Mean response during 0-24 hours was 86.7%, 80%, 83.3% in ondansetron, haloperidol and midazolam groups, respectively. No significant difference through the three groups was found. (p-value=0.787). Regarding rescue antiemetics, there was no statistically significant difference between the three groups. Upon arrival to PACU and after 60 minutes, there was no statistically significant difference in sedation score.<br />Conclusion: In the studied surgical population, the efficacy and toxicity of post-operative nausea and vomiting prophylaxis with haloperidol 1mg or midazolam 2mg were not significantly different from ondansetron 4mg.https://mjcu.journals.ekb.eg/article_52326_7a19f85c678ee2b9da714ae6c86addd4.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Safety and Efficacy of Supracostal Approach for Percutaneous Nephrolithotomy (A Prospective Study)991055232710.21608/mjcu.2019.52327ENMOHAB M. ELIBA, M.Sc.;KARIM S.M. SAAD, M.D.The Department of Urology, Faculty of Medicine, Tanta UniversityAHMED S.H. EL-ABD, M.D.;MOHAMED O. ABU-FARHA, M.D.The Department of Urology, Faculty of Medicine, Tanta UniversityOSAMA M.EL-GAMAL, M.D, F.R.C.S.The Department of Urology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: The management of large kidney stones is still one of today's topics in endourology. Supracostal Percu-taneous Nephrolithotomy (PCNL) is found to be a highly effective procedure in treatment of renal calculi. However, many factors are affecting the safety and efficacy of the procedure.<br />Aim of Study: The aim of this study was to evaluate the factors that affect the safety and efficacy of supracostal PCNL in kidney stones.<br />Patients and Methods: Fifteen patients with renal calculi underwent supracostal percutaneous nephrolithotomy either with single access or multiple accesses. Pre-operative, operative and post-operative data were reported. Multivariate analyses as well as univariate analyses were used to investigate the effects of different variables on residual stones and blood transfusion rate. These factors include age, sex, laterality, body mass index, history of ipsilateral open renal surgery, operative time, and stone density.<br />Results: The study included 15 patients with mean stone size is 2.5cm±0.6, all stones were radiopaque with mean HFU 969±134, R, 4 patients had upper calyceal stone (26.7%), 9 patients had stone pelvis and upper calyx (60%), and 2 patients had complex stone. (13.3%), 9 patients had multiple kidney punctures (60%) and 6 patients had single kidney puncture (40%), one case had positive signs of hydrothorax intraoper-atively (6.7%) by fluoroscopy, one case had pelvic perforation (6.7%), mean operative time was 105 minutes ±0.23, post-operative chest X-ray revealed positive signs in 2 cases (13.4%) with mild symptoms and needed no intervention, 1 case had significant post-operative bleeding (6.7%) and needed blood transfusion, mean hospital stay time was 2.7 days ±1.8, residual stones were encountered in 4 cases (27%).<br />Conclusion: Supracostal PCNL is a safe and effective procedure for kidney stones more than 2cm. The stone free rate in the study was related mainly to patient’s comorbidities like BMI, stone size and site. Chest complications needed intervention in only one case, later on was completely free.https://mjcu.journals.ekb.eg/article_52327_0a9ca16310805ad1af7db1a66cd109ef.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Perioperative Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide (NT- proBNP) Level in Patients Undergoing Open Heart Surgery1071115232810.21608/mjcu.2019.52328ENAHMED M.M. HAMED, M.Sc.;MOHAMED M. ABO EL-NASR, M.D.The Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta UniversityEL-ATAFY E. EL-ATAFY, M.D.;ABD EL-HADY M. TAHA, M.D.The Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: In this article, we examined the relationship between the pre- and postoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and occurance of complications in patients undergoing open heart surgery.<br />Aim of Study: To find out the prognostic value of NT-proBNP as a valuable marker in predicting postoperative myocardial insult, short term outcome in patients undergoing open heart surgery and evaluate the independency of this biomarker.<br />Patients and Methods: It was carried out on 105 patients who had cardiac surgery in our department from April 2016 to August 2017. All patients had preoperative and postoperative ECG, Echocardiography and full investigations. Venous blood samples were drawn for estimation of serum level NT-pro BNP by ELISA one hour prior to the operation and 24 hours after the operation. Intraoperative and postoperative data include cardiopulmonary bypass time, aortic cross clamping time, requirement for cardiac support immediately after the operation, ICU and hospital stay and occurance of postoperative complications.<br />Results: There was highly statistically significant differ-ence between preoperative and postoperative NT-proBNP (p<0.001). Also, we found a significant relation between postoperative NT-proBNP and need of inotropes immediately after operation (p=0.035). Patients who had prolonged ICU stay and hospitalization had significantly higher postoperative NT-proBNP levels with (p<0.001) and (p=0.009) respectively. Our results showed that there was a significant relationship between postoperative NT-proBNP and most of postoperative complications (p<0.001).<br />Conclusion: NT-proBNP levels strongly correlated with postoperative complications, suggesting its value as a useful prognostic predictor after cardiac surgery which can predict early outcome after cardiac surgery. NT-proBNP levels may be an option when an echocardiogram is not feasible and inotropes may be needed, especially if these levels can be measured in the patient's bed. So, NT-proBNP may become a clinical routine biomarker capable of predicting patients' perioperative and early postoperative risk because of it is convenient, quick and not expensive. The quantitative cut-off values may be used by physicians in their decision to delay heart surgery in order to further ameliorate the patient.https://mjcu.journals.ekb.eg/article_52328_71b754c98968aac5e594a28fdd859164.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Study of Endometrial Spiral Arteries by Transvaginal Color Doppler Ultrasonography in Assessment of Patients with Dysfunctional Uterine Bleeding1131165232910.21608/mjcu.2019.52329ENMOHAMED A.W. ABOURADY, M.B.B.Ch.;AMAL E. MAHFOUZ, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta UniversityAHMED H. ABOU FREIKHA, M.D.;HESHAM M.E. BORG, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Abnormal Uterine Bleeding (AUB) is a common problem. Abnormal uterine bleeding includes both dysfunctional uterine bleeding and bleeding from structural causes. Dysfunctional Bleeding (DUB) can be anovulatory, which is characterized by irregular bleeding, or ovulatory, which is characterized by heavy but regular periods (i.e., menorrhagia). In the past, D & C was considered as the gold standard to exclude endometrial pathology. Transvaginal Sonography (TVS) is relatively cheap, needs no anesthesia and being non-invasive, it can be the first diagnostic step in evaluation of DUB as it measures endometrial thickness and exclude organic causes. Over recent years, Color Doppler Sonography (CDS) have been started to be used to predict endometrial pathologies. CDS, a noninvasive and simple tool, is useful indistinguishing endometrial lesions, helps to decide what is necessary for invasive tests and plans the invasive method to be chosen.<br />Aim of Study: To investigate the diagnostic value of blood flow measurements in spiral artery by transvaginal Color Doppler Sonography (CDS) in predicting different endometrial pathologies in patients having dysfunctional uterine bleeding.<br />Patients and Methods: Fifty patients aged between 20 & 39 years presenting with dysfunctional uterine bleeding and requiring endometrial assessment were included in this pro-spective observational study. Endometrial thickness was recorded. Pulsatility Index (PI) and Resistive Index (RI) of the spiral artery were measured by transvaginal CDS. En-dometrial sampling was performed for all subjects. Sonographic and histopathologic findings were compared.<br />Results: The histopathological diagnoses were as follows; 22 cases (44%) secretory endometrium, 18 cases (36%) proliferative endometrium, 5 cases (10) mixed proliferative and secretory endometrium, 5 cases (10%) endometrial hy-perplasia. There was statistically significant difference between spiral artery RI & PI and histopathological results.https://mjcu.journals.ekb.eg/article_52329_9576adfb88a956d3fc0ad45fd87ea2e0.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Antiepileptic Drugs on Plasma Carnitine Level in Children with Idiopathic Epilepsy1171215233010.21608/mjcu.2019.52330ENAHMED M. EL-NINY, M.Sc.;SAHAR A. ABD EL-AZIZ, M.D.The Department of Pediatrics, Faculty of Medicine, Tanta UniversityKHALED T. MUHAMMAD, M.D.;HESHAM A. EL-SOROGY, M.D.The Department of Pediatrics, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Prolonged antiepileptic drugs treatment can result in secondary carnitine deficiency. Clinical studies indicate a decrease in total and free plasma carnitine level in children treated with old antiepileptic drugs especially val-proate.<br />Aim of Study: Was to evaluate the plasma carnitine level in children with idiopathic epilepsy treated with old antiepi-leptic drugs (valproate and carbamazepine) and new antiepi-leptic drugs (leviteracetam and oxcarbazepine).<br />Patients and Methods: This study was a prospestive study including 50 patients with newly diagnosed idiopathic epilepsy classified into four groups according to their antiepileptic drug treatment into: Group 1, 20 patients received valproic acid. Group 2, 10 patients treated with carbamazepine. Group 3, 10 patients treated with leviteracetam. Group 4, 10 patients treated with oxcarbazepine. The study was carried out in duration of 1 year from January 2017 to January 2018.<br />Results: There was significant difference between mean plasma level of carnitine in children treated with valproate and the controls. There was inverse correlation between the duration of treatment with valproate and the mean plasma carnitine level. There was inverse correlation between the level of valproate and the mean plasma carnitine level. The higher the level of valproic acid, the more significant decrease in the mean plasma carnitine level.<br />Conclusion: Valproic acid was the only antiepileptic drug reported to cause carnitine deficiency. Also this study showed inverse correlation between plasma carnitine level and duration of treatment with valproic acid. The longer the duration of treatment, the more significant decrease in mean plasma carnitine level. Also, there was inverse correlation between the level of valproate and the mean plasma carnitine level. The higher the level of valproic acid, the more significant decrease in the mean plasma carnitine level.https://mjcu.journals.ekb.eg/article_52330_a6a71db3c7e59935b3cc4a38c3ff6406.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Study of Serum Betatrophin Level as A Novel Endocrinal Regulator Involved in Diabetic Nephropathy Development1231305233110.21608/mjcu.2019.52331ENGEHAD A.A. GOMA, M.Sc.;HESHAM A. EL-SROUGY, M.D.The Departments of Clinical Pathology* and Internal Medicine**, Faculty of Medicine, Tanta UniversityGAMAL F.M. EL-NAGAR, M.D.;SARAH A. HAMAM, M.D.The Departments of Clinical Pathology* and Internal Medicine**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction and failure of various organs. Diabetic Nephrop-athy (DN) is the leading cause of chronic kidney disease which ultimately progresses to end stage renal disease. There-fore, early diagnostic markers for predicting and monitoring the progression of DN are needed to enable the timely admin-istration of the mostly appropriate protective treatments, we hypothesized that betatrophin may be a novel endocrine regulator involved in DN development.<br />Aim of Study: It was to examine circulating betatrophin level in patients with type 2 diabetes mellitus with or without diabetic nephropathy in comparison with healthy controls.<br />Patients and Methods: The study was carried out on forty patients with type 2 diabetes mellitus. They were recruited from internal Medicine Department of Tanta University Hos-pital who classified into, 20 type 2 diabetic patients without nephropathy. 20 type 2 diabetic patients with nephropathy. Another twenty apparently healthy subjects were chosen from outpatient clinics of Tanta University Hospital and served as control group. This study was carried out from June 2016 to May 2017. An approval by Ethical Committee of Tanta Uni-versity Faculty of Medicine was obtained. They were subjected to thorough history taking, clinical examination including anthropometric measurements (sex, age, BMI) and laboratory investigations including glycated Hb, fasting and post prandial blood glucose, liver function tests, UACR, kidney function, lipid profile, serum betatrophin estimation by ELISA.<br />Results: Betatrophin was significantly higher in both T2DM with nephropathy and T2DM as compared to control group and significantly higher in T2DM with nephropathy than T2DM. There was significant positive correlation between betatrophin hormone and HbA1c, BMI, serum total cholesterol, serum triglycerides, LDL and negative correlation with HDL in both T2DM group and T2DM with nephropathy group. There was positive correlation between betatrophin and Albumin/Creatinine Ratio (ACR) in T2DM with nephropathy group.<br /> Conclusion: There was no significant correlation between betatrophin and Albumin/Creatinine Ratio (ACR) in T2DM group, while there was positive correlation between betatrophin and ACR in diabetic nephropathy group. Thus, betatrophin may be a novel endocrinal regulator involved in diabetic nephropathy development.https://mjcu.journals.ekb.eg/article_52331_4a89e574d25af5431d5b041a92ed2bdb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Dexmedetomidine Versus Neostigmine in Addition to Bupivacaine for Caudal Analgesia in Pediatrics Undergoing Congenital Inguinal Hernia Repair1311385233210.21608/mjcu.2019.52332ENHANI M. OMAR, M.Sc.;LOBNA M. ABO EL-NASR, M.D.The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta UniversityASHARF E. EL-ZEFTAWY, M.D.;GEHAN M. EID, M.D.The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Post-operative pain management in children is a necessity for both medical and ethical reasons. Caudal block is one of the oldest and the most popular regional block in pediatric anesthesia. Dexmedetomidine is a specific a2 adrenergic receptor agonist with sedative, anxiolytic, and analgesic properties. Respiratory depression, sedation and pruritis ascribed to the use of caudal opioids are not encoun-tered with neostigmine.<br />Aim of Study: Our aim is to compare the effect of dexme-detomidine versus neostigmine in addition to bupivacaine for caudal analgesia in pediatrics undergoing congenital inguinal hernia repair.<br />Methods and Material: This study was carried out on 90 children, 1-6 years, ASA I-II, scheduled for congenital inguinal hernia repair. Patients were randomly classified into 3 equal groups, 30 patients each, caudal block with a total volume of 0.5ml/kg Group I: Bupivacaine 0.25%, Group II: 0.25% bupivacaine and dexmedetomidine 2mg/kg and Group III: 0.25% bupivacaine with neostigmine 2mg/kg in. HR, MAP and SpO2 were recorded at baseline & 15 (5 minutes after caudal), 25, 35, 45, 60min after induction of anesthesia & 5, 30, 60 & 120min after recovery. Pain score was recorded at 1, 2, 4, 6, 24hr after recovery using the FLACC Behavioral Scale, number of patients who needed rescue analgesia in the 1st 24hr' post-operative. Rescue analgesia was administered at FLACC score £4, total amount of acetaminophen within the 1st 24h, time till administration of first rescue analgesia & any undesirable side effects.<br />Results: HR and MAP were statistically non-significant difference in the three groups, but it was statistically significant difference between the pre-operative HR and MAP and at 25min. FLACC behavioral pain score & total does of analgesia was significantly lower in group II than in group III than in group I. The time of first rescue analgesia was earlier in group I than in group III than in group II.<br />Conclusions: Addition of dexmedetomidine or neostigmine to bupivacaine in a dose of 2mg/kg results in superior analgesia than bupivacaine alone. But dexmedetomidine had better analgesic effect than addition of neostigmine to bupivacaine.<br /> https://mjcu.journals.ekb.eg/article_52332_2038b29c40708d3ab74e0ceb7fb7bcd2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Marker of Disease Activity in Rheumatoid Arthritis1391455233310.21608/mjcu.2019.52333ENREHAB M. HELAL, M.Sc.;MOHAMMED H. EL-NAGGAR, M.D.;The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityMOHAMED K. ZAHRA, M.D.;NASHWA M. ABO EL-NASR, M.D.The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: RA is a chronic disease that carries a sub-stantial burden for both the individual and society. The indi-vidual burden results from musculoskeletal deficits, with attendant decline in physical function, quality of life, and cumulative comorbid risk. The socioeconomic burden, aside from major direct medical costs, is a consequence of functional disability, reduced work capacity, and decreased societal participation. Efforts to establish the diagnosis early, initiate treatment promptly, and design novel treatment strategies to control inflammation and reduce or prevent consequent damage are paramount.<br />Aim of Study: Is to evaluate the Neutrophil-Lymphocytic Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) as markers of disease activity in rheumatoid arthritis.<br />Methods: This study included 50 patients with rheumatoid arthritis divided into three groups; group 1 including 30 patients with clinically active disease, group 2 including 20 patients without clinical activity and group 3 including 20 apparently healthy age and gender matched volunteers as controls. CBC, ESR, CRP, Anti-CCP, RF were done to all participants.<br />Results: The NLR and PLR of RA patients was signifi-cantly higher compared to that of the controls. Furthermore, a significant correlation between NLR and the DAS 28 score was observed.<br />Conclusion: NLR and PLR is a promising markers in the assessment of RA disease activity.https://mjcu.journals.ekb.eg/article_52333_05ed4b05612951310435dfb5dbefb0ec.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Frequency of Spontaneous Bacterial Peritonitis in Patients of Liver Cirrhosis with Ascites at Tanta University Hospitals1471525233410.21608/mjcu.2019.52334ENSHEREEN A. ABOGALALA, M.Sc.;MUHAMMAD T. ABD EL-GHAFAR, M.D.The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityABDALLAH A. EL-SAWY, M.D.;MABROUK R. AL-SHEIKH, M.D.The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Liver cirrhosis represents one of the major causes of death worldwide. Many complications can be de-tected in liver cirrhosis. Among these complications is ascites which seems to be the most frequent one. Patients with cirrhosis and ascites show a higher susceptibility to bacterial infections mainly because of the inadequate defense mecha-nisms. In those patients, the most frequent infectious compli-cation that occurs and at the same time the most severe one is spontaneous bacterial peritonitis.<br />Aim of Study: To identify the frequency of spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites at Tanta University Hospitals.<br />Patients and Methods: This study included three hundred patients with liver cirrhosis and ascites. Data were collected including; clinical, demographic and laboratory data. Ascitic fluid analysis and/or culture were done for diagnosis of SBP. Statistical analysis was carried out for all collected data using IBM & SPSS Version 20. Statistical significance was deter-mined at a p-value <0.05.<br />Results: The frequency of spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites at Tanta University Hospitals represented by 41.7%.<br />Conclusions: The frequency of spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites at Tanta University Hospitals represented by 41.7% of the collected cases.https://mjcu.journals.ekb.eg/article_52334_f13167167daa5de3e1f7a27f07b8a433.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Role of Magnetic Resonance Imaging in Assessment of Pancreatic Iron Overload in Pediatric Beta-Thalassemic Major Patients1531595233510.21608/mjcu.2019.52335ENMOHAMED A. YOUSEF, M.D.;IBRAHIM M. BADRAIA, M.D.The Departments of Radiodiagnosis* and Pediatrics**, Faculty of Medicine, Tanta UniversityMOHAMED M. ALASHWAH, M.D.;MEREHAN M. AHMED, M. S C.The Departments of Radiodiagnosis* and Pediatrics**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Thalassemia patients have diabetes mellitus subaltern to hemosiderosis.<br />Aim of Study: To asses iron overload in pancreas of pediatrics beta-thalassemia major patients by T2*-Gradient-echo Magnetic Resonance Imaging (MRI) and to study corre-lation of results of data of MRI with affection with diabetes, serum ferritin level, hepatic hemosiderosis, and spleen removal.<br />Methods: 20 (3-thalassemia major patients with regular blood transfusion (11 males and 9 females) follow-up at the Hematology Clinic, Children's Hospital, Tanta University.<br />Results: Striking reduction in hepatic and pancreatic Signal Intensity Ratio (SIR) was appeared in thalassemic patients contrasted with controls (p<0.001), Thalassemic patients with anomalous glucose tolerance; demonstrating a more level of secondary hemosiderosis in the form of low signal intensity of pancreas and liver tissue contrasted with thalassemics with typical glucose tolerance or controls (p<0.001). Thalassemic patients with surgically removed spleen had essentially bring down SIR of pancreas contrasted with intact spleen patients (p<0.047). A solid connection was available amongst hepatic and pancreatic siderosis in examined patients (p<0.003).<br />Conclusions: T2* GRE MRI assume a vital part in detec-tion of iron over-burden in B thalassemic patients, and was more obvious in patients with unusual glucose tolerance. After spleen removed, iron deposition might be more out of control in the pancreas. We prescribe serious chelation system to thalassemic patients generally and more in thalassemic patients with IGT with regular follow-up by susceptibility weighted sequences of magnetic resonance imaging.https://mjcu.journals.ekb.eg/article_52335_5ebb3ae61241981bd7413b1100c3ca06.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Early Prediction of Functional Outcome after Cerebral Small Arteries Infarctions Using Diffusion Tensor MRI Tractography1611685233610.21608/mjcu.2019.52336ENYASMEEN I. EL-SAYED MABROUK, M.Sc.;RASHA A. EL-SHAFEY, M.D.The Department of Diagnostic Radiology, El-Menshawy General Hospital*,
The Departments of Diagnostic Radiology** and Neurology***, Faculty of Medicine, Tanta UniversityWAFIK S. BAHNASY, M.D.;MAHMOUD A. DAWOUD, M.D.The Department of Diagnostic Radiology, El-Menshawy General Hospital*,
The Departments of Diagnostic Radiology** and Neurology***, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Lacunar Infarctions (LIs) are ischemic strokes caused by occlusion of the deep penetrating arteries. They constitute about 25% of all ischemic strokes and have variable consequences based on affected tracts disruptions.<br />Aim of Study: Were to assess the role of MRI Diffusion Tensor Imaging (DTI) fiber tractography as an early biomarker of LIs prognosis.<br />Patients and Methods: This work was conducted on 42 first-ever symptomatic motor or sensorimotor LIs patients (3 1 male and 11 female) submitted to stroke severity assess-ment using the National Institute of Health Stroke Scale (NIHSS), carotid duplex, brain MRI to determine LIs dimeter and occult small vessel disease imaging markers. Corticospinal Diffusion Tensor Tractography (CS-DTT) was done within 48 hours from stroke onset. Thirty-eight patients continued a 3-months follow-up schedule, at the end of which their physical dependences were assessed using the Modified Barthel Index (MBI) scale which were compared with the baseline assessment parameters to determine the prognostic biomarkers.<br />Results: Dependent patients' group showed significant increase in their age, BMI, carotid intima media thickness and white matter hyperintensities grade than independent patients' group. The FA ratio was the earliest parameter showed significant changes which were lower in dependent than independent patients' groups. On the other hand, each of ipsilateral DTI fractional anisotropy, mean diffusivity and fiber number showed non-significant differences.<br />Conclusion: Factors associated with poorer functional outcome after newly diagnosed LIs include advanced age, hypertension, obesity, premorbid physical inactivity, increased CIMT and the presence of imaging biomarkers of occult SVD. Reduced ipsilateral/contralateral FA ratio of the CS-DTT is a reliable early predictor of short-term functional outcome and motor disability after motor and sensorimotor LIs.https://mjcu.journals.ekb.eg/article_52336_69c8673d50153a49fbd154d57aa476c7.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Prospective Randomized Controlled Study Evaluating Efficacy of Alpha-Blockers, Antimuscarinics or Combination Therapy in Relieving Ureteral Stent-Related Symptoms1691745233710.21608/mjcu.2019.52337ENMOHAMED S. EL-DANEEN, M.Sc.;AHMED F. GHAITH, M.D.The Department of Urology, Faculty of Medicine, Tanta University, Tanta, EgyptMAGED M. RAGEB, M.D.;ABD EL-NASER K. EL-GAMASY, M.D.The Department of Urology, Faculty of Medicine, Tanta University, Tanta, EgyptJournal Article20181001Abstract<br />Background: Double-J ureteral stent placement is a routine urologic procedure after most of urological interventions. Great efforts are being done to decrease stent symptoms including; improving stent materials, physical properties, and design. Also the application of a combination of alpha-blockers and antimuscarinics are used in our study.<br />Aim of Study: We evaluated the effectiveness and safety of tamsulosin, solifenacin, and combination of both in reducing double-J stent-related lower urinary symptoms.<br />Patients and Methods: A total of 120 patients with double-J ureteral stenting were randomly divided, post-operatively, into 4 groups. In Group A (n=30), tamsulosin 0.4mg was given, Group B (n=30) received solifenacin 10mg daily, Group C (n=30) received solifenacin 10mg and tamsulosin 0.4mg daily, and Group D (n=30) received placebo (control group). Two weeks after discharge was the first time of evaluation (pre-treatment assessment), using an arabic validated version of USSQ. The second visit was after 4 weeks from surgery just before stent removal (post-treatment assessment).<br />Results: There were statistical significance in urinary symptoms, pain, general health and work performance scores in favour of Group III as compared to the tamsulosin group, the solifenacin group, and the control group (p-value <0.001).<br />Conclusion: Combined therapy of tamsulosin and solif-enacin significantly alleviated symptoms associated with double-J stents as compared to either medication alone.https://mjcu.journals.ekb.eg/article_52337_138c84af615faebeeddc309752ccfccb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Evaluation of Relationship between Nonalcoholic Fatty Liver and Coronary Artery Disease Severity by Multidetector Computed Tomography1751825233810.21608/mjcu.2019.52338ENAMIRA A. KHEDR, M.Sc.;TAYMOUR M. ABDALLAH, M.D.The Departments of Radiodiagnosis & Medical Imaging* and Cardiology**, Faculty of Medicine, Tanta UniversitySAMEH A. KHODAIR, M.D.;KHALED I. EL-SHAFEY, M.D.The Departments of Radiodiagnosis & Medical Imaging* and Cardiology**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Coronary Heart Disease (CHD) is considered to be a leading cause of morbidity and mortality worldwide, so early detection of CHD in asymptomatic individuals is required. Several metabolic risk factors contribute to devel-opment of both Nonalcoholic Fatty Liver Disease (NAFLD) and CHD.<br />Aim of Study: To evaluate the association between (NAFLD) and (CAD) severity.<br />Material and Methods: This study included thirty patients with symptoms suggestive of ischemic heart disease. All patients were subjected to clinical evaluation, coronary CT angiography and Gensini score was used to assess the coronary artery disease severity. Ultrasound examination of the liver to assess the hepatic steatosis.<br />Results: Among thirty patients enrolled in our study 13 patients had positive coronary findings 9 of them showed also hepatic steatosis. The association between NAFLD and CAD was significant as regard the age (p=0.010), BMI (p=0.011). And diabetes mellitus (p=0.011). In comparison with the normal group. There was significant association between Gensini score and grading of fatty liver infiltration (p-value=0.017).<br />Conclusion: There was high prevalence of NAFLD in patients with documented CAD (69.2%) with significant association between Gensini score and grading of fatty liver infiltration.https://mjcu.journals.ekb.eg/article_52338_8080fb296e978a34ebb82d25497b29d6.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Assessment of Medical Records Documentation in Secondary Health Care Facilities in Kafr El-Sheikh and El-Mahalla El-Kubra Cities1831945233910.21608/mjcu.2019.52339ENHEBAT ALLAH A. AHMED, M.Sc.;RANYA M. EL-SALAMI, M.D.;The Department of Public Health & Community Medicine, Faculty of Medicine, Tanta UniversityKHALIL M. AYAD, M.D.ABD EL-AZIZ F. EL-DEEB, M.D.The Department of Public Health & Community Medicine, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Accurate, timely and accessible health care data play an important role in the planning, development and maintenance of health care services.<br />Aim of Study: This study was undertaken to assess the quality of medical records documentation in three healthcare facilities, two of them in Kafr El-Sheikh City (Kafr El-Sheikh General Hospital and El Obor Health Insurance Hospital) and the third one in El-Mahalla El-Kubra City (El-Mahalla El-Kubra General Hospital, Gharbia Governerate).<br />Subjects and Methods: The medical record sample calcu-lated was (200) record sample from El-Mahalla El-Kubra General Hospital, (300) record sample from Kafr El-Sheikh General Hospital and (350) record sample from El Obor Health Insurance Hospital. The calculated record sample for each hospital was selected from the discharge logs of "2017" using the systematic random sampling method.<br />Results: General consent form and discharge summary sheet were completely absent from the medical records of El-Obor Health Insurance Hospital. Almost all documentation assessment items of patient identification part were present in more than two third of checked records in El-Obor Health Insurance Hospital. The documentation assessment items of front sheet and discharge summary sheet were not present in more than the half of reviewed records at Kafr El-Sheikh General Hospital. Recording of clinical progress notes daily was not present in more than two third of reviewed records in the three hospitals. Recording of nursing progress notes within each shift was present in the majority of reviewed records (80%) in the three studied hospitals.<br />Conclusion: There was considerable variations between the three studied hospitals according to documentation quality.https://mjcu.journals.ekb.eg/article_52339_5a392e14063d6c95ba4149a3b922dd6c.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Prophylactic Measures in Early Recurrent Pregnancy Loss in Women with Polycystic Ovary Syndrome and Hyperhomocysteinemia1951995234010.21608/mjcu.2019.52340ENMAHMOUD F. MAHDIA, M.Sc.;TAREK M. EL-HAWARY, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta UniversitySHAHENAZ H. EL-SHORBAGY, M.D.;NAREMAAN M. EL-HAMAMY, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: The Polycystic Ovary Syndrome (PCOS) is the commonest endocrine disturbance affecting women, several complications of pregnancy in women with Polycystic Ovary Syndrome (PCOS) including recurrent pregnancy loss, the exact mechanisms that may cause RPL in PCOS patients are obscure. Several etiologies have been proposed, hyperhomo-cysteinemia is a common finding in women with PCOS and was found to be associated with both RPL and PCOS.<br />Aim of Study: Aim of the study is to evaluate prophylactic measures against early recurrent pregnancy loss before 20 weeks of gestation in women with polycystic ovary syndrome and hyperhomocysteinemia by either Low Dose Aspirin (LDA), LMWH or both.<br />Patient and Methods: The present study was carried out on 120 pregnant women in reproductive period, their age ranged between 20 and 35 years. They were classified into three groups, group I treated with Low Dose Aspirin (LDA) (40), group II treated with low molecular weight heparin (40) and group III treated with low dose aspirin and low molecular weight heparin (40).<br />Result: Hyperhomocysteinemia is a common finding in women with PCOS and was found to be associated with both RPL and PCOS. It was shown that combined treatment with aspirin and Low Molecular Weight Heparin (LMWH) in women with hyperhomocysteinemia improved successful pregnancy rates.<br />Conclusion: The use of clexane or Clexane with LDA prevent early recurrent pregnancy loss in patients with PCOS and hyperhomocysteinemia better than LDA alone.https://mjcu.journals.ekb.eg/article_52340_d37b5d5f68fa1388dc6b3d7ccac49078.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Prevalence of Clinically Significant Endoscopic Findings in Outpatients with Dyspepsia2012085234110.21608/mjcu.2019.52341ENLAMIAA A.A. EL-HABAB, M.Sc.;MOHAMED M. EL-BEDEWY, M.D.The Department of Internal Medicine, Faculty of Medicine, Tanta UniversityMOHAMED A. TAWFIK, M.D.;HANAA I. OKDA, M.D.The Department of Internal Medicine, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Dyspepsia is a common clinical problem. More patients with dyspepsia have no detectable lesion. Organic causes of dyspepsia only detected by endoscopy if suspected by age or alarm features.<br />Aim of Study: To evaluate the prevalence of significant endoscopic findings and use alarm features and the age in outpatients with dyspepsia in predicting the presence of Significant Endoscopic Findings (SEFS).<br />Patients and Methods: This is cross-sectional observational study was carried out in Tanta University Hospitals Internal Medicine Department on one hundred Egyptian outpatients with dyspepsia in the period from July 2017 to January 2018. All patients enrolled in this study were subjected to upper gastro intestinal endoscopy, and histopathological examination to suspected cases only.<br />Results: Our study showed that the prevalence of SEFS in dyspepsia patients was 25%, mostly found in patients who were old age and or had alarm features. The most common endoscopic abnormality was non erosive gastritis (73.2% n 37), followed by small HH (70.9% n 35), class A esophagitis represent (16.8% n 8), gastric ulcer disease was found in (17% n 11), Malignancy was found in only (6.4% n 3), erosive esophagitis was found in (6.4% n 3), sever gastritis was found in (12.8% n 6) and sever doudonitis in (4.3% n 2).<br />Conclusion: The study showed the low prevalence of SEFs, and no need for endoscopy in young patients with no alarm features and they can be managed by non-endoscopic approach. However, it is highly recommended in all patients represented with alarming symptoms.https://mjcu.journals.ekb.eg/article_52341_8b98586c6dd9e3e9500047df3f1acefe.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Relationship between Epicardial Adipose Tissue Thickness and Coronary Artery Disease2092145234210.21608/mjcu.2019.52342ENAHMED M. MAHFOUZ, M.B.B.Ch.;IBTSAM Kh. IBRAHIM, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversityEHAB A. EL-GENDY, M.D.;SEHAM F. BADR, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Epicardial adipose tissue (EAT) is a complex endocrine organ that express a variety of inflammatory medi-ators which may contribute to the pathogenesis of coronary artery disease (CAD).<br />Aim of Study: To investigate the relation between EAT thickness and presence of coronary artery disease.<br />Patient and Methods: This study included 100 patients who were candidates for coronary angiography. All patients were subjected to full history taking, and clinical examination. Echocardiographic techniques and calculations of different cardiac dimensions were performed and to measure the EAT. Coronary angiography was performed by standard technique to assess the presence or absence of coronary artery disease and the number of coronary arteries diseased.<br />Results: EAT equal or more than 0.45cm is related to the presence of coronary artery disease, with a specificity and a sensitivity of 63.6% and 69.2% respectively. Our study revealed a positive correlation between EAT thickness and the presence of CAD.<br />Conclusions: Epicardial adipose tissue thickness is sig-nificantly associated with presence of coronary artery disease.https://mjcu.journals.ekb.eg/article_52342_dd8a079690589ac4a3b6d1fb688dceb8.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Optical Coherence Tomography Angiography of Optic Disc Perfusion in Primary Open Angle Glaucoma2152235234310.21608/mjcu.2019.52343ENBASMA G. MOHAMED, M.Sc.;SAID M. SHALABY, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityWALEED A. ALLAM, M.D.;EL-SAYED A. NASSAR, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Glaucoma is a major disease that potentially results in irreversible blindness. Optical coherence tomography angiography (OCTA) is a novel technique for evaluation of retinal vascular changes. Using OCTA have provided useful information about the papillary and peripapillary microvas-culature. Optic nerve head perfusion measurements.<br />Aim of Study: To investigate optic disc perfusion differ-ences between normal and primary open angle glaucoma eyes using optical coherence tomography angiography (OCTA).<br />Methods: This prospective comparative cross-sectional selective pilot study was performed on 15 eyes of 15 primary open angle glaucoma (POAG) patients and 20 eyes of 20 healthy age-matched controls. OCT and OCTA were performed using swept source TOPCON 3D OPTICAL COHERENCE TOMOGRAPHY DRI OCT Triton. The optic nerve head (ONH) was imaged with a 4.5x4.5mm scan and assessed in 4 different levels of segmentation; the superficial Papillary, deep papillary, outer retina level and choroidal level. Density map images gave qualitative data and quantitative assessment, these images were processed using Image J program (IJ 1.46 r edition) for determining vascular density index (VDI). The Central corneal thickness, retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), stereometric parameters cup/disc area, rim area, cup volume and visual field parameters [mean deviation (MD), pattern standard deviation (PSD) were tested for correlation with vascular density.<br />Results: The vascular density index in the OCT angi-ograms, as a quantitative assessment, of the optic nerve head (ONH) perfusion was significantly lower in the glaucoma group when compared with the normal age matched control groups. This reduction was significant in POAG with average VDI was reduced by 6.29%. However, in qualitative assessment the dense microvascular network that was visible on OCTA in normal discs, was visibly attenuated with marked capillary drop out in subjects with glaucoma. This reduction in vascular density i.e. ischemia may have a primary element as detected by decreased VDI at choroidal level POAG that reduced by 17.37%. In addition, it may be secondary to elevated IOP that has direct impact with decrease VDI at superficial papillary level that is marked in cases with high IOP. The vascular density index was correlated significantly with all functional and structural parameters and the rate of disease progression and severity.<br />Conclusions: OCTA may offer insights into the patho-physiology of glaucomatous damage and understanding the role of vascular factors in the pathogenesis of the disease. Hence, it may be a promising technology in glaucoma man-agement.https://mjcu.journals.ekb.eg/article_52343_6e5c43d5fbf1f39ac8e43ecd0ae28647.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Role of Melatonin in Treatment of Necrotizing Enterocolitis in Preterm Neonates2252305234410.21608/mjcu.2019.52344ENAZZA M.A. GAD ALLAH, M.Sc.;MOSTAFA M.A. EL-HUSSENY, M.D.The Departments of Pediatrics* and Clinical Pathology**, Faculty of Medicne, Tanta UniversityNAHED M. ELWAN, M.D.;MOHAMED Sh. EL-FARARGY, M.D.The Departments of Pediatrics* and Clinical Pathology**, Faculty of Medicne, Tanta UniversityJournal Article20181001Abstract<br />Background: Necrotizing enterocolitis (NEC) is one of the most dangerous gastrointestinal diseases that affects the neonates especially preterm neonates. It can lead to severe morbidity and even mortality, so early detection of NEC would give us good chance for early prevention and treatment with better prognosis. Free radicals play a significant role in the pathogenesis of neonatal sepsis and NEC. It has been suggested that melatoninas an antioxidant can be used to counteract the toxicity of oxygen radicals that are released during neonatal illness.<br />Aim of Study: Is to Determine the role of melatonin as an adjuvant therapy in treating necrotizing enterocolitis (NEC) in preterm neonates.<br />Patients and Methods: A prospective clinical trial study was conducted on 20 preterm neonates which suffer from NEC diagnosed on the basis of both clinical and laboratory criteria. group (G I) (n=10) received melatonin and antibiotics, while the control group (G II) (n=10) was treated with antibi-otics only. Melatonin was administered as 20 mg for 3 con-secutive days and antibiotics were administered according to a standard protocol protocol and followed-up of symptoms and signs of NEC after 5,10 and 15 days of starting treatment.<br />Results: As regard outcome of NEC, In group I there were 9 (90%) cases improved and 1 (10%) case not improved but In group II there were 5 (50%) cases improved and 5 (50%) cases not improved, so more cases in group I who received melatonin showed improvement of NEC than group II. As regard mortality, one baby (10%) died and 9 (90%) survived in group I compared to 3 babies (30%) died and 7 babies (70%) survived in group II.As regard length of NICU stay the patients who received melatonin (group I) stay for a shorter period in NICU compared to group II who received traditional therapy only.<br />Conclusion: Melatonin administration as an adjuvant therapy in NEC treatment in preterm neonates is associated with improvement of clinical and laboratory outcome.https://mjcu.journals.ekb.eg/article_52344_543e8e01d39844cdae06a8ffb0b53fcc.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Catheter Directed Thrombolysis in Management of Acute Thrombotic Lower Limb Ischemia2312375234510.21608/mjcu.2019.52345ENMOHAMMED H. ABD EL-ATY, M.Sc.;AMR M. ABO RAHMA, M.D.The Department of Vascular Surgery, Faculty of Medicine, Tanta UniversityMOHAMMED A. EL-HENIEDY, M.D.;ADEL H. KAMHAWY, M.D.The Department of Vascular Surgery, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Acute limb ischemia is a limb threatening condition that require wise decision making to achieve limb salvage.<br />Aim of Study: To evaluate the safety, efficacy and outcome of catheter directed thrombolysis (CDT) in management of acute thrombotic lower limb ischemia.<br />Patients and Methods: 20 patients suffering from acute limb ischemia (ALI) due to infrainguinal arterial thrombosis were submitted to catheter directed thrombolysis under fluor-oscopic guidance, treated by Actilyse “tissue plasminogen activator” during the period from April 2017 to April 2018, outcome was assessed by angiographic imaging “technical success” and clinical improvement “clinical success”.<br />Results: Overall thrombolysis success and limb salvage were achieved in 16 patients (80%), major amputation was performed in 4 cases (20%), surgical interference “throm-bectomy” was needed in 2 cases (10%), complementary balloon angioplasty was done in 4 cases (20%). Regarding complications, peri-sheath hematoma was observed in 5 patients (25%), one case developed compartment syndrome (5%), epistaxis in 2 cases (10%) and hematuria in 3 cases (15%), no mortality recorded during hospital stay or two weeks follow-up.<br />Conclusion: Catheter directed intra-arterial thrombolysis is a safe, effective management for thrombotic etiology of ALI.https://mjcu.journals.ekb.eg/article_52345_c6fef84e6b1e5c1111a0b1e3b741ef34.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Neurological Study of Patients with Systemic Lupus Erythematosus2392475234610.21608/mjcu.2019.52346ENSAMAR F. MARZOUK, M.Sc.;ABEER A. SHAHBA, M.D.The Departments of Neuropsychiatry* and Internal Medicine**, Faculty of Medicine, Tanta UniversityMHAMED O. RABIE, M.D.;EL-SAYED A. TAG ELDIN, M.D.The Departments of Neuropsychiatry* and Internal Medicine**, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology affecting multiple organ systems including the joints, skin, heart, lungs, kidneys and the nervous system.<br />Aim of Work: Is to study the neurological manifestations in patients with systemic lupus erythematosus attending Tanta University Hospitals over 6 months.<br />Patients and Methods: Cross sectional study was carried out on 60 patients with SLE diagnosed according to American College of Rheumatology criteria attending Tanta University Hospitals during six months.<br />Results: Mean age was 46.7±12.1. Fifty two patients were females and 8 patients were males. This study found that 43 patients showed neurological manifestations, headache was the most common representing 51.7% followed by cognitive impairment 46.7% and cerebrovascular stroke 13%. 6 patients complicated by seizures in whom 3 patients were focal. Focal slowing was the most common EEG abnormalities while white matter hyper intensity lesions were the most common MRI brain abnormalities.<br />Conclusion: Neurological manifestations are frequent in SLE patients. Headache is the most common neurological manifestation followed by cognitive impairment.https://mjcu.journals.ekb.eg/article_52346_ce4e969bd1a10680f80e7be3f00b4a49.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Progressive and Prognosis Role of Lipogenic Pathway in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis2492565234710.21608/mjcu.2019.52347ENREHAB M. SAMAKA, M.D.;MOHAMMAD I. SHABAN, M.D.The Department of Pathology, Faculty of Medicine* and National Liver Institute**, Menoufia University, Shebin El-Kom, EgyptMERVAT M. SULTAN, M.D.;SHEREEN F. EL-GODAY, M.D.The Department of Pathology, Faculty of Medicine* and National Liver Institute**, Menoufia University, Shebin El-Kom, EgyptDINA M.SWEED, M.Sc.The Department of Pathology, Faculty of Medicine* and National Liver Institute**, Menoufia University, Shebin El-Kom, EgyptJournal Article20181001Abstract<br />Background and Aims: Despite the advance in treatment modalities, Hepatocellular Carcinoma (HCC) remains a com-mon cause of cancer morbidity and mortality worldwide. Lipogenic pathway is expected to become a potential thera-peutic target for prevention and treatment of HCC.<br />Aim of Study: Studying the role of lipogenic pathway in hepatocellular carcinoma.<br />Material and Methods: We searched the PubMed and Google scholar databases for relevant studies that evaluated the expression of lipogenic pathway markers; Sterol Regulatory Element-binding Protein1 (SREBP1), Fatty Acid Synthase (FASN) and Stearoyl-CoA Desaturase1 (SCD1) in human HCC tissues.<br />Results: This review included 12 studies that enrolled 1031 patients with HCC or chronic hepatitis and normal subjects. SREBP1, FASN and SCD1 were overexpressed in HCC. SREBP1 expression was positively correlated with FASN and SCD expressions (r=0.74, pConclusion: We concluded that lipogenic pathway acti-vation plays an important role in HCC development and prognosis. This review was registered with PROSPERO (CRD 42018087933).https://mjcu.journals.ekb.eg/article_52347_98baec3cae8820d3e6a4cac5c6c0abd2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Clinical Outcome of Surgical Excision of Spheno-Orbital Meningiomas: Local Experience2572635234810.21608/mjcu.2019.52348ENTARIQ EL-EMAM AWAD, M.D.,SALEM FAISAL, M.D., Ph.D.The Department of Neurosurgery, Faculty of Medicine, Suez Canal UniversityMOHAMED H.MAHMOUD, M.Sc.The Department of Neurosurgery, Faculty of Medicine, Suez Canal UniversityJournal Article20181001Abstract<br />Background: Spheno-orbital meningiomas are considered as tumors involving the sphenoid wing, orbit, and cavernous sinus. Their complete surgical resection is difficult. Sphenoidal hyperostosis that results in incomplete resection makes these tumors prone to high rates of recurrence.<br />Aim of Study: The aim of this retrospective study was to investigate the outcome of twelve consecutive patients treated by microsurgical resection of spheno-orbital meningiomas.<br />Patients and Methods: This series consisted of twelve patients who were retrospectively analyzed over a 5-year period. Visual function was evaluated pre-and post-operatively in all patients. We used a standardized surgical approach through supraorbital-pterional approach with drilling of all sphenoidal hyperostotic bone. Surgical outcome, complications and recurrence were clarified.<br />Results: There were two men and ten women included in the study, with a mean age of 50.8 years (range 27-63 years). Pre-operative symptoms include proptosis (67%), blurred vision (58%) and diplopia. All patients underwent microsur-gical resection through supraorbital-pterional approach. An excellent clinical result was observed in six patients. Recur-rence was evident in four patients.<br />Conclusions: Spheno-orbital meningiomas are character-ized by potentially extensive hyperostosis of the skull base. Successful resection necessitates drilling of the superior orbital fissure and orbital osteotomy within anatomical limitations. Complete resection was found to be limited by tumor remaining in the cavernous sinus and the optic canal.https://mjcu.journals.ekb.eg/article_52348_b975f9c5806826f38c96822a03b3c2cd.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Surgical Management of Morbid Obese Patients Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy2652695234910.21608/mjcu.2019.52349ENIBRAHIM A. EL-KORASHY, M.Sc.;ABD EL-SALAM A. EMAD, M.D.The Department of General Surgery, Faculty of Medicine, Al-Azhar UniversityMOHAMMAD A.ABD EL-MAKSOUD, M.D.The Department of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20181001Abstract<br />Background: Nowadays obesity considered as a disease. Obesity is complex and poorly understood and the causes of this disease likely include a combination of genetic and environmental factors, but it also includes behavioral, psy-chological, and other factors.<br />Aim of Study: Comparative study between the laparoscopic Roux-en-y gastric bypass and sleeve gastrectomy in manage-ment of morbid obesity.<br />Patients and Methods: Study included 20 morbidly obese patients, 10 patients subjected for laparoscopic sleeve gast-rectomy and 10 patients for laparoscopic Roux-en-y gastric bypass.<br />Results: There was significant difference in % Weight Loss (WL) between the LSG and LRYGB at 12-month with greater % WL in the LRYGB group than the LSG group. However, there was no significant difference between LSG and LRYGB in WL at 6-month follow-up. Overall postoper-ative morbidity was higher after LRYGB group compared with LSG.<br />Concluion: LRYGB and LSG are effective procedures for treatment of morbid obesity. Both can be performed very safely in an experienced hand, but LSG is a simpler and safer procedure with no significant disadvantage compared to LRYGB.<br />Objective: Comparative study between the laparoscopic Roux-en-y gastric bypass and sleeve gastrectomy in manage-ment of morbid obesity.https://mjcu.journals.ekb.eg/article_52349_19c9b4c7ec427eab66f347cc5c965fdf.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Alterations of Some MicroRNAs Expression in Hepatocellular Carcinoma Cell Lines by Sodium Butyrate2712785235010.21608/mjcu.2019.52350ENREHAM SROUR, M.Sc.;NADIA EL-GUENDY, Ph.D.The Department of Cancer Biology, National Cancer Institute* and the Department of Zoology, Faculty of Science**, Cairo UniversityMONA MOHAMED MOSTAFA, Ph.D.;MEDHAT SALAH EL-HALAWANY, Ph.D.The Department of Cancer Biology, National Cancer Institute* and the Department of Zoology, Faculty of Science**, Cairo UniversityABD EL-HADYALI ABD EL-WAHAB, Ph.D.The Department of Cancer Biology, National Cancer Institute* and the Department of Zoology, Faculty of Science**, Cairo UniversityJournal Article20181001Abstract<br />Background: Epigenetic gene regulation is important in human cancer.<br />Aim of Study: We investigated the possible role of acetyla-tion level in the regulation of microRNAs (miRNAs) expres-sion in hepatocellular carcinoma.<br />Material and Methods: We first determined the inhibitory concentration (IC20, IC35 and IC50) of the histone deacetylase inhibitor Sodium Butyrate (SB) in HepG2 and Huh7 cells. Then, we analyzed the expression level of five miRNAs (miR-133b, miR-122-5p, miR-26a-5p, miR-539-5p and miR-518f-3p after treatment using qRT-PCR assay. MiRTarBase, MiROB and GeneCards databases were used for the identification of strong validated targets of examined microRNAs, and the detection of possible functions of the selected targets and related pathways.<br />Results: SB revealed an anti-proliferative effect in both HepG2 and Huh7 cells, with IC50 values of 6.7mM and 9.2mM, respectively. MiR-133b showed up-regulation in HepG2 and miR-122-5p was down-regulated in HepG2 and Huh7 (29.5 and 1000 folds) in a dose dependent manner. MiR-26a-5p exhibited decrease in its level in both cell lines at IC35, but was increased at IC50 in HepG2 cells. MiR-518f-3p showed increase in its level during various doses of SB in both cell lines. Finally, miR-539-5p showed down expression in both cell lines. Prediction pathway analysis referred to the important role of each of miR-133b, miR-122-5p and miR-26a-5p in proliferation, apoptosis, angiogenesis and metastasis.<br />Conclusion: Sub-lethal doses of SB have significant effects on miRNAs expression in human hepatocellular car-cinoma cells. Understanding the epigenetic regulation of miRNAs may enhance the development of therapeutic strate-gies against HCC.https://mjcu.journals.ekb.eg/article_52350_ad338fb9641b3bdbc9700df810834660.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Inspiratory Muscle Training on Quality of Life in Patients with Chronic Heart Failure2792855235110.21608/mjcu.2019.52351ENSALAH G. MOHAMED, M.Sc.;ZIENAB M. HELMY, Ph.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorder & Geriatrics, Faculty of Physical Therapy, Cairo UniversityBASSANT H.AL-REFAAY, Ph.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorder & Geriatrics, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: The present study was applied on thirty patients with chronic heart failure to detect the efficacy of inspiratory muscle training on their quality of life.<br />Aim of Study: The present study was conducted to inves-tigate the efficacy of inspiratory muscle training on quality of life in patients with chronic heart failure.<br />Material and Methods: Thirty chronic heart failure patients were included in this study, their ages ranged from 50 to 60 years, they had Body mass index (BMI) ranged from 25-29.9 (kg/m2), they were selected from Tajora Heart Hospital in Libya and at the out-patient clinic, Faculty of Physical Therapy, Cairo University. They were divided randomly into two equal groups (A and B). Group (A) received selected physical therapy program about half an hour, while Group (B) received same physical therapy program that applied in the group (A) in addition to inspiratory muscle training using Inspiratory Muscle Trainer (IMT). The variables that used on this study, included Quality of Life Questionnaire (QLQ), dyspnea scale and ejection fraction, were assessed before and after treatment program in both groups. Both groups received treatment program 3 times/week for twelve weeks.<br />Results: The results revealed significant improvement of all measured variables in two groups after twelve successive weeks, also revealed significant difference when compared the two groups after treatment in favor of the group B.<br />Conclusion: Within the limitation of the present study it could be concluded that: The IMT results in marked improve-ment in Quality of Life Questionnaire (QLQ), dyspnea scale and ejection fraction.https://mjcu.journals.ekb.eg/article_52351_37d13db6517f21684d7f001c8f222310.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Histological Effect of Formaldehyde as Food Preservative on Cerebellar Cortex of Albino Rat2873085235210.21608/mjcu.2019.52352ENHAYAM M. FARHOUD, M.D.;AMANY M. ABO OUF, M.D.The Department of Anatomy & Embryology, Faculty of Medicine for Girls, Al-Azhar UniversityHEBA A.ABO EL-SOUD, M.Sc.The Department of Anatomy & Embryology, Faculty of Medicine for Girls, Al-Azhar UniversityJournal Article20181001Abstract<br />Background: Formaldehyde is an important chemical compound that is used widely in the industrial and medical setting. It is illegally used in excess amounts to preserve various kinds of foods that can affect the central nervous system particularly the cerebellar cortex.<br />Aim of Study: This work aims to evaluate the extent of histological changes of the cerebellar cortex of albino rat's offspring that may be induced by oral administration of formaldehyde to their mothers throughout pregnancy and lactation or direct administration to the offspring itself.<br />Material and Methods: The maximum dietary dose of formaldehyde (41.9mg/person/day) was used in this work. The used doses according to rat age were 0.74mg/adult, 0.104mg/2 weeks and 0.240mg/4 weeks. In this work, 42 pregnant albino rats and 120 of their offspring were used. They divided into 2 main groups; control and treated groups. The control group (Group C) consisted of 12 pregnant rats and 60 of their offspring. They were divided equally into C1, C2 and C3. The treated group (Group T) consisted of 30 pregnant rats and 60 of their offspring. They were divided equally into T1, T2 and T3. The pregnant rats of C1 and T1 received distilled water and formaldehyde respectively through-out pregnancy and for 2 weeks after delivery, then the 2 weeks old offspring received distilled water and formaldehyde respectively till the end of 8 weeks. The delivered rats of C2 and T2 received distilled water and formaldehyde respectively for 2 weeks. Then the 2 weeks old offspring received distilled water and formaldehyde respectively till the end of 8 weeks. The 2 weeks old offspring of C3 and T3 received distilled water and formaldehyde respectively till the end of 8 weeks. The cerebelli of all groups were extracted at two ages, at 4 and 8 weeks and immersed into suitable fixatives then prepared for light microscopic examination, in addition, the cerebelli of 8 weeks offspring were used for electron microscopic examination and morphometric studies.<br />Results: In the present work, oral administration of for-maldehyde induced delayed development of all layers of the cerebellar cortex in form of irregularity and change in the shape and size of cells, decreased the thickness of its layers. It also induced degenerative changes in the form of cytoplasmic vacuoles, pyknosis, ill-defined nuclei, fragmented cytoplasmic processes, dilated rough endoplasmic reticulum, dilated Golgi apparatus, mitochondria with destructed cristae, and presence of areas of ill-defined structures.<br />Conclusion: It could be concluded that the oral adminis-tration of formaldehyde caused delayed development and induced different histological changes in the cerebellar cortex of albino rat's offspring. These effects were directly propor-tional with the duration of its administration.https://mjcu.journals.ekb.eg/article_52352_3fe47d6ef7b8484af47bdc7299568034.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Correlation between Hamstring Tightness and Plantar Fasciitis3093135235310.21608/mjcu.2019.52353ENMOHAMED A.SAYED, M.Sc.The Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy and The Department of Radiology, Faculty of Medicine, Cairo UniversitySALWA FADLABD EL-MEGID, Ph.D.The Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy and The Department of Radiology, Faculty of Medicine, Cairo UniversityHATEM M.EL-AZIZY, M.D.The Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy and The Department of Radiology, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: A significant number of individuals suffer from pain in the heel and many go on to have chronic symptoms and went to disability, and it may affect sedentary and active adults of all ages. Active knee extension test (AKE) is com-monly used to assess flexibility and length of the hamstring muscles that’s may be related to plantar fasciitis.<br />Aim of Study: To assess the relationship between hamstring tightness and plantar fasciitis.<br />Subjects and Methods: Thirty patients who were coming complaining of heel pain, their age ranged from 30-50 years. All participants were asked to assess plantar fascia thickness by ultrasonoghraphy and to assess hamstring length by range of active knee extension test; aiming to detect the correlation between hamstring tightness and plantar fasciitis. The mean age was 39.72±5.58 years (range: 31-48 years), 83.3% were female, 66.6% were affected bilaterally and the mean BMI was 28.94±2.94Kg/m2.<br />Results: There is a strong negative linear correlation between the thickness of plantar fasciitis and range of active knee extension test. This means that any increase in the thickness of plantar fasciitis, will be associated with decrease in active knee extension angle.<br />Conclusions: There is a strong correlation between plantar fasciitis and hamstring tightness.https://mjcu.journals.ekb.eg/article_52353_279305a1b55986d41988f6692e12287c.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Vitamin D Repletion by Medication Versus Sunlight-Exposure on the Testicular Functions of Vitamin D Deficient Rats3153235235410.21608/mjcu.2019.52354ENMAHMOUD M.A.ABULMEATY, M.D.The Departments of Medical Physiology and Clinical Pharmacology, Faculty of Medicine, Zagazig University and The Department of Nutrition and Food Science, Faculty of Home Economics, Helwan UniversityALAA I.ALI, M.D.The Departments of Medical Physiology and Clinical Pharmacology, Faculty of Medicine, Zagazig University and The Department of Nutrition and Food Science, Faculty of Home Economics, Helwan UniversityMOHAMED F.EL-SADEK, Ph.D.The Departments of Medical Physiology and Clinical Pharmacology, Faculty of Medicine, Zagazig University and The Department of Nutrition and Food Science, Faculty of Home Economics, Helwan UniversityEBTESAM M.IBRAHIM, M.D.The Departments of Medical Physiology and Clinical Pharmacology, Faculty of Medicine, Zagazig University and The Department of Nutrition and Food Science, Faculty of Home Economics, Helwan UniversityJournal Article20181001Abstract<br />Background: The causal relationship between Vitamin D (VD) and gonadal function is still under-investigated especially the impact of VD repletion on the testicular structure and function. The sunlight exposure as a natural source of VD and VD supplementation are the fundamental remedies for VD repletion during deficiency conditions.<br />Aim of Study: To compare the efficacy of VD medications versus sunlight exposure on the testicular functions and histology in adult rats.<br />Material and Methods: Sixty weaned male albino rats (103.12±11.67g) were fed either a synthetic balanced formula with normal VD level (group A, n=30), or fed a customized synthetic diet with traces of VD (group B, n=30) for 6 weeks. Rats in both groups were further subdivided into three sub-groups (n=10 each): Oil-treated control (subgroup A-I and B-I), VD3 treated (subgroup A-II and B-II) which were given a dose of 75mg of VD3/rat every other day via a feeding tube, and the sun-exposed (subgroup A-III and B-III) which were exposed daily to the direct sunlight from 9am to 1pm. Plasma 25-hydroxyvitamin D (25OHVD) and testosterone (T) were measured by ELISA kits. After euthanasia, the testes were isolated, and the number of spermatids per each gram of testicular tissue and Daily Sperm Production (DSP) were calculated. Furthermore, testicular sections were stained and examined under a light microscope.<br />Results: VD deficient rats showed a marked reduction of T when compared with normal control (p<0.001), positive correlation with plasma 25OHVD (r=0.739, p<0.05) and histologically, there were a reduction in the Leydig cell mass and degenerative changes in all levels of the spermatogenesis. Repletion of VD by the supplement (subgroup B-II) showed a better increment of the plasma T than in sun-exposed rats. Sunlight produced a T-stimulatory effect without a concomitant rise of the 25OHVD but the Ca level was normalized in subgroup B-III (vs. A-I, p>0.05). The spermatid count per g of testis and DSP were significantly improved in both sub-groups (B-II and B-III) when compared with deficient controls (p<0.05), with no difference between both modalities of VD repletion. Microscopically, a marked improvement of germinal epithelium and all stages of spermatogenesis, together with an increase in Leydig cell counts were detected in subgroup B-II rather than in subgroup B-III.<br />Conclusions: VD supplementation could improve plasma T levels and structure of the testes better than sunlight exposure. Sunlight exposure improved T level by a non-VD-dependant mechanism, most probably by normalization of the Ca level. Future research should investigate the underlying mechanisms.https://mjcu.journals.ekb.eg/article_52354_1120b4121cd673216ab3a99e5150632c.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Obestatin on Bone Turnover in Normal and Obese Male Albino Rats3253345235510.21608/mjcu.2019.52355ENSAMA S. KHALIL, M.D.;REHAM H. IBRAHIM, M.D.The Department of Physiology, Faculty of Medicine, Zagazig University, EgyptJournal Article20181001Abstract<br />Background: Obestatin is a peptide hormone derived from the posttranslational cleavage of the same peptide precursor as ghrelin, it has been shown to regulate food intake, pancreatic, adipocyte, cardiac function as well as cell proliferation, however, to date, no studies have shown the effect of obestatin on bone turnover.<br />Aim of Study: This work was designed to investigate the effects of obestatin on bone metabolism in normal and obese rats and to explain the possible underlying mechanisms.<br />Material and Methods: Experiments conducted on 32 healthy adult male albino rats, which were randomly and equally divided into 2 groups, group I (normal) and group II [high fat diet induced obese group (HFD)]. Each group further subdivided into equal 2 subgroups: Group a (received a single intraperotoneal (ip) injection of 100ml saline daily for 30 consecutive days) and group b (daily ip injected with obestatin "1nmol/100gm BW" for 30 consecutive days). In all groups, gene expression of osteocalcin (OC), osteoprotegerin (OPG) and Receptor activator nuclear factor kB ligand (RANKL) bone markers were measured by real time PCR (RT-PCR), serum calcitonin, interleukin-6 (IL-6), insulin, glucose, total cholesterol (TC), total triglycride (TG) were measured, HO-MA-IR and BMI were calculated, bone histopathology was also done.<br />Results: In both normal and obese groups, obestatin caused significant decrease in RANKL, significant increase in oste-opetrogenin, OPG/RANKL ratio, osteocalcin expression and serum calcitonin in comparison to their control, in subgroup Ib (obestatin treated normal group), there was significant decrease in BMI, however, there was non-significant change in serum glucose, insulin levels, HOMA-IR index, TC, TG, IL 6 levels in comparison to subgroup Ia. While, in subgroup IIb (obestatin treated obese group), there was a significant decrease in BMI, serum glucose, TG, TC, serum insulin levels, HOMA-IR index and IL 6 levels in comparison to subgroup IIa. In bone histopathology, subgroup Ib showing slight increase in bone trabeculae thickness in comparison to the control and subgroup IIa showed thin atrophic bone trabeculae with wide marrow spaces. While, subgroup IIb showed in-creased bone trabeculae thickness in comparison to the later.<br />Conclusion: Obestatin has anabolic effect on bone in normal and obese rats, which it can be used in regime diet induced weight loss, as it prevent the decrease of bone mass that accompany weight loss.https://mjcu.journals.ekb.eg/article_52355_d9ddbad14256ae073c3af82b052b1120.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Possible Association between Serum Hepcidin and Hemostatic Parameters in Chronic Renal Failure Rat Model: Influence of Inhibition of Angiotensin Converting Enzyme3353495235610.21608/mjcu.2019.52356ENMAHA A. FATHY, M.D.;NADINE A. RAAFAT, M.D.The Department of Medical Physiology, Faculty of Medicine, Zagazig University, EgyptJournal Article20181001Abstract<br />Background: Chronic renal failure (CRF) is usually asso-ciated with abnormal coagulation profile. Hepcidin is a major regulator of iron metabolism and was reported to have an impact on anemia, insulin resistance, dyslipidemia, inflam-mation and oxidative stress which were all reported to play a potential role in CRF induced coagulopathy. Renin angi-otensin system (RAS) is involved in the pathophysiology of CRF and can affect coagulation profile.<br />Aim of Study: To evaluate changes in coagulation profile in a rat model of chronic renal failure and the possible asso-ciation of these changes with serum hepcidin level in relation to some metabolic, inflammatory and oxidative stress param-eters and to evaluate whether changes in these parameters induced by inhibition of angiotensin converting enzyme (ACE) can affect serum hepcidin level.<br />Material and Methods: Forty adult male albino rats divided into: Group I (n=8): Control group: Rats received subcutaneous injection with the vehicle (0.3M NaHCO3, 5ml/Kg) once weekly for 5 weeks. Group II (n=16): Chronic renal failure-induced group (CRF): Rats received subcutaneous injection with folic acid (300mg/kg in 5ml) once weekly (dissolved in 0.3M NaHCO3) for 5 weeks. Group III (n=16): (CRF + captopril): Chronic renal failure was induced by folic acid as in group II with concomitant administration of the ACE inhibitor; captopril in a daily dose of (100mg/kg/day) orally by gastric gavage. The following was measured in all groups: Blood pressure, Kidney function, haematological and haemo-static parameters, HOMA-IR, lipid profile, CRP, IL6, MDA, SOD and histopathological examination was made.<br />Results: There was a significant increase in serum hepcidin level in group II compared to control which was correlated positively with serum creatinine, blood urea and negatively with creatinine clearance, while its level decreased significantly in group III compared to group II. A significant increase in bleeding time, WBCT, PT, APTT, INR, FDPs, D dimer and protein C was found in group II compared to control with an increase in HOMA-IR, CRP, IL6, MDA, systolic and diastolic blood pressure and a significant decrease in Hb, MCV, MCH, platelet count, MPV and SOD. In group III, bleeding time, WBCT and protein C remained significantly elevated versus control and further increase in APTT was found versus group II. A significant decrease in FDPs and D dimer was found in group III versus group II with a significant decrease in HOMA-IR, TG, LDL, VLDL, CRP, IL6, MDA, systolic and diastolic BP.<br />Conclusion: Chronic renal failure induced significant increase in hepcidin level associated with an abnormal coag-ulation profile. Hepcidin can indirectly affect coagulation profile through its effect on anaemia, IR, oxidative stress and inflammatory mediators. Inhibition of ACE by captopril caused significant improvement of renal function with significant decrease in hepcidin level and significant decrease in hyper-coagulopathy.https://mjcu.journals.ekb.eg/article_52356_5b8cea4f9f773120b487a983e8ddeefb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301How to Achieve the Best Treatment of Tibial Occlusive Disease? Early Experience in Benha University Hospitals3513635235710.21608/mjcu.2019.52357ENEL-SAYED A. ABD EL-MABOOD, M.D.;MOHAMED T. YOUNIS, M.D.Vascular Unit, The Department of General Surgery, Faculty of Medicine, Benha UniversityJournal Article20181001Abstract<br />Background: The treatment of constructable tibial occlu-sive disease has changed dramatically because of the advent of catheter-based interventions. However, surgical bypass techniques continue to evolve in response to increasingly complex scenarios such as failed endovascular procedures.<br />Aim of Study: To achieve the best treatment using the endovascular intervention versus distal bypass in constructable tibial occlusive disease.<br />Patients and Methods: This prospective randomized controlled study was done on 40 patients (60 limbs) assigned into two groups, each group contains 30 limbs. Group A 30 limbs prepared for distal surgical bypass. Group B 30 limbs prepared for endovascular intervention. Follow-up period was for 18 months.<br />Results: Despite endovascular intervention had equal patency rates at 6th month as distal surgical bypass; 21 limbs (70%), p=1.000. It was much less than surgical bypass in morbidities; in Group A 11 limbs (36.7%) didn't develop complications and 19 limbs (63.3%) underwent complications. In Group B 25 limbs (83.3%) passed without complications and 5 patients (16.7%) with complications; less post-operative pain; pain score in Group (A) was (5.95±1.99) vs. (2.9±1.93) in Group (B) and p-value: 0.001.<br />Conclusions: Due to innovations in endovascular tech-niques and as it is a minimal invasive; proudure angioplasty became the first line of treatment of BK PAD. Endovascular intervention treat the lesion and keep the arterial tree with its native anatomical pattern so angioplasty can be done again if restenosis occur. Unlike surgical intervention in which it's too difficult to re-interfere after surgical bypass.https://mjcu.journals.ekb.eg/article_52357_11847f5241fe43dce737ddda8aec2e20.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Current Status of Mitral Valve Repair3653765235810.21608/mjcu.2019.52358ENMOHAMMED Sh.H. ABDALLAH, M.D.;OSAMA S. ABD EL-MONEM, M.D.The Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University and The Department of Cardiac Surgery, National Heart InstituteMOHAMMED A. HASSAN, M.D.;TAMER A.K. MOHAMED, M.Sc.The Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University and The Department of Cardiac Surgery, National Heart InstituteJournal Article20181001Abstract<br />Background: Techniques of MV repair have undergone many modifications and improvements in the last three decades, which have made it a more predictable and reproducible method either in rheumatic or degenerative mitral valve repair.<br />Aim of Study: 1- Comparing the results of repairing degenerative mitral valve versus the rheumatic pathology. 2- Assessment the results of resectional technique (excising part of valve leaflet) and the respect one (preserving the valve leaflet without excision any part of it) for posterior leaflet prolapse during the degenerative mitral valve repair.<br />Patients and Methods: This prospective study was con-ducted in the Department of Cardiac Surgery, National Heart Institute (NHI) from July 2014 to December 2017 including postoperative follow-up at 6 months. One hundred cases with severe mitral valve regurgitation underwent mitral valve repair divided into two groups: Group “D” where 50 cases had degenerative mitral valve pathology with a predominant mitral regurgitation and Group “R” where 50 cases had rheumatic valve disease with a predominant mitral regurgitation and high likelihood of repair. Techniques used for repair of prolapsed degenerative PML divided into resection technique and respect one.<br />Results: As regards comparison between Group “D” versus Group “R” there was significant increase in MV area, MPAP and mean diastolic gradient of MV in group “D” than group “R” at 6 months of post-operative follow-up. Five cases in Group “R” had a mean diastolic mitral gradient more than 10mmHg that needed mitral valve replacement, four cases of them were post leaflets' shaving and decalcification. Degree of residual mitral regurgitation in Group “D” included 41 (82%) cases with no or trivial regurgitation while 9 (18%) cases were mild, whereas in group “R” 37 (74%) cases had no or trivial regurgitation, 9 (18%) had mild mitral regurgita-tion, 2 (4%) was mild to moderate and 2 (4%) cases had moderate mitral regurgitation that needed further follow-up with echocardiography every 6 months. Comparison between resection technique versus respect one revealed a significance difference between both groups as regards MVA and size of the ring annuloplasty but no significance difference was found between both groups as regards degree of residual MV regurgitation or mean diastolic MV gradient after 6 months of follow-up.<br />Conclusions: The early postoperative results for posterior mitral leaflet repair with respect technique using Uniscalloping of posterior leaflet or artificial chordae-ePTFE-is very accept-able and recommended. Using of artificial chordae to AML is very effective and safe to solve the problem of leaflet prolapse. Rheumatic valve repair appears to be possible in selected cases with rheumatic mitral valve dysfunction. Leaflet procedures in rheumatic valve repair may be associated with reduced durability of rheumatic MV repair.https://mjcu.journals.ekb.eg/article_52358_768470d1af147d09042dd96a4e7ed3f9.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Cranial Bone Flap Fixation: Comparison of Titanium-Based Device (Skull Fix) and PEEK-Based Device (Cranial Loop): Technical Report3773845235910.21608/mjcu.2019.52359ENISLAM ABOULFETOUH, M.D.;WALID A. YOUNES, M.D.The Department of Neurosurgery, Faculty of Medicine, Banha UniversityJournal Article20181001Abstract<br />Background: Reconstruction of the cranial bone flap after craniocerebral surgery is crucial for preservation of skull symmetry, maintenance of aesthetics, brain protection, as well avoiding complications like floating or sunken skull flaps. A host of techniques and materials for fixation of the cranial flaps have emerged over the past several decades.<br />Aim of Study: The aim of this study was to compare the clinical outcomes of bone flap fixation using peek-based (cranial loop) versus titanium-based (skull fix) fixation systems.<br />Patients and Methods: Between July 2013 and December 2016 a series of 54 patients undergoing either an emergency or an elective craniotomy for different intracranial lesions in which the original bone flaps were refixed using cranial loop in 27 patients and skull fix in 27 patients. Clinical and radio-logical outcomes and complication rates were compared between these 2 groups.<br />Results: Satisfactory results were achieved in both fixation systems. Epidural collection occurred in 4 patients 3 in skull fix and one in cranial loop, subdural collection in 4 patients 2 in cranial loop and one in skull fix treated conservatively. One case with cranial loop experienced a bone flap dislocation which was revised and refixed. Subcutaneous effusion occurred in two patients one in skull fix and one in cranial loop. One patient in skull fix developed a mild postoperative wound infection. Post-operative imaging showed satisfactory ana-tomical and morphological position of the flap in all patients.<br />Conclusion: Skull fix and cranial loop are reasonable alternatives to present craniotomy fixation methods. They are easy to use, fast, safe, reliable with very acceptable cosmetic results. The main advantage of the cranial loop might ultimately lie in the absence of artifacts on post-operative CT or MR imaging.https://mjcu.journals.ekb.eg/article_52359_ad5eb606e71102d7dd050ef629a6b653.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Swimming on Serum Irisin Levels in Experimentally-Induced Rat Model of Postmenopausal Osteoporosis3853955236010.21608/mjcu.2019.52360ENMOHAMMED A. EL-GHANNAM, M.D.;KAMELIA I. ATTIA, M.D.;The Department of Physiology, Faculty of Medicine, Zagazig UniversityMARWA A. HABIB, M.D.;LAMIAA G. MOHAMMED, M.Sc.The Department of Physiology, Faculty of Medicine, Zagazig UniversityJournal Article20181001Abstract<br />Background: Irisin is a new myokine that has been linked to many metabolic diseases. Postmenopausal osteoporosis is a metabolic disease manifested by decreased bone mineral density; and physical exercise may play a role in its prevention and treatment. The relationship between irisin and physical exercise, and the role of irisin in osteoporosis are not clear yet.<br />Aim of Study: The present study was performed to clarify the effect of swimming training on serum irisin levels in a rat model of postmenopausal osteoporosis induced in female albino rats.<br />Material and Methods: Forty eight adult female rats were divided into 4 equal groups: Control (CONT), swimming (SWIM), ovariectomized (OVX), and ovariectomized plus swimming (OVX + SWIM). Serum levels of irisin, estradiol, calcium, phosphorus alkaline phosphatase, and bone calcium, phosphorus, and femoral ash weights were measured and histopathological examination of femoral bones were per-formed in all groups.<br />Results: Serum irisin levels were significantly increased in SWIM group compared with CONT group, and decreased in OVX group compared with CONT and SWIM groups. In OVX + SWIM group, they were significantly increased com-pared with those of CONT and OVX groups; but, insignifi-cantly changed compared with SWIM group. Positive corre-lations were found between serum irisin and serum levels of estradiol, bone calcium and phosphorus, femoral bone ash weights in all groups; and with serum alkaline phosphatase in SWIM and OVX + SWIM groups.<br />Conclusion: Swimming training increased serum irisin levels in ovariectomized rats and guarded against the occur-rence of osteoporotic changes. So, the beneficial effects of swimming training on bone may be mediated by irisin.https://mjcu.journals.ekb.eg/article_52360_a250f85bc9c123a95f988896961cec58.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Monosodium Glutamate Induced Hepatotoxicity and Oxidative Stress: Pathophysiological, Biochemical and Electron Microscopic Study3974065236110.21608/mjcu.2019.52361ENHODA ATEF, M.D.;DOAA A. EL-MORSI, M.D.MOHAMED EL-SHAFEY, M.D.;MOHAMED EL-SHERBINY, M.D.HANY A. EL-KATTAWY, M.D.;ESLAM K. FAHMY, M.D.ABEER ABDAL-MONIEM SAEED, M.D.Journal Article20181001Abstract<br />Background: Monosodium Glutamate (MSG) is a widely used flavor enhancer with an umami taste.<br />Aim of the Work: The present work was designed to study the potential hepatotoxic effect of monosodium glutamate as regard biochemical; pathophysiological and electron micro-scopic changes; besides whether these changes were due to oxidative stress process. In addition, the possibility of recovery after MSG cessation was studied.<br />Material and Methods: The study was conducted on thirty-six adult male Sprague Dawley rats, classified into three groups (12/each). Distilled water was given orally to the control group for 90 days. Rats of MSG group administered daily oral dose of 4mg/Kg for 90 days and the recovery group received the same dose as group II then kept four weeks later for recovery. After rats were sacrificed; blood samples were taken to measure liver enzymes [(Alanine Transaminase (ALT) and Aspartate Aminotransaminase (ASAT)], cholesterol and TGs. The liver tissues were used to measure products of oxidative stress and examined for histopathological; immmuo-histochemical and Electron Microscopic (EM) changes.<br />Results: The results revealed statistically highly significant increase in hepatic enzymes, cholesterol, TGs and product of lipid peroxidation (Malondialdehyde, MDA) in combination with decrease in antioxidant glutathione transferase and superoxide dismutase in MSG group compared to control group (p<0.001). The histopathological and immunohisto-chemical results showed steatosis; increased vacuolation; extensive fibrosis and apoptosis in the hepatic cells especially centrilobular in MSG group. EM confirms the previous changes.<br />Conclusion: It could be concluded that MSG has hepato-toxic and oxidant effects and its use should be prohibited during treatment of liver disorders.https://mjcu.journals.ekb.eg/article_52361_e98be5f43f7b0bfc4b905a0aaadf314a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Relationship between Nursing Staff's Decisional Involvement and Their Decision-Making Abilities in Cairo University Hospital4074135236210.21608/mjcu.2019.52362ENALYAA A. AHMED, M.Sc.;EGLAL A. ABD EL-WAHAB, D.N.Sc.The Department of Nursing Administration, Faculty of Nursing, Cairo UniversitySAHAR H.ALY, D.N.Sc.The Department of Nursing Administration, Faculty of Nursing, Cairo UniversityJournal Article20181001Abstract<br />Background: Decisional involvement recommends the decentralization of decision-making and the proximity of staff members who provide healthcare, in which workers have their participation ensured and are entitled to take part in discussions concerning the decision-making process. Decisional involve-ment is important in healthcare and initially adopted in for the nursing discipline to achieve excellence in patient care.<br />Aim of Study: To investigate the relationship between nursing staff's decisional involvement and their decision-making abilities in New Kasr El-Aini Teaching Hospital.<br />Material and Methods: A descriptive correlational research design was utilized to carry out the study. One hundred and fifteen baccalaureate nurses including one nursing director, three associate directors, thirty-nine supervisors, thirty-six head nurses, twenty-two charge nurses and fourteen staff nurses. Two tools were used to collect data. First tool divide to two parts demographic data and nurse's decision making involvement questionnaire, second tool was nursing staff's decision making abilities questionnaire.<br />Results: Study findings revealed that there was a statistical significant correlation between study demographic character-istics and decision making abilities. While, there is no statistical significant correlation between study demographic character-istics and decision making involvement. Also, there was no statistical significant correlation between study sample's decision making abilities and their decision making involve-ment.<br />Conclusion: The study concluded that decisional involve-ment is performed according to the management positions regardless the staff abilities to make a decision.<br />Recommendations: It is recommended that the organization should provide training courses to improve decision making abilities of nursing staff. Also, nursing director should increase their involvement in decision making process and put an evaluative measure to be used as a standard in choosing managerial and administrative position regarding their abilities and skills regardless their ages.https://mjcu.journals.ekb.eg/article_52362_3d180343653c608d160dc31865c174ce.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301ECG Reporting in Children Attending Assiut University Children Hospital (Clinical Audit)4154205236310.21608/mjcu.2019.52363ENGHADA O. EL-SEDFY, M.D.;FAISAL EL-KHATEEB A. ABDALLAH, M.D.The Department of Pediatrics, Faculty of Medicine, Assiut University, EgyptAL-MOATZ BELLAH Z.AL-MOATZ BELLAH Z.The Department of Pediatrics, Faculty of Medicine, Assiut University, EgyptJournal Article20181001Abstract<br />Background: An Electrocardiogram (ECG) may be re-quested as part of the investigation of a wide range of problems in pediatrics, often in patients who have no clinical evidence of cardiac disease. Frequently the request is made by practi-tioners with no particular expertise in cardiology. The basic principles of interpretation of the ECG in children are identical to those in adults, but the progressive changes in anatomy and physiology which take place between birth and adolescence result in some features which differ significantly from the normal adult pattern and vary according to the age of the child. Correct interpretation of the ECG is therefore potentially difficult and a detailed knowledge of these age dependent changes is critically important if errors are to be avoided.<br />Aim of Study: Is to evaluation of ECG interpretation and reporting competence on children attending Assiut University Children Hospital. Patients and methods the study included 90 patients over one month of age admitted in different units of Assiut Children Hospital with different causes of admission for whom ECG was one of their investigation, data of the included patients having ECG was collected and analyzed against normal value of ECG. Values were expressed in terms of percentages.<br />Results: Shows that from 90 ECG report only 7 (7.7%) has even incomplete ECG reporting only heart rate, rhythm and axis were documented, the rest of data were absent. Where the other 83 cases (92%) ECG report had no documentation and were left empty.<br />Conclusion: Complete ECG reporting was not done in almost all patient. Only 7 (7.7%) had incomplete ECG report in the form of HR, rhythm and axis only. The rest of the ECG report were completely empty.https://mjcu.journals.ekb.eg/article_52363_042f9e5cc9a344cff63c02983e108099.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Sex Hormones on Serum Levels of Nesfatin-1 in Experimental Rats4214285236410.21608/mjcu.2019.52364ENMAHER N. IBRAHIM, M.D.;KAMELIA I. ATTIA, M.D.The Department of Physiology, Faculty of Medicine, Zagazig UniversityMARWA A. HABIB, M.D.;DALIA A. ROSHDY, M.Sc.The Department of Physiology, Faculty of Medicine, Zagazig UniversityJournal Article20181001Abstract<br />Background: Nesfatin-1 is nucleobindin 2-derived polypeptide involved in feeding regulation. The expression of Nesfatin-1 in the hypothalamus, pituitary gland and repro-ductive organs drew the attention to its potential role in regulation of hypothalamic-pituitary-gonadal axis. Yet, very few data are available regarding the effect of gonadal hormones on the regulation of Nesfatin-1.<br />Aim of Study: The present study was designed to explore the probable sex difference in serum Nesfatin-1 levels and the relationship between serum levels of sex hormones and Nesfatin-1 in adult male and female albino rats.<br />Material and Methods: The study involved 18 male and 30 female albino rats. The male rats were divided in to three equal groups: Control (M Cont.), orchidectomized (ORX), and testosterone-treated orchidectomized (T-treated ORX). The female rats were divided in to five equal groups: Control (F Cont.), ovariectomized (OVX), estradiol-treated ovariect-omized (E-treated OVX), progesterone-treated ovariectomized (P-treated OVX), and estradiol and progesterone-treated ovariectomized (E + P-treated OVX). Serum levels of Nesfatin-1, LH (in all rats), testosterone (in male rats), estradiol and progesterone (in female rats) were measured.<br />Results: Serum levels of Nesfatin-1 were higher in female than in male control rats. Nesfatin-1 levels significantly decreased in ORX group compared with M Cont. group and increased in T-treated ORX group compared with ORX group. Nesfatin-1 positively correlated with testosterone in ORX and T-treated ORX groups, but insignificantly correlated with LH in all groups. Serum levels of Nesfatin-1 were significantly decreased in OVX group compared with F Cont. group and increased in E-treated OVX, P-treated OVX and In E + P-treated OVX groups when compared with those of OVX group. Positive correlations were found between Nesfatin-1 and both estradiol and progesterone in OVX, E-treated OVX, P-treated OVX, and E+P-treated OVX groups; however, no significant correlations were found with LH in all groups.<br />Conclusion: From the above results it can be concluded that gonadal hormones are important regulators of serum levels of Nesfatin-1 in albino rats.https://mjcu.journals.ekb.eg/article_52364_aec93126a1bcc75a87d87a4630aa5586.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Fractional Ablative Erbium: YAG Laser Resurfacing of Rhinophyma4294345237810.21608/mjcu.2019.52378ENMAI A.OSMAN, M.D.Dermatology Unit, The Department of Medical Applications of Lasers, National Institute of Laser Enhanced Sciences (N.I.L.E.S), Cairo UniversityJournal Article20181001Abstract<br />Background: Management of rhinophyma can be chal-lenging. There are numerous approaches for treating rhino-phyma. Fractional laser resurfacing has been recently proposed as a treatment modality for rhinophyma.<br />Aim of Study: To evaluate the efficacy and safety of fractional ablative 2,940-nm erbium: YAG laser in the treatment of rhinophyma.<br />Patients and Methods: Eight patients with mild to moderate rhinophyma received 4 successive monthly treatments with a fractional 2,940-nm erbium: YAG laser. Clinical assessment scores and patient satisfaction surveys were obtained at 3- month follow-up. The final assessment took place at 6 months to detect recurrence.<br />Results: Cosmetic results were evaluated as excellent or very good in 75% of patients. Patient satisfaction scores paralleled the physician assessment scores. All of the patients tolerated the procedure well with healing time at 2-5 days. None of the patients had post-operative complications. One patient experienced recurrence.<br />Conclusion: Fractional ablative erbium: YAG laser is an efficient treatment alternative for patients with mild to moderate rhinophyma who are unable or unwilling to endure the pro-longed post-operative recovery and the high incidence of adverse effects associated with ablative lasers and surgical procedures.https://mjcu.journals.ekb.eg/article_52378_3c24a67a15fba8ad84366c8f099f35d2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Cholecalciferol Supplementation on Glycemic Control, Beta Cell Function and Insulin Resistance among Type 2 Diabetics Attending the Family Medicine Outpatient Clinic Affiliated to Suez Canal University Hospital, Ismailia City, Egypt4354435237910.21608/mjcu.2019.52379ENDALIA E. IBRAHIM, M.Sc.;HASSAN A. ABD EL-WAHED, M.D.;The Department of Family Medicine, Faculty of Medicine, Suez Canal UniversityHANAN A. ABDO, M.D.;ENAYAT M. SOLTAN, M.D.The Department of Family Medicine, Faculty of Medicine, Suez Canal UniversityJournal Article20181001Abstract<br />Background: Diabetes is a complex chronic illness that adversely affects patients' quality of life. Approximately 425 million adults (20-79 years) were living with diabetes in 2017. Vitamin D levels had been shown to alter insulin synthesis and secretion suggesting its role in the pathogenesis of type 2 diabetes mellitus.<br />Aim of Study: To promote the quality of care provided to type 2 diabetic patients in the family practice setting.<br />Patients and Methods: This is a randomized controlled trial conducted on 60 uncontrolled type 2 diabetics. Patients were randomly allocated to Vitamin D3 group; received oral daily 2000IU of Cholecalciferol plus their usual care and a control group; received only their usual care for 3 months. Baseline anthropometrics, blood pressure, FBS, HBA1C, fasting insulin, HOMA indices and lipid profile were measured and repeated after 3 months.<br />Results: No statistically significant sociodemographic differences were found between both groups. The majority were younger than 60 years, hypertension was found in 76.7% of them. There were post intervention statistically significant differences (p<0.05) between both groups in blood pressure, FBS and HOMA-b. The pre-post relation in the intervention group shows statistically significant differences (p<0.05) in blood pressure, FBS, fasting insulin, HOMA-b and HOMA-IR. There is a statistically significant positive correlation between HBA1C, blood pressure, and FBS.<br />Conclusion: Adding a daily dose of 2000IU of oral Vitamin D3 for type 2 diabetic patients may be beneficial through improving blood pressure, fasting blood glucose and HOMA-b.https://mjcu.journals.ekb.eg/article_52379_acc332710488f500e2e357a9ad7cfc08.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Expression of CASK Antibody in Non-Mucinous Colorectal Adenocarcinoma4454535238010.21608/mjcu.2019.52380ENSAHAR F. MANSOUR, M.D.;REHAM H ABDUL-AZIM, M.Sc.The Department of Pathology, Faculty of Medicine, Suez Canal UniversityNOHA R. NOUFAL, M.D.;HOWAYDA ABD EL-AL, M.D.The Department of Pathology, Faculty of Medicine, Suez Canal UniversityJournal Article20181001Abstract<br />Background: Colorectal cancers are one of the leading causes of cancer related morbidity and mortality worldwide. In Egypt was 4% in the year 2012 ranking as the sixth cancer in Egypt and representing 53% of GI malignancy. It is obvious that there is no single determining factor for the process of carcinogenesis or spread of colorectal carcinoma. There are many proposed contributing factors, including disturbances in Epithelial-Mesenchymal Transition (EMT) and loss of regulation of adhesion molecules and polarity proteins. Cal-cium/calmodulin-dependent serine protein kinase (CASK) belongs to the Membrane-Associated Guanylate Kinase (MAGUK) family. The role of CASK in Colorectal cancer hasn't been yet fully understood.<br />Aim of Study: To evaluate the expression of Calci-um/calmodulin-dependent serine protein kinase (CASK) in non-mucinous colorectal adenocarcinoma and to evaluate its correlation with variable clinicopathological factors.<br />Material and Methods: It is retrospective descriptive study is conducted in the Department of Pathology, Faculty of Medicine, Suez Canal University Teaching Hospital. It include 42 archived paraffin blocks of non-mucinous colorectal adenocarcinoma of patients who underwent surgical excision without previous chemotherapy or radiation, 15 adenomatous polyps and 5 normal mucosa samples. The clinical and path-ological data of studied patients are taken from medical records, pathology referral reports and pathology reports. Patients with incomplete data excluded from the study. Re-viewing the data of survival from the archived registry files at department of Oncology, Suez Canal University Teaching Hospital. Sections cut into 5um thick sections and mounted on positive charged slides for immunohistochemical staining using CASK Antibody (S56A-50): Mouse Monoclonal, Novus Biologicals, Catalogue no. NBP1-47648. Staining intensity graded according to the Allred score on a 0-3 scale.<br />Data Analysis: The relation between CASK antibody staining intensity in the studied biopsies and other clinico-pathological parameters including (age, gender, histopatho-logical tumor features) was evaluated using Pearson's x2 test. The level of statistical significance (p-value) was set at Results: The study revealed that CASK protein had mainly cytoplasmic and cytoplasmic-membranous pattern of expres-sion. The CASK protein was overexpressed in the majority of CRC samples with 85.7% of cases showing moderate to strong expression, while only 14.3% of cases displayed minimal faint expression. On the other hand, CASK expression was low in the majority (53.3%) of adenoma samples. Addi-tionally, adenomas with high grade dysplasia showed stronger staining intensity for CASK protein and higher percentage of positive cases than the ones with low grade dysplasia by IHC. As regard to the association between CASK protein overex-pression and clinicopathological prognostic factors we found that CASK demonstrated significantly higher expression in tumor samples with early stages (I/II) rather than advanced stage (III/IV). Low grade tumors showed higher percentage of positive cases and stronger intensity of staining for CASK protein than high grade tumors. Expression of CASK protein showed no statistically significant correlation with patients' gender or age respectively. There was also no significant correlation with tumor site, gross tumor size, histologic tumor border configuration, lymphovascular invasion or distant metastasis.<br />Conclusion: CASK protein was overexpressed in the majority of non-mucinous colorectal adenocarcinoma (CRC) cases with mainly cytoplasmic and cytoplasmic-membranous localization. However, its expression was significantly less in adenomas with a possible association with the grade of dysplasia; giving positive pattern in highly dysplastic cases suggesting a role in the progression of adenomas into carci-nomas. CASK overexpression also associated with both TNM stage of tumors and their histologic grade. CASK was signif-icantly overexpressed in early stage and low grade tumors rather than tumors with advanced stage and higher histological grades. This suggests that CASK protein is a good prognostic factor and might contribute in tumor confinement and local-ization.https://mjcu.journals.ekb.eg/article_52380_49c3113e9c3d5ab939b20aa104af30ce.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Efficacy of Whole Body Vibration Exercises Versus Aerobic Training On Glycemic Control in Overweight Women with Type II Diabetes4554635238110.21608/mjcu.2019.52381ENGABER S. SOLIMAN, Ph.D.;AHMED A.A. EL-KERDAWY, Ph.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorder & Geriatrics, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: Diabetes is a global health problem affecting all ages and uncontrolled diabetes has a negative impact on people's lives and is one of the most important causes of cardiovascular disease and hypertension and is a cause of death globally.<br />Aim of Study: The aim of the current study was to compare the effect of whole body vibration exercises versus aerobic exercises on glycemic control in overweight women with type II diabetes.<br />Material and Methods: Sixty overweight women type II diabetes with aging ranged from 40 to 50 years and BMI ranged from 25-29.9Kg/m2, divided randomly into two groups equal in number (A) and (B). Each of them consisted of thirty participants; Group (A) enrolled into whole body vibration exercise program, and Group (B) enrolled into aerobic (cycling) training program. They were randomly selected from the women that frequently visit National Diabetes Institute in Cairo. The study conducted through January 2017 to August 2018. The study lasted for twelve weeks at a frequency of three sessions per week. Evaluation included, body mass index, glycated hemoglobin and blood glucose level. Glycated hemoglobin was measured at the start and after the exercise program.<br />Results: Results of the current study showed a statistically significance reduction in blood glycated hemoglobin in both groups. But when comparing the two groups with each other there is no statistically significance value. Results the current study approved that both vibration exercise and aerobic training have similar effect on long term glycemic control in overweight women with type II diabetes.<br />Conclusion: The findings of the current study suggest that whole body vibration exercises may be beneficial tool and needs less time to enhance glycemic control in overweight women with type II diabetes when compared with aerobic exercise especially in women with decreased fitness.https://mjcu.journals.ekb.eg/article_52381_2b3e1291ab22a4193b1f2f9d3aa7ab0b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Protective Effect of Sodium-Glucose Co-Transporter 2 Inhibitor (Dapagliflozin) on Diabetic Retinopathy in Streptozotocin Induced Diabetes in Rats4654705238210.21608/mjcu.2019.52382ENHEBA S. SHOUKRY, M.D.;MAHA M. TAHER, M.Sc.The Department of Physiology, Faculty of Medicine, Cairo University and The Department of Pharmacology, Faculty of Pharmacy, Modern Sciences and Arts UniversityAHMED AMIN, M.Sc.;AHMED ALLAM, M. S C.The Department of Physiology, Faculty of Medicine, Cairo University and The Department of Pharmacology, Faculty of Pharmacy, Modern Sciences and Arts UniversityYARASAMY, M. S C.The Department of Physiology, Faculty of Medicine, Cairo University and The Department of Pharmacology, Faculty of Pharmacy, Modern Sciences and Arts UniversityJournal Article20181001Abstract<br />Background: Diabetic retinopathy is a serious diabetic complication as it is considered the most common cause of blindness in diabetes. There is a link between chronic hyper-glycemia and the occurrence and progression of diabetic retinopathy.<br />Aim of Study: To investigate for the effect dapagliflozin, Sodium-Glucoseco-Transporter2 (SGLT2) inhibitor in reduc-tion of diabetic retinopathy.<br />Material and Methods: Thirty (30) male albino rats (120- 150) were randomly divided into control (n=6); DM (diabetic non treated group, n=10), DM + DAPA (diabetic treated with dapagliflozin for 8 weeks, n=10). Blood samples and retinal tissues were collected to assess glycated hemoglobin (HbA1c), serum Interleukin 6 (IL-6), lipid profile and retinal expression levels of hydrogen peroxide (H2O2) and Brain Derived Nerve Growth (BDNG) moreover histological assessment was per-formed.<br />Results: Diabetes increased all measured parameters while decreased the expression of BDNG. Supplementation of dapagliflozin improved all measured parameters.<br />Conclusion: This study showed the harmful effect of diabetes on retina which could be mediated by oxidative stress and inflammation. On the other hand, dapagliflozin improved diabetic retinopathy via antioxidant and anti-inflammatory actions also it improved retinal regeneration via increasing the expression of brain derived nerve growth factor.https://mjcu.journals.ekb.eg/article_52382_fa6cea5fa706443c56a6c10f5a8904c4.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Postoperative Hepatobiliary Surgeries' Fungal Infections Epidemiology: Prevalence and Risk Factors4714755240910.21608/mjcu.2019.52409ENWESAM S. MORAD, M.D.;ESSAM EL-SHIMII, M.D.The Departments of Epidemiology & Preventive Medicine, Hepatology, Clinical Pathology and Hepatopancreato-Biliary Surgery, National Liver Institute, Menoufia UniversityAMAL EL-SHARNOBY, M.D.;AMR MOSTAFA AZIZ, M.D.The Departments of Epidemiology & Preventive Medicine, Hepatology, Clinical Pathology and Hepatopancreato-Biliary Surgery, National Liver Institute, Menoufia UniversityJournal Article20181001Abstract<br />Background: Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in ICU, the incidence of invasive candidiasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Risk factors for invasive candidiasis & candidaemia include prior antimicrobial therapy, central venous catheters, urinary catheters, ICU admission, parenteral nutrition, major surgery and immunosuppressive therapies. Candida species were the most frequently isolated organism from any sites and comprise 85% of total number of cultures.<br />Aim of Study: Assessing the rate of fungal infections after hepatobiliary surgery and identification of the risk factors associated with the development of fungal infections in such patients.<br />Patients and Methods: A prospective cohort hospital based study was carried out at National Liver Institute. The studied group consisted of 210 patients. All of them were examined thoroughly, their data were registered and sampled at two times, one at day of admission to be sure that they are free of fungal infection and the second was after hepatobiliary surgery pre-designed questionnaire was used which include data about personal history, medical history and suggested risk factors for fungal infections.<br />Results: In the present study the incidence rate of fungal infection among patients undergone hepatobiliary surgeries in NLI is (45.2%) and the main predictors of fungal infection were age (p-value 0.001), antibiotic use (p-value 0.05), liver disease (p-value 0.006), CVC (p-value 0.043), urinary catheter (p-value 0.05), and ICU hospitalization more than 48 hours (p-value 0.000008).<br />Conclusions: High incidence of fungal infection after hepatobiliary surgeries may reach 45% due to type of patient doing such surgeries. The great prevalence of fungal coloni-zation inside ICU which is easily transmissible emphasizes very strongly on the importance of infection- control guidelines.<br />Recommendations: Aggressive antibiotics shouldn't be used outside ICU and only antibiotics according to culture and sensitivity should be used to lessen down emergence of resistant strains and fungal flourishment.https://mjcu.journals.ekb.eg/article_52409_230561ba4f8604ea1f891ada975065d6.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Profile of Newly Diagnosed Type 1 Diabetic Children Admitted in Assiut University Children Hospital, Egypt4774825241010.21608/mjcu.2019.52410ENHANAA A. MOHAMMAD, M.D.;HEKMA S. FARGHALY, M.D.The Department of Pediatrics, Faculty of Medicine, Assiut UniversityEKRAAM M. ABD EL-KHALIK, M.D.;SANAA A. MOHAMMAD, M.Sc.The Department of Pediatrics, Faculty of Medicine, Assiut UniversityJournal Article20181001Abstract<br />Background: Since risk factors for development of type 1 diabetes mellitus vary greatly between different countries, so study of the epidemiological features of type 1 diabetes mellitus in our country may suggest the most important risk factors that could be prevented in the future. We aimed to identify the main epidemiological patterns and risk factors for newly diagnosed children with T1DM in Egypt.<br />Aim of Study: To determine the rate of newly diagnosed type 1 diabetes and to find out the different risk factors associated with type 1 DM among infants and children attended Assiut University Children Hospital.<br />Patients and Methods: A descriptive case- control hospital based study included 179 case of newly diagnosed T1DM children who attended Assuit University Children Hospital and similar number as a controls during a period of one year.<br />Results: Our results indicate that our study children with T1DM had positive family history of DM, about 76% of them ingest junk foods, with late age of introduction of cereal and gluten, small for gestational age delivery, with prolonged normal vaginal delivery and high socioeconomic state.<br />Conclusion: Environmental factors have an important role in development of T1DM in the form of exposure to environmental risk factors during perinatal and neonatal period and also exposure to environmental factors during the first years of life as feeding pattern. There was no significant statistically difference as regard viral infection and maternal diseases.https://mjcu.journals.ekb.eg/article_52410_2f330ceb6a70c89b729b0c9838dd7a1a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Needs and Expectations of Parents Having Children with Cancer from Nurses4834955241110.21608/mjcu.2019.52411ENRASHA A. MOHAMMED, M.Sc.;AFKAR R. MOHAMED, D.N.Sc.The Department of Head Nurse in Medical, National Cancer Institute, Pediatric Nursing, Faculty of Nursing and Pediatric Oncology, National Cancer Institute, Cairo University, EgyptMARWA A. IBRAHIM, D.N.Sc.;WAEL Z. KHALED, M.D.The Department of Head Nurse in Medical, National Cancer Institute, Pediatric Nursing, Faculty of Nursing and Pediatric Oncology, National Cancer Institute, Cairo University, EgyptJournal Article20181001Abstract<br />Background: Parents dealing with childhood cancer face different stressors. The ability of parents to deal with these stressors may depend on the supportive care available to them.<br />Aim of Study: The current study aimed to determine the needs and expectations of parent of children with cancer from nurses.<br />Design: A descriptive exploratory research design was utilized for the current study.<br />Setting: The study was conducted in two pediatric wards in the National Cancer Institute (NCI) affiliated to Cairo University.<br />Sample: A convenient sample of 260 parents of children with cancer were participated in this study. Data was collected by using structured interview questionnaire sheet which consisted of two parts. Part I included personal data about parents of children with cancer, as well as their children, and medical history of the children. Part II included assessment sheet for needs of the parents (informational, psychosocial, physical, practical, and spiritual) and assessment sheet for expectations of the parents of children with cancer.<br />Results: The current study revealed that three quarters of parents were mothers accompanying the child to the hospital. The majority of children had leukemia, one third of them was in school age and male gender. There were statistically sig-nificant relation between parent's needs, expectations and their age and marital status. There were no statistical significant relation between parent's needs and their education and working status.<br />Conclusion: The current study concluded that the highest percentages of parents' needs were focused on informational, psychosocial, physical, practical, and spiritual. Parents have great expectations from nurses as they are the main source of support. In addition parents reported that they have unmet supportive needs from nurses.<br />Recommendations: The current study recommended that continuous assessment of the information needs of parents of children with cancer can help nurses in providing relevant and specific information according to parents' needs. Design a framework for supportive care needs may be useful in determine the parents' needs for proper planning to provide needs-based care.https://mjcu.journals.ekb.eg/article_52411_86cd3f0535267d6a103b70d7805aea90.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Association of Complement Factor H (CFH) Y402H Gene Polymorphism and Serum CFH with Risk of Age Related Macular Degeneration in Egyptian Patients4975035241210.21608/mjcu.2019.52412ENMARIANNE S.M. ISSAC, M.D.;NAHLA A. FAWZY, M.D.The Departments of Clinical & Chemical Pathology and Ophthalmology, Faculty of Medicine, Cairo UniversityRIHAM A. El-ESSAWY, M.D.;MOHAMED A. ZAYED, M.D.The Departments of Clinical & Chemical Pathology and Ophthalmology, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Age related Macular Degeneration (AMD) is stated as the most common cause of irreversible blindness among aging populations. It has been reported that both Complement Factor H (CFH) Y402H polymorphism and serum CFH concentration are linked to AMD.<br />Aim of Study: To determine whether Y402H polymorphism and serum level of CFH are associated with AMD in the Egyptian population.<br />Material and Methods: Eighty subjects were recruited; 40 AMD patients and 40 matched healthy individuals as control. Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) was performed for the analysis of CFH Y402H gene polymorphism. Serum CFH concentration was measured using Enzyme Linked-Imm-unosorbent Assay (ELISA).<br />Results: Susceptibility to AMD in Egyptian population was not associated with CFH Y402H polymorphism and the presence of C allele is not considered risky; Odds Ratio (OR): 0.545, 95% CI (0.291-1.022). No significant association between CFH genotypes and AMD. Serum CFH concentration showed no statistically significant difference between cases & controls (p=0.706). In controls, there was a statistically significant decrease in serum CFH level in CC genotype compared to both CT genotype (p=0.038) and TT genotype (p=0.007), while in AMD group, no statistically significant difference in serum CFH concentration between different genotypes.<br />Conclusion: CFH Y402H polymorphism does not confer risk of AMD in Egyptian patients. Further larger scaled studies are needed to confirm CFH role in AMD.https://mjcu.journals.ekb.eg/article_52412_3df89f1021825b9142207570e2bc9549.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Electroencephalography Findings in Children with Congential Heart Disease5055105241310.21608/mjcu.2019.52413ENAYAT ALLAH F. HUSSEIN, M.D.;AMIRA E. EL-TANTAWY, M.D.Pediatric Cardiology Unit and Clinical Neurophysiology Unit, Faculty of Medicine, Cairo UniversityNEVEEN M. EL-FAYOMY, M.D.;REEM A. EL-HADIDY, M.D.Pediatric Cardiology Unit and Clinical Neurophysiology Unit, Faculty of Medicine, Cairo UniversityRODINA S. MOHAMED, M.D.;SALMA M. MARZOUK, M.D.Pediatric Cardiology Unit and Clinical Neurophysiology Unit, Faculty of Medicine, Cairo UniversityRASHA M.YOUSEF, M.B.B.Ch.Pediatric Cardiology Unit and Clinical Neurophysiology Unit, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Children with Congenital Heart Disease (CHD) as well as survivors of cardiac surgeries are at risk for brain injury and neurodevelopmental deficits.<br />The Aim of this Work: Is to evaluate the Electroencepha-lography (EEG) findings as an indicator for cerebral function in children with congenital heart disease and to correlate these findings to the oxygen saturation.<br />Patients and Methods: This is a cross-sectional study included 30 patients (17 males and 13 females) with CHD (20 with cyanotic and 10 with acyanotic CHD) with age range 4-9 years. Compared with 30 age and sex matched healthy children as controls. All children underwent; digital EEG recording for detection of background slowing and epileptic changes and measurement of oxygen saturation using pulse oximeter.<br />Results: EEG findings were present in 17 (30%) patients (16 patients with cyanotic and 1 with acyanotic CHD). Detected EEG changes were: Epileptic activity in 6 (20%) patients (all had cyanotic CHD), background activity slowing in 16 (53.3%) patients (1 with acyanotic and 15 with cyanotic CHD), while both epileptic changes & back ground activity slowing were detected in 5 (16.7%) patients (all with cyanotic CHD). The cut off value of O2 saturation below which background activity slowing are liable to occur was 87%, with a sensitivity and specificity of 81.2% and 71.4% respectively.<br />Conclusion: Children with cyanotic CHD had significantly higher EEG changes than those with acyanotic CHD.<br />Recommendation: The digital EEG should be performed routinely in patients with CHD (particularly cyanotic) to detect abnormalities in the cerebral function.https://mjcu.journals.ekb.eg/article_52413_53d7bf85040177ac324b7d93ed3c8ebb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Correlation between Degree of Forward Head Posture and Rounded Shoulder Posture in Physical Therapy Students5115155241410.21608/mjcu.2019.52414ENAYA A. SAAID, M.Sc.;GHADA A. MOHAMMED, Ph.D.The Department of Basic Science, Faculty of Physical Therapy, Cairo UniversityHAYTHAM M.EL-HAFEZ, Ph.D.The Department of Basic Science, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: Forward head posture has been shown to be a common postural displacement, with a conservative estimate being 66% of the patient population. Failure of the head to align with the vertical axis of the body can lead to malalign-ments in the body such as rounded shoulders and hyper-kyphosis to compensate for altered location of the line of gravity leading to further impairments. Although most previous researches were conducted to determine the relation between Forward Head Posture (FHP) and cervical pain or thoracic kyphosis or temporomandibular joint and the relation between FHP and Rounded Shoulder Posture (RSP) is not clearly understood.<br />Aim of Study: The present study aimed to investigate the correlation between different degrees of forward head posture and changes in shoulder angle in asymptomatic subjects with forward head and rounded shoulder posture.<br />Subjects and Methods: 114 physical therapy subjects (58 males and 56 females) aged 18-27 years and body mass index ranged from 16-35kg/cm2 were recruited for this cross section study. The craniovertebral and shoulder angle were used to measure the degree of FHP and RSP respectively from standing position by photogrammetry.<br />Results: Significant negative negligible correlation was detected between mild degree of forward head posture and rounded shoulder (p0.3 and r=0.08).<br />Conclusion: It was demonstrated that, mild and moderate degrees of forward head posture change the degree of the rounded shoulder. However, the sever degrees of forward head posture don't change the degree of the rounded shoulder.https://mjcu.journals.ekb.eg/article_52414_a7f2914356a612f966e13b5dd2963d3f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Evaluation of Claudin-1 and Ki-67 in Different Molecular Subtypes of Breast Ductal Carcinoma: Immunohistochemical Study5175265241610.21608/mjcu.2019.52416ENMARWA S. ABD ALLAH, M.D.;AMR F. EL-SEBAAIE, M.D.The Departments of Pathology, Faculty of Medicine, Benha University and Military Medical Academy, Cairo, EgyptEMAN S. OMAR, M.D.;EMAN A. SAAD, M.Sc.The Departments of Pathology, Faculty of Medicine, Benha University and Military Medical Academy, Cairo, EgyptSAMIA A.YOUSSEF, M.D.The Departments of Pathology, Faculty of Medicine, Benha University and Military Medical Academy, Cairo, EgyptJournal Article20181001Abstract<br />Background: The role of claudin-1 in aggressiveness and increased metastatic phenotype is controversial issue in different cancers.<br />Aim of Study: Evaluation of immunohistochemical ex-pression of Claudin-1 and Ki-67 in different molecular subtypes of breast ductal carcinoma and correlation with other prognostic clinicopathologic factors.<br />Patients and Methods: This is a retrospective controlled Immunohistochemical study performed to examine the expres-sion of Claudin-1 and Ki-67 in 54 cases of breast ductal carcinoma (NST) with different molecular subtypes. Statistical analysis methods were used to evaluate the relationship between Claudin-1 and Ki-67 with various clinicopathological, parameters and molecular subtypes.<br />Results: 19 cases (35.2%) were Luminal A, 14 cases (25.9%) were Luminal B, 10 cases (18.5%) were Her2 En-riched, and 11 cases (20.4%) were Triple Negative (TN). There is a statistically significant correlation between claudin-1 & Ki-67 expression and various pathological parameters and molecular subtypes. High expression of both markers have direct significant correlation with poor prognostic factors as higher tumor grade and, higher nuclear grade, large tumor size, positive lymph node metastasis, positive distant metas-tasis, high stage, positive LVI and poor NPI. Luminal B and TN tumors have higher Ki-67 compared to other subtypes. TN tumors & Her2 enriched tumors have higher claudin-1 expression compared to other subtypes. All luminal A tumors have low expression of both Ki-67 and caludin1.<br />Conclusions: Claudin-1 overexpression is associated with poor prognostic factors and high Ki-67 proliferative index in breast ductal carcinoma and may have diagnostic role in discrimination between different molecular subtypes of breast ductal carcinoma.https://mjcu.journals.ekb.eg/article_52416_4757bf2fb58ee650c9e3cd767a68b7f2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Erdosteine Versus N-acetyl Cysteine as a Potential Therapy for Hepatorenal Syndrome5275345241810.21608/mjcu.2019.52418ENASEM A. ELFERT, M.D.;KAMAL M. OKASHA, M.D.The Departments of Tropical Medicine & Infectious Diseases and Internal Medicine, Faculty of Medicine, Tanta UniversityREHAM A. EL-KHOULY, M.D.;SHAIMAA E. AHMED, M.Sc.The Departments of Tropical Medicine & Infectious Diseases and Internal Medicine, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Hepatorenal Syndrome (HRS) is a unique form of acute kidney injury seen in patients with acute liver failure or chronic liver disease in absence of any other iden-tifiable cause of renal failure. Hepatorenal syndrome is asso-ciated with significant morbidity and mortality.<br />Aim of Study: The aim of this study was to assess the safety and efficacy of Erdosteine versus N-acetyl cysteine with octreotide and albumin in the treatment of hepatorenal syndrome in cirrhotic patients.<br />Patients and Methods: The study enrolled 60 liver cirrhosis patients diagnosed to have hepatorenal syndrome who were randomized to receive Erdosteine 300mg or N-acety-lcysteine 600mg three times daily with octreotide (100μgsc three times a day) midodrine (12.5mg orally three times a day) and albumin (1g/kg body weight up to a maximum of 100g) or receive octreotide, midodrine and albumin as a control for two weeks. Renal function was assessed before and after treatment. Side effects and improvement of liver function were recorded.<br />Results: In NAC group; creatinine level was significantly lower after the second week of therapy than baseline level (p=0.006), also there was significantly higher GFR after the first and the second weeks of therapy than baseline level (p= 0.038, 0.001 respectively) and significant higher GFR after the second week than after the first week of therapy (p= 0.015). Meanwhile, no significant difference of creatinine or GFR was detected in Erdosteine group or when the three groups were compared.<br />In NAC group, Child-Pugh score significantly improved compared to control group after 2 weeks of therapy (p=0.004). In the first and second weeks of therapy, the grade of enceph-alopathy was significantly lower in Erdosteine group (p=0.032, 0.040) and in NAC group (p=0.009, 0.004) compared to control group.<br />The side effects were few with no significant difference between their occurrences in the three groups.<br /> Conclusion: This study was a pilot study that investigated the effects of Erdosteine versus NAC on human patients with HRS. No significant difference of creatinine or GFR was detected when Erdosteine, NAC and control groups were compared. Improvement of Child-Pugh score in NAC group and hepatic encephalopathy in Erdosteine group were second-ary outcomes of our study.<br />As these drugs had a high safety profile, we recommend further studies using higher doses of the drugs for longer periods and enrollment of larger number of patients to optimize treatment of HRS.https://mjcu.journals.ekb.eg/article_52418_33da7b11bf742573d818c81b5e81700b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Dietary Supplementation of Quercetin and the Reproductive Functions in Hypertensive Male Rats5355455241910.21608/mjcu.2019.52419ENAHMED A. ABD AL-FATTAH, M.D.;YASSER M. ABD EL-RAOUF, M.D.The Departments of Physiology and Internal Medicine, Metabolism Unit, Faculty of Medicine, Tanta University, EgyptJournal Article20181001Abstract<br />Background: Hypertension is considered one of the com-monest medical problems and affects more than 25% of the general population, with its prevalence increases with age. It is associated with a wide variety of health challenges like stroke, heart failure, renal failure and reproductive disorders.<br />Aim of Study: The prevention of hypertension induced reproductive impairment remains unclear. Hence, the aim of the present study was to investigate the possible protective effects of quercetin on male reproductive functions in L-NAME- induced hypertensive rats.<br />Material and Methods: 50 Male Wister Albino rats (200- 220g) were divided into 5 groups 10 per each. G1: The control group was placed on the basal diet (received saline with the same volume used to dissolve L-NAME and quercetin by gavage) for 4 weeks. G 2: The Quercetin group was adminis-tered with Quercetin 50mg/Kg b.w. by gavage for 4 weeks. G 3: The L-NAME group (hypertensive induced group received L-NAME (40mg/Kg/day by gavage) for 4 weeks. G 4: The L-NAME plus atenolol received L-NAME plus atenolol (10 mg/kg/day) by gavage for 4 weeks. G 5: The L-NAME plus Quercetin received L-NAME (40mg/Kg/day) plus quercetin 50mg/Kg b.w. by gavage for 4 weeks.<br />Results: Quercetin abrogated the mean blood pressure elevation induced by L-NAME. Administration of quercetin increased the antioxidant enzyme activities and glutathione, whereas it suppressed the oxidative stress biomarkers and the arginase activity. Quercetin significantly restored hypertension induced impairment of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone hormone. Quer-cetin improves the sperm motility and viability. Histopatho-logical findings supported our results.<br />In Conclusion: Quercetin supplementation may be con-sidered a beneficial approach targeting reproductive deficits in male hypertensive patients.https://mjcu.journals.ekb.eg/article_52419_0d59a57789eca3f0639124909a650367.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Cisplatin on the Kidney of the Albino Rat and Possible Protective Role of Vitamin C5475555242010.21608/mjcu.2019.52420ENREEM H. MOHAMED, M.Sc.;YEHIA M. YOUSSEF, M.D.The Department of Anatomy, Faculty of Medicine, Al-Azhar University, CairoMANAL H. EL-KAFRAWY, M.D.;OLA A. EL-SAYED, M.D.The Department of Anatomy, Faculty of Medicine, Al-Azhar University, CairoAMINA M.TOLBA, M.D.The Department of Anatomy, Faculty of Medicine, Al-Azhar University, CairoJournal Article20181001Abstract<br />Background: Cisplatin has a major nephrotoxic effect.<br />Aim of Study: To evaluate the protective effect of vitamin C against cisplatin-induced nephrotoxicity.<br />Material and Methods: Sixty adult albino rats divided into 5 groups; group I (10 rats; control), group II (10 rats); received single dose of cisplatin 6mg/kg IP. Group III (10 rats); received single dose of cisplatin 6mg/kg IP 6 hours after single dose of oral vitamin C 350mg/kg. Group IV (15 rats); received single dose of cisplatin 2mg/kg/week for 4 weeks IP and subdivided into three subgroups (5 rats each). Group V (15 rats); received single dose of cisplatin 2mg/kg/week for 4 weeks IP 6 hours after single dose of oral vitamin C 350mg/kg and subdivided into three subgroups (5 rats each). Kidneys were dissected and stained by (H&E), Masson's trichrome (MT) and Periodic acid Schiff (PAS) and examined by light microscopy, and fresh tissue taken from group I, IV-<br />B and V-C examined by electron microscopy.<br />Results: Our results showed toxic effect of cisplatin on renal glomeruli and proximal tubular lining in group II with improvement in group III, chronic toxicity effect in group IV-<br />C in the form of hyaline casts and thickened BM with apparent improvement in group V.<br />Conclusion: We conclude that the vitamin C has a protec-tive effect against cisplatin- induced nephrotoxicity.https://mjcu.journals.ekb.eg/article_52420_6f7cd2751bf651c19820d484edb1d140.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Pulsed Magnetic Field Therapy on Pain in Children with Acute Burn Injury5575605242110.21608/mjcu.2019.52421ENELHAM E. SALEM, Ph.D.;ASMAA O. SAYED, Ph.D.The Departments of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University and Plastic Surgery, Faculty of Medicine, Cairo UniversityAMIRA E. ABD EL-MAGEID, M.Sc.;AYMAN NOAMAN, M.D.The Departments of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University and Plastic Surgery, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Pain management is essential in burn injury for children to better out come during all stages of treatment and rehabilitation.<br />Aim of Study: Was to determine effect of pulsed magnetic therapy on pain in children after second degree of burn.<br />Subjects and Methods: We have utilized children with acute burn injury, experimental design study, randomized, convenate on forty child, subjects divided into two group, control group (A) received specific design physical therapy program me and study group (B) received specific design physical therapy program me in addition to pulsed magnetic field therapy. Pulsed electromagnetic therapy application 3 days weekly, 20 minutes every session received pulsed elec-tromagnetic field. Pain was assessed with Wong backer faces pain scale in both groups after three days of injury and after three weeks of injury results. There were significant decrease in pain post application of pulsed electromagnetic field com-pared to its pre application, there was significant decrease in pain, post application of specific design physical therapy programme compared to its pre application and a significant decrease in the pain of study group compared with that of control group post-treatment (p=0.0001).<br />Conclusions: The present study demonstrate that pulsed electromagnetic field justify amount of improvement in pain relieve in acute burn injury.https://mjcu.journals.ekb.eg/article_52421_4513febe09438dfd94dd507a668e243d.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Role of Magnetic Resonance Imaging in the Diagnosis of Different Pancreatic Lesions5615705242210.21608/mjcu.2019.52422ENEMAN M. DARWISH, M.Sc.;FATMA A. EL-SHAARAWY, M.D.The Departments of Radiology and Clinical Oncology, Faculty of Medicine, Tanta UniversityASHRAF F. BARAKAT, M.D.;ABD EL-MONEM N. DARWISH, M.D.The Departments of Radiology and Clinical Oncology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Pancreatic cancer is one of the most lethal human cancers that requires early diagnosis. Ultrasound, CT and MRI are different imaging modalities used for diagnosis of pancreatic masses. Diffusion-Weighted Imaging (DWI) and Time-signal Intensity Curve (TIC) can add to the diagnosis of pancreatic masses.<br />Aim of Study: The aim of this study was to evaluate the role of magnetic resonance imaging in the diagnosis of different pancreatic lesions.<br />Patients and Methods: Twenty-three patients were divided into 4 groups, group A (Acute Pancreatitis) (AP), group B (pancreatic cysts) which subdivided into malignant and benign cysts, group C (adenocarcinoma) and group D (Focal Pancre-atitis) (FP), all patients groups were compared to the control group. MRI protocol included MRI-c (T1WI, T1 Fat Suppres-sion (FS), T2WI, T2FS and IV dynamic contrast study) and DWI which performed on (1.5 Tesla) Magnet Unit General Electric (GE). TIC was obtained from the dynamic study and the results were divided into three patterns of curves.<br />Results: Control group demonstrated type-I TIC, group (A & D) demonstrated type-II and group C demonstrated type-III.<br />The mean Apparent Diffusion Coefficient (ADC) values were significant lower (p<0.001) in (A & C) groups, statically different (p<0.02) between benign and malignant cysts. Stat-ically different (p<0.001) between control and patients' groups. The sensitivity, specificity, accuracy, positive and negative predictive values of DWI and MRI-c were 92.3%, 90%, 91.3%, 92.3%, 90% and 100%, 90%, 95.7%, 92.9%, 100%, respec-tively.<br />Conclusion: DWI and TIC were useful tools in diagnosis, characterization and differentiation between pancreatic lesions.https://mjcu.journals.ekb.eg/article_52422_bdfc4dea7d00119af1391447283c3e7b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Effect of Cervicogenic Headache on the Myoelectrical Activities of Suboccipital Muscles, Range of Motion and Functional Activities of the Neck at Different Ages5715805242310.21608/mjcu.2019.52423ENMOHAMED A. EMAM, M.Sc.;FATMA S. AMIN, Ph.D.The Departments of Basic Sciences, Faculty of Physical Therapy and Neurology, Faculty of Medicine, Cairo UniversityDOAA I. AMIN, Ph.D.;RADWA AZMY, M.D.The Departments of Basic Sciences, Faculty of Physical Therapy and Neurology, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Cervicogenic Headache (CGH) represents a major health problem, aggravating Quality of Life (QOL) and work productivity. The Suboccipital Muscles (SOM) have been identified as playing a role in cervical pain, and are therefore a target for rehabilitation.<br />Aim of the Study: To asses the effect of CGH on myoe-lectrical activities of suboccipital muscles, functional activities and ROM of neck.<br />Subjects and Methods: Thirty patients with CGH of both genders participated in this study. They were recruited from the out patient clinic of Kasr El-Ainy and thirty normal subjects, their ages ranged from 18-55 years old. They were randomly assigned into 2 experimental groups: Group A (18- 35 years)-group B (36-55 years) & 2 control groups: Group C (18-35 years)-group D (36-55 years). Myoelectrical activities was measured by Natus nicolet vikingquest to analyze the motor unit potentials by quantitative measures & neck range of motion was measured by Cervical Range of Motion (CROM) device and functional activities of the neck was measured by Neck Disability Index (NDI).<br />Results: There was non significance increase in myoelec-trical activities of the suboccipital muscles in cervicogenic patients than normal subjects with (p-value=0.147). And there was statistical significant decrease in all ROM values and functional activities in cervicogenic patients than normal subjects in cervicogenic patients than normal subjects with (p-value <0.05).<br />Conclusion: This study provides sound evidence for SOM alterations in in myoelectrical activities in patients with CGH.https://mjcu.journals.ekb.eg/article_52423_9b4c7a830465e90da4995d52234908e0.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Correlation between Findings of Optical Coherence Tomography And Optical Coherence Tomography Angiography in Patients with Diabetic Macular Ischemia5815895242410.21608/mjcu.2019.52424ENMUHAMMAD A. ABOUHAMID, M.Sc.;EL-SAIED E. EL-DESSOUKY, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityMOHAMED H. EL-BRADEY, M.D.;MONA S. EL-KODDOUSY, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Diabetic Macular Ischemia (DMI) is a variant of diabetic maculopathy that can be overlooked but has serious implication on management of Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME).<br />Aim of Study: The aim of the study was to study the findings of OCT (optical coherence tomography) and OCTA (optical coherence tomography angiography) in patients with DMI and correlate them.<br />Patients and Methods: A cross sectional study that included 30 eyes: 20 eyes with DMI as diagnosed by FFA (fundus fluorescein angiography) and 10 healthy eyes as control. Both groups underwent OCT and OCTA imaging. OCT images were assessed for thickness and structural abnormalities. Macular perfusion was quantified using OCTA images by 2 parameters: FAZ (foveal avascular zone) area and VAD (vessel area density) at 2 levels; SCP (superficial capillary plexus) and DCP (deep capillary plexus).<br />Results: A statistically significant difference as regard values of FAZ area and VAD in both SCP and DCP, using OCTA, was found between patients and control groups.<br />There was a statistically significant correlation between the retinal thickness of ischemic macular areas and SCP FAZ area, SCP VAD and DCP VAD. DRIL (disorganization of retinal inner layers) was found in 55% of patients. A statistically significant correlation was found between the presence of DRIL and both SCP FAZ area and SCP VAD (r=0.755, pConclusion: OCTA is able to detect and quantify DMI and it can substitute FFA for that purpose. OCT can detect ischemic areas of the macula as these areas appear to be thinner than normal and to show disorganization of its inner retinal layers.https://mjcu.journals.ekb.eg/article_52424_f2287d080a9e16f938afd9ed45bbf84f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Study of Serum Level of Lipoxin A4 in Exercise-Induced Bronchoconstriction in Asthmatic Children5915995242510.21608/mjcu.2019.52425ENMOHAMED E.A. EL-KASHLAN, M.Sc.;NABIL M. EL-ESAWY, M.D.The Departments of Pediatrics and Clinical Pathology, Faculty of Medicine, Tanta UniversityAHMED M. ABDEL-RAZIK, M.D.;DINA A. EL-SHAHAT, M.D.The Departments of Pediatrics and Clinical Pathology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Asthma is a chronic lung disease character-ized by wheezy chest, resulting from allergic inflammation and hyperresponsivness of the bronchi to various stimuli. Exercise-induced broncho constriction is a common manifes-tation of asthma in children and adolescents, occurring in up to 90% of asthmatic children. Lipoxins are the first agents determined to be anti-inflammatory endogenous lipid mediators involved in the resolution of inflammation. Since there is defective lipoxin biosynthesis in patients with severe asthma, we hypothesized that Lipoxin A4 may be related to develop-ment of exercise induced bronchoconstriction.<br />Aim of Study: It was to measure serum level of lipoxin A4 before and after exercise to evaluate its role in exercise induced bronchoconstriction in asthmatic children.<br />Patients and Methods: The study was carried out on fifteen children with mild intermittent or mild persistant asthma with positive response to exercise challenge test and fifteen children with mild intermittent or mild persistant asthma with negative response to exercise challenge test who attended to the outpatient clinic of Chest and Allergic Diseases, Pediatric Department, Tanta University Hospital. Also it was carried on fifteen apparently healthy children with matched age and sex served as a control group. All studied children were subjected to full history taking, thorough clinical exam-ination, plain chest X-ray, pulmonary function tests (FEV 1and PEFR) by spirometer before and after exercise challenge test, eosinophilic count, serum Lipoxin A4 by ELISA before and immediately after exercise challenge test. Data was analyzed by using SPSS.<br />Results: There was significant more decrease in serum Lipoxin A4 after exercise in asthmatic children with exercise induced bronchoconstriction as compared to asthmatic children without exercise induced bronchoconstriction. Regarding pulmonary function tests (FEV 1 and PEFR), there was signif-icant more decrease in FEV 1 after exercise in asthmatic children with exercise induced bronchoconstriction as com-pared to asthmatic children without exercise induced bron-choconstriction but, there was no significant difference between the asthmatic children with exercise induced bronchoconstric-tion and asthmatic children without exercise induced bron-choconstriction regarding the decrease in PEFR after exercise. And there was no statistical significant difference between subject's sex, age, residence nor BMI.<br />Conclusion: There was inverse correlation between serum LXA4 levels and a reduction in FEV 1 after exercise in asth-matic children. The demonstration of lower levels of lipoxin A4 in association with exercise induced bronchoconstriction suggest that the development of exercise-induced bronchoc-onstriction in asthmatic children may be due to reduced endogenous lipoxin biosynthetic capability. This association not affected by ages and sex of patients.https://mjcu.journals.ekb.eg/article_52425_67330798387f5417b436db7757d9f543.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Evaluation of Cosmetic Appearance and Ocular Motility Following Evisceration Surgery6016065251310.21608/mjcu.2019.52513ENOSAMA E. SHALABY, M.D.;AMR M. AWARA, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityHEBA M. SHAFIK, M.D.;HOSSAM M.F. DAWOUD, M.B.B.Ch.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Evisceration is a surgical technique that is used for cosmetic and curative reasons in many ocular diseases such as phthisis bulbi.<br />Aim of the Study: Evaluation of the cosmetic results and motility of the artificial prosthesis after two techniques of evisceration with insertion of prosthesis.<br />Patients and Methods: The study was carried out in ophthalmology department in Tanta University Hospital included 20 patients divided randomly into 2 equal groups. We underwent full history taking and acquired ophthalmolog-ical examination.<br />Operation and Follow-up: Evisceration of the eye with scleral quadrisection and insertion of an implant inside sclera in 10 patients (the first group) and addition of relaxing circumferential incision at posterior sclera in another 10 patients (the 2nd group). Follow-up was carried out in 1st day after operation, 1 week, 3 weeks and 6 weeks.<br />Results: Postoperative superior sulcus deformity difference between 2 groups was statistically significant (p-value=0.031) and it was markedly deformed in 40% of cases in group 1 and 20% in group 2. Palpebral fissure height had also statistically significant difference between 2 groups (p-value=0.030). enophthalmos was significantly reduced in the 2nd group (mean=0.700±0.483) in comparison to the 1st group (mean= 1 .700± 1 .059).<br />Conclusion and Recommendations: Performing relaxing posterior sclerotomies with evisceration surgeries allows insertion of larger implant with no increased risk of extrusion and this technique improves cosmetic appearance and motility of the prosthesis.https://mjcu.journals.ekb.eg/article_52513_7c90be3df320e0d5c5b80a78c301de85.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Targeting Heme Oxygenase-1 in Hypothyroidism Induced Reproductive Dysfunction in Adult Male Rats6076175251410.21608/mjcu.2019.52514ENISLAM I. HEGAB, M.D.;RANIA N. ABD EL-LATIF, M.D.The Departments of Physiology and Biochemistry, Faculty of Medicine, Tanta University, EgyptHEMAT E.EL-HORANY, M.D.The Departments of Physiology and Biochemistry, Faculty of Medicine, Tanta University, EgyptJournal Article20181001Abstract<br />Background: Hypothyroidism can impair reproductive function leading to infertility.<br />Aim of the Study: The present study was designed to investigate the possible modulating effect of Heme Oxygenase-1 (HO-1) induction on hypothyroidism-induced reproductive dysfunction in rats.<br />Material and Methods: Rats were categorized into four groups, 10 rats each. Group I was control, group II (PTU): Received oral 0.05% propyl-thiouracil (PTU) for 8 weeks, group III (PTU + hemin ) received co treatment of oral PTU and hemin (30μmol/kg) by i.p. injections three times per week for 8 weeks and group IV, co administered with oral PTU and zinc protoporphyrin IX (ZnPP) (20μmol/kg) by i.p. injections three times per week for 8 weeks and served as (PTU + Znpp) group. Serum samples were taken to asses thyroid function and serum sex hormones level. Semen samples were taken to detect sperm count and quality, while testicular tissue homoge-nates were used to evaluate oxidative stress markers, ster-oidogenic enzymes and c-Jun NH2-terminal kinases (JNK) activation level together with DNA fragmentation in testicular tissue.<br />Results: Compared to PTU group, hemin-induced HO-1 up regulation improved the oxidative stress state with enhance-ment of reproductive hormone secretion, which was parallel to abrogation of semen analysis parameters. Further hemin blocked the PTU induced activation of JNK and DNA frag-mentation. On the contrary, inhibition of HO-1 by ZnPP further aggrevated all of the PTU induced changes.<br />Conclusion: These findings suggested the potential strategy of targeting of HO-1 in improving the hypothyroidism induced reproductive dysfunction.https://mjcu.journals.ekb.eg/article_52514_e9c9303fe0d533c6c70fd683945e6363.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Role of Awake Trans Nasal Esophagoscopy in Diagnosis of GERD in Infants with Laryngomalacia6196245251510.21608/mjcu.2019.52515ENAYATALLAH R. SHEIKHANY, M.D.;AISHA F. ABD EL-HADY, M.D.The Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Laryngomalacia is the most common con-genital anomaly causing stridor in infants.<br />Aim of Study: Was to evaluate Egyptian infants having laryngomalacia and presenting with feeding difficulties to assess the role of awake trans nasal esophagoscopy in diagnosis of GERD and compare the laryngoscopic and esophagoscopic findings in those with failure to thrive to those without failure to thrive to ascertain if severity of the symptoms in those infants influences the laryngeal picture and the esophageal function.<br />Patients and Methods: The study was conducted on 56 infants at the feeding and swallowing disorders clinic at the Phoniatric Unit, Cairo University Hospitals. They were selected from those who presented with inspiratory stridor and one or more symptoms of feeding difficulties. They were divided into Laryngomalacia cases with FTT and another group of laryngomalacia cases without FTT. History taking, laryngo-scopic and awake trans-nasal esophagoscopic assessments were carried out for the two groups.<br />Results: Revealed that infants with FTT showed significant difference in some symptoms of feeding difficulties than those without FTT. There was non significant difference between the two groups regarding the laryngoscopic and the esophago-scopic findings.<br />Conclusion: Laryngoscopic findings don't change with the laryngomalacia severity. Laryngomalacia cases with feeding difficulties should be evaluated by both laryngoscopy and awake trans-nasal esophagoscopy.https://mjcu.journals.ekb.eg/article_52515_c8db9acd437efcda60feb8712b0f46ce.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Added Value of Foot X-Ray to the Clinical Foot Postural Index in Patients with Early and Late Rheumatoid Arthritis: A Comparative Study6256295251610.21608/mjcu.2019.52516ENHATEM AHMED, M.Sc.;MOHAMED KAMAL, M.D.MOUSTAFA E. RADWAN, M.D.;ABD EL-MAGEED EL-ASHMAWY, M.D.Journal Article20181001Abstract<br />Background: FPI-6 is considered a quick and simple clinical test in patients with Rheumatoid Arthritis (RA). However, its associations with different clinical and radiolog-ical parameters of the disease are not fully studied.<br />Aim of Study: To assess the added value of foot radiology to the Foot Postural Index-6 (FPI-6) in assessment of early and late rheumatoid arthritis.<br />Patients and Methods: The subjects were recruited over a period of 6 months from the Rheumatology outpatient's clinics in Al-Azhar University Hospitals, Egypt. FPI-6 was calculated in 90 subjects, 30 patients with early RA (disease duration 5 years) and 30 age and gender matched control subjects. Foot digital X-rays in the standing position were performed to measure foot angles; TNC (Talonavicular Coverage), first metatarsal talar (1st MT) and Calcaneal Pitch (CP) angles.<br />Results: Pesplanus valgus was detected in 20% of early and 80% of late RA patients. Patients with late RA showed significantly higher bilateral FPI-6 than both the control subjects and patients with early RA (p=0.001). They also had significantly higher TNC, and 1st MT and lower CP (p=0.001). In RA patients, FPI-6 correlated significantly with both the duration of RA and the foot radiographic changes.<br />Conclusions: The combined use of FPI-6 with radiological measurements of three angles of plain X-ray in addition to, the collapse of the longitudinal arch; Talonavicular Coverage angle (TNC); Lateral talar-1st metatarsal angle and Calcaneal pitch can be used in the clinical assessment of forefoot abduction and the severity of RA.https://mjcu.journals.ekb.eg/article_52516_2a9f8ece9eb7f795b9209b59171731ad.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Mild Versus Moderate Exercises on Glucose Level in Type 2 Diabetes Mellitus Patients6316355251710.21608/mjcu.2019.52517ENHANY M.Gh. ABD EL-AZIZ, Ph.D.;ZAHRA M.H. SERRY, Ph.D.DINA M. ABAZA, M.D.;NAGWA A. MOHAMMED, M.D.GIHAN S.MOHAMED, Ph.D.Journal Article20181001Abstract<br />Background: Glucose level is increased in diabetic patient and exercise is an important method in decreasing fasting and postprandial glucose level.<br />Aim of Study: The main objective of this study was to determine the effect of mild exercises versus moderate exercise on glucose level in patients with type 2 diabetes.<br />Subject and Methods: 40 patients (men and women) diagnosed with type 2 diabetes (non-insulin dependant diabetes mellitus) with age ranged from 50 to 60 years old. They were selected from medical Health insurance clinic in Misr El-Gedida. They were divided into two groups. Group A included 20 patients participated in mild exercise in form of 10 minute walking program 3 times weekly for two months and Group B included 20 patients participated in a moderate exercise in form of 10 minute walking program 3 times weekly for two months. Blood sample for measuring fasting and postprandial glucose level before and after exercise program.<br />Results: It showed that in most measures the rate of decrease of fasting and postprandial glucose level in group B who participated moderate exercise is greater than Group A who participated mild exercise.<br />Conclusion: Participatingexercise decreases fasting and postprandial glucose level in patients with type 2 diabetes. Moderate exercise had a greater effect on decreasing glucose level than mild exercise.https://mjcu.journals.ekb.eg/article_52517_197462b4dce6c2fa03de0c39fc51bbf7.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Role of Gradient Echo T2 Star in Assessment of Secondary Hemosiderosis in Pediatric Patients with Thalassemia Major6376435251810.21608/mjcu.2019.52518ENMEREHAN M. AHMED, M.Sc.;MOHAMED M. AL-ASHWAH, M.D.The Departments of Radio Diagnosis and Pediatrics, Faculty of Medicine, Tanta UniversityIBRAHIM M. BADRAIA, M.D.;MOHAMED A. YOUSEF, M.D.The Departments of Radio Diagnosis and Pediatrics, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Thalassemia patients have diabetes mellitus subaltern to hemosiderosis.<br />Aim of Study: To asses iron overload in pancreas of pediatrics beta-thalassemia major patients by T2* gradient echo MRI and to correlate results of MRI with serum ferritin level, hepatic hemosiderosis, diabetes and spleen removal.<br />Patients and Methods: 20 patients with thalassemia major (11 males and 9 females) were evaluated with MRI using T2* gradient echo sequence on 1.5 magnet and signal intensity ratio of the liver and the pancreas were calculated in addition to clinical assessment and laboratory investigation.<br />Results: Striking reduction in hepatic and pancreatic signal intensity ratio was appeared in the twenty patients contrasted with controls. Patients with anomalous glucose tolerance demonstrating a more level of secondary hemosi-derosis in the form of low signal intensity of pancreas and hepatic tissue contrasted with patients with typical glucose tolerance or controls. Surgical removal of the spleen had essentially bring down SIR of pancreas contrasted with intact spleen patients (p<0.047).<br />Conclusions: T2* GRE MRI assume a vital part in detec-tion of iron over-burden. After spleen removed, iron deposition might be more out of control in the pancreas.https://mjcu.journals.ekb.eg/article_52518_8e1aeafe2f69fe8b39ed4f20942c219d.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Prospective Evaluation of Laparoscopy in Management of Infantile Intussusception6536595252010.21608/mjcu.2019.52520ENMAGED E. KHAIRALLAH, M.Sc.;HAMED M. SELEIM, M.D.The Department of Pediatric Surgery, Faculty of Medicine, Tanta UniversityMOHAMED I. EL-SAWAF, M.D.;KHALED A. ISMAIL, M.D.The Department of Pediatric Surgery, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Laparoscopy was initially utilized as a diagnostic tool for failed reduction of intussusception and then was tried as an aid to hydrostatic reduction and recently laparoscopy is used as a definitive treatment.<br />Aim of Study: In this study we are trying to evaluate the role of laparoscopy in management of infantile intussusception.<br />Patients and Methods: This prospective study was con-ducted on 58 childern suffering from intussusception, admitted to the Pediatric Surgery Unit of Tanta University Hospital from June 2017 to June 2018.<br />Results: Our study included 58 patients with intussuscep-tion with a mean age of 10.95 months. 32 (55.2%) presented early with mild symptoms, 38 (65.5%) showed red currant jelly stool, 37 (63.8%) presented with intestinal obstruction, and 3 (5.2%) showed signs of peritonitis. Mass was sub-hepatic in 33 infants (56.9%). Hydrostatic reduction was attempted in stable cases (55) and 3 cases with peritonitis underwent immediate laparotomy. Of 55 cases, 39 (71%) were successfully managed using hydrostatic reduction. Laparo-scopic reduction was attempted in 16 (29%) cases, 12 (75%) were completed laparoscopically and 4 (25%) cases were converted to laparotomy, one reduced manually and 3 cases had bowel resection. Operative time ranged between 30-180 with a mean of 83.95 minutes. Mean hospital stay was 1.8 days. One case had port site hernia (1.7%) and there was no recurrence detected in any case. Follow-up ranged between 1-12 months.<br />Conclusion: Laparoscopic reduction of idiopathic intus-susception is safe, feasible and provides minimally invasive approach with significantly early oral feeding and reduced hospital stay.https://mjcu.journals.ekb.eg/article_52520_886c7c24e72a681eecbb349472a64cd7.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Structural Changes Induced by Potassium Dichromate in Renal Cortex of Adult Male Albino Rats and the Possible Protective Role of Selenium6616755252110.21608/mjcu.2019.52521ENALSHYMAA O.H. AHMED, M.Sc.;HANAN E.L. MOKHTAR, M.D.The Department of Anatomy & Embryology, Faculty of Medicine, Zagazig UniversityHEBA O.M. HELMY, M.D.;SAMAA S. ABD EL-FATAH, M.D.The Department of Anatomy & Embryology, Faculty of Medicine, Zagazig UniversityJournal Article20181001Abstract<br />Background: Potassium Dichromate (Cr) is a common environmental agent that has been considered potentially carcinogenic, making it an issue of major environmental and search concern.<br />Aim of Study: The aim of this study was to throw light on the possible structural changes in the renal cortex of adult male albino rats after administration of Cr and to elucidate the possibility of protection by selenium (Se) against the deleterious effects of Cr.<br />Material and Methods: Thirty six adult male albino rats weighing 200-230g were divided equally into four groups as follow: Group I received balanced diet and tap water only; Group II received Se orally 0.25mg/kg b.w/daily; Group III rats were received Cr orally 67mg/kg/daily and Group IV rats were received oral Cr and Se at same previous doses. Animals were sacrificed on day 28.<br />Results: The Cr-treated group showed damage of the renal cortex including capsule and renal interstitium. Masson's trichrome staining showed abundant collagen fibers. The expression of caspase-3 in the cytoplasm showed strong positive immune reaction in group III. Biochemical results showed Cr induced significant increase in blood urea nitrogen (BUN), serum creatinine (SC) and uric acid (UA). While morphometric measurement indicated that Cr induced a sta-tistical significant decrease in rat body weight and diameter of glomeruli when compared with other groups. The Cr-treated group also showed a statistical significant increase in kidney weight, surface area of Bowman space, diameter of the con-voluted tubules, area percentage of collagen fibers and ex-pression of caspase-3. Meanwhile, administration of Se showed some protection against the toxic effect of Cr on renal cortex.<br />Conclusion: It is suggested that administration Se mod-erately improves the deleterious histological and biochemical changes induced by Cr on renal cortex.https://mjcu.journals.ekb.eg/article_52521_478c4d1940b36710fadf3009ce972fff.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Sexual Dimorphism of Mandibular Ramus in an Egyptian Sample: A Radiographic Study6456515252210.21608/mjcu.2019.52522ENMOHAMED EL-SHAFEY, Ph.D.;MOHAMED EL-SHERBINY, Ph.D.RANIA N. SHERIF, Ph.D.;HEND M. ABO EL-ATTA, Ph.D.Journal Article20181001Abstract<br />Background: Determination of the sex is an important step in the identification of skeletal remains especially in missing persons and mass disasters. Mandible, being a strong bone that is difficult to damage and disintegrate, is an important tool in sex determination.<br />Aim of the Study: The present study aimed to evaluate accuracy of mandibular metric standards for estimating sexual dimorphism.<br />Methods: The study was conducted on 90 males and 92 females of Egyptian sample. Orthopantomographs were taken for evaluating eleven mandibular metric parameters. Four models were adopted by the stepwise discriminant analysis test to define the best predictor of sex discrimination in the Egyptian population sample.<br />Results: All parameters were found to be significantly different between both sexes; and the most dimorphic param-eters were coronoid height, projective height, and mandibular canal length, followed by mandibular notch depth and condylar height. Meanwhile the least variables were gonial angle and bicondylar length.<br />Conclusion: This study proves that mandibular measure-ments on digital radiograph are useful in sex determination.https://mjcu.journals.ekb.eg/article_52522_1d2332d75890cea780070257a4a8dc00.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Progesterone Versus Erythropoietin on Neurological Outcome after Traumatic Brain Injury6776855252310.21608/mjcu.2019.52523ENFATMA S. SHAALAN, M.Sc.;HALA M. EL-GENDY, M.D.The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta UniversityGHADA F. EL-BARADEY, M.D.;MOHAMED E. AFANDY, M.D.The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Traumatic Brain Injury (TBI) is a global health problem. Preclinical trials in animals shows that early injection of progesterone after experimental TBI decreased brain edema, neuronal loss, and behavioral deficits. Erythro-poietin (EPO) attenuates TBI due to its neuroprotective actions and its effect on erythropoiesis.<br />Aim of Study: The aim of this study was to evaluate the effect of progesterone hormone versus erythropoietin on neurological outcome of patients with moderate traumatic brain injury.<br />Material and Methods: The patients were randomly as-signed to 3 equal groups (35 in each group). Group C (control): Standard care and treatment. Group P (progesterone): Standard care + progesterone 1mg/kg IM and then once/12 hours for 5 consecutive days. Group E (erythropoietin): Standard care + EPO IV 40,000IU within 6hr of the time of injury. The modified Marshall CT scan classification: Was obtained at admission and day 7. GCS: Daily evaluations over the initial 14-day period, adverse experiences, surgical procedures, intracranial complications and intake & output of fluids were recorded. Disability Rating Scale (DRS) were measured on admission and after 1 Mon., length of ICU & hospital stay and complications were measured.<br />Results: There was statistically significant increase in GCS in group P compared to group C and E. There was statistically significant improvement in DRS in group P compared to group C and E on admission and after one month. There was statistically significant decrease in the length of ICU and hospital stay in group P compared to group C and E.<br />Conclusion: Progesterone hormone and erythropoietin improved neurological outcome in moderate head injury patients in the form of improvement in GCS and DRS and decrease in the length of ICU and hospital stay with better outcome in progesterone in comparison with erythropoietin.https://mjcu.journals.ekb.eg/article_52523_410eac3e7a10544c63a82c2961101086.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Study of Prevalence of Nonalcoholic Fatty Liver Disease in Type II Diabetes Mellitus Patients and Variations in Liver Enzymes and Lipid Profile in Diabetic Patients with Fatty Liver in Comparison With Patients Without Fatty Liver6876915252510.21608/mjcu.2019.52525ENOSAM SAEEDABDO GABALI, M.D.The Department of Internal Medicine, Faculty of Medicine and Health Sciences, Aden UniversityJournal Article20181001Abstract<br />Background: Type 2 diabetes mellitus (T2DM) patients potentially are at risk of developing non-alcoholic fatty liver disease (NAFLD), Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developing and developed countries, Global prevalence of NAFLD is 25.24% with highest prevalence in the Middle East and South America and lowest in Africa.<br />Aim of Study: This study aimed to determine the prevalence of NAFLD among T2DM patients, diagnosed by ultrasonog-raphy of liver, to study the age, sex in NAFLD and to compare liver enzymes and lipid profile between individuals with NAFLD and without NAFLD.<br />Patients and Methods: A prospective study was conducted of 100 type 2 diabetic Patients visited a private clinic in Aden republic of Yemen, in the period from October 2017 to June 2018.<br />Results: Total of (100 patients) type 2 diabetes mellitus ambulatory patients were selected for the study. 62 patients (62%) had NAFLD and 38 patients (38%) had normal liver on ultrasonography, the prevalence of NAFLD in the present study was 62%, Majority of the study population observed with type 2 diabetes mellitus and NAFLD were females (n=40, 65%), and 22 were males (35%), the age range of diabetic patients with NAFLD was 40-65 years, mean age 53.16 SD ±7.64, Subjects with diabetes mellitus and NAFLD had sig-nificant elevation in Alanine transaminase (ALT), cholesterol, LDL, and triglyceride than diabetic subjects without NAFLD.<br />Conclusions: Early detection and optimum control of diabetes mellitus is important to minimize the effect of diabetes on liver. Hence, assay of serum levels of hepatic enzymes, and abdominal ultrasound to detect NAFLD should be done in all patients with T2DM as preliminary diagnostic tests.https://mjcu.journals.ekb.eg/article_52525_36a96615abfd4cdc551eed60c289d6bb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Vitamin D3 (Cholecalciferol) Administration as an Adjuvant Therapy in Preterm Neonates with Respiratory Distress Syndrome6937035252610.21608/mjcu.2019.52526ENHASSAN GAMAL ABOU-KOURA, M.Sc.;MOHAMED AHMED ROWISHA, M.D.The Departments of Pediatrics and Biochemistry, Faculty of Medicine, Tanta UniversityABD EL-RAHMAN MOHAMED EL-MASHAD, M.D.;HEMAT AL-SAYED AL-HOURANY, M.D.The Departments of Pediatrics and Biochemistry, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: RDS is one of the major problems among newborns and a major reason for increased morbidity and mortality among infants. Preterm babies are the main risk factor for development of RDS. Vitamin D is a steroid hormone that has been known for its important role in regulating body levels of calcium and phosphorus and in mineralization of bone. Since vitamin D deficiency may have a role in several diseases involving the respiratory system as respiratory distress syndrome, we hypothesized that vitamin D3 administration may have a role in improvement of respiratory distress syn-drome in preterm neonates.<br />Aim of Study: It was to evaluate the effect of Vitamin D as an adjuvant therapy in treatment of respiratory distress syndrome.<br />Patients and Methods: This study was conducted on 60 preterm neonates, their ages ranged between 28 weeks to 36 weeks gestation according to New Ballard Score. They were chosen from those at the Neonatal Intensive Care Unit (NICU), Pediatric department, Tanta University Hospital. They were allocated into three groups (20 each), Group 1 given the traditional therapy of RDS, Group 2 given vitamin D in the low ideal dose (400IU/Day) in addition to the traditional therapy of RDS, Group 3 given vitamin D in the high ideal dose (800 IU/Day) in addition to the traditional therapy of RDS. All preterm neonates were subjected to complete history taking, thorough clinical examination, routine laboratory investigations in addition to serum 25-hydroxyvitamin D by ELISA techniques, chest X-ray at the first 24 hours after delivery. Follow-up of the three groups was done at day 1, 3 and 7 of admission. At Day 21 of Life: Blood samples were taken from the serum of infants again for measuring the serum 25-hydroxyvitamin D level. Data was analyzed by using SPSS.<br />Results: There was statistical significant increase as regard vitamin D level after treatment in group 3 as compared to group 2 as the difference increase value in group 3 (Mean ± SD=75.719±18.231) was higher than in group 2 (Mean ± SD =43.453±14.728). There was significant improvement in the ABG findings, chest X-ray findings, Down's Score value in group 2,3 but especially in the group 3 of the intake of 800 IU/Day at day seven of admission. There was high statistical significant decrease as regarding the hospital stay duration in group 3 as compared to group 1. There was statistical significant decrease in the morbidity between the three studied groups as group 3 was lower than group 2 and group 2 was lower than group 1. There was no significant difference between all the studied groups as regard the number of died cases.<br />Conclusion: 25 hydroxy-vitamin D level was found defi-cient in most cases of RDS in preterm neonates and adminis-tration of Vitamin D as an adjuvant therapy in cases of RDS was associated with decreased severity, complications and days of hospital stay in the group that received 800 IU/Day more than the group that received 400 IU/Day.https://mjcu.journals.ekb.eg/article_52526_b3e7abac18092f61a8f63c2f326261b2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Comparative Study between Safety and Efficacy of Pharmacoinvasive Strategy and Primary Percutaneous Coronary Angioplasty in Patients Presenting by Acute ST Segment Elevation Myocardial Infarction7057125252710.21608/mjcu.2019.52527ENAHMED G. SHAHIN, M.Sc.;SAMIA M. SHARAF EL-DIN, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversityYASSER H. EL-BARBARY, M.D.;AYMAN A. AL-SHEIKH, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Ischemic heart disease is considered the most common cause of death worldwide. Reperfusion treatment in acute myocardial infarction aims at early and sustained reperfusion of the myocardium at risk. Traditionally reperfusion can be obtained by thrombolysis or by primary Percutaneous Coronary Intervention (pPCI).<br />Aim of Study: Study and assess the safety and efficacy of a Pharmacoinvasive (PI) strategy compared with (pPCI) strategy in ST Segment Elevation Myocardial Infarction (STEMI) management.<br />Patients and Methods: Comparing clinical results regard-ing mortality, Major Adverse Cardiac Events (MACE) and Left Ventricular (LV) systolic function by echocardiography during hospital admission and 30 days follow-up, in 200 patients presenting with STEMI.<br />Results: During hospital admission, the composite of death/Congestive Heart Failure (CHF) in patients treated with PI strategy versus the group managed by pPCI occurred in 4% versus 7% (p=0.352); 9% versus 13% (p=0.366) respec-tively. No cases of re-infarction recorded during hospital admission.<br />After 30-days follow-up, the composite of death/congestive heart failure/re-infarction in PI and pPCI arms occurred in 3% versus 3% (p=0.635); 8% versus 3% (p=0.211); 0% versus 3% (p=0.139) respectively.<br />Conclusion: In daily clinical practice pharmacoinvasive, strategy is considered safe alternative to primary PCI. Espe-cially considering logistical issues and delay in the initiation of management of STEMI.https://mjcu.journals.ekb.eg/article_52527_04112f8afb48f04196a6835bb4d42270.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effectiveness of Noninvasive Ventilation in Acute Respiratory Failure7137225252810.21608/mjcu.2019.52528ENOLA A. ROMEH, M.Sc.;SALWA A. GANNA, M.D.The Departments of Chest and Cardiology, Faculty of Medicine, Tanta UniversityTAYMOOR M. ABDALLAH, M.D.;YOUSSEF M. MANSOUR, M.D.The Departments of Chest and Cardiology, Faculty of Medicine, Tanta UniversityALI MOHAMED A.ABDELLA, M.D.The Departments of Chest and Cardiology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Primary advantage of NIV is the prevention of complications from invasive ventilation, the acute first disorders treated with NIV were exacerbation of COPD and ALE and over the last 20 years the use of it has been extended to patients with hypoxemic RF.<br />Aim of Study: Was to determine the effectiveness of NIV, the factors predicting failure of it in ARF.<br />Patients and Methods: This study was prospective obser-vational study on 60 patients with acute respiratory failure which were divided into 3 groups, Group A included 20 patients with ARF type II due to COPD exacerbation, Group B included 20 patients with ARF due to acute lung edema in patients with acute or chronic heart failure and Group C included 20 patients with ARF due to pulmonary causes other than ACPE. NIV applied and complete clinical examination including: Vital signs, (GCS) scale and APACHE II score assessment were done at first. (ABG) the first was at the admission to ICU and the second ABG after 2 hours from the start of NIV.<br />Results: Regarding the fate of NIV either the success or failure it was found that the total percent of patients in which the NIV successed was 68.33% and the total percent of patients in which the NIV failed was 3 1.67%, group C show the higher percentage of failure of NIV (60%). Logistic regression was assessed at the start of NIV to elucidate parameters that had relation to failure at the start showed that GCS was the parameter most closely related to failure followed by APA-CHEII score then type of the respiratory failure of the studied groups, Logistic regression was assessed for the change of ABG parameters & vital signs at the start after 2 hours from NIV to elucidate parameters that had relation to failure found that the change in HR was the parameter most closely related to failure followed by the change in RR and the change in temperature then the change in PaO2.<br />Conclusion: The type of acute respiratory failure is inde-pendent risk factor for failure of NIV so, NIV is an effective modality with hypercapnic RF due to exacerbation of COPD and cardiogenic pulmonary edema and can avoid the endotra-cheal intubation, the use of it in hypoxemic RF should be assessed on an individualized basis but the key factor in deciding the use of NIV is the probability of failure which can worsen the prognosis of patients regardless the type of ARF and our results had identified several independent pre-dictors of failure as the GCS and the APACHEII score at the start of NIV, the change of respiratory rate, heart rate and PO2 level from baseline to the second hour from its suspensionhttps://mjcu.journals.ekb.eg/article_52528_abb51caf9e055a27c4f4709090918031.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Assessment of the Absorption Characteristics of Tear Production Tests Under Different Environmental Conditions7237275252910.21608/mjcu.2019.52529ENALI A.ABUSHARHA, Ph.D.The Department of Optometry and Vision Sciences Vice Dean for Academic Affairs, College of Applied Medical Sciences, King Saud UniversityJournal Article20181001Abstract<br />Background: Aqueous deficiency dry eye is considered one of the main categories of dry eye syndrome. Many tech-niques have been developed to assess tear production and monitor tear film turnover. Methods such as Schirmer test, phenol red thread (PRT) test, and tear function index (TFI), have been widely used to diagnose aqueous deficient dry eye. All these tests are based on the principle of absorption of the tear from the lacrimal sac and then measuring the wetting length of the paper strip or cotton thread. The wetting length can be affected by environmental factors, particularly relative humidity, that could exert a strong effect on the absorption mechanism of the strips or threads used to measure tear production.<br />Aim of the Work: The aim of this study was to investigate the effect of changing room relative humidity on the absorption properties of phenol red thread (PRT) and Schirmer strips, and their accuracy of measuring tear film production.<br />Methods: Twenty healthy subjects (40 eyes) were recruited for this study. Tear film production was assessed using PRTs and Schirmer strips in two different environmental conditions. Two visits were required to conduct this study. One visit was used to measure tear production in a room without installing a humidifier. The other visit was used to measure tear film production after the room was humidified using portable air humidifiers.<br />Result: Mean tear production measurements in non-humidified room were 16.04-}4.09 and 16. 12±9. 10mm using PRTs and Schirmer strips respectively. At high humidity visit, mean measurements was 20-}8.03mm and 19.35-}8.35mm.<br />Conclusion: The physical properties of the examination strips and threads used for measuring tear quantity could be affected by environmental conditions. Eye care practitioners should be aware of the variation in tear production measure-ments that may result from external factors.https://mjcu.journals.ekb.eg/article_52529_de84a08893dd221ca14c17a2ebc79b2b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Levetiracetam Monotherapy on Hematological Parameters in Children with Idiopathic Epilepsy7297365253010.21608/mjcu.2019.52530ENSARA M. IBRAHIM, M.Sc.;SAHAR A. ABD EL-AZIZ, M.D.The Departments of Pediatric* and Clinical Pathology**, Faculty of Medicine, Tanta University, EgyptKHALED T. MUHAMMAD, M.D.;HESHAM A. EL-SEROGY, M.D.The Departments of Pediatric* and Clinical Pathology**, Faculty of Medicine, Tanta University, EgyptJournal Article20181001Abstract<br />Background: Levetiracetam is broad spectrum, second generation antiepileptic drug which is highly tolerated in children with minor adverse events. Studies evaluating the effect of levetiracetam on hematological parameters have reported an unexplained increased incidence of infections such as pharyngitis and rhinitis. There have been case reports of pancytopenia, thrombocytopenia, eosinophilia and lympho-penia. However, cases of isolated low red blood cell counts, hemoglobin and hematocrit as compared to placebo are re-ported.<br />Aim of Study: This study aimed to evaluate the changes in complete blood picture, prothrombin time, partial throm-boplastin time and platelet functions in children with idiopathic epilepsy who were treated with levetiracetam as monotherapy.<br />Patients and Methods: This study was conducted on fifty children of both sexes presented with idiopathic epilepsy during the period from June 2016 to May 2017. Patients were assessed by monitoring complete blood picture, prothrombin time, partial thromboplastin time and platelet functions before and 6 months after receiving levetiracetam monotherapy.<br />Results: There were no significant alterations in the evaluated parameters during the study after levetiracetam administration when compared to results before treatment.<br />Conclusion: Levetiracetam monotherapy has proven to be well tolerated in treatment of children with idiopathic epilepsy and does not appear to cause significant changes in complete blood picture, prothrombin time, partial thrombo-plastin time and platelet functions.https://mjcu.journals.ekb.eg/article_52530_6aa32308df4aef3b8120c9601a5ed2e6.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301A Study of the Anatomical Variations in the Shape and Diameter of the Suprascapular Notch and Spinoglenoid Notch in Dried Human Scapulae7417465253110.21608/mjcu.2019.52531ENAHMED H. KHALIL, M.D.,M.R.C.S.;MOHAMMED KHATTAB, M.Sc.The Department of General Surgery, Faculty of Medicine, Cairo UniversityKAREEM HOSNY, M.D.;MOSTAFA EL-SHAZLY, M.D.The Department of General Surgery, Faculty of Medicine, Cairo UniversityAYMAN SALAH ELDIN, M.D.;ADEL HOSNY, M.D.The Department of General Surgery, Faculty of Medicine, Cairo UniversityHANAN N. GADALLAH, M.D.;AMANY E. HAMOUD, M.D.The Department of Anatomy and Embryology, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: The suprascapular notch is a depression on the superior border of scapula which gives passage to the suprascapular nerve to enter the supraspinous fossa. During its course there is a possibility of entrapment of the nerve while in the notch due to its variant shapes and dimensions which leads to suprascapular nerve entrapment syndrome. Also the spinoglenoid notch with its ligament is affected by the position of the glenohumeral joint. These pressure changes in combination with repetitive shoulder movement are likely components that cause repeated trauma or compression on the distal suprascapular nerve.<br />Aim of Study: The present work was designed to study the variation of the shape and diameter of the suprascapular notch and spinoglenoid notch of the scapula.<br />Material and Methods: The study will be carried out on 100 dried human scapula obtained from Anatomy department, Faculty of Medicine, Cairo University. The shape of the suprascapular notch was determined and recorded as follow U shaped, V shaped, flat or absent at all. Out of 100 scapulae 56 were right sided and 44 were left sided. Also the mean values for suprascapula notch was measured.<br />Results: The most common shape was V- shaped, followed by U-shaped, then the least common one is the flat one. About 14 % scapulae showing absent foramen. Regarding the side of scapulae, V shaped suprascapular notch were recorded in 44.2% scapulae (22 left side, 16 right side), while 39.5% were U shaped (12 left side, 22 right side). Only 16.3% scapulae showed flat suprascapular notch (8 left side, 6 right side).<br />Conclusion: This study may help the clinicians to have precise anatomical knowledge of the suprascapular notch before making proper diagnosis and surgical interventions of suprascapular nerve entrapment syndrome.https://mjcu.journals.ekb.eg/article_52531_28137ee6776f1b86643d9dc96ce67549.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Comparative Study between Multidetector Computed Tomography (MDCT) Angiography and Echocardiography in Assessment of Cardiac Anomalies Associated with Aortic Coarctation7477525253210.21608/mjcu.2019.52532ENABRAR EL-SALLAKH, MSc.;ELATAFY E. ELATAFY, M.D.The Departments of Radiodiagnosis & Medical Imaging and Cardiothoracic Surgery, Faculty of Medicine, Tanta UniversityHOSSAM ZAYTOUN, M.D.;MOHAMMED DAWOUD, M.D.The Departments of Radiodiagnosis & Medical Imaging and Cardiothoracic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: In patients with aortic coarctation, it is important for preoperative detection of associated cardiac anomalies. MDCT and echocardiography are currently the most reliable methods of diagnosis.<br />Aim of Study: To evaluate the role of multidetector com-puted tomography (MDCT) angiography in assessment of associated cardiac anomalies in cases of aortic coarctation as compared to echocardiography.<br />Patients and Methods: Sixty patients that were known to have aortic coarctation underwent MDCT for assessment of associated cardiac anomalies. MDCT angiography findings were compared with both Doppler echocardiography and surgical results.<br />Results: There was a 30% agreement between the findings of MDCT angiography and echocardiography in detection of extracardiac vascular anomalies and a 68% agreement in detection of intracardiac anomalies.<br />Conclusion: Considering MDCT angiography the modality of choice in detection of extracardiac vascular anomalies showing higher sensitivity (100%) while the echocardiography is of choice in detection of intracardiac anomalies with 100% sensitivity.https://mjcu.journals.ekb.eg/article_52532_cdac6fdf301061f49150ea8e219a7b98.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Ruptured Middle Cerebral Artery Aneurysms: A Single-Center Series Evaluating Microsurgical and Endovascular Treatment7537625253310.21608/mjcu.2019.52533ENMOHAMED AMER, M.D.;MOHAMED SHADAD, M.D.The Department of Neurosurgery, Faculty of Medicine, Tanta UniversityESSAMABD EL-HAMEED, M.D.The Department of Neurosurgery, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Middle cerebral artery (MCA) represents 20% and is the 3rd most common location of intracranial aneurysms (IAs). MCA aneurysms are close to brain surface; this made surgical clipping the standard treatment for them. New advances in endovascular techniques and devices in-creased feasibility and safety of coiling of MCA aneurysms.<br />Aim of the Study: The aim of this study is to evaluate and compare feasibility, safety and outcome of surgical versus endovascular treatment of ruptured MCA aneurysms.<br />Patients and Methods: A retrospective study was done on 38 patients with ruptured MCA aneurysms who were treated between October 2013 and May 2017 at the Neurosurgery Department of Tanta University hospitals. They were divided into 2 groups: Surgical clipping (20 patients) and endovascular coiling (18 patients). Feasibility, complications and outcome were recorded and analyzed.<br />Results: The study included 38 patients with MCA aneu-rysms, 23 females and 15 males. The mean age was 53.5 years (20-67 years). Our microsurgical cases included 20 patients presenting with SAH and good clinical condition, Hunt & Hess score 1 and 2 in 60%. At discharge, 16 (80%) had good GOS and 4 (20%) patients had poor GOS. After endovascular management of MCA aneurysms, all the 18 cases had favorable outcome (GOS grade 5&4) which remained the same at the last follow-up. The rate of total MCA aneurysm occlusion in control angiogram performed after microvascular management was 100 % and at the last follow-up was the same. The rate of total MCA aneurysm occlusion in control angiogram at the end of the endovascular procedure was 72%, subtotal occlusion was achieved in 3 patients (17%) and incomplete occlusion in another 2 patients (11%).<br />Conclusion: Clipping and coiling for ruptured MCA aneurysms have comparable outcome. Microsurgery has less cost, good feasibility and more stability. Coiling has higher cost, better feasibility and less stability. However, patient selection is extremely important to optimize the outcomes.https://mjcu.journals.ekb.eg/article_52533_e954d15dd301104eadbd8ad80974ff53.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Saudi Teachers' Knowledge and Practices Related to Management of Students with Epilepsy7637685253410.21608/mjcu.2019.52534ENYOUSSEF ALI MOHAMAD AL-QAHTANI, M.D.;LUBNA HADDAJ AL-RUWAILI, M.B.B.S.ASMA SAEED N. AL-RUWAILI, M.B.B.S.;WAFA DAIFALLAH AL-SHEHRI, M.B.B.S.YARA MOFARAH ASSIRI, M.B.B.S.;SALHA ALI ASERY, M.B.B.S.OSSAMA A.MOSTAFA, Dr.Ph.Journal Article20181001Abstract<br />Background: To assess teachers' knowledge and practice regarding management of epilepsy among schoolchildren.<br />Aim of Study: This study aimed to assess teachers' knowl-edge and their practices toward epileptic students in Arar City, northern Region of Saudi Arabia.<br />Subjects and Methods: A cross-sectional study was con-ducted in Arar City, at the Northern Region of Saudi Arabia. It included 404 school teachers (320 males and 84 females). A questionnaire testing teacher's knowledge and practice regarding management of students with epilepsy was con-structed and used for data collection.<br />Results: Almost all participants (99%) knew what epilepsy is, while only 39.4% knew that epilepsy is not contagious. Only 46.5% knew causes of epilepsy, while only 30.4% denied the relation between epilepsy and evil eyes, and 50.5% cor-rectly responded to questions related to role of certain types of food as triggering factors related to epileptic seizures. Most participants (83.4%) correctly stated the relation between epilepsy and increased brain electric charges, while only 44.3% stated the early symptoms/signs of an imminent epileptic fit. Only 15.6% of participants denied that epilepsy does not affect child's intelligence, 67.3% knew complications of epilepsy, while 38.9% knew treatment of epilepsy. Participants' mean total knowledge score (out of 10) was 5.15±1.32. Relatives and friends constitute the main source of teachers' knowledge about epilepsy (49.1%), followed by internet (44.1%) and lastly mass media (4.9%), and books (1.9%). 75.5% of participant teachers witnessed epileptic schoolchil-dren while in seizure. Their practices were mainly to call an ambulance (72%), remove any dangerous objects around the victim (69.1%), put a soft object between his teeth (68.6%), ensure good ventilation (63.4%) and pull his tongue out (50.5%). Participants' mean total practice score (out of 10) was 4.85±1.28. Mean teachers' knowledge and practice scores were highest among those aged >50 years (5.34±1.75 and 5.20±1.63, respectively). However, differences were statisti-cally significantly only regarding practice scores (p<0.001). Female teachers' knowledge and practice scores were higher than those of male teachers, with statistically significant difference only regarding practice scores (p=0.003). Teachers' knowledge and practice scores were highest among those with Master Degree, but with significant difference only regarding their practice (p=0.029). Moreover, knowledge and practice scores did not differ significantly according to teachers' type of school.<br />Conclusions: School teachers in Northern Saudi Arabia have relatively poor knowledge and practices about manage-ment of epilepsy among students. It is recommended to provide teachers with information about handling seizures in the educational setting through development and implementation of epilepsy education programs.https://mjcu.journals.ekb.eg/article_52534_7b0c78928840de63c4693192c2aa2e13.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Left Atrial Function Assessment in Patients with Rheumatic Mitral Valve Diseases7697805253510.21608/mjcu.2019.52535ENRANIEN H. EL-SHAFAI, M.Sc.;MAGDY M. EL-MASRY, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversitySAHAR A. EL-SHEDOUDY, M.D.;MONA A. EL-SAEDY, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: The assessment of Left Atrial (LA) function is used in various cardiovascular diseases. LA plays a com-plementary role in cardiac performance by modulating Left Ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and Doppler echocardiography can measure LA function non-invasively. However, evaluation of LA deformation derived from 2D Speckle Tracking Echocar-diography (STE) is a new feasible and promising approach for assessment of LA mechanics. These parameters are able to detect subclinical LA dysfunction in different pathological condition.<br />Aim of Study: To assess left atrial function by conventional echo Doppler study and tissue Doppler based strain imaging as well as global longitudinal strain in patients with rheumatic mitral valve disease.<br />Patients and Methods: A total of 50 rheumatic mitral valve disease patients appearing consecutively for echocardi-ogram (ECHO) test at the Cardiology Department in a tertiary care hospital were recruited into the study as per the pre-set inclusion and exclusion criteria. The data were pooled using Microsoft Excel and analysed using SPSS software by appli-cation of appropriate statistical tests.<br />Results: Of the 50 subjects, 22 had Mitral Stenosis (MS), 14 had Mitral Regurgitation (MR), and 14 of them were found to have both MS and MR. The major presenting symptom as observed in 23 patients was dyspnea. LA functions were significantly reduced in double mitral lesion group which was observed in LA indices such as LA emptying fraction, LA passive emptying fraction, atrial fraction, and LA expansion index among groups.<br />Conclusion: LA reservoir, conduit and contractile function were significantly affected in rheumatic mitral valve disease due to increased hemodynamic load. Global longitudinal strain was significantly reduced in patients with MS and MR.https://mjcu.journals.ekb.eg/article_52535_902aff19c0be0a2bef70b84235da67ad.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Incidence of Bacteriuria in Adult Renal Stone Patients Having Ureteric Stents and Undergoing Extracorporeal Shock Wave Lithotripsy7817855253610.21608/mjcu.2019.52536ENABDULAZIZ AL-AMRI, F.R.C.Sc.;FATIH EL-RAHMAN O. BABIKER, M.D.The Department of Surgery, College of Medicine, King Khalid University and The Department of Urology, Aseer Central Hospital, Abha, Saudi ArabiaMOHAMMED RASHID, M.D.;ABDULMAJEED AYDH, M.D.The Department of Surgery, College of Medicine, King Khalid University and The Department of Urology, Aseer Central Hospital, Abha, Saudi ArabiaJournal Article20181001Abstract<br />Background: To evaluate the effect of Extracorporeal Shock Wave Lithotripsy (ESWL) on the incidence of bacte-riuria in patients with JJ stents who had sterile urine prior to ESWL.<br />Aim of Study: This study aimed to evaluate the effect of ESWL on the incidence of bacteriuria in patients with JJ stents who had sterile urine prior to ESWL.<br />Material and Methods: The study was conducted between January and August 2015 in Aseer Central Hospital, Abha, Saudi Arabia. We prospectively recruited 126 patients who had JJ stents previously inserted for renal or ureteral stones. Elderly patients and those with chronic medical diseases and other risk factors were excluded. All the patients had negative urine culture just before ESWL. Urine cultures were done twice, immediately after ESWL and two weeks later to detect the presence of bacteriuria. Those who had one or two positive cultures for bacterial growth were labeled to be having bac-teriuria after ESWL, while those with negative cultures were labeled as negative for bacteriuria.<br />Results: Out of 126 patients with JJ stents, 20.6% devel-oped bacteriuria after ESWL. The incidence of bacteriuria in females was higher than males (p=0.002). Duration since JJ stent insertion (54.3±11.4 days) and the number of JJ stents were found to be significantly associated with positive bacte-riuria (pConclusions: Incidence of bacteriuria in patients with renal stones with ureteric stents undergoing ESWL was 20.6%, which was comparable to that of patients with ureteric stents who did not undergo ESWL. Therefore, antibiotic prophylaxis in patients with ureteric stents undergoing ESWL may not be necessary, except in certain cases (i.e., female gender, several stents and their prolonged duration, as well as the multiple stones and their large size). <br /> https://mjcu.journals.ekb.eg/article_52536_c396c81b8cf93c3d3a269024a497f376.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Correlation between Structural and Functional Changes in Glaucoma Patients Using Optical Coherence Tomography and Pattern Electroretinogram7877955253710.21608/mjcu.2019.52537ENASMAA M. EL-GOHARY, M.Sc.;TAREK M. EID, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityHISHAM A. HASBY, M.D.;HAZEM A. EL-BEDEWY, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: To study the correlation between peripapillary retinal nerve fiber layer (RNFL) thickness measured with Optical Coherence Tomography (OCT) and pattern electroretin-ogram (pERG) parameters in primary open-angle glaucoma (POAG) patients.<br />Aim of Study: To study the correlation between peripap-illary RNFL thickness measured with OCT and pERG param-eters in POAG patients.<br />Patients and Methods: Fifty eyes of 50 patients diagnosed with POAG and 15 eyes of 15 normal subjects as control group, were enrolled in a prospective comparative study. The eyes in the POAG group were further subdivided into mild, moderate, and severe subgroups. All eyes had visual field testing using 24-2 Humphery standard automated perimetry, peripapillary RNFL average thickness using the 3.4mm circular scan of the Heidelberg OCT spectralis and pERG using CSO RetiMax device in accordance with the International Society for Clinical Electrophysiology of Vision (ISCEV) guidelines.<br />Results: There were significant differences in the visual field mean deviation (VF MD), peripapillary RNFL average thickness & some pERG measured parameters (N95 latency & P50-N95 latency) between normal and POAG eyes as were as among the three subgroups of POAG. Significant correlation was found between peripapillary RNFL average thickness and N95 amplitude (p<0.001), P50-N95 amplitude (p=0.002), N95 latency (p=0.034) & P50-N95 latency (p=0.045). We found significant correlation between peripapillary RNFL average thickness and N95 amplitude (p=0.001), P50-N95 amplitude (p=0.017) in POAG patients.<br />Conclusion: Peripapillary RNFL average thickness is significantly correlated with pERG N95 amplitude & P50- N95 amplitude. In combination with OCT, pERG can be used to objectively assess functional loss in glaucoma.https://mjcu.journals.ekb.eg/article_52537_e3ffd63370f182b119413bef95eb7605.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Evaluation of the Role of Gonadotropins in Regulating Differentiation of Mesenchymal Stem Cells Into Testicular Leydig Cells7978015253810.21608/mjcu.2019.52538ENDALIA H. ABOUELELA, M.D.;THORIA A. OMAR, M.D.The Department of Clinical Pathology, Faculty of Medicine, Menoufia University, EgyptHAGER S. ABOU EL-NAGA, M.B.B.Ch.;EMAN S. SHABAN, M.B.B.Ch.The Department of Clinical Pathology, Faculty of Medicine, Menoufia University, EgyptJournal Article20181001Abstract<br />Background: Testicular Leydig cells are the cells who responsible or testosterone hormone production which in turn is the principle male sex hormone and is responsible for reproductive growth and development in male 2nd ry sexual characters.<br />Leydig cells depletion may result from different issues may be congenital, acquired as a result of trauma, radiation, chemotherapy and others which result in low testosterone level.<br />Transplantation of Leydig cells which obtained from Mesenchymal stem cells differentiation by effect of gonado-tropins has become a main treatment modality in patients with low testosterone levels.<br />Aim of Study: In this study, Wharton's jelly MSCs were isolated and induced to differentiate into leydig cells as promising tool for transplantation.<br />Material and Methods: The Leydig differentiation was induced using gonadotropins and evaluated by secretion of testosterone were determined using immunoassay and the results were compared between the experimental and control groups.<br />Results: Wharton's jelly MSCs induced with gonadotropins successfully differentiated to leydig cells that secret testoster-one.<br />Conclusion: The present study showed that Wharton's jelly MSCs can differentiated in vitro to leydig cells as future therapy of male infertility.https://mjcu.journals.ekb.eg/article_52538_3d09dc995709fdd5530654ed5b55f74b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Evaluation of the Clinical Effects of Ombitasvir/Paritaprevir/ Ritonavir Regimen in the Treatment of Chronic HCV Patients in CKD Versus ESRD Patients in Assiut University Hospital8038085253910.21608/mjcu.2019.52539ENSHALA Kh. EL-SHERIF, M.D.;ESSAM M. ABD EL-AZIZ, M.D.The Departments of Internal Medecine & Endocrinology and Npherology, Faculty of Medicine, Assiut University, EgyptMONA ABDEL-LATIF ALI, M.Sc.The Departments of Internal Medecine & Endocrinology and Npherology, Faculty of Medicine, Assiut University, EgyptJournal Article20181001Abstract<br />Background: Assesing curability of Ombitasvir/Parit-aprevir/Ritonavir regimen in chronic HCV infected patients in those with ESRD and CKD.<br />Aim of Work: To asses, curability of Ombitasvir/Paritap-revir/Ritonavir in chronic HCV infected patients in those with ESRD vs CKD, and assess duration of sustained viral therapy in Assiut Hospital University.<br />Patients and Methods: It is a prospective study which included 40 patients at Hemodialysis unit and Internal Medicine department in Assiut University Hospitals though one year. Then Patient will be divided into 2 group: Group I: 20 ESRD Patients on regular heamodialysis >6 months with chronic HCV infection. Group II: 20 CKD Patients with chronic HCV infection did not start dialysis.<br />Results: (SVR) was assessed at 12 and 24 weeks post-therapy. All patients in each group achieved SVR at 12 weeks but at 24 week. 85% of patients with ESRD achieved SVR while all those with CKD achieved SVR.<br />Conclusion: We found that the curability of Ombitasvir /Paritaprevir/Ritonavir plus Ribavirin has SVR12 about 100% and SVR24 100% in CKD patients, 85% in ESRD patients. With less incidence of anemia with that regimen as only 10% patients need blood transfusion. With high tolerability and less side effects with no occurrence of discontinuation of treatment.https://mjcu.journals.ekb.eg/article_52539_92b66d39e092e3efaab5039ec5dd3751.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effects of Oral Zinc Supplementation in Diabetic Children and Adolescents with Asymptomatic Cardiac Insult8098185254010.21608/mjcu.2019.52540ENREHAM M. ATALLA, M.Sc.;OSAMA ABD RAB EL-RASOL, M.D.The Departments of Pediatric and Clinical Pathology, Faculty of Medicine, Tanta UniversityWESAM S. MOHAMMED, M.D.;SHYMAA M. EL-RIFAEY, M.D.The Departments of Pediatric and Clinical Pathology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Diabetes is a pro-inflammatory condition. Chronic inflammation plays an important role in the progres-sion of diabetic complications. High glucose levels induce the release of pro-inflammatory cytokines, including TNF-a, IL-1(3, and IL-6 in patients with both type 1 and type 2 diabetes leading to multiorgan failure. Cardiovascular disease (CVD) is recognized as the major cause of morbidity and mortality among diabetic patients. Oxidative stress is a key risk factor contributing to the development and progression of CVDs. Zinc protects the cell from oxidation damage by free radicals. Zinc also act as anti- inflammatory.<br />Aim of Study: It was to evaluate the recent echocardio-graphic modalities in detection of silent left ventricular dysfunction in children with type 1 diabetes mellitus, assess the potential role of oxidative stress inflammatory cytokines, apoptosis and fibrosis in diabetic cardiac insult and to inves-tigate the possible protective role of zinc supplement on diabetic left ventricle (LV) in type 1 diabetic children and adolescents.<br />Patients and Methods: The study was carried out on fifty patients with type 1 diabetes mellitus who were diagnosed and followed-up in Endocrinology Unit and endocrinology outpatient clinic, Pediatric Department, Tanta University Hospital. Subdivided into: Twenty-five patients who received insulin treatment only and twenty-five patients who received insulin and oral zinc supplementation according to their Dietary Recommended Intakes (DRI) (7.5-15mg/d) for 6 months. Also on twenty-five apparently healthy children with matched age and sex who served as a control group. All studied children were subjected to detailed history taking, complete physical examination, measurement of level of IL-6 before and after zinc supplementation also Echocardiography (conventional, tissue Doppler and Speckling Tracking Tech-nique) before and after zinc supplementation.<br />Results: There was statistical significance between the 2 diabetic groups and the controls according to level of inter-leukin 6 which was markedly elevated in the diabetic patients than the controls. There was statistically significance between the 2 diabetic groups and the controls according to the param-eters detected by Tissue Doppler as E/A ratio and MPI (myo-cardial performance index) which showed subclinical systolic and diastolic impairment in the diabetic patients than the controls. There was statistically significance between the 2 diabetic groups and the controls according to the parameters detected by speckle tracking as 2DS (2 dimensional strain) which show subclinical systolic impairment in the diabetic patients than the controls. There was no statistical significance between the 2 diabetic groups and the controls according to the parameters detected by Tissue Doppler as ejection fraction and mitral annulus systolic velocity. There was no statistically significant difference between the diabetic patients who received oral zinc supplementation for 6 months and the controls according to level of interleukin 6. This shows the effect of zinc supplementation as anti-inflammatory. There was no statistically significant difference between the diabetic patients who received oral zinc supplementation for 6 months according to the parameter detected by Tissue Doppler and speckle tracking (E/A ratio, MPI, 2DS) which show marked improvement in the systolic and diastolic function of the diabetic patient after zinc supplementation.<br />Conclusion: There is evidence of increase level of serum interleukin 6 in patients with type 1 DM. Also evidence of subclinical systolic and diastolic dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography and Tissue Doppler. Oral Zinc supplemen-tation has a significant beneficial effect in patients with type 1 DM due to the anti-inflammatory and cardio-protective effect of the Zinc.https://mjcu.journals.ekb.eg/article_52540_9ac0e0f311a33b276a35a4b6e342dc89.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Evaluation of Incidental Thyroid Findings Detected by Positron Emission Tomography/Computed Tomography8198265254110.21608/mjcu.2019.52541ENFATMA E. EL-KADY, M.Sc.;HANAN M. EL-AHWAL, M.D.The Departments of Radio-diagnosis & Medical Imaging, Faculty of Medicine, Tanta University and Nuclear Medicine, Maadi Armed Forces Medical CompoundMEDHAT A. ABD EL-HAMED, M.D.;ALY A. AL-BARBARY, M.D.The Departments of Radio-diagnosis & Medical Imaging, Faculty of Medicine, Tanta University and Nuclear Medicine, Maadi Armed Forces Medical CompoundJournal Article20181001Abstract<br />Background: Thyroid incidenteloma detected on 18F-FDG PET/CT carries a high risk of malignancy. This high risk of malignancy supports the performance of a further diagnostic procedure, such as ultrasonography and fine needle aspiration biopsy.<br />Aim of Study: To determine the role of PET/CT in evalu-ation of incidental thyroid lesions detected in patients being studied for lymphomas and/or cancers other than of thyroid.<br />Material and Methods: This study included thirty four patients with incidental abnormal increased FDG uptake. All patients were subjected to ultrasound examination and patients with focal increased tracer uptake were subjected to fine needle aspiration biopsy.<br />Results: This study included a total of 1263 consecutive patients who underwent a FDG PET/CT study for staging of an advanced cancer of any site of the body other than the thyroid gland during the period. An incidental abnormal increase in FDG uptake in the thyroid gland was observed in 39 (3.08%) patients. Out of these patients, 26/39 (66.6%) presented with a focal and 13/39 (33.4%) with a diffuse thyroid uptake giving a prevalence of 2.06% for focal uptake and 1.03% for diffuse uptake. Six patients out of 23 patients with focal abnormal thyroid uptake were proven to have thyroid malignancy (Four patients with papillary thyroid carcinoma, one patient with follicular thyroid carcinoma and the remaining patient with atypical Hurthle cells). Thus the malignancy rate in patients with thyroid incidentalomas which proceeded to tissue biopsy was about 26%.<br />Conclusion: An incidental focal uptake of 18F-FDG in the thyroid gland is of significant risk of malignancy. A high value of SUVmax increases the risk of malignancy and SUVmax does not correlated with the diameter of malignant lesions, so FDG-PET/CT can detect malignancy in small thyroid lesions.https://mjcu.journals.ekb.eg/article_52541_5e1569a616dc0702e44161c6360154ab.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Dexamethasone Iontophoresis on Acute Bell's Palsy Patients8278345254510.21608/mjcu.2019.52545ENMOHAMED N. EL-BAHRAWY, Ph.D.;HANAN H. ABD EL-ALEEM, M.D.;The Departments of Physical Therapy for Neuromuscular & Neurosurgical Disorders & its Surgery,
Faculty of Physical Therapy and Department of Neurology, Faculty of Medicine, Cairo University, EgyptWALEED T. MANSOUR, Ph.D.;MOHAMMED R. IBRAHIM, M.Sc.The Departments of Physical Therapy for Neuromuscular & Neurosurgical Disorders & its Surgery,
Faculty of Physical Therapy and Department of Neurology, Faculty of Medicine, Cairo University, EgyptJournal Article20181001Abstract<br />Background: Bell's palsy is an idiopathic lower motor neurone palsy of the facial nerve. It is the most common cause of rapid-onset unilateral facial weakness. It often manifests rapidly.<br />Aim of the Study: This study aimed to evaluate the effect of Dexamethasone iontophoresis on acute Bell's palsy.<br />Subject and Methods: Thirty patients from both sexes, diagnosed as acute Bell's palsy were included in this study recruited from Neurology Outpatient Clinic of Faculty of Physical Therapy, Cairo University from July 2014 to October 2015. They were assigned into two equal groups a control group (A) and study group (B). GA received oral systemic steroids and aplacebo effect of iontophoresisWhile GB received the same oral drugs and Dexamethasone Iontophoresis. The patients were assessed with Electrical Response Grading as objective method for assessment and the Yanagihara Grading Scale (YGS) as clinical method for evaluation pre and post the iontophoresis.<br />Results: Post physiotherapeutic evaluation revealed sig-nificant difference between group A and group B regarding (ERG) and (YGS) 0.001.<br />Conclusion: Dexamethasone iontophorsis is effective in treatment of acute Bell's palsy.https://mjcu.journals.ekb.eg/article_52545_c0157f3adb89194ea4b90bb2ad7087b4.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Ultrasound Cavitation Versus Cryolipolysis on Central Obese Patients8358425262710.21608/mjcu.2019.52627ENAMR N.A. ABOTALEB, M.Sc.;AKRAM A. SAYED, Ph.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, 6th of October* and Cairo** Universities and the Department of Internal Medicine, Faculty of Medicine, Cairo University***, EgyptHEBA A. ABDEEN, Ph.D.;MARRY W. FAWZY, M.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, 6th of October* and Cairo** Universities and the Department of Internal Medicine, Faculty of Medicine, Cairo University***, EgyptJournal Article20181001Abstract<br />Background: Central Obesity is one of the most common worldwide diseases afflicting humans. It is a major health problem throughout the world because of its high prevalence and its association with increased risk of cardiovascular and liver diseases.<br />Aim of the Study: Was to determine the effect of ultrasound cavitation versus cryolipolysis on central obese patients.<br />Subjects: Thirty (30) patients of both sexes, 15 men and 15 women. They were assigned into two groups equal in number. Their ages ranged from 45 to 55 years. Group A with mean age (50.47±3.31) years and Group B with mean age (49.47±3.89) years.<br />Methods: Body Mass Index (BMI), Waist Circumference (WC) and abdominal fat percentage was measured before and after performing ultrasound cavitation and cryolipolysis sessions in both groups. Group A patients received ultrasound cavitation sessions for one month (8 sessions/patient), Group B patients received cryolipolysis sessions for one month (one session/patient).<br />Results: The results revealed that there was statistically significant reduction in central obesity (BMI, abdominal fat% and WC) in both Group A and Group B. But there wasn't statistically significant reduction in central obesity (BMI, abdominal fat% and WC) between two groups. There was improvement in Group B than Group A. In Group A, the percentage of improvement for BMI, abdominal fat% and WC was 2.94%¯, 11.07%¯ and 5.59%¯, respectively. In Group B, the percentage of improvement for BMI, abdominal fat% and WC was 3.62%¯, 19.11%¯ and 4.68%¯ respectively.<br />Conclusion: There was improvement in central obesity after applying ultrasound cavitation and cryolipolysis sessions with mild better results in cryolipolysis than ultrasound cavitation.https://mjcu.journals.ekb.eg/article_52627_dca0950d532ec93b9d8e77de61716955.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Relation between Findings of Nerve Conduction Study and Hand Function in Carpal Tunnel Syndrome8438495262810.21608/mjcu.2019.52628ENNAWAL A. ABU SHADY, Ph.D.;MYE A. BASHEER, M.D.The Departments of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy* and Special Medicine, Faculty of Medicine**, Cairo University and Physical Therapist College, Human Performance in Health and Disability, Al-Kasr Al-Einy Hospital***AHMED A. SHEHAB EL-DEIN, M.Sc.;EMAN YASEN, Ph.D.The Departments of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy* and Special Medicine, Faculty of Medicine**, Cairo University and Physical Therapist College, Human Performance in Health and Disability, Al-Kasr Al-Einy Hospital***Journal Article20181001Abstract<br />Background: Functional problems occur in carpal tunnel syndrome patients affecting their daily living activities.<br />Aim of Study: The purpose of this study was to investigate the relation between nerve conduction study and hand function findings in carpal tunnel syndrome.<br />Subjects and Methods: The study included 40 female patients diagnosed with carpal tunnel syndrome. They were assessed by nerve conduction study, pinch dynamometer for pinch strength and Boston questionnaire for assessing the symptoms severity and functional status of patients with CTS.<br />Results: This study revealed that there was no correlation between motor latency and symptoms subscale (r=0.113, p= 0.489), functional subscale (r=0.212, p=0.189), total hand function scale (r=0.177, p=0.274), tip pinch (r=–0.093, p= 0.567), and key pinch (r=–0.025, p=0.88) and palmar pinch (r=0.001, p=0.995).<br />There was no correlation between motor amplitude and symptoms subscale (r=0.018, p=0.911), functional subscale (r=–0.075, p=0.645), total hand function scale (r=–0.03, p= 0.855), key pinch (r=0.196, p=0.225) and palmar pinch (r= 0.062, p=0.705). While, there was weak positive significant correlation between motor amplitude and tip pinch (r=0.351, p=0.027*).<br />There was no correlation between velocity of motor nerve and symptoms subscale (r=0.199, p=0.217), functional subscale (r=0.245, p=0. 127), total hand function scale (r=0.247, p= 0.125), tip pinch (r=0.174, p=0.282), between, key pinch (r= 0.049, p=0.764), and palmar pinch (r=–0.013, p=0.936).<br />There was no correlation between onset sensory latency and symptoms subscale (r=0.01, p=0.951), functional subscale (r=–0.036, p=0.826), total hand function scale (r=–0.013, p= 0.935), tip pinch (r=–0.095, p=0.56), key pinch (r=–0.212, p=0.19) and palmar pinch (r=–0.188, p=0.245).<br />There was no correlation between sensory amplitude and symptoms subscale (r=0.033, p=0.841), functional subscale (r=0.143, p=0.379), total hand function scale (r=0.096, p= 0.555), tip pinch (r=0.178, p=0.273), key pinch (r=0.099, p= 0.543) and palmar pinch (r=–0.019, p=0.909).<br />Conclusion: Hand function assessment should be done separately from nerve conduction study when assessing carpal tunnel syndrome patients. Psychological factors should be considered.https://mjcu.journals.ekb.eg/article_52628_cb3184f324491df2d0d620faa09314d0.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Pilates Exercise on Cardio Metabolic Risk Factors in Women with Type 2 Diabetes8518515263010.21608/mjcu.2019.52630ENYASMIN M. ABD EL-MONIM, M.Sc.;NESREEN G. EL-NAHAS, Ph.D.SALLY A.HAKEM, M.D.Journal Article20181009Abstract<br />Background: Diabetes mellitus represents a syndrome of complex metabolic diseases united by the occurrence of hyperglycemia which also exhibits diverse origins (insulin deficiency, insulin resistance, systemic consequences of pregnancy) and has variable accompanying physiological and metabolic disorders leading to increase incidence and frequency of chronic complications due to micro vascular (e.g., neph-ropathy and retinopathy) and macro vascular (stroke, macro vascular coronary and peripheral artery diseases) alterations, as well as the difficulties of controlling it.<br />Aim of Study: The current study intended to determine the effect of pilates exercises on cardio metabolic risk factors in patients with type 2 diabetes.<br />Patients and Methods: Forty women with type 2 diabetes, aging from 35 to 55 years with 5-7 years ago suffering from diabetes, they were assigned randomly into two groups of equal numbers, control and study. Women in controlled group received regular medical treatment with no change on their regular daily activities. Those in the study group received a designed pilates exercises three days/week for 12 weeks. Blood samples were collected and were subjected to laboratory investigations for glycosylated hemoglobin and lipid profile analysis, measure blood pressure, waist-hip ratio, before intervention, and were repeated after twelve weeks of treat-ment.<br />Results: Pre and post-treatment comparisons showed a statistically significant improvement of the measured variables in the two groups. Moreover, significant difference was recorded in the study group.<br />Conclusions: Designed pilates exercises contributed to improve cardio metabolic risk factors in patients with type 2 diabetes.https://mjcu.journals.ekb.eg/article_52630_01d5a88af13d3d2b3348c43a88d1b507.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Autogenic Drainage versus Counter Rotation Effect on Blood Gases in Post Thoraco Abdominal Surgery8598635263210.21608/mjcu.2019.52632ENMAI G. MOUSTAFA, M.Sc.;NESREEN G. EL-NAHAS, Ph.D.The Department of Physical Therapy for Cardiovascular, Respiratory Disorders & Geriatrics,
Faculty of Physical Therapy* and the Department of Anesthesia, Faculty of Medicine**, Cairo UniversityMONA M. TAHA, Ph.D.;MOHAMED M. ABD EL-HAQ, M.D.The Department of Physical Therapy for Cardiovascular, Respiratory Disorders & Geriatrics,
Faculty of Physical Therapy* and the Department of Anesthesia, Faculty of Medicine**, Cairo UniversityJournal Article20181001Abstract<br />Background: This study was conducted to find outthe effect of autogenic drainage and counter rotation on blood gases in thoraco abdominal surgery.<br />Aim of the Study: To compare the effect of autogenic drainage and counter rotation on blood gases in thoraco abdominal surgery.<br />Patients and Methods: This study comprised 40 adult patients aged from 40-50 of both sexes who chosed from Kasr Aini Hospital.<br />Methods: They were divided into two groups equal in number.<br />1-Group A: 20 patients that received first traditional physio-therapy (breathing exercise, percussion, vibration with postural drainage) then autogenic drainage.<br />2-Group B: 20 patients that received first traditional physio-therapy (breathing exercise, percussion, vibration with postural drainage) then counter rotation. The treatment done 3 times per day for 2 weeks.<br />Results: The results showed that there was no significance difference between both groups in PH, PAO2, PACO2, HCO3. But there was significant difference in oxygen saturation between both group at the end of 14 days. There was a significant increase in SaO2 of group A compared with that of group B at 14th day (p=0.001).<br />Conclusion: Autogenic drainage had a positive effect on oxygen saturation than counter rotation technique, the results of this study support the importance of adding autogenic drainage to traditional physiotherapy to improve oxygen saturation.https://mjcu.journals.ekb.eg/article_52632_12bce077c0dadf23d606a6d32d3b80d4.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Outcome of Snodgrass (Tabularized Incised Plate) in Repair of Primary Distal Hypospadias with Narrow Urethral Plate8658695263410.21608/mjcu.2019.52634ENMOSAB I. EL-DEEB, M.Sc.;SALAH A. NAGLA, M.D.The Department of Urology, Faculty of Medicine, Tanta UniversityMOHAMED O. ABO FARHA, M.D;AYMAN A. HASSAN, M.D.The Department of Urology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Options for urethroplasty in children with hypospadias can be classified as tubularizations of the urethral plate, skin flaps and grafts. Throughout the history of surgery for this condition flaps have been most commonly used, but in the past 10 years incision and tubularization of the urethral plate (tubularized incised-plate, TIP) has rapidly gained popularity for correcting distal, proximal and re-operative hypospadias. TIP potentially simplifies both decision-making and surgical technique, and has a low complication rate with better cosmetic results. However, careful attention to surgical details and awareness of contraindications to the procedure are needed to achieve optimal results.<br />Aim of Study: Outcome of Snodgrass (Tabularized Incised Plate) in repair of primary distal hypospadias with narrow urethral plate.<br />Patients and Methods: Twenty patients with primary distal and midpenile hypospadias were enrolled for repair with Snodgrass technique.<br />Demographic data, hereditary relationship, urethral plate length and width, glans width, and intraoperative time were recorded and post-operative early and late complications were observed for parents and surgeon satisfaction.<br />Results: Between the 20 patients, only three patients developed post-operative complication one was urethrocuta-neous fistula and two showed meatal stenosis with success rate 85%.<br />Conclusion: Tubularized incised plate in repair of primary distal and midpenile hypospadias successfully fulfils all traditional hypospadias repair criteria. It offers a viable option in the management of primary hypospadias with a narrow urethral plate.https://mjcu.journals.ekb.eg/article_52634_4ac7bce81969731b30f28ed8e38f3a90.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Glycemic Control on Adipokines in Diabetic Patients with Pulmonary Hypertension8718765263610.21608/mjcu.2019.52636ENMANAR M. EL-ZAKI, M.D.;NADER KANDIL, M.D.The Departments of Cardiology*, Medical Biochemistry & Molecular Biology** and Medical Physiology***, Faculty of Medicine, Zagazig University, EgyptSAMIA HUSSEIN, M.D.;MAI M. HASAN, M.D.The Departments of Cardiology*, Medical Biochemistry & Molecular Biology** and Medical Physiology***, Faculty of Medicine, Zagazig University, EgyptABEER A.SAEED, M.D.The Departments of Cardiology*, Medical Biochemistry & Molecular Biology** and Medical Physiology***, Faculty of Medicine, Zagazig University, EgyptJournal Article20181001Abstract<br />Background: Recent studies suggested a role of diabetes in regulating the outcome of pulmonary hypertension. Several cytokines are dysregulated in pulmonary hypertension, and were considered accurate predictors of the prognosis.<br />Aim of Study: To evaluate the effects of glycemic control on hemodynamics, metabolic and adipokines (leptin, apelin and adiponectin) levels in patients with pulmonary hyperten-sion and diabetes.<br />Subjects and Methods: Thirty-five pulmonary hypertension patients with diabetes assigned into two groups according to glycosylated hemoglobin (HbA1c) level; tightly controlled group (Group I) (n=20) and conventionally controlled group (Group II) (n=15). Demographic characteristics, hemodynamic assessment, metabolic and serum adipokines levels were assesed.<br />Results: Both groups showed insignificant difference in age, BMI and left ventricular ejection fraction; while mean pulmonary arterial pressure, HbA1c, fasting blood glucose, insulin, HOMA-IR, Cholesterol, triglycerides, Interleukin-6, leptin and apelin were significantly decreased in group I. IL-6, leptin and apelin have significant positive correlation with glucose, insulin, HOMA-IR, Cholesterol, TG and MPAP in both groups.<br />Conclusion: Good glycemic control has an impact on hemodynamics, metabolic, inflammatory and adipokine pattern in diabetic patients with pulmonary hypertension, which may affect the progression of the disease.https://mjcu.journals.ekb.eg/article_52636_bd9499fc58039532ef7e40a3a0acf741.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Case Report: Syringocystadenoma Papilliferum in the Middle Ear8778805263810.21608/mjcu.2019.52638ENWAEL A.ALZAMIL, M.D.The Department of Otorhinolaryngology, Hearing and Speech Institute, General Organization for Teaching Hospitals and Institutes, Giza, EgyptJournal Article20181001Abstract<br />Background: Syringocystadenoma papilliferum is a rare adnexal tumor of controversial origin that often occurs as a solitary tumor derived from apocrine and eccrine glands. It is more common in children and adolescents and affects the head and neck regions,although occurrences on other anatom-ical locations have been described. Routine H & E-stained sections revealed cystic epidermal invaginations with papillary projections. The superficial portions of the cyst were lined by stratified keratinizing epithelium, whereas the deeper papillated portion exhibited a double layer of basal-like cells and luminal eosinophilic columnar cells with focal decapitation secretions.<br />Patient and Method: A female patient, aged 29 years, presented to us in the outpatient clinic suffering from left earache and hearing loss since the past 3 months, with gradual onset and a slowly progressive course. On examination, we found a left aural polyp, which was firm and grayish in color, but extremely tender on touch. Biopsy for histopathological examination was consistent with a diagnosis of syringocysta-denoma papilliferum. The patient received regular follow-up and is doing well with regard to her earache with marked hearing improvement. To conclude, solitary lesions seen in unusual locations generate multiple differential diagnoses and should be confirmed by histopathology in order to exclude other pathologies and define the appropriate therapeutic approach.<br />Conclusion: Solitary lesions seen in unusual locations generate multiple differential diagnoses and they must be confirmed by histopathologyhttps://mjcu.journals.ekb.eg/article_52638_6f6062912478866a33be95b8ed181f65.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Arch Support on Prevention of Foot Pain During Pregnancy8818885270810.21608/mjcu.2019.52708ENMOHAMED A. AWAD, Ph.D.;AFAF M. BOTLA, Ph.D.The Department of Physical Therapy for Obstetrics and Gynaecology, Faculty of Physical Therapy, Cairo University* and The Department of Orthopaedic Surgery, Faculty of Medicine (Girls), Al-Azhar University**, EgyptABD EL-HAMID A. ATTA ALLAH, M.D.;SARA A. AMR, M.Sc.The Department of Physical Therapy for Obstetrics and Gynaecology, Faculty of Physical Therapy, Cairo University* and The Department of Orthopaedic Surgery, Faculty of Medicine (Girls), Al-Azhar University**, EgyptJournal Article20181001Abstract<br />Background: During pregnancy women experience several changes in the body's physiology, morphology and hormonal system. These changes may affect the balance and body stability and can cause discomfort and pain.<br />Aim of Study: This study was conducted to investigate the effect of arch support on prevention of foot pain during pregnancy.<br />Material and Methods: Sixty pregnant women shared in this study. They were selected randomly from Al-Zahraa University Hospital, Al-Azhar University, in Cairo. Their ages were ranged from 20 to 30 years old and their BMI were less than 30Kg/m2. They were divided randomly into two groups equal in number: Group A (control group) which consisted of 30 pregnant women received no intervention and group B (study group) which consisted of 30 pregnant women wore arch support from the beginning of 2nd trimester till 6 weeks postpartum. All women in both groups were evaluated through Navicular Index (NI) and Visual Analog Scale (VAS) before treatment (at the beginning of the 4th month of pregnancy), at the end of third trimester (at the end of 9th month of pregnancy) and at the end of puerperium (six weeks post-partum).<br />Results: Results of this study revealed that there was no statistically significant difference in navicular index between both groups (A and B) at the 4th month of pregnancy and after six weeks postpartum (p=0.403). But there was statistically significant difference between them at 9th month of pregnancy in favour of group B (decrease) (p=0.002). There was a statistically significant difference in VAS between both groups at both 9th month of pregnancy and 6 weeks postpartum in favour of group B (decrease) (p=0.001).<br />Conclusion: It can be concluded that wearing arch support prevents foot pain during pregnancy.https://mjcu.journals.ekb.eg/article_52708_69c4d9b15099cdec020a8d1d10c7dc2f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Pulsed Ultrasound on Discoid Lupus Erythematosus8898955271010.21608/mjcu.2019.52710ENSHERIF E. BAZAN, M.Sc.;MOHAMED M. KHALAF, Ph.D.MARWA A. EID, Ph.D.;MOHAMED T. REKABY, M.D.Journal Article20181001Abstract<br />Background: Pulsed ultrasound has a lot of uses and in this study I used it to help patients with discoid lupus ery-thematosus to improve healing of scars.<br />Aim of Study: To determine the effect of pulsed ultrasound therapy on patients with Discoid lupus erythematosus.<br />Patients and Methods: Thirty patients (male and female), aged ranging from 20-40 years, suffering from discoid lupus erythematous participated in this study. They were selected randomly from Alhoud Almarsoud Hospital from first of May 2015 till thirty first of June 2015. They were randomly divided into 2 equal groups in number, one control group (A) and a study group (B). The control group (A) who did not receive the pulsed ultrasound therapy but they just received their traditional medical treatment, and they were instructed about avoiding sun light. The study group (B) received the ultrasound therapy (low intensity pulsed ultrasound) for 5-7 minutes every session, application was done 3 times per week for a month as a total period of treatment at Physiodiet Clinic in Nasr City. Their scars have been evaluated using Vancouver's Scar assessment Scale. Measurements were conducted before starting the treatment as a first record and at the end of the month of treatment as a second (final) record.<br />Results: Result showed that the ultrasound therapy was effective and fruitful in decreasing scar tissue as evidenced by the highly significant decrease in the total score of Van-couver Scar assessment scale.<br />Conclusion: Ultrasound therapy is beneficial in improving scars in Discoid lupus erythematosus.https://mjcu.journals.ekb.eg/article_52710_4422733baee97ddd1569bbf05a695c6b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Aerobic Exercise on Bone Mineral Density in Lean Postmenopausal Women8979075271210.21608/mjcu.2019.52712ENMOHAMED A. AWAD, Ph.D.;ENGY M. EL-NAHAS, Ph.D.MOHAMMED R. SOLIMAN, M.D.;MARWA A. BIOMY, M.Sc.Journal Article20181001Abstract<br />Background: Osteoporosis is considered as the most common bone disease in humans, and it represents a major public health problem as outlined in Bone Health and Oste-oporosis.<br />Aim of Study: This study was carried out to determine the effect of aerobic exercises on bone mineral density in lean postmenopausal women.<br />Participants: Forty osteoporotic lean postmenopausal women participated in this study. Their ages were ranged from 49-69 years. Their Body Mass Index (BMI) was less than 25kg/m2. Their T-Score was less than –2.5. The study was conducted from January to July 2017.<br />Design: They were selected randomly from outpatient clinic of Physiotherapy Department.<br />Location: This study conducted at they were selected from Physiotherapy Department in Abu-Elmatameer General Hospital in Abu-Elmatameer City, Behera Governate.<br />Material and Methods: They were divided randomly into two groups equal in number (A and B). Group A (study group) performed aerobic exercise in the form of walking on treadmill, for thirty minutes, three times per week for twelve weeks, starting with warming up exercises and ended by cooling down exercises in addition to their usual daily calcium intake (cal preg tablets 1200mg/day). Group B (control group) took only their usual daily calcium intake (cal preg tablets 1200 mg/day). Evaluation all women in both groups (A and B) were assessed pre and post treatment program.<br />Outcome Measure: Measuring Bone Mineral Density (BMD) of lumbar regain, left femur and forearm by using DEXA.<br />Results: There was highly statistical significant increase in the mean values of BMD and T-score of lumbar spine, left femur and forearm post treatment in both groups A and B. There was no statistical significant difference between both groups (A & B) pre treatment in the mean values of BMD & T-score of lumbar spine, left femur and forearm where the p-value was (>0.05). While, post-treatment there was a statistical significant difference between both groups (A & B) in the mean values of BMD & T-score of lumbar spine, left femur and for arm where, the p-value was (<0.05) in favor of group A (more increase).<br />Conclusion: It can be concluded that aerobic exercise has been shown to be effective in improving bone mineral density in lean post-menopausal women.https://mjcu.journals.ekb.eg/article_52712_b070023f005ec614df68c85746b616a2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Ultrasound Cavitation on Weight Reduction for Prediabetic Obese Patients9099175271310.21608/mjcu.2019.52713ENJERMEEN E. YOUSEF, M.Sc.;MAHER A. AL-KABALAWY, M.D.The Department of Basic Science, Faculty of Physical Therapy, Deraya* and Cairo** Universities and The Department of Internal Medicine, Faculty of Physical Therapy, Deraya University***AMIRA H. DRAZ, M.D.;MANAR S. MOHAMED, M.D.The Department of Basic Science, Faculty of Physical Therapy, Deraya* and Cairo** Universities and The Department of Internal Medicine, Faculty of Physical Therapy, Deraya University***Journal Article20181001Abstract<br />Background: Obesity has received considerable attention as a major health hazard and can be an underlying cause of many disorders such as type 2 diabetes.<br />Aim of Study: The purpose of present study is to investigate the effects of ultrasound cavitation on weight reduction for prediabetic obese patients.<br />Design: Randomized control trial design.<br />Subjects: Fifty patients prediabetic obese women from the out clinic of Faculty of Physical Therapy of Deraya University, Minia, Egypt. They were randomly assigned into two groups, each group twenty-five patients.<br />Patients and Method: Group I (control group): Twenty-five patients were received aerobic exercises and low caloric diet, three times per week for twelve weeks. Group II (exper-imental group): Twenty-five patients were received aerobic exercise, ultrasound cavitation and low caloric diet treatment, twice weekly ultrasound cavitation sessions for six weeks, and aerobics exercise three times per weeks for twelve weeks. (Bщ WHR, skin fold, fasting blood sugar level, post prandial blood sugar level and HbA1c level) were measured before treatment (pre-test data), and after the completion of the treatment program, as a post-test measurement.<br />Results: There was a statistical significant effect of ultra-sound cavitation to low calorie balanced diet and treadmill exercise on reduction in weight, Bщ WHR, skin fold, fasting blood glucose level, post prandial blood glucose level and HbA1c level in prediabetic obese female patients.<br />Conclusions: Adding Ultrasound cavitation to low calorie balanced diet and treadmill exercise could be utilized as physical therapy program design for treatment to prediabetic obese female patients.https://mjcu.journals.ekb.eg/article_52713_d890a21f35919530a749018f688d78e4.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Influence of Medial Wedge Support on Pain and Function in Patients with Patellofemoral Pain Syndrome9199255271510.21608/mjcu.2019.52715ENMOSTAFA I. EL-SHAFEY, M.Sc.;NADIA A. FAYAZ, Ph.D.EBTESSAM F. GOMAA, Ph.D.;AHMED H. HAFEZ, M.D.Journal Article20181001Abstract<br />Background: Patellofemoral Pain Syndrome (PFPS) is a common complaint in athletes and populations which described as a dull and aching pain in anterior or retropatellar area in absence of other pathology. It is commonly believed that main problems of PFPS are pain and also impaired knee function.<br />Aim of Study: To investigate the efficacy of medial wedge support on pain relief and functional improvement in patients with PFPS.<br />Material and Methods: Thirty patients (10 females and 20 males) aged between 18-35 years were assigned randomly into two equal groups. Experimental group (A): Included 15 patients were treated with hip abductors and lateral rotators strengthening exercises in addition to wearing medial wedge support whereas control group (B): Included 15 patients were treated with only hip abductors and lateral rotators strength-ening exercises. Anterior knee function was measured by Anterior Knee Pain Scale (AKPS) and pain intensity was measured by Visual Analogue Scale (VAS) in both groups before and after 12 successive sessions over six weeks.<br />Results: The findings of this study indicated a significant decrease in VAS and significant improvement in AKPS after treatment in comparison to before treatment values in both groups A and B. Post-treatment comparison of both groups showed statistically significant difference with better improve-ment in group A and p=0.0018 for AKPS and p=0.0004 for VAS.<br />Conclusion: The obtained results suggest that using medial wedge support together with the hip abductors and lateral rotators strengthening exercises have proved to be more beneficial in decreasing pain intensity and improving functional level in Patellofemoral Pain Syndrome (PFPS) patients.https://mjcu.journals.ekb.eg/article_52715_9a7f7c8174d955eab367f2a7c441f522.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Pelvic Control Exercises on Pelvic Asymmetry and Gait in Stroke Patients9359395277810.21608/mjcu.2019.52778ENMOHAMED H. MARZOUK, M.Sc.;MOHAMED S. EL-TAMAWY, M.D.The Departments of Neuromuscular Disorder, Faculty of Physical Therapy* and Neurology, Faculty of Medicine**, Cairo UniversityMOSHERA H. DARWISH, Ph.D.;HEBA A. KHALIFA, Ph.D.The Departments of Neuromuscular Disorder, Faculty of Physical Therapy* and Neurology, Faculty of Medicine**, Cairo UniversityISLAM M.AL-AZAB, Ph.D.The Departments of Neuromuscular Disorder, Faculty of Physical Therapy* and Neurology, Faculty of Medicine**, Cairo UniversityJournal Article20181001Abstract<br />Background: Gait abnormality is one of the most common impairments after stroke. Pelvic control exercises may affect gait and pelvic asymmetry in stroke patients.<br />Aim of Study: To determine the effect of pelvic control exercises on pelvic asymmetry and gait in stroke patients.<br />Patients and Methods: Thirty male ischemic stroke patients represented the study. Their age ranged from 45 to 60 years. The patients were assigned into two equal groups; control group (GA) treated by selected physical therapy program and study group while (GB) treated by the same program in addition to pelvic control exercises. The spatiotemporal gait parameters were assessed by Biodex gait trainer 2TM system. Sagittal pelvic tilt angles were measured by Palmation meter (PALM) inclinometer from standing position.<br />Results: Post-treatment there were a significant improve-ment in all measured variables except the average step length of the non-affected side in both groups. Comparison between both groups revealed a significant decrease of the anterior pelvic tilting angles on both sides, the average step length of the affected side and the percent of time spent on the non affected foot with significant increase of the percent of time spent on the affected foot in favor to (GII) (p<0.05). No significant difference of the average walking speed and average step length of the non affected side was detected between both groups.<br />Conclusion: Pelvic control exercises have a positive effect on the pelvic asymmetry and consequently on gait performance in stroke patients.https://mjcu.journals.ekb.eg/article_52778_00a7b1f915b949f687e97a031c2d4d62.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Prevalence of Work Related Low Back Pain among Physical Therapists with Different Foot Postures at Fayoum, Egypt: A Survey Study9419515278110.21608/mjcu.2019.52781ENHOSSAM EL-DIN A. IBRAHIM, M.Sc.;SALWA F. ABD EL-MEGED, Ph.D.The Department of Orthopedic Physical Therapy, Fayoum General Hospital, Fayoum*, The Department of Physical Therapy for Orthopedics, Faculty of Physical Therapy, Cairo University** and Department of Orthopedic Surgery, Fayoum General Hospital***, EgyptEBTESSAM F. GOMAA, Ph.D.;ALAA EL-MARAKBY, M.D.The Department of Orthopedic Physical Therapy, Fayoum General Hospital, Fayoum*, The Department of Physical Therapy for Orthopedics, Faculty of Physical Therapy, Cairo University** and Department of Orthopedic Surgery, Fayoum General Hospital***, EgyptJournal Article20181001Abstract<br />Background: Low Back Pain (LBP) is the commonest form of musculoskeletal disorder among physical therapists. Repetitive tasks, high force manual techniques bending/twisting postures, patient transfer assisting with mat activities, lifting heavy equipment, prolonged constrained posture and foot abnormalties identified as risk factors of low back pain which is common in the field of physical therapy.<br />Aim of the Study: The purpose of this study was to identify prevalence of work related LBP among physical therapists with different foot postures working in governmental hospitals in fayoum-Egypt.<br />Subjects and Methods: 147 physical therapists who are working in the governmental hospitals in Fayoum-Egypt, the LBP will be measured by Nordic Questionnaires (NQ) and foot postures measured by Foot Posture Index (FPI).<br />Results: 112 of the 147P. Ts (76.19%) have completed the questionnaire. WRLBP (n=68), non WRLBP (n=25), no LBP (n=19). The lifetime prevalence of WRLBP was 60.71%, the twelve-month prevalence of WRLBP was 52.67%, the point prevalence of WRLBP was 47.32%, concerning BMI and WRLBP 74.28% of subjects with BMI of 20-24.9kg/m2 and 54.54% of subjects with BMI of 25-29.9kg/m2, the WRLBP was present in 54.83% of female subjects and in 68% of male subjects, the WRLBP was present in 56% of subjects with normal foot posture, 55% of subjects with pronated foot posture, 91% of subjects with highly pronated foot posture, 100% of subjects with supinated foot posture and 67% of subjects with highly supinated foot posture.<br />Conclusion: There was no statistically significant associ-ation between LBP and foot postures, however there was a statistically significant association between WRLBP and BMI. There was a high prevalence of WRLBP among physical therapists who working in governmental hospitals in Fayoum-Egypt.https://mjcu.journals.ekb.eg/article_52781_2b8765c310bf6664dd8ee6bc01fc6a1e.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Correlation between Functional Capacity and Autistic Features for Children with Autism Spectrum Disorder9539575278410.21608/mjcu.2019.52784ENHADEER A. ABD EL-KHALIK, M.Sc.;EMAN I. EL-HADIDY, Ph.D.The Department of Physical Therapy, Mattaria Teaching Hospital*, The Departments of Physical Therapy for Pediatrics, Faculty of Physical Therapy** and Psychology, Faculty of Art***, Cairo UniversitySAMIA A. ABD EL-RAHMAN, Ph.D.;KAMILIA S. ABD EL-HAMID, Ph.D.The Department of Physical Therapy, Mattaria Teaching Hospital*, The Departments of Physical Therapy for Pediatrics, Faculty of Physical Therapy** and Psychology, Faculty of Art***, Cairo UniversityJournal Article20181001Abstract<br />Background: Autism spectrum disorder is a life-long neuro-developmental condition interfering with the person's ability to communicate and relate to others. Autistic features are stereotype behavior, deficits in social interaction and communication.<br />Aim of Study: To examine the relation between the autistic features and the functional capacity in children with autism spectrum disorder.<br />Patients and Methods: 30 children with autism spectrum disorder aged from 5 to 8 years old were recruited from the Pediatric Clinic of El-Mattaria Teaching Hospital in Mattaria, Cairo. Their autism index ranged from mild to moderate according to the Arabic version of the Gilliam Autism Rating Scale. Autistic features were assessed by Arabic version of the Gilliam Autism Rating Scale while the functional capacity was assessed by the six-minute walk test.<br />Results: There was no relation between the autistic features and the functional capacity of all participated children.<br />Conclusion: Autistic features did not affect the functional capacity in children with autism spectrum disorder.https://mjcu.journals.ekb.eg/article_52784_cbc4b8590b3eb362379e0d12e11f2195.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Weight Bearing Exercises on Osteoporosis in Breast Cancer Patients Receiving Chemotherapy9599655282410.21608/mjcu.2019.52824ENZAKARIA M.E. MOWAFY, Ph.D.;KHOWAILED A. KHOWAILED, M.D.The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University* and The Department of Surgery, Faculty of Medicine, Beni Suef University**, EgyptEMAN M.EL-GENDY, M.Sc.The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University* and The Department of Surgery, Faculty of Medicine, Beni Suef University**, EgyptJournal Article20181001Abstract<br />Background: Bone is a piezoelectric material and conse-quently, it exhibits the converse piezoelectric effect (mechanical deformation under the influence of an applied electric field).<br />Aim of Study: To evaluate the efficacy of the treadmill weight bearing exercises on Bone Mineral Density (BMD) and T-score mean in cases of osteoporosis in breast cancer patients receiving chemotherapy.<br />Material and Methods: Thirty breast cancer patients receiving chemotherapy and complaining from osteoporosis were randomly divided into two groups. Group (A) received aerobic exercise on treadmill as form of weight bearing exercise 20 minutes 3 times per week for 2 months and drug therapy (vitamin D supplements and calcium). Group (B) received only drug therapy (vitamin D supplements and calcium).<br />Results: The results showed that the treadmill weight bearing exercises and drug therapy application) had a valuable effects more than application of the drug therapy alone in improving on the Bone Mineral Density (BMD) in cases of osteoporosis in breast cancer patients receiving chemotherapy.<br />Conclusion: Application of the treadmill weight bearing exercises and drug therapy had fruitful effects more than application of the drug therapy alone in cases of osteoporosis in breast cancer patients receiving chemotherapy as evidenced by the highly significant decrease in BMD and T-score mean.https://mjcu.journals.ekb.eg/article_52824_7687bf082969a6a3e04d15c6674d52e8.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Efficacy of Biofeedback Exercise of Deep Neck Flexors on Cervicogenic Headache9679805282510.21608/mjcu.2019.52825ENMAHA M. AHMED, M.Sc.;SALWA F. ABD EL-MAGEED, Ph.D.KARIMA A. HASSAN, Ph.D.;EMAD S.B. SAWEERES, F.R.C.S. (Tr &Orth), M.D.Journal Article20181001Abstract<br />Background: Cervicogenic Headache (CGH) is a common condition causing significant disability. Patients with CGH had less strength and endurance of Deep Neck Flexors (DNF).<br />Aim of Study: The purpose of this study was to investigate the efficacy of (DNF) strength exercise using Pressure Bio-feedback Unit (PBU) for CGH patients.<br />Material and Methods: Thirty patients (15 females and 15 males) with CGH, their age ranged from twenty to forty years, were randomly allocated into DNF group received DNF strength exercise using PBU in addition to traditional program and traditional treatment group received traditional physical therapy program only. Treatment applied three times per week for 4 weeks, each patient has been assessed for pain, functional disability, and cervical range of motion using Visual Analog Scale (VAS), Neck Disability Index (NDI) and OB Myrin goniometry respectively in addition to headache frequency per week pre and post-treatment.<br />Results: The results showed that: There was no significant difference in the mean values of the headache pain (p=0.13), neck pain (p=0.78), NDI (p=0.77) and ROM (p>0.5) between DNF group and traditional group post-treatment but there was a significant decrease in the mean values of headache frequency of the DNF group post-treatment compared with that of traditional treatment group (p=0.003).<br />Conclusion: These results suggest that deep neck flexors exercises using pressure biofeedback unit is effective in the reducing headache frequency in individuals with the cervico-genic headache than traditional exercise only.https://mjcu.journals.ekb.eg/article_52825_c87abef190f896558ff5ef970ece9199.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Outcomes of Decompressive Craniectomy for Spontaneous Deep Supratentorial Intracerebral Hemorrhage9819855282610.21608/mjcu.2019.52826ENISLAM ABOUL-FETOUH, M.D.;ABD EL-AAL ABD EL-BAKY, M.D.The Department of Neurosurgery, Faculty of Medicine, Benha University, EgyptJournal Article20181001Abstract<br />Background: Spontaneous Intracerebral Hemorrhage (ICH) is one of the most devastating forms of cerebrovascular disease and is associated with high mortality and morbidity rate. Mass-effects of hematoma and surrounding edema lead to increase intracranial pressure and subsequent brain herni-ation. Decompressive Craniectomy (DC) provide space for the edematous brain to expand away from the midline structures and reduce intracranial pressure.<br />Aim of Study: The aim of this study was to evaluate the outcome of Outcomes of Decompressive Craniectomy for Spontaneous Deep Supratentorial Intracerebral Hemorrhage.<br />Patient and Methods: We retrospectively reviewed the medical records of the patients with spontaneous deep su-pratentorial ICH who underwent DC without evacuation of hematoma within 24 hour of ictus. Outcome was assessed by the Glasgow Outcome Scale (GOS) 6 months after surgery.<br />Results: A total of 12 patients were included in this study. The mean age was 45 years. Mean pre-operative Glasgow Coma Scale (GCS) score was 6.7. Mean hematoma volume was 68ml. At 6 months after surgery, 8 patients (67%) had favorable outcome while 4 (33%) had unfavorable outcome, 2 patients (17%) died. 83% of patients with pre-operative GCS score 8-9 compared to 50% with pre-operative GCS score 5-7 had favorable outcome. 71% of patients with he-matoma volume less than or equal to 70ml compared with 60% with hematoma volume more than 70ml had favorable outcome.<br />Conclusions: Decompressive craniectomy can be benefi-cial in treatment of spontaneous deep supratentorial ICH in selected patient group. Patients with high pre-operative GCS score and small hematoma volume are more likely to have favorable outcome.https://mjcu.journals.ekb.eg/article_52826_368e9c971313c7e74ee23267eb26897f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Efficacy of Sacro-Occipital Technique on Sacroiliac Joint Instability in Females9879935282710.21608/mjcu.2019.52827ENEMAN M.H. SHERIF, M.Sc.;SALWA F. ABD EL-MAGEED, Ph.D.MAHMOUD M.I.ABD EL-GHAFFAR, M.D.Journal Article20181001Abstract<br />Background: Sacroiliac function is considered to be important in many manual therapy systems because of the complexity and location of the Sacroiliac joint in the kinetic chain, moreover 98% of patients having low back pain had mechanical dysfunction of the sacroiliac joints.<br />Aim of Study: The aim of this study is to explore the effect of Sacro-occipital technique on pelvic obliquity in patients with Sacroiliac joint instability.<br />Patients and Methods: Thirty female patients were ran-domly assigned into two groups and each group consists of 15 patient. Control Group (A) treated by Therapeutic ultrasound and study Group (B) treated by Sacro-occipital technique + Pelvic belt + Therapeutic ultrasound. Referred from orthopedist with the diagnosis of Sacroiliac joint pain with mean age, weight and height 29.5 (3.8) years, 74.7 (5.3) kg, and 163 (4.4) cm respectively. Pelvic obliquity was objectively meas-ured by using pelvic inclinometer.<br />Results: No statistically significant difference between groups in pelvic obliquity before treatment. But a significant reduction in pelvic obliquity was observed in the study group (B) compared to the control group (A).<br />Conclusion: The study proved that Sacro ocipital technique decreased the pelvic obliquity in patient with sacro iliac joint instability.https://mjcu.journals.ekb.eg/article_52827_ce6cb4a516ab347ae4996e7c640f00cb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Relationship between Age, Gender and Core Stability in Cervicogenic Headache9959995282810.21608/mjcu.2019.52828ENAHMED M. HAMED, M.Sc.;NADIA A. FAYAZ, Ph.D.The Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo UniversityEBTESSAM F. GOMAA, Ph.D.;AHMED M.A. MOHASSEB, M.D.The Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: Cervicogenic headache is a secondary head-ache. It originates from the cervical spine and is typically chronic in nature. The deep cervical flexors muscles especially longus colli and longus capitis are more affected with this type of headache.<br />Aim of Study: To investigate if neck core stability in cervicogenic headache patients is related to a specific age and gender.<br />Methods: Sixty subjects diagnosed as cervicogenic head-ache of both genders participated in this study. Their ages ranged from 20 to 49 years. Pressure biofeedback unit was used for assessment of neck muscles core strength. The correlation between gender and neck muscles core strength was tested using Pearson-chi square; while the correlation between age and neck muscles core strength was tested using two-tailed Pearson correlation test.<br />Results: There was no statistical significant correlation between gender (p-value: .937), age (p-value: .438) and neck muscles core strength.<br />Conclusion: The weakness of the deep cervical flexors muscles in cervicogenic headache patients doesn’t belong to a specific age or gender.https://mjcu.journals.ekb.eg/article_52828_494768a913a7d0399aca22e857cb50dd.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Aerobic Exercises on Iron Deficiency Anemia in Postnatal Women100110055282910.21608/mjcu.2019.52829ENMAI M. SHERIF, M.Sc.;HALA M. HANAFE, Ph.D.The Department of Women's Health, Faculty of Physical Therapy, Cairo University* and The Department of Gynecology & Obstetrics, El-Mataria Teaching Hospital**GHADA E. EL-REFAYE, Ph.D.;MAGDY ABD EL-RAHMAN, M.D.The Department of Women's Health, Faculty of Physical Therapy, Cairo University* and The Department of Gynecology & Obstetrics, El-Mataria Teaching Hospital**Journal Article20181001Abstract<br />Background: Iron Deficiency Anemia (IDA) is diminished red blood cell production due to low iron stores in the body. It is the most common nutritional disorder worldwide and accounts for approximately one-half of anemia cases, it is a common problem in postnatal period due to dietary deficiency of iron and folates during pregnancy and the blood loss during delivery.<br />Aim of Study: This study was conducted to determine the effect of aerobic exercises on iron deficiency anemia in postnatal women.<br />Material and Methods: Fifty post natal women after delivery complaint from iron deficiency anemia (diagnosied by gynacolgist/physican) shared in this study. their ages ranged from 20 to 35 years old, their body mass index >35kg/m2 and thir serum ferritin level ranged from 30 to 70ng/dl. They were devided randomly into two groups (A & B) equal in numbers. Group A (study group) was treated by iron supplemnt tablets (ferrous sulfate 200mg once per day), diet therapy and aerobic exercises in a form of walking on elctrical treadmill (30min/ session, 3 times/week for 3 months), while group B (control group) was treated by iron supplement tablets (ferrous sulfate 200mg once per day) and diet therapy only. Serum ferriten level, body weight and body mass index were measured befor and after performing the treatment program for both groups (A & B).<br />Results: The obtaied result showed that there was signif-icant decrease (p>0.01) in the mean values of serum ferriten levels, body weight and BMI in group (A) post-treatment when it compared to pre-treatment mean values, whlie in group (B) there was a statitcally signifcant increase in (p>0.01) in the mean values of serum ferritin levels in post-treatment when in compared to pre-treatmen mean values and there is significant decreace in mean values of body weight in posttest when it compared to pretest mean values with no significant difference in mean values of BMI in pre and post-test.<br />Conclusion: The result of this study could be concluded that aerobic exercises was not recommended for women with iron deficiency anemia during postnatal period.https://mjcu.journals.ekb.eg/article_52829_30e986e09b8b4fc90aa4f34acba788ea.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Arm Sling on Postural Stability in Stroke Patients100710115283010.21608/mjcu.2019.52830ENEMAN S. FAYEZ, Ph.D.;RANIA M. TAWIK, Ph.D.The Departments of Physical Therapy for Neuromuscular Disorder & its Surgery, Faculty of Physical Therapy* and Neurology, Faculty of Medicine**, Cairo UniversityHATEM SAMIR, M.D.;MOHAMED A. EL-HOSENY, M.Sc.The Departments of Physical Therapy for Neuromuscular Disorder & its Surgery, Faculty of Physical Therapy* and Neurology, Faculty of Medicine**, Cairo UniversityJournal Article20181001Abstract<br />Background: Stroke is the second leading cause of death worldwide, and is the major cause of morbidity, particularly in the middle aged and elderly population. Despite some uncertainty about their efficacy and timing, arm slings are still the most preferred treatment modality for shoulder sub-luxation in stroke patients.<br />Aim of Study: This study was designed to determine the effect of arm sling on postural stability in stroke patients.<br />Patients and Method: This study was conducted on forty-five patients of both sexes (30 males and 15 females) with hemi paretic stroke (in the domain of carotid system). Their ages ranged from 45-60 years, the duration of stroke ranged from 6 to 18 months. They were assigned into one group (study group). All patients were assessed on biodex balance device. Data obtained from the study group under two condi-tions, without arm sling and with arm sling. Data of overall stability index, anteroposterior stability index and mediolateral stability index were statistically analyzed and compared between the two conditions.<br />Results: The results of the present study revealed that there was a statistically significant improvement in values of overall stability index in arm sling condition compared to without arm sling condition (p=0.0001)*. The mean difference between without and with arm sling conditions was 1.16 and the percent of change was 28.85%.<br />Conclusion: In view of the results of this study, it's possible to conclude that there was a beneficial effect of using arm sling on postural stability in stroke patients and it may play a role in stroke rehabilitation.https://mjcu.journals.ekb.eg/article_52830_eb5dc9286c6bc9c07b6c1353bfaa1404.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Relationship between Pain and Neck Mobility in Patients with Grade II Whiplash Injury101310175283110.21608/mjcu.2019.52831ENMOHAMED N. EL-BAHRAWY, Ph.D.;SHERIF G. AL-MEKAWI, M.D.WALAA M. RAGAB, Ph.D.;MAHMOUD M. NABIL, M.Sc.Journal Article20181001Abstract<br />Background: Patients with grade II whiplash injuries have physical signs of decreasing range of neck movement and palpable tenderness. Many patients with whiplash injury report diffuse symptoms of sensory disturbances and generalised muscle weakness. Whiplash injury has profound effects on both peripheral and central pain-processing mechanisms. Approximately 50% of subjects who sustain a whiplash injury will not recover but will continue to report ongoing pain and disability one year after the injury.<br />Aim of Study: This study aimed to evaluate the correlation between pain and neck mobility in Egyptian patients with grade II whiplash injury.<br />Subjects and Methods: Fifteen Egyptian patients with grade II whiplash injury from both genders were selected for this study. All the patients were assessed for pain by visual analogue scale and cervical range of motion by Cervical Range of Motion goniometer (CROM).<br />Results: There is strong negative significant correlation between level of pain by Visual Analogue Scale (VAS) and neck bending to right and left only.<br />Conclusion: There is negative correlation between level of pain and side bending to right and left in Egyptian patients with grade II whiplash injury.https://mjcu.journals.ekb.eg/article_52831_cd8d67d5488d621b09074fafff2fd0a0.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Induced Fatigue of Unaffected Limb on Balance in Children with Hemiplegia101910225283210.21608/mjcu.2019.52832ENMARWA M. NAGEEB, M.Sc.;FATEN H. ABD EL-AZEIM, Ph.D.The Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo UniversitySHOROUKEL-SHENNAWY, Ph.D.The Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: Children with hemiplegic cerebral palsy bearing weight mostly through the unaffected leg and may be a strategy to compensate for muscle paresis in the hemiplegic leg causing fatigue of unaffected limb and impaired balance.<br />Aim: To determine the immediate effect of induced fatigue of unaffected limb on balance in children with hemiplegic cerebral palsy.<br />Patients and Methods: 29 children with hemiplegic cere-bral palsy (8.9±2.3 years). Before and after induced fatigue of unaffected limb the balance were recorded by Biodex balance system.<br />Results: There were significant difference before and after fatigue in balance overall stability index (p<0.001), antroposterior stability index (p=0.003), mediolatral stability index (p=0.002).<br />Conclusion: Fatigue of unaffected limb deteriorates bal-ance in children with hemiplegia.https://mjcu.journals.ekb.eg/article_52832_d174813abf06da36b5976a4704722594.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Relationship between Posture Changes and Each of Ankle Joint Range of Motion and Dynamic Balance102310295283310.21608/mjcu.2019.52833ENFATMA GABR, M.Sc.;KHALED AYAD, Ph.D.The Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy* and The Department of Orthopedic Surgery, Faculty of Medicine**, Cairo University, EgyptINAS METWALY, Ph.D.;MOHAMMED SAFWAT, M.D.The Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy* and The Department of Orthopedic Surgery, Faculty of Medicine**, Cairo University, EgyptJournal Article20181001Abstract<br />Background: Various activities of daily living require sitting for prolonged periods of time. These activities include driving a car, working on a computer. This can lead to postural changes such as exaggerated forward head posture. Which can lead to over activation of the ankle plantar flexor to maintain body balance. On the other hand, ankle movement may be restricted as the body is connected through fasciae network were the upper quadrant disturbance may affect lower quadrant.<br />Aim of Study: The current study aimed to determine the relationship between forward head posture and both ankle joint range of motion and dynamic balance in 35 healthy students. Their age ranged from 19 to 22 years.<br />Material and Methods: Posture was evaluated using Biotonix posture print while Biodex stability system was used to evaluate dynamic postural control. Universal goniometer was used to measure ankle joint range of motion.<br />Results: Three-Dimensional (3-D) head posture changes affected dynamic balance at level four of the Biodex dynamic balance test (only medio-lateral stability index), while no changes were observed in the dynamic balance at level eight. Three-dimensional head posture changes affected ankle joint range of motion.<br />Conclusion: Three-dimensional head posture changes affected ankle joint range of motion through the fascial system which connects different body segments with each other. Dynamic balance was also affected as changes of head posture alters center of gravity position.https://mjcu.journals.ekb.eg/article_52833_6dd38c0d4df6ba832e2f085473b2137a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Efficacy of Inspiratory Muscles Training on Functional Capacity for Patients on Chemotherapy103110365283410.21608/mjcu.2019.52834ENMARIAN A. AZIZ, M.Sc.;NESREEN G. MOHAMED, Ph.D.The Departments of Physical Therapy for Cardiovascular/Respiratory Disorder & Geriatrics, Faculty of Physical Therapy* and Medical Oncology, National Cancer Institute**, Cairo UniversityHEBA A. ABDEEN, Ph.D.;MAHA Y. ISMAIL, M.D.The Departments of Physical Therapy for Cardiovascular/Respiratory Disorder & Geriatrics, Faculty of Physical Therapy* and Medical Oncology, National Cancer Institute**, Cairo UniversityJournal Article20181001Abstract<br />Background: Cancer is a major public health problem that gives an economical burden on the patient and government. The incidence of different types of cell tumors are increasing nowadays.<br />Aim of Study: To investigate the effect of inspiratory muscles training on functional capacity for patients on chem-otherapy.<br />Material and Methods: Forty male patients on chemother-apy from at least one cycle and their mean ages 37.1±4.89 years. The patients were selected from National Cancer Institute, Cairo (inpatient ward). The study lasted from March 2018 to June 2018. Patients were randomly assigned into two groups. Group A (30 patients) who received inspiratory muscles training for 4 successive weeks, 5 sessions/week; and Group B (10 patients) acted as a control group on chemotherapy only. Data obtained from both groups regarding forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio and 2min walk test were statistically analyzed and compared.<br />Results: After 4 weeks of management for both groups the results showed that in FVC in the study group a significant increase by 33.44% while in control group, a significant decrease by 37.3%. FVE1 increased by 34.52% in the study group while it decreased by 34.09% in the control group. However, it was shown that no significant difference in the FEV 1/FVC ratio. Also results related to 2min walk test distance showed increase by 17.29% in group A while decrease by 15.48% in group B.<br />Conclusion: It can be concluded that inspiratory muscles training can be adjunctive to the rehabilitation program for patients on chemotherapy aiming for enhancing their functional capacity.https://mjcu.journals.ekb.eg/article_52834_13f8c809d83951e76c1b14ff701da882.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Relation between Language Development, Cognitive Skills and Play Skills103710495283510.21608/mjcu.2019.52835ENDALIA M. OSMAN, M.D.;AISHA F. ABD EL-HADY, M.D.Phoniatrics Unit, ENT Department, Faculty of Medicine, Cairo University* and Ministery of Health**, EgyptHEBA M. FARAG, M.D.;AMANY AHMED SAKR, M.Sc.Phoniatrics Unit, ENT Department, Faculty of Medicine, Cairo University* and Ministery of Health**, EgyptJournal Article20181001Abstract<br />Background: Play is very important as it helps cognitive, language, social, emotional and physical development. The value of play is increasingly recognized by researchers for children as the evidence mounts of its relationship with intellectual achievement, language development and emotional wellbeing.<br />Aim of Study: To assess play skills in a group of children having cognitive delay (mild and moderate cognitive delay with or without Down's syndrome) and to study the correlation between play level, language skills and cognitive skills in these children.<br />Subjects and Methods: 75 Egyptian preschool children aged between 2 and 5 years were divided into 3 groups; group of normal children, group of children with Cognitive Delay (CD) and group of Down Syndrome's (DS). They were sub-jected to the protocol of Arabic language assessment and a play observation checklist designed in this study. The checklist covered the following items; level of play, behavior of the child during play, receptive skills & language use during play, child interaction with peers & with adults as well as problem solving during play.<br />Results: Normal children under study had higher play skills and language skills than children with CD & DS children. Cognitive level of children with CD and DS was correlated positively with some aspects of their play skills such as language use during play in CD and problem solving, receptive skills and language use during play in DS children. Total Language score was highly correlated with all play aspects in CD and most of play aspects in DS children.<br />Conclusion: Cognitive level, development of play skills and language abilities were interrelated in groups under study (CD and DS).https://mjcu.journals.ekb.eg/article_52835_b60175944bae9942a4b717b3c3956ab2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Epidemiology (Seroprevalence and Risk Factors) of Parenteral Hepatitis (B and C) among Prisoners in Menoufia Governorate105110585283610.21608/mjcu.2019.52836ENWESAM S. MOURAD, M.D.;REDA A. IBRAHEM, M.D.The Departments of Epidemiology & Preventive Medicine, National Liver Institute*, Public Health & Community Medicine, Faulty of Medicine** and Hepatology, National Liver Institute***, Menoufia UniversityESSAMEL-SHIMII, M.D.The Departments of Epidemiology & Preventive Medicine, National Liver Institute*, Public Health & Community Medicine, Faulty of Medicine** and Hepatology, National Liver Institute***, Menoufia UniversityJournal Article20181001Abstract<br />Background: During incarceration, prisoners may acquire new infections due to overcrowding, poor medical diagnosis and treatment, insufficient infection control, an absence of harm reduction efforts like condom use or needle exchange, and sudden transfer to other facilities or discharge into the community without provisions for ongoing therapy. Prisons are considered facilities liable of high risk of infectious disease. Investigations carried out in prisons around the world have shown a high prevalence of blood borne hepatitis viruses.<br />Aim of Study: This study conducted aiming to determine the prevalence and behavioral correlates of HCV, and HBV infections among Egyptian prisoners with especial emphasis on their risk factors.<br />Patients and Methods: All studied prisoners were subjected to a predesigned questionnaire including socio-demographic data, pre-imprisonment risk factors and intra-prison risk factors. Blood samples were collected from the studied pris-oners who had never investigated before for HBV and or HCV infection and examined for Anti-HBc and Anti-HCV.<br />Results: Prevalence of HBV among studied group was 8.02%, HCV was 16.4% and with both HBV and HCV infec-tion was 1.9%. Multivariate analysis of risk factors of HBV and HCV infection among prisoners revealed that previous imprisonment history, education status, age, history of tattoo, history of intra-prison dentist visiting, imprisonment duration 10 years were independent predictors of viral hepatitis infection among prisoners.<br />Conclusion: Prisoners with chronic HCV infection should undergo a full diagnostic procedure and clinical staging before being considered for treatment, since inmates with HCV related chronic hepatitis can achieve a sustained virological response with the same frequency as free patients.<br />Recommendations: The prison authorities and physicians should implement strategies to improve the diagnostic and therapeutic approach to HCV in prisoners, general screening for anti HCV antibody being the first step in this approach.https://mjcu.journals.ekb.eg/article_52836_41c441af556937ff6d19720ca9a50935.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Mirror Neuron Applications on Motor Recovery in Stroke Patients: A Systematic Review105910765283710.21608/mjcu.2019.52837ENAHMED A. EL-ZALABANY, M.Sc.;GEHAN M. NOUR, Ph.D.The Department of Neuro-Rehabilitation, Faculty of Physical Therapy, Pharos University, Alexandria,
The Departments of Physical Therapy for Neuromuscular disorder** and Physical Therapy for Pediatrics***, Faculty of Physical Therapy, Cairo UniversityMAYA G.ABD AL-WAHAB, Ph.D.The Department of Neuro-Rehabilitation, Faculty of Physical Therapy, Pharos University, Alexandria,
The Departments of Physical Therapy for Neuromuscular disorder** and Physical Therapy for Pediatrics***, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: Mirror neurons represent a variety of neurons that fire when the subject executes a motor act or observes others making the same action. A lot of therapeutic applications based on the existence of mirror neurons are widely used today in the field of stroke rehabilitation.<br />Objectives: To summarize the best evidence of the effec-tiveness of mirror neuron applications for improving motor function, activities of daily living, spasticity, pain, visuospatial neglect, sensation, quality of life and muscle power in the stroke patients.<br />Methods: We searched the following electronic databases: Pubmed (October 2017), Cochrane Library (November 2017) and PEDro (November 2017). We also checked the reference lists. We included Randomized Controlled Trials (RCTs) that compare mirror neuron applications (mirror therapy, motor imagery/mental practice, action observation therapy or virtual reality reflection therapy) with conventional physical or occupational therapy for patients after stroke. Then we selected the trials that match the inclusion criteria, and we assessed the methodological quality of studies and extracted data. Finally, we analyzed the results by pooling the data of change scores between pre- and post-intervention through calculation of the overall Standardized Mean Differences (SMDs) with 95% Confidence Interval (CI).<br />Results: We included 44 studies with a total of 1792 participants. Of the 44 studies, 4 interventions based on mirror neurons were studied. Firstly, mirror therapy may have a significant effect on motor function of the upper extremity; however, effects on motor function are influenced by the variation of mirror therapy, activities of the unaffected limb showed greater effect than bilateral activities. We found limited evidence for improving walking ability. Secondly, motor imagery/mental practice showed a significant improve-ment on the motor function specially for the lower extremity functions. Thirdly, we found limited evidence of action ob-servation therapy in improving motor function of the upper extremity, walking ability. Finally, we included only one study that used virtual reality reflection therapy in stroke rehabili-tation, so we didn't include it in the pool analysis.<br />Conclusion: There is an evidence from the included RCTs on the effectiveness of mirror therapy on improving motor function of the upper extremity. Additionally, we found a significant positive effect of mental practice on motor function specially the walking ability. And there was a poor evidence on the effects of action observation on motor recovery in patients after stroke. However, much more studies should be conducted to assess the benefits of virtual reality reflection therapy.https://mjcu.journals.ekb.eg/article_52837_82164c518da71bcd8c86d69c7e57d045.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Assessment of Contact Lens with the High Definition (HD) Property107710825283810.21608/mjcu.2019.52838ENRAIED A.FAGEHI, Ph.D.The Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud UniversityJournal Article20181001Abstract<br />Background: Contact lenses have been in use since the 1930s. During these years, many materials have been consid-ered with the aim of producing more advanced and biocom-patible devices. The 1940s was the era of the first modern contact lenses, with the debut of polymethyl methacrylate (PMMA). The lack of oxygen supply to the cornea was the main disadvantage of PMMA. This oxygen impermeability was solved with the development of different contact lens materials, new generation of contact lens use hydrogel and silicone to enhance oxygen permeability. Recently, the new contact lens material known as silicone hydrogel lenses has been used to produce a new lens with the HD property.<br />Aim of Study: The aim of this study was to assess a new high definition silicone hydrogel contact lens.<br />Patients and Methods: 22 subjects have been recruited from King Saud University students (male, age 21±1.5 years). The new Balafilcon A lenses (PUREVISION 2 HD); (Bausch + Lomb, Tokyo, Japan) has been assessed and compared with another (non HD) silicone hydrogel lens Balafilcon A (Pure-Vision, Bausch & Lomb Inc., Rochester, NY).<br />The participants asked to wear each of the two lenses for one week (the lens was given randomly) and 48 hours wash out period was allowed between the lenses. Clinical tests including visual acuity (VA) and contrast sensitivity (CS) were applied to evaluate the lens performance at the end of each week. Additionally, contact lens dry eye questionnaire (CLDEQ-8) has been used to obtain the subjective feedback.<br />Result: The mean of CLDEQ-8 with PureVision was 8.1 and with Pure Vision 2 HD was 6. For contrast sensitivity the mean with PureVision was 1.74 while with Pure Vision 2 HD was 1.77. The mean of Visual Acuity was equal with the two lenses 1.00 log. Statistical tests using Wilcoxon-signed rank test showed no significant difference exist between the HD PureVision 2 and PureVision lens. For Visual Acuity (p= 0.317), Contrast sensitivity (p=0. 150) (Fig. 2) and CLDEQ-8 (p=0.339).<br />Conclusion: The silicone hydrogel HD lens evaluated in this study showed good performance. However, no significant difference in clinical performance was observed between the HD lens and the non HD silicone hydrogel lens.https://mjcu.journals.ekb.eg/article_52838_97cc4ad72eb0cc44c09f236f85245af7.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Relationship between Sagittal Curvature (Lumbar Lordosis) and Extensor Muscle Volume in Lumbar Region: A Morphological and Radiological Study10831095328710.21608/mjcu.2019.53287ENSAHAR MAHMOUD ABD EL-SALAM, M.D.;HANAN DAWOOD YASSA, M.D.The Departments of Radiology* and Anatomy**, Faculty of Medicine, Beni-Suef University and Anatomy***, Faculty of Medicine, Cairo University, EgyptMOHAMED EMAD EL-DIN IBRAHIM, M.D.;NOURHAN THARWAT AHMED, M.Sc.The Departments of Radiology* and Anatomy**, Faculty of Medicine, Beni-Suef University and Anatomy***, Faculty of Medicine, Cairo University, EgyptJournal Article20181001Abstract<br />Background: The vertebral column has a variable range of movements. It provides a load-carrying capacity that supports physical activities during daily life. The forces exerted by extensor muscles to stabilize the lumbar spines is related to its size which is affected by lumbar lordosis. The forces would be greater in cases of larger sagittal curvature (lordosis).<br />Aim of Study: Was to detect the relationship between extensor muscle volume and lumbar lordosis by using magnetic resonance imaging (MRI) of the lumber region and to Compare the results in subjects not complaining of low back pain with those presenting with low back pain. Findings could guide the physicians during training programs in the field of sports and rehabilitation.<br />Material and Methods: Two hundred subjects were clas-sified into two groups; group (A) representing individuals with no history of back pain and group (B) with history of low back pain (LBP). Magnetic resonance imaging (MRI) examinations of the lumbar spines were done for all cases. Axial and sagittal T1WI, T2WI and gradient images were done. The lower lumbar curvature was determined from sagittal images. The volume of the extensor muscles caudal to the mid-lumbar level was estimated in axial MRIs spanning the lumbar spine.<br />Results: Statistically significant positive correlation between the angle of lumbar curvature and muscle volume was found at all ages of group A (p=0.001) and group B-III (p=0.008). While no statistically significant correlation was detected in group B-I: p=0.089 and group B-II: p=0.061. The mean muscle volume in LBP subjects (group B) was signifi-cantly smaller than group A in all ages.<br />Conclusion: The magnitude of the lumbar lordosis present in a normal subject is related to the quantity of the extensor muscle and any deviation in the angle of the lumbar curvature or the size of the muscle by decreasing or increasing than normal could be the beginning of low back pain or a patho-logical condition.https://mjcu.journals.ekb.eg/article_53287_3ec5e62f068e82a478c134c91e4fb202.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Infrasellar Extension of Pituitary Macro-Adenomas109310975328810.21608/mjcu.2019.53288ENAHMED R. RIZK, M.D.;MARTIN BETTAG, M.D.The Department of Neurosurgery, Brueder Hospital Trier, Germany* and Banha Faulty of Medicine*,**, EgyptJournal Article20181001Abstract<br />Background: Growth patterns of pituitary adenomas have been observed to vary according to the histopathological subtype.<br />Aim of Study: The authors aimed to analyse infrasellar extension pattern in cases of functional and non-functional macroadenomas.<br />Patients and Methods: Retrospective analysis of pituitary adenoma patients who underwent endoscopic trans-sphenoidal surgery in the time period between 2007 and 2013 at our institute. Patients with microadenomas and prior operations were excluded from the analysis. Preoperative MR images were reviewed to assess patterns of extrasellar extension in the varying tumor subtypes.<br />Results: The cohort comprised 150 patients, after exclusion of microadenomas and previously operated patients, the analysis involved 93 cases. Most of the cases were non-functional macroadenomas (66 patients, 71%), the remaining were functional macroadenomas (GH-macroadenoma: 17 patients, 18%; Macroprolactinoma: 8 patients, 9%; TSH-producing macroadenoma: 1 patient, 1%; and ACTH-cell macroadenoma: 1 patient, 1%). Extension of the non-functional macroadenomas occurred into the following regions: Supra-sellar, 63 patients (96%); infrasellar, 11 patients (17%); and parasellar, 17 patients (26%). Extension of the GH-mac-roadenomas occurred into the following regions: Suprasellar, 7 patients (41%); infrasellar, 9 patients (53%); and parasellar, 3 patients (18%). Extension of macroprolactinomas occurred into the following regions: Suprasellar, 8 patients (100%); infrasellar, 2 patients (25%); and parasellar, 4 patients (50%). Isolated infrasellar extension was noticed in 8 patients with GH-macroadenoma (47%) and in 2 patients with non-functional macroadenoma (3%). GH-macroadenomas had higher overall rates of infrasellar extension (53%, p<0.05), and isolated infrasellar extension (47%, p<0.05).<br />Conclusions: Extrasellar growth patterns in cases of pituitary macroadenoma showed substantial differences in relation to histological subtypes. GH-macroadenomas dem-onstrated a tendency for infrasellar extension. Existing data suggests lower surgical cure rates in adenomas with infrasellar extension. This fact may contribute particularly to the low normalisation rate after GH-adenoma surgery. If adaption of surgical technique may lead to better results, should be addressed in prospective studies.https://mjcu.journals.ekb.eg/article_53288_716ec7b33bee7674a4b826dbc17730ee.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Comparative Study between Topical Flutamide Alone or Combined with Carboxytherapy in Treatment of Patients with Melasma109911055328910.21608/mjcu.2019.53289ENARWA M. HASSAN, M.D.;GAMAL M. EL-MAGHRABY, M.D.The Departments of Dermatology & Venereal Diseases, Faculty of Medicine* and Pharmaceutical Technology, Faculty of Pharmacy**, Tanta UniversityGHADA F.R. HASSAN, M.D.;HEMMAT M. EL-ADAWY, M.Sc.The Departments of Dermatology & Venereal Diseases, Faculty of Medicine* and Pharmaceutical Technology, Faculty of Pharmacy**, Tanta UniversityJournal Article20181001Abstract<br />Background: Melasma is one of the most common causes of facial hyperpigmentation which causes cosmetic disfigure-ment and leads to psychological proplems, although various treatments are available for melasma, it remains a difficult condition to treat.<br />Aim of Study: To evaluate and compare the efficacy of topical flutamide 1% alone and in-combination with Carbox-ytherapy in treatment of patients with melasma.<br />Patients and Methods: The study included 30 female patients with different types and patterns of melasma. They were divided into two groups, each group included 15 patients: Group A, patients were treated with 1% flutamide topical gel on the face and group B, patients were treated with 1% flutamide topical gel on the face and carboxytherapy injection was done in both sides of the face every four weeks for three sessions.<br />Results: Both groups showed highly significant decrease in mMASI score after the treatment in which group B showed better results with (p-value=0.048*) than group A with (p-value=0. 007*).<br />Conclusion: As new treatment for melasma topical fluta-mide was effective and safe therapeutic modalities. Carboxy-therapy could be effective and safe new treatment modality for melasma as adjuvant treatment with topical flutamide.https://mjcu.journals.ekb.eg/article_53289_71fea1e6e275b3c49065564b3370fd1a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Quality Level of Clinical Record for Pediatric Physiotherapy in Teaching Hospital “Audit Tool”110711155329010.21608/mjcu.2019.53290ENAHMED M. SHAKSHOUK, M.Sc.;HODA A. EL-TALAWY, Ph.D.The Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo UniversityFATEN H.ABD EL-AZIEM, Ph.D.The Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo UniversityJournal Article20181001Abstract<br />Background: Documentation is the process of recording of all aspects of Patient care, management including the results of the initial examination, diagnosis, prognosis, plan of treatment, interventions, response to interventions, changes in Patient relative to the interventions, re-examination, and discharge.<br />Aim of Study: The current study examined the quality level of clinical record and documentation of pediatric phys-iotherapy departments at teaching hospitals and institutes according to the criteria of the Physical Therapy Chartered Society Standards to determine points of documentation lacking and work on solving them to improve the quality of record and documentation in medical institutions.<br />Material and Methods: This study was carried as Cross-sectional study at teaching hospitals and institutes for 310 patient record files which were selected randomly from Elmatarya Teaching Hospital (100) The National Institute of Neuromotor system (100), Faculty of physical therapy outpa-tient clinic (100) and Elsahel Teaching Hospital (10). Assess-ment of the quality of patient record files was carried out by using of the standardized patient record audit approved by the Chartered Society Standards. To describe, assess and report the quality of the working system.<br />Results: There are statistically significant differences among the teaching hospitals and institute in the Assessment, Examination, Analysis, Implementation, Transfer of care discharge, Documentation and Patient record conform to the following requirements axes, however there is critical lacking in the axis of documentation of informed consent, evaluation and treatment planning. There is no information technology system for the patient record files at all Teaching Hospitals and Institute.<br />Conclusion: Using of the standardized patient record are not implemented in the included the Egyptian Pediatric Phys-ical Therapy Departments at Teaching Hospitals and Institute. There is no using of electronic medical records.https://mjcu.journals.ekb.eg/article_53290_4419ac044e024c91eae8ba086f04d230.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Virtual Reality for Motor Rehabilitation of Children with Down Syndrome: Systematic Review111711235329110.21608/mjcu.2019.53291ENJournal Article20181001Abstract<br />Background: Down syndrome is one of the most common genetic causes of developmental delays. Virtual reality is an innovative tool of rehabilitation based on computer technology. It has been applied in the rehabilitation of many developmental areas.<br />Aim of Study: To systematically review the available studies on the effect of virtual reality in motor rehabilitation of children with Down syndrome.<br />Patients and Methods: An electronic search was made in Cochrane (CENTRAL), Pedro, PubMed (MEDLINE), Google scholar and TRIP databases from July 2017 to July 2018, in addition to manual search in reference lists of the included studies. The inclusion criteria were: Published studies of any design which investigatethe effect of virtual reality on motor rehabilitation of children with Down syndrome, reviews studies were excluded. The outcome measures were: Balance, sensorimotor functions, coordination, strength andagility.Two independent reviewers assessed the methodological quality and extracted data from the included studies. Score differences were discussed between the two reviewers and disagreements were revealed by consultation with a third author until con-sensus was reached.<br />Results: A total number of 30 records, 7 of them were duplicated, 19 of them were excluded after screened the title and abstract. Only 4 articles met the inclusion criteria; 2 were randomized controlled trials, one was quasi-experimental study and one was case report. One study fulfills the criteria of high methodological quality; two studies were of moderate quality and one of weak quality. Descriptive analysis was performed as data extracted from the included studies heter-ogeneous.<br />Conclusion: Despite the few number of studies found and the heterogeneity present between its characteristics, the methodological quality of the included study gave moderate evidence regarding the effectiveness of virtual reality in motor rehabilitation of children with Down syndrome. Further well designed randomized controlled trials on the effectiveness of virtual reality on children with Down syndrome are necessary.https://mjcu.journals.ekb.eg/article_53291_13a6c0c53851c85c004b38cc72efb2a7.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Efficacy of Narrow Band Ultraviolet B on Renal Pruritus in Patients with Chronic Kidney Disease112511325329210.21608/mjcu.2019.53292ENRAYDA M. MOHAMED, M.Sc.;HEBA M. MOHAMADY, Ph.D.The Departments of Physical Therapy for Surgery, Faculty of Physical Therapy* and Plastic Surgery, Faculty of Medicine**, Cairo UniversitySHERIF A. SWAR, Ph.D.;NESMA M. ABD EL-AZIZ, Ph.D.The Departments of Physical Therapy for Surgery, Faculty of Physical Therapy* and Plastic Surgery, Faculty of Medicine**, Cairo UniversityJournal Article20181001Abstract<br />Background: Pruritus is a frequent and troublesome symptom in patients with chronic renal failure receiving hemodialysis. However, it also may occur in patients on conservative uremia treatment or undergoing continuous ambulatory peritoneal dialysis. Narrowband ultraviolet B phototherapy may be an effective treatment for patients with uremic pruritus.<br />Aim of Study: The current study was conducted to examine the effect of narrow band ultraviolet B on renal pruritus in patients with chronic kidney disease.<br />Subjects and Methods: Thirty patients with renal pruritus participated in this study. Their ages ranged from 40-60 years. They were selected from Hemodialysis Unit of Mansura University Hospitals and were divided randomly into two equal groups. Group (A) composed of 15 patients who received narrow band ultraviolet B 3 times/week for 6 weeks and medical treatment (oral antihistaminic and topical emollients). Group (B) composed of 15 patients who received only their medical treatment (antihistaminic and topical emollients). Method of evaluation was measurements of VAS and 5-D itch scale.<br />Results: There was a significant decrease in severity of pruritus in ultraviolet group when compared with the control group.<br />Conclusion: Narrow band ultraviolet B can be considered as an effective method in decreasing severity of pruritus in patients with chronic kidney disease.https://mjcu.journals.ekb.eg/article_53292_3bfbec7773cc16ac52b3337ac1c97c77.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Etiologies of Pleural Effusion in Assuit University Hospital: One Year Study113311395329310.21608/mjcu.2019.53293ENSARA H. NOAMAN, M.Sc.;RANDA E. ABD-EL-KADE, M.D.The Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut UniversityKHALED H. AHMED, M.D.;AHMED H. MOHAMMED, M.D.The Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut UniversityJournal Article20181001Abstract<br />Background: Etiological diagnosis of exudative pleural effusion is sometimes difficult despite cytological, biochemical and microbiological tests.<br />Aim of Study: Was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy, thoracosopy and PCR of pleural fluid.<br />Patients and Methods: This prospective study was per-formed from September 2015 to August 2016 in Chest De-partment, Assiut University Hospital A total of 50 patients with exudative pleural effusion in whom the diagnosis was uncertain after routine biochemical, cytological and micro-biological evaluation of pleural fluid were included in the study. These patients underwent pleural biopsy by Abram's needle and histopathology was done to determine the etiology of pleural effusion. Also thoracosopy was done to undiagnosed pleural effusion, and PCRof pleural effusion was done.<br />Results: Out of 50 patients, most (28,56%) were male. Majority was malignant pleural effusion (18,36%). Pleural fluid was straw color in 15 (100%) cases of tuberculous effusion and hemorrhagic in 11 (61.1%) cases of malignant effusion. Pleural biopsy diagnosed 14 (77.8%) cases of ma-lignant effusion and 10 (66.7%) cases of tuberculous effusion, PCR of pleural fluid diagnosed 14 (93.3%) cases of tuberculous effusion.<br />Conclusions: Pleural biopsy was diagnostic in the patients with exudative pleural effusion. PCR of pleural fuild was diagnostic in Tuberculous effusion.https://mjcu.journals.ekb.eg/article_53293_d8c9a0b153d3f2b39842c93cde90f17a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Educational Program About Care of Patients Connected to Extracorporeal Membrane Oxygenation (ECMO) on Nurses Knowledge and Practices114111475329410.21608/mjcu.2019.53294ENMONA M. SHABAN, M.Sc.;WARDA Y. MOHAMED, D.N.Sc.The Department of Critical Care & Emergency Nursing, Faculty of Nursing, Cairo University and ELSO & SWAAC**, EgyptAKRAM M. ABD EL-BARY, Ph.D.;FATMA S. ALI, D.N.Sc.The Department of Critical Care & Emergency Nursing, Faculty of Nursing, Cairo University and ELSO & SWAAC**, EgyptJournal Article20181001Abstract<br />Background: Extracorporeal membrane oxygenation (EC-MO) or Extracorporeal life support (ECLS) is a technique of providing both cardiac and respiratory support for apatient whose heart and lung are unable to provide an adequate gas exchange to sustain life. Therefore, crtical care nurses should have specific knowledge and practice to provide safe, and efficient care for such group of patients.<br />Aim of Study: This study was carried out to evaluate the effect of ECMO educational program on nurses' knowledge and practices.<br />Subject and Methods: A quasi-experimental research design was utilized in the current study. Research hypotheses:<br />(1)Critical care nurses who attend the educational program about care of patient connected to ECMO will have a higher post-test mean knowledge scores as compared to their pre-test mean knowledge scores all through the assessment times.<br />(2)Critical care nurses who attend the educational program about care of patients connected to ECMO will have a higher post mean practice scores as compared to their pre-test mean practice scores all through the assessment times. A conven-ience sample of 34 nurses was included in the current study. The study was conducted in a selected Critical Care Depart-ment affiliated to Cairo University Hospitals. Three tools were utilized to collect data pertinent to the study: Critical care nurses personal Data sheet; Critical care Nurses' knowl-edge Questionnaire regarding care of patients connected to ECMO; and Critical Care Nurses' observational check list about care of patient connected to ECMO. The current study revealed that, the majority (94.1%) of nurses did not attend any training courses about care of patient connected to ECMO. The two stated research hypotheses were supported indicating significant improvement of critical care nurses knowledge and practices after implementation of ECMO educational program (F-ratio 494.8 at p£0.0001* & 242.204 at p£.0001 respectively).<br />Conclusion: Impementation of a nursing educational program about care of patient connected to ECMO helped in assessment and enhancement of nursing knowledge and prac-tices. This will be reflected on critically ill patients' care.<br />Recommendations: Carrying out in-service training, work-shops and continuing educational program a bout ECMO; provision of written guidelines about care of patients on ECMO; and strict observation of nurses practices.https://mjcu.journals.ekb.eg/article_53294_6d7b49f18e98bb81fc79c590c2315d28.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Thiamine Supplementation is Beneficial as Adjunctive Therapy to ACE Inhibitors to Improve the Course of Nephrogenic Complications of Type II Diabetes Mellitus: Possible Involvement of the Inflammatory Cascade as a Mechanism of this Effect114911645329510.21608/mjcu.2019.53295ENMOHAMED M. KHALIFA, M.D.;AKEF A. KHOWAILED, M.D.MINA J. AYAD, M.Sc.;HANAN FOUAD, M.D.MAHMOUDR.M. EL-ANSARI, M.D.Journal Article20181001Abstract<br />Background: Diabetic nephropathy is one of the most common complications of type II diabetes mellitus. Different recent researches investigated the therapeutic effects of different medications and therapeutic agents on the progression of diabetic nephropathy.<br />Aim of Study: Compare the reno-protective effects of thiamine in addition to ACE inhibitors in type 2 diabetic kidneys.<br />Material and Methods: A total of 50 male albino rats were were divided into 5 groups:<br />Group 1: Control group.<br />Group 2: Type 2 diabetic rats.<br />Group 3: Type 2 diabetic nephropathy rats.<br />Group 4: Lisinopril-treated type 2 diabetic nephropathy rats. Group 5: Thiamine mononitrate-treated type 2 diabetic neph-ropathy rats.<br />Blood samples were collected for the measurements of fasting blood glucose, fasting blood insulin, blood urea, and blood albumin-creatinine ratio. Urine samples were collected for measurement of urinary albumin excretion. Systolic and diastolic blood pressure were measured. Nuclear factor kappa-B gene expression was estimated.<br />Results: Treatment with ACE inhibitors reduced fasting blood glucose, fasting blood insulin, blood urea, urinary albumin excretion, nuclear factor kappa B gene expression, systolic blood pressure and diastolic blood pressure. While treatment with thiamine mononitrate reduced fasting blood glucose, blood urea, urinary albumin excretion and systolic blood pressure.<br />Conclusion: The use of ACE inhibitors and thiamine in the treatment of kidney disease with type 2 diabetes significantly offered renal protection and improved the diabetic condition and may postpone the onset of renal injury in type 2 diabetic person.https://mjcu.journals.ekb.eg/article_53295_2882571b9fff0e19327758000b31454d.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Relationship between Refractive Visual Errors and Cervical Spine Angles and Range of Motion116511715329610.21608/mjcu.2019.53296ENARWA A.M. IDRES, M.Sc.;SOHEIR SHEHATA, Ph.D.The Departments of Basic Science* and Ophthalmology**, Faculty of Physical Therapy, Cairo University*, Faculty of Medicine, Cairo University** and Oseem Hospital***YASSR RAMZY, Ph.D.;MANAR HUSSEIN, M.D.The Departments of Basic Science* and Ophthalmology**, Faculty of Physical Therapy, Cairo University*, Faculty of Medicine, Cairo University** and Oseem Hospital***Journal Article20181001Abstract<br />Background: Myopia is one of the common Refractive Visual Errors (RVE) that produces musckeloskeltal complaines, such as stiffness, fatigue and muscular pain in the neck which in turn may affect cervical curvature and range of motion.<br />Aim of Study: To investigate the relationship between refractive visual errors subjects and cervical curvature and cervical range of motion.<br />Patients: Fifty participants 15-30 years old from Kasr Al-Aini Hospital in October 2016. They assigned in two equal groups refractive myopic and normal sighted).<br />Methods: Cervical Range of Motion (CROM) was assessed by using O.B gonyometer, cervical angles (OC-C2, C1-C2, C2-C7) were measures by using corel draw program in X-ray.<br />Results: Comparison between groups revealed no signif-icant different in OC-C1 and a significant different in C1-C2 and C2-C7, additionally there was a significant difference in flexion, extension, Rt. and Lt. rotation (p=0.007, 0.01, 0.0001, 0.001) between groups respectively, there was no significant correlation between right and left eye and cervical angles and range of ROM.<br />Conclusion: Myopia causes changes in cervical curve and ROM but the degree of Myopia is not correlated to this changes of cervical curve and ROM.https://mjcu.journals.ekb.eg/article_53296_d05aef5457b5c8b9766a1b7de2b79d02.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Aerobic Versus Strengthening Exercises on Fibromyalgia in Postmenopausal Women117311775332010.21608/mjcu.2019.53320ENHALA M. HANAFY, Ph.D.;GHADA I. EL-REFAYE, Ph.D.The Department of Women's Health, Faculty of Physical Therapy, Cairo University* and The Department of Gynecology & Obstetrics, Faculty of Medicine, Al-Azhar University**HOSSAM EL-DIN H. KAMEL, M.D.;MOHAMED M. AMIN, M.Sc.The Department of Women's Health, Faculty of Physical Therapy, Cairo University* and The Department of Gynecology & Obstetrics, Faculty of Medicine, Al-Azhar University**Journal Article20181001Abstract<br />Background: Fibromyalgia (FM) is a syndrome, with unknown aetiology, characterized by chronic widespread pain and several associated non-specific symptoms such as pain, fatigue, sleep disorders, depression and anxiety. It affects approximately 2-3% of the general population with more than 90% of patients being female.<br />Aim of Study: This study was aimed to determine which is more effective in alleviating pain and fibromyalgia symp-toms; aerobic exercises or strengthening exercises in postmen-opausal women.<br />Material and Method: Sixty postmenopausal women with FMS will be selected according to American College of Rheumatology (ACR) criteria from the Physical Therapy Department in Naser General Hospital to share in this study, their age ranged from 50-60 years and their Body Mass Index (BMI) will not exceed 30kg/m2, the participants were assigned into two groups of equal numbers. The group (A) received aerobic exercise program, in the form of treadmill 3 times/week for 8 weeks. Each session will take about 30 minutes, while the group (B) received strengthening exercises for the four limbs and trunk using their body weight or resistance band (Thera band) 3 times/week for 8 weeks. Each session will take about 30 minutes. All subjects in both groups were assessed through the Visual Analogue Scale (VAS) for pain and the Fibromyalgia Impact Questionnaire (FIQ) for the fibromyalgia related symptoms.<br />Results: The results of the present study revealed that there was a statistically significant improvement (p<0.05) in both pain and fibromyalgia related symptoms in group (A) than in group (B).<br />Conclusion: It can be concluded that aerobic exercises is more effective than strengthening exercises in relieving pain and fibromyalgia related symptoms in postmenopausal women.https://mjcu.journals.ekb.eg/article_53320_637fe69e9cc3fb054ba59dbd98267c7f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Combined Aerobic Training and Inspiratory Muscle Trainer on Ventilatory Functions in Hemodialysis Patients117911855332310.21608/mjcu.2019.53323ENZAHRA M. HASSAN, Ph.D.;HEBA A. BAHEY EL-DEEN, Ph.D.SAHIER O. EL-KHASHAB, M.D.;HEBA A. YUSUF, M.Sc.Journal Article20181001Abstract<br />Background: Decreased respiratory muscle strength is associated with decreased pulmonary functions and considered as a serious mortality risk in patients on hemodialysis [1,2].<br />Aim of Study: This study was conducted to compare between the effect of 12 weeks of supervised aerobic training program combined with Inspiratory Muscle Trainer (IMT) and using Inspiratory Muscle Trainer (IMT) alone on ventila-tory functions in hemodialysis patients (HD). Pulmonary functions were measured by electronic spirometer including (Forced Vital Capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, Peak Expiratory Flow (PEF) and Maximum Voluntary Ventilation (MMV) in HD patients respectively.<br />Subjects and Methods: Thirty patients from both sexes participated in the study. They were divided randomly into two groups of equal number. Group (A) received combined IMT with supervised program of aerobic training in the form of leg pedaling exercises, while Group (B) received IMT alone.<br />Results: The results of this study revealed significant improvement in all measured values of pulmonary functions in both groups. Surprisingly, it was more significant in favor of group B.<br />Conclusion: It was concluded that either a combined IMT with supervised program of aerobic training or IMT alone for 12 weeks, both have significant improvement regarding pulmonary functions in hemodialysis patients, while it was more significant with IMT alone.https://mjcu.journals.ekb.eg/article_53323_deba669afad0148d80792b2e7e2b443b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Pilates Exercise on Primary Dysmenorrhea118711925332610.21608/mjcu.2019.53326ENEMAN M. EL-BABLY, M.Sc.;KHADIGA S. ABD EL-AZIZ, Ph.D.The Department of Physical Therapy for Woman’s Health, Faculty of Physical Therapy, Cairo University* and The Department of Obstetrics & Gynecology & its Surgery, Om El-Masryeen Hospital, Ministry of Health**ASMAA M. EL-BANDRAWY, Ph.D.;MOHAMAD F. ABO EL-ENEIN, M.D.The Department of Physical Therapy for Woman’s Health, Faculty of Physical Therapy, Cairo University* and The Department of Obstetrics & Gynecology & its Surgery, Om El-Masryeen Hospital, Ministry of Health**Journal Article20181001Abstract<br />Background: Primary dysmenorrhea complicates the lives among adolescents females, affects the quality of life of many women in their reproductive years. Pilates exercise is a safe, non invasive treatment modality to relief pain of primary dysmenorrhea.<br />Aim of Study: To investigate the effect of Pilates exercises on primary dysmenorrhea.<br />Subjects and Methods: This study was carried out upon 30 girls, theirage ranged between 18-23 years. They diagnosed as having primary dysmenorrhea with regular menstrual cycles. They were selected from students of Faculty of Physical Therapy, Cairo University with body mass index did not exceed 30kg/m2. They did not receive any anti-inflammatory or anti-spasmotic drugs during the study. They were randomly assigned into two groups. Control group (A) received TENS (frequency 100Hz with pulse width of 95 microseconds) only andthe study group (B) received Pilates exercises in addition to TENS for eight weeks. Assessment of all participants in all groups (A & B) was carried out through Visual Analogue Scale (VAS) and plasma cortisol level before and after treat-ment.<br />Results: The results revealed a significant decrease in intensity of pain and plasma cortisol levelfor both groups (A and B) after the treatment program (study group, pConclusion: Pilates exercises are effective, safe and non invasive therapeutic modality in reducing menstrual pain.https://mjcu.journals.ekb.eg/article_53326_f02b6f39cd3ad9022bf591bbe4109a2f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Level of Ischemia Modified Albumin in the Sera of Families with a Case of Rheumatic Fever and/or Rheumatic Heart Diseases119312015332810.21608/mjcu.2019.53328ENEBTSAM A. ATTIA, M.Sc.;SALAH A. SHOHEIB, M.D.WALID A. EL-SHEHABY, M.D.;NAHED M. ELWAN, M.D.AHMED SHABANA, M.D.;AHMED S. SHOHEIB, M.D.The Departments of Pediatrics*, Clinical Pathology** and Cardiology***, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Ischaemia-modified albumin (IMA), a novel biochemical marker for tissue ischaemia, was found to be associated with oxidative stress.<br />Aim of Study: Was to measure the level of ischemia modified albumin in sera of families with a case of rheumatic fever/rheumatic heart diseases whatever their presentation.<br />Patients and Methods: This study was done on 10 families of RF including 10 index cases, 10 mothers and 10 fathers and 20 siblings (total n=50) attending the RF clinic of pediatric department, All Patients had a full sheet, complete clinical examination and routine laboratory investigations (ESR, CRP, Blood group, CBC, ASOT and IMA) and ECHO. Control group, comprised 10 families including 10 mothers, 10 fathers and 30 siblings (total n=50).<br />Results: There was significant increase of IMA in between [cases of typical group as compared to control cases p(<0.001*)<br />-cases of atypical group as compared to control cases p(0.001*)<br />-cases of atypical group as compared to their siblings p(<0.001*), there was no significant increase of IMA in between (cases of typical group as compared to their siblings p(0.071) - siblings of atypical group as compared to control siblings p(0. 182)].<br />Conclusion: Our study concluded that serum IMA level and ASOT increased in children with ARF/RHD as well as their siblings which facilitate early detection and management of RF in siblings of a case of RF depending on positive family history and elevating anti-streptococcal antibodies and serum Ischemia modified albumin.https://mjcu.journals.ekb.eg/article_53328_e5718d3321b02b5d67b671ff529c6394.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Variability of Level of Tibial Tuberosity120312075332910.21608/mjcu.2019.53329ENAHMED E. AHMED, M.Sc.;HESHAM A. EL-KADY, M.D.MOHAMMED M. ABD EL-HAMID, M.D.;DORREIA A.M. ZAGHLOUL, M.D.The Department of Orthopedics, El-Mabara Hospital, Assiut and The Department of Human Anatomy & Embryology, Assiut University Hospitals*, AssiutJournal Article20181001Abstract<br />Background: Life assessment of this parameters were related to its importance in many orthopaedic surgical proce-dures, as tibial tuberosity level is used as a landmark in high tibial osteotomy and total knee replacement.<br />Aim of Study: Epidemiological study for assessment of the following levels in adult Egyptians which may affect many orthopedic surgical procedures. Level of tibial tuberosity from the tibial plateau to tibial tuberosity.<br />Patients and Methods: Our study is a Prospective descrip-tive cross sectional study. We studied level of tibial tuberosity of the knee in 500 cases divided as 231 males and 269 female egyptian subjects between the ages of 20 to 60 years. The cases were selected from the records of the Orthopaedic Department of Assiut University Tertiary Hospitals in Egypt during 2016-2017.<br />Results: The tibial tuberosity level ranges from 22 to 31mm. Male hight range from 21 to 33mm. Femal hight range from 22 to 28mm.<br />Conclusion: As regard to the tibial tuberosity level in comparison to other study we revealed that Egyptian tibial tuberosity height is higher than that of the Chinese.https://mjcu.journals.ekb.eg/article_53329_bed34bb1826faafe1696b24de70e0e41.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Differential Expression of Autophagy-Related Marker (Beclin-1) in Relation to Clinicopathological Parameters in Different Breast Cancer Molecular Subtypes120912175333410.21608/mjcu.2019.53334ENRANIH Z. AMER, M.D.;SHAIMAA M.N. EL-ZAMLY, M.D.HALA A. AGINA, M.D.;MONA A.M. ABO EL-KHAIR, M.Sc.The Department of Pathology, Faculty of Medicine, Benha UniversityJournal Article20181001Abstract<br />Background: Beclin-1 plays a vital role in the vesicle nucleation in the process of autophagy and has an important role in development, tumorigenesis, and neurodegeneration.<br />Aim of Study: Study the role of beclin-1 and correlate the degree of its expression with available clinic-pathological data in different molecular types of breast cancer.<br />Material and Methods: Immunohistochemistry was per-formed to examine the expression of Beclin-1 different mo-lecular subtypes of invasive ductal carcinoma and correlating it to clinicopathological parameter.<br />Results: The expression of Beclin-1 was decreased in breast cancer in relation to normal tissue. High expression was significantly correlated with tumor grade, distant metas-tasis and stage. All the cases with high Beclin-1 expression were triple negative breast cancer cases.<br />Conclusions: Triple negative breast cancer cases showed the highest tumor stage, grade, distant metastasis and beclin-1 expression suggesting that the overexpression of Beclin 1 may by itself confer an aggressive biological course. It could be a therapeutic target.https://mjcu.journals.ekb.eg/article_53334_d3e2881eb822347828676bbdd17be428.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Assessment of the Rule of Intubation on the Outcome of External Dacryocystorhinostomy121912255333710.21608/mjcu.2019.53337ENAIMAN A. HASHISH, M.D.;OSAMA E. SHALABY, M.D.MOLHAM A. EL-BAKARY, M.D.;OMAR M. MASSOUD, M.Sc.The Department Opthalmology, Faculty of Medicine, Tanta UniversityJournal Article20181001Abstract<br />Background: Dacryocystorhinostomy (DCR) surgery through an external approach has been the gold standard for the treatment of nasolacrimal duct obstruction. The question whether to use silicone tube or not.<br />Aim of Study: The aim of this study was to evaluate the rule of bicanalicular intubation in the success rate of external DCR. This study was to evaluate the effect of intubation on the outcome of external dacryocystorhinostomy.<br />Patients and Methods: It was a prospective interventional randomized study that was carried on 45 eyes of patients had done DCR. All operations were done under general anathesia and they were divided into 3 groups as follow:<br />1-Group (A): 15 patient had done DCR with long term intubation (12 weeks).<br />2-Group (B): 15 patient had done DCR with short term intubation (2 weeks).<br />3-Group (C): 15 patient had done DCR with no intubation.<br />Results: There is no significant difference between the use of intubation or not in cases of acquired NLDO and chronic dacryosistitis.<br />Conclusion: External dacryocystorhinostomy is still the gold standard surgical treatment in primary nasolacrimal duct obstruction. This study shows that the silicone tube implanta-tion is not necessary in the surgery.https://mjcu.journals.ekb.eg/article_53337_287862d5de5d71e838bbdab66c27b26a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Value of the Chest X-Rays in Diagnosis of Children with Heart Disease in the Age Group 1-4 Years122712325334110.21608/mjcu.2019.53341ENSALAH EL-DIN A. AHMAD, M.D.;KOTB A. METWALLEY, M.D.HEBA K.NODY, M.Sc.The Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, EgyptJournal Article20181001Abstract<br />Background: Chest X-ray continues to have an important role in diagnosis of heart diseases.<br />Aim of Study: We aim by this the study to evaluate the use of chest X-ray in the Pediatric Cardiology Unit in Assiut University Children Hospital for children (1-4 years old) with suspected heart disease.<br />Patients and Methods: This was a six-month, case series clinical study undertaken in the inpatient Pediatric Cardiology Unit, Assiut University Hospital, Assiut City, Egypt; between 1 of April 2016 to 30 of September 2016.<br />Results: Chest X-ray is an important tool in evaluating heart disease in children. Noninvasive imaging such as echocar-diography and cardiac MRI provide valuable and detailed assessment of the cardiovascular system; however, the cost incurred from these diagnostic procedures is significant making their routine use difficult.<br />Conclusion: Auditing the guidelines of interpretation of the chest radiograph for children aged one year to four years at the Pediatric Cardiology Unit of Assiut University Hospital for Children, it could be concluded: Chest roentgenogram is accurate in detecting cardiac site and situs.https://mjcu.journals.ekb.eg/article_53341_802df0c9aa719b6af51b86bf57e1d715.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Frontal Plane Projection Angle during Step Down Test in Subjects With and Without Patellofemoral Pain Syndrome123312395334310.21608/mjcu.2019.53343ENRANA S. YOUSSIF, M.Sc.;NADIA A. FYAZ, Ph.D.KARIMA A.HASSAN, Ph.D.The Department of Musculoskeletal Disorders and their Surgeries, Faculty of Physical Therapy, Badr* and Cairo** Universities, EgyptJournal Article20181001Abstract<br />Background: Patellofemoral Pain (PFP) is considered one of the most common forms of knee pain. Increased frontal-plane knee motion during dynamic activities may play a role in the development of PFP due to alterations in joint loading at the patellofemoral joint and increased stress on the peri-articular structures of the patella.<br />Aim of Study: To determine if there is an alteration of the frontal plane projection angle during step down test in subjects with and without Patellofemoral Pain Syndrome (PFPS).<br />Subjects and Methods: Forty participants, with age be-tween 18-35 years, 20 PFPS and 20 healthy control group. FPPA angle for both groups was measured by digital video camera and was analyzed by kinovea software for motion analysis during performing Step down test.<br />Results: There was no significant difference in the median value of FPPA between the affected side in the PFPS group and the healthy group (p=0.72).<br />Conclusion: PFPS is not linked to altered FFPA during step down task, this finding suggests that assessment of lower extremity kinematics in clinical practice need 3-D motion analysis not only one plane assessment.https://mjcu.journals.ekb.eg/article_53343_20e7dac81e409c9d3de773f43ed42737.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Electromyographic Activity of Gluteus Maximus Muscle in Nonspecific Chronic Low Back Pain124112455334710.21608/mjcu.2019.53347ENHATEM Y. MOHAMMED, M.Sc.;REHAM H. DIAB, Ph.D.RANIA R.MOHAMED, Ph.D.The Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, EgyptJournal Article20181001Abstract<br />Background: Nonspecific chronic low back pain is a common problem that can cause economic and social problems for an individual. Although there were alot of studies have reported the changes in the gluteus maximus activity in nonspecific chronic low back pain patients but it still debated.<br />Aim of Study: This study was conducted to investigate electromyographic activity of gluteus maximus muscle in nonspecific chronic low back pain male patients.<br />Subjects and Methods: Thirty nonspecific chronic low back pain male patients and 30 healthy male subjects with age from 20 to 40 years old with body mass index less than 30kg/m2 were recruited and assigned into 2 groups. Assessment was conducted by surface electromyography to assess gluteus maximus activity. Normalized root mean square of gluteus maximus muscle was collected and analyzed by SPSS version (24).<br />Results: There were significance decrease in electromy-ographic activity of right and left gluteus maximus in the study group when compared to control with p-values >0.005.<br />Conclusion: There was a decrease in the activity of the gluteus maximus in nonspecific chronic low back pain male patients when compared to the control group.https://mjcu.journals.ekb.eg/article_53347_2b7c10ad16f83c1978b9005780c5fcd9.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Mild Versus Moderate Exercises on Inflammatory Cytokines in Type 2 Diabetes Mellitus Patients124712515335010.21608/mjcu.2019.53350ENHANY M.G. ABD EL-AZIZ, Ph.D.;ZAHRA M.H. SERRY, Ph.D.DINA M. ABAZA, M.D.NAGWA A. MOHAMMED, M.D.GIHAN S.MOHAMED, Ph.D.Journal Article20181001Abstract<br />Background: Immunity is decreased in diabetic patient and exercise is an important method in decreasing inflamma-tory cytokines and increasing immunity.<br />Aim of Study: The main objective of this study was to determine the effect of mild exercise versus moderate exercise on inflammatory cytokines in patients with type 2 diabetes.<br />Subjects and Methods: 40 patients (men and women) diagnosed with type 2 diabetes (non-insulin dependant diabetes mellitus) age ranged from 50 to 60 years old. They were selected from medical health insurance clinic in Misr El-Gedida during 2017. Theywere divided into two groups. Group A included 20 patients participated in mild exercise in form of 10 minute walking program 3 times weekly for two months and Group B 20 patients participated in a moderate exercise in form of 10 minute walking program 3 times weekly for two months. Blood sample for measuring inflammatory cy-tokines level (IL1 and IL6) were taken before and after exercise program.<br />Results: It showed that in most measures that rate of decrease of inflammatory cytokines in group B who partici-pated moderate exercise is greater than Group A who partic-ipated mild exercise.<br />Conclusion: Participating exercise increases immunity by decreasing rate of inflammatory cytokines in patients with type 2 diabetes. Moderate exercise had a greater effect on decreasing inflammatory cytokines than mild exercise.https://mjcu.journals.ekb.eg/article_53350_c1febf48f6055f33bbae7dfd8b42a8ad.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Role of MRI in Diagnosis of Uterine Adenomyosis125312625335110.21608/mjcu.2019.53351ENAMIRA T. SALEM, M.Sc.;ALYAA A. EL-NAGGAR, M.D.MOHAMMED Kh.OMAR, M.D.The Department of Diagnostic Radiology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EgyptJournal Article20181001Abstract<br />Background: Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myometrium. It is a disease of the inner myometrium and results from infiltration of the basal endometrium into the underlying myometrium. Magnetic Resonance Imaging (MRI) is the radiologic tool of choice for this condition. A thickness of the junctional zone of at least 12mm is the most frequent MRI criterion in establishing the presence of adenomyosis.<br />Adenomyosis can appear as a diffuse or focal form. Adenomyosis is often associated with hormone-dependent lesions such as leiomyoma, deep pelvic endometriosis and endometrial hyperplasia/polyps.<br />Aim of Study: In this study we illustrate the role of MRI in evaluation of uterine adenomyosis, its findings and associ-ated conditions.<br />Patients and Methods: Thirty female patients were sus-pected to have uterine adenomyosis were enrolled for MRI using 1.5-T MR imaging unit. Patients were selected according to their age group (child bearing period), their clinical mani-festations, then later MRI findings for each case, collection of data then statistical analysis was performed.<br />Results: MRI for Uterine Adenomyosis is considered an accurate noninvasive modality for diagnosis of adenomyosis and associated lesions. Diagnostic sensitivity, specificity and accuracy of diagnosis of MRI were 92.3%, 75% and 90% respectively in our study.<br />Conclusion: Our study revealed that MRI represents an accurate evaluation tool for adenomyosis allowing its diagnosis and detection of associated pathologies and can differentiate it from mimicking lesions noted at other imaging modalities and planning of appropriate treatment.https://mjcu.journals.ekb.eg/article_53351_6e25eff37babb47f94ed7e2ed389777f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Therapeutic Efficacy of Tyrosine Kinase Inhibitors Treatment for Metastatic Renal Cell Carcinoma Using 18F-FDG PET/CT126312715335210.21608/mjcu.2019.53352ENTAMER W. KASSEM, M.D.;MAGED A. HAWANA, M.D.The Department of Radiology, Faculty of Medicine, Cairo University, EgyptJournal Article20181001Abstract<br />Background: Renal Cell Carcinoma (RCC) diagnosis increased due to increased use of cross-sectional imaging studies, metastases are common in RCC. 18F-FDG PET/CT has a limited role in detection of primary RCC, but it is helpful in restaging, detection of distant metastasis and can be used in assessment of number and sites of RCC metastasis as baseline for future re-treatments.<br />Nowadays therapy with drugs targeting vascular endothe-lial growth factor receptor such as Tyrosine Kinase Inhibitors (TKI) showed promising efficacy. Response to chemotherapy has been monitored by Response Evaluation Criteria in Solid Tumors (RECIST) based on size measurements.<br />Aim of Study: The aim of this study was to use FDG uptake as indicator for assessment of biological response of Renal Cell Carcinoma (RCC) metastatic deposits to Tyrosine Kinase Inhibitors (TKI).<br />Patients and Methods: 30 patients having pathologically proven metastatic RCC in post total nephrectomy state under-went PET/CT examination at private center in period between March 2017 and April 2018 and following a preset protocol as baseline study. They all received 4 cycles (six weeks cycles) of TKI therapy then all had a second PET/CT examination following same protocol after 6 months to assess therapeutic response.<br />Results: Out of 30 cases 22 cases (73.3%) showed disease regression, 6 cases (20%) showed stationary course and 2 cases (6.7%) showed disease progression.<br />Conclusion: 18F-FDG PET/CT is an effective index in monitoring efficacy of TKI treatment for RCC metastasis.https://mjcu.journals.ekb.eg/article_53352_e1bb5485c7dcd49e0804ac44ae42cc0d.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Audit of Golden Hour Practice in Neonate Assiut University Children Hospital127312785335410.21608/mjcu.2019.53354ENRAHMA S. MOHAMED, M.Sc.;ABD EL-LATEF M. ABD EL-MOEZ, M.D.MOATAFA M.EMBABY, M.D.The Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, EgyptJournal Article20181001Abstract<br />Background: A golden-hour strategy is a philosophical approach that reinforces communication and collaboration (inter-and intra-team) using evidence-based protocols and procedures that standardize as many elements as possible for delivery and initial management of a newborn. Golden-hour strategies lay out how the neonatal team will receive notification from the obstetrical service of an impending periviable birth and stress the importance of collaborative counseling of the family.<br />The Vermont Oxford Network (VON), a worldwide non-profit collaborative of neonatal healthcare providers, began to use "golden hour" to describe the first hour of life for the Very Low Birth Weight (VLBW) infant in the late 1990s.<br />Pre-resuscitation check lists are used for briefing the care team to the equipment that they will need to prepare both in the delivery room and Neonatal Intensive Care Unit (NICU) in the form of standardized check lists. Personnel have clearly assigned roles and responsibilities. This promotes training and adherence to the American Academy of Pediatrics/ Amer-ican Heart Association Neonatal Resuscitation Program (NRP) algorithm.<br />Aim of Study: The aim of the study is to assess the degree of adherence of medical physician to Assiut University Chil-dren Hospital protocol for application of golden hour practice in neonate. Also to review potentially better practice that can be applied during the golden hour to ensure the optimal outcome.<br />Patients and Methods: The study included 100 cases that were delivered at Assiut University Maternal Health Hospital and followed-up during the first hour of life. The included cases were chosen according to the inclusion criteria and the data was collected during the period between October 2016 to March 2017.<br />Results: The study included 100 newborn infants their gestational ages ranged from >29 weeks to Conclusion: This study provides valuable insight to assess the degree of adherence of medical physician to Assiut Children Hospital protocol for application and effectiveness of golden hour practice in neonate. Also to review potentially better practice that can be applied to ensure the optimal outcome using a statistically powerful calculated sample size and powerful data.https://mjcu.journals.ekb.eg/article_53354_c22a9165afa3dd1a6a41aac1f69a19ba.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301A Clinical Audit for Children with Acute Bronchiolitis at Assiut University Children’s Hospital127912855335510.21608/mjcu.2019.53355ENAHMED S. KAMEL, M.Sc.;FATMA A. ALI, M.D.FAISAL AL-KHATEEB A.ABDULLAH, M.D.The Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, EgyptJournal Article20181001Abstract<br />Background: Bronchiolitis is a disorder most commonly caused in infants by viral infection. It is the most common lower respiratory tract infection in the first two years of life. Signs and symptoms are typically rhinitis, tachypnea, wheez-ing, cough, crackles, use of accessory muscles, and/or nasal flaring.<br />Aim of Study: Comparing lines of management of acute bronchiolitis in children in our hospital with Nottingham University Children’s Hospital guideline for the management of acute bronchiolitis in children.<br />Patients and Methods: Data of 160 children from 1 month to 2 years of age with acute bronchiolitis admitted at Assiut University Children’s Hospital during the period between 1 of April 2015 to 31 of March 2016 was collected and analyzed and clinical management was compared with the standard management guidelines according to Nottingham University Children’s Hospital guideline for the management of acute bronchiolitis in children (July 2013).<br />Results: The study included 119 males (74.3 7%) and 41 females (25.63%). CBC was done to 154 cases (96.3%), chest X-ray was done to 149 cases (93.1%), pulse oximetry was done to 130 cases (81.3%). All patients (160 cases, 100%) received antibiotics, nebulised hypertonic saline and Inhaled Salbutamol, while 136 cases (85%) received intravenous fluids, 117 cases (73.1 %) received oxygen therapy, 100 cases (62.5%) received inhaled Ipratropium.<br />Conclusion: We need to stick with the international guidelines as a reference standard to avoid missing important investigations or use of unnecessary investigations or lines of management unless recommended to improve the health services provided in Emergency Unit.https://mjcu.journals.ekb.eg/article_53355_d57cc3fd02e7c531482fb180fc380d2c.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Ultrasound Guided Transversus Abdominis Plane Block Using Dexmedetomidine and Bupivacaine in Children Undergoing Laparoscopic Orcheopexy: Randomized Controlled Trial128712915335610.21608/mjcu.2019.53356ENFATMA A. ABD EL-AAL, M.D.;RAGAA A. HERDAN, M.D.JUMMAH J.M.ABORIMA, M.Sc.The Department of Anesthesia and Intensive Care Surgery, Assiut University Hospitals, Assiut, EgyptJournal Article20181001Abstract<br />Background: To assess the onset time, duration and post-operative analgesic efficacy of ultrasound guided TAP block in children with undescended testis who underwent laparo-scopic orcheopexy.<br />Aim of Study: The addition of dexmedetomidine to bupi-vacaine in TAP block achieves better local anesthesia quality and provides better pain control postoperatively without any major side-effects.<br />Patients and Methods: A prospective randomized control-led double blind study using a computer generated randomi-zation was conducted in Assiut University between March 2016 and September 2017.<br />Results: Regarding SpO2 and HR of the studied groups at different times; it was noticed that there was no statistically significant differences between the two groups (p>0.05). Regarding end tidal CO2 measurements, there was a statisti-cally significant difference (p<0.05) after induction, at 10 minutes and at 70 minutes. There was statistically significant difference (p<0.001) after 30-60 minutes and from 80 minutes up to end of surgery with higher mean values at Group A. There was no statistically significant difference at others times. For mean arterial blood pressure recordings, there was statistically significant difference (p>0.001) from time before induction up to after 40 minutes, 80 minutes and at end. There was no statistically significance difference (p>0.05) at time 50-70 minutes, 90 minutes and before extubation. Regarding post-operative pain scores, in Cry, Facial and Torso there was no statistically significant difference at 4 hours, but there was statistically significant difference (p<0.001) at 8 and 12 hours. As regarding child verbal, touch and legs there was a statisti-cally significant difference (p<0.05) at 4, 8 and 12 hours. Regarding frequency of post-operative analgesic request, there was a statistically significant difference between Groups A and B (p<0.05) with (85.0%) request analgesia in Group A vs. (60.0%) in Group B. Egarding the time of the first analgesic request, there was statistically significant difference between Group A and Group B (p<0.001) with higher mean values in Group B than Group A.<br /> Conclusion: The addition of dexmedetomidine to bupi-vacaine in TAP block achieves better local anesthesia quality and provides better pain control post-operatively without any major side-effects.https://mjcu.journals.ekb.eg/article_53356_55b824192867931df294afda2408a27f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Effect of Aerobic Exercise on Fetal Outcomes in Diabetic Pregnant Women129312975335810.21608/mjcu.2019.53358ENFATIMA M. EL-BELIDY, M.Sc.;ADLY A. SABBOUR, Ph.D.ABEER M. EL-DEEB, Ph.D.;AMIR A. GABR, M.D.The Department of Physical Therapy for Women's Health, Faculty of Physical Therapy* and The Department of Medicine for Gynecology & Obstetrics, Faculty of Medicine**, Cairo University, EgyptJournal Article20181001Abstract<br />Background: This study aimed to evaluate the effect of aerobic exercise on fetal outcomes including body weight, fetal length, head circumference, infants' chest circumference, abdominal circumference and Apgar score 1 and 2 in gesta-tional diabetic women.<br />Material and Methods: Thirty gestational diabetic women were randomly distributed into two groups equal in number. The control group received insulin therapy and diet recom-mendations, while the exercise group received the same treatment and aerobic exercise in form of treadmill training for 30 minutes/day for 3 times/week.<br />Results: Comparing both groups post-intervention, results revealed that there were statistically non-significant differences in the gestational age (p=0.48), infants' length (p=0.86), head circumference (p=0. 15), infants' chest circumference (p=0.09), and Apgar score 1 (p=0.051). However, there was a statistical significant decrease in infants' weight (p=0.003), and abdom-inal circumference (p=0.001), as well as a statistical significant increase in Apgar score 2 (p=0.02).<br />Conclusion: The aerobic exercise showed improvements in the fetal outcomes without producing any harmful effects to infants of diabetic women.https://mjcu.journals.ekb.eg/article_53358_087c8770c3ea69074dc96c3f9e258979.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Relation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Short Term Outcome in Patients with Acute ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention129913085336010.21608/mjcu.2019.53360ENAHMED I. EL-SHALL, M.B.B.Ch.;SEHAM F. BADR, M.D.HATEM F. EL-SOKKARY, M.D.;AHMED F. ALARAG, M.D.The Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, EgyptJournal Article20181001Abstract<br />Background: Ischemic heart disease is considered the most common cause of death worldwide. Inflammation and oxidative stress play an important role in the pathogenesis of all phases of atherosclerosis and atherosclerotic plaque rupture which are the main mechanisms in the pathophysiology of acute ST-segment elevation myocardial infarction (STEMI). Monocyte to HDL ratio (MHR) was defined as a novel potential marker to determine inflammation and used to predict clinical outcome in patients with STEMI.<br />Objectives: To study the relation between monocyte to high-density lipoprotein cholesterol ratio and short-term outcome in patients with acute ST-segment elevation myocar-dial infarction undergoing primary percutaneous coronary intervention (PCI).<br />Methods: This study was conducted on a number of 100 patients diagnosed with STEMI and underwent primary PCI in Tanta University Hospitals, Cardiovascular Department, from June 2017 to December 2017. The primary end points were all cause mortality and major adverse cardiovascular events (MACE) including a composite of death, nonfatal re-infarction, target vessel re-vascularization, or new onset congestive heart failure during hospitalization and during the 3-months clinical follow-up.<br />Patients were divided into 3 tertiles according to the monocyte to high- density lipoprotein cholesterol ratio (MHR); Tertile 1: MHR20 (number of patients=23).<br />Results: Patients in the high MHR tertile showed signif-icantly lower systolic blood pressure, higher Killip class II-IV, lower final angiographic TIMI flow, higher WBCs, neu-trophils and monocytes count, higher serum LDL level and lower HDL levels, higher ejection fraction, higher all the composite endpoints of MACE including death, reinfarction and CHF. The study showed that MHR level >12.3 predicted the overall MACE following STEMI with a sensitivity and specificity above 75%. Conclusion: Monocyte to high-density lipoprotein cho-lesterol ratio is an independent prognostic factor for both in-hospital adverse outcomes, as well as, short-term adverse outcomes among STEMI patients who underwent primary PCI.https://mjcu.journals.ekb.eg/article_53360_0110808ea56bdbd8db2bc459aca196c6.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Clinical and Haemodynamic Effects of Bi-Level Positive Airway Pressure in Patients with Decompensated Heart Failure130913155336110.21608/mjcu.2019.53361ENSOHEIR M.K. AHMED, M.D.;HATEM H.M. MAGHRABY, M.D.SAMIR EL-HADIDY, M.D.;AHMED S.A. MAHFOUZ, M.Sc.The Departments of Internal Medicine*, Anaesthesia & Intensive Care**, Faculty of Medicine, Assiut University, Assiut and Department of Critical Care Medicine***, Faculty of Medicine, Cairo UniversityJournal Article20181001Abstract<br />Background: Heart failure is a growing problem worldwide with high degree of morbidity and mortality especially in those with dilated cardiomyopathy. We hypothesized that noninvasive bi level positive airway pressure ventilation (BIPAP) could play a crucial role in those patients.<br />Aim of Study: To study the effect of Non Invasive bi-level positive air way pressure (BIPAP) ventilation on the clinical, hemodynamic parameters in patients with heart failure NYHA class 3-4 due to dilated cardiomyopathy.<br />Patients and Methods: Forty adult patients, (18-83 years old) of both sex with decompensated heart failure and dilated cardiomyopathy (LVEF <35%) were included in the study, they were recruited from both emergency department and critical care unit of internal medicine department, Assiut university hospital. They were divided into two groups: Group A (20 patients) received the standardmedical therapy for heart failure and supported Noninvasive positive pressure ventilation (NIV) through BIPAP, while group B (20 patients) received only the standard medical therapy for heart failure with simple mask oxygen therapy.<br />Results: There was a statistically significant improvement in dyspnea, tachypnea (p=0.041*, 0.03 1) in the group A compared to the group B, Meanwhile there was insignificant improvement in tachycardia, and hypotension in group A compared to group B. All patients were cooperative, and only one patient from each group needed intubation, deteriorated rapidly, and died.<br />Conclusion: In our study, adding Noninvasive Bi Level Positive airway ventilation (BiPAP) to conventional medical treatment improved clinical, hemodynamic, parameters in dilated cardiomyopathy patients with decompensated heart failure. We concluded, “BiPAP is not only a safe adjuvant to the conventional treatment but also, it can be more advanta-geous in the management of patients with dilated cardiomy-opathy with decompensated heart failure”.https://mjcu.journals.ekb.eg/article_53361_94577c7a2937a303e666aad375ee5719.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301The Role of Stem Cells on the Ovarian Failure Induced by Busulfan in Female Albino Rat131713305336210.21608/mjcu.2019.53362ENBADRIA F. AHMED, M.D.;HALA H. MOHAMED, M.D.AMANY F. MOHAMED, M.D.;FATMA A. ABU ZAHRA, M.D.EMAN S.MAHMOUD, M.Sc.The Department of Anatomy & Embryology, Faculty of Medicine for Girls, Al-Azhar University and Fellow Molecular Biology & Tissue Culture*, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20181001Abstract<br />Background: Many researches about stem cell therapy in premature ovarian failure treatment have been carried out. The adipose tissue has recently been identified as one of the alternative sources of multipotent resident stem cells in humans. One of the most devastating effects of chemotherapy is the damage of the reproductive system, which in young girls and women younger than 40 years of age is frequently associated with premature ovarian failure. Busulfan has a wide range of using as in a conditioning regimen prior to allogeneic hematopoietic progenitor cell transplantation for chronic myeloid leukemia and in patients undergoing bone marrow transplantation.<br />Aim of the Study: The aim of the study was to evaluate the effect of administration of adipose tissue derived stem cells on the ovarian failure induced by the busulfan in female albino rats.<br />Material and Methods: 70 female 8 weeks old albino rats were divided into 5 groups. Group I (control Group): They consisted of 20 female albino rats. They were received no treatment and served as untreated control. Group II (adipose tissue derived stem cells treated group): They consisted of 20 female albino rats. They were received adipose tissue derived stem cells (AT-ASCs). They received million and half of million units of AT-ASCs/single dose for each animal I.V. Group III (busulfan treated Group): They consisted of 10 female albino rats. In this group the ovarian failure was induced using busulfan therapy by a dose 2mg for successive 4 days. Group IV (busulfan treated, followed by AT-ASCs treated group): They consisted of 10 female albino rats. In this group the ovarian failure was induced by the same regimen as in group III. After one week of chemotherapeutic treatment, the animals received million and half of million units of AT-ASCs/single dose for each animal I.V. Group V (busulfan treated, followed by AT-AS Cs treated group): They consisted of 10 female albino rats. The rats in this group received the same regimen as group IV but they were sacrificed 4 weeks after the AT-ASCs injection. Biochemical study: Blood samples were taken from all rats from retro-orbital venous plexus and the serum samples were measured for FSH, LH and serum estrogen level using ELISA technique. Paraffin sections for female albino rat ovaries were prepared to be stained with H&E and Masson’s Trichrome stain for Light microscopic study. Specimens of the ovary were also prepared for electron microscopic study.<br />Results: The AT-ASCs induced definite improvement in the histopathological changes associated with busulfan induced ovarian failure. This improvement was marked one week after AT-ASCs treated but after 4 weeks, there was some regression in this improvement.<br />Conclusion: AT-ASCs transplantation can improve the ovarian damage induced by the busulfan. The need for second dose of AT-ASCs is suggested.https://mjcu.journals.ekb.eg/article_53362_172ec7db77435868a7618f704ed07a87.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387March20190301Characterization of Fibrinolytic Enzymes Produced by the Halophilic Streptomyces Flaveolus and Streptomyces Galtieri Isolated from Wady El-Natron Area in North Egypt232323325454710.21608/mjcu.2019.54547ENMOHAMED E. OSMAN, M.D.;SAID M. ABD EL-ALL, M.D.SHAMEL Y.E.KHALIFA, M.Sc.The Department of Botany and Microbiology, Faculty of Science, Helwan University* and The Microbiology Division, National Organization for Drug Control and Research (NODCAR)**, Cairo, EgyptJournal Article20181001Abstract<br />Background: Intravascular thrombosis is responsible for an increasing number of deaths every year. Lung blood clots in USA alone affect 1,000,000 patients annually. Clots formed from insoluble fibrin restrict the smooth flow of blood in blood vessels, leading to thrombosis and heart attacks. World-wide, over 29% of the total mortalities are due to thrombosis, thus antithrombotic therapy is of great interest. The three fibrinolytic (thrombolytic) agents that are currently being used for this purpose are urokinase, streptokinase and genet-ically engineered tissue-type Plasminogen Activator (t-PA). However, these enzymes are expensive, thermolabile, with low specificity and stability, large therapeutic doses and can produce undesirable side effects such as gastrointestinal bleeding, allergic reactions, and resistance to repercussion. This warrants the search for novel fibrinolytic enzymes from various sources with higher efficacy, safety, specificity and stability and preferably those direct acting activities. Though new fibrinolytic enzymes are being explored from microbes, microorganisms remain the preferred source due to their biochemical versatility, feasibility of mass culture and ease of genetic manipulation. Hence, many fibrinolytic enzymes have been isolated from a variety of microorganisms, including actinomycetes, bacteria, fungi, and algae.<br />Aim of Study: To detect the characterization of fibrinolytic enzymes produced by the halophilic Streptomyces flaveolus and Streptomyces galtieri that were isolated from soil of Wady El-Natron region, in North Egypt, as a potential thrombolytic agent.<br />Material and Methods: Fibrinolytic enzymes, extracted from Streptomyces flaveolus and Streptomyces galtieri, were purified by ammonium sulfate precipitation and gel filtration. By using SDS-Page electrophoresis, determining their molec-ular masses, classified by inhibitory acting materials, charac-terized by determining metal ions influences, anticoagulation clotting time delay with CaCl2, their proteolytic activity in units/mg, the active conc. in μg/ml and the least conc. in μl/ml of thrombolytic activity.<br />Results: The fibrinolytic enzymes extracted from both Streptomyces flaveolus and Streptomyces galtieri are classified as metallo-protease enzymes, their molecular masses were 1 6kDa and 4 1kDa, their proteolytic activity are 1.4 and 2.3 units/mg of proteins, the anticoagulation clotting time assay showed 20 and 15min delay in clotting time with CaCl2, the active conc. of each enzyme was determined from the standard curve using streptokinase as standard fibrinolytic enzyme as 200 and 300μg/ml, and the least conc. of enzyme thrombolytic activity was measured by performing the modified Holmstrom method, as the crude thrombolytic activity were at concentra-tions of 80-100μl, whereas, precipitated enzymes, showed thrombolytic activity at concentrations 20μl and 30μl/ml respectively. Metal ions exhibited different influences on the fibrinolytic enzyme activity produced by Streptomyces flave-olus, such as Ca2+, Cu2+ and Fe2+ promoted the activity of the enzyme, whereas Mg2+ is strongly promoted it. But on the fibrinolytic enzyme activity produced by Streptomyces galtieri, Cu2+ promoted the activity of the enzyme, whereas Ca2+, partially inhibit the enzyme, but the Fe2+ and Mg2+ were strongly and completely inhibit it.<br />Conclusion: These results suggest that the extracted enzymes from both isolated Streptomyces flaveolus and Streptomyces galtieri are with potent and potential applications as thrombolytic agent.https://mjcu.journals.ekb.eg/article_54547_c45efe28c1adda44ef86914b19e7ca53.pdf