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CASE REPORTS
'Humming bird sign', 'Mickey Mouse sign', and 'morning glory sign' in progressive supranuclear palsy
Muhammed Jasim A Jalal, Murali K Menon
January-March 2017, 30(1):325-326
DOI:10.4103/mmj.mmj_204_16  
Progressive supranuclear palsy (PSP), also known as the Steele–Richardson–Olszewski syndrome, is a form of Parkinson-plus syndrome. Patients with PSP show interesting radiological signs such as the 'Humming bird sign' and the 'Mickey mouse sign'. Here, we report a patient with PSP, in whom the MRI brain demonstrated the 'Humming bird sign', the 'Mickey mouse sign', and the 'Morning glory sign'.
  17,249 719 -
ORIGINAL ARTICLES
The role of fibroscan in assessment of liver cirrhosis in patients with chronic liver disease
Mohamed S Elzawawy, Shaimaa A Hassanein, Rasha M El Nomrosy
April-June 2018, 31(2):520-524
DOI:10.4103/mmj.mmj_26_17  
Objective The aim of this study is to evaluate the accuracy of fibroscan in the assessment of liver cirrhosis in chronic liver disease. Background Fibroscan is a noninvasive imaging study for measuring liver stiffness by transducer probe-induced elastic share wave that propagates through liver tissue to measure its velocity. Patient and methods The present study was conducted on 50 patients with chronic liver disease. There were 32 males and 18 females, and their ages ranged from 34 to 75 years, with mean age of 51 years. The study was conducted in the hepatology units of Menoufiya University Hospitals, and the disease was confirmed by standard diagnostic criteria. All cases were subjected to the following protocol: full history, clinical examination, laboratory investigation, and ultrasound examination. The patients were subjected to fibroscan examination. The elasticity is directly correlated with the degree of hepatic fibrosis, and 7 kPa has been proposed as a cut-off for fibrosis equal to or greater than F2, and 12.5 kPa for cirrhosis. Results Liver stiffness was significantly correlated with liver cirrhosis. The fibroscan technique has high sensitivity and high specificity of 100%, with the area under the receiver operating characteristic curve (95% confidence interval) of 1.00, at the cut-off level of 14.5 kPa. Conclusion Transient elastography is a promising noninvasive method for detection of cirrhosis in patients with chronic liver disease. Therefore, fibroscan can be used regarding the decision of treatment and follow-up of patients with cirrhosis for screening and detection of the complications.
  17,294 419 -
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.
  13,832 1,740 3
How to avoid the false diagnosis of venous leakage by pharmaco-penile duplex ultrasonography?
Abd Allah M. Attia, Hossam A Yasien, Mohamed S Abdullah, Mohamed S Abo Hola
July-September 2017, 30(3):928-934
DOI:10.4103/1110-2098.218292  
Objectives The aim of the present study to carefully reassess the erectile hemodynamic status in men previously diagnosed with venous leak on penile duplex ultrasonography (DUS) under the guidelines of the Australasian Society for Ultrasound in Medicine (ASUM). Background Erectile dysfunction (ED) is a widespread problem affecting men across all age groups (about 50% in 40–70-year age group) and disturbing the quality of life of sexually active men. Vascular insufficiency is one of the major causes of ED. DUS is a useful, minimally invasive method for evaluating penile hemodynamics in patients with ED, but has a propensity to inaccurately assign a diagnosis of venous leak. Patients and methods Fifty patients from 18 to 50 years olds selected from the Andrology Unit, Dermatology and Andrology Department, Faculty of Medicine, Menoufia University, Egypt were included in the study. All cases were subjected to the following: detailed history, thorough clinical examination, routine and hormonal investigations, and imaging studies including re-evaluation through DUS under the guidelines of ASUM. Results Overall, 50% of the patients previously diagnosed with venous leak were shown to be normal when re-evaluated under the guidelines of ASUM. The other 50% demonstrated a significant improvement in the value of end diastolic velocity (EDV). The study demonstrated a significant increase in the value of peak systolic velocity in repeated DUS with a mean difference of 10.29, and a significant decrease in the value of EDV with a mean difference of 4.19 compared with the original DUS. Our results indicated a significant negative correlation between age and value of peak systolic velocity, and an insignificant positive correlation between age and value of EDV for all participants, in both original and repeated DUS. Conclusion Careful assessment should be carried out when performing DUS, especially in younger men without a significant vascular risk factor in history for ED, to avoid misdiagnosis of venous leak.
  14,617 209 -
REVIEW ARTICLES
Obsessive-compulsive disorder, an Islamic view
Nabil R Mohamed, Morsey Sh Elsweedy, Somaia M Elsayed, Afaf Z Rajab, Said T Elzahar
April-June 2015, 28(2):289-294
DOI:10.4103/1110-2098.163869  
Objective The aim of this work was to study obsessive-compulsive disorder (OCD) from the Islamic viewpoint and programs of Islamic cognitive behavioral therapy (CBT) in OCD. Background OCD in Arab and Islamic populations is mostly viewed and managed from a religious perspective, and these individuals are often more religious and more likely to seek out religious counseling and less likely to receive medical treatment. Most early Islamic scholars associated most cases of OCD to the devil and related it to religion; they established Islamic legislations on the basis of this concept. Research from the Islamic viewpoint on issues linked to these disorders can prevent exploitation of patients by swindlers and imposters on the basis of religion. Methods The authors performed a systematic review and a narrative synthesis of studies; relevant publications were identified, reference lists were examined, and citation searches were performed. No restrictions on date or type of study were applied. Recent findings Religious patients receiving religious psychotherapy showed significantly more rapid improvement, and required lower dosage of medications and for periods less than others. The role of religion as CBT could be significant in the Islamic culture. Conclusion OCD is quite different from the whispers of Satan or self-talk by the Islamic understanding. Islamic legislation for patients with OCDs has to be revised in accordance with changes in the concept of obsessions in Islamic considerate. The religious component in CBT can be effective for religion-oriented OCD patients in Islamic culture. Education on OCD and specialized treatment trainings in religious settings could be beneficial to providing therapies. The correct teachings of Islam provide adequate support for individuals with scrupulous obsessions.
  13,755 539 -
ORIGINAL ARTICLES
Fistulectomy versus fistulotomy in the management of simple perianal fistula
Olfat I Elsebai, Alaa A Elsesy, Mohammed S Ammar, Ahmed M Khatan
July-September 2016, 29(3):564-569
DOI:10.4103/1110-2098.198710  
Objective The objective of this research was to study the functional and clinical outcomes of fistulectomy versus fistulotomy in the treatment of simple perianal fistula. Background Anal fistula has been known as a common surgical ailment for over two and a half millennia. Current management remains dependent on surgeon preference between options such as fistulotomy and fistulectomy. Patients and methods This is a prospective clinical study that included 30 patients suffering from simple perianal fistula; patients were divided into two groups each containing 15 patients: group A was managed by fistulectomy and group B was managed by fistulotomy. Both groups were evaluated according to the operative time, postoperative pain, time of wound healing, postoperative complication, incontinence, and recurrence. Results There was a significant decrease in the operative time in group B compared with group A (P < 0.05), there was a significant decrease in postoperative pain in group B compared with group A (P < 0.05), and there was a significant decrease in the time needed for wound healing in group B compared with group A (P < 0.05). There was no significant difference in postoperative complications, incontinence, and recurrence between the two groups (P > 0.05). Conclusion Fistulotomy is a simple and effective method for the treatment of simple perianal fistula, as it has shorter operating time with less postoperative pain and less time needed for wound healing compared with fistulectomy, with the same incidence of postoperative complications, incontinence, and recurrence as fistulectomy.
  11,914 330 -
Prevalence of urinary tract infection among pregnant women and possible risk factors
Hala M Shaheen, Taghreed M Farahat, Nesreen A El-Hakeem Hammad
October-December 2016, 29(4):1055-1059
DOI:10.4103/1110-2098.202505  
Objectives The aim of this study was to estimate the frequency of urinary tract infection (UTI) during pregnancy and the possible risk factors. Background UTIs during pregnancy are among the most common health problems worldwide, especially in developing countries. It has several adverse outcomes not only on the mother but also on the fetus. Patients and methods A case–control study nested in a cross-sectional investigation was carried out on 250 pregnant women who were attending Berket El Sabae Family Health Center in Menoufia Governorate. Data were collected from the first of September to the end of November 2014. Each participant was assessed using a predesigned questionnaire, which included age, personal history, occupation, present history, past history, obstetric history, and personal hygiene. Urine sample was collected from the studied women for analysis. According to history and urine analysis women were divided into two groups: group I had UTI and group II did not have UTI. Results The result of this study revealed that the frequency of UTIs during pregnancy was 32%, with 63.3% of them having moderate infection. UTIs were more significant among women with an intermediate socioeconomic score (37.9%). The most important risk factors associated with UTI in the studied group were unsatisfied personal hygiene, positive history of diabetes mellitus, anemia, and past history of UTI. Conclusion This study concluded that about one-third of pregnant women had UTI with different degrees of severity. The most important risk factors associated with UTI during pregnancy were unsatisfactory personal hygiene, history of UTI, diabetes mellitus, and anemia. Therefore, the study recommends health education on personal sanitary hygiene and frequent complete urine analysis during pregnancy.
  11,044 1,001 -
Effect of pornography on married couples
Mohamed A Gaber, Hesham N Khaled, Manal M. A. Nassar
July-September 2019, 32(3):1025-1029
DOI:10.4103/mmj.mmj_905_17  
Objective The objective of this study was to study the effects of pornography on married couples in their sexual and social live. Background Pornography has long been a major problem in our society, but since the arrival of the internet it has grown to proportions no one could have imagined. Participants and methods The study included 300 married men and women selected randomly with age ranging from 20 to 50 years having regular sexual intercourse. They were asked to fill a self-report questionnaire. The study was carried out in the outpatient clinics of Obstetrics/Gynecology and Dermatology of Menoufia Faculty of Medicine, Sirs Elyan and El-Bagour General Hospital. Internal validity and item domain of the questionnaire were assessed using Cronbach's α statistical analysis to assess the six main domains of the questionnaire: sociodemographic characters, source of pornography, partner watching pornography, sexual relationship, satisfaction with sexual life, and social life. The results showed high internal consistency and reliability of the questionnaire of Cronbach's α of 0.93 and high item domain and domain total correlation (r = 0.86–0.97). Results The prevalence of positive watchers among participants was 43.3%. The main source of watching was internet (47.6%). Male participants watching pornography were higher than female participants (69.2 vs. 30.8%) and 46.2% of pornography watchers said that coital frequency after watching increases only on the watching day. Watching pornography increases with increase in the years of marriage was the opinion of watchers (70%). Sexual desire increase with watching pornography in 53.1% of watchers. Also, lubrication always increase with watching was the opinion of 56.2% of watchers. Pornography increases masturbation among 74.6% of watchers, but it could not help to reach orgasm among 61.5% of them. Pornography watching increases the incidence of divorce (33.8%) (P = 0.001). Conclusion Pornography has a negative effect on marital relation.
  9,819 225 -
The effect of prophylactic laser barrage treatment before phacoemulsification in high myopia
Moustafa Kamal Nassar, Hatem Mohammed Marey, Kareem Mohamed Abdelreheem
January-March 2015, 28(1):203-206
DOI:10.4103/1110-2098.155995  
Objective The aim of this work was to study the effect of prophylactic laser barrage treatment before phacoemulsification in high myopia. Background High myopia is considered as an important risk factor for the development of peripheral retinal degeneration and the subsequent development of retinal detachment, and hence, prophylactic laser barrage treatment is used for such uses. Patients and methods Thirty eyes of 20 patients with high myopia were divided into the following two groups: group I, high myopia with peripheral retinal degeneration subjected to laser retinopexy, and group II, high myopia with peripheral retinal degeneration not subjected to laser retinopexy. The two groups after undergoing phacoemulsification had been followed for the development of retinal detachment. Results Prophylactic laser barrage treatment significantly reduces the incidence of retinal detachment after phacoemulsification in high myopia. Conclusion Prophylactic laser barrage treatment decreases the incidence of retinal detachment after phacoemulsification in high myopia.
  9,739 260 -
Sexual and reproductive functions in men with Down's syndrome
Abdalla M Attia, Naglaa M Ghanayem, Heba H El Naqeeb
April-June 2015, 28(2):471-476
DOI:10.4103/1110-2098.163904  
Objective The aim of this study was to evaluate sexual and reproductive functions in men with Down's syndrome. Background Down's syndrome is a genetic condition that occurs due to an extra copy of chromosome 21. Affected children show characteristic features and associated diseases in different body systems. All of these diseases have received much interest of researchers and can be managed. However, sexually transmitted infections (STIs), the sexual development, associated congenital anomalies of the genital organs, sexuality, and reproductive disorders of these people have not gained much attention. Patients and methods A case-control study was carried out on 21 Down's syndrome male patients (patient group), aged 21-28 years. Another 21 healthy, age-matched volunteers were included as the control group. Full sexual history was obtained from all participants , including the age at puberty, desire of marriage and parenting children, practice of masturbation, and attraction to the other sex. Follicle-stimulating hormone, luteinizing hormone, prolactin, total testosterone, and estradiol levels were measured and the BMI was evaluated. Results Patients included in the study entered puberty and became fully sexually mature, but later than their healthy peers. More than half (57.1%) of Down's syndrome patients were sexually active, masturbated, were attracted to the other sex, and had the desire to marry. Down's syndrome patients showed a higher BMI. Follicle-stimulating hormone, luteinizing hormone and prolactin levels were significantly higher in Down's syndrome patients compared with the controls. They showed a lower serum total testosterone. The serum estradiol was normal. Conclusion According to our results, some men with Down's syndrome have normal sexual development. They can marry and father children.
  9,708 170 1
Comparisonbetweenfasting and nonfasting lipid profile in patients receiving treatment with statin therapy
Walaa F Abdel-Aziza, Ghada M Soltana, Ahmed M Ahmed Amer
April-June 2017, 30(2):614-618
DOI:10.4103/1110-2098.215443  
Objectives The aim of this study was to assess the effect of ordinary meal on the lipid profileofpatients receiving statin therapy. Background The lipid profile is an essential investigation for the patient who comes to cardiology outpatient clinic. Numerous guidelines recommend sampling in the fasting state for cardiovascular risk assessment. Fasting for 12–14h is not only cumbersome and unpleasant for patients, but may result in limited compliance to disease monitoring and treatment. Patients and methods This study was performed on 100patients with dyslipidemia receiving statin therapy whose doses had not changed for 2 or more months(group I), and 100patients with dyslipidemia not receiving statin therapy(group II). Lipid profile was determined for fasting and postprandial statuses. Results The lipid profile parameters in both groups in fasting and postprandial statuses were compared. In group I, the mean fasting serum triglyceride level was 176.21mg/dl and mean postprandial serum triglyceride level was 213.49mg/dl(P=0.0001); the mean fasting low-density lipoprotein(LDL) level was 161.19mg/dl and mean postprandial LDL was 159.25mg/dl (P=0.184). In group II, the mean fasting serum triglyceride level was 231.06mg/dl and mean postprandial triglyceride level was 284.60mg/dl(P=0.005); the mean fasting LDL was 185.18mg/dl and mean postprandial LDL was 181.32mg/dl(P=0.871). Conclusion Finally, from this study we found that there is no significant clinical difference between fasting and nonfasting levels of total cholesterol, high-density lipoprotein, and LDL. Thus, we can use the nonfasting tests to follow-up the dyslipidemic patients.
  9,523 305 -
Knowledge, attitude and practice of rural mothers towards home injuries among children under 5 years of age in Menouf District- Menoufia Governorate, Egypt
Mohamed A Megahed, Nora A Khalil, Reda A Ibrahem, Reham S El Disoki
October-December 2016, 29(4):1033-1039
DOI:10.4103/1110-2098.202506  
Objective The aim of this study was to assess rural mothers' knowledge, attitudes, and practices as regards first aid for home-related injuries among children under 5 years of age before and after implementation of educational program and to measure the prevalence of these injuries. This study was conducted to assess rural mothers' knowledge, attitudes, and practices toward home-related injuries and their first aids among children under 5 years of age before and after implementation of educational program. Background Accidental injuries are a major health problem in children. They are the most common cause of death in children under 5 years of age. Every year they leave many thousands permanently disabled. Most of the children at risk from a home accident are in the 0–5 years' age group. Most of these accidents are preventable through increased awareness, improvements in the home environment, and greater product safety. Materials and methods This cross-sectional interventional study included 270 mothers from Bijirim village, Queisna district, Menoufia, Egypt. A predesigned questionnaire was administered to them before and after application of educational program. The first part of the questionnaire included sociodemographic and economic characteristics of the mothers. The second part included mothers' knowledge about the causes, prevention, and first aid of home injuries. The third part included mothers' practice followed toward their children in case of exposure to any type of home injuries and its occurrence. Results The study result revealed that mass media were the main source of knowledge for 43.3% of the participants. There was a statistically significantly higher percent of satisfactory knowledge among highly educated mothers and those with middle and high socioeconomic level. There was a significant positive correlation between mothers' practice and either their education or their socioeconomic level. There was a significant correlation between socioeconomic level and either knowledge or attitude of mothers toward home injuries. There was a significant improvement in mothers' knowledge after intervention. Conclusion The study revealed that there was a significant improvement in mothers' knowledge and practice as regards home injuries after intervention.
  8,600 640 -
REVIEW ARTICLE
Management of nephrotic syndrome in family practice: a systematic review
Mahmoud A Kora, Hala M Shahin, Noura A Khalil, Basma A Hafez El Beah
October-December 2016, 29(4):765-771
DOI:10.4103/1110-2098.202532  
Objective The aim of the study was to perform a systematic review to summarize the diagnosis and management of nephrotic syndrome in family practice. Data sources Medline, articles in Medscape, American Family Physician (AAFP), and PubMed were searched. The search was performed on 1 November 2014 and included all articles with no language restrictions. Study selection The initial search yielded 250 articles. Six articles fulfilled the inclusion criteria. The articles included nephrotic syndrome clinical presentation, investigation to confirm the diagnosis, and management in family practice. Data extraction Data from each eligible study were abstracted independently in duplicate using a data collection form to obtain information on study characteristics, interventions, and quantitative results reported for each outcome of interest. Data synthesis There was heterogeneity in the data collected. A meta-analysis could not be carried out. Significant data were collected. Thus, a structured review was performed. Conclusion Six articles were reviewed; five articles and one systematic review summarize the clinical presentation investigation and management. Patients with nephrotic syndrome present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia. In adults, diabetes mellitus is the most common secondary cause, and focal segmental glomerulosclerosis and membranous nephropathy are the most common primary causes. Family physicians may encounter patients with nephrotic syndrome because of primary renal disease or a number of secondary causes, and should initiate appropriate diagnostic workup and medical management pending specialist consultation.
  4,355 3,661 -
ORIGINAL ARTICLES
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.
  7,203 798 6
Hepatocellular carcinoma in Egypt: epidemiological and histopathological properties
Nanis S Holah, Dina S El-Azab, Hayam A Aiad, Dina M Sweed
July-September 2015, 28(3):718-724
DOI:10.4103/1110-2098.167895  
Objectives To study the epidemiological and pathological properties of hepatocellular carcinoma (HCC) cases eligible for surgical resection. Background HCC is the sixth most common cancer worldwide and the third most common cause of cancer death. In Egypt, liver cancer forms 1.68% of the total malignancies. HCC constitutes 70.48% of all liver tumors among Egyptians. HCC represents the main complication of cirrhosis. Materials and methods This longitudinal study included 92 HCC patients who had undergone surgical intervention. Clinical and demographic data were collected from medical records, and paraffin blocks were retrieved from the Archives of the Pathology Department, National Liver Institute, Menoufia University, during the period between March 2007 and October 2014. Results revealed that 51.1% of the studied HCC patients were at least 58 years old, 81.5% male and 18.5% female, 51.2% of the patients had an a-fetoprotein level of at least 200 ng/ml and 95.7% were positive for hepatitis viral infection. Revision of the pathological data revealed that 82.6% of the HCC cases presented as a single focal lesion with a median size of 5 cm. About 76.1% were on top of a cirrhotic liver and 44.5% showed dysplastic changes and 96.7% of the cases were of the classic type. About 57.6% of the cases presented with stage T1 and 34.8% of the cases had lymphovascular invasion. Conclusion On the basis of 92 surgical specimens of HCC, most of the HCC in Egypt occurred in men who developed a cirrhotic liver due to HCV infection. Epidemiological and histopathological data of HCC highlight the importance of an integrated strategy for the prevention and the treatment of viral hepatitis infections and chronic liver disease.
  6,889 1,066 -
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.
  7,132 344 2
Cardiac troponin I as an early predictor of perinatal asphyxia
Ahmed T Mahmoud, Maha El-Bassuny, Ayat Shebl
July-December 2013, 26(2):145-150
DOI:10.4103/1110-2098.126148  
Objective The objective of this study was to test the hypothesis that cardiac troponin I (cTnI), a known marker of myocardial injury, is also an early predictor of both severity and mortality in cases of perinatal hypoxia. Background Delivery is a stressful and risky event that poses a risk to newborns. The mother-dependent respiration has to be replaced by autonomous pulmonary breathing immediately after delivery. If delayed, it may lead to deficient oxygen supply, compromising the survival and development of the central nervous system. The outcomes of perinatal asphyxia are devastating and permanent, making it a major burden for the patient, the family, and society. Thus, there has been considerable focus on the early identification of newborns exposed to perinatal asphyxia and development of therapeutic strategies to reduce long-term morbidity and mortality. Troponin is an inhibitory protein complex located on the actin filament in all striated muscles and consists of three subunits: T, C, and I. cTnI was measured as an indicator of cardiac injury for a long time, but it has been of interest for the prediction of poor neonatal outcome in perinatal asphyxia. Aim of the study The aim of this work was to test the hypothesis that cTnI, a known marker of myocardial injury, is also an early predictor of both morbidity and mortality in cases of perinatal hypoxia. Materials and methods This study was carried out between October 2011 and June 2012. It included 40 neonates with perinatal asphyxia admitted to the neonatal ICU, El-Ahrar Zagazig General Hospital. Twenty healthy neonates matched for both age and sex were selected randomly as a control group. Blood samples were collected from the two study groups. cTnI was measured in relation to neurological sequelae, and deaths in both the groups were also evaluated. Results The mean cTnI of asphyxiated neonates was 4.6 ΁ 4.4 ng/ml, significantly higher than that of the control neonates, which was 0.55 ΁ 0.6 ng/ml. This difference was statistically significant. Conclusion cTnI was markedly increased in perinatal asphyxia. This was related to the severity of perinatal asphyxia. It can also be used as an early predictor of neonatal morbidity and mortality in perinatal asphyxia.
  1,975 5,286 1
Genetic evaluation of children with ambiguous genitalia
Soheir S Abou El-Ella, Maha A Tawfik, Wafaa M Abo El-Fotoh, Ahmed Sh Abo Howla
January-March 2016, 29(1):79-88
DOI:10.4103/1110-2098.178991  
Objectives The aim of the study was to conduct a clinical assessment of pediatric patients with ambiguous genitalia, perform molecular genetic studies for SRY and SOX9 genes, and provide genetic counseling for patients and their families. Background Ambiguous genitalia, currently known as disorders of sex development (DSDs), are associated with atypical development of chromosomal, gonadal, or anatomical sexual characteristics, with an incidence of one in 4500 live births. Their early management is crucial for preventing complications, especially psychiatric impacts on the patient and the family, and should be decided after careful consideration of the child's welfare. Materials and methods Sixteen patients aged 1 day to 6 years were selected from the Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Egypt. All patients were subjected to detailed history taking, a thorough clinical examination, routine and hormonal investigations, imaging studies, and cytogenetic and molecular studies for SRY and SOX9 genes. Results History revealed seven patients (43.75%) with positive consanguinity and five patients with similar conditions in their families. Hormonal study revealed five patients (31.25%) above normal ranges for serum 17-OH progesterone levels and two patients (12.5%) below normal ranges. Karyotyping revealed six patients with 46, XX DSD, eight with 46, XY DSD, one with 45, X, and another with 45, X/46, XY. On the basis of molecular studies, the SRY gene was positive for six patients with a normal male 46, XY karyotype and for one patient with 45, X karyotype (translocated SRY). SRY was negative for five patients with a normal female 46, XX karyotype and for one patient with 45, X/46, XY karyotype (deleted SRY). All patients were positive for the SOX9 gene and no deletions were detected. Conclusion Early identification of the genetic cause of DSD will in many cases streamline and direct clinical management of the patient with more focused endocrine and imaging studies and better surgical decision.
  6,901 195 -
Effect of phototherapy on serum calcium level in neonatal jaundice
Mohammed Hamed Bahbah, Fathia Mohamed ElNemr, Rania Salah ElZayat, Elham Aziz Khalid Aziz
April-June 2015, 28(2):426-430
DOI:10.4103/1110-2098.163896  
Objectives The aim of the study was to determine the effect of phototherapy on serum calcium level in neonatal jaundice. Background Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia in neonates. However, this treatment modality may result in the development of some complications such as induction of hypocalcemia. Patients and methods This study included 50 full-term neonates with jaundice (25 males and 25 females) who received phototherapy for treatment of neonatal indirect hyperbilirubinemia and 25 neonates (13 males and 12 females) complaining of exaggerated physiological hyperbilirubinemia taken as control not exposed to phototherapy. Serum calcium was checked before and 48 h after starting phototherapy. A comparative study was conducted between these groups to determine the effect of phototherapy on serum calcium level. Results In the neonates of the study group, the serum bilirubin level before phototherapy was 15.48 ± 1.94 mg/dl. However, the serum bilirubin level after phototherapy was 12.41 ± 2.10 mg/dl. There was highly statistically significant decrease of the serum bilirubin levels after phototherapy as compared with serum bilirubin levels before phototherapy in the study group (P < 0.001). With respect to the calcium level, the total serum calcium level before phototherapy was 9.36 ± 0.29 mg/dl, whereas the serum calcium level after phototherapy was 8.58 ± 0.76 mg/dl. There was highly statistically significant decrease of the serum calcium levels after phototherapy as compared with serum calcium levels before phototherapy in the study group. Conclusion Hypocalcemia is a common complication of phototherapy.
  6,322 747 2
Direct closure versus local flaps in management of pilonidal sinus
Mohamed Leithy Ahmed Alam El-Dein, Tarek Fouad Abd El-Hameed Keshk, Magdy Ahmed Loulah, Ehab Abd El-Fattah Mohamed El-Ariny
October-December 2014, 27(4):623-628
DOI:10.4103/1110-2098.149616  
Objectives The aim of this randomized prospective trial was to compare both the results of direct closure and local flaps in management of pilonidal sinus. Background The best surgical technique for sacrococcygeal pilonidal disease is still controversial in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. Materials and methods From February 2012 to February 2013, 30 consecutive patients with chronic pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group 1, n = 15 patients) or excision and flap reconstruction [group 2, n = 15 patients; classic Limberg flap ( n = 5), modified Limberg flap ( n = 5), and V-Y advancement flap ( n = 5)]. Demographic data, operative time, postoperative pain, hospital stay, duration of incapacity for work, postoperative complications (infection, flap edema, wound dehiscence), patient satisfaction, and postoperative recurrence were recorded. Results The mean follow-up was 12 months. A significant difference was observed between the two groups in terms of operative time (min), postoperative complications, and patient satisfaction (P < 0.05) for all comparisons. There were no significant differences among the two groups with respect to age, sex distribution, postoperative pain, length of hospital stay (in days), duration of incapacity for work (in days), and frequency of recurrent disease (P>0.05) for all comparisons. In the modified Limberg flap, no wound infection or recurrence of the disease occurred. Conclusion Flap reconstructions were superior to primary closure after excision of pilonidal sinus, and modified Limberg flap was superior with respect to wound infection and recurrence.
  3,491 3,497 -
A prospective study of some medicolegal aspects of physical and sexual family violence cases at Menoufia University hospital over 2 years
Samy M. Badawy, Naira F. Gergis, Amira M. El-Seidy, Fatma S. Kandeel
January-June 2014, 27(1):122-129
DOI:10.4103/1110-2098.132781  
Objective To study some medicolegal aspects of family violence cases at Menoufia University hospital beginning from 1 June 2009 to 31 May 2011 in terms of sociodemographic pattern, injuries pattern, relation between family violence and substance abuse, and outcome of these cases. Background Family violence occurs in all socioeconomic groups, in every race, ethnic group, religion, and also in same-sex relationships and it can be perpetrated by both men and women. It may be called battery, child abuse, elder abuse, intimate partner violence, family violence or domestic violence, and other violent acts between family members. Patients and methods This was a prospective study including all family violence cases after obtaining their written valid consents, and clinical sheets were obtained including assessment of history and examination. Results A total of 472 cases were studied. Physical violence constituted 98.5% (465 cases) and sexual violence constituted 1.5% (seven cases) of cases. Most violence occurred indoor (84.7%) and in a repeated manner (80.7%). Social causes of violence (50.2%) outnumbered other causes, followed by economic causes (28.2%). The most common assailants in family violence were husbands (23%), followed by brothers (16%). Most of the assailants were men (89.2%), from rural areas (71.8%), of low socioeconomic standard (53.2%). Sexual violence was significantly associated with lower age of victims and assailants. Conclusion Family violence was mainly of the physical type. Most of the assailants were men. Social and economic causes were the main causes. Sexual violence was significantly associated with lower age of victims and assailants.
  6,585 282 -
The role of sildenafil citrate(viagra) suppositorieson endometrial response(thickness and mean resistance index of endometrial spiral artery) in cases of unexplained infertility
Shahinaz El-Shourbagy, Ahmed M. E. Ossman, Ashraf El-Mohamady
April-June 2017, 30(2):343-349
DOI:10.4103/1110-2098.215451  
Objective The oblective of this study was to evaluate the endometrial response of women with unexplained infertility after treatmentwithsildenafil citrate(viagra) suppositories. Background Unexplained infertility refers to failure to conceive in a couple with no definitive cause. Endometrial thickness(ED TH) and perfusion may have an important contribution to etiopathogenesis of unexplained infertility. Patients and methods A total of 50 women with unexplained primary infertility were treated with 25mg of sildenafil citrate suppositories four times per day for 7days starting from the fifth day of the menstrual cycle for three cycles. Ultrasonographic measurement of ED TH and the mean resistance index(RI) values of endometrial spiral artery(SA) assessed by transvaginal color-pulsed Doppler ultrasound were measured in women with unexplained infertility before and after sildenafil citrate treatment and compared with an equal number of a fertile control group receiving no treatment. The conception rate and pregnancy outcome were recorded in the two groups. Results Women with unexplained infertility in the present study had a significantly thinner endometrium and a higher SA-RI(6.52+0.77; 1.00+0.23mm, respectively), meaning lower peri-implantation blood flow compared with fertile controls(11.98+1.23; 0.58+0.06mm, respectively). Sildenafil citrate-treated women showed a statistically significant increase in ED TH(8.87+0.56mm; P <0.001) and a significant decrease in the mean SA-RI(0.61+0.07; P <0.001), yielding a better conception rate. Conclusion Treatment with viagra suppositories enhances endometrial blood flow by decreasing the SA-RI and consequently improves endometrial growth and receptivity in cases of unexplained infertility, thus yielding a better conception rate.
  6,590 251 -
Improving esthetic outcome of facial scars by fat grafting
Fouad Ghareeb, Dalia M Elsakka, Yahia Alkhateep, Hossam M Zayed
April-June 2017, 30(2):412-419
DOI:10.4103/mmj.mmj_718_16  
Objective The aim of this study was to evaluate the effects of different techniques of fat grafting on improving the esthetic outcome of facial scars. Background Control of facial scarring is one of the most difficult challenges in surgical practice, and represents a difficult therapeutic problem facing plastic surgeons to achieve good results. To date, no gold standard exists for the treatment of scar tissue. Autologous fat grafting has been introduced as a promising treatment option for scar tissue-related symptoms. However, the scientific evidence for its effectiveness remains unclear. Patients and methods This study was conducted on 30patients with obvious facial scars. Patients' age ranged from 8 to 48years. Patients were selected randomly to be treated with fat grafting. The abdomen and thigh were the most commonly chosen donor sites. Fat was processed to be injected at the dermohypodermal junction(microfat grafting) or intradermal injection(nanofat grafting) was used. Results Fat grafting proved to have a significant role in scar remodeling. This was measured clinically by the Vancouver Scar Scale. Regarding patient satisfaction with cosmetic appearance, 15cases were evaluated as excellent, eight cases were evaluated as good, and five cases were evaluated as fair. Conclusion Autologous fat grafting has a significant role in facial scar remodeling and provides a beneficial effect on facial scar tissue and scar-related conditions with not only esthetic results but also functional results. Significant improvement in scar appearance, skin characteristics, and restoration of volume and three-dimensional contour is reported.
  6,203 213 1
Correlation between clinical examination and ultrasound of liver and spleen span in normal children between 12 and 18 years of age
Ali M El-Shafie, Fathia M El-Nemr, Alif A Allam, Abdelrazek M El-Afifi
April-June 2015, 28(2):382-386
DOI:10.4103/1110-2098.163889  
Objectives The aims of this study were to correlate liver span measured clinically in healthy Egyptian children from 12 to 18 years of age in Dakahliah with ultrasound findings, and to obtain normal values of both liver and spleen spans in Egyptian children. Background A sound measurement of the liver size in children of different age groups is necessary to enable the pediatrician to exclude hepatomegaly. Participants and methods This study included 331 healthy Egyptian school children from Dakahliah, Aga district, from 12 to 18 years of age of both sexes (224 male and 107 female). The children underwent a complete physical examination and subsequent ultrasonographic scans were performed for the liver and spleen. The liver span in the midclavicular line was estimated clinically by palpation and percussion, both the liver and the spleen were measured by ultrasonography, and the values were tabulated and graphed. Results Normal values of liver and spleen measures were classified by age and sex; data were tabulated and graphed. There was a statistically significant correlation between clinical and ultrasound measures of liver span (midclavicular line, midsternal line) in healthy children. The liver span also correlated with body weight, height, and BMI and ultrasound spleen axis. Conclusion We could record a standard liver and spleen normogram on Egyptian children from 12 to 18 years of age. Also, clinical estimation of liver span showed a significant correlation with ultrasonographic findings in all our healthy children; thus, we can continue to use clinical methods for the evaluation of liver size in children.
  6,161 205 -
REVIEW ARTICLE
Dermoscopy in hair disorders
Iman A Seleit, Olaa A El-Bakry, Rawnaa M El-Sherif
October-December 2014, 27(4):762-765
DOI:10.4103/1110-2098.149746  
Hair loss can have significant effects on patients' quality of life, and a prompt diagnosis of the different types of alopecias and early intervention are needed. This review highlights the main dermoscopic findings in the different types of alopecia, such as androgenetic alopecia, alopecia areata, trichotillomania, lichen planopilaris, and discoid lupus erythematosus of the scalp. We believe that this important tool has been demonstrated to help dermatologists in finding the right site for the biopsy or, furthermore, avoiding unnecessary biopsies. Data sources were medical text books, medical journals, and medical websites that have updated research with the key word Dermoscopy in the title of the paper. Systematic reviews that addressed dermoscopy, its impact on dermatological lesions, and the role of physicians in prevention and management were selected. A special search was conducted at midline with the key word Dermoscopy in the title of the papers; extraction was made, including assessment of the quality and the validity of papers that met the prior criteria that describe Dermoscopy and its use in the diagnosis of hair disorders. Each study was reviewed independently, and the data obtained were rebuilt in new language according to the need of the researcher and arranged into topics through the article. Hair and scalp dermoscopy (trichoscopy) is a fast and noninvasive technique that allows the identification of hair and scalp diseases on the basis of analysis of trichoscopy structures and patterns without the need for removing hair for diagnostic purposes or unnecessary biopsies. Dermoscopy may be useful in the differential diagnosis of various hair and scalp disorders such as alopecia areata, androgenetic alopecia, and tenia capitis and also in the differential diagnosis between discoid lupus erythematosus and lichen planopilaris.
  5,914 436 -