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ORIGINAL ARTICLES
Ventilator-associated pneumonia in the neonatal intensive care unit
Ahmed A. Khattab, Dalia M. El-Lahony, Wessam F. Soliman
January-June 2014, 27(1):73-77
DOI:10.4103/1110-2098.132753  
Objective Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in the ICU. We studied the characteristics and risk factors of VAP in critically ill neonates. Background VAP, which was not present at the time of intubation, accounted for up to 30% of nosocomial infections in neonatal intensive care unit (NICU) patients. Patients and methods This study was carried out in the NICU in Benha Children's Hospital on 85 neonates with different diagnoses admitted from April to October 2012 who needed mechanical ventilation. All studied neonates were subjected to history taking, clinical examination, routine investigations (assessment of complete blood count, C-reactive protein levels, and arterial blood gas volumes, blood culture, and liver, serum albumin, and kidney function tests), and chest radiography daily, as well as to nonbronchoscopic alveolar lavage culture. Results Of 85 neonates who needed mechanical ventilation, 55.2% developed VAP. Prematurity, low birth weight, and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leukocyte count, C-reactive protein, and hypoalbuminemia were significantly present in the VAP group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO 2 , and PaO 2 . The microorganisms associated with bloodstream infection in the VAP-diagnosed group were Staphylococcus aureus (15%), Klebsiella spp.(8.5%), Candida spp.(6.5%), Pseudomonas spp. (4.2%), and Escherichia coli (4.2%); 61.7% of obtained blood cultures in VAP patients were sterile. The results of nonbronchoscopic bronchoalveolar lavage cultures revealed the presence of Klebsiella spp. (34%), Pseudomonas spp. (25.5%), S. aureus (17%), E. coli (17%), and Candida spp. (6.4%). K. pneumoniae was the most commonly isolated pathogen in nonbronchoscopic bronchoalveolar lavage. Conclusion The most important risk factors of VAP are prematurity, low birth weight, prolonged duration of mechanical ventilation, enteral nutrition, and umbilical catheterization.
  6 3,497 518
An epidemiological study of tramadol HCl dependence in an outpatient addiction clinic at Heliopolis Psychiatric Hospital
Nabil R Mohamed, Lamia G El Hamrawy, Amro S Shalaby, Mohamed S El Bahy, Mohammad M Abd Allah
April-June 2015, 28(2):591-596
DOI:10.4103/1110-2098.163924  
Objectives The aim of this study was to detect the prevalence of tramadol HCl dependency among substance abusers, assess the severity of addiction, recognize comorbid psychiatric disorders, and identify risk factors to start tramadol abuse. Background An increasingly alarming phenomenon of tramadol drug abuse has been demonstrated in the Egyptian community. Participants and methods The studied group had 330 Egyptian substance abusers. They were subjected to the following: a semistructured interview sheet, a structured clinical interview for DSM-IV (SCID-I) to diagnose psychiatric disorders, the addiction severity index scale, and urine screening for substance abuse. Results The prevalence of tramadol HCl dependency according to all substance abusers was 49%. The prevalence of comorbid psychiatric disorders was 43%. On studying risk factors for tramadol abuse we found sexual purpose and pleasurable effect were the strongest predictors. Conclusion The increase in the prevalence of tramadol HCl dependency over other substances in the Egyptian community calls for more attention from family and educational and health institutes.
  6 3,900 403
Dual diagnosis and psychosocial correlates in substance abuse in Menoufia, Egypt
Nabil R Mohamed, Samy A Hammad, Lamia G El Hamrawy, Afaf Z Rajab, Mohamed S El Bahy, Mohamed R Soltan
July-December 2013, 26(2):114-121
DOI:10.4103/1110-2098.126139  
Objectives To study the comorbid psychiatric disorders among substance abusers in Menoufia and to identify whether there is a correlation between the type of substance and the comorbid disorder that occurred, and also to determine whether there are specific risk factors that can cause this comorbidity. Background A dual diagnosis presents a challenging problem to clinicians as substance use disorders occurring together with mental health disorders represent a major health problem. Participants and methods Study participants comprised 120 Egyptian substance abusers. They were subjected to the following: semistructured interview sheet, Fahmy and El Sherbini Social Classification scale, semistructured clinical interview for DSM-IV (SCID) both SCID-I for Axis-I diagnosis and SCID-II for Axis-II diagnosis, Addiction Severity Index scale, and a urine screening for substance abuse. Results The findings of the study suggested that 20% of the studied participants were tramadol abusers, 10% were both alcohol and cannabis abusers, 23% were other substances abusers, and 37% were polysubstance abusers. With respect to psychiatric comorbidity, 63.3% of the participants had comorbid psychiatric disorders and comorbid personality disorders (PDs). On studying risk factors for substance abuse, major depressive disorder was found to be the strongest predictor of alcohol abuse. Dependent PD and schizophrenia were the strongest predictors of cannabis abuse. Major depressive disorder and borderline PD were the strongest predictors of opioid abuse. Anxiety disorders and borderline PD were the strongest predictors of sedative abuse. On studying risk factors for comorbid psychiatric disorders in the participants studied, young age (<25 years) and being single were found to be the strongest predictors of comorbid Axis-I disorders. Conclusion Individuals with psychiatric disorders are at an increased risk of having a comorbid substance abuse disorder and vice versa.
  4 2,978 272
Study of risk factors of diabetic foot ulcers
Nabil Abd El Fatah Al Kafrawy, Ehab Ahmed Abd El-Atty Mustafa, Alaa El-Din Abd El-Salam Dawood, Osama Mohammed Ebaid, Omnia Mahmoud Ahmed Zidane
January-June 2014, 27(1):28-34
DOI:10.4103/1110-2098.132298  
Objective To study the risk factors for diabetic foot ulcers (DFUs) in Menoufia University Hospitals. Background Problems associated with the diabetic foot are prevalent worldwide. DFUs contribute significantly toward the morbidity and mortality of patients with diabetes mellitus. This study was carried out to evaluate the risk factors for DFUs. Patients and methods One hundred patients with diabetic foot were enrolled and 50 patients had foot ulcers. All were subjected to the following: assessment of full history, physical examination including foot examination through peripheral pulses including Doppler examination of dorsalis pedis and posterior tibial arteries, sensations, reflexes and callus, and routine investigations including HbA1c, fasting, and 2 h postprandial blood glucose. Results DFUs occurred mostly in patients who had had diabetes for a long duration more than 10 years (94%), smokers (50%), those with diabetic retinopathy (92%), those with previous ulcers (74%), those who had a previous amputation (42%), those with peripheral neuropathy assessed by [lost monofilament (100%), lost vibration sensation (100%), lost pinprick sensation (100%)], peripheral vascular disease assessed by [ankle brachial index≤0.9 (84%), Doppler examination detected ischemia (84%)], foot fissures (12%), foot callus (24%), foot deformities (36%), limited joint mobility (26%), dyslipidemia on the basis of elevated total cholesterol greater than 200 mg/dl (40%), and poor glycemic control on the basis of (hemoglobin A1C>7.5%). The types of ulcers were neuropathic (16%) and neuroischemic (84%). Age, sex, diabetic nephropathy, obesity detected by BMI, abnormal ankle reflexes, and elevated serum creatinine were not risk factors for DFUs. Conclusion Peripheral neuropathy, duration of diabetes, peripheral vascular disease, and poor glycemic control were significant predictors of DFUs.
  4 6,596 764
Serum markers for the early detection of hepatocellular carcinoma in patients with chronic viral hepatitis C infection
Ibrahim Baghdady, Farouk Fouad, Mohammed Sayed, Ahmed Shoaib, Yassin Salah, Elsayed Elshayeb, Alaa Efat Hasan
July-September 2014, 27(3):544-550
DOI:10.4103/1110-2098.145509  
Objective The aim of this study was to identify the serum markers and the use of abdominal ultrasound for early detection of hepatocellular carcinoma (HCC) in patients with chronic viral hepatitis C virus infection. Background HCC meets the criteria of a tumor that would benefit from a surveillance program, but the poor sensitivity and specificity of currently available tools have prevented widespread implementation of surveillance. Patients and methods This study included 110 patients, age from 23 to 70 years, from Menoufia University hospitals during the period from July 2011 to November 2013. They were classified into three groups: group I, non-HCC group (50 patients); group II, HCC group (40 patients with chronic hepatitis C virus infection); and group III, healthy controls (20 individuals). Members of the study were subjected to thorough history taking, complete physical examination, liver function testing (serum bilirubin, albumin, prothrombin time, serum transaminases), serum α-fetoprotein (α-FP), and transforming growth factor β1 (TGF-β1) level. Group I was subjected to serum TGF-β1 at 0-, 9-, and 18-month intervals. Results The mean age was 46.72 ± 9.03 years in the non-HCC group (group I), 58.70 ± 5.76 years in the HCC group (group II), and 42.15 ± 11.33 years in the control group (group III). The mean serum level of TGF-β1 was 232.25 ± 70.53 ng/ml in the HCC group, 42.16 ± 13.34 ng/ml in the non-HCC group, and 13.92 ± 7.73 ng/ml in the control group; there was a highly significant difference between all groups (P < 0.001). The mean value of α-FP was 334.40 ± 311.30 ng/ml in group II and 4.82 ± 2.18 ng/ml in group I; the HCC group had a shooting serum level of α-FP with a highly statistically significant difference. Conclusion This study recommends TGF-β1 as being more accurate than α-FP in differentiating patients with HCC from those with nonmalignant chronic liver disease.
  4 2,046 277
Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children
Fathea El-Nmer, Aml A Salama, Dalia Elhawary
July-September 2014, 27(3):612-616
DOI:10.4103/1110-2098.145529  
Objective The aim of the study was to assess the effect of parental nutritional knowledge, attitude, and practice (KAP) on their children nutritional behavior and growth. Background Good nutrition is cornerstone for growing children during early childhood and school-age years; children begin to establish habits for eating and exercise that stick with them for their entire lives. If children establish healthy habits, their risk for developing many chronic diseases will be greatly decreased. Participants and methods This was a cross-sectional study through multistage stratified random sampling technique. Bialla district of Kafr-Elsheikh governorate was selected randomly from 10 district of Kafr-Elsheikh governorate. Predesigned questionnaires that assess parents and children (KAP) were then given to parents and children and 120 pairs of completed questionnaires were returned. Results There was no significant correlation between nutritional knowledge (KAP) of parents and nutritional practice of their children (P>0.05), whereas there was a significant correlation between parent's knowledge score and healthy food intake in general by children (r = 0.222; P < 0.05). There was no significant correlation between nutritional practice of children and their BMI and height, whereas there was significant correlation between nutritional practice of children and their weight. There was a highly significant correlation between social class of parents and their children nutritional behavior; in addition, there is significant correlation between father's education and mother's education and their children nutritional practice (χ2 = 15.3 and 14.6; P = 0.018 and 0.023, respectively). Conclusion There is no relationship between parents knowledge, attitude, and healthy food intake by their children. Parents education and socioeconomic status constituted important determinants of healthy food intake by their children.
  3 12,379 1,597
The effect of zinc supplementation on growth and development in preterm neonates
Seham Mohammed Ragab, Hosam Hemdan Hegran, Sameh Ali Kassem
July-September 2014, 27(3):524-528
DOI:10.4103/1110-2098.145500  
Objective This study aimed to show the effect of zinc supplementation on growth and development in preterm neonates in the first 6 months of life. Background Preterm infants have impaired zinc status because of low body stores as 60% of fetal zinc is acquired during the third trimester of pregnancy in addition to their limited capacity to absorb and retain micronutrients, coupled with increased endogenous losses associated with organ immaturity. Patients and methods The present study was carried out in the Department of Obstetrics in Nasr City Health Insurance Hospital on 80 healthy preterm infants between 32 and 36 weeks of age divided into two groups: a zinc-supplemented group fed with breast milk, and supplemented with multivitamins and zinc (2 mg/kg/day) since the first day of life, and a non-zinc-supplemented group fed breast milk with multivitamins only (without zinc supplementation). Both groups were followed for 6 months for growth with assessment of development by the Age and Stage Questionnaire at 4 and 6 months of corrected age and serum levels of zinc, alkaline phosphatase, and hemoglobin at corrected age of 3 and 6 months. Results The zinc-supplemented group showed a significant increase (P < 0.001) in both weight and length (figures and centiles) at chronological ages of 3 and 6 months and acquired higher head circumference centiles compared with the non-zinc-supplemented group. There was a highly significant increase in the serum zinc levels of the zinc-supplemented group compared with the non-zinc-supplemented group, in addition to a significant positive correlation between zinc level and both weight and length at 3 and 6 months of age. Also, the developmental score of the zinc-supplemented group was significantly higher (P < 0.001) than that of the non-zinc-supplemented group in all tested domains. Conclusion Zinc supplementation in the first 6 months of life was found to be an effective enhancer for both the growth and the development of preterm infants.
  3 2,184 298
Procalcitonin for discrimination between bacterial and viral lower re spiratory tract infections
Fahema Mohamed Hassan, Ahmed Anwar Khattab, Dina Abd El Rzaek Midan, Rania Mohamed Azmy El-Shazly, Neamh Mohamed Khattab
October-December 2014, 27(4):717-721
DOI:10.4103/1110-2098.149709  
Objective The aim of this study is to assess whether procalcitonin (PCT) can distinguish between bacterial and viral lower respiratory tract infections (LRTIs). Background LRTIs are common diseases in children and are common causes of antibiotic prescription, especially in primary care. It is difficult to distinguish viral from bacterial disease because the clinical presentations of LRTIs because of different causative agents may be similar. Inappropriate use of antibiotics contributes toward the development of antibiotic-resistant bacteria, and increases both the length of stay and the costs of hospitalization. Therefore, a routine test that can safely discriminate between viral and bacterial infection is needed. Methods This prospective single study included 45 patients diagnosed clinically with LRTIs (pneumonia and bronchiolitis) and confirmed by radiological laboratory and microbiological investigations and 10 patients as a control group. The participants were categorized into group 1 bacterial infection (pneumonia, 15 patients), group 2 viral infection (bronchiolitis, 30 patients), and group 3 control (10 individuals). Serum PCT levels were determined for the three groups; complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were determined only for group I and group II. Radiological and microbiological investigations were performed for group I and group II. Results Although CRP, ESR, and PCT concentrations were significantly different between patients with bacterial and viral LRTIs, the sensitivity and specificity of PCT were higher. PCT had an area under the curve of 0.995 (95% confidence interval, 0.98-1). Conclusion LRTI is a major health problem. Serum PCT can improve differentiation between patients with a bacterial or viral LRTI compared with CRP and ESR.
  3 3,430 292
Treatment of postburn axillary contracture
Ahmed Walash, Tarek Kishk, Fouad Mohamed Ghareeb
April-June 2014, 27(2):278-283
DOI:10.4103/1110-2098.141676  
Objectives The aim of the study was to evaluate different options for postburn axillary contracture treatment. Background Axillary postburn contractures remain a frequent problem after thermal burns involving the trunk and upper arm. Difficulties in rehabilitation of shoulder abduction during the initial period and the contractile evolution of the scar contribute to this problem. Patients and methods A prospective study of 25 patients with postburn axillary contracture was conducted. The contractures were classified according to the Kurtzaman classification and reconstructed using different methods including skin grafting, local flaps (Z-plasty and five flaps), and regional flaps (parascapular, scapular, and thoracodorsal artery flap). Postoperative follow-up continued for 6 months. Patients had to undergo a physiotherapy course as a routine part of each technique. Results The ages of the patients ranged from 7 to 46 years. Type of contracture was type 1A in 12 cases (48%), type 1B in four cases (16%), type 2 in four cases (16%), and type 3 in five cases (20%). The degree of abduction ranged between 50 and 130° with a mean of 100°. Split thickness graft was used in four cases (16%). Local flaps were used in 16 patients - Z-plasty in six patients (24%) and five flaps in 10 patients (40%) - and regional flaps were used in five patients (20%). The improvement in abduction seen postoperatively in the studied cases ranged from 25 to 80° with a mean of 55°. The overall functional and cosmetic results were satisfactory in most of the cases. Conclusion Z-plasty is suitable for short linear band contractures; the five-flap technique is indicated in longer ones. For type II and III contractures regional flaps are the treatment of choice whenever available. For severe cases release and split skin graft is indicated. Postoperative rehabilitation is very important to avoid recurrence and to maintain the result achieved.
  3 2,536 262
Effect of pentoxifylline and pioglitazone on rheumatoid arthritis induced experimentally in rats
Mohamed A Mohamed, Mona F Mahmoud, Asmaa M Rezk
October-December 2014, 27(4):766-774
DOI:10.4103/1110-2098.149748  
Objective To investigate the effect of pentoxifylline (PTX) and pioglitazone (Pg), each alone and in combination with methotrexate (MTX), on rheumatoid arthritis (RA) induced experimentally in male albino rats. Background Individuals have long feared RA as one of the most disabling types of arthritis. It is estimated that over 46 million individuals have arthritis, ~1% worldwide. Material and methods One hundred and eighty adult male albino rats were used in the present study. MTX was administered intraperitoneally at a dose of 0.25 mg/kg daily. PTX was administered intraperitoneally at a dose of 150 mg/kg/rat/day, whereas Pg was administered orally at a dose of 3 mg/kg/day. All doses were administered for a period of 2 weeks. RA was induced by two methods: adjuvant-induced arthritis and pristane-induced arthritis (PIA). Adjuvant-induced arthritis was induced by an intradermal injection of 0.1 ml of complete Freund adjuvant. This type of arthritis appears about 8-12 days after injection. PIA was induced by a single intradermal injection with 0.2 ml pristane at the base of the tail. PIA develops in 2-3 weeks after injection and progresses with a relapsing course that persists for months. Results The anti-inflammatory properties of these drugs were confirmed by reduction of erythrocyte sedimentation rate, serum rheumatoid factor level, serum C-reactive protein level, serum tumor necrosis factor-a level, serum nitrite level, and blood superoxide dismutase level, whereas antioxidant activities were confirmed by an increase in the blood reduced glutathione level. Our study showed that Pg alone exerts portentous effects in the treatment of RA. However, it was more active in combination with MTX. Conclusion Our study showed that Pg was the most potent drug in treating arthritic rats, followed by PTX, with lesser potency in treating arthritic rats. When comparing the two combinations, the combination of Pg with MTX was the most potent one. The second combination was the combination of PTX with MTX.
  3 1,858 246
Histological study on the possible protective effect of pentoxifylline on pancreatic acini of l-arginine-induced acute pancreatitis in adult male albino rats
Maha El-sayed Soliman, Maisa Attia Kefafy, Magda Ahmed Mansour, Amira Fahmy Ali, Walaa Abdellah Ismail Ibrahim Esa
October-December 2014, 27(4):801-808
DOI:10.4103/1110-2098.149789  
Objective The aim of this study was to determine the histological changes of l-arginine-induced acute pancreatitis and the possible protective effect of pentoxifylline on pancreatic acini in adult male albino rats. Background Acute pancreatitis is a reversible inflammation that is either localized to the pancreas or may spread to adjoining tissues. Materials and methods Forty adult male albino rats weighing 180-200 g each were used in this study. The rats were divided into four equal groups (10 rats each). Group I was the control group. In group II (l-arginine-treated), rats were administered two intraperitoneal injections of l-arginine at a dose of 200 mg/100 g/body weight with 1-h interval. They were randomly subdivided into two equal subgroups: in IIA, rats were killed after 24 h of the last l-arginine injection and in IIB, rats were killed after 1 week of the last l-arginine injection. In group III (l-arginine and pentoxifylline-treated), rats were administered l-arginine and pentoxifylline. l-arginine was given similar to group II and pentoxifylline was given as a single intraperitoneal injection at a dose of 12 mg/kg body weight/day. They were randomly subdivided into two equal subgroups: in IIIA, rats were given a single dose of pentoxifylline then were killed after 24 h and in subgroup IIIB, rats were given pentoxifylline daily for 1 week then were killed. In group IV (pentoxifylline-treated), rats were administered pentoxifylline as a single intraperitoneal injection of 12 mg/kg body weight/day for 1 week then rats were killed. Results l-arginine-treated rats for 24 h showed pancreatic edema, degenerative changes of pancreatic acini, and inflammatory cell infiltration. These changes were marked after 1 week; however, pentoxifylline supplementation in group III showed amelioration of the histological picture, which was marked after daily pentoxifylline treatment for a week. Conclusion It is concluded that pentoxifylline was found to improve the histological changes of pancreatic acini caused by l-arginine.
  3 1,758 219
Seroprevalence of hepatitis B among pregnant women attending maternal and child health centres in Shebin El-Kom district (Menoufia governorate)
Mahmoud El Sayed Abo-Salem, Omayma Abo-Elfateh Mahrous, Ahmed Ahmed El-Shaarawy, Hala Marawan Mohamed, Sania Ali Soliman Yehia
October-December 2014, 27(4):847-852
DOI:10.4103/1110-2098.149805  
Objectives This work aimed to determine the seroprevalence and the risk factors for acquiring hepatitis B virus (HBV) among pregnant women in Shebin El-Kom district, Menoufia governorate. Background HBV infection is a major global health problem. Egypt is among the countries with an intermediate endemicity of hepatitis B surface antigen (HBsAg) (range 2-8%). In areas with high/intermediate endemicity, the most common route of infection is still the vertical transmission from mother to child. Passive immunoprophylaxis with hepatitis B immunoglobulin and active immunoprophylaxis with hepatitis B vaccine in the infants of HBV-positive carrier mothers are necessary for the protection of newborns. Participants and methods A cross-sectional study was carried out on 397 pregnant women, who were randomly selected from pregnant women attending maternal and child health centres in Shebin El-Kom district, Menoufia governorate, and were subjected to a personal interview with a predesigned questionnaire and screened for HBsAg in the serum using enzyme-linked immunosorbent assay. Results The seroprevalence of HBV among pregnant women in Shebin El-Kom district, Menoufia governorate, was 2.3%, and the main risk factors for acquiring infection were the habit of one-syringe multiple use [odds ratio (OR) = 12.03], a family history of HBV infection (OR = 8.73), and HBV infection in the husband (OR = 96.5). Conclusion HBV is of intermediate endemicity among pregnant women in Shebin El-Kom district, Menoufia governorate, and the Ministry of Health and Population should adopt a program for the screening of all pregnant women for HBsAg at maternal and child health centres and for health education of the public about the modes of transmission of HBV and the application of infection control measures at health facilities to control the spread of HBV.
  2 1,416 142
Treatment of humeral shaft fractures by a single elastic stable intramedullary nail in children
Ahmad Abd El-Azeem Abosalim, Ahmad Fouad Shams El-Din, Hesham Mohammed El-Mowafy
January-March 2015, 28(1):125-132
DOI:10.4103/1110-2098.155967  
Objective The aim of this study was to assess the effectiveness of intramedullary fixation of displaced humeral shaft fractures in skeletally immature children using a single elastic stable intramedullary nail. Background Almost all pediatric humeral shaft fractures can be treated successfully using closed methods. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. In this study, the functional and radiological results of the management of humeral shaft fractures in children using a single retrograde elastic intramedullary nail will be evaluated. Patients and methods Twenty pediatric patients ranging in age from 6 to 16 years (mean age 10 years) were treated surgically using a retrograde single elastic intramedullary nail. Relative surgical indications included open fractures, inability to maintain an acceptable reduction, concomitant lower extremity fractures, and closed head injury. Two patients had associated radial nerve injury at presentation. Among the patients, 16 were males and four were females. Results The patients were followed for a mean of 5.5 months, with a range from 4 to 6 months. Radiographically, all fractures healed in good alignment. Solid union occurred from 5 to 10 weeks, with a mean of 8 weeks. There were no intraoperative complications, including neurologic or vascular injury, and two patients developed superficial wound infections postoperatively. Conclusion It was found that single elastic intramedullary nail fixation with the aid of a functional arm brace is an adequate technique for the treatment of humeral shaft fractures in pediatric patients when surgical stabilization is indicated. This simple minimally invasive technique provides stable fixation, with minimal soft tissue stripping at the fracture site, and led to bone union in all the cases studied. Level of evidence Case series, level IV.
  2 6,370 309
Minimally invasive plate osteosynthesis versus open reduction and plate fixation of humeral shaft fractures
Mahmoud Mohamed Hadhoud, Amr Eid Darwish, Mustafa Mohamed Kamel Mesriga
January-March 2015, 28(1):154-161
DOI:10.4103/1110-2098.155974  
Objective This study compared clinical outcomes and complications in patients with humeral shaft fractures treated using two methods of fixation by means of plating. Background Plate osteosynthesis has been the treatment of choice for humeral shaft fractures when operative treatment is required. However, plate osteosynthesis of comminuted humeral fractures is a challenging operation, which requires surgical experience and meticulous attention to soft tissue. Minimally invasive plate osteosynthesis (MIPO) is an emerging procedure for the treatment of humeral shaft fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods Thirty patients were analyzed and divided into two groups. Group 1 (n = 15) patients were treated with MIPO and group 2 (n = 15) with open reduction and internal fixation (ORIF). The major characteristics of the two groups in terms of age, sex, mode of injury, fracture location, and associated injuries were similar. Results Primary union was achieved in all patients in the MIPO group and in 14 of 15 in the ORIF group. The mean time to union was similar in the two groups. The mean operation time in the MIPO group (80 min) was shorter than that in the ORIF group (125 min) (P < 0.0001). Bone grafting was performed in one patient in the ORIF group, but in no patients in the MIPO group. There was one case of deep infection in the ORIF group. There was one case of postoperative radial nerve palsy in the MIPO group and two cases in the ORIF group. Functional outcome was satisfactory in both groups. Conclusion The MIPO technique achieves comparable results with the ORIF method in simple and complex fractures of humeral shafts. Although MIPO potentially has a radiation hazard, it reduces perioperative complications with shortened operation time and minimal soft tissue dissection.
  2 2,168 198
Effect of monosodium glutamate on the ovaries of adult female albino rats and the possible protective role of green tea
Ahmed Abozaid Ali, Ghada Hassan El-Seify, Hala Mohammed El Haroun, Mona Abd El Mawla Mohammed Soliman
October-December 2014, 27(4):793-800
DOI:10.4103/1110-2098.149773  
Objective The aim of this study was to determine the histological, histochemical, and immunohistochemical effects of monosodium glutamate (MSG) on the ovaries of adult female albino rats and the possible protective role of green tea. Background MSG is a commonly used food additive. It plays an important role in the pathogenesis of anovulatory infertility. Materials and methods A total of 35 female adult albino rats were used in this study. The rats were divided into four groups: groups I-IV. Group I was the control group. In group II (MSG treated) 10 rats were treated with MSG at a dose of 4 mg/g body weight by subcutaneous injection daily for 14 days. The rats were killed 24 h after MSG treatment. In group III [combined green tea extract (GTE) and MSG treated] 10 rats were treated with GTE and MSG for 14 days. MSG was given at the same dose as that in group II and GTE was given at 300 mg/kg body weight orally daily. The rats were killed 24 h after MSG and GTE treatment. In group IV (GTE treated) five adult rats were treated with GTE only for 14 days and then killed. Results MSG-treated rats showed degenerative changes of the ovary with many atretic follicles. The stroma appeared vacuolated. The medulla showed multiple vacuoles with congested blood vessels. However, combined treatment of GTE and MSG in group III showed amelioration of the histological changes in the ovary. Conclusion It has been concluded that GTE improves the histological changes caused by MSG in the ovary.
  2 2,935 386
Fronto-orbital bone fracture: management and outcome
Fouad M Ghareeb, Ahmed M Elbarah, Yaser M Elsheikh, Ahmed Th. Nassar, Osama M Ebied, Hana Z Nohc
April-June 2014, 27(2):379-385
DOI:10.4103/1110-2098.141712  
Objective The aim of this study was to review the effect of early and late surgical intervention and armamentarium used on the functional and esthetic outcome of fronto-orbital fracture repair. Background Orbital roof fractures represent an important group of orbital fractures because of their close relation to the frontal lobe of the brain and also because of their relation to the eye. Management of orbital roof fractures requires good assessment, early reconstruction, if possible, and team management. Functional and esthetic outcomes should be assessed. Patients and methods Twelve patients with orbital roof and frontal bone fractures were included in this study. Surgical treatment included open bone reduction alone, open reduction with fixation, and/or orbital reconstruction. Postoperative assessment of functional ocular deformities (limited eye movement and diplobia) and esthetic deformities (enophthalmos, dystopia, and proptosis) was carried out. Radiologic assessment for bone reduction and orbital volume was carried out. Results All patients were males. They ranged in age from 16 to 61 years. Road traffic accidents were the cause of trauma in about 67% of patients. Early intervention was performed in 50% of patients, with 100% correction of functional deformities, 90% correction of esthetic deformities and accurate bone reduction in 95% of cases, and good patient satisfaction in 85% of cases. This was much better than late intervention. Titanium mesh was used in 50% of the cases, with accurate orbital volume reduction in 90% of the cases, which was only 50% with bone graft use. Conclusion Early management of orbital roof and frontal bone fractures yields the best results. The use of titanium mesh leads to good functional and esthetic outcomes, with no donor-site morbidity, and saves time.
  2 1,438 128
The effect of body mass index on cervical characteristics and on the length of gestation in low-risk pregnancies
Mohamed Samy Kandeel, Zakaria Fouad Sanad, Tarek Mohamed Sayyed, Sheren Gamil Abo Elyazid Elmenawy
July-September 2014, 27(3):518-523
DOI:10.4103/1110-2098.145499  
Objective This study was undertaken to evaluate the effect of different BMIs on the cervical diameter and its relation to the length of gestation among low-risk pregnant Egyptian women. Background The effect of BMI on the length of gestation is not clearly documented. There are claims that obese women may have longer gestations and longer cervices compared with normal and underweight women through changes in cervical diameters, which have an effect on the pregnancy outcome. Participants and methods This observational cohort study included 100 pregnant women from a total of 120 women at Helwan General Hospital (Egypt). All enrolled women were primigravidae with singleton pregnancies at 20-22 weeks' gestation. Enrolled women were equally allocated into four groups according to their BMIs. A vaginal ultrasonography was performed to measure the cervical length and width. Enrolled participants were followed up until delivery after recording their mean cervical length and width by transvaginal ultrasonography. Results There were five preterm births and five post-term births, representing 5 and 5% of the total cohort study. One neonatal death occurred due to prematurity, and four women developed postpartum hemorrhage with no maternal mortality. The incidence of SPTB was high among underweight women (12%) from a total of 25 women, whereas the incidence of post-term delivery was common among overweight and obese women, representing 8 versus 12%, respectively. Conclusion Underweight women are more liable to have more preterm delivery and low birth weight. However, overweight and obese women are less vulnerable to preterm delivery. They have a tendency for post-term gestation, increased incidence of cesarean section and macrosomia.
  2 2,173 126
In-vitro and in-vivo assessment of the effect of soybean extract on Fasciola gigantica infection in comparison with triclabendazole
Nashaat E. Nassef, Wafaa M. El-Kersh, Mona M El Sobky, Nancy M. Harba, Samar A El Refai Khalil
January-June 2014, 27(1):93-102
DOI:10.4103/1110-2098.132768  
Objective The aim of this study was to assess the effect of genistein (soybean extract) on fascioliasis. Background Continued use of triclabendazole (TBZ) as the major antifascioliasis drug has resulted in resistance. Genistein, a major isoflavone in soybean extract, shows activity against different parasites. Materials and methods This was an in-vivo study that included 28 male New Zealand rabbits grouped as follows: GI, infected and nontreated; GII, infected and treated with TBZ; GIII, infected and treated with soybean extract; GIV, normal control group; GV1, not infected and treated with TBZ; and GV2, not infected and treated with soybean extract. Treatment started on the 80th day postinfection (d.p.i.) Stool examination by formol ether concentration and egg count per gram of feces were performed on day 0 of treatment, 3rd and 7th day post treatment (d.p.t.) Cure rate and fecal egg count reduction of TBZ and soybean extract were compared. Rabbits were killed on the 95th d.p.i. Liver sections were stained with hematoxylin & eosin (H&E) and with caspase-3 immunostain. The in-vitro study included 24 adult worms classified as follows: GI, control nondrug exposed; GII, TBZ exposed; GIII, soybean extract exposed; and GIV, incubated with DMSO (soybean solvent). Adult Fasciola DNA was extracted for electrophoresis. Results Fecal egg count reduction of soybean extract was 41.6% on the 3rd d.p.t. and 95.8% on the 7th d.p.t. compared with 100% of TBZ on the 3rd and 7th d.p.t. The cure rate of this extract was 0% on the 3rd d.p.t. and 83.3% on the 7th d.p.t compared with 100% of TBZ on the 3rd and 7th d.p.t. Soybean extract improved most hepatic lesions shown by H&E staining and decreased the apoptotic changes detected by caspase-3 immunostaining. It also induced apoptotic damage of Fasciola gigantica DNA. Conclusion Soybean extract can be used in the treatment of fascioliasis to decrease the emergence of TBZ resistance.
  2 2,554 221
Lipid profiles in β thalassemic children
Seham M. Ragab, Manal A. Safan, Asmaa S. Sherif
January-June 2014, 27(1):66-72
DOI:10.4103/1110-2098.132749  
Objectives To study the pattern of serum lipids in β thalassemic children. Background β Thalassemia is a common chronic hemolytic anemia in Egypt. Iron overload is a common sequelae in these patients. Abnormal lipid profile patterns have been suggested to occur in thalassemic patients. Materials and methods Forty-two children with β thalassemia (22 thalassemia major and 20 thalassemia intermedia) were included in the present study with 30 matched controls. Complete blood count, kidney function tests (serum creatinine, blood urea), liver function tests (alanine aminotransferase, aspartate aminotransferase), serum ferritin, and 12-h overnight fasting Serum lipid profiles including total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) triglycerides were performed for patients and controls. Results The thalassemic children had significantly higher platelets count, WBCs count, serum ferritin, alanine aminotransferase, aspartate aminotransferase, and serum triglyceride levels, with significantly lower Hb level, RBCs count, total cholesterol, HDL-C, LDL-C levels, and LDL/HDL ratio compared with the control group. Conclusion β Thalassemic children are at risk of developing disturbed lipid profile patterns that could place them at risk for atherosclerosis and thromboembolic events.
  2 3,115 306
Immunohistochemical expression of topoisomerase II a and tissue inhibitor of metalloproteinases 1 in locally advanced breast carcinoma
Hala S El Rebey, Hayam A Aiad, Nancy Y Asaad, Moshira M Abd El-Wahed, Iman L Abulkheir, Fatma M Abulkasem, Shereen F Mahmoud
January-June 2014, 27(1):1-9
DOI:10.4103/1110-2098.132294  
Objectives To evaluate immunohistochemical expression of topoisomerase II a (TOP2α) and tissue inhibitor of metalloproteinases 1 (TIMP-1) in an attempt to identify their prognostic roles in locally advanced breast cancer (LABC). Background LABC is a heterogeneous clinical entity that remains a clinical challenge. Efforts are still needed to identify new markers in an attempt to predict response to therapy and prognosis. Patients and methods This study included 84 pretreatment needle core biopsies of LABC cases subjected to TOP2α and TIMP-1 immunohistochemical staining and the expression was correlated with some prognostic clinicopathlogical parameters of the patients studied. Results Fifty-seven of 84 cases (67.9%) showed positive TOP2͍ expression, with the proportion of TOP2α immunopositive cells (%score) ranging from 0 to 95%, mean ± SD of 27.84 ± 26.16%, and the median was 25%. Positive TOP2α expression was significantly associated with the presence of necrosis (P = 0.03). There was also a near-significant association between positive TOP2α expression and high mitotic count (P = 0.08). Forty-eight of 84 cases (57.1%) showed positive TIMP-1 expression with proportion of TIMP-1 immunopositive cells (%score) ranged from 0 to 95%, mean ± SD of 35.59 ± 32.93%, and the median was 30%. Positive TIMP-1 expression was significantly associated with a low apoptotic count (P = 0.03). Conclusion TOP2α-positive expression in diagnostic samples of LABC patients is associated with poor prognostic features such as the presence of necrosis, whereas TIMP-1 is associated with a low apoptotic count.
  2 1,594 182
Effects of isolated obesity on left ventricular function: a longitudinal strain imaging study
Walaa F. Abdelazez, Rehab I. Yaseen, Ahmed M. Alkersh, Mohammad A.H. Ebada
January-June 2014, 27(1):130-135
DOI:10.4103/1110-2098.132785  
Background Obesity is associated with heart failure, cardiovascular morbidity, and mortality. A direct effect of weight on left ventricular (LV) structure and myocardial function is not well established. Aim The aim of this study was to determine the effect of isolated obesity on LV morphology and systolic function using LV standard ECG indices and strain imaging indices. Patients and methods Sixty-five individuals were enrolled into this study: 45 with isolated obesity, defined as a BMI of 30 kg/m 2 or higher with no other cardiovascular comorbidities, and 20 nonobese age-adjusted and sex-adjusted controls. All participants underwent standard two-dimensional ECG and myocardial strain imaging. Results There was no significant difference between patients and controls as regards height (P > 0.05). In contrast, weight, BMI, and waist circumference were significantly higher in the patient group compared with the control group (P < 0.001). Obese participants had significantly increased left atrial diameter, aortic diameter, septal wall thickness, LV posterior wall thickness, and LV mass (P < 0.001). There was no significant difference between patients and controls as regards LV diastolic diameter, LV systolic diameter, ejection fraction, fractional shortening, LV mass index, E velocity, A velocity, and the E/A ratio (P > 0.05). Comparative analysis of LV two-dimensional longitudinal strain parameters between patients and controls shows a significant decrease in longitudinal strain in obese patients in the apical long-axis, apical four-chamber, and apical two-chamber views (P < 0.001). Conclusion Obesity is associated with morphologic alterations in the LV, in the form of increased LV mass, interventricular septum thickness, and LV posterior wall thickness, as well as subclinical changes in LV systolic function, which can be detected by strain imaging even without overt heart disease.
  2 1,453 143
Role of magnetic resonant diffusion-weighted imaging in evaluation of acute cerebral stroke
Mohamed Ahmed El-Brashy, Hala Hafez Mohamed, Osama Mohamed Ebied
October-December 2014, 27(4):752-757
DOI:10.4103/1110-2098.149744  
Objectives This study aimed to show the role of diffusion-weighted MRI (DWI) in the diagnosis of acute stroke. Background DWI is highly sensitive in detecting early cerebral ischemic changes in acute stroke patients. In this study, we compared the role of DWI with that of conventional MRI techniques. Furthermore, we compared the size of ischemic lesions on DWI scans with the fluid-attenuated inversion recovery (FLAIR) images. Materials and methods We performed T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), FLAIR, and DWI MRI in 30 patients who presented with acute stroke. T1WI, T2WI, FLAIR, and DWI were performed for all patients and an apparent diffusion coefficient map on only 10 patients. The size of ischemic lesions was measured on DWI and FLAIR images. Results With DWI, 100% of the ischemic lesions were detected, with FLAIR recovery 83% were detected, whereas with T1-weighted and T2-weighted images, only 63% of lesions were identified. The size of the lesion on DWI scans was larger than the FLAIR images, particularly in patients examined within the first 6 h of stroke onset. Conclusion DWI is more sensitive than conventional MRI in detecting early ischemic lesions in acute stroke patients. The size of the lesions measured on DWI and FLAIR images in the first 6 h was larger than those measured between 6 h and 3 days. MRI is recommended strongly for the accurate diagnosis of acute stroke.
  2 1,741 157
Prevalence of obesity in primary school children living in Alexandria governorate
Ali Mohamed El-Shafie, Hossam Hemdan Hogran, Abdelhamed Mohamed Dohein
July-September 2014, 27(3):529-532
DOI:10.4103/1110-2098.145502  
Objective The aim of the work was to assess the prevalence of obesity among children of primary schools in Alexandria governorate. Background Childhood obesity has more than tripled in the past 30 years. The prevalence of obesity among children aged 6-11 years increased from 6.5% in 1980 to 19.6% in 2008. Participants and methods A cross-sectional study was carried out on 3500 Egyptian children to calculate prevalence of overweight and obesity among primary school children at age of 6-12 years living in Alexandria governorate. Four schools from urban areas and two from rural areas including both sexes were selected randomly in this study. They were subjected to physical examination and anthropometric measurements including BMI. Data were expressed in terms of Z-scores using the WHO Z-score cutoff points. Conclusion Pediatric obesity is a prevalent and rapidly increasing problem that poses a serious risk to the health and well-being of the nations' youths. Overweight and obesity were relatively high among age group 6-12 years. It was more common in female individuals than male individuals. It was more common in urban than rural areas. It was common in private schools than in governmental schools. Children of high socioeconomic level were more obese than other children.
  2 2,142 316
Quality of drinking water in Menoufia Governorate
Rabie El Bahnasy, Hewaida El Shazly, Manal Al Batanony, Hala M Gabr, Ghadeer M El Sheikh
July-September 2014, 27(3):617-622
DOI:10.4103/1110-2098.145530  
Objectives The aim of the study was to assess the quality of drinking water of different sources in Menoufia Governorate. Background Access to safe drinking water is one of the basic human rights and is essential for healthy life. Failures in water treatment processes and recontamination of treated drinking water are the major causes of morbidity and mortality worldwide. Therefore, monitoring of drinking water from source to tap is an essential step toward hygiene safety. Materials and methods A cross-sectional study was carried out in Menoufia Governorate. Five towns and five villages were chosen randomly. Ten samples were taken from the main water stations in these areas and 150 samples were taken around each station. Five samples were taken from private stations, five samples were taken from water carts, and another five samples were taken from home filters. Results Parameters of water quality of studied samples were within the Egyptian standards, except for turbidity, iron, manganese, free available chlorine, coliform group, and total bacterial count. Seventeen samples have exceeded the Egyptian standards for turbidity. Regarding manganese and iron, there were 34 and 44% of the samples that exceeded the Egyptian standards for manganese and iron, respectively. Free available chlorine of 41 samples was outside the standards. In all, 22% of the samples showed count above the standard level of total coliforms. In addition, 28% of the samples showed total bacterial count greater than 50 cells/cm 3 . Conclusion Parameters of water quality of studied samples were within the permissible limit of the Egyptian standards except for increased levels of turbidity, ammonia, iron, and manganese in addition to presence of residual chlorine concentrations lower than the standards. Similarly, drinking water was also contaminated with coliform bacteria. Therefore, we advocate regular water quality monitoring with special emphasis on water distribution system and private water stations for the safety of public health.
  2 1,235 158
Bone marrow injection in treatment of long bone nonunion
Taher Abd Elsattar, Adel Ibrahim Alseedy, Ahmed Abd Elfattah Khalil
October-December 2014, 27(4):632-635
DOI:10.4103/1110-2098.149627  
Objectives The goal of this study was to report the role of bone marrow injection in treatment of nonunited long bones fractures and to evaluate the relationship between bony union and bone marrow. Background Bone marrow injection has been used for the management of fracture nonunion since a long period of time. The main advantages for this technique are: it can be used in patient unfit for open grafting, is safe, uses osteogenic cells, has no complications in graft site, and can prevent nonunion development. Other advantages include: it is simple, quick, inexpensive, and causes minimal surgical trauma. Patients and methods From November 2009 to February 2013, 20 patients, 16 male patients and four female patients, mean age 36.5 years, suffering from nonunited lower limb fractures were treated in the Orthopedic Department, El-Menoufiya University Hospital by bone marrow injection in site of fracture nonunion. Results Of the 20 patients who had bone marrow injection for nonunion, 16 (80%) patients achieved union and four (20%) patients failed to achieve union. Of the four patients who were not healed, one patient had received three bone marrow injections, whereas three patients had received four bone marrow injections. Conclusion In our study, the patient's age and smoking were inversely proportional to healing after bone marrow injection. In addition, patients who had closed fracture at the time of initial injury achieved union more than patients who had open fracture at the time of initial injury.
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* Source: CrossRef