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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
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.
  6,493 1,049 1
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
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.
  4,652 593 2
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
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.
  4,111 787 -
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
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.
  4,467 224 2
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
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.
  4,255 155 -
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
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.
  4,177 161 -
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
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.
  3,745 192 -
Additive effect of ozone therapy to insulin in the treatment of diabetic rats
Sohair Saleh, Mamdouh El-Ridi, Sherif Zalat, Safaa El-Kotb, Sally Donia
January-June 2014, 27(1):85-92
Background Chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the heart and blood vessels. Therapy in the past few decades was mainly aimed at reducing hyperglycemia. It became clear that ameliorating oxidative stress through treatment with antioxidants might be an effective strategy for reducing diabetic complications. Medical ozone treatment may be useful in the treatment of diabetes and its complications. Objective This study aims to show the additive effect of ozone to insulin in the treatment of diabetes in rats. Materials and methods Diabetes was induced by an intraperitoneal injection of streptozotocin (45 mg/kg) in 0.2 ml of 10 mmol/l citrate buffer. Rats were considered diabetic when fasting blood glucose was at least 113 mg/dl. Rats proved to be diabetic were isolated and subdivided into four subgroups: (a) diabetic nontreated rats (n = 8), (b) diabetic ozone-treated rats (n = 8), (c) diabetic insulin-treated rats (n = 8), and (d) diabetic insulin + ozone-treated rats (n = 8). After induction, all rats were fasted for 12 h. Systolic blood pressure (SBP) was measured. Retro-orbital blood samples were collected for estimation of fasting serum glucose, glycosylated hemoglobin, total antioxidant capacity (TAC), and malondialdehyde (MAD) level. Rats were then sacrificed; vascular reactivity to norepinephrine and acetylcholine with and without endothelial lining was estimated. Results The data showed that insulin reduced the elevated fasting serum glucose, glycosylated hemoglobin, MAD, and SBP significantly when compared with the diabetic nontreated group. Also, it significantly reduced TAC and vascular reactivity to norepinephrine with and without endothelium, but there was an increase in the percent of relaxation to acetylcholine. Ozone therapy potentiated the effects of insulin on SBP and vascular reactivity. Importantly, serum MAD and TAC and glycemic state were significantly improved. Conclusion This study shows that ozone therapy may have an additive effect in the treatment of diabetes by insulin; this may attribute to the multiprotective antioxidant effect of ozone.
  3,526 241 -
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
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.
  1,943 1,678 -
Dermoscopy in hair disorders
Iman A Seleit, Olaa A El-Bakry, Rawnaa M El-Sherif
October-December 2014, 27(4):762-765
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.
  3,292 298 -
Calprotectin as a fecal marker for diagnosis and follow-up in patients with ulcerative colitis
Mohamed A.E. Nouh, Atef A.E. Ali, Emad F.A. El Halim, Hosam I. Mohamed, Ayman M.A. El Ghany, Amira M. Badawy
January-June 2014, 27(1):35-43
Objective This study is designed to evaluate the role of fecal calprotectin as a marker for the diagnosis of ulcerative colitis (UC) and its correlation with disease activity and remission. Background Inflammatory bowel diseases (IBD) are lifelong intestinal inflammatory conditions of unknown etiology, characterized by remissions and exacerbations. The diagnosis and classification of IBD is usually established by a combination of tests (laboratory, endoscopic, and/or radiologic) in the presence of clinical symptoms. Fecal calprotectin serves as a noninvasive biomarker of intestinal inflammation, and has been found to be useful in the diagnosis of IBD, assessment of response to medical therapy, and in prediction of clinical relapse. Materials and methods This study was carried out on 40 patients. Twenty of these patients had clinical, laboratory, colonoscopic, and histopathological findings of UC. Group I was subdivided as follows: GIa: 20 patients with active UC and GIb: the same patients as in GIa while on remission. Group II included 20 patients as controls, matched for age and sex without clinical, laboratory, colonoscopic, and histopathological findings of UC. Complete stool analysis, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) titer, complete blood count, colonoscopy and biopsy, histopathological examination of biopsy specimens, measurement of ulcerative colitis activity index (UCAI), and quantitative determination of calprotectin in stool sample were carried out for all patients. Results There was a highly significant increase in the mean value of fecal calprotectin in active UC patients in comparison with the inactive UC patients and controls. Also, there was a highly significant increase in the mean value of fecal calprotectin in the inactive UC patients in comparison with the controls. There was also a highly significant positive correlation between fecal calprotectin and UCAI, CRP, ESR, total leukocyte count, and platelets count. At the cut-off value of 131 μg/g, fecal calprotectin has 100% accuracy, sensitivity, specificity, positive predictive value, and negative predictive value in differentiating UC patients from other patients with lower gastrointestinal symptoms and at the cut-off value of 253 μg/g fecal calprotectin has 95% accuracy, sensitivity, specificity, positive predictive value, and negative predictive value in differentiating active from inactive UC patients. Conclusion Fecal calprotectin is a valuable, simple, easily performed, and cost-effective noninvasive marker for evaluation of patients with UC. It differentiated UC and other diseases causing colonic symptoms (cut-off value of 131 μg/g) and between active and inactive UC (cut-off value of 235 μg/g) with high accuracy, sensitivity, and specificity. It also correlates well with other markers for UC activity (UCAI, ESR, CRP, total leukocyte count, and platelets count) and could be a reliable surrogate marker for the severity of UC.
  3,251 235 -
Methods and applications for mesenchymal stem cells
Eman A Ahmedy, Samia H Kandel, Samia H Rizk, Hala M Gabr, Khaled A Khalifa, Samar M Kamal
July-December 2013, 26(2):71-77
Objective The aim of this work is to study neurogenesis using mesenchymal stem cells (MSCs) as a model of stem cells and then follow them as they form neurons. Background MSCs are multipotent adult stem cells present in all tissues. They are present in the bone marrow, and can differentiate in vitro into neurons, glial cells, and myofibroblasts. MSCs have been proposed as sources of stem cells for regeneration of the central nervous system. Thus, one of the goals of regenerative medicine is to ameliorate irreversible destruction of brain tissue and spinal cord by harnessing the power of stem cells to initiate neurogenesis in damaged areas of the brain. Materials and methods MSCs were cultured from bone marrow aspirate and detected morphologically and by flow cytometric analysis of surface markers CD44 and Oct3/4, then differentiated into neural cells using neural induction media, which consisted of a cocktail of retinoic acid dissolved in DEMSO, recombinant human basic fibroblast growth factor, recombinant human epidermal growth factor, and insulin-like growth factor I, and detected by glial fibrillary acidic protein (GFAP). Results The results of this study showed that MSCs could be isolated from the bone marrow and assumed the typical fibroblastoid morphology and reached 80-90% confluence at about 9 days. They expressed CD44 with a mean ± SD of 81.54 ± 11.58 and CD Oct3/4 with a mean ± SD of 56.12 ± 17.37. MSCs showed positive expression for double expression of CD44-OCT3/4, with a mean ± SD of 54.03 ± 17.42. A highly significant statistical correlation (P < 0.001) was found between age and double expression of CD44-OCT3/4. No statistically significant correlation (P > 0.05) was found between MNCs and double expression of CD44-OCT3/4. MSCs induced with neural induction media show morphological changes consistent with neurogenesis as compared with the symmetric morphologies of the uninduced cells, as shown by an inverted microscope. Induced cells showed positive staining with GFAP whereas uninduced cells showed negative staining. Conclusion MSCs can be isolated successfully from bone marrow aspirate and can be differentiated into GFAP-positive neural cells.
  1,634 1,664 -
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
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.
  1,325 1,942 -
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
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.
  2,799 466 -
Infection control awareness among healthcare providers in family health settings in Shebin El-kom district, Menoufia Governorate, Egypt
Mahmoud El Sayed Abu Salam, Hewaida M Anwar El-Shazly, Marwa Ahmed Abu Shady Dewidar
October-December 2014, 27(4):840-846
Objectives The aim of the study was to assess the knowledge, the attitude, and the practice of healthcare providers in family health settings regarding infection control measures in Shebin El-kom district. Background Hospital-acquired infections are among the leading causes of death; prevention of hospital-acquired infection therefore must be cost effective, but achievable even with the limited resources for infection control programs in primary healthcare. Participants and methods This was a cross-sectional study conducted in two urban and two rural family health settings in Shebin El-kom district, Menoufia Governorate. Four different settings were selected from cluster sampling followed by stratified random sampling. The self-administered anonymous questionnaire was administered to 412 participants including physicians, nurses, and paramedical personnel. Each healthcare facility was observed for infection control measures by an observation checklist, followed by comparative analysis of different categories of participants. Results The knowledge scores were low to moderate among all participants; only 32.5% had a high level of knowledge, in comparison with 96.6% of the participants who had a positive attitude towards infection control measures. However, 54.3% of the physicians showed a high practice score in comparison with 32.6% of the nurses. Conclusion Standards of infection control practices were not optimum at family healthcare settings, although the reported practice was better than the reported knowledge. Further studies are required to determine the other factors associated with compliance of infection control practices, and training courses on hospital-acquired infection for such personnel would be required.
  2,855 343 -
Varicocele repair outcome with respect to hormonal profile and spermogram pattern
Alaa Eldin M Almahdy, Ahmed A Gamal Eldin, Mohammed M. Abdullah, Mohammed I. Abuzaid
January-June 2014, 27(1):164-168
Objectives This study aims to evaluate the outcome of varicocelectomy on the hormonal and spermatogenic function of the testis. Background Varicocele of the testis is the most common male factor causing subfertility. The harmful effect of varicocele on the testis has been documented, and the value of varicocelectomy in improving spermatogenesis has also been confirmed. However, the effect of varicocele on steroidogenesis and the role of varicocelectomy in improving testicular testosterone production are still under evaluation. Patients and methods This prospective study included 46 patients with bilateral varicocele. Semen analysis was carried out and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone were obtained preoperatively. Bilateral inguinal varicocelectomy was performed in all 46 patients. All patients were followed up 3 months postoperatively by semen analysis and serum levels of FSH, LH, and testosterone. Only 32 patients were followed up 6 months postoperatively, also by semen analysis and serum levels of FSH, LH, and testosterone. Results There was no statistically significant change in the levels of FSH, LH, and testosterone postoperatively even after 6 months of follow-up. However, a significant increase in the testosterone level was found in patients with preoperative low testosterone level (≥3 ng/ml) both at 3 months (P = 0.005 ) and at 6 months (P = 0.004) from the operation. Both sperm concentration and progressive sperm motility showed statistically significant increases both at 3 months (P = 0.0003 and 0.0001, respectively) and 6 months (P = 0.0001 and 0.002, respectively) of follow-up. Normal morphology of sperm showed a statistically significant improvement only after 3 months of follow-up (P = 0.008). Conclusion Varicocelectomy improves the spermatogenic function of the testis. In addition, it has a favorable effect on testosterone production in patients with varicocele and low serum testosterone.
  2,847 157 -
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
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.
  2,753 251 -
Kidney injury molecule-1 as an early marker for acute kidney injury in critically ill patients
Ibrahim M Boghdady, Mostafa M EL Naggar, Mahmoud M Emara, Rania M EL-Shazly, Karim S Mahmoud
July-December 2013, 26(2):98-104
Objective The aim of this study was to evaluate the role of kidney injury molecule-1 (KIM-1) as an early marker for acute kidney injury (AKI) in critically ill patients as compared with conventional markers (e.g. serum creatinine). Background Depending on traditional markers for renal functions, namely, blood urea and serum creatinine, has led to unacceptable delay in the diagnosis of AKI and in initiating treatment. Materials and methods This study included 89 individuals: 79 critically ill patients and 10 healthy individuals who served as controls. All patients were prospectively followed up from the time of ICU admission. Blood and urine samples were collected simultaneously at predetermined time points: at the time of ICU admission, 6 h after arriving, 12 h after arriving, and daily thereafter for a minimum of the next 2 days and a maximum of 5 days. Results KIM-1 can detect AKI as early as 6 h from its occurrence and before the elevation of conventional markers. KIM-1 is (unlike conventional markers) not influenced by age, sex, and BMI. Conclusion KIM-1 is a reliable indicator for early detection of AKI in critically ill patients.
  2,791 182 -
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
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.
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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
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.
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Sublay hernioplasty versus onlay hernioplasty in incisional hernia in diabetic patients
Mohamed Leithy, Magdy Loulah, Hesham Abu Greida, Fawzy Abu Baker, Atef Moussa Hayes
April-June 2014, 27(2):353-358
Objective This study aims to compare between sublay hernioplasty and onlay hernioplasty in incisional hernia repair in diabetic patients. Background Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. A wide spectrum of surgical techniques have been developed, ranging from suturing techniques to various types of prosthetic mesh repair. Use of a preperitoneal mesh repair technique showed a reduced number of postoperative complications and recurrence compared with other techniques. Materials and methods A prospective study was carried out on 30 diabetic patients who underwent incisional hernia repair with sublay hernioplasty or onlay hernioplasty between January 2012 and February 2013 in Sherbin Central Hospital and Menoufia University Hospital. The patients were divided into two equal groups (groups A and B). Patients in group A were treated with sublay repair, whereas patients in group B were treated with onlay repair. All patients underwent a preoperative assessment and postoperative follow-up. Outpatient clinical notes, discharge summary, operative notes, and laboratory data were reviewed. Results Sublay hernioplasty proved to be better with fewer complications compared with onlay hernioplasty. There was a statistically significant difference between the two groups regarding postoperative wound infection and seroma (40% in the onlay group; P > 0.0005). There was no statistically significant difference between two groups as regards postoperative recurrence (P < 0.0005). Conclusion Sublay mesh repair showed excellent short-term results, with minimal morbidity. It resulted in fewer postoperative complications and no recurrence. Compared with the onlay technique (in the literature) sublay mesh repair is a gold standard treatment for incisional hernia repair.
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Resurrection of the Amsler chart in macular diseases
Moustafa Kamal Nassar, Nermeen Mahmoud Badawi, Mostafa Mohammed M Diab
January-March 2015, 28(1):174-180
Objectives To assess the validity of the Amsler chart as a screening test for the detection of macular diseases and to test its reliability in the follow-up of patients with macular diseases compared with other confirmatory investigative methods such as fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). Background The Amsler chart provides a convenient method to detect and monitor macular diseases on the basis of a grid pattern that allows both scotomas (detected by missing or blurred lines) and metamorphopsia (bowed or distorted lines) to be detected. Since its discovery, the Amsler grid has become important in the evaluation of the central 20° of the visual field surrounding the fixation. Methods A total of 50 eyes of 50 patients with different types of macular diseases were tested by the Amsler chart and compared with other diagnostic investigations (fundus fluorescein angiography and optical coherence tomography) in each patient. These patients were followed at 1, 3, and 6 months by BCVA, the Amsler chart, and other investigations. Results Fifty patients (50 eyes) were analyzed statistically. The sensitivity of detection of macular disease by the Amsler grid was 88% (95% confidence interval: 77.9-97.6%). There was substantial agreement between the results of the Amsler grid and those of other investigations on the follow-up evaluation. Conclusion The Amsler chart is an accurate test in detecting macular disease, and if used properly, it could be effective in the early detection of macular diseases. The Amsler chart could be used for the follow-up of patients suffering from macular diseases with high reliability.
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Relationship between MTHFR polymorphism and side effects of high-dose methotrexate in pediatric acute lymphoblastic leukemia
Farida H El Rashedy, Seham M Ragab, Ashraf A Dawood, Mahmoud A El-Hawy
July-December 2013, 26(2):138-144
Objectives To study the relationship between plasma methotrexate (MTX) level, methylenetetrahydrofolate reductase (MTHFR) gene polymorphism, and the occurrence of complications associated with high-dose methotrexate (HDMTX) in pediatric acute lymphoblastic leukemia (ALL). Background ALL is the most common type of cancer in children. Administration of HDMTX, followed by leucovorin rescue is an important component in the treatment of childhood ALL. MTX toxicity mainly includes mucositis, myelosuppression, and hepatic toxicity. MTX toxicity can vary with genetic variability in folate-metabolizing enzymes (e.g. MTHFR). Patients and methods A total of 26 ALL children were studied. Clinical assessments, laboratory detection of complete blood count parameters, detection of liver and renal functions before and after HDMTX, detection of MTX level after HDMTX, and PCR (restriction fragment length polymorphism) for the MTHFR polymorphism (C677T and A1298C) were carried out. Results The plasma MTX level was found to be related to HDMTX toxicity, especially mucositis. For the C677T MTHFR polymorphism, neutrophil recovery days were higher in TT, followed by CT and CC polymorphism, platelet recovery days were higher in TT, followed by CT and CC polymorphism, and days required for plasma MTX level to decrease to less than 0.1 μmol/l were higher in TT, followed by CT and CC polymorphism. For the A1298C polymorphism, postinfusion platelet count was lower in AA than in AC and CC polymorphism and platelet recovery days were lower in AA than in CC and AC polymorphism. Neutrophil recovery days and days required for plasma MTX level to decrease to less than 0.1 μmol/l were higher in AA, followed by AC and CC polymorphism. For the A1298C polymorphism, AC patients had a significantly higher overall survival than CC and AA patients. Conclusion The increase in plasma MTX level after HDMTX might be associated with an increase in the risk for complications. Genotyping of folate polymorphisms might be useful in ALL to optimize MTX therapy, reducing the associated toxicity with possible effects on survival.
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Compliance of diabetic patients with the prescribed clinical regimen
Ayman A. Attyia, Rabie E. El Bahnasy, Mahmoud E. Abu Salem, Manal A. Al-Batanony, Ayat R. Ahamed
Jan-June 2013, 26(1):54-57

This study aimed at studying the prevalence of noncompliance among diabetic patients in Gharbia governorate in Egypt as well its causes, its effect on glycemic control, and factors affecting it.


There is growing evidence suggesting that because of the alarmingly low rates of compliance, increasing the effectiveness of compliance interventions may have a great impact on the health of the population. Promotion of therapeutic compliance is considered an integral component of patient care. It has been shown that despite effective methods of treatment, many diabetic patients fail to achieve satisfactory glycemic control, which leads to accelerated development of complications and increased mortality.

Patients and methods

A total of 339 diabetic patients who fulfilled the inclusion criteria were recruited in the present study. Compliance to treatment was evaluated during patients’ visits to health units in Gharbia governorate. Medication compliance was assessed during a personal interview with each patient using a multiple-choice questionnaire. Blood samples were obtained for measurement of glycated hemoglobin (HbA1c).


In the study population, the compliance rates were observed to be suboptimal. The most important social factors that significantly affected compliance rates included age, income, and educational level. Among the factors that significantly affected compliance rates were duration of treatment, presence of diseases other than diabetes, and the number of prescribed drugs. Another factor that played an important role was diabetes care costs. The most common reasons for low rates of compliance were forgetfulness and high cost of treatment.


An improvement in the compliance level may be achieved through improvement of patients’ economic levels as well as reduction in the cost of medication. The number of drugs and doses should be reduced as much as possible through continuous research involving doctors and pharmaceutical companies.

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Lipid profiles in β thalassemic children
Seham M. Ragab, Manal A. Safan, Asmaa S. Sherif
January-June 2014, 27(1):66-72
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.
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