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  Citation statistics : Table of Contents
   2016| January-March  | Volume 29 | Issue 1  
    Online since March 18, 2016

 
 
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ORIGINAL ARTICLES
The prevalence of bronchial asthma among primary school children in Menoufiya Governorate (El-Bagour Center)
Ghada M El-Mashad, Asmaa A Mahmoud, Ahmed A Abdel Hafez
January-March 2016, 29(1):89-94
DOI:10.4103/1110-2098.178992  
Objective To study the prevalence of bronchial asthma among primary school children in Menoufiya Governorate (El-Bagour Center). Background Asthma is a common disease in children that forms a major comorbidity illness. It is prevalent worldwide, especially in developed countries where its prevalence is increasing to epidemic proportions. Patients and Methods This is an observational study carried out on 2544 children from a representative sample of children attending eight primary schools in El-Menoufiya Governorate (El-Bagour Center): four schools were located inside El-Bagour Center, representing the urban locality, and the other four schools were located in villages around El-Bagour Center, representing the rural locality. Children were screened for chest symptoms by a questionnaire. Results The prevalence of asthma in rural and urban schools was 5.34 and 6.58%, respectively, with a total prevalence of 6.09%. A low socioeconomic level, a positive family history of similar disease, and exposure to smoke showed a highly significant effect as risk factors for asthma. Bronchial asthma had a highly significant effect on delayed weight gain, disturbed sleep, missed school days, limited activity, and emergency room visits and had a significant effect on delayed growth. Conclusion The overall point prevalence of childhood bronchial asthma among primary school children in Menoufiya governorate was 6.5%, which reflects a significant increase over the last 20 years when compared with a previous prevalence rate of 2.2% in a similar study conducted more than 20 years ago. This reveals a significant increase in the magnitude of the problem of bronchial asthma in our community and the need for effective prevention and management programs.
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Bovine colostrum versus prebiotics in children with acute gastroenteritis
Ghada M El Mashad, Sameh A Abd El Naby, Mohammed S Mahmoud Abd El Bary
January-March 2016, 29(1):95-99
DOI:10.4103/1110-2098.178994  
Objective The aim of the study was to compare the effect of bovine colostrum with that of prebiotics in children with acute gastroenteritis. Background Gastroenteritis is a major global problem and affects infants in both developing and developed countries. Viral infection is the most common cause of gastroenteritis. Rotavirus is the most common virus causing gastroenteritis in children. It accounts for significant morbidity and mortality in children younger than 5 years of age. It is estimated that 3-5 billion cases of gastroenteritis occur globally on an annual basis, primarily affecting children and those in the developing world. It resulted in about 1.3 million deaths in children younger than 5 years as of 2008. Patients and methods Two hundred children aged 1-5 years were prospectively included in this study. They were divided into four groups: group 1 included 50 children who received prebiotics (lactobacillus LB) one sachet twice daily for 5 days along with traditional medications (oral rehydration salts (ORS), intravenous fluids, and symptomatic treatment). Group 2 included 50 children who received one sachet of the first 6 h bovine colostrum once daily for 5 days along with traditional medications. Group 3 included 50 children who received prebiotic and bovine colostrum plus traditional medications. Group 4 included 50 children who received traditional medications only. All patients were compared with respect to the following: hospital stay, number of diarrheal and vomiting attacks before and after treatment, intravenous fluid therapy before and after treatment, any other complication during the course of the disease (central nervous system and chest complications), laboratory investigations, and associated symptoms (fever, headache, anorexia, malaise). Results In this study we found that the group that received prebiotic and bovine colostrum had better results than the other groups in terms of duration of hospital stay, number of diarrheal and vomiting attacks, degree of dehydration, electrolyte disturbance, rehydration method, and associated complications. No significant difference was seen among the groups regarding pretreatment clinical status. Conclusion Early use of both bovine colostrum and prebiotics in children with acute gastroenteritis decreases the duration of hospital stay, the number of vomiting and diarrheal attacks, the degree of dehydration, intravenous fluid therapy, electrolyte disturbance, and associated complications.
  1 1,108 155
Association of CTLA-4 (+49A/G) gene polymorphism with type 1 diabetes mellitus in Egyptian children
Maha A Tawfik, Soheir S Abou El-Ella, Zeinab S Abouzouna
January-March 2016, 29(1):100-106
DOI:10.4103/1110-2098.178996  
Objective The aim of the study was to investigate the distribution of cytotoxic T-lymphocyte antigen-4 (CTLA-4) (+49A/G) gene variants and its association with type 1 diabetes (T1D) in Egyptian children. Background T1D is a complex autoimmune disease characterized by T-cell-mediated destruction of the pancreatic island. Human leukocyte antigen (HLAs) account for about 60% of genetic susceptibility for the disease. About 20 non-HLA loci contributing to disease susceptibility have been identified. One among these is the CTLA-4 gene. CTLA-4 polymorphisms are associated with T1D in some but not all populations. The aim of our study was to investigate the frequency of CTLA-4 49A/G polymorphism in Egyptian children, and its susceptibility for development of T1D. Materials and methods A case-control study was conducted on 40 Egyptian children with T1D diagnosed according to ADA (2010). Their ages ranged from 1 to 16 years, with a mean of 8.76 ± 4.70 years; 15 were male and 25 were female. In addition, 20 age and sex-matched healthy controls were included. CTLA-4 (+49A/G) gene polymorphism typing was done by PCR amplification, followed by restriction fragment length polymorphism. Results The frequency of CTLA-4 polymorphisms (AA, AG, and GG) in T1D patients was 42.5, 52.5, and 5% versus 60, 40, and 0% in controls, respectively, with predominance of the AG variant in diabetic patients. Distributions of the CTLA-4 gene polymorphism on the basis of sex showed a normal pattern. The AA genotype was present in 64.7% of female diabetic patients versus 35.3% of male patients, whereas the heterozygous AG genotype was seen in 57.1% of female patients versus 42.9% of male patients, and the homozygous GG genotype was present in two female patients (5%) and was not recognized in male patients; the female predominance can be explained by steroid hormone association. Conclusion In this study the overall pooled prevalence of the CTLA4 (+49A/G) polymorphism was recognized but still not a risk susceptibility factor for T1D in Egyptian children.
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The role of serum apelin in diabetic patients with retinopathy
Sanaa Sayed Gazareen, Alaa Eldin Abdl El-salam Dawood, Amin Faisal Ellakwa, Dalia Hosny Abou Elela, Amany Anwar Mohamed Serag
January-March 2016, 29(1):22-29
DOI:10.4103/1110-2098.178940  
Objective The aim of this work is to study serum apelin in patients with diabetic retinopathy and its possible pathophysiological role in such patients. Background Diabetic retinopathy is the most common microvascular complication of diabetes, and it remains a leading cause of blindness and visual impairment in the working-age population in the developed world. Apelin is a peptide isolated from bovine stomach extracts that acts as an endogenous ligand for the previously orphaned G protein-coupled receptors (angiotensin 1-related putative receptors). Apelin has been recognized as a factor promoting angiogenesis, but its role in the development of proliferative diabetic retinopathy (PDR) has not been fully examined. Materials and methods Sixty patients were included in the study and classified into three groups. Group 1, the control group, included individuals without diabetes mellitus (10 patients), group 2 included patients with diabetes mellitus but without retinopathy (20 patients), and group 3 included patients classified into two subgroups: group 3a, which included patients with nonproliferative diabetic retinopathy (NPDR) (15 patients), and group 3b, which included patients with PDR (15 patients). Results Apelin was significantly higher among patients with diabetes without retinopathy, NPDR, and PDR than the control group (P < 0.001); the mean value of apelin was significantly higher in patients with PDR than in those with diabetes without retinopathy (P < 0.05). Also, the mean value of apelin was significantly higher in patients with PDR than NPDR (P < 0.001). Conclusion Serum apelin was significantly higher in patients with PDR compared with those without nonproliferative retinopathy and in those with diabetes without retinopathy, and apelin plays a role in the development of PDR. Ischemic retinopathy could be trated with Inhibition of the apelinergic system. Serum apelin correlated significantly with serum creatinine in patients with retinopathy, which may indicate the role of apelin in diabetic nephropathy.
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REVIEW ARTICLES
Role of iron in diabetes mellitus and its complications
Mohamed A Shaaban, Alaa Eldeen A Dawod, Mohammed A Nasr
January-March 2016, 29(1):11-16
DOI:10.4103/1110-2098.178938  
Introduction Iron is one of the essential minerals that is required for a variety of molecules to maintain their normal structures and functions. Although it is essential, iron can also be toxic in excess amounts. Oxidative stress is one of the major causative factors for diabetes and diabetic complications. Increasing evidence has indicated that iron overload not only increases risks for insulin resistance and diabetes but also causes cardiovascular diseases in nondiabetic and diabetic individuals. Objective The aim of this study was to investigate the role of iron in diabetes mellitus and its complications. Data analysis Data sources: Data were collected from medical text books, medical journals, medical websites that had updated research with keywords (iron and diabetes mellitus) in the title of the paper. Study selection: Systematic reviews that addressed diabetes mellitus and studies that addressed the role of iron in the pathogenesis of diabetes and diabetic complications were selected for study. Data extraction: A special search was carried out at midline with keywords (iron and diabetes mellitus) in the title of papers and extraction was made, including assessment of quality and validity of papers that met with the prior criteria that describe the role of iron in the pathogenesis of diabetes and diabetic complications. Data synthesis: Each study was reviewed independently and the obtained data were rebuilt in new language according to the need of the researcher and arranged in topics through the article. Recent findings: Iron overload not only increases risks for insulin resistance and diabetes but also accelerates diabetic complications. Conclusion Oxidative stress is one of the major causative factors for diabetes and diabetic complications. Increasing evidence has indicated that iron overload not only increases risks for insulin resistance and diabetes but also causes cardiovascular diseases in nondiabetic and diabetic individuals.
  1 1,634 321
CASE REPORTS
Air leak syndrome complicating measles: report of two cases
Ibrahim Aliyu
January-March 2016, 29(1):174-176
DOI:10.4103/1110-2098.179010  
Measles still remains a public health concern despite an understanding of its immunology and availability of potent vaccines. The problem of maintenance of cold chain and vaccine acceptance has decreased the level of herd immunity in most Nigerian communities; therefore, yearly outbreaks are not surprising. Among the complications of measles in the respiratory system are subcutaneous emphysema, pneumothorax, and pneumomediastinum, which may be fatal in some cases. Therefore, cases of air leak seen during a recent measles outbreak are reported.
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Hydrops fetalis: our experience in a rural setting
Ibrahim Aliyu
January-March 2016, 29(1):177-178
DOI:10.4103/1110-2098.179011  
The presence of two or more of the following: ascites, pleural fluid, pericardial fluid, or generalized edema, defines hydrops fetalis. It occurs worldwide, but there is limited information on its incidence in Nigeria. It may follow massive intrauterine destruction of the fetal red blood cells, resulting in severe fetal anemia and subsequently anemic heart failure. This occurs in those with immune-mediated hemolysis; other notable causes are fetal arrhythmias, respiratory disorders, and inborn errors of metabolism. Early detection of at-risk pregnancy is the key to a successful outcome; hence, the importance of antenatal care cannot be overemphasized. Therefore, the case of an hour-old male newborn who presented with generalized edema, ascites, and central cyanosis is reported here. He had a normal packed cell volume and was diagnosed with nonimmune hydrops fetalis; however, the patient died 30 min later, and although an autopsy was not performed, the clinical features were suggestive of a cardiovascular cause.
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Kayser-Fleischer-like rings in a patient with vitamin-B 12 deficiency
Vasu Vardhan, Anil Kumar Pawah, Manu Chopra, Sanjay Singhal
January-March 2016, 29(1):179-180
DOI:10.4103/1110-2098.179012  
An 18-year-old man presented with recurrent jaundice over the past 2 years. Physical examination indicated severe pallor, icterus, and glossitis. Systemic evaluation indicated Kayser-Fleischer rings on slit-lamp examination. Laboratory parameters indicated severe anemia and indirect hyperbilirubinemia with normal liver enzymes. Further evaluation indicated a diagnosis of severe nutritional vitamin-B 12 deficiency. Here, we report the unusual case of the presence of Kayser-Fleischer-like rings in a patient with severe vitamin-B 12 deficiency.
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ORIGINAL ARTICLES
Evaluation of osteoporosis educational program on knowledge, attitude, and practice of secondary school female students
Hala M El Meselhy, Howaida A AlShazly, Aml A Salama, Dina S El Karsh
January-March 2016, 29(1):107-110
DOI:10.4103/1110-2098.178998  
Objectives This study aimed to assess the effect of educational program concerning osteoporosis on the knowledge, attitude, and practice among secondary school female students (Shebin El-Kom City, Menoufia Governorate). Background Osteoporosis is a systemic disease characterized by a decrease in skeletal bone mass. It is considered a worldwide health problem, including Egypt. Raising awareness about its burden and risk factors is an essential step in modifying behaviors related to it. Participants and methods The study was conducted on 302 secondary school female students. They were chosen randomly from three secondary schools during the scholastic year 2013/2014. A predesigned questionnaire was used to test their knowledge, attitude, and practice on osteoporosis (a pretest). In addition, a health education program was conducted for improving their knowledge, attitude, and practice. A post-test was conducted after 3 months for 294 of the pretest participants (response rate = 97.4%). Results The mean score of knowledge on osteoporosis risk factors, diagnosis, and protective measures (e.g. nutritional and physical activity) showed a significant improvement. The mean score of attitude as regards calcium-containing food and barrier to have calcium, healthy intentions such as attitude toward disease (regular exercise and barriers to exercise) showed significant improvement. Healthy nutritional practice and regular exercise showed significant improvement after osteoporosis preintervention and postintervention program. Conclusion The applied health education program improved female secondary school students' knowledge, attitude, and practice as regards osteoporosis, which is a cornerstone in its prevention through modification of related risk factors.
  - 713 161
Parvovirus B19 viremia in Egyptian adults with systemic lupus erythematosus
Sanaa S Gazareen, Samar G Soliman, Safaa I Tayel, Emad M El Shebini, Alaa E Abd El-Hamid
January-March 2016, 29(1):30-36
DOI:10.4103/1110-2098.178942  
Objective This study was undertaken to investigate the seroprevalence of parvovirus B19 DNA in systemic lupus erythematosus (SLE) patients and its correlation with disease activity. Background Infection with parvovirus B19 (B19) has been suggested to contribute to the pathogenesis of SLE. B19 infection may simulate both clinical and laboratory features of SLE, presenting either as a potential first-time diagnosis of SLE or as an exacerbation of previously established disease. Patients and methods Sera from 30 adult patients with SLE and from 15 normal controls were examined for parvovirus B19 infection by means of nested PCRs to detect B19 DNA. Results B19 DNA was detected in two of 15 (13.5%) controls and in 12 (40%) of 30 SLE patients, with no significantly positive rates observed in SLE patients compared with healthy controls (P > 0.05). B19 was positive in seven (58.5%) patients with severe activity compared with 8.3% without activity, 16.7% patients with mild activity, and 16.7% patients with moderate activity. No significant differences were observed between patients with virological positivity and those with virological negativity for B19 infection as regards the activity of SLE or any clinical manifestations of SLE. Conclusion Parvovirus B19 infection is not associated with SLE.
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Study of epidemiological features of hepatitis D virus infection in HBsAg-positive chronic hemodialysis patients
Hassan A El Hady, Yassein S Yassein, Ahmed R Tawfek, Amir F Elsayed, Mohamed K Dewedar
January-March 2016, 29(1):37-43
DOI:10.4103/1110-2098.178945  
Objective Study the prevalence, clinical, and laboratory features of hepatitis D virus (HDV) infection in hepatitis B surface antigen positive chronic hemodialysis (HD) patients. Background Delta virus or HDV is a small RNA-containing virus requiring the concomitant presence of hepatitis B virus (HBV) for its survival and pathogenicity. Worldwide, 20 million of chronic HBV patients are thought to be infected with HDV. It is important to know that HDV infection is present in a HD patient with HBV infection, because it allows a more accurate determination of prognosis, and the response of HDV patients to antiviral therapy and needed dosage therapeutic regimens are different from those with chronic hepatitis B alone. Materials and methods The study included 50 chronic HBV-infected renal patients and 25 chronic HBV nonrenal patients collected from Shebin El-Kom Fever Hospital and Menoufiya University Hospital, Menoufiya, Egypt. The study was conducted from January 2013 to May 2014. Enzyme-linked immunosorbent an assay was used to detect hepatitis B surface antigen and HDV antibodies (total antibody). Results HDV antibody (total) was positive in 58% of the HBV renal patients and in 24% of the HBV nonrenal patients, with high significant statistical difference. Laboratory data showed significant statistical differences between the two groups regarding platelet concentration (higher in HBV renal patients), albumin and prothrombin (higher in HBV nonrenal patients), bilirubin levels, and renal functions (higher in HBV renal patients). Furthermore, the infection with hepatitis delta is more common in HBV renal patients in the HD group IA (72%) than HBV renal patients on conservative treatment group IB (44%), with significant statistical differences of laboratory data between the two groups regarding hemoglobin (higher in group IB) and platelet concentration (higher in group IA), albumin and prothrombin (higher in group IA), bilirubin levels (higher in group IB), and renal functions (higher in group IA). Conclusion It is concluded that HD may have a major role in widening the prevalence of delta infection among the studied HBV renal patients (72%).
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Study of echocardiographic changes among adult patients on maintenance hemodialysis
Hassan A Ahmed, Yassein S Yassein, Seham A Zaki, Ahmed M Al Qersh, Fahim S Fahim
January-March 2016, 29(1):44-51
DOI:10.4103/1110-2098.178949  
Objective The aim of this study was to identify the major echocardiographic abnormalities in end-stage renal disease (ESRD) patients on maintenance hemodialysis. Background Cardiovascular disease is the most important cause of mortality in patients with chronic kidney disease. Prevalence of cardiovascular death, especially in patients with ESRD, has been recognized as accounting for more than 50% of overall mortality in these patients. Patients with chronic kidney disease have a 3-30-fold risk for cardiovascular disease in comparison with the general population. Patients and methods A case-control study was conducted that included 40 patients with ESRD on maintenance hemodialysis and 10 apparently healthy volunteers as controls. All participants were thoroughly interrogated, examined clinically, and subjected to complete blood count, kidney function tests, evaluation of serum electrolytes, serum calcium, PO 4 level, lipid profile, fasting blood sugar (FBS), post prandial blood sugar (PPBS), HbA1c, and serum parathyroid hormone, and to transthoracic echocardiography. Patients were classified into two groups according to the presence or absence of echocardiographic changes: group 1 (G1), with echocardiographic changes, and group 2 (G2) without echocardiographic changes. Results Echocardiographic changes were seen in 75% correct of the studied dialysis patients (30/40). The major echocardiographic changes were: concentric left ventricular hypertrophy in 80% of G1 patients, diastolic dysfunction in 53.3% of G1 patients, valvular calcifications in 40% of G1 patients, systolic dysfunction in 36.3% of G1 patients, and regional wall motion abnormalities in 33.3% of G1 patients. Left atrium was dilated in 26.6% of G1 patients, whereas pericardial effusion was seen in 16.7% of G1 patients and pulmonary hypertension in 16% of G1 patients. Conclusion Our study supports the high prevalence of echocardiographic changes in hemodialysis patients (75%) with predominance of left ventricular hypertrophy (80%) and diastolic dysfunction (53.3%).
  - 759 158
Quality of life in patients with primary knee osteoarthritis
Taher E Abd Elstaar, Aml A Salama, Heba G Esaily, Samer A Bolty
January-March 2016, 29(1):111-114
DOI:10.4103/1110-2098.178999  
Objectives The aim of this study was to assess the quality of life (QoL) in patients with primary knee osteoarthritis (OA). Background OA is the most common degenerative joint disorder and a major public health problem worldwide. OA of the knee is a major cause of mobility impairment, which has an unpredictable and negative impact on health and QoL. Patients and methods This was a cross-sectional analytical study involving 116 patients with primary knee OA, who were admitted to the outpatient clinic of rheumatology and orthopedics in Menoufia University Hospital during the period of the study. Patients were included if they had radiographic evidence of hip or knee OA. QoL in these patients was assessed using the OAKHQOL questionnaire, which includes 43 items and describes QoL in five domains: physical activities (16 items), mental health (13 items), pain (four items), social support (four items), social functioning (three items), and three independent items. Each item is scored on a scale from 0 to 10. Results This cross-sectional study was carried out on 116 of patients with primary knee OA; 74.1% of these patients were women and 25.9% were men. The mean age of the studied population was 51.37 ± 8.85 years. For the KHOAQOL score, a statistically significant correlation was reported with the duration of the disease. Age, sex, BMI, site of OA, and regular use of drug showed no statistically significant difference in their KHOAQOL score. This study found a significant positive correlation of BMI of patients and their physical activity parameter of KHOAQOL. Conclusion The perception of QoL is affected negatively by the duration of the disease, whereas age, sex, site if disease unilateral or bilateral, and socioeconomic status showed no significant correlation. The study also reported that performing daily physical activity is affected by the BMI of the patient.
  - 820 183
Knowledge, attitudes, and practices of organophosphorus pesticide exposure among women affiliated to the Manshat Sultan Family Health Center (rural area) in Menoufia governorate: an intervention study
Taghreed M Farahat, Hala M Shaheen, Zakaria F Sanad, Nagwa A Frag
January-March 2016, 29(1):115-120
DOI:10.4103/1110-2098.179000  
Objective The aim of this study was to determine the impact of an educational program in terms of the knowledge, attitudes, and practices of organophosphorus (OP) pesticides among women in rural areas. Background OP pesticides are used widely in developing countries despite their known toxicity. Unsafe use of pesticides is common in developing countries. In Egypt, many pesticides are used to control pests in agriculture. Patients and methods A quasi interventional study was carried out that included 40 pregnant women exposed to OP pesticides. The study was carried out during the period from the 1 July 2012 to the end of June 2013. Knowledge, attitudes, and practices of OP pesticide exposure were assessed using a predesigned questionnaire. A postintervention evaluation was carried out after 6 months. Results The mean ΁ SD age of the participants was 26.3 ΁ 3.93 years. The majority of knowledge parameters including source of knowledge, route of entry, symptoms of long-term OP pesticide exposure or toxicity, and parameters related to all attitudes improved significantly after the implementation of a health education program (P < 0.05). The majority of practice parameters, including the use of OP pesticides in the home or field, following the instructions written on the pesticide bottle's label, and checking the expiry date, improved significantly after the implementation of a health education program (P < 0.05). Conclusion The level of knowledge, attitudes, and practices of OP pesticides were low. The educational sessions improved the level of knowledge, attitudes, and practices among the participants.
  - 1,080 140
Comparative study between adult and elderly patients as regards adherence to antihypertensive medication
Taghreed M Farahat, Hala M Shaheen, Nora A Khalil, NN Hegazy, Aya M Barakat
January-March 2016, 29(1):121-125
DOI:10.4103/1110-2098.179001  
Objectives The aim of this study was to compare adherence to antihypertensive medication between adult and elderly patients and factors affecting it. Background Poor medication adherence is the most important cause of uncontrolled blood pressure. It is estimated that 50-70% of people do not take their antihypertensive medication as prescribed. Therefore, understanding barriers to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes. Literature and methods This was a cross-sectional study conducted in Munshaat Sultan family health center, Menoufia governorate. A total of 120 hypertensive patients who attended the family health clinics during the period of the study were included. They were classified on the basis of age into adult patients aged 21-59 years and elderly patients aged 60 years or older and into adherent and nonadherent on the basis of adherence. A predesigned questionnaire was used to assess their adherence to medication using the Morisky scale and factors affecting it, such as patient, physician, disease, and drug. Results An overall 60.34% of elderly patient were adherent to medication, which was higher compared with adherence among adult patients (29.03%). There was statistically significant difference between the two groups as regards sex, education, and presence of family members helpful in reminding about medication, patients' belief about medication causing addiction, patient satisfaction toward healthcare providers and facility, frequency of drug doses, duration of hypertension, presence of another chronic illness, and hypertension complication. Conclusion In both groups, adherence was higher among patients who were married, patients having family members helpful in reminding medication, those receiving antihypertensive medication once daily, and those who had acceptable waiting time; therefore, interventions enhancing doctor - patient communication and empowering the patient have the potential to improve the adherence of hypertensive patients' medication and can consequently reduce hypertension-related costs.
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Validity of the General Health Questionnaire as a screening tool for mental health disorders among secondary school students (Menoufia Governorate)
Gaafar M Abdel-Rasoul, Omaima A Mahrous, Hewaida M El Shazly, Zeinab A Kasemy, Mohamed S Elbahy, Nasser EM Gebril
January-March 2016, 29(1):126-130
DOI:10.4103/1110-2098.179002  
Objective The aim of this study was to assess the validity of the Arabic version of the 30-item General Health Questionnaire (GHQ-30) and the prevalence of psychiatric morbidity among the studied students in Menoufia governorate, Egypt. Background The GHQ was developed by Goldberg in the 1970s. It has been translated into many languages, and it is extensively used in different settings and different cultures. A Medline and an Egyptian literature search showed no study that validated the Arabic version of the GHQ-30 in primary healthcare in Egypt. Participants and methods A cross-sectional comparative study was carried out in 454 secondary school students in Ashmoun city, Menoufia governorate, Egypt. Socioeconomic standard application, Arabic version of the GHQ-30, and Structured Clinical Interview according to DSM-IV were administered to 454 students. Results Using the Structured Clinical Interview of DSM-IV for studied groups, the prevalence of psychiatric disorders was 16.7%. Anxiety disorders were the most common in the sample with an incidence of 10.3%, including phobia (3.7%), generalized anxiety disorder (3.3%), and obsessive compulsive disorder (3.3%). The incidence of depressive disorder was 4.8%, conduct disorder was 1.1%, and that of adjustment disorder was 0.4%. This study has shown that the Arabic version of GHQ-30 is a valid and useful screening instrument of psychiatric morbidity in a primary care setting in Egyptian patients. The best cutoff point was found to be 38 between sensitivity (77%) and specificity (78%). The principal component analysis with the varimax rotation of the Arabic version of GHQ-30 was found to contain four underlying factors. These factors were identified as psychological distress, self-esteem, daily life activities, and social relationships. Conclusion The Arabic version of GHQ-30 was found to have satisfactory internal consistency and construct validity, and it was a useful instrument for assessing the psychological well-being of secondary school students.
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Predictors of poor response to the hepatitis B vaccine among healthcare workers at the National Liver Institute Hospital
Rabie E El Bahnasy, Mahmoud E Abu Salem, Hewaida M El Shazly, Wesam S Morad, Enas M Moaz
January-March 2016, 29(1):131-135
DOI:10.4103/1110-2098.179003  
Objectives This study aimed to estimate the nonresponder rates to the hepatitis B vaccine and identify possible risk factors of nonresponse among a group of healthcare workers (HCWs) at the National Liver Institute Hospital. Background Hepatitis B is the most important infectious occupational disease among HCWs. The most effective preventive measure is hepatitis B vaccination. Response to the hepatitis B vaccine [significant hepatitis B surface antibodies (HBsAbs) titer] ranges from 85 to 90% globally. HCWs are at a high risk of acquiring hepatitis B virus (HBV), and nonresponder rates after HBV vaccination have not been reported previously among HCWs at the National Liver Institute. Participants and methods A retrospective and follow-up study was carried out at the National Liver Institute. The studied group included 200 HCWs who were evaluated for immune response by measuring serum HBsAbs levels within 6 months after completing three doses of the HBV vaccine. A questionnaire was administered to them to assess the risk factors of nonresponse. Results The nonresponder rate to the hepatitis B vaccine (nonsignificant HBsAbs titer) was 9%. The results showed that there was a significant relationship between nonresponse and older age, high BMI, and the presence of chronic diseases; 55.6% of the nonresponders were older than 30 years of age, 66.7% of the nonresponders had BMI above 30, and 100% of hepatitis C-infected HCWs showed no response to the vaccine (P < 0.05). Conclusion and recommendations Nonresponder HCWs to the HBV vaccine who work in a high-risk environment are at a high risk of acquiring HBV infection. Therefore, it is crucial to check postvaccination HBsAbs in all HCWs. This strategy will ensure safety at work by reducing nosocomial transmission, and will have a cost-effective impact at an individual as well as at a national level.
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The role of proton magnetic resonance spectroscopy in grading of brain gliomas
Hala Hafez, Basma Abd Elmoneim, Tarek Fawzy, Suzan F Omar
January-March 2016, 29(1):136-140
DOI:10.4103/1110-2098.179004  
Objective This study aimed to evaluate the role of proton magnetic resonance spectroscopy ( 1 H-MRS) in grading of brain gliomas. Background Noninvasive and accurate grading of brain gliomas is important for determining the correct treatment plane and in some cases to avoid unnecessary aggressive surgical treatment. 1 H-MRS has a potential for providing metabolic information about tumor tissues without surgical tissue sampling. Patients and methods This prospective study included 70 patients with brain gliomas. Single voxel spectroscopy was obtained using PRESS sequence with TE 136 ms. Results The number of male and female patients was 38 and 32, respectively; their ages ranged from 11 to 58 years with a mean age of 49.9 years. The mean Cho/Cr ratio was 1.46 in low-grade gliomas and 3.9 in high-grade gliomas. The mean Cho/N-acetylaspartate was 1.17 in low-grade gliomas and 3.7 in high-grade gliomas. Lipid/lactate peak was present only in high-grade gliomas. Conclusion 1 H-MRS is a noninvasive method that provides greater information concerning tumor activity and characterization of the tumor tissue than is possible with standard MRI technique alone.
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The diagnostic value of serum squamous cell carcinoma antigen for prediction of hepatocellular carcinoma
Maha A El-Bassuonia, Rawhya H El-Edel, Eman A Gawesh, Sally S Mandour
January-March 2016, 29(1):141-146
DOI:10.4103/1110-2098.179005  
Objective The aim of this study was to determine the efficacy of serum squamous cell carcinoma antigen (SCCA) in comparison with α-fetoprotein (AFP) in the detection of hepatocellular carcinoma (HCC). Background HCC is the most common type of primary liver cancer and shows a growing incidence worldwide, related to the increased prevalence of various risk factors for chronic liver diseases, such as hepatitis infection with hepatitis C and B viruses. Each year HCC is diagnosed in more than half a million people worldwide. Therefore, prompt diagnosis of HCC is imperative. Patients and methods This study was carried out at the Clinical Pathology Department, Faculty of Medicine, and Clinical Pathology Department, National Liver Institute, Menoufia University, from June 2012 to November 2013. The study included 30 patients with liver cirrhosis and 30 patients with HCC, in addition to 17 unrelated healthy adults of matched age and sex who were included as controls. Serum AFP and serum SCCA level were estimated using enzyme linked immunosorbent assay. Results Although SCCA has more sensitivity than AFP in the detection of HCC, AFP remains a relatively good diagnostic marker for HCC, with high specificity. Conclusion AFP is a relatively good diagnostic test for cirrhosis with high specificity. Moreover, a combination of the two markers may improve sensitivity, making their combination a perfect screening test for the prediction of HCC.
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Current role of MRI in cerebellopontine angle lesions
Mohamed A Maaly, Amr A Sultan
January-March 2016, 29(1):147-151
DOI:10.4103/1110-2098.179006  
Objective The aim of our study is to evaluate the current role of MRI in the diagnosis of cerebellopontine angle lesions. Background MRI is considered the gold-standard method for the diagnosis of cerebellopontine angle lesions. This study aimed to explore an appropriate diagnosis to assess the extent and type of the lesion allowing for proper treatment. Patients and methods This study included 25 patients with symptoms suggestive of neurological disorders. Patients were subjected to different MRI sequences such as precontrast, postcontrast, diffusion MR, and MR spectroscopy. Results Of the 25 patients studied, the final diagnosis by MRI showed acoustic schwannoma in 12 (48.0%) patients, which was the most common lesion, followed by meningioma, was noted in seven (28.0%) patients, epidermoid cyst in one (4.0%) patient, prominent anterior inferior cerebellar artery (AICA) in one (4.0%) patient, paraganglioma in one (4.0%) patient, cystic neurofibroma in one (4.0%) patient, neurofibromatosis type 2 in one (4.0%) patient, and an arachnoid cyst in one (4.0%) patient. Conclusion MRI is the gold-standard method to differentiate the lesions by anatomical site of origin, shape, signal intensity, and behavior after an injection of contrast media.
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Golgi protein 73 versus alpha fetoprotein as a marker for hepatocellular carcinoma
Mariam A Fouad, Emad F Haleim, Waleed F Azeim, Dalia HA Elela, Osama H Abdelsalam
January-March 2016, 29(1):152-159
DOI:10.4103/1110-2098.179007  
Objective The aim of this work was to assess the clinical utility of Golgi protein 73 (GP73) among Egyptian hepatocellular carcinoma (HCC) patients in comparison with α-fetoprotein (AFP). In addition, the level of GP73 was evaluated after surgical resection of HCC. Background Serum Golgi protein 73 (sGP73) is a promising biomarker for detection of HCC. Patients and methods This study included 76 patients; 38 of them had proved HCC (10 of them were followed up after hepatectomy to detect the level of GP73 after treatment), 25 patients had chronic liver diseases (CLDs) and 13 apparently healthy individuals were considered as controls. Clinical examination, abdominal ultrasonography and triphasic computed tomography for focal lesion were performed. Liver function tests were performed using Synchron Cx9 ALX Clinical Autoanalyzer, serum AFP was measured using ELISA method and hepatitis markers and GP73 were determined by ELISA kit for GP73. Results There was highly statistically significant difference in GP73 between HCC and the control group and also between HCC and the CLD group. Moreover, GP73 is significantly lower after hepatectomy. For discrimination of HCC from healthy control, receiver operating characteristic curve showed that sGP73 levels had area under the receiver operating characteristic (AUROC) curve of 0.89 [95% confidence interval (CI) 0.81-0.98)] and sensitivity of 76.3% and specificity of 92.3% at a cutoff point 192 ng/l, whereas AFP had AUROC curve of 0.83 (95% CI 0.71-0.95) and sensitivity of 73.7% and specificity of 61.5% at a cutoff point 10.5 ng/ml. For discrimination of HCC from CLD, receiver operating characteristic curve showed that the sGP73 levels had the AUROC curve of 0.88 (95% CI 0.79-0.96) and sensitivity of 76.3% and specificity of 84% at a cutoff point 195 ng/l, whereas AFP had AUROC curve of 0.83 (95% CI 0.72-0.93) and sensitivity of 73.7% and specificity of 68% at a cutoff point 10.5 ng/ml. Conclusion GP73 expression is highly increased in HCC patients. Its diagnostic performance is superior to that of AFP and is a useful marker for follow-up of HCC patients after surgical hepatectomy.
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Study of clinical significance of protein tyrosine phosphatase-1B gene polymorphism in essential hypertension and dyslipidemia
Emad F Abd El-Halim, Seham Z Khodair, Mahmoud A Kora, Dalia M Abou-Elela, Noran T Abo El-khair
January-March 2016, 29(1):160-166
DOI:10.4103/1110-2098.179008  
Objectives The aim of the study was to investigate the role of protein tyrosine phosphatase-1B (PTP-1B) gene polymorphism in essential hypertension and dyslipidemia. Background Essential hypertension is the most common chronic disease and an important risk factor for major health problems. PTP-1B has been recognized as a key modulator of several important physiological pathways. Multiple SNPs of PTP-1B have been shown to be associated with diseases accompanying insulin resistance, such as dyslipidemia and hypertension. Participants and methods The study included 57 individuals divided into two groups: group I comprised 37 hypertensive patients and group II comprised 20 healthy individuals as controls. The participants were subjected to the following: history taking and clinical examination, assessment of weight, height, and BMI, fasting blood sugar, lipid profile, renal function tests, and PCR-RFLP for determination of genotype and allele frequencies of the g54281T > A polymorphism of the PTP-1B gene. Results Group I had statistically higher fasting blood sugar, weight, BMI, and TG. The TT genotype recorded higher frequency in group II than in group I (70%, 43.2%, respectively). While, AA genotype showed higher frequency in group I than in group II (29.7%, 5%, respectively) and TA genotype was higher in group I than in group II (27%, 25%, respectively). However, the differences were without statistical significance. The T allele was more prevalent in group II (82.5%) than in group I (56.8) and the A allele was more prevalent in group I (43.2%) than in group II (17.5%). TA carried a 1.75-fold higher risk than TT [confidence interval (CI): 0.48-6.36], whereas AA carried a 9.63-fold higher risk than TT (CI: 1.10-84.23). The A allele carried a 3.59-fold higher risk than the T allele (CI: 1.41-9.16). In group I, AA genotype was higher in BMI than TT, also TA and AA genotypes were higher in TG than TT. Conclusion The g54281T > A polymorphism of the PTP-1B gene can be implicated in the pathogenesis of essential hypertension.
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Study of toll-like receptor 4 in type 2 diabetic patients with or without nephropathy
Waleed M Fathy, Mohamed A Soliman, Ahmed Ragheb, Ghada H Al Ashram
January-March 2016, 29(1):167-173
DOI:10.4103/1110-2098.179009  
Objective The aim of this work was to study the role of toll-like receptor 4 (TLR4) in the development of type 2 diabetes mellitus (T2DM) as well as its relation to the occurrence of diabetic nephropathy. Background Chronic kidney disease is one of the major complications of T2DM and is the leading cause of end-stage renal disease. There is growing evidence indicating that chronic low-grade inflammatory response is a recognized factor in the pathogenesis and progression of diabetic renal injury. Patients and methods A total of 50 T2DM patients were divided into three groups according to urinary albumin excretion: those with normoalbuminuria, those with microalbuminuria, and those with macroalbuminuria. In addition, 10 apparently healthy individuals were included as a control group. Fasting blood glucose, glycated hemoglobin, blood urea, and serum creatinine were measured in all patients. Urinary albumin excretion was measured using a morning spot urine sample and the urinary albumin/creatinine ratio was calculated. Quantification of CD14 and TLR4 expression on monocyte subsets was performed by means of flow cytometry. Results Levels of CD14 were found to be significantly increased in patients with macroalbuminuria, whereas TLR4 levels were increased in T2DM patients, with further elevation in patients with macroalbuminuria. Both markers showed significant positive correlations with the duration of diabetes, glycated hemoglobin, serum creatinine, and urinary albumin/creatinine ratio and significant negative correlations with estimated glomerular filtration rate. Multivariate regression analysis demonstrated that CD14 and TLR4 are independent predictors of the occurrence of microalbuminuria in T2DM patients. Conclusion TLR4 levels were higher in T2DM patients compared with normal individuals. These observations significantly add to the emerging role of TLRs in T2DM development. TLR4 was also found to correlate well with the severity of albuminuria in T2DM and to be a good predictor of microalbuminuria, suggesting its possible role in the pathogenesis and progression of diabetic nephropathy.
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Early effects of right ventricular pacing on the left ventricle in single-chamber and dual-chamber pacemakers
Alaa S Algazzar, Mohamed A Moharram, Azza A Katta, Ghada M Soltan, Walaa F Abd Elaziz
January-March 2016, 29(1):52-59
DOI:10.4103/1110-2098.178977  
Objectives Our study aimed at demonstrating the early impacts of right ventricular apical pacing induced by single-chamber (VVI) and dual-chamber (DDD) pacemakers on left ventricular (LV) functions, and to assess whether brain natriuretic peptide (BNP) after 2 months of implantation is correlated for LV dyssynchrony. Background Long-term effects of right ventricular apical pacing have been studied, and not much information is available on the early effects of right ventricular pacing on the LV function and dyssynchrony. Patients and methods The study was conducted on 40 patients who came for the implantation of permanent pacemakers. Patients were divided into two groups of 20 patients each: group A included patients who were implanted with VVI pacemakers and group B included patients who were implanted DDD pacemakers. Both groups were examined before implantation and after 2 and 6 months of implantation for BNP and predetermined parameters for LV dyssynchrony and systolic and diastolic functions by echocardiography. After 6 months, patients with DDD pacemakers were crossed over to the VVI mode of pacing by programming for a period of 2 weeks, and then a blood sample was collected for BNP. Results The mean BNP level in VVI pacing (group A) was 196.5 ΁ 123 pg/dl, which was higher than that in DDD pacing (group B 79.35 ΁ 65.36 pg/dl), after 2 months, with P value equal to 0.001, while a comparison after 6 months showed P value equal to 0.023. There was a statistically significant difference between groups in their myocardial performance index with a P value of 0.03. Results of the aortic pre-ejection delay showed a significant difference with a P value of less than 0.05. BNP was correlated to aortic pre-ejection delay (r = 0.651 and P = 0.001) and the pacing percentage (r = 0.687 and P = 0.00). Conclusion Loss of atrioventricular synchrony in the VVI mode leads to a significant difference in LV dyssynchrony between both groups. Myocardial performance index was affected more than the other parameters for systolic and diastolic functions. The BNP level was correlated to LV dyssynchrony and the pacing percentage.
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Cystatin C as an early diagnostic marker for contrast nephropathy in diabetic patients undergoing coronary angiography
Abdallah Mostafa, Amira Al-Hendy, Ahmed Emara, Ezzat Adly
January-March 2016, 29(1):60-66
DOI:10.4103/1110-2098.178981  
Objective The aim of this study was to assess the utility of cystatin C as an early biomarker for acute kidney injury (AKI) compared with serum creatinine. Background Contrast-induced nephropathy (CIN) is a form of AKI that is caused by exposure to contrast media in diagnostic imaging and interventional procedures such as angiography. At present, serum creatinine and creatinine clearance are standard tests for CIN. A few studies have been published that have analyzed the potential use of cystatin C in AKI. Patients and methods We studied 30 diabetic and 20 nondiabetic consecutive patients with normal serum creatinine undergoing coronary angiography (CA). The nondiabetic group was used to assess diabetes as a risk factor for CIN. After providing informed consent, the patients underwent the following before CA: estimation of blood glucose, glycosylated hemoglobin, serum creatinine, blood urea, estimated creatinine clearance, and cystatin C. Serum cystatin C was measured by means of the enzyme-linked immunosorbent assay technique and was evaluated again at 24 h after CA, whereas serum creatinine was evaluated at 24 and 72 h after CA. Results In patients with CIN there was a significant increase in serum cystatin C 24 h after angiography, whereas serum creatinine increased significantly only at 72 h after the procedure. The incidence of CIN was 20% in the diabetic group, 5% in the nondiabetic group, and 14% in the whole population sample. Conclusion The present study highlights the importance of serum cystatin C in detecting AKI associated with contrast administration earlier than serum creatinine.
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Prediction of short-term mortality after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction
Abdalla M Kamal, Mahmoud A Soliman, El Sayed A El Sebaay Ali Habba
January-March 2016, 29(1):67-72
DOI:10.4103/1110-2098.178987  
Objective The aim of this work was to predict short-term mortality after a primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) in terms of demographic, clinical, echocardiographic, and coronary angiographic data. Background Accurate risk stratification after primary PCI is important as mortality in STEMI patients represents a considerable number of all causes of mortality. Patients and methods This registry included 50 patients who presented to the emergency department at Nasr City Health Insurance Hospital in Cairo during the period from September 2012 to June 2013 and were diagnosed with STEMI. Every patient underwent demographic, clinical, echocardiographic, and angiographic assessments for risk factors leading to mortality in hospital and after 6 months of follow-up. Results Eight variables were identified in our registry as predictors of short-term mortality after primary PCI including age (P = 0.005), increased serum creatinine (P = 0.010), KILLIP class (P < 0.001), left ventricular ejection fraction less than 40% (P = 0.021), multivessel disease (P = 0.018), type of culprit vessel (P < 0.001), postprocedural TIMI flow (P < 0.001), and postprocedural myocardial blush (P < 0.001). Conclusion In acute myocardial infarction patients treated with primary PCI, eight risk factors were identified. These factors predict short-term mortality accurately.
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Role of heart fatty acid-binding protein (h-FABP-type III) as a diagnostic biomarker in acute coronary syndrome
Ahmed A Reda, Mohammed A Moharram, Mostafa A Soliman
January-March 2016, 29(1):73-78
DOI:10.4103/1110-2098.178990  
Objective To determine the role of heart-type fatty acid-binding protein (h-FABP type III) as a diagnostic biomarker in acute coronary syndrome in the early detection of myocardial ischemia or myocardial necrosis (30 min to 6 h from onset of chest pain). Background Cardiac biomarkers play an important role in the diagnosis of acute coronary syndrome. Cardiac troponins have been the preferred biomarker, but because of their delayed appearance in the serum, there is still a need for reliable. h-FABP, a small (15 kDa) cytoplasmic tissue-specific protein, is mainly expressed by cardiac biomarkers. Methods and results The patients were classified into two main groups. Group I included patients who presented with ST-segment elevation myocardial infarction (STEMI, n = 25) and group II included patients who presented with non-STEMI/unstable angina (NSTEMI/UA, n = 25) within 20 min and 6 h of acute chest pain. Blood h-FABP levels were measured using a QuickSens test (semiqualitiative) and were compared with first cTn-I and creatine kinase-MB at the time of admission and second troponin 12 h from onset of chest pain. Then, according to the serum level of h-FABP, the patients were classified into two subgroups: h-FABP-positive patients and h-FABP-negative patients. The diagnostic sensitivity, specificity, and receiver operating characteristic curve were evaluated. Serum h-FABP was significantly elevated within 20 min to 6 h. In terms of the relation between h-FABP and second troponin, h-FABP showed a sensitivity of 92.59%, a specificity of 52.17%, a positive predictive value of 69.44%, a negative predictive value of 85.71%, and an accuracy of 74%. Our results showed that h-FABP was significantly higher than other biomarkers less than 6 h after the onset of chest pain. Conclusion h-FABP can be used as an early diagnostic cardiac biomarker in the early detection of patients with an acute coronary syndrome within 30 min to 6 h of onset of chest pain.
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Genetic evaluation of children with ambiguous genitalia
Soheir S Abou El-Ella, Maha A Tawfik, Wafaa M Abo El-Fotoh, Ahmed Sh Abo Howla
January-March 2016, 29(1):79-88
DOI:10.4103/1110-2098.178991  
Objectives The aim of the study was to conduct a clinical assessment of pediatric patients with ambiguous genitalia, perform molecular genetic studies for SRY and SOX9 genes, and provide genetic counseling for patients and their families. Background Ambiguous genitalia, currently known as disorders of sex development (DSDs), are associated with atypical development of chromosomal, gonadal, or anatomical sexual characteristics, with an incidence of one in 4500 live births. Their early management is crucial for preventing complications, especially psychiatric impacts on the patient and the family, and should be decided after careful consideration of the child's welfare. Materials and methods Sixteen patients aged 1 day to 6 years were selected from the Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Egypt. All patients were subjected to detailed history taking, a thorough clinical examination, routine and hormonal investigations, imaging studies, and cytogenetic and molecular studies for SRY and SOX9 genes. Results History revealed seven patients (43.75%) with positive consanguinity and five patients with similar conditions in their families. Hormonal study revealed five patients (31.25%) above normal ranges for serum 17-OH progesterone levels and two patients (12.5%) below normal ranges. Karyotyping revealed six patients with 46, XX DSD, eight with 46, XY DSD, one with 45, X, and another with 45, X/46, XY. On the basis of molecular studies, the SRY gene was positive for six patients with a normal male 46, XY karyotype and for one patient with 45, X karyotype (translocated SRY). SRY was negative for five patients with a normal female 46, XX karyotype and for one patient with 45, X/46, XY karyotype (deleted SRY). All patients were positive for the SOX9 gene and no deletions were detected. Conclusion Early identification of the genetic cause of DSD will in many cases streamline and direct clinical management of the patient with more focused endocrine and imaging studies and better surgical decision.
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REVIEW ARTICLES
Toll-like receptors: from bench to bedside
Ali Z Galal, Sabry A Alla Shoaib, Mahmoud M Emara, Shimaa S Mohamed El-Sayed
January-March 2016, 29(1):1-4
DOI:10.4103/1110-2098.178936  
Objective The aim of the work was to highlight toll-like receptors and their therapeutic use in different diseases. Data sources Data were obtained from medical text books, medical journals, and medical websites, which had updated investigations with the key word (toll-like receptors) in the title of the papers. Study selection Selection was carried out by supervisors for studying toll-like receptors and their clinical significance. Data extraction Special search was carried out for the key word toll-like receptors in the title of the papers, and extraction was made, including assessment of quality and validity of papers that met with the prior criteria described in the review. Data synthesis The main result of the review and each study was reviewed independently. The obtained data were translated into a new language based on the need of the researcher and have been presented in various sections throughout the article. Recent findings We now know that innate immunity plays an important role in the initiation of an immune response that follows the activation of antigen specific acquired immunity. A complete understanding of the mechanisms of innate immunity will be helpful for the future development of innovative therapies for the treatment of infectious diseases, cancer, allergies, and renal diseases.
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The role of laser and intense pulsed light in the treatment of hyperpigmentation disorders
Mostafa A Hammam, Eman S Abd Alsalam Tabana
January-March 2016, 29(1):17-21
DOI:10.4103/1110-2098.178939  
Objective This article reviews the treatment of hyperpigmentation disorders with laser and intense pulsed light (IPL). Data sources Previous literatures, reviews, and studies as well as medical websites (PubMed, MD consult, Medscape) and scientific journals databases were searched from the start date of each database. Study selection Selection was done by supervisors for studying new advancements in treating hyperpigmented lesions with laser and IPL devices. Data extraction In this review data from published studies were manually extracted and summarized. Study quality assessment included determining whether ethical approval was obtained, prospective design, eligibility criteria specified, appropriate controls used, adequate follow-up and defined outcome measures achieved. Data synthesis In this review several studies of the role of laser and IPL in treating hyperpigmented lesions were included. There are different laser and IPL devices for treating hyperpigmented lesions with different indications. We got our data from studying the different types of laser and IPL approaches to know which one is preferred taking into consideration different complications of the approaches. Findings A total of 44 studies were included in the review as they were deemed eligible by fulfilling the inclusion criteria. Of these 44 articles, included in this review, 32 were laser studies and 12 were IPL studies. Studies indicate that laser and IPL therapy can be effective in the treatment of a wide variety of hyperpigmented skin lesions using the basic principles of selective photothermolysis. A full understanding of laser and IPL principles and the characteristics of the lesion to be treated is essential for the effective and safe use of light-based therapies. Conclusion Progress in laser and IPL technology has involved the development of safer and more efficient methods of achieving the desired effects on hyperpigmented skin lesions. The Q-switched lasers with their high peak power and pulse width in the nanosecond range are best suited to treat various epidermal, dermal, and mixed lesions. Long-pulsed ruby and alexandrite lasers have been shown to be effective in the treatment of Q-switched ruby laser-resistant congenital nevi and other pigmented lesions. Nonablative fractional photothermolysis holds great promise in treatment of both pigmentary variation as well as skin textural abnormalities. Intense pulsed technology is a highly versatile, safe, and effective modality for the treatment of pigmented lesions.
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Epigenetics meets hematology
Ali Z Galal, Sabry A Shoieb, Mohammad A Abdelhafez, Mohammad S Elhawwary
January-March 2016, 29(1):5-10
DOI:10.4103/1110-2098.178937  
Objectives The aim of the study was to review the concept of epigenetics and its role in the evolution and treatment of blood disorders. Data sources Data were obtained from Medline databases (PubMed, Medscape, Science Direct) and from materials available on the Internet from 2002 to 2014. Study selection The initial search presented 90 articles, of which 30 met the inclusion criteria. The articles studied the role of epigenetics in the pathogenesis and treatment of hematological diseases. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval had been obtained, eligibility criteria had been specified, appropriate controls had been established, adequate information was available, and assessment measures had been defined. Data synthesis Each study was reviewed independently; the obtained data were translated into the language of the researcher and have been presented in sections throughout the article. Findings In total 30 potentially relevant publications were included: 29 were human studies and one was an animal study. The studies define epigenetics as changes in gene expression without changes in the DNA itself. Epigenetic regulation was achieved by DNA methylation, histone modification, and microRNA interference. Deregulations in epigenetic mechanisms present an important pathway toward the development of hematological disorders. DNA-demethylating and histone-deacetylating agents are the first era of drugs directed at treating epigenetic deregulations with significant success rates. Conclusion Unlike genetics, the reversible nature of epigenetics makes them highly attractive targets for cancer therapies. DNA-demethylating and histone-deacetylating agents are the first drugs directed at treating epigenetic deregulations. Understanding epigenetic mechanisms will be helpful in introducing new lines of treatment.
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