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   2014| April-June  | Volume 27 | Issue 2  
    Online since September 26, 2014

 
 
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ORIGINAL ARTICLES
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
DOI:10.4103/1110-2098.141708  
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.
  4,740 262 -
Knowledge and attitude of students in Menoufia University, Shebin Elkom city toward premarital care in 2012
Taghreed Mohamed Farahat, Hala Mohammed Elmoselhy Shaheen, Hala Marawan Mohamed, Marwa Mohamed Mahmoud Mohaseb
April-June 2014, 27(2):347-352
DOI:10.4103/1110-2098.141706  
Objective The aim of the study was to assess the knowledge and attitude of Menoufia University students toward premarital care (PMC). Background PMC is a worthwhile activity to prevent reproductive health hazards, sexual dysfunction, marital distress, divorce, and family breakdown; hence, it will save the society and allow people to enjoy life. Patients and methods The study was a cross-sectional study conducted in Menoufia University faculties in Shebin Elkom city during the period from October 2012 to May 2013; the sample size was 345 students selected through stratified random sample by the proportional allocation method through predesigned questionnaire used for assessment of students' knowledge and attitude toward PMC services using SPSS for data analysis. Results Students from practical faculties showed more proper knowledge about items of PMC services, examination, and investigation components than students from theoretical faculties, with statistically significant difference. Students from practical faculties showed more positive attitude toward the usefulness and necessity of the service than students from theoretical faculties, with statistically significant difference between the two groups. There was nonsignificant difference in the overall knowledge among students of practical and theoretical faculties regarding PMC (c2 = 1.49 and P = 0.83), but there was significant difference in their overall attitude (c2 = 30.76 and P = 0.000). There was nonsignificant difference between male and female students regarding their overall knowledge (c2 = 3.86 and P = 0.43) and their overall attitude (c2 = 5.22 and P = 0.27) regarding PMC. There was nonsignificant difference between urban and rural students regarding their overall knowledge (c2 = 8.47 and P = 0.99) toward PMC, but there was significant difference in their overall attitude (c2 = 10.91 and P = 0.03) regarding PMC. Conclusion PMC is a multidimensional issue that plays a very important role in minimizing marital difficulties; although the majority of participants had favorable and positive attitude about PMC services, they showed no sufficient knowledge in some aspects of PMC services.
  2,625 251 -
Treatment of postburn axillary contracture
Ahmed Walash, Tarek Kishk, Fouad Mohamed Ghareeb
April-June 2014, 27(2):278-283
DOI:10.4103/1110-2098.141676  
Objectives The aim of the study was to evaluate different options for postburn axillary contracture treatment. Background Axillary postburn contractures remain a frequent problem after thermal burns involving the trunk and upper arm. Difficulties in rehabilitation of shoulder abduction during the initial period and the contractile evolution of the scar contribute to this problem. Patients and methods A prospective study of 25 patients with postburn axillary contracture was conducted. The contractures were classified according to the Kurtzaman classification and reconstructed using different methods including skin grafting, local flaps (Z-plasty and five flaps), and regional flaps (parascapular, scapular, and thoracodorsal artery flap). Postoperative follow-up continued for 6 months. Patients had to undergo a physiotherapy course as a routine part of each technique. Results The ages of the patients ranged from 7 to 46 years. Type of contracture was type 1A in 12 cases (48%), type 1B in four cases (16%), type 2 in four cases (16%), and type 3 in five cases (20%). The degree of abduction ranged between 50 and 130° with a mean of 100°. Split thickness graft was used in four cases (16%). Local flaps were used in 16 patients - Z-plasty in six patients (24%) and five flaps in 10 patients (40%) - and regional flaps were used in five patients (20%). The improvement in abduction seen postoperatively in the studied cases ranged from 25 to 80° with a mean of 55°. The overall functional and cosmetic results were satisfactory in most of the cases. Conclusion Z-plasty is suitable for short linear band contractures; the five-flap technique is indicated in longer ones. For type II and III contractures regional flaps are the treatment of choice whenever available. For severe cases release and split skin graft is indicated. Postoperative rehabilitation is very important to avoid recurrence and to maintain the result achieved.
  2,175 238 3
A comparative study between internal sphincterotomy and sentinel pile flap in treatment of chronic anal fissure
O El-Sebai, AA El-Sisy, MS Amar, Mohamed Hamdy El-Shafey
April-June 2014, 27(2):419-422
DOI:10.4103/1110-2098.141718  
Objective The aim of the study was to compare the results of internal sphincterotomy and sentinel pile flap (SPF) in the treatment of chronic anal fissure. Patients and methods This prospective study on consecutive 40 patients was conducted from July 2010 to February 2013. Patients were divided into two groups; 20 patients underwent lateral internal sphincterotomy (LS) and 20 patients underwent SPF. All patients were evaluated with respect to operative time and postoperative complications. Results were documented and statistically analyzed. Results The mean time of LS operation was 5.9 ± 0.97 min and that of SPF was 9.2 ± 0.89 min. Flatus incontinence was reported in 8/20 (40%) patients of the LS group and 2/20 (10%) patients of the SPF group; wounds healed within 2 weeks in 12/20 (60%) patients of the LS group and 18/20 (90%) patients of the SPF group; and recurrence occurred in 2/20 (10%) patients of the LS group and did not occur in the SPF group. Conclusion On the basis of this study, we conclude that SPF operation has several advantages over LS in treatment of chronic anal fissure.
  2,178 108 -
Study of insulin resistance in patients with systemic lupus erythematosus and rheumatoid arthritis
Sanaa Gazareen, Dalia Fayez, Mostafa El-Najjar, Alaa Dawood, Enas Essa, Khaled El-zorkany
April-June 2014, 27(2):215-225
DOI:10.4103/1110-2098.141634  
Objective The aim of the study was to study insulin resistance (IR) and pancreatic b-cell function in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and their relationship with disease activity. Background IR is an important contributor to the increased cardiovascular risk attributed to the metabolic syndrome, a constellation of cardiovascular risk factors that includes central obesity, dyslipidemia, hypertension, and disturbed glucose metabolism, in patients with RA or SLE. Patients and methods The study included 35 SLE and 35 RA patients and 20 controls. Disease activity was assessed by Systemic Lupus Activity Measure score and Disease Activity Score-28. BMI, C-reactive protein, erythrocyte sedimentation rate, lipid profile, fasting glucose and insulin, and c-peptide were determined. The homeostasis model of assessment (HOMA) was used to evaluate IR and secretion. Results SLE patients had high-grade systemic inflammation, IR, and secretion compared with controls (P < 0.05). RA patients revealed high-grade systemic inflammation, IR, and secretion compared with controls (P < 0.001). Active SLE and RA patients were more insulin resistant than nonactive patients. Conclusion The present study demonstrated that both SLE and RA patients had a higher IR and abnormal insulin secretion than age-matched apparently healthy controls. This conclusion was based on the measurement of fasting insulin concentration, HOMA IR, and HOMA b-cells. IR and abnormal insulin secretion were associated with markers for inflammation (erythrocyte sedimentation rate and C-reactive protein) and disease activity indices (Systemic Lupus Activity Measure and Disease Activity Score-28). Higher IR and abnormal insulin secretion were found in RA patients in comparison with SLE patients.
  1,961 242 -
Prevalence of proteinuria among type 2 diabetic patients in Menoufia governorate, Egypt
Taghreed Mohamed Farahat, Gehan Kamal Elsaeed, Sanaa Sayed Gazareen, Tamer Ibrahim Elsayed
April-June 2014, 27(2):363-371
DOI:10.4103/1110-2098.141710  
Objective The aim of the study was to determine the prevalence and risk factors of proteinuria among type 2 diabetic patients in Menoufia governorate. Background Type 2 diabetes is the leading cause of end-stage renal disease worldwide. Microalbuminuria or incipient diabetic nephropathy is one of the initial clinical manifestations of early diabetic nephropathy. Patients and methods A total of 234 type 2 diabetic patients were included in this study; they attended the outpatient clinics of the Family Health Center of 'Kafr Tanbedy' and Internal Medicine Department of Faculty of Medicine, Menoufia University, for routine follow-up. Patients were classified according to their urinary albumin-to-creatinine ratio (ACR) as having normoalbuminuria (ACR < 30 mg/g creatinine), microalbuminuria (ACR = 30 to <300 mg/g creatinine), or macroalbuminuria (ACR≥300 mg/g creatinine). The three groups were compared to analyze the association between albuminuria and its risk factors. In addition, independent predictors of albuminuria were determined using multivariate logistic regression and presented as an odds ratio. Results Prevalence of microalbuminuria (incipient diabetic nephropathy) was 34.2% and that of macroalbuminuria (overt diabetic nephropathy) was 12.8% in the studied group. Conclusion The overall prevalence rate of albuminuria was considerably high (47.01%) among the studied diabetic patients. Therefore, regular screening for microalbuminuria is recommended for all diabetic patients, as early treatment is critical for reducing cardiovascular risks and slowing the progression to late stages of diabetic nephropathy (overt proteinuria and end-stage renal disease).
  1,827 214 -
Difficulties during laparoscopic cholecystectomy
Mohammed Leithy Ahmed, Magdy Ahmed Lolah, Moharram Abdel-Samie Mohammed, Maher Mohammed Sharabash
April-June 2014, 27(2):469-473
DOI:10.4103/1110-2098.141729  
Objective The aim of the study was to record different difficulties during laparoscopic cholecystectomy and how to manage with special respect to the preoperative detection of these difficulties. Background 'Difficult' is a relative term but generally difficult cholecystectomies include difficult peritoneal access due to morbid obesity or previous abdominal surgery, intra-abdominal adhesions, acute cholecystitis, liver cirrhosis, gall bladder mucocele, contracted gall bladder, frozen Calot's triangle, floppy left lobe of the liver, and aberrant anatomy. Patients and methods Fifty patients of difficult laparoscopic cholecystectomies were recorded over a period of about 18 months; most of them were preoperatively expected to be difficult and most of these difficulties were overcome by means of laparoscopic techniques. Results Laparoscopic cholecystectomy was successfully accomplished in 47 patients (94%) with a mean operative time of 52.6 ± 18.66 min. Three patients were converted to open cholecystectomy (6%), in two patients due to dense adhesions with the gall bladder and in one patient due to iatrogenic injury to the cystic duct during skeletonization of frozen Calot's triangle. Our most common intraoperative pathology was dense intraperitoneal adhesions between the gall bladder and the surrounding structures (28%). The second most common intraoperative pathology was cirrhotic liver (16%). The preoperative parameters that significantly predicted difficult laparoscopic cholecystectomy were previous acute attacks of cholecystitis and long duration of the disease, local signs of acute cholecystitis, obesity, contracted gall bladder, gall bladder with large stones, and increased gall bladder wall thickness greater than 5 mm (based on ultrasound). Conclusion Low conversion rate was attributed to adequate vision, minimal use of electrocautery at the triangle of Calot, displaying the structures at the triangle of Calot before clipping, adequate traction in proper direction, use of gauze dissection and hydrodissection in difficult patients and reconfirming the anatomy from time to time.
  1,731 222 -
Assessment of limited stage reconstruction of auricular deformities using autogenous costal cartilage
Abdul-Latif El-Rashidy, Fouad Gharib, Ahmed Ragab, Tarek Abd Elrahman Abd Elhafez
April-June 2014, 27(2):490-496
DOI:10.4103/1110-2098.141735  
Objective To evaluate the results of ear reconstructions in cases of auricular dysplasia utilizing autogenous costal cartilage graft, using two-stage versus three-stage technique of auricular reconstruction. Background Total reconstruction of the absent auricle because of congenital microtia is a complex topic that can be carried out either by alloplastic material or by autogenous material such as costal cartilage. Patients and methods This prospective study evaluated 22 patients with auricular deformities who were presented to ENT and Plastic Surgery Departments. Patients are assessed preoperatively by history, general and local examination. Esthetic assessment, photo documentation, audiological and radiologic evaluation were carried out. The patients were divided into two groups according to the stages of reconstruction: two-stage (using temporalis fascia and skin graft) and three-stage (using tissue expander) reconstruction. Patients were assessed postoperatively according to doctor and patient satisfaction. The latter was measured by Glasgow benefit inventory questionnaire. Results The surgical outcome was good to fair for the majority of the patients in terms of size, texture and shape of the ear, according to doctor satisfaction, with no significant difference between the two techniques (P > 0.05). Regarding patient satisfaction, there were no significant differences between both the techniques (P > 0.05). There was a significant difference between the two techniques regarding postoperative skin texture and the rate of development of postoperative complications in favor of group II, using tissue expander (P = 0.002). Conclusion The microtic ear can be satisfactorily reconstructed using autogenous costal cartilage graft either by two-stage technique (using temporalis fascia flap and skin graft) or three-stage technique (using tissue expander), with no significant difference between the two techniques regarding doctor and patient satisfaction.
  1,746 135 -
α2 -Microglobulin predicts renal injury in asphyxiated neonates
Fady Mohamed El-Gendy, Khalid Abd El-mo'men, Hassan Said Badr, Amira El-Sayed Mohammed
April-June 2014, 27(2):316-321
DOI:10.4103/1110-2098.141689  
Objective The aim of the study was to predict early renal injury in asphyxiated neonates by measuring urinary level of b2 -microglobulin (b2 MG). Background b2 MG has a molecular weight of 12 000 and it belongs to the light chain part of membrane-bound HLA antigens. It consists of two polypeptide chains, a heavy chain with antigenic structure and a light chain. Urinary b2 MG, specific urinary marker of renal tubular damage, can identify renal damage from asphyxia within 48 h of the insult. Methods This study included 50 asphyxiated newborns along with 35 weight-matched and gestational age-matched normal neonates as controls. First, voided urinary samples were collected within the first day of life and values of urinary b2 MG was determined by immunometric enzyme immunoassay. Results In this study, we found that acute kidney injury occurred in 56% of asphyxiated neonates. The remaining 44% patients had subclinical tubular proteinuria. Urea and creatinine levels among patients were significantly higher on day 4 than on day 1. We found that, at the optimum cutoff level of 11.9 mg/ml of urinary b2 MG, the sensitivity, specificity, and accuracy of predicting renal injury in asphyxiated neonates were found to be 86, 68, and 74%, respectively. Conclusion Incidence of acute kidney injury in asphyxiated neonates was 56%. b2 MG is a sensitive and accurate marker of renal insult among these patients. Studies on other biomarkers such as NGAL, KIM-1, and cystatin C may be performed to evaluate their role in predicting renal injury.
  1,675 149 -
Should a neonate with possible late-onset sepsis always have lumbar puncture?
Ahmed A Khattab, Dalia M El-Lahony, Shimaa Abdallah
April-June 2014, 27(2):230-233
DOI:10.4103/1110-2098.141649  
Objectives The aim of this work was to study the incidence of neonatal meningitis among newborns with late-onset sepsis, and to determine whether it is mandatory to perform a lumbar puncture and cerebrospinal fluid (CSF) analysis in all cases of late-onset neonatal sepsis. Background Neonatal sepsis is an important cause of neonatal morbidity and mortality and often results in prolonged hospitalization of infants who are admitted to neonatal ICUs. A positive blood culture confirms sepsis, and when the blood culture is negative, the condition is considered as clinical sepsis. It is almost impossible to distinguish sepsis from meningitis in the neonate clinically. However, CSF that is positive for pathogenic bacteria indicates meningitis. Patients and methods This study was carried out in the neonatal ICU in the Benha Children Hospital over 60 neonates presenting with late-onset neonatal septicemia. All studied neonates were subjected to history taking, clinical examination stressing on points of the clinical sepsis score, routine investigations (complete blood count, C-reactive protein, blood culture), and CSF analysis and culture. Results All 60 neonates were positive for the clinical sepsis score: 48 cases were positive for the hematological sepsis score and 12 cases out of 60 were positive for CSF culture; among the 12 cases with positive CSF cultures, there were six cases (50%) with negative blood cultures. Conclusion There is a high incidence of neonatal meningitis among neonates with late-onset sepsis. Neonatal meningitis frequently occurs in the absence of bacteremia. Hence, lumbar puncture and CSF examination is mandatory in all cases with late-onset sepsis.
  1,629 191 1
Study of the relation between diabetes mellitus and hepatic encephalopathy in patients with liver cirrhosis
Atef Abo El Soud Ali, Hossam Ibrahim Mohamed, Eman Abdel Fatah Badr, Mohamed Abdel Moneim Mohamed
April-June 2014, 27(2):296-300
DOI:10.4103/1110-2098.141679  
Objective This study was designed to determine the role of diabetes mellitus (DM) in the pathogenesis of hepatic encephalopathy (HE) in patients with liver cirrhosis. Background DM and its complications may play a role in the mortality of hepatitis C virus (HCV)-related cirrhotic patients. DM is considered a comorbid disease in these patients and strict control of blood glucose level could improve survival in HCV-related cirrhosis. Patients and methods This study was carried out on 100 cirrhotic patients with DM [50 encephalopathic patients (group I) and 50 nonencephalopathic patients (group II)]. All patients in the study were subjected to a thorough assessment of history taking and thorough physical examination, laboratory investigations, including complete blood picture, liver function tests, liver, viral HBsAg and HCVAb, kidney function tests, serum sodium and potassium levels, abdominal ultrasonography, serum ammonia level, fasting and postprandial blood sugar levels, glycosylated hemoglobin (HbA1c) as well as tests to detect the presence of autonomic neuropathy (tilt-table test and diurnal variation of blood pressure measurements). Results The present study found a significant positive tilt-table test result and diurnal variation in blood pressure measurements in the encephalopathic group in comparison with the nonencephalopathic group, and a highly significant positive correlation between duration of DM and HbA1c levels when compared with grades of HE in the encephalopathic group. Conclusion Cirrhotic patients with longstanding and uncontrolled DM are more likely to have higher grades of HE. Autonomic neuropathy, which may complicate cirrhotic patients with longstanding uncontrolled diabetes, may play a role in the pathogenesis of HE in these patients.
  1,557 180 -
Management of diaphysealtibial fracture in pediatrics by elastic stable intramedullary nails
KF Elsayed Ahmed, B Zakaria, M Hadhood, A Shaheen
April-June 2014, 27(2):401-406
DOI:10.4103/1110-2098.141715  
Objectives The objectives of this study were to investigate the safety and the efficacy of elastic stable intramedullary nailing in the treatment of pediatric tibial shaft fractures. Background Use of the intramedullary nailing technique in the treatment of one of the common injuries involving the lower extremities in children and adolescents. Patients and methods A prospective study of 20 children with tibial shaft fracture, who had been admitted to the Menoufia University Hospital and the Nasr City Medical Insurance Hospital between March 2012 and June 2013; all patients had diaphysealtibial fracture. The average age of the patients in this series was 11.3 years (range 5-15 years), and the mean follow-up was 8.1 months (range 6-15 months). Patient charts and radiographs were reviewed prospectively. Outcomes were classified as excellent, satisfactory, or poor according to Flynn's classification for flexible nail fixation; functional assessment and radiological assessment using the Radiographic Union Scale of the Tibial Fracture scoring system was carried out in the 4th and the 12th weeks. Results All patients achieved full weight bearing at a mean of 9.7 weeks (range 8-16 weeks). The results were excellent in 15 (75%) patients and satisfactory in five (25%) patients; two cases showed 5-10΀ of angular malalignment, and the other three cases were complicated with nail-end protrusion and a limb-length discrepancy of 2 cm of less. No patient was with poor result. Conclusion On the basis of these results, elastic stable intramedullary nailing with titanium elastic nails is an effective surgical technique that allows rapid healing of tibial shaft fractures with an acceptable rate of complications.
  1,393 155 -
Oxidants and antioxidants role in acne vulgaris
Mohamed Abd El Wahed Gaber, Ashraf Abd El Raoof Dawood, Amira Adel Mahmoud
April-June 2014, 27(2):465-468
DOI:10.4103/1110-2098.141728  
Objectives The aim of the study was to determine the effects of oxidative stress in acne vulgaris by measuring the levels of an oxidant [malondialdehyde (MDA)] and an antioxidant [superoxide dismutase (SOD) enzyme] in acne patients. Background Acne vulgaris is one of the common dermatological diseases, and its pathogenesis is multifactorial. Materials and methods Twenty-seven consecutive acne patients and 10 controls were enrolled. The parameters of oxidative stress, such as serum SOD and MDA, were measured spectrophotometrically. Results There was significantly higher enzymatic level of SOD (P < 0.001) and MDA (P < 0.001) in blood of patient with acne compared with that of healthy control. There was significant positive correlation between serum SOD and serum MDA level. Conclusion Oxidative stress exists in acne patients.
  1,324 182 -
Incidence of congenital hypothyroidism in Jordan
Hussein Alawneh
April-June 2014, 27(2):503-506
DOI:10.4103/1110-2098.141737  
Objective The aim of the study was to compare the incidence of congenital hypothyroidism (CH) in Jordan with its incidence worldwide. Background CH is a preventable disease of mental retardation. Its incidence worldwide is almost 1 : 4000. Early screening, diagnosis, and treatment are mandatory to prevent later sequelae. Materials and methods This is a descriptive retrospective analysis of 13 452 newborns screened for CH. Data were collected from records during the period from February 2010 to November 2013 in the pediatric endocrine clinic in Queen Rania Al Abdullah Hospital for Children at King Hussein Medical Center, Amman, Jordan. There were 5978 male and 7474 female participants. Their age ranged between 3 and 10 days. Heel-prick whole blood was collected on a filter paper and sent everyday to the Princess Eman Laboratory Center for analysis. The thyroid-stimulating hormone (TSH) level using the enzyme-linked immunosorbent assay was considered as normal if the TSH value was less than 10 mU/ml, equivocal at values between 10 and 20 mU/ml, and positive for CH if TSH values were greater than 20 mU/ml. Parents of newborns with positive and equivocal results were called to return for further assessment. Central blood samples for free T4 and TSH were sent for patients with equivocal results and for those with TSH screen greater than 20 mU/ml. These two groups were reassessed for symptoms and signs of CH. Newborns screened for CH younger than the age of 3 days and older than the age of 10 days were excluded from the study. Newborns with clinical sepsis and premature babies were also excluded. Descriptive analysis using frequencies was applied to describe the study variables. Results Out of the 13 452 newborns tested, 5978 (44%) were male and 7474 (56%) were female. Newborns were categorized into three groups according to the TSH screening result. Group 1 included 13 231 newborns [5903 male (45%) and 7328 female (55%)] with normal TSH screen less than 10 mU/ml. Group 2 included 173 newborns [52 male (30%) and 121 female (70%)] with TSH 10-20 mU/ml. Group 3 included 48 newborns [23 male (48%) and 25 female (52%)] with TSH level greater than 20 mU/ml. Central samples for T4 and TSH were sent for group 2 and group 3. In group 2, one female newborn was confirmed to have primary hypothyroidism, whereas in group 3, five newborns were diagnosed to have CH, one male and four female. Conclusion The incidence of CH in Jordan is higher than the incidence worldwide; this could be due to the higher rate of consanguineous marriages in Jordan, which can increase the incidence of primary hypothyroidism due to dyshormonogenesis, although other contributing factors should be considered.
  1,365 136 1
Evaluation of retromuscular mesh repair technique for treatment of ventral incisional hernia
Hazem M Goda El-Santawy, Alaa Abd El-Azeem El-Sisy, Ahmad Sabry El-Gammal, Ahmed Farag El-Kased, Hatem Mahmod Sultan
April-June 2014, 27(2):226-229
DOI:10.4103/1110-2098.141640  
Introduction Incisional hernia is a common surgical condition with a reported incidence of 2-11% following all laparotomies. Results of tissue repair have been disappointing. The optimal approach for abdominal incisional hernias is still under discussion. Objectives The aim of the study was to evaluate the retromuscular mesh repair technique in the treatment of ventral incisional hernia as one of the standard techniques for treatment of such cases. Materials and methods This prospective study on 52 consecutive patients was performed from July 2010 to February 2013. Patients were prepared to be operated by the retromuscular mesh repair technique. All patients were evaluated with respect to operative time and postoperative complications. Results were documented and statistically analyzed. Results In this study on 52 patients, there were 37 female patients (71.2%) and 15 male patients (28.8%). The age of the studied patients ranged between 20 and 61 years with mean age of 45.4 years. The mean operative time was 84.88 ± 18.04 min. The mean period of drainage was 3.1 ± 0.9 days. Seroma was not encountered in any patient. No recurrence was reported in the studied patients during the period of follow-up (12-30 months). Conclusion On the basis of this study, we conclude that retromuscular (sublay) mesh repair is the ideal technique for incisional hernia repair.
  1,309 191 -
Comparison between strain and strain rate in hypertensive patients with and without left ventricular hypertrophy: a speckle-tracking study
Said Shalaby Monaster, Mahmoud Kamel Ahmad, Ahmad Gabr Braik
April-June 2014, 27(2):322-328
DOI:10.4103/1110-2098.141691  
Objective The aim of the study was to compare strain and strain rate (SR) values, measured by speckle tracking, in hypertensive patients with left ventricular hypertrophy (LVH) and in those without LVH. Background Echocardiographic evaluation of the left ventricular (LV) strain and SR by two-dimensional speckle tracking may be a useful tool to assess the substantial impairment of systolic or diastolic function both in hypertensive patients with and without LVH. Patients and methods We compared 50 patients with hypertension, 25 with LVH and 25 without LVH, with age-matched and sex-matched control group (25 patients) using two-dimensional speckle tracking measurements of LV longitudinal strain and SR in the apical two-chamber, three-chamber, and four-chamber views. Results Significant reduction of global longitudinal LV systolic strain was observed in hypertensive patients with LVH (group 1) when compared with hypertensive patients without LVH (group 2) (P = 0.04). Significantly reduced global LV longitudinal SR values were found in group 1 when compared with controls at peak systole (peak S) (P = 0.02) and when compared with group 2 (P = 0.02) in early diastolic phase (at peak E). In contrast, no significant reduction of SR values was found between the studied groups in late diastolic phase (at peak A) (P = 0.13). Conclusion Substantial impairment of LV systolic function assessed by longitudinal strain was found in both the hypertensive groups as evidenced by the highly significant reduction of LV global strain values. The SR values were significantly reduced in both the hypertensive group in early diastole and the hypertensive group with LVH at peak systole.
  1,283 215 1
Study of schistosomiasis among school children in Berket El Sab district, Menoufia Governorate
Mohammed Hamed Bahbah, Wael Abd El Hamied El Shikhsalem
April-June 2014, 27(2):239-243
DOI:10.4103/1110-2098.141664  
Objectives This study aimed to estimate the rate of schistosomiasis among school children in Berket El Sab district and also to determine factors affecting its prevalence among school children. Background The study area was in Menoufia Governorate, the southern part of the Nile Delta 100-150 km north of Cairo. Berket El Sab district is a model for rural Egypt that depends on the water of the Nile for almost all of its agricultural output. Participants and methods In this study, a multistage random sample of 1000 children of school age (6-15 years) was selected randomly from three primary and three preparatory schools in the study rural area of Berket El Sab district. Data were collected through a predesigned questionnaire including data on name, age, sex, parent education, housing sanitation, and some special habits such as swimming at river. Urine and stool samples were collected for laboratory investigation for schistosomiasis by microscopic examination. Results The rate of schistosomiasis among children in Berket El Sab district was 0.8%. All positive cases were of Schistosoma mansoni, but no Schistosoma haematobium was detected. A highly significant positive correlation was found between male sex and increasing prevalence of schistosomiasis (P<0.05) as 87.5% of positive cases were among males and 12.5% among females. Conclusion The rate of schistosomiasis among children in Berket El Sab district is high, raising an alarm that schistosomiasis remains a major public health problem among children in rural Egypt. There was a predominance of S. mansoni in the study area. The majority of positive cases were among males than females.
  1,256 187 -
Management of intertrochanteric fracture in elderly high-risk patients using simple external fixation
Hesham Elmowafy, Taher Abd Elsattar, Amr Darwish, Mohamed Elreweny
April-June 2014, 27(2):249-254
DOI:10.4103/1110-2098.141667  
Objectives The goal of this study was to report and evaluate the role of external fixation in the treatment of trochanteric fractures in patients with a high unacceptable operative risk to withstand conventional osteosynthesis and to obviate the many disadvantages of traction and prolonged rest in bed. Background External fixation has been used for the management of fractures for a long period of time. Good fixation, mild blood loss, and early ambulation are always the main advantages of this technique. Its other advantages are that it is simple, quick, inexpensive, and causes minimal surgical trauma. Materials and methods Between March 2011 and September 2012, 20 patients, six men and 14 women, mean age 65.9 years, with trochanteric fractures and considered preoperatively as 'poor medical status', were treated in the Orthopedic Department, El-Menufiya University Hospital, by external fixation and early mobilization. The technique was prescribed. Results All fractures were united at ~22.2 weeks (range 16-26 weeks). A superficial pin-tract infection was found in 14 patients. Two cases showed penetration of the femoral head; shortening of more than 2 cm was observed in four patients. Conclusion The use of the external fixator in these patients reduced their time in the hospital and facilitated their postoperative rehabilitation by allowing uncomplicated healing of a complicated fracture.
  1,303 126 -
Prevalence of quinolones resistance among patients with urinary tract infection at Menoufia
Samia Hassan Kandel, Amira Abd El-Kader El-Hendy, Rasha Rashed Mohamed
April-June 2014, 27(2):440-446
DOI:10.4103/1110-2098.141724  
Objective The aim of the study was to examine the prevalence of quinolone resistance and determine appropriate empiric antibiotics for patients with urinary tract infection (UTI). Background UTI is the most common disease of the urinary tract and it is a major cause of morbidity in both hospitals and communities. Most infections arise from Escherichia coli. Quinolones are effective for treatment of UTIs. Therapy against infectious diseases with antimicrobial agents such as quinolones is very dynamic, with high probability for bacterial resistance. Patients and methods This study was carried out on 150 patients (80 patients suffering from UTI with positive bacterial growth; 55 patients with mixed growth; and 15 patients with Candida). All studied patients with positive bacterial growth were submitted to complete history taking, clinical examination, urine analysis, biochemical tests, bacterial count, urine culture, and antimicrobial sensitivity of all isolates to quinolone drugs (nalidixic acid, ciprofloxacin, levofloxacin, ofloxacin, and gatifloxacin). Results In this study 80 (53%) patients had positive urine culture (54% male and 46% female). The most commonly isolated bacterium was E. coli (52.5%). Individuals over the age of 50 years were more frequently affected by UTI. The sensitivity of male and female patients to ciprofloxacin and levofloxacin showed a highly statistically significant difference (P < 0.001) for each, and sensitivity to ofloxacin, gatifloxacin, and nalidixic acid showed a statistically significant difference (P<0.05). In catheterized patients, prevalence of infection with Enterobacter spp. and Citrobacter spp. was higher, whereas in noncatheterized patients infection with E. coli, Gram-positive cocci, and Klebsiella spp. was high. Antibiotic sensitivity of the isolated pathogens was ascertained, which showed that gatifloxacin was the most effective antibiotic against pathogens and nalidixic acid was the least effective. Conclusion UTI is a serious health problem. Random use of quinolones in UTI should be discouraged because of increased antimicrobial resistance.
  1,174 251 -
Late postoperative complications after single-stage transanal endorectal pull-through for Hirschsprung's disease
Magdi A Lolah, Tamer A Sultan, Mahmoud F Zalat
April-June 2014, 27(2):274-277
DOI:10.4103/1110-2098.141675  
Objective The aim of the study was to assess the late postoperative complications after single-stage transanal endorectal pull-through for Hirschsprung's disease. Background Hirschsprung's disease is a common cause of bowel obstruction during the newborn period. One-stage surgery for Hirschsprung's disease is well established, and the results are comparable or better than multistage surgery. Patients and methods This was a retrospective study conducted at the Pediatric Surgery Unit of Department of General Surgery, Menoufia University Hospital and Abu-El Reesh Insurance Hospital between October 2007 and November 2011. This study included 20 patients with Hirschsprung's disease; there were 15 boys and five girls, their ages ranging from 6 months to 5 years. All these patients were subjected to transanal pull-through, and their data were retrieved by checking their files. Results The mean age of these patients was 32.1 ± 17.47 months. Rectal biopsy was diagnostic in all patients, whereas barium enema was diagnostic only in 16 patients. The mean operative time was 91.3 ± 11.89 min. The commonest postoperative complication was enterocolitis (30%); two patients (10%) were in need for frequent dilatation, three patients (15%) complained of rectal prolapse, two other patients (10%) complained of increased stool frequency, and finally four patients (20%) complained of recurring constipation. Conclusion Transanal pull-through is both feasible and safe for the management of patients with Hirschsprung's disease, and it is associated with acceptable morbidity.
  1,291 122 -
Study of puberty in type 1 diabetic boys
Abdalla M Attia, Naglaa M Ghanayem, Mostafa M El Najjar, Doha A Taha
April-June 2014, 27(2):255-259
DOI:10.4103/1110-2098.141668  
Objective This work aimed to study puberty and its disorders - if any, in type 1 diabetes mellitus (T1D) boys. Background T1D is a lifelong disease that may affect prepubertal boys. It is an autoimmune disease that destroys the insulin-producing cells of the pancreas, causing hypoinsulinemia. The effects of this disease on the different body systems and organs have received considerable attention from researchers and most of these are well known at present. Unfortunately, its effects on puberty, growth of sexual organs, and sexual maturation have not received such attention. Patients and methods A case-control study was carried out on 20 T1D boys, 14-18 years old, who were selected as the patient group. Another 20 healthy, age-matched volunteers were included as a control group. For both groups, the stage of sexual maturation - Tanner's stage and hormonal profile - follicle-stimulating hormone, luteinizing hormone (LH), prolactin, and total testosterone were measured and the growth parameters, including the weight, height, and BMI, were evaluated. Results The patients included in this study had poor glycemic control. T1D caused marked retardation of puberty as 25% of the boys were still sexually immature. Follicle-stimulating hormone, LH, and total testosterone were lower in the T1D boys compared with the controls (significantly in the former and latter and insignificant for LH). Prolactin was significantly lower in the diabetic group. T1D boys showed lower growth parameters (weight, height, and BMI) than the controls. Conclusion According to our results, T1D boys showed markedly delayed puberty and lower growth parameters compared with the controls.
  1,267 137 1
Retrospective study of mortality and causes of death in Menofia University Burn Center
Asmaa Mohammed El Mehrat, Fouad Mohammed Ghareeb, Tarek Fouad Keshk, Yasser M El Sheikh, Ahmed Hosny Ibrahim
April-June 2014, 27(2):290-295
DOI:10.4103/1110-2098.141678  
Background Mortality rates are important outcome parameters after burn injury and can serve as objective endpoints for quality control. Causes of death after severe burn have changed over time, but the exact distribution of causes of death remains unknown. Objective The aim of the study was to estimate the mortality rates and determine the causes of death in patients admitted to the Burn Center of the Faculty of Medicine, Menofia University, between 1 January 2006 and 31 June 2010. Patients and methods Between January 2006 and June 2010, 516 patients were enrolled. A predesigned questionnaire was used to collect data about percentage of burn, site of burn, and inhalation injury as well as data about age, sex, burnt area, occurrence, and causes of death. Results Of the 516 patients included, 96 died, giving an overall mortality rate of 18.6%. The main cause of death was multiorgan failure, which accounted for 48.1% of the mortality cases. Septicemia caused about 27% of deaths, burn shock led to 19.7% of deaths, and other causes were the reason for 5.2% of mortality cases. Comparison of the overall mortality during 2006-2010 with that observed in a previous study conducted in the same unit during 2002-2004 revealed a decrease in rate (24.1-18.6%). Conclusion and recommendations Mortality rate among burn patients is influenced by several risk factors such as age, total body surface area involved, and the presence of inhalation injury. The mortality rate from severe burns has decreased but remains high despite improvements in burn care. Early fluid resuscitation, early detection and correction of any laboratory defects, nutritional support, diagnosis and treatment of inhalation injury, and prevention of burn-related infections are recommended in the treatment of acute burn.
  1,186 177 1
Study of frequency of prediabetes in Egyptian patients with chronic hepatitis C virus infection
Atef Abo El Soud Ali, Gamal Saad El Deeb, Abd Allah Said Essa, Nabawya Said Salim Ahmed
April-June 2014, 27(2):453-457
DOI:10.4103/1110-2098.141726  
Objective The aim of the study was to estimate the frequency of prediabetes in Egyptian patients with chronic hepatitis C virus (HCV) infection. Background Chronic HCV infection is an important risk factor for insulin resistance (IR) and prediabetes. Patients and methods This study was performed on 50 patients with chronic HCV infection. They included 38 men and 12 women; their age ranged from 20 to 61 years. They were categorized into two groups according to presence or absence of IR, and 25 healthy volunteers of matched age, sex, and BMI were enrolled as the control group. IR was measured by Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Results In all, 64% of HCV patients were prediabetic with HOMA-IR value greater than 2. Conclusion Chronic HCV patients should be screened regularly for IR.
  1,250 103 1
Assessment and evaluation of visual acuity, indications, and complications after penetrating keratoplasty
Moustafa K Nassar, Abd El-Rahman E Sarhan, Moatz F El-Sawey, Ahmed I Alsherbiny
April-June 2014, 27(2):234-238
DOI:10.4103/1110-2098.141661  
Objective The aim of the study was to assess and evaluate the indications of penetrating keratoplasty (PKP), visual outcome, complications, and causes of suboptimal visual acuity after PKP. Background PKP involves surgical removal of diseased or damaged cornea from the host and replacement with a full-thickness donor cornea. Patients and methods PKP alone or triple procedure (PKP combined with extracapsular cataract extraction and intraocular lens implantation) was performed in 50 eyes of 50 patients at National Eye Center Hospital, Cairo, Egypt, between 1 January 2009 and 31 December 2011. The outcome was evaluated in terms of graft survival (number of clear grafts at final follow-up) and final best-corrected visual acuity. Results Of 50 patients who underwent PKP, 66% were male patients and 34% were female patients. The mean recipient age was 36.5 years (range 9-78 years). Leading indication of PKP was keratoconus (36%). PKP alone was performed in 88% patients, and 12% patients underwent triple procedure. Follow-up period after surgery was on the first postoperative day and after 1 week, 1 month, and 3 months. Overall graft survival was 86%. Excluding failed grafts, final best-corrected visual acuity achieved was 0.5 or better in 4% patients, 0.3-0.16 in 54% patients, 0.1-0.016 in 28% patients, and less than counting fingers (CF) in 14% patients. Keratoconus had most favorable outcome with graft survival of 94.4% and final visual acuity of 0.16 or better in 83.3% patients. Graft survival and final best-corrected visual acuity of 0.16 or better were found in remaining indications: corneal scar due to trauma (90 and 40%), corneal scar due to infection (66.7 and 44.4%), corneal dystrophy (100 and 71.4%), and other indications (66.7 and 16.7%). Conclusion This series showed that PKP is an effective procedure for corneal disease with poor vision. Visual outcome was good especially in cases of keratoconus.
  1,184 167 -
Laparoscopic versus open appendectomy in children
Mohamed Yasser Abdelaty, Magdy Ahmed Lolah, Moharam Abdel Samie Mohamed, Ahmed Saad Arafa
April-June 2014, 27(2):244-248
DOI:10.4103/1110-2098.141665  
Objective The aim of the present work is to compare laparoscopic appendectomy (LA) versus open appendectomy (OA) in children in terms of the following: duration of operation, postoperative pain, analgesic requirement, hospital stay, postoperative complications, and return to normal activities. Background LA is the routine technique used in the management of acute appendicitis in children in many centers. In this study, the classic three-port LA technique is compared with the OA technique in the management of acute appendicitis. Patients and methods This was a retrospective study of cases of noncomplicated acute appendicitis treated laparoscopically between February 2011 and February 2012. Patients treated by the laparoscopy and open techniques were compared in terms of the duration of operation, operative and postoperative complications, and the length of hospital stay. Results During the study period, 40 children (18 males and 22 females) underwent LA or OA for acute appendicitis: 20 children by the laparoscopic technique (group I) and 20 children by the open technique (group II). The mean age of the children was 9.4 years (range 4-18) in group I and 12 years (range 3.5-18) in group II. The mean operative duration was 33.1 min (range 19-45) in group I and 23.7 min in group II (range 14-35). Port-site infection (redness or discharge) was the same in both groups (10%). Postoperative ileus (>48 h) occurred in one patient (5%) in group I and in two patients (10%) in group II. The mean length of hospital stay was 1.8 days in group I and 2.4 days in group II. Two patients in group I were converted to OA (conversion rate 8%). Conclusion LA has the advantage of resulting in less postoperative pain, shorter postoperative ileus, earlier postoperative recovery, lower complication rates, and shorter hospital stay, whereas OA has the advantage of being a shorter procedure.
  1,250 98 -
Fronto-orbital bone fracture: management and outcome
Fouad M Ghareeb, Ahmed M Elbarah, Yaser M Elsheikh, Ahmed Th. Nassar, Osama M Ebied, Hana Z Nohc
April-June 2014, 27(2):379-385
DOI:10.4103/1110-2098.141712  
Objective The aim of this study was to review the effect of early and late surgical intervention and armamentarium used on the functional and esthetic outcome of fronto-orbital fracture repair. Background Orbital roof fractures represent an important group of orbital fractures because of their close relation to the frontal lobe of the brain and also because of their relation to the eye. Management of orbital roof fractures requires good assessment, early reconstruction, if possible, and team management. Functional and esthetic outcomes should be assessed. Patients and methods Twelve patients with orbital roof and frontal bone fractures were included in this study. Surgical treatment included open bone reduction alone, open reduction with fixation, and/or orbital reconstruction. Postoperative assessment of functional ocular deformities (limited eye movement and diplobia) and esthetic deformities (enophthalmos, dystopia, and proptosis) was carried out. Radiologic assessment for bone reduction and orbital volume was carried out. Results All patients were males. They ranged in age from 16 to 61 years. Road traffic accidents were the cause of trauma in about 67% of patients. Early intervention was performed in 50% of patients, with 100% correction of functional deformities, 90% correction of esthetic deformities and accurate bone reduction in 95% of cases, and good patient satisfaction in 85% of cases. This was much better than late intervention. Titanium mesh was used in 50% of the cases, with accurate orbital volume reduction in 90% of the cases, which was only 50% with bone graft use. Conclusion Early management of orbital roof and frontal bone fractures yields the best results. The use of titanium mesh leads to good functional and esthetic outcomes, with no donor-site morbidity, and saves time.
  1,224 114 2
Clinical, pathological, and molecular aspects of recurrent versus primary pterygium
Moustafa K Nassar, Abdel-Rahman El-Sebaey, Mohamed H Abdel-Rahman, Khaled El-Ghonemy, Ahmed M Shebl
April-June 2014, 27(2):386-394
DOI:10.4103/1110-2098.141713  
Objectives The objective of this study was to evaluate the clinical aspects of primary and recurrent pterygia and correlate them with the histopathological, immunohistochemical, and molecular characteristics of the pterygial sections. Background Pterygium is a fibrovascular, usually triangular membrane that begins growing from limbal epithelium and advances on the corneal surface, characterized by degenerative and hyperplastic changes in the conjunctival epithelium, proliferative and inflammatory characteristics, and a rich vasculature. The pathogenesis of pterygium is still incompletely understood. Ultraviolet irradiation is believed to be the most important factor in its development. Materials and methods This study included 44 pterygium patients who underwent pterygium excision by the bare sclera procedure. The tissues obtained were subjected to a histopathological examination as well as an immunohistochemical analysis for phospho-P53 and ki-67 and PCR for the human papillomavirus (HPV). Results Histopathological findings included epithelial and stromal inflammation, vascular proliferation, fibrosis, and solar elastosis. Epithelial dysplasia was detected in 43.6% of the specimens. The phospho-P53-positive rate was 96.2% and the ki-67-positive rate was 96.3%. HPV DNA was not detected in any of the pterygial specimens. Conclusion The high frequency of epithelial dysplasia supports the neoplastic theory of pterygium pathogenesis. Phospho-p53 expression is increased in pterygial epithelium as well as ki-67, which indicates the high proliferative activity. The absence of HPV suggests that it is not an etiological factor for pterygium pathogenesis in Egypt.
  1,128 186 -
Mobile phone use and its risk on hearing
Ahmed Ragab, Mahmoud El Sayed Abu Salem, Lamiaa Mohamed Abd El Hady
April-June 2014, 27(2):432-439
DOI:10.4103/1110-2098.141723  
Objectives The aim of this study was to assess the potential changes in human hearing function as a consequence of exposure to electromagnetic fields produced by mobile phones through a review of in-vivo and in-vitro published studies. Data sources Medline databases (PubMed, Medscape, ScienceDirect and EMF-Portal) and all materials available in the internet from 2003 to 2012. Study selection The initial search presented 170 articles, of which 44 met the inclusion criteria. The articles studied the relation between mobile phones, the auditory system and genotoxicity. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was obtained, whether the eligibility criteria were specified, and whether appropriate controls, adequate information and defined assessment measures were included. Data synthesis Comparisons were made by a structured review with the results tabulated. Findings In total, 44 potentially relevant publications were included: 32 were human and 12 were animal studies. The studies do not indicate an association between any problem related to the auditory system and short-term exposure of mobile phone radiations, whereas long-term use of mobile phones may lead to high-frequency hearing loss. Studies concerning mobile phone radiation and the risk of acoustic neuroma have controversial results. Some authors did not notice evidences of a higher risk of tumour development in mobile phone users, whereas others report that usage of analog cellular phones for 10 or more years increases the risk of developing the tumour. Conclusion We found no overall increased risk of hearing problems among short-term cellular phone users, whereas long-term use of mobile phones may lead to high-frequency hearing loss and an increased risk of acoustic neuroma after 10 years of mobile phone use. The potential elevated risk of brain tumours after long-term cellular phone use awaits confirmation by future studies
  977 271 -
Clinical study of poisoned cases by some drugs admitted to the menoufia poisoning control center over 1 year (2011), with a focus on ECG changes
Samy Abd El-Hady Hammad, Safaa Abdelzaher Amin, Amira Mohamed El-Seidy, Nagwa Mahmoud Habib
April-June 2014, 27(2):260-268
DOI:10.4103/1110-2098.141671  
Objective The aim of this work was to study ECG changes in cases of poisoning by digoxin, theophylline, and antidepressant overdose that were admitted to Menoufia Poisoning Control Center (MPCC) in 2011, with a focus on evaluation of ECG changes in correlation with both arterial blood gases and electrolyte changes, together with clinical manifestations. Background Numerous drugs can cause ECG changes and lead to cardiac dysrhythmias, and the diagnoses and subsequent management of patients with ECG changes following poisonings can be a challenge for even the most experienced physician. Digoxin toxicity often presents with gastrointestinal side effects, cardiac dysrhythmias, and neurological effects. Overdoses of antidepressants are common and deadly, and sudden cardiovascular deterioration is the hallmark of toxicity. Theophylline overdose can lead to neurotoxicity and cardiac toxicity associated with life-threatening dysrhythmias. Patients and methods In this study, patients who had overdosed on digitalis, theophylline, and antidepressants admitted to MPCC in 2011 were included. Clinical data, serum electrolytes, arterial blood gas changes, and ECG changes were assessed. Results A total of 77 patients were studied. Most patients in the study were females in the age group of 20 to less than 40 years, and they outnumbered males in both suicidal and accidental modes. Theophylline overdose cases were the most common, followed by antidepressants and then digoxin overdose. A significant relation was found between the type of drug overdose and clinical manifestations, wherein vomiting occurred most frequently with digoxin overdose. Convulsions occurred only in cases of overdose with antidepressants. Hypokalemia was more evident in cases of overdose with antidepressants. In terms of ECG changes, sinus bradycardia and ST segment depression were found only in digoxin overdose cases. Sinus tachycardia occurred most frequently in theophylline overdose cases. A highly significant relation was found between potassium (K + ) blood-level and ECG changes such as sinus tachycardia and ST segment depression. A significant relation was found between metabolic acidosis and a wide QRS complex. No case fatality was recorded in this study. Conclusion Drug overdose is a major and longstanding source of morbidity worldwide. Digitalis overdose manifested as sinus bradycardia and ST segment depression. Theophylline overdose manifested as sinus tachycardia and antidepressant overdose cases were characterized by sinus tachycardia and a wide QRS complex.
  1,131 96 -
Study of microvascular complications of chronic hepatitis C virus in nondiabetic patients
Nabil Abd El Fatah Al kafrawy, Mahmoud Abd El-Aziz Kora, Ashraf Gharib Dala, Walaa Khalil Mohamed Ali Sultan
April-June 2014, 27(2):458-464
DOI:10.4103/1110-2098.141727  
Objective To study the relationship between chronic hepatitis C infection and microvascular complications in nondiabetic individuals. Background Several extrahepatic manifestations have been reported in the natural history of hepatitis C virus (HCV) infection. Further, extrahepatic manifestation syndromes could represent the first signal of an HCV infection, as many patients show no hepatic symptoms. As known microvascular complications of diabetes include neuropathy, nephropathy and retinopathy, this study was conducted to evaluate the effect of chronic HCV infection on microvascular complications in nondiabetic patients. Subjects and methods Fifty patients with chronic hepatitis C infection were enrolled. All were subjected to full clinical assessment including routine blood tests, fasting and 2 h postprandial blood glucose, HbA1c, HCV-RNA PCR, urinary albumin concentration indicating the presence of microalbuminuria, liver biopsy and fundus examination. Results Microalbuminuria was diagnosed in five patients (10%) with chronic hepatitis C, whereas 15 patients (30%) had peripheral neuropathy as diagnosed by clinical examination; no retinopathy was diagnosed in these patients. Peripheral neuropathy correlated with age, HCV viremia and stages of liver biopsy. Conclusion Patients with chronic HCV infection had a high incidence of developing microalbuminuria (10%), a very high incidence of developing peripheral neuropathy (30%) and no incidence of developing retinopathy (zero%). Age, the HCV-RNA level and liver fibrosis are prominent risk factors for the occurrence of peripheral neuropathy in chronic HCV-infected patients.
  1,102 104 -
Prescription errors in family practice in Menoufia governorate
Taghreed M Farahat, Mohammad M Al-Kot, Mohamed F Ahmed, Shimaa M Mohamed Sammara
April-June 2014, 27(2):306-309
DOI:10.4103/1110-2098.141682  
Objective The aim of this study was to improve drug prescriptions in family practice through assessment of the types and frequency of prescription errors in family practice. Background Prescription is a written directive, as for the compounding or dispensing and administration of drugs, or for other services to a particular patient. Prescriptions should be clear, legible, and written in plain English. A prescription has three components: superscription (patient and prescriber data, diagnosis, and date), inscription: the body of the prescription (Rx symbol, drug data, and instructions for drug intake), and subscription (refills and prescriber signature). Prescribing faults and prescription errors are major problems among medication errors; although they are rarely fatal, they can affect patients' safety and quality of healthcare. Patients and methods A retrospective study of all available prescriptions (No. 691) during the period of the study (323 prescriptions from the Menouf family health center and 368 prescriptions from Monshaat Soltan family health unit) was carried out. The site of the study was selected using a stratified multistage random sampling technique to select a family health center and unit representing the urban and rural family practice sites in Menoufia governorate. These prescriptions were examined according to the ideal prescription writing mentioned in the article. Results Only 33.3% prescriptions were dated, whereas patients' weight, height, and address were absent in all of the prescriptions studied. Prescriber information was present in 64.3% and prescriber signature was present in 98.6%. The generic name of the drugs was mentioned in only 31.3% of the prescriptions. Only about one-third of the prescriptions were complete. Conclusion Prescribing errors contribute significantly toward adverse drug events. The frequency of drug prescription errors is high. Physicians should be trained more rigorously to learn the art of prescription writing.
  1,026 112 -
Reliability and sensitivity of transcranial Doppler in the prediction of recurrence in ischemic stroke
Mohamed A Okda, Wafik M El-Sheikh, Ahmed M El-Shereef, Ahmed M Ateya
April-June 2014, 27(2):426-431
DOI:10.4103/1110-2098.141721  
Objectives This study was designed to evaluate the role of serial transcranial Doppler (TCD) examinations in the prediction of early recurrence in acute cerebral ischemia (ACI). Background In patients with ACI, either transient ischemic attack or acute ischemic stroke, the risk of early recurrence is significant. TCD enables the examination of hemodynamic patterns of intracranial circulation blood flow. After transient ischemic attack or acute ischemic stroke, developing cerebral flow hemodynamics is related to the stroke outcome. Materials and methods A prospective trial was performed on 60 patients with the first ever or second-time ACI affecting the anterior circulation territory. A diagnostic work up including full clinical examination, routine laboratory tests, brain computed tomography, and TCD examination were performed to evaluate the risk factors of recurrence. Patients were followed up by clinical and TCD examination for 90 days after ischemia (days 2, 7, 30, and 90) to detect clinical and hemodynamic evidences of correlated with early recurrence. Results Patients were divided into two groups [group A with early recurrence (n = 12) and group B without early recurrence (n = 48)]. Diabetes mellitus, atrial fibrillation, and a history of cerebrovascular ischemia were found to be significantly associated with early recurrence of ischemia (P < 0.05). Initial TCD parameters showed that about 75% of the study patients had an abnormally increased mean arterial flow velocity (MFV) of the intracranial artery supplying the affected vascular territory. Group A patients tended to have a higher MFV (M = 77 ± 11.7) than group B patients (M = 66.47 ± 15.3) with significant effect (P < 0.05). Microembolic signals were detected in 10/12 patients (83%) with early recurrence, showing a significant relationship (P < 0.001). Conclusion Our results indicate that TCD parameters of intracranial hemodynamics, especially increasing MFV of the affected intracranial arteries and detection of microembolic signals, are of predictive value in risk stratification of early recurrence in patients with ACI.
  966 128 -
Diagnostic value of the QuantiFERON-TB gold assay (T-SPOT.TB test) in patients with pulmonary tuberculosis after a full course of antituberculous therapy
Osama Faheem Mansour, Nourane Yehia Azab, Rana Helmy El-Helbawy, Emad Mohamed Eed, Shireen Mahmoud El-Sayed
April-June 2014, 27(2):269-273
DOI:10.4103/1110-2098.141674  
Objectives The study aims to clarify the effectiveness of the T-SPOT.TB test as a method of evaluation of antituberculous (anti-TB) treatment. Background Among the various diagnostic tools of TB disease, the T-SPOT.TB test is the most advanced. It depends on the detection of interferon-g released from sensitized T cells when exposed to Mycobacterium tuberculosis antigens in vitro. Materials and methods The T-SPOT.TB test was carried out for two groups of individuals; the first group included 25 patients diagnosed previously by a positive culture of M. tuberculosis after a full course of anti-TB treatment. The second group included 10 healthy individuals. Results Twenty-one patients (84%) of the first group had a positive T-SPOT.TB test, whereas only four patients (16%) had a negative T-SPOT.TB test. Of the 23 patients with a negative result by culture and microscopy, 19 (82.6%) had a positive T-SPOT.TB test. Conclusion The T-SPOT.TB test is a weak test for use during treatment monitoring. As conversion of IGRA results might be later than smear conversion results of clinical specimens, we should not consider the IGRA test as a surrogate marker of a cure or a predictor of disease relapse.
  972 120 1
Neutrophil expression of CD64 in the diagnosis of early-onset neonatal sepsis
MA Bassuoni, MA Helwa, Mona MA Donia
April-June 2014, 27(2):284-289
DOI:10.4103/1110-2098.141677  
Objective The aim of the study was to determine the role of CD64 expression as a neutrophil surface marker in the early diagnosis of neonatal sepsis. Background Neonatal sepsis is a life-threatening disease with an incidence of 1-10 per 1000 live births and a mortality rate of 15-50%. The clinical signs are nonspecific and indistinguishable from those caused by a variety of neonatal noninfectious disorders. Patients and methods The studied population comprised 62 neonates with gestational ages of 26-41 weeks who were suspected to have sepsis (poor suckling, fever, vomiting, diarrhea, pallor, tachycardia, and others) in the first 15 days of life, and 18 healthy age and sex-matched neonates. Complete blood count analysis, C-reactive protein determination, blood culture, and flow cytometric analysis of CD64 expression on the neutrophil surface were carried out. Results CD64 expression was significantly higher in the group with sepsis than in the control groups (P < 0.001). Sensitivity and specificity of CD64 were 95 and 98.3%, respectively. The negative and positive predictive values of CD64 for identifying sepsis were 95 and 98.3%, respectively. Conclusion A change in cell surface expression of CD64 on peripheral blood neutrophils may be considered a sensitive marker for the detection of neonatal sepsis if used in combination with other laboratory parameters.
  912 144 -
Clinical outcome and survival of head and neck cancer patients treated at Clinical Oncology Department, Menoufia University
Khaled K El Din, Mohamed A El-Fetouh, Suzan Ahmed, Amira H Hegazy
April-June 2014, 27(2):359-362
DOI:10.4103/1110-2098.141709  
Objective The aim of the study was to evaluate the effect of clinicopathological characteristics of head and neck cancer (HNC) patients of Menoufia University on patient response to treatment and relapse status and to determine the overall survival rate and mean survival time. Background HNC arises from the mucosa of the upper aerodigestive tract. In Egypt, it constitutes about 17% of all malignant tumors. It affects both sexes and all races. Tobacco and alcohol continue to remain the two major risk factors of HNC. Patients and methods This study included 120 patients of HNC presented to Clinical Oncology Department, Menoufia University from January 2005 to December 2010; the data were collected from the files regarding patients and disease characteristics and treatment modalities, and then clinical outcome and survival data were reported. Results It was found that most of patients were men (70%), smokers (51.7%), and 60 years of age or less (61.7%). The majority of patients had hemoglobin level greater than 12 g/dl (70%) and pathological grade II (52.5%). The commonest site of malignancy among the group of patients was the larynx (31.7%). Stage III disease represented most of the patients (36.7%) in our study. The patients were treated either by radiotherapy, chemoradiotherapy, induction chemotherapy followed by chemoradiotherapy, or chemotherapy. It was found that complete response rate was 25.8% and partial response rate was 13.3%. There was statistically significant association between hemoglobin level, stage of disease, radiotherapy fractionation, and response to treatment (P = 0.04, <0.001, <0.001, respectively). There was also statistically significant difference between different age groups, stages, and response regarding overall survival rate (P = <0.001 for all factors). Conclusion Hemoglobin level, stage, and radiotherapy fractionation are strong factors affecting patient response.
  867 134 -
Echocardiographic assessment of right ventricular function in patients with pulmonary hypertension: Strain imaging study
Mohamed Fahmy Elnoamany, Nagla Fahim Ahmed, Essam Mohamed Saleh Ragab
April-June 2014, 27(2):336-341
DOI:10.4103/1110-2098.141700  
Objective The aim of the study was to assess the right ventricular (RV) function in patients with pulmonary hypertension (PH) using strain imaging. Background Noninvasive techniques evaluating RV performance have important limitations, and strain imaging studies have helped overcome some of these limitations. Patients and methods Fifty patients with PH (72% male and 28% female; mean age 55.76 ± 14.60 years) and 20 age-matched and sex-matched controls were studied using Vivid 9. Apical four-chamber view was used to measure the strain and strain rate of the RV free wall and septal wall. Parameters were quantified in basal, mid, and apical segments of the septal and RV free wall and measures were correlated with pulmonary artery systolic pressure. Results There was a statistically significant difference between patients and controls with regard to strain of the RV free wall (P < 0.001) and strain rate of the RV free wall (P < 0.001). There was significant negative correlation between pulmonary artery systolic pressure and strain of the RV free wall (r = −0.459, P < 0.001) and strain rate of the RV free wall (r = −0.526, P < 0.001). Conclusion The impairment of RV myocardial deformation is evident in patients with PH using strain and strain rate.
  863 120 -
Risk factor profile and in-hospital complications in patients admitted with acute coronary syndrome in Menoufia Governorate
Ahmed A Reda, Walaa F Abdelazez, Rehab I Yaseen, Mohammed M Galal Elsawaf
April-June 2014, 27(2):342-346
DOI:10.4103/1110-2098.141705  
Objective The aim of this work was to study the pattern of risk factors in patients admitted with acute coronary syndrome (ACS) to the coronary care unit in Menoufia Governorate and their relationship with the in-hospital complications. Background Coronary artery disease is a progressive disease process that generally begins in childhood and manifests clinically in mid-to-late adulthood. Patients and methods The study included 120 patients admitted to Coronary Care Unit with ACS during the period from October 2009 to April 2010. Patients were divided into three groups according to their age (≤40, 40-60, and ≥60 years) and followed up during the period of their admission, and the in-hospital complications were recorded. Statistical presentation and analysis of the present study was conducted using the mean, SD, and the c2 -test by SPSS v. 16. Results Our study included 95 men (79.1%) and 25 women (20.9%). ACS was higher in the older women group III than in the other groups (P < 0.05). Family history and smoking were prevalent in the younger patients group I than in other groups; fasting and 2-h postprandial patients were higher in group II than in other groups; and waist circumference and BMI were significantly higher in group II than in other groups. Women had a higher incidence of diabetes mellitus and hypertension, and more atherogenic lipid profile pattern than men. In contrast, smoking was more prevalent in men (63.1%) than in women (0%). Conclusion Group I (<40 years) had fewer risk factors as they represented the lowest incidence of diabetes mellitus, hypertension, obesity, and metabolic syndrome. In addition, they had better pattern of lipid profile than the other groups. In contrast, they had increased incidence of other risk factors such as positive family history of premature coronary artery disease, higher incidence of current smoking, low HDL value, and being male sex.
  852 105 -
Cytotoxic T-lymphocyte antigen-4 gene polymorphisms in hepatocellular carcinoma patients in Egypt
Hala H El-Said, Naglaa M Ghanayem, Eman A Badr, Ashraf Y El-Fert, Ahmed K Gaballah
April-June 2014, 27(2):372-378
DOI:10.4103/1110-2098.141711  
Objective Our objective is to examine the genotypes at rs231775 in the cytotoxic T-lymphocyte antigen 4 gene (CTLA4) in an Egyptian population to detect the association between this single-nucleotide polymorphism (SNP) and susceptibility to hepatocellular carcinoma (HCC). Background CTLA-4 is an important negative regulator in immune response. Its polymorphism +49G>A (dbSNP: rs231775) has been linked to an increased risk of T-cell-mediated autoimmune diseases, infectious diseases, and even carcinomas. Methods This study included 30 HCC patients (26 men and four women) and 20 healthy controls (18 men and two women). Laboratory investigations including complete blood picture, liver function tests, serum a-fetoprotein, and hepatitis viral markers (HBsAg, anti-HCV-Ab) were performed for all participants. The CTLA4 polymorphism at rs231775 was genotyped using the TaqMan allelic discrimination Assay technique. Results The data showed a higher frequency of the A/A genotype (40 vs. 10%) and the A allele (55 vs. 27.5%) in patient groups (HCC) compared with the healthy controls. Our results also indicated a statistically significant difference in CTLA4 rs231775 between HCC patients and healthy controls in the AA genotype and the A allele (P = 0.04, 0.012), respectively. Conclusion Our results suggested that the A/A genotype and the A allele of rs231775 increase the risk of developing HCC in an Egyptian population, whereas the G allele appeared to have a protective effect in developing HCC.
  843 107 -
Role of dobutamine stress echocardiography in the assessment of diastolic reserve in hypertensive patients
Ahmed Ashraf Reda, Rehab Ebrahim Yassen, Mohamed Abdelsalam Mohamed Abulnaga
April-June 2014, 27(2):329-335
DOI:10.4103/1110-2098.141695  
Objective The aim of the study was to assess the role of dobutamine stress echocardiography in the assessment of diastolic reserve in hypertensive patients with preserved left ventricle systolic function at rest. Background Impaired left ventricular diastolic filling at rest is a common finding in hypertensive patients, especially in those with ventricular hypertrophy, even in the absence of evidence of decreased systolic performance. The stress test may also reveal diastolic dysfunction in patients with normal diastolic function at rest. Patients and methods We prospectively identified 30 hypertensive patients, and 20 patients who had no evidence of hypertension served as controls. Left ventricular diastolic function was assessed by dobutamine stress echocardiography using tissue Doppler imaging at rest and during peak stress. Results Both patients and controls showed significant increase in systolic function (ejection fraction%) at peak stress, whereas diastolic parameters showed significant changes between patients and controls at rest. E/Ea was significantly higher (P < 0.001) and IVRT was significantly longer (P < 0.001) in hypertensive patients. At peak stress E/Ea was significantly higher (P < 0.001) and IVRT was significantly longer (P < 0.001) in hypertensive patients. Conclusion Diastolic stress test could be helpful in patients with unexplained exertional dyspnea who have diastolic dysfunction and normal ejection fraction at rest using conventional and Doppler tissue imaging parameters.
  828 115 -
Elderly abuse among patients admitted to the family health unit of Meet Rady village (Kalubia Governorate)
Taghreed Mohammed Farahat, Hala Mohamed El Meselhy, Afaf Zein El Abedin Rajab, Safaa El-Sayed El Siefy
April-June 2014, 27(2):301-305
DOI:10.4103/1110-2098.141681  
Background Elder abuse in general is an important issue and must be addressed by family physicians who have intimate knowledge of patients' medical, functional and social problems. Objective The aim of the study was to estimate the prevalence of the abuse among geriatrics and to determine the types of elder abuse. Patients and methods This study was a cross-sectional study for all registered elderly people, aged 60 years and above, who attended the outpatient clinic of Meet Rady village; there were 123 patients during the period from April 2012 to April 2013. This study included 23 patients with elderly abuse, 13 female patients and 10 male patients, aged 60 years and above. All these patients were subjected to predesigned questionnaire and their data were retrieved by checking their files. Results The prevalence of elderly abuse in the primary healthcare was 23%. Negligence and financial abuse were the most common types of abuse in primary healthcare. Elderly abuse increases in people with low socioeconomic status. The quality of life that affects prevalence is higher in the abused group versus the nonabused group. The prevalence of good quality of life was 33% and the prevalence of bad quality of life was 67%. The prevalence of psychiatric disorders was 12% and about two-third of them had elderly abuse. Conclusion The continuous rise in elderly mistreatment in the society is a new challenge for the healthcare providers and needs an integrated effort from all the workers involved in the health service.
  825 115 -
Left ventricular dyssynchrony in hypertensive patients with normal systolic function: tissue synchronization imaging study
Mahmoud A Soliman, Rehab I Yaseen, Mohammed A Ahmed
April-June 2014, 27(2):407-412
DOI:10.4103/1110-2098.141716  
Objective The objective of our study was to assess left ventricular (LV) dyssynchrony in hypertensive patients with normal systolic function using tissue synchronization imaging (TSI). Background LV systolic and diastolic dyssynchrony are not uncommon in patients with hypertension. Dyssynchrony is associated with increasing incidence of heart failure, cardiovascular morbidity, and mortality. Patients and methods A total of 71 individuals were enrolled in this study. They were divided into two groups. Group A included 51 hypertensive patients with good LV systolic function (ejection fraction≥ 50%) and narrow QRS on the ECG (<120 ms). We excluded individuals with any of the following: acute coronary syndrome, diabetes mellitus, atrial fibrillation, significant valvular heart disease, chronic renal failure, pulmonary hypertension, or myocardial or pericardial disease. Group B included 20 age-matched and sex-matched healthy volunteers and represented the control group. All participants underwent standard two-dimensional echocardiography and TSI. Results The hypertensive group had significantly higher septal wall and posterior wall thickness than the control group. In addition, the LV mass was significantly higher in hypertensive patients than in controls (P < 0.05). The delay between the septal and lateral walls was significantly higher in hypertensive patients than in controls (67.882 ± 53.536 in HTN vs. 44.400 ± 39.495 in controls) (P < 0.05). The severity of dyssynchrony is significantly related to the LV mass, septal wall thickness, posterior wall thickness, and left ventricular end-diastolic dimension. Conclusion Patients with systemic hypertension and normal systolic function may demonstrate LV dyssynchrony by TSI. The severity of dyssynchrony is significantly related to LV mass, septal wall thickness, posterior wall thickness, and left ventricular end-diastolic dimension. Systolic dyssynchrony may identify hypertensive patients at risk for the development of congestive heart failure, and who may benefit from more intensive hypertension control at an earlier stage in their disease process.
  806 96 1
Study on nitric oxide level in septicemic neonates
Ahmed Thabet Mahmoud, Maha Atef M Tawfik, Maather Kamel Alshafey, Samar Moustafa El Hak
April-June 2014, 27(2):474-477
DOI:10.4103/1110-2098.141731  
Objectives The aim of this work was to study on the clinical importance of nitric oxide (NO) level in neonatal septicemia. Background Diagnosis of neonatal septicemia is very important. This study was conducted to evaluate the role of NO in the diagnosis of neonatal septicemia in the neonatal ICU of Menoufia University. Patients and methods This study was conducted on 50 neonates (30 septic and 20 healthy neonates). All neonates were subjected to detailed history taking, through clinical examinations, and laboratory investigations (complete blood count, C-reactive protein, blood culture, and serum NO level). Results The serum level of NO was increased in all studied septic neonates, in comparison with the control group. The elevation in the NO level is independent of gestational age, and there was no significant relation between the NO level and neonatal body weight. The elevation in the NO level is independent of the onset of sepsis, with a cutoff value of 43.7 ΅mol/l. Conclusion Serum levels of NO were elevated in newborn infants with sepsis. Serum NO can be added to the sepsis screen for the early prediction of neonatal sepsis.
  741 94 -
Evaluation of the short-term outcome of anterior approach surgery of the dorsal and lumbar spine
Mohamed Nabil Hanafy, Adel Mahmoud Hanafy, Ahmed Fathy Sheha, Shawky Shaker Gad
April-June 2014, 27(2):413-418
DOI:10.4103/1110-2098.141717  
Objective The aim of this study is to evaluate the short-term outcome of anterior decompression and fusion surgery of the dorsal and lumbar spine, in cases of traumatic and pathologic vertebral fractures, in terms of stability and function. Background Surgical treatment of dorsal and lumbar spine fractures aims to achieve bony union and restore spinal anatomy. An anterior approach is recommended for repair of anterior bone loss and to release medullary compression. Materials and methods Selection criteria included traumatic and pathologic lesions causing vertebral body comminution, kyphotic angulation, or intractable pain. Exclusion criteria included patients with complete cord injury, osteoporosis, or less than 3 months life expectancy. Seven patients (group A) underwent the solo anterior approach surgery, whereas the other seven patients (group B) underwent initial posterior decompression and instrumented fusion, followed by anterior surgery. Operative and postoperative events were noted. Patients were followed up clinically and radiologically for 6 months. Results Seven patients showed improved ASIA grade postoperatively. The mean improvement in the ASIA grade was 0.6 in group A and 1.0 in group B. Seven patients regained bladder control, whereas two remained catheter dependent (one from each group). The pain visual analog scale range was 3-9 preoperatively and 0-5 postoperatively. The mean postoperative improvement in segmental kyphosis was 2.42° in group A and 1.85° in group B. After 6 months, 28.57% of patients in group A had grade-5 bone fusion, 42.86% had grade-4 fusion, 7.14% had grade-3, and 7.14% had grade-2 fusion, whereas 42.86% of patients in group B had grade-5 bone fusion and 57.14% had grade-4 fusion. No instability was detected in the dynamic radiographic films of all patients. Only one case had metallic device malposition because of trauma. Postoperative complications included chest infection (four cases), wound infection (two cases), urinary tract infection (one case), retroperitoneal hematoma (one case), and sympathetic dysfunction (one case). Conclusion The anterior approach for dorsal and lumbar fractures enables direct, under-vision satisfactory decompression of the neural tissue, facilitating improvement in the neurological functions of the patients. It also helps to correct the instability of the fractured vertebral column by both internal metallic fixation for temporary stability and bone grafting with a high percentage of bony fusion to achieve permanent stability.
  744 83 -
Intrafamilial transmission of hepatitis C virus in Menoufia Governorate
Mohammad A El-Dien Nouh, Omaima A AlFateh Mahrous, Islam A Zekry Farg
April-June 2014, 27(2):478-483
DOI:10.4103/1110-2098.141732  
Objective This study was conducted to focus on the intrafamilial transmission of hepatitis C virus (HCV) infection and to determine the impact of a suggested health education program on the knowledge, the attitude and the practice of the participants regarding the prevention of intrafamilial transmission of HCV. Background The HCV is one of the most important causes of chronic liver disease in Egypt . Information on the current magnitude and the rate of intrafamilial transmission of HCV and its risk factors in Egypt is scarce. Patients and methods This study was a cross-sectional analytic study with an intervention (health education program) that was conducted in both the Monshaat Sultan University Hospital and the Menouf General Hospital on all previously diagnosed HCV-positive patients and their spouses as well as their family members with corresponding control groups. Results HCV-positive patients were significantly higher among family members of HCV-positive spouses compared with HCV-negative ones, 19.1 versus 15.4%, which indicates that HCV may be transmitted through social relations among different family members. Conclusion The data of this study provide evidence that there is a greater probability of intrafamilial transmission of HCV infection, especially wife-to-husband transmission rather than husband-to-wife transmission of HCV, in Egypt. The data also support the plausible hypothesis that the probability of transmission is greater if the spouse is positive for HCV RNA.
  691 93 1
Relationship between cardiac mechanics evaluated by two-dimensional strain imaging and T-wave alternans in patients with hypertrophic cardiomyopathy
Hala M Badran, Naglaa F Ahmed, Ahmed A Attia
April-June 2014, 27(2):447-452
DOI:10.4103/1110-2098.141725  
Objective The aim of this study was to assess the relationship between left ventricular (LV) deformational abnormalities, measured by two-dimensional strain imaging, and T-wave alternans (TWA) in hypertrophic cardiomyopathy (HCM). Background HCM is a prevalent hereditary cardiac disorder linked to arrhythmia and sudden cardiac death. Microvolt TWA involves periodic beat-to-beat variation in the amplitude or the shape of the T wave in an ECG. In HCM, TWA has been linked to increased LV mass and used previously as noninvasive prognostic tools in the evaluation and patient risk stratification. Patients and methods The study group consisted of 40 consecutive HCM patients. The HCM group was compared with 33 age-matched and sex-matched healthy participants. All patients and control participants underwent 12-lead ECG, conventional echocardiographic examination, two-dimensional strain imaging, treadmill exercise test, and measurement of TWA, 24-h Holter monitoring. Results Depending on TWA results, the patients were divided into two groups: TWA+ patients, and TWA- patients. There were no significant differences among the most conventional echocardiographic measures between TWA groups. Absolute values of esys, SRsys, SRe, and SRa were significantly smaller in HCM patients than the controls at rest and peak exercise (P < 0.001). LV dyssynchrony was evident in TWA+ patients at rest and amplified at peak stress compared with TWA- patients. TWA was closely correlated with LV dyssynchrony at rest and during exercise, and was inversely related to resting esys, SRsys, SRe, SRa, and the functional systolic and diastolic reserve as estimated by ∆ and percent of change of these variables. Conclusion The considerable association of myocardial dysfunction with TWA+ outcome provides important new evidence on arrhythmia vulnerability in HCM.
  710 68 -
Superiorly based pharyngeal flap versus endoscopic augmentation of the posterior pharyngeal wall, using cartilage graft in the treatment of velopharyngeal insufficiency
Abdel-Latif I El-Rashidy, Essam W Behairy, Ayman A Abdel-Fattah, Ashraf A El-Demerdash
April-June 2014, 27(2):484-489
DOI:10.4103/1110-2098.141733  
Objectives The aim of this study was to compare the functional outcome of the superiorly based pharyngeal flap and endoscopic augmentation pharyngoplasty, using cartilage graft in patients with velopharyngeal insufficiency (VPI). Background Surgical alteration of the velopharyngeal sphincter is directed at decreasing the horizontal cross-sectional surface area of the sphincter's tissue boundaries that can be achieved by different surgical operations with different outcomes. Materials and methods A total of 30 patients with VPI were enrolled into our study from July 2010 to March 2012. Patients were assessed by preoperative flexible fibro-optic nasopharyngoscopy and tape recording at phoniatrics clinic. Patients were classified into two groups: group I consisted of 12 patients for augmentation pharyngoplasty, and group II consisted of 18 patients for superiorly based pharyngeal flap. Each group was divided into two categories: (A) With good palatal movement and small central gap (B) With poor palatal movement and large central gap. Tape recording was repeated after phonotherapy (3-4 months postoperatively), and hypernasality was assessed using a five-degree rating scale, in which 0 = normal nasality and 4 = severe hypernasality. Complications were documented and statistical comparisons were made between subgroups IA and IIA and subgroups IB and IIB. Results We had four subgroups: IA that included seven patients, IB that included five patients, IIA that included 10 patients, and IIB that included eight patients. Subgroup IIA had a mean hypernasality score of 0.4 ± 0.8 SD, which was better than the mean score of 1.6 ± 0.5 SD in subgroup IA. Subgroup IIB had a mean hypernasality score of 0.8 ± 1.1 SD, which was significantly better than the mean score of 1.2 ± 0.8 SD in subgroup IB (P = 0.04). The complications were not significantly different between the two groups, and were all relatively mild. Conclusion Superiorly based pharyngeal flap proved to be better than augmentation pharyngoplasty in the management of hypernasality because of VPI, with significant difference in patients with poor palatal movement and a large central retropalatal gap. Both the techniques had accepted incidence of complications with no significant intergroup difference.
  698 75 -
Endogenous secretory receptor of advanced glycated end products of type II diabetic and hypertensive patients
Naglaa Mohammed Ghanayem, Walaa Fareed Abdel Aziz, Yasser Abd El-Sattar El-Ghobashi, Rania Mohammed Azmy El-Shazly, Amany Mohammed Salah El-Din Wahb
April-June 2014, 27(2):395-400
DOI:10.4103/1110-2098.141714  
Objective The aim of this study was to examine the role of the endogenous secretory receptor for advanced glycation end products (esRAGE) as a biochemical marker for hypertensive patients with type II diabetes mellitus. Background Advanced glycation end products may cause vascular stiffening by forming cross-links through the collagen molecule or by interaction with their cellular transductional receptor [receptor for advanced glycation end products (RAGE)]. A secreted isoform of RAGE, termed endogenous secretory receptor for advanced glycation end products, may contribute toward the removal/detoxification of advanced glycation end products by acting as a decoy. This work aimed to study the role of esRAGE in hypertensive and diabetic patients. Participants and methods This study included 60 patients (20 patients with type II diabetes mellitus, 20 hypertensive patients, and 20 hypertensive type II diabetic patients) and 20 healthy individuals as a control group. The patients were recruited from the Cardiology Department, Menofia University Hospital. The studied participants were subjected to a full assessment of history, clinical examination (including measurement of blood pressure), and laboratory investigations including measurement of fasting blood glucose, lipid profile, urea, and creatinine measured using the enzymatic colorimetric method and esRAGE determined by the enzyme-linked immunosorbent assay measured by the ELISA technique. Results The results of the present study showed that the levels of serum esRAGE were significantly lower in all patient groups compared with the control group (P<0.001). esRAGE levels were also significantly lower in type II diabetic hypertensive patients than in hypertensive or diabetic patients alone (P<0.001). In the patient group, there was a significantly negative correlation between esRAGE and each of systolic and diastolic blood pressure, triacylglycerol, total cholesterol, and low-density lipoprotein cholesterol, whereas a significant positive correlation was found with high-density lipoprotein cholesterol. Conclusion esRAGE may be a novel and potential protective factor for essential hypertension and type II diabetic patients.
  691 69 -
Passive smoking as a stress factor in diabetic children
Soheir S El-Ella, Maha A Tawfik, Maha A El Bassuoni, Rabab A Elsabagh
April-June 2014, 27(2):310-315
DOI:10.4103/1110-2098.141685  
Objective This study aimed to measure urinary cotinine level and urinary cotinine/creatinine ratio as a biomarker of passive smoking in diabetic children. DNA damage was estimated in peripheral leukocytes by a DNA fragmentation assay in diabetic children. Background Exposure to passive smoking is associated with a number of health hazards such as prenatal damage to the fetus, poor growth, respiratory illness, atopy and asthma, coronary heart disease, and sudden infant death syndrome. Patients and methods This study was carried out on 54 diabetic children attending the Genetic and Endocrine Unit of the Pediatric Department, Faculty of Medicine, Menoufia University. The children were divided into two groups: group I (34 children exposed to passive smoking) and group II (20 children not exposed to passive smoking). The studied groups were subjected to a detailed assessment of history, thorough clinical examination, investigations, and family counseling. Results Significantly higher urinary cotinine levels and urinary cotinine/creatinine ratios were found in children with a history of exposure to passive tobacco smoke (120.4 ± 86.2 and 173.7 ± 130.1, respectively) in comparison with children with no history of exposure (2901.5 ± 1423.2 and 3284.7 ± 2322.8, respectively, P ≤ 0.000), and the urinary cotinine levels were found to be dependent on the daily exposure to tobacco smoke as indicated by the number of cigarettes consumed by the smoker in the presence of the child. Also, significantly higher positive gel electrophoresis results (DNA damage) were found in children with a history of exposure to passive tobacco smoke (29.4%) in comparison with children with no history of exposure (0%). Conclusion Passive smoking is a risk factor for many health hazards and cotinine is a valuable biomarker for assessment of exposure to second-hand smoking, especially among children. Also, passive smoking is a cause of enhanced apoptotic changes in diabetic children.
  599 78 -
Ultrasound-guided renal biopsy in various renal disorders
Abbas Elanani, Tarek A Ella, Basma Dessouky, Mohamed El-Zawawi
April-June 2014, 27(2):423-425
DOI:10.4103/1110-2098.141720  
Objectives This study aims to illustrate indications, contraindications, techniques, and complications of ultrasound-guided renal biopsy and its role in the diagnosis of various renal disorders. Background Percutaneous ultrasound-guided renal biopsy is the gold standard in the evaluation of renal diseases. Recent advances in technique have improved the safety of the procedure. Material and methods This prospective study was conducted between October 2010 and October 2012 on 30 consecutive patients with various indications for ultrasound-guided renal biopsy. Results There were 24 patients with diffuse renal pathology and six patients with focal renal pathology; 15 patients used free-handed biopsy and 15 patients used automated gun biopsy, and complications of the renal biopsy was observed in 10 patients with hematuria (33.3%), whereas 20 patients showed no complications (66.7%). Conclusion Our results support that the use of automated gun loaded with Tru-cut needles under ultrasound guidance is a safe and an efficient method for performing renal biopsies in patients. The use of smaller (18 G) needles would reduce the complication rate while allowing the retrieval of sufficient tissue for histological diagnosis.
  577 87 -
Plasma urotensin II as a marker for severity of rheumatic mitral regurgitation
Ibrahim Elmadbouh, Mahmoud Ali Soliman, Ahmed Farouk Abd Elhameed, Abd Allah Mostafa Kamal
April-June 2014, 27(2):497-502
DOI:10.4103/1110-2098.141736  
Objectives The aim of the present study was to measure plasma urotensin II concentrations in patients with rheumatic mitral regurgitation, and to examine its correlation with severity of valve impairment, function [New York Heart Association (NYHA)] class, and pulmonary artery pressure (PAP). Background Urotensin II is mainly regarded as a cardiovascular autacoid/hormone; it is associated with different cardiovascular diseases. It might have a pathophysiological role in heart valve disease. Patients and methods A total of 35 patients with moderate-to-severe rheumatic mitral valve regurgitation and 20 healthy controls were selected after performing the echocardiography. Plasma urotensin II level was measured for all participants. Results Urotensin II level was highly significant in patients with mitral valve regurgitation (1.83 ± 0.92 ng/ml) versus the controls (0.48 ± 0.13 ng/ml, P < 0.001). In addition, there was a significant positive correlation between urotensin II level and left ventricular end-diastolic diameter (LVEDD) (r = 0.318, P = 0.03) and PAP (r = 0.706, P < 0.001), but there was no significant correlation between urotensin II level and left ventricular end-systolic diameter (r = 0.271, P = 0.115). Linear regression analysis of LVEDD (r2 linear = 0.101, P < 0.05) and PAP (r2 linear = 0.498, P < 0.001), two among the multiple echocardiographic parameters that predict elevated urotensin II level, was carried out. Conclusion Urotensin II was found to be elevated in patients with rheumatic mitral regurgitation, and positively correlated with increased LVEDD and PAP. Elevation of LVEDD and PAP was found to have a strong prediction for the elevated level of urotensin II. Therefore, urotensin II level may be used as a diagnostic and prognostic marker for severity in patients with rheumatic mitral valvular diseases.
  565 60 -