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ORIGINAL ARTICLES
Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children
Fathea El-Nmer, Aml A Salama, Dalia Elhawary
July-September 2014, 27(3):612-616
DOI:10.4103/1110-2098.145529  
Objective The aim of the study was to assess the effect of parental nutritional knowledge, attitude, and practice (KAP) on their children nutritional behavior and growth. Background Good nutrition is cornerstone for growing children during early childhood and school-age years; children begin to establish habits for eating and exercise that stick with them for their entire lives. If children establish healthy habits, their risk for developing many chronic diseases will be greatly decreased. Participants and methods This was a cross-sectional study through multistage stratified random sampling technique. Bialla district of Kafr-Elsheikh governorate was selected randomly from 10 district of Kafr-Elsheikh governorate. Predesigned questionnaires that assess parents and children (KAP) were then given to parents and children and 120 pairs of completed questionnaires were returned. Results There was no significant correlation between nutritional knowledge (KAP) of parents and nutritional practice of their children (P>0.05), whereas there was a significant correlation between parent's knowledge score and healthy food intake in general by children (r = 0.222; P < 0.05). There was no significant correlation between nutritional practice of children and their BMI and height, whereas there was significant correlation between nutritional practice of children and their weight. There was a highly significant correlation between social class of parents and their children nutritional behavior; in addition, there is significant correlation between father's education and mother's education and their children nutritional practice (χ2 = 15.3 and 14.6; P = 0.018 and 0.023, respectively). Conclusion There is no relationship between parents knowledge, attitude, and healthy food intake by their children. Parents education and socioeconomic status constituted important determinants of healthy food intake by their children.
  3,872 638 -
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.
  3,568 441 1
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.
  3,128 132 2
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
DOI:10.4103/1110-2098.132726  
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.
  2,649 176 -
CASE REPORTS
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
DOI:10.4103/1110-2098.132759  
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.
  2,617 165 -
ORIGINAL ARTICLES
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
DOI:10.4103/1110-2098.126131  
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.
  2,495 137 -
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.
  2,128 447 -
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.
  2,287 137 -
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.
  2,121 92 -
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.
  1,976 190 -
ORIGINAL ARTICLES
Safety and efficacy of endovascular treatment of ruptured cerebral aneurysms
Ahmed S. Mansour, Essam E. Gaber, Tamer Hassan, Hytham AlBeltagy, Waseem Hamed, Mohammed Shadad, Shawky S. Gad
January-June 2014, 27(1):184-190
DOI:10.4103/1110-2098.132798  
Objectives The aim of this study was to study the safety and efficacy of endovascular treatment of ruptured cerebral aneurysms. Background Endovascular treatment has become a standard method for the treatment of intracranial aneurysms. Materials and methods A total of 12 patients were referred for endovascular treatment of ruptured aneurysms: six women and six men, with a mean age of 48.8 years. Patients were classified according to the Hunt and Hess grading system. There were one grade I patient (8.3%), five grade II (41.6%) patients, and six grade III (50%) patients. No patient belonged to grade IV (0%) or grade V (0%). Clinical follow-up was conducted at 6 months, and the results are classified according to the Glasgow Outcome Scale (GOS). Control angiograms were obtained immediately and at 6 months. Results Immediate angiographic results were satisfactory in seven patients (58.3%; complete obliteration), and five patients experienced some residual symptoms of their aneurysms (41.6%). The mortality and morbidity was low. At 6 months, the outcomes were as follows: GOS score of 1, two patients (16.6%); GOS score of 2, seven patients (58.3%); GOS score of 3, three patients (25%); and GOS score of 4 and 5, zero patients (0%). Six-month angiographic follow-up data were available for 10 patients (83.3%). The morphological results were satisfactory in most patients: complete occlusion in seven patients (58.3%) and residual or incomplete occlusion in three patients (25%); two patients (16.6%) underwent recoiling. Conclusion Endovascular treatment of ruptured aneurysms was attempted without clinically significant complications in 91.6% of patients. Morphological results were unsatisfactory in 16.6% of patients. Complete obliteration of the sac, with or without residual neck, is essential to prevent subsequent bleeding, which occurred in 66.6% of patients. The overall outcome at 6 months was satisfactory, despite a selected group of patients [three patients (25%)] having residual complications or residual aneurysms.
  2,085 73 -
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.
  2,053 80 -
Lipid profiles in β thalassemic children
Seham M. Ragab, Manal A. Safan, Asmaa S. Sherif
January-June 2014, 27(1):66-72
DOI:10.4103/1110-2098.132749  
Objectives To study the pattern of serum lipids in β thalassemic children. Background β Thalassemia is a common chronic hemolytic anemia in Egypt. Iron overload is a common sequelae in these patients. Abnormal lipid profile patterns have been suggested to occur in thalassemic patients. Materials and methods Forty-two children with β thalassemia (22 thalassemia major and 20 thalassemia intermedia) were included in the present study with 30 matched controls. Complete blood count, kidney function tests (serum creatinine, blood urea), liver function tests (alanine aminotransferase, aspartate aminotransferase), serum ferritin, and 12-h overnight fasting Serum lipid profiles including total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) triglycerides were performed for patients and controls. Results The thalassemic children had significantly higher platelets count, WBCs count, serum ferritin, alanine aminotransferase, aspartate aminotransferase, and serum triglyceride levels, with significantly lower Hb level, RBCs count, total cholesterol, HDL-C, LDL-C levels, and LDL/HDL ratio compared with the control group. Conclusion β Thalassemic children are at risk of developing disturbed lipid profile patterns that could place them at risk for atherosclerosis and thromboembolic events.
  1,932 200 1
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
DOI:10.4103/1110-2098.149804  
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.
  1,880 238 -
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
DOI:10.4103/1110-2098.126146  
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.
  1,929 184 -
Impact of stone density on the outcome of extracorporeal shock wave lithotripsy
Sultan M Sultan, Tarek M Abdel-Elbaky, Eid A Elsherif, Mohamed H Hamed
July-December 2013, 26(2):159-162
DOI:10.4103/1110-2098.126152  
Objectives This study aims to evaluate the attenuation of renal calculi measured by Hounsfield unit (HU) by noncontrast spiral computerized tomography (NCSCT) as a predictor of calculus fragmentation by extracorporeal shock wave lithotripsy (SWL). Background The outcome of extracorporeal SWL is measured in terms of stone fragmentation and clearance. Some authors have suggested that HU of renal calculi by NCSCT may predict stone-free rates after extracorporeal SWL. Patients and methods This prospective nonrandomized open study included 100 patients with renal stone up to 20 mm in size. Stone attenuation was measured by HU on NCSCT. Patients were grouped according to stone attenuation as group (1), less than 500 HU, (2), 500-1000 HU, and (3), greater than 1000 HU. Patients were treated subsequently with extracorporeal SWL. The outcome was categorized as stone free, clinically insignificant stone fragments, and residual fragments more than 3 mm. Results The rate of stone fragmentation was 100% (41 of 41 cases) in group 1, 95.7% (44 of 46) in group 2, and 0% (0 of 13) in group 3. A statistically significant association was found between SWL treatment outcome and stone density. When we correlated the absolute stone HU measured with the number of shock waves required for complete fragmentation, we found that the mean number of shock waves was 248 122 in group 1, 334 826 in group 2, and 726 077 in group 3 (P < 0.001). Conclusion Stone attenuation measured by HU by NCSCT is a predictor of outcome of SWL and suspected number of shock waves required for fragmentation.
  1,812 234 -
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
DOI:10.4103/1110-2098.132792  
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.
  1,888 98 -
Dual diagnosis and psychosocial correlates in substance abuse in Menoufia, Egypt
Nabil R Mohamed, Samy A Hammad, Lamia G El Hamrawy, Afaf Z Rajab, Mohamed S El Bahy, Mohamed R Soltan
July-December 2013, 26(2):114-121
DOI:10.4103/1110-2098.126139  
Objectives To study the comorbid psychiatric disorders among substance abusers in Menoufia and to identify whether there is a correlation between the type of substance and the comorbid disorder that occurred, and also to determine whether there are specific risk factors that can cause this comorbidity. Background A dual diagnosis presents a challenging problem to clinicians as substance use disorders occurring together with mental health disorders represent a major health problem. Participants and methods Study participants comprised 120 Egyptian substance abusers. They were subjected to the following: semistructured interview sheet, Fahmy and El Sherbini Social Classification scale, semistructured clinical interview for DSM-IV (SCID) both SCID-I for Axis-I diagnosis and SCID-II for Axis-II diagnosis, Addiction Severity Index scale, and a urine screening for substance abuse. Results The findings of the study suggested that 20% of the studied participants were tramadol abusers, 10% were both alcohol and cannabis abusers, 23% were other substances abusers, and 37% were polysubstance abusers. With respect to psychiatric comorbidity, 63.3% of the participants had comorbid psychiatric disorders and comorbid personality disorders (PDs). On studying risk factors for substance abuse, major depressive disorder was found to be the strongest predictor of alcohol abuse. Dependent PD and schizophrenia were the strongest predictors of cannabis abuse. Major depressive disorder and borderline PD were the strongest predictors of opioid abuse. Anxiety disorders and borderline PD were the strongest predictors of sedative abuse. On studying risk factors for comorbid psychiatric disorders in the participants studied, young age (<25 years) and being single were found to be the strongest predictors of comorbid Axis-I disorders. Conclusion Individuals with psychiatric disorders are at an increased risk of having a comorbid substance abuse disorder and vice versa.
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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
DOI:10.4103/1110-2098.132753  
Objective Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in the ICU. We studied the characteristics and risk factors of VAP in critically ill neonates. Background VAP, which was not present at the time of intubation, accounted for up to 30% of nosocomial infections in neonatal intensive care unit (NICU) patients. Patients and methods This study was carried out in the NICU in Benha Children's Hospital on 85 neonates with different diagnoses admitted from April to October 2012 who needed mechanical ventilation. All studied neonates were subjected to history taking, clinical examination, routine investigations (assessment of complete blood count, C-reactive protein levels, and arterial blood gas volumes, blood culture, and liver, serum albumin, and kidney function tests), and chest radiography daily, as well as to nonbronchoscopic alveolar lavage culture. Results Of 85 neonates who needed mechanical ventilation, 55.2% developed VAP. Prematurity, low birth weight, and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leukocyte count, C-reactive protein, and hypoalbuminemia were significantly present in the VAP group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO 2 , and PaO 2 . The microorganisms associated with bloodstream infection in the VAP-diagnosed group were Staphylococcus aureus (15%), Klebsiella spp.(8.5%), Candida spp.(6.5%), Pseudomonas spp. (4.2%), and Escherichia coli (4.2%); 61.7% of obtained blood cultures in VAP patients were sterile. The results of nonbronchoscopic bronchoalveolar lavage cultures revealed the presence of Klebsiella spp. (34%), Pseudomonas spp. (25.5%), S. aureus (17%), E. coli (17%), and Candida spp. (6.4%). K. pneumoniae was the most commonly isolated pathogen in nonbronchoscopic bronchoalveolar lavage. Conclusion The most important risk factors of VAP are prematurity, low birth weight, prolonged duration of mechanical ventilation, enteral nutrition, and umbilical catheterization.
  1,635 311 3
Effect of 3-month treatment of obesity by low-calorie diet on anthropometric, health, and nutritional status for obese female individuals
Olfat M Ibrahim Nassar
January-June 2014, 27(1):115-121
DOI:10.4103/1110-2098.132779  
Background In the majority of obese patients, adjustment of the diet will be required to reduce calorie intake. In general, diets containing 1000-1200 kcal/day should be selected for obese patients. Objective The objective was to study the effect of treatment by low-calorie diet on obese female individuals for 3 months. Participants Forty obese female individuals (BMI΃40 kg/m 2 ) with ages ranging from 27 to 30 years were divided into two main groups: the nontreated group (n = 20) in which obese female individuals did not follow any diet and the treated group (n = 20) in which obese female individuals consumed low-calorie diet (LCD) containing 1200 kcal as 60 g protein, 165 g carbohydrate, and 33 g fats for 3 months. Materials and methods Food intakes, anthropometric measurements, follow-up weights, and blood samples were studied. Results After weight-loss phase, the anthropometric measurements (weight, hips, waist circumference, and BMI) for the treated group (consumed LCD) were decreased significantly. The mean serum total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) in the treated group were decreased significantly (P < 0.001) at the end of weight-loss phase, whereas serum high-density lipoprotein (HDL) was increased but insignificantly when compared with the nontreated group. Serum red blood cell, hemoglobin, hematocrit, and platelet in the treated group were decreased significantly at the end of weight-loss phase (P < 0.001 and P < 0.05), whereas in the nontreated group after the same time they were slightly increased (P < 0.01 and P < 0.001) except WBC and platelet, which decreased. The mean values of serum aspartate aminotransferase, alanine aminotransferase, glucose, uric acid, creatinine, and blood urea nitrogen in the treated group were decreased significantly (P < 0.001) compared with that in the nontreated group with slightly increased values, but the differences were insignificant. All obese patients (n = 40) before weight-loss phase (3 months) consumed a diet rich in energy, protein, and micronutrients (calcium, iron, vitamin A, C, D, B6, and B12). However, the weight-loss phase treated group (n = 20) (consumed LCD) consumed a diet that had reduced requirements (DRI) for energy, calcium, iron, vitamin A, vitamin C, vitamin D, and vitamin B6 by 54.5, 22.58, 36, 48.31, 83.33, 64.0, and 12.5%, respectively, whereas they consumed a diet that had increased requirements for total protein and vitamin B12. Hence, consumed LCD has a positive role in controlling body weight, anthropometric measurements, and health status but has a negative impact on nutritional status because it lacks some of the nutrients. Conclusion Body weight reduction after LCD has a positive impact on anthropometric measurements and health status but has a negative impact on nutritional status because it lacks some of the nutrients.
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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
DOI:10.7123/01.MMJ.0000431238.74393.f8   
Objectives

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.

Background

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).

Results

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.

Conclusion

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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Posterolateral fusion versus posterior interbody fusion in adult lumbar isthmic spondylolisthesis
Hosam A.M. Habib
January-June 2014, 27(1):191-196
DOI:10.4103/1110-2098.132800  
Objective The aim of this study is to assess and compare the outcomes of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in adult isthmic spondylolisthesis. Background Both PLIF and PLF have been used widely in the treatment of lumbar degenerative spinal diseases. Although PLIF has theoretical and demonstrable advantages over PLF, many authors did not observe this and report that outcomes of both surgical methods are comparable. Materials and methods Fifty patients with lumbar spondylolisthesis were operated for isthmic spondylolisthesis complaining of low back pain with or without sciatica and neurogenic claudication. The patients were allocated randomly to two groups according to the mode of bony fusion into PLIF and PLF groups. The two groups were statistically similar with respect to demographic and clinical data. Results No significant differences were found between PLIF and PLF in blood loss, short-term postoperative clinical result, or complications, but the operation time was longer with PLIF. Postoperative long-term visual analogue scale (VAS) for back pain, the Oswestry disability index, and fusion rates were significantly better in PLIF. Conclusion PLIF seems to be a better bone fusion technique than PLF in the management of isthmic spondylolisthesis.
  1,726 119 -
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
DOI:10.4103/1110-2098.126094  
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.
  1,348 471 -
Study on the use of impulse oscillometry in the evaluation of children with asthma
Fathea M El-Nemr, Mohamed I Al-Ghndour
July-December 2013, 26(2):151-158
DOI:10.4103/1110-2098.126149  
Objective The aim of this study was to determine the use of impulse oscillometry in the evaluation of children with asthma and to analyze lung parameters, order effect, and utility, compared with spirometry. Background Asthma is a disease characterized by ongoing inflammation of the airway, overproduction of mucus, and airway constriction due to tightened muscles, which results in permanent structural changes in the lungs, a condition often called airway remodeling. In turn, these changes usually lead to accelerated declines in lung function, including irreversible decreases in airflow because of narrowed air passages. The Impulse Oscillometry System measures respiratory impedance using short pulses (impulses) of air pressure. Impulse oscillometry has been used with success to assess lung function in healthy and asthmatic children, as well as in adolescents. Materials and methods This case-control study was carried out on 66 children divided into two groups: group 1 included 46 children who were previously diagnosed as asthmatic, and group II (control group) included 20 children without a history of asthma. All studied children were subjected to full history taking; clinical evaluation, including general examination and local chest examination; pulmonary function testing; impulse oscillometry before and after spirometry. Pulmonary function testing (impulse oscillometry and spirometry) was repeated in group 1 after bronchodilator administration. Results Asthma prevalence was increased among children with a family history of atopy and among those with family members who smoked. Postbronchodilator impulse oscillometry results were significant, especially R5% and X5pred.-X5. Performing forced expiratory maneuvers during spirometry causes a marked decrease in lung function, detected using impulse oscillometry. Conclusion Impulse oscillometry is useful in the evaluation of children with asthma.
  1,665 151 -
Fixation of subtrochanteric fracture femur using a proximal femoral nail
Hesham M. El-Mowafi, Taher A. Eid, Amro S. El-Sayed, Soliman H. Zalalo
January-June 2014, 27(1):208-214
DOI:10.4103/1110-2098.132811  
Objectives The aim of this work was to evaluate the results of management of 20 adult patients with subtrochanteric femoral fractures using a proximal femoral nail (PFN). Background Fractures of the proximal femur are a big challenge in traumatology. Rapid strides in implant and instrumentations in quest of ideal fixation of subtrochanteric femoral fractures have made various options available. The present study aims to study the role of standard PFN in the management of these fractures. Materials and methods We reviewed the results of 20 consecutive patients who had undergone intramedullary fixation with PFN for traumatic subtrochanteric fractures in our hospital from May 2011 to June 2013, including the follow-up. The average age of the patients was 45 years. Clinical and radiographic analyses were performed during follow-up at 6, 12 weeks, 6 months, and 1 year. Results All patients were clinically assessed according to the Merle d'Aubigné hip scoring system. Our final results were excellent in 25%, good in 40%, fair in 20%, and poor in 15% of patients. Poor results were seen in three cases. Radiologic assessment included union, malunion, failure of fixation, and implant failure. There was only one case of delayed union and two nonunited cases, with a union rate of 85% at final follow-up. Shortening and varus deformity occurred in two cases but had no effect on the clinical and functional outcome. Failure of fixation occurred in only one case but there were no implant failures. Also there were no intraoperative or postoperative shaft fractures. Conclusion The current study shows that PFN is an evolving safe and successful approach in the treatment of subtrochanteric femoral fractures and can be carried out in a minimally invasive manner.
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