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   2019| July-September  | Volume 32 | Issue 3  
    Online since October 17, 2019

 
 
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ORIGINAL ARTICLES
Effect of pornography on married couples
Mohamed A Gaber, Hesham N Khaled, Manal M. A. Nassar
July-September 2019, 32(3):1025-1029
DOI:10.4103/mmj.mmj_905_17  
Objective The objective of this study was to study the effects of pornography on married couples in their sexual and social live. Background Pornography has long been a major problem in our society, but since the arrival of the internet it has grown to proportions no one could have imagined. Participants and methods The study included 300 married men and women selected randomly with age ranging from 20 to 50 years having regular sexual intercourse. They were asked to fill a self-report questionnaire. The study was carried out in the outpatient clinics of Obstetrics/Gynecology and Dermatology of Menoufia Faculty of Medicine, Sirs Elyan and El-Bagour General Hospital. Internal validity and item domain of the questionnaire were assessed using Cronbach's α statistical analysis to assess the six main domains of the questionnaire: sociodemographic characters, source of pornography, partner watching pornography, sexual relationship, satisfaction with sexual life, and social life. The results showed high internal consistency and reliability of the questionnaire of Cronbach's α of 0.93 and high item domain and domain total correlation (r = 0.86–0.97). Results The prevalence of positive watchers among participants was 43.3%. The main source of watching was internet (47.6%). Male participants watching pornography were higher than female participants (69.2 vs. 30.8%) and 46.2% of pornography watchers said that coital frequency after watching increases only on the watching day. Watching pornography increases with increase in the years of marriage was the opinion of watchers (70%). Sexual desire increase with watching pornography in 53.1% of watchers. Also, lubrication always increase with watching was the opinion of 56.2% of watchers. Pornography increases masturbation among 74.6% of watchers, but it could not help to reach orgasm among 61.5% of them. Pornography watching increases the incidence of divorce (33.8%) (P = 0.001). Conclusion Pornography has a negative effect on marital relation.
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REVIEW ARTICLES
The role of osteopontin in dermatological diseases
Alaa H Marea, Wafaa A Shehata, Sally M El-Hefnawy, Amany M Mohsen
July-September 2019, 32(3):751-755
DOI:10.4103/mmj.mmj_903_17  
Objective The aim of this study was to study the role of osteopontin (OPN) in dermatological diseases through a meta-analysis study. Data sources Previous literatures, reviews, and studies as well as medical websites (PubMed, Medscape and Science Direct), all material available in the internet from 2014 to 2017, and scientific journals databases were searched from the start date of each database. Study selection The initial search presented 10 articles of which five met the inclusion criteria. Selection was done by supervisors for studying the role of OPN in dermatological diseases. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Data synthesis Comparisons were made by a structured review with the results tabulated. Findings In total five potentially relevant publications were included; all were human studies. The studies show an elevated level of OPN in some dermatological diseases such as allergic contact dermatitis, alopecia areata, psoriasis, sarcoidosis, and systemic lupus erythematosus in comparison to the controls. Conclusion As OPN was elevated among allergic contact dermatitis, alopecia areata, psoriasis, sarcoidosis, and systemic lupus erythematosus patients, it may play a role in the pathogenesis of such diseases.
  306 88 -
Role of functional MRI in assessment of voice, language, and speech disorders
Mohamed Baraka, Hossam El-Dessouky, Eman Ezzat, Marwa G A El-Hameed
July-September 2019, 32(3):763-769
DOI:10.4103/mmj.mmj_719_17  
Objective The objective of this study was to review the role of functional MRI (fMRI) in assessment of voice, language, and speech disorders. Materials and Methods Medline databases (PubMed, Medscape, and ScienceDirect) and all materials available in the Internet from 1993 to 2017 were the sources of data. The initial search presented 267 articles of which 62 met the inclusion criteria. The articles studied the role of fMRI in assessment of communication disorders as regards voice, language, and speech. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Results Significant data were collected. Data were heterogeneous. Thus, a structured review was performed with the results tabulated. Conclusion fMRI brain imaging provides a new perspective on the organization of language, speech, and voice in the human brain. It can provide basic information about brain disease, and determine and monitor treatment outcomes of communication disorders. It gives a better definition of the distributed nature of the brain circuits involved and appreciation of the flexibility of these circuits in adapting to the different aspects of language, speech, and voice production.
  249 64 -
Role of microneedling in treatment of patients with striae distensae
Magda M Hagag, Rehab M Samaka, Hanan A E Mahmoud
July-September 2019, 32(3):756-762
DOI:10.4103/mmj.mmj_36_18  
Objective The aim of this work was to elucidate the efficacy and safety of microneedling in the treatment of striae distensae (SD). Background SD is a common form of dermal scarring that appears on the skin as violaceous, erythematous, or hypopigmented linear striations. Microneedling therapy or collagen induction therapy is a minimally invasive, nonsurgical, and nonablative procedure that involves the use of a microneedling device to create controlled skin injury. Data sources Medline databases such as PubMed, Medscape, Science Direct, and EMF-Portal and all materials available on the Internet from 2010 to 2017 were searched. Study selection The initial search presented seven articles that have studied the role of microneedling in the treatment of SD. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls mentioned, adequate information provided, and assessment measures defined. Data synthesis Comparisons were made by structured review with the results tabulated. Findings The use of skin microneedling is found to be effective in the treatment of SD. Conclusion This study concluded that the use of skin microneedling is effective as a new modality for the treatment of SD.
  247 65 -
ORIGINAL ARTICLES
Urinary incontinence among elderly women attending a rural family health center in Gharbiya Governorate, Egypt
Fatma A Elserafy, Hala M E Shaheen, Nora A Khalil, Heba Allah M. Abdelrahman
July-September 2019, 32(3):955-960
DOI:10.4103/mmj.mmj_701_17  
Background Urinary incontinence (UI) is considered as a distressing and debilitating condition in elderly women. It has a significant negative impact on quality of life. Objective The aim of this study was to assess the prevalence of UI among elderly women attending a family health center and identify the risk factors associated with the development of UI among the studied group. Patients and methods This was a cross-sectional study conducted in a rural family health center, Gharbiya Governorate. The study was carried out on 217 elderly women. A structured questionnaire sheet was used to determine the sociodemographic criteria of the studied participants and predesigned questionnaires for the diagnosis of UI and to assess its severity. Results The overall prevalence of UI among the studied participants was 67%. The prevalence of mixed, stress, urgency UI was 31, 27, 9%, respectively. Its severity among the studied women ranged from slight (11%) to moderate (55.5%), severe (30.1%), and very severe (3.4%). The mean age was significantly higher among the incontinent group (67.55 ± 7.12). There was a significant association between UI and diabetes mellitus, hypertension, and urinary tract infection (odds ratio = 20.44, 13.63, 6.07), respectively. Obesity and constipation were significantly associated with stress incontinence and mixed incontinence. No significant relationship was found between the different types of UI and obstetric history. Conclusion A high prevalence of UI (67%) was detected among the studied group. The most commonly associated risk factors were age, obesity, diabetes, hypertension, urinary tract infection, and constipation.
  269 18 -
Subendocardial systolic dysfunction in hypertensive patients with strain ST-T changes on ECG by speckle tracking
Mahmoud A Soliman, Morad B Mena, Gerges R Thabet
July-September 2019, 32(3):855-860
DOI:10.4103/mmj.mmj_873_17  
Objective The aim of this study was to evaluate longitudinal strain by speckle tracking in hypertensive patients with strain ST-T on ECG. Background Hypertension causes ST-T changes on ECG which may predict subclinical systolic dysfunction detected by two-dimensional speckle tracking. Patients and methods Longitudinal strain analysis was done in 82 hypertensive patients, who were divided into three groups: the first group included 30 hypertensive patients with echocardiographic evidence of left ventricular hypertrophy (LVH) and strain ST-T changes on ECG (group 1), the second included 31 hypertensive patients with echocardiographic evidence of LVH but without changes on ECG (group 2), and the third control group included 21 hypertensive patients without echocardiographic evidence of LVH (group 3). Results A high significant difference was detected in relation to hypertension duration, which divided into two categories (>10 and ≤10 years) (P < 0.001). A highly significant increase was present regarding echocardiography data on left ventricular (LV) mass (P < 0.001), LV mass index (P < 0.001), relative wall thickness (P < 0.001) and interventricular septum (P < 0.001), posterior wall (P < 0.001), left atrium (P < 0.001), and aorta diameters (P < 0.001) between group 1 compared with group 2 and group 3. Moreover, significant decrease was found on Doppler data regarding E/A ratio between group 1 compared with group 2 and group 3. There was a highly significant reduction between group 1 compared with group 2 and group 3 regarding mean value of global and regional LV longitudinal systolic strain (P < 0.001). Conclusion Subtle LV systolic dysfunction evident by speckle tracking was present in hypertensive patient with strain ST-T changes on ECG independent of left ventricular ejection fraction percentage.
  225 15 -
REVIEW ARTICLES
Nutrition in critically Ill pediatric patients: a systemic review
Ali M Elshafie, Dalia M El-Lahony, Zein A Omar, Wael A Bahbah, Hanem R M Ghetas
July-September 2019, 32(3):812-817
DOI:10.4103/mmj.mmj_2_18  
Objective The study aimed to review the different types of nutrition in critically ill pediatric patients. Data sources Medline databases (PubMed, Medscape, Science Direct, EMF-Portal, Google Scholar) and all materials available in the Internet from 2001 to 2014 were searched. Study selection The initial search presented 150 articles of which 50 met the inclusion criteria. The articles studied the role of nutritional management in critically ill pediatric patients. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, adequate information provided, and assessment measures defined. Data synthesis Comparisons were made by structured review with the results tabulated. Findings In total, 50 studies indicated that ICU patients who present with malnutrition or at a high probability of developing malnutrition during their hospital stay and those who are not expected to be on a full oral diet within 3 days should receive specialized enteral and/or parenteral nutritional support. Feeding should be started early within the first 24–48 h to facilitate diet tolerance and reduce the risk of intestinal barrier dysfunction and infections. Conclusion This review found that critically ill pediatric patients are at risk of malnutrition. Enteral nutrition is the preferred mode of nutrition and should be used whenever possible. Total parental nutrition is used only if the gastrointestinal tract is unable to meet the nutritional requirements for 1–3 days in infants and 4–5 days in children and adolescents.
  172 30 -
ORIGINAL ARTICLES
Pharmacological conversion of recent-onset atrial fibrillation: a randomized study of propafenone and amiodarone
Abdallah M Kamal, Naglaa F Ahmed, George S Kamil
July-September 2019, 32(3):851-854
DOI:10.4103/mmj.mmj_748_17  
Aim The aim of this study was to compare the efficacy and rapidity of recent-onset atrial fibrillation (AF) conversion by oral propafenone versus an intravenous infusion of amiodarone. Background Amiodarone and propafenone are the most widely used drugs in Egypt for the pharmacological cardioversion of AF. Patients and methods Fifty patients with recent-onset AF – within less than 48 h – were investigated. The patients were divided randomly into two groups: the first group (group A) included 25 patients in whom amiodarone was administered and the second group (group B) included 25 patients in whom propafenone was administered. Results 88% of patients in group A were converted successfully into sinus rhythm compared with 84% of patients in group B (receiving propafenone). The time elapsed between the onset of drug administration to conversion of AF into sinus rhythm in group A was 9 h: 7 min ± 5 h: 04 min, whereas that of group B was 3 h: 9 min ± 1 h: 54 min, with P value 0.001 (highly significant). Conclusion Intravenous infusion of amiodarone as well as oral propafonone can be used successfully in cardioversion of AF into sinus rhythm. Intravenous infusions of amiodarone and oral propafonone are not only highly effective but also well-tolerated drugs in the management of recent-onset AF. Time needed for conversion of AF into sinus rhythm using oral propafenone is significantly shorter than that needed by amiodarone.
  177 17 -
The role of color Doppler ultrasonography in evaluation of hemodialysis graft dysfunction
Aya H El-Sabbagh, Mohammed S El-Zawawi, Yasmin H Hemida
July-September 2019, 32(3):889-894
DOI:10.4103/mmj.mmj_126_18  
Objective To evaluate role of duplex Doppler ultrasound in assessing arteriovenous graft (AVG) function, detecting complications and analyzing the resistance index (RI) and flow in the afferent artery. Background End-stage renal disease causes serious health problems all over the world. The numbers of patients requiring dialysis have grown. In Egypt, it is the cause of 1.3% of all deaths, with much more incidence in later years of life. A well-functioning dialysis access is the lifeline for those patients. Patients and methods This study included 20 patients (male/female: 11/9) with end-stage renal disease and on regular hemodialysis using AVG. The prospective analyses of vascular access-related data included examination of graft morphology, shunt complications, and measurement of RI and volume of blood flow at the afferent artery. Results The most common complication seen was thrombosis (53.8%). Significant relation was found between graft function and flow volume of afferent artery (P < 0.001), with mean 1011.0 ± 135.9 ml/min in functional grafts and mean 220.8 ± 202 ml/min in dysfunctional grafts. There was a highly significant relation between graft function and afferent artery RI (P < 0.005), as 57.1% of functional grafts had their RI less than 0.5, with mean of 0.45 ± 0.05; 28.6% of complicated graft had their RI more than 0.5, with mean of 0.44 ± 0.12; and all dysfunctional graft had RI more than 0.5, with mean of 0.66 ± 0.09. Conclusion Duplex sonography has high accuracy in diagnosing and assessing most hemodialysis AVG-related complications while providing us with anatomic and hemodynamic information.
  180 13 -
Relationship between thyroid nodule size and incidence of thyroid cancer
Ahmed S El-Gammal, Mohammed A E-Balshy, Kareem M Zahran
July-September 2019, 32(3):1142-1148
DOI:10.4103/mmj.mmj_178_18  
Objective The aim of this study was to study the size of thyroid nodule as a risk factor of thyroid malignancy. Background The nodular thyroid lesions are of interest to surgeons and patients since the major differential diagnosis is cancer. These thyroid lesions are present as solitary or multiple nodules. Patients and methods This study was carried out on 330 patients aged from 13 to 65 years, every patient included in the study were subjected to history taking, physical examination, preoperative investigations (thyroid function test and routine investigations and ultrasonography on thyroid gland to detect the size of lobes and size of nodules and their dimensions). According to the cases we performed they were classified as total, subtotal, or hemithyroidectomy. The specimens were sent for routine histopathology after the operation to detect the percentage of thyroid cancer related to the thyroid nodule size Results Our results showed that most of the studied patients with thyroid nodules were aged less than 45 years and most of them were women. About 81% of the patients had nodular sizes greater than or equal to 2 cm. The prevalence of cancer was 15.5% among the studied cases. The prevalence of cancer among female patients aged greater than or equal to 45 years, had bilateral nodules with normal function. The cases with a nodular size of 1.0–1.9 cm were more prevalent among cancer patients than in benign cases. After adjustment of confounding factors, the size of nodules (1.0–1.9 cm) and age were still predictors of cancer in the studied cases. Nodular size had 2.5 times prediction of cancer while age had about 0.5 times. Conclusion A larger nodule size increases malignancy risk by up to 2 cm but further growth beyond 2 cm no longer influences malignant risk.
  170 23 -
The value of serum zinc in early detection of nephropathy in type 2 diabetic patients
Mahmoud A.E.A. Kora, Ahmed R Tawfeek, Mahmoud A Sakr
July-September 2019, 32(3):910-915
DOI:10.4103/mmj.mmj_709_17  
Objective The aim of this research was to study the value of serum zinc in early detection of nephropathy in patients with type 2 diabetes. Background Zinc is involved in multiple aspects of cellular metabolism. It is required for the catalytic activity of nearly 100 enzymes and it plays a major role in immunity, protein synthesis, wound healing, DNA synthesis, and cell division. Zinc is also important for normal growth and development during pregnancy, childhood, and adolescence, and is required for proper sense of taste and smell. A daily intake of zinc is required to keep a steady state because the body has no specialized zinc storage system. Zinc plays important role in the development and progression of type 2 diabetes. Zinc supplementation for 12 weeks can reduce albumin excretion in patients with diabetic microalbuminuria probably through antioxidative mechanisms. Patients and methods This case–control study was conducted on 100 participants classified into four groups: 25 healthy individuals (group I), 25 diabetic patients without albuminuria (group II), 25 diabetic patients with albuminuria (group III), and 25 nondiabetic patients with chronic kidney disease (group IV). Results Mean serum zinc level was found to be lower in group III (37.6 ± 15.92) compared with the control group (80.48 ± 12.06) and other patient groups, group II (50.28 ± 15.85) and group IV (39.72 ± 16.21), with a high statistical significance. Conclusion Low serum zinc levels were related to the development of diabetic nephropathy.
  173 16 -
The role of antibiotic prophylaxis in the prevention of surgical-site infection after hernioplasty in Menoufia University Hospital
Samir M. H. Kahla, Ahmed Gaber, Mahmoud M. A. Al-Rahawy
July-September 2019, 32(3):1137-1141
DOI:10.4103/mmj.mmj_10_16  
Objective The aim of this paper was to evaluate the effectiveness of prophylactic antibiotics in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair. Background Inguinal hernia is one of the most common conditions encountered in clinical practice. Mesh repair is becoming the most popular technique for the repair of inguinal hernia. A surgical-site infection is defined as an infection that occurs at or near a surgical incision within 30 days of the procedure or within three months if an implant is left in place. The decision of perioperative antibiotic prophylaxis is made according to a number of risk factors, in particular, in aseptic interventions. The use of antibiotic prophylaxis for clean surgical procedures such as inguinal hernia surgery is controversial. Patients and methods Between November 2014 and November 2015, this prospective randomized-controlled study included 40 patients who presented with inguinal hernia. Patients were randomized into two groups. Group A was administered an antibiotic at the induction of anesthesia. Group B was administered sterile normal saline. After Lichtenstein inguinal hernioplasty, patients were followed up at 7–10 and 28–35 days to assess surgical-site infection. Results Of a total of 40 patients (37 men and three women), 20 in each group, one (2.5%) patient developed wound infection in group A and two (5%) patients developed wound infection in group B. Conclusion There is no benefit of an intravenous single-dose antibiotic prophylaxis in the prevention of wound infection following Lichtenstein inguinal hernioplasty in patients with no other co-morbid conditions.
  168 11 -
REVIEW ARTICLES
Evaluation of feline McDonough sarcoma-like tyrosine kinase 3 (CD135) expression in acute myeloblastic leukemia
Samia H Kandel, Iman A Ahmedy, Suzan A Al-Hassanin, Samar S H El-Gazzar
July-September 2019, 32(3):784-789
DOI:10.4103/mmj.mmj_691_17  
Objective The aim of this study was to evaluate the role of feline McDonough sarcoma (FMS)-like tyrosine kinase 3 (FLT3) in acute myeloblastic leukemia (AML). Background AML is the most common acute leukemia affecting adults, and its incidence increases with age. FLT3 belongs to the class III receptor kinase family, which plays an essential role in hematopoiesis, driving differentiation of early myeloid and lymphoid lineages. Data sources Medline databases (PubMed, Medscape, Science Direct) and all materials available in the Internet from 1996 to 2017. Study selection The initial search yielded 107 articles, of which 20 fulfilled the inclusion criteria. The articles studied the relation between FLT3 and AML. Data extraction Midline searches with the keywords 'acute myeloblastic leukemia, Feline McDonough Sarcoma like tyrosine kinase, FLT3' in the title of the papers; extraction was performed, including assessment of the quality and validity of papers that fulfilled the previous criteria of FLT3 expression in AML. Data synthesis Each study was reviewed independently; the data obtained were rebuilt in a new language according to the needs of the researcher and categorized into topics throughout the article. Comparisons were made by structured reviews, with the results tabulated. Findings The studies indicated that FLT3 is significantly increased in patients with AML. Conclusion FLT3 overexpression was found in patients with AML and correlated with relapsed cases, worse survival, and poor outcome. This indicated that FLT3 overexpression can be used as a poor prognostic predictor for AML.
  157 21 -
ORIGINAL ARTICLES
Study of lung ultrasonography as a diagnostic tool in childhood pneumonia
Ghada M Elmashad, Wael A Bahbah, Waleed A Mousa, Mostafa M Shalaby
July-September 2019, 32(3):1043-1050
DOI:10.4103/mmj.mmj_800_17  
Objective The aim of this study was to compare chest ultrasonography with chest radiography (CXR) in the diagnosis of children with pneumonia. Background In Egypt, pneumonia and other acute respiratory infections were the causes of death in ∼19% of children younger than 5 years. According to current guidelines, pneumonia is diagnosed by clinical history, respiratory rate, fever, respiratory signs, and symptoms. Patients and methods A cross-sectional study was conducted on 60 patients with fever and signs of respiratory distress, and they were divided in two groups: group I with pneumonia, which included 45 patients who were finally diagnosed as having clinically evident pneumonia, and group II without pneumonia, which included 15 patients who did not have pneumonia. Full history taken, clinical examination, laboratory investigations, CXR, and chest ultrasonography were done. Results There was no statistically significant difference between the two groups regarding age, birth order, weight, residence, parent's education, and employment. C-reactive protein level was higher in pneumonia group than nonpneumonia group (P < 0.001). Lung ultrasonography could detect consolidation in more than one lobe than CXR, which was statistically significant (P = 0.048). Conclusion Chest ultrasonography offers an important contribution to the diagnostic procedures of pleuropulmonary disorders in children, such as pneumonia and pleural effusion, with higher sensitivity, specificity, and positive predictive index compared with CXR.
  158 18 -
Clinical and angiographic predictors of success in chronic total occlusion coronary angioplasty
Ahmed A E Emara, Alaa-Eldeen A Hataba, Ahmed M Elkersh, Ahmad M Mahmoud Elsheikh
July-September 2019, 32(3):868-875
DOI:10.4103/mmj.mmj_229_15  
Objective The aim of this study was to define the preinterventional parameters for procedural success of chronic total occlusion (CTO) coronary angioplasty. Background CTOs are encountered in 15–30% of patients undergoing coronary angiography. Compared with failed CTO angioplasty, successful CTO angioplasty has been associated with improvement in angina and left ventricular function and increased survival. Compared with intervention of nonoccluded stenoses, the recanalization of CTOs requires expert operator skills, increased procedural time, and increased radiation exposure to the patient, physician, and catheterization laboratory staff. Materials and methods This prospective study was conducted from April 2014 to March 2015 in Kobry El Kobba Military Hospital and included 30 patients with CTO of more than 1-month duration having significant angina (class III/IV) or recent acceleration of previously chronic stable angina. Clinical and angiographic variants were listed, and rate of success and failure of each was calculated after CTO angioplasty trial. Results There were 25 successful angioplasty cases. There was no significant affection of the different clinical variants and risk factors on the success rate. On the contrary, some of the angiographic variants showed a significant affection on the success and failure rates. The criteria of failure were difficult antegrade and retrograde wiring, unhealthy donor vessel, blunt calcified distal cap, and no continuous collaterals. Conclusion The success rate of CTO percutaneous coronary intervention mainly depends on certain angiographic factors. The clinical factors, although not statistically significant, play a crucial role in decision planning of CTO percutaneous coronary intervention.
  152 17 -
Endothelin-1 gene polymorphism in Egyptian patients with vitiligo
Mohammed A Shoeib, Ola A Bakry, Sally M El-Hefnawy, Douaa S Alsaadany
July-September 2019, 32(3):1019-1024
DOI:10.4103/mmj.mmj_862_17  
Objective The aim was to investigate the association between endothelin-1 (ET-1) gene polymorphism and vitiligo occurrence or increased vitiligo risk in Egyptian population. Background ET-1 is a keratinocyte-derived cytokine, which also has been defined as a strong mitogen and melanogen for human melanocytes and a potent stimulant of melanocyte proliferation, melanogenesis, and migration, implying a link with vitiligo. Patients and methods This study was conducted on 60 female patients with vitiligo. Their ages ranged from 6 to 70 years Overall, 54 cases presented with nonsegmental vitiligo and six cases presented with segmental vitiligo. Moreover, 40 age-matched and sex-matched apparently healthy volunteers with no past, present, or family history of vitiligo were included as a control group. Every case and control underwent detection of genotyping of ET-1 by restriction fragment length polymorphism-PCR. Results AA genotype of ET-1 was significantly associated with cases. It increases the risk of vitiligo by 15.9 folds. GA genotype was prevalent in 36.7% of cases. It increases the risk of vitiligo by 3.3 folds. Conclusion There is an association between ET-1 gene polymorphism and vitiligo occurrence.
  150 18 -
REVIEW ARTICLES
Acquired von Willebrand syndrome: a systemic review
Sabry Shoeib, Mohamed A El Hafez, Alaa Efat, Fatma Noaman
July-September 2019, 32(3):823-828
DOI:10.4103/mmj.mmj_11_18  
Objective The aim was to study the relationship between acquired von Willebrand syndrome (AvWS) and other diseases. Materials and methods Medline, Embase, and PubMed databases were searched and also material available in the internet was made use of. The search was performed on 1 May 2016 and included articles published ahead of print with no language restrictions. The search was performed in the electronic databases from 2013 to 2017. The initial search presented 50 articles, papers, and journals. The articles studied the relationship between AvWS and other diseases. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest. Owing to the heterogeneity of the causes of AvWS, it was not possible to pool the data and carry out a meta-analysis. Significant data were collected. Thus, a structured review was performed with the results tabulated. Findings In total, 10 potentially relevant publications were included. The studies indicate the relationship between AvWS and other diseases, such as monoclonal gammopathy of uncertain significance, and lymphoproliferative and myeloproliferative disorders. Conclusion Excellent outcomes have been achieved on the topic of AvWS and several diseases such as monoclonal gammopathy of undetermined significance, multiple myeloma, essential thrombocytosis, polycythemia vera, and non-Hodgkin's lymphoma.
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ORIGINAL ARTICLES
Severity of atherosclerotic coronary artery disease in relation to glycated hemoglobin level in diabetic patients
Abdullah M Kamal, Ahmed A Mostafa, Bayoumi M Bayoumi
July-September 2019, 32(3):844-850
DOI:10.4103/mmj.mmj_726_17  
Objective The aim of this work was to assess the relationship between the level of glycated hemoglobin (HbA1c) and the severity of coronary artery disease (CAD) among diabetic patients and perform a comparison with nondiabetic patients. Background Diabetes mellitus and coronary heart disease are closely associated and generally coexist. The severity CAD is directly related to the quality of glucose control in diabetic patients. Patients and methods This study included 150 patients referred to coronary angiography. In addition to the routine evaluation, assessment of HbA1c level, transthoracic echocardiogram, and coronary angiography were performed and the Gensini score (GS) was calculated. Diabetic patients were classified as controlled and uncontrolled on the basis of the cut-off point of HbA1c value of 7%. Nondiabetic patients were classified as low-risk and high-risk groups. Results Among the patients, 64.7% had diabetes mellitus and 54.7% were hypertensive. Also, 74.23% of the patients in the diabetic group had HbA1c greater than or equal to 7 mg%, with a mean HbA1c of 9.7 ± 2.2. The mean GS was 41 ± 31.3. There was a significant positive correlation between the level of HbA1c and fasting plasma glucose (r = 0.454, P = 0.000), waist–height ratio (r = 0.19, P = 0.045), regional wall motion score index (r = 0.23, P = 0.019), and GS (r = 0.312, P = 0.049) (in the diabetic group). Also, in the nondiabetic group, there was a significant correlation between HbA1c, GS (r = 0.448, P = 0.032), fasting plasma glucose (r = 0.470, P = 0.000), and weight (r = 0.264, P = 0.046). Conclusion HbA1c level is a useful biomarker and has prognostic value to predict the severity of CAD among diabetic and nondiabetic patients.
  150 17 -
Left ventricular mechanics before and after myectomy in patients with hypertrophic obstructive cardiomyopathy
Hala M Badran, Ali M Alamin, Naglaa F Ahmed, Taher S Abdel Kareem
July-September 2019, 32(3):836-843
DOI:10.4103/mmj.mmj_35_17  
Objectives The objective of this paper is to detect changes in left ventricular (LV) mechanics after surgical myectomy in patient with hypertrophic obstructive cardiomyopathy (HOCM). Background Septal myectomy is the gold standard method to relieve LV outflow tract pressure gradient in patients with HOCM. Myocardial mechanics are abnormal in those patients, demonstrating low longitudinal strain, high circumferential strain, and high apical rotation, compared with healthy patients. The aim of this study was to determine whether functional improvement after myectomy is associated with improved myocardial mechanics. Patients and methods A total of 15 patients (60% males and 40% female) with HOCM refractory to medical treatment were subjected to septal myectomy. Clinical data and paired echocardiographic studies before and within 6 months after myectomy were analyzed and compared. Myocardial mechanics including longitudinal and circumferential strain and rotation and LV synchronization were assessed using two-dimensional strain software (velocity vector imaging). Results Results showed significant symptomatic relief. LV outflow gradient decreased dramatically from 63.13 ± 10.25 to 9.96 ± 2.72 mmHg (P < 0.0001) and left atrial volume index decreased from 37.8 ± 5.61 to 26.38 ± 3.37 cm3/m2 (P < 0.05). E/e′ decreased from 15.23 ± 2.39 to 9.18 ± 1.42 (P < 0.05). Low longitudinal strain decreased at the myectomy site (basal septum), increased in the basal inferior segment, and remained unchanged globally − 6.43 ± 6.54 to − 8.70 ± 2.30 (P = 0.232). High circumferential strain decreased from − 28.47 ± 3.35 to − 18.26 ± 2.86 (P < 0.05). High LV twist normalized from 16.52 ± 2.25 to 14.02 ± 2.27 (P < 0.05). Conclusion Patients with HOCM show mechanical adaptations to chronic elevated afterload similar to patients with severe aortic stenosis in whom there is increased circumferential strain, increased basal and apical rotation, and LV twist. However, within 6 months after myectomy, global longitudinal strain remained unchanged, circumferential strain and rotation decreased, LV twist normalized, and LV dyssynchrony showed no significant changes. Thus, improvement of symptoms after myectomy is mainly because of improvement of the predictors of diastolic function.
  149 16 -
Cord blood albumin–bilirubin as a predictor for neonatal hyperbilirubinemia
Ghada M El Mashad, Hanan M El Sayed, Wael A El Shafie
July-September 2019, 32(3):1071-1077
DOI:10.4103/mmj.mmj_13_18  
Objective The aim was to evaluate the predictive value of cord blood albumin and bilirubin in identifying infants greater than or equal to 35 weeks for subsequent hyperbilirubinemia. Background Hyperbilirubinemia is the most common cause for readmission during the early neonatal period. Early discharge of healthy term newborns after delivery has become a common practice for socioeconomic reasons. Patients and methods A prospective cohort study was carried out on 75 neonates, greater than or equal to 35 weeks, with 34 female and 41 male neonates, delivered in Menoufia University hospital during the period from June 2016 to December 2017. Full history taking, clinical examination immediately after birth, and laboratory investigations were recorded. Results With cord albumin less than 2.8 g/dl, 81.8% of cases developed significant hyperbilirubinemia, whereas levels greater than 3.3 mg/dl were considered safe with no incidence of hyperbilirubinemia. Moreover, in the total group, the highest sensitivity (83.3%) was for cut-off value of cord bilirubin (CB) at 1.88 mg/dl, with positive predictive value of 72.9%, whereas the highest specificity (84.8%) was for cut-off value of CB–cord albumin at −0.6, with negative predictive value of 74.1. In high-risk group, the highest sensitivity (88.9%), highest positive predictive value (94.1%), highest specificity (85.7%), and negative predictive value (75%), were for cut-off value of CB–cord albumin at − 0.82. Conclusion Cord blood albumin and bilirubin examination can be used as an early useful indicator to predict significantly hyperbilirubinemia in neonates. Researches on large scale should be done for more clarification on the predictive value of cord blood albumin and bilirubin for early prediction of significant hyperbilirubinemia.
  144 20 -
The role of diffusion-weighted MRI on the differentiation of complex adnexal masses
El-Sayed M El-Sayed, Mohmad S Abdullah, Hamed G Ali
July-September 2019, 32(3):881-888
DOI:10.4103/mmj.mmj_100_18  
Background Conventional MRI has an established role in gynecologic imaging. However, increasing clinical demand for improved lesion characterization and disease mapping to optimize patient management has resulted in the incorporation of newer sequences, such as diffusion-weighted imaging (DWI), into routine protocols for pelvic MRI. DWI provides functional information on the microenvironment of water in tissues, hence augmenting the morphologic information derived from conventional MRIs. Objective The objective of this study was to highlight the role of DWI in differentiating benign from malignant complex adnexal masses. Patients and methods Twenty-five patients with adnexal masses underwent conventional MRI and DWI and the cases were proven by postsurgery pathological examination. Analysis of the pathological specimen with lesion morphology, signal characteristics, and correlation with the appearance at DWI followed by apparent diffusion coefficient values measurement were obtained. Results Twenty-five patients with adnexal mass lesions were included. Included masses proved benign in 18 (72%) and malignant in seven (28%). Restricted diffusion was observed in proved malignant masses (24%, n = 6/25). Benign tumors with high DWI signal intensity evidence at 24% also. The mean apparent diffusion coefficient value was 1.4+0.34×10−3 and 1.02+0.06×10−3 mm2/s, for benign and malignant masses, respectively. Conclusion DWI supported by conventional MRI data can confirm or exclude malignancy in suspicious ovarian masses. A combined analysis of quantitative and qualitative criteria and a knowledge of the sequence pitfalls are required.
  142 21 -
REVIEW ARTICLES
Evaluation of the relationship between glutathione peroxidase 1 polymorphism and hepatocellular carcinoma
Gehan K El-Saeid, Mohammed A Rady, Belal A Montaser, Heba S Mohammed Ghanem, Sara M A Aboagiza
July-September 2019, 32(3):777-783
DOI:10.4103/mmj.mmj_906_17  
Objective The objective of this study was to investigate association of genetic polymorphism of glutathione peroxidase 1 (rs1050450) with liver fibrosis and hepatocellular carcinoma (HCC). Materials and methods Electronic searches were conducted in PubMed, Embase and Cochrane Library from the start of the database to 2017. The initial search presented 215 articles of which 20 met the inclusion criteria. The articles studied the relation between glutathione peroxidase 1 (GPX1) and liver fibrosis and HCC. Extraction was performed, including the assessment of the quality and the validity of the papers that met with the prior criteria that describe the review. If the studies did not fulfil the inclusion criteria, they were excluded. Study quality assessment included when ethical approval was obtained, eligibility criteria defined, sufficient information, convenient controls and known assessment measures. Each study was reviewed independently; the data obtained were rebuilt in a new manner according to the need of the researcher and arranged into topics through the article. Then, comparisons were made with the results tabulated. Results In total, 20 potentially relevant publications were included. The studies indicate a significant association between GPX1 polymorphism and liver diseases. Conclusion We found that the GPX1 Pro198Leu (rs1050450) GPX1 polymorphism plays a major role in liver fibrosis progression and HCC development.
  142 21 -
ORIGINAL ARTICLES
Decreased expression of microRNA-451 is associated with imatinib mesylate resistance in patients with chronic myeloid leukemia
Khaled A Khalifa, Omaima M Abbas, Raafat M Abdlfattah, Suzan A El-Hassanein, Amira M. F. Shehata, Sally S Mandour Esawy
July-September 2019, 32(3):1004-1008
DOI:10.4103/mmj.mmj_130_19  
Objectives To measure the expression levels of microRNA-451 (miR-451) in patients with chronic myeloid leukemia (CML) and to correlate miR-451 expression levels with response to imatinib mesylate (IM)-based therapeutic protocol. Background miRNAs are regulatory RNAs that have been classified as crucial players of cancer initiation and progression. Recent studies have illustrated an association between certain hematological malignancies and dysregulated miRNAs expressions; other studies have focused on the utilization of miRNAs as molecular biomarkers of cancer detection, outcome, and response to therapy. Patients and methods Real-time quantitative PCR technique was used to estimate the plasma miR-451 expression levels of 10 newly diagnosed patients and 30 patients with CML who received first-line therapy with imatinib. European Leukemia Net-recommended response criteria were used to classify patients according to their response to imatinib treatment. Results Our results revealed up-regulation of miR-451 expression levels in imatinib treated as compared with newly diagnosed patients with CML (P = 0.003). MiR-451 expression was significantly upregulated in IM-responder when compared with the IM-resistant group (P < 0.001). Moreover, we demonstrated that miR-451 was significantly down-regulated in IM-resistant in comparison with the healthy control group (P < 0.001), whereas no significant difference was detected between IM-responder group and healthy controls (P = 0.620). Conclusion miR-451 can be used as a promising biomarker in patients with CML for prediction of imatinib treatment response and may be employed as a novel therapeutic tool.
  146 15 -
Effect of ursodeoxycholic acid on indirect hyperbilirubinemia in neonates treated with phototherapy
Fady M El-Gendy, Wael A Bahbah, Eman El-Sayed Al Kafory
July-September 2019, 32(3):1059-1063
DOI:10.4103/mmj.mmj_885_17  
Objective The aim was to evaluate the role of ursodeoxycholic acid (UDCA) on neonatal indirect hyperbilirubinemia treated with phototherapy. Background Hyperbilirubinemia is a common neonatal problem. The present study aimed to investigate the role of UDCA on neonatal hyperbilirubinemia treated with phototherapy. Participants and methods This randomized controlled clinical trial was conducted on 100 full-term neonates with unconjugated hyperbilirubinemia, who received phototherapy in the neonatal ICU of Menoufia University Hospital, and they were randomly divided into two groups: group 1, which is the case group (n = 50), received ursofalk (250 mg capsule) in dose of 10 mg/kg/day divided every 12 h with phototherapy, and group 2, which was the control group (n = 50), received only phototherapy. Total serum bilirubin levels measured every 24 h till phototherapy were disrupted. The duration of phototherapy was measured. Results The mean total bilirubin level measured at 24, 48, 72, and 96 h of treatment in group I was 13.6 ± 1.47, 10.9 ± 1.19, 9.13 ± 0.74, and 7.00 ± 0.14, respectively, and in group II was 14.5 ± 1.63 at 24 h, 12.2 ± 2.34 at 48 h, 10.5 ± 1.35 at 72 h, and 9.42 ± 0.82 at 96 h. Moreover, the mean duration of phototherapy was 65.2 ± 12.8 h in group I and was 82.5 ± 19.4 h in group II, showing high significant reduction in group I (P < 0.001). Conclusion Addition of oral UDCA to phototherapy in treatment of indirect hyperbilirubinemia will be highly effective and the duration of phototherapy and admission of affected newborns will be shorter.
  135 24 -
REVIEW ARTICLES
Role of hepcidin in iron metabolism and pathophysiology of different types of anemia
Fady M El Gendy, Mahmoud A EL-Hawy, Nehal K El Shennawy
July-September 2019, 32(3):818-822
DOI:10.4103/mmj.mmj_20_18  
Objectives The study aimed to demonstrate the critical role of hepcidin in regulation of iron metabolism in various types of anemia. Data sources Medline databases (PubMed, Science Direct, Medscape) and all materials available in the Internet from 2007 to 2017 were searched. Study selection The initial search presented 38 articles, of which 11 met the inclusion criteria. The articles studied the relation between hepcidin and iron homeostasis in various types of anemia. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls included, adequate information provided, and assessment measures defined. Data synthesis Comparisons were made by structured review with the results tabulated. Findings In total, 11 potentially relevant publications were included. All were human studies. The studies indicated that hepcidin levels were markedly reduced in cases with thalassemia intermedia, which resulted in iron overload. However, hepcidin levels were increased in cases with anemia of chronic disease, which resulted in decreased bioavailability of iron. Conclusion Hepcidin has key role in iron regulation and pathogenesis of various types of anemia including anemia of chronic disease and anemia with iron overload. Hepcidin may provide promising therapeutic target in cases with dysregulated iron metabolism.
  138 21 -
CASE REPORTS
Late-onset congenital diaphragmatic hernia, misdiagnosed as hydropneumothorax: a case report
Aditya P Singh, Arun K Gupta, Ramesh Tanger, Dinesh K Barolia
July-September 2019, 32(3):1154-1156
DOI:10.4103/mmj.mmj_831_17  
Congenital diaphragmatic hernia (CDH) is herniation of bowels and abdominal solid organs in the thoracic cavity, causing pulmonary hypoplasia with decreased pulmonary vasculature and dysfunction of the surfactant system. In severe cases, left ventricular hypoplasia is also observed. Usually CDH present in the neonatal period. Late-onset CDH is a rare anomaly with misleading symptoms and signs. We present here a case of late presentation of congenital diaphragmatic hernia misdiagnosed as hydropneumothorax in an 11-month-old male child.
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REVIEW ARTICLES
Role of circulating endothelial progenitor cells in patients with breast cancer
Laila M Montaser, Ahmed A Sonbol, Ahmed S EL-Gammal, Asmaa S Abo El-Yazeed
July-September 2019, 32(3):770-776
DOI:10.4103/mmj.mmj_727_17  
Objective The aim was to assess the role of the circulating endothelial progenitor cells (CEPCs) in stages of breast cancer (BC) in patients. Materials and Methods We reviewed papers on the relation between CEPCs and stages of BC from Medline databases (PubMed, Medscape, Science Direct, and EMF-Portal) and all materials available on the internet from 1994 to 2016. The initial search presented 100 articles, of which, 30 met the inclusion criteria. The articles studied the relation between endothelial progenitor cells and stages of BC. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Comparisons were made by structured review with the results tabulated. Findings Endothelial progenitor cells counts were significantly higher in advanced stages of BC compared with those with early stages and controls in almost all the studied publications. Conclusion Our review concludes CEPCs elevation in the blood of patients is a useful marker of tumor angiogenesis and progression and early predictor of metastasis in patients with BC.
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ORIGINAL ARTICLES
Study of adipocytokines (visfatin and resistin) levels in children with β-thalassemia major and intermedia
Mohsen M Deeb, Ashraf A Dawoud, Mahmoud A El-Hawy, Yasser F. M. Wasel, El Sayed A Elsayed
July-September 2019, 32(3):1051-1058
DOI:10.4103/mmj.mmj_835_17  
Objective The objective of this study was to assess visfatin and resistin levels in children with β-thalassemia major and intermedia. Background β-Thalassemia represents a major public health problem in Egypt. Adipocytokines are bioactive mediators released from the adipose tissue including adipocytes and other cells present within fat tissues. Patients and methods This study was conducted on 70 patients with β-thalassemia diagnosed by both clinical and laboratory criteria. They were divided into two groups: group I included 50 patients with β-thalassemia major and group II consisted of 20 patients with β-thalassemia intermedia. Moreover, 20 healthy individuals were included as a control group. All the participants were included from February 2016 to February 2017. Full history, routine physical examination, and special investigations were taken. Results BMI (kg/m2) was significantly lower in patients with β-thalassemia than control group, and it was higher in β-thalassemia intermedia group than β-thalassemia major group. Lipid profile and serum resistin and visfatin levels were significantly higher in patients with β-thalassemia than control group. Resistin was positively correlated with total leukocyte count, ferritin, urea, serum glutamic pyruvic transaminase, and serum glutamic oxaloacetic transaminase and negatively correlated with BMI and hemoglobin. Serum visfatin was positively correlated with total leukocyte count, urea, serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, lipid profile, and glucose and negatively correlated with BMI and hemoglobin. Conclusion The adipocytokines (resistin and visfatin) were significantly higher in patients with β-thalassemia (major and intermedia) than control group. The measurement of these adipocytokines may be helpful in differentiating the degree of inflammation. Moreover, a novel association was found between the increasing concentrations of proinflammatory adipocytokines (resistin and visfatin) and the severity of β-thalassemia types.
  133 17 -
Role of contrast-enhanced computed tomography in the evaluation of acute pancreatitis according to the revised Atlanta classification
Adel M El-Wakeel, Waleed A F Mousa, Sara M Sultan
July-September 2019, 32(3):895-900
DOI:10.4103/mmj.mmj_438_18  
Objective The aim of this study was to detect the role of contrast-enhanced computed tomography (CT) in the diagnosis of acute pancreatitis according to the revised Atlanta classification. Background Imaging plays a very important role in the management of pancreatitis. It assists diagnosis and in differentiation of the severity of pancreatitis. Besides, it helps to detect and manage the associated complications through image-guided drainage and aspiration. Contrast-enhanced CT is the most clinically useful study. In 1992, morphological stages of acute pancreatitis were made. Between interstitial pancreatitis and sterile or infected necrosis Atlanta classification was made whereas in the revised Atlanta classification focuses heavily on the morphologic criteria for defining the various manifestations by means of CT. Materials and methods This prospective study was performed on 60 patients. The study was carried out at the Diagnostic Radiology Departments of Menoufia University Hospital and the National Liver Institute. The patients were presenting with acute abdominal pain, mainly epigastric, radiating to the back and the lesions were classified according to the Atlanta classification. Results Forty-two patients were with interstitial pancreatitis, 32 patients were with acute peripancreatic collection and 10 patients were with pseudocysts and 18 patients were with necrotizing pancreatitis, nine patients with acute necrotic collection and nine patients were with walled-off necrosis with statistically significant difference of age between groups (P = 0.014). Conclusion Contrast-enhanced CT is a perfect diagnostic modality to stage the severity of inflammatory process, identify the pancreatic necrosis and describe local complications and grading of severity of acute pancreatitis. Revised Atlanta classification is more accurate for assessing patient mortality and organ failure.
  131 18 -
Thyroid in patients receiving new direct-acting antiviral agents for treatment of hepatitis C virus
Mohamed A Shaaban, Walid A Shehab El-Din, Mohamed Z Nouh, Belal A Montaser, Mukhtar R Al-Shabrawy
July-September 2019, 32(3):928-931
DOI:10.4103/mmj.mmj_771_17  
Objective The aim was to judge thyroid dysfunction in patients receiving new direct-acting antiviral agents (DAAs) for treatment of hepatitis C pathogen. Background Persistent hepatitis C is a gradually progressive disease. DAAs provide high sustained viral response rates and much reduced adverse effects and impaired health-related quality of life during treatment. Patients and methods The analysis included 100 patients with persistent hepatitis C contamination with normal thyroid functions before starting treatment with DAAs. After obtaining written informed consent, all patients were analyzed and clinically assessed. Laboratory investigations including complete blood picture, assessment of liver organ and kidney function, thyroid-stimulating hormone, and free thyroxin 4 were done for all patients before the start of the remedy, and by the end of treatment of direct-acting antiviral remedy. Results An evaluation of the analyzed patients who were obtaining direct-acting antiviral drugs for treatment of hepatitis C pathogen before and after remedy with respect to the PCR findings proved significant decrease of PCR values after treatment (P = 0.0001). There is no statistically significant difference before and after remedy with new DAA regarding laboratory findings as serum thyroid-stimulating hormone (P = 0.580) and serum free T4 (P = 0.279). Conclusion Thyroid function in patients with chronic hepatitis C infection was not afflicted with treatment with new direct-acting antiviral drugs for treatment of hepatitis C virus.
  131 17 -
Societal and cultural values toward female sexuality
Mohammed A. W. Gaber, Reham M. A. Rasoul
July-September 2019, 32(3):1030-1036
DOI:10.4103/mmj.mmj_22_18  
Objective To evaluate the level of knowledge and perceptions of the Egyptian women regarding virginity, pain, and bleeding during hymen defloration; assess the forced virginity examination; evaluate the magnitude of sexual education of females; and assess its effect on female sexuality. Background Problems related to sexuality have consequences for men, women, and public health. Female virginity has had special significance for centuries, especially for traditional societies. Formal sexual education should be introduced in the curriculum of the schools within the context of our religion and culture. Patients and methods This a cross-sectional cohort study that included 100 married women and 100 virgin women, aged from 16 to 60 years, who attended the Dermatology and Andrology Outpatient Clinic of Menoufia University Hospitals. The self-filling questionnaire was written in English and translated into Arabic. The questionnaire was explained to the participants, and they were instructed on how to fill it out. Results A girl should remain virgin till marriage was the opinion of 100% in group A and 80% in group B. Moreover, 97.8% in group A and 65.9% in group B disagreed with premarital sex for men, because it is 'religiously haram'. Most of the participants in group A had a defect in knowledge concerning sexuality, and 45% in group A and 42% in group B acquired their knowledge from friend's activity. Conclusion The study showed a conservative opinion related to virginity and the hymen examination. Formal sexual education should be introduced in the curricula of the schools within the context of our religion and culture.
  128 20 -
Study of serum lipid profile before and after hepatitis C virus treatment
Ayman M El-Lehleh, Marwa M El-Shiekh, Moamena S El-Hamouly
July-September 2019, 32(3):1126-1131
DOI:10.4103/mmj.mmj_141_19  
Objective To study the lipid profile in hepatitis C virus (HCV) patients before and after treatment with daclatasvir (DAV)+sofosbuvir (SOF)±ribavirin (RBV) to determine the effect of virus clearance on the lipid profile. Background Chronic HCV infection is associated with lipid and lipid protein metabolism disorders. There is a marked increase in serum low-density lipoprotein-cholesterol (LDL-C) in HCV-infected patients treated with SOF and RBV. Participants and methods A total of 100 chronic hepatitis C patients were included in a case–control study from February 2017 to August 2017. Twenty healthy individuals volunteered as a control group. Lipid profile changes were analyzed at baseline, after the end of treatment, and 12 weeks after treatment. Results Before treatment, the levels of serum LDL-C, cholesterol and triglycerides (TGs) were significantly lower in patients than the controls. At the end of treatment and 12 weeks after treatment with DCV + SOF + RBV, there was a significant increase in serum LDL-C, high-density lipoprotein-cholesterol, cholesterol, and TGs (P = 0.0001, 0.0001, 0.0001, and 0.007), respectively, and there was also a significant increase in patients treated with DCV + SOF (P = 0.035, 0.036, 0.01, and 0.0001), respectively. 100% of the treated patients achieved a sustained viral response (week 24). Conclusion Eradication of HCV was associated with an increase in the serum level of total cholesterol, TGs, LDL-C, and high-density lipoprotein-cholesterol; so follow up of the patient's lipid profile after Hepatitis C virus treatment is very important to avoid hyperlipidemia which is a risk for atherosclerotic heart disease.
  126 22 -
REVIEW ARTICLES
Effect of adiponectin and highly sensitive C-reactive protein on the severity of coronary artery disease
Ahmed A Reda, Waleed A Ibrahim, Ahmed O Elsisy
July-September 2019, 32(3):790-796
DOI:10.4103/mmj.mmj_880_17  
Objective The objective of our study was to estimate the effect of adiponectin (ADPN) and highly sensitive C-reactive protein (hsCRP) level on the severity of coronary artery disease (CAD) in patients with chronic stable angina. Materials and methods MEDLINE databases (PubMed, Journal of Clinical Endocrinology and Metabolism, British Medical Journal, Journal of American College of Cardiology, and European Heart Journal) and also materials available in the internet were searched. The search was performed in the electronic databases from 2000 to 2017. The initial search presented 122 articles of which 29 met the inclusion criteria. The articles studied ADPN, hsCRP, and severity of CAD. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Comparisons were made by structured review with the results tabulated. Findings In total, 29 potentially relevant publications were included. The studies indicate an association between ADPN and hsCRP and severity of CAD in patients with CAD. Conclusion ADPN and hsCRP are markers of poor prognosis in patients with CAD.
  126 22 -
Predictive prognostic value of neutrophil–lymphocytes ratio in acute coronary syndrome
Ahmed A Reda, Waleed A Ibrahim, Markos Z Salama
July-September 2019, 32(3):803-811
DOI:10.4103/mmj.mmj_35_18  
Objective To evaluate the relations between preprocedural neutrophil/lymphocyte (N/L) ratio and in-hospital outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Data sources We utilize the medical journals, medical text books, and Medline databases (PubMed, Medscape, and Science Direct) which have updated research with keywords 'neutrophil/lymphocyte ratio and acute coronary syndrome' in the title of the paper and all materials available on the Internet from 2013 to 2017. Study selection The initial search presented 1270 articles of which 21 met the inclusion criteria. The articles studied the correlation between N/L ratio and the occurrence of no-reflow, along with assessment of the prognostic value of N/L ratio in patients with STEMI. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures were made. Data synthesis Comparisons were made by meta-analysis with the results tabulated. Findings The levels of inflammatory markers such as the N/L ratio should be routinely checked in all patients presenting with acute STEMI as they may help in the prediction of prognosis; they may guide the emergency physician to provide the best type of therapy in such cases, and they may be useful in the follow-up of patients after reperfusion. Conclusion Preprocedural N/L ratio was an independent prognostic factor for both in-hospital mortality and adverse outcomes among the STEMI patients who underwent primary PCI during the hospital stay. N/L ratio was an independent predictor of no-reflow/reflow and angiographic grade after PCI.
  131 17 -
ORIGINAL ARTICLES
Urinary podocalyxin and cyclophilin A: markers for early detection of type 2 diabetic nephropathy
Gehan K El-Saeed, Walid A Shehab El-Deen, Belal A Montasr, Thoria A Omar, Doaa S Mohamed
July-September 2019, 32(3):996-1003
DOI:10.4103/mmj.mmj_223_18  
Objective To investigate urinary podocalyxin (PCX) and cyclophilin A (CypA) as useful markers for early detection of type 2 diabetic nephropathy (DN). Background PCX is a transmembrane protein that localizes to the apical cell of glomerular podocytes. PCX maintains podocytes shape. PCX is shed from injured podocytes into urine as small vesicles. CypA is an 18-kD protein that is distributed in the cytoplasm and facilitates protein folding and trafficking. It acts as a cellular receptor for cyclosporine A. The expression of CypA is quite high in the kidney, where proximal tubular epithelial cells contain more CypA than other kidney tissues. CypA was detected in diabetic patients' plasma and secreted by monocytes in response to hyperglycemia, indicating that CypA could be a potential secretory marker in type 2 DN. Patients and methods This case–control study was conducted at the Clinical Pathology Department of Menoufia University Hospitals from September 2017 to February 2018 on 66 type 2 diabetic patients and 20 healthy participants as a control group. They all underwent full history, clinical examination, routine renal functions, urinary creatinine and albumin, urinary albumin creatinine ratio, glycated hemoglobin (%), and quantification of urinary PCX and CypA by enzyme-linked immunosorbent assay. Results Urinary PCX/creatinine ratio and urinary CypA/creatinine ratio were highly significant (P < 0.001) in the patient group compared with the control group. Conclusion Urinary PCX and CypA may be markers for early stage of DN, with more specificity of CypA.
  124 22 -
Hemodialysis versus peritoneal dialysis: a comparative study Menoufia Medical Journal
Mahmoud Abd El-Aziz Kora, Ahmad M Zahran, Khaled M A El-Zorkany, Ahmad M Ewedah
July-September 2019, 32(3):901-905
DOI:10.4103/mmj.mmj_669_17  
Objective To compare between dialysis modalities and their effect on anemia control, chronic kidney disease mineral bone disease (CKD-MBD) control, dialysis adequacy, and dialysis complication on end-stage renal disease (ESRD) patients. Background Hemodialysis (HD) and peritoneal dialysis (PD) are dialysis modalities for ESRD patients that have its own effect on patients. Many publications studied the modality effect on ESRD patients, but in Egypt few data was reported about these items. Patients and methods This cross-sectional study was carried out in January 2017 on 82 patients with ESRD maintained on HD and 21 patients with ESRD on PD. HD patients were collected randomly from a pool of HD patients attending regular HD in the Nephrology and Dialysis Department of Damanhour Medical National Institute. The PD patients were collected from the Nephrology and Dialysis Department of Damanhour Medical National Institute (16 patients) and Nephrology and Dialysis Department of New Mansura General Hospital (International) (five patients). A comparison between the two groups regarding anemia control, CKD-MBD, dialysis adequacy, and dialysis complication was performed. Results The PD group was better regarding the target levels of intact parathyroid hormone than HD (61 and 34%, respectively) (P = 0.038) and in the achievement of target Kt/V (90 and 48%, respectively) (P = 0.001). There was no significant difference regarding anemia control or complications. Conclusion PD has a better effect on CKD-MBD and it is easy for the PD patients to achieve adequacy than the HD patients. PD should have more chance as an RRT for the ESRD patients in Egypt.
  123 22 -
REVIEW ARTICLES
Pattern of coronary artery disease in high-risk patients without prior myocardial infraction
Hala M Badran, Naglaa F Ahamed, Abd Elmoaty G. Kishk
July-September 2019, 32(3):797-802
DOI:10.4103/mmj.mmj_917_17  
Objective This study aimed to assess the causes, risk factors, outcome, and recommendation of patients with coronary artery disease without prior obstruction. Materials and methods Medline databases (PubMed, Circulation, American Society of Echocardiography, Journal of American Colleague of Cardiology, and ScienceDirect) and also materials available on the internet. The search was performed in the electronic databases from 2012 to 2017. The initial search presented 60 articles of which 23 met the inclusion criteria. The articles studied the pattern of coronary artery disease in patients with risk factors without prior obstruction. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Comparisons were made by a structured review with the results tabulated. Findings In total, 27 potentially relevant publications were included. The studies indicate that cardiovascular risk factors have a differential effect on women, and some risk factors are more common in women than in men. Conclusion Patients with angina and nonobstructive coronary angiograms are predominantly women, and many have a prognosis that is not as benign as commonly thought. Therapy should be directed at symptom relief; aggressive anti-ischemic medication should be applied when risk factors are present or when the prognostic risk is high.
  125 20 -
ORIGINAL ARTICLES
Screening intelligence of primary school children using 'draw-a-person test' in Mansoura district, Al Dakahlia Governorate
Ali M El-Shafie, Dalia M El Lahony, Zein A Omar, Mohamed A. M. Dagher
July-September 2019, 32(3):1037-1042
DOI:10.4103/mmj.mmj_790_17  
Objective The aim was to screen the intelligence level among primary school children using 'draw-a-person (DAP) test' in Dakahlia Governorate. Background For more than 100 years, clinicians and psychologists have studied children's drawing as a measure of one's cognitive ability. In 1926, Florence Goodenough developed a drawing test called the DAP test. The DAP test consists of having a child draw -a whole person on a piece of paper that is scored via a list of items that are commonly present in the drawings. It showed that a child's drawing is a reflection of one's intellectual skills and development. Participants and methods This cross-sectional study was carried out on 1012 of apparently healthy primary school children aged from 6 to 12 years in Mansoura district, Dakahlia Governorat from October 2015 to February 2016. Mansoura district includes 157 primary schools, of which three schools are in the central area including 1006 students, 75 schools in Mansoura east administration including 23 439 students, and 80 schools in Mansoua west administration including 27 630 students. The total number of students chosen was 1012 distributed to 32 schools, out of which 20 schools were in rural areas and 10 schools were in urban areas. All of them are governmental primary schools. No language schools and none of them received specific qualified drawing lessons. Children with hearing loss or mental disability were not included as they have separate nonincluded schools. Some students with physical disability not affecting the test were included, for example polio. All students in the study were subjected to an adequate assessment of history, full clinical examination, socioeconomic level, school achievement, and also subjected to DAP test. Results The study showed that children with superior intelligence represented 10.9%, those with average intelligence 69.2%, and with borderline intellectual function 17.3%, and children with mild mental retardation 2.7%. Also positive correlations were found between intelligence quotient (IQ) levels and socioeconomic standards, school achievement, residence, and BMI. There was no correlation between IQ levels and children's sex. Conclusion IQ levels obtained by DAP test were positively correlated with socioeconomic standards, BMI, residence, and school achievement. No correlation was found between IQ levels and sex.
  126 18 -
Evaluation of platelet-rich plasma injection in knee osteoarthritis patients
Samar J Suleiman, Alaa A Labeeb, Mahmoud A El-Sorogy
July-September 2019, 32(3):1108-1112
DOI:10.4103/mmj.mmj_144_18  
Objectives The aim of this study was to determine the effect of local injection of platelet-rich plasma (PRP) in patients with mild and moderate knee osteoarthritis (OA) and its effect on pain in comparison to corticosteroid injection. Background OA is one of the most prevalent chronic musculoskeletal diseases worldwide. The use of PRP appeared in the last years for the management of symptoms of knee OA. Patients and methods This study included 50 patients with knee OA. Our patients were divided to two groups: a group of 25 patients who were injected intra-articularly with about 3–4 ml of PRP and another of 25 patients who were injected intra-articularly with triamcinolone acetate for one affected knee. We measure and assess all patients by Western Ontario and McMaster Universities Osteoarthritis Index and visual analog score – pain questionnaires before injection and after 1 and 3 months of injection. Results There was a highly statistically significant difference between preinjection and postinjection after 1 month with more decrease in postinjection (P < 0.001) and highly statistically significant difference between preinjection and follow-up injection in Western Ontario and McMaster Universities Osteoarthritis Index score with more decrease in follow-up (P < 0.001). Also there was a highly significant decrease in visual analog score scale readings in postinjection (P < 0.001) and follow-up after 3 months of injection (P < 0.001). Conclusion Intra-articular injection PRP is an effective method for the treatment of knee OA. Also, PRP intra-articular injection is more effective than intra-articular injection of corticosteroid.
  123 20 -
Dialysis vintage and risk factors of hyperparathyroidism in hemodialysis patients
Ahmed R Al Arbagy, Yassein S Yassein, Mahmoud M Emara, Mahmoud A Elsayed
July-September 2019, 32(3):932-937
DOI:10.4103/mmj.mmj_797_17  
Objective The objective of this study was to study the risk factors of hyperparathyroidism based on hemodialysis vintage (duration in months or years that hemodialysis patients spend on dialysis). Background Hyperparathyroidism is associated with high risk of fractures, cardiovascular morbidity, and death; therefore, it is important to identify risk factors predicting or influencing parathyroid gland secretion. Patients and methods Patients were divided into two groups: short dialysis vintage (<10 years), and long dialysis vintage (≥10 years). Each group was further divided at parathyroid hormone (PTH) cutoff value of 300 pg/ml. Results Short dialysis vintage patients with PTH more than 300 pg/ml have higher alkaline phosphatase (147.9 ± 101.4 vs. 102.1 ± 89.18; P = 0.009), phosphorus (5.913 ± 1.621 vs. 5.044 ± 1.387; P = 0.048), calcium phosphate product (49.60 ± 13.45 vs. 42.35 ± 13.61; P = 0.04), and serum creatinine (10.8 ± 3.353 vs. 8.96 ± 2.311; P = 0.005 for predialysis serum creatinine and 4.987 ± 1.364 vs. 4.035 ± 1.426; P = 0.007 for postdialysis serum creatinine) compared with nonhigh PTH group. Long dialysis vintage patients with PTH more than 300 pg/ml have higher alkaline phosphatase (222.1 ± 184.7 vs. 99 ± 29.47; P = 0.024), lower serum sodium (137.3 ± 2.8 vs. 141.4 ± 2.937; P = 0.004), and lower mean arterial blood pressure (81.42 ± 14.65 vs. 96.38 ± 12.87; P = 0.019) compared with nonhigh PTH group. Conclusion Serum alkaline phosphatase, phosphorus, calcium phosphate product, and serum creatinine were found to be associated with hyperparathyroidism in short hemodialysis vintage patients (<10 years), but this association was lost in long dialysis vintage patients (≥10 years) except for 'alkaline phosphatase'. Moreover, serum sodium was found to be associated with hyperparathyroidism in long dialysis vintage patients.
  128 15 -
Study of CD14+ and CD16+ peripheral blood monocytes in asthmatic patients
Laila M Montaser, Ahmed A Sonbol, Mohammed A Agha, Mona A Ibrahim
July-September 2019, 32(3):961-966
DOI:10.4103/mmj.mmj_735_17  
Objective This study aimed to investigate the enhanced frequencies of CD14++ CD16 + peripheral blood monocytes in asthmatic patients. Background CD16 + monocytes are increased in inflammatory conditions. It was reported that CD16 + monocytes can be divided into two subsets with different potential of modulating inflammatory responses: CD14++ CD16 + and CD14 + CD16 + monocytes. CD14++ CD16 + and CD14 + CD16 + monocyte subsets are quantified in asthmatic patients regarding severity of disease and glucocorticoids treatment options. Patients and methods CD14++ CD16 + was examined in 20 cases of completely controlled asthma, 20 cases of partly controlled asthma, 20 cases of uncontrolled asthma, and 25 healthy controls using flow cytometry. Results The results showed highly significant difference among the controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups regarding pulmonary function tests and also showed highly significant difference among controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups regarding percentage of CD14++ CD16 + cells. Moreover, the results showed highly significant correlation between CD14++ CD16 + cells and percentage of forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, C-reactive protein, erythrocyte sedimentation rate, immunoglobulin E, neutrophils, and eosinophils (laboratory investigations) of controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups. Conclusion CD14++ CD16 + monocytes showed the highest levels of expression in uncontrolled asthmatic cases as compared with other monocyte subsets. CD14++ CD16 + monocytes showed higher levels of expression in uncontrolled asthma cases than other asthmatic cases.
  123 19 -
Evaluation of transthoracic sonography in patients with interstitial lung diseases
Osama F Mansour, Mohammed Abd El-Sattar Agha, Ahmed Abd El-Rahman El-Asdody, Naglaa S. B. Mehana
July-September 2019, 32(3):1099-1103
DOI:10.4103/mmj.mmj_819_17  
Objective The aim of this study was to determine the diagnostic value of lung ultrasound (US) in the detection of interstitial lung diseases (ILDs), and to assess the correlations of these features with diagnostic parameters of the disease. Background Chest US can be used as a complementary method for the diagnosis of ILDs especially in situations where chest computed tomography is not available, where bilateral B lines, thickened pleura, irregular pleura, and subpleural lesions are found. Patients and methods This study was carried out on 53 patients ranging in age from 47 to 60 years (21 men and 32 women) and 23 apparently healthy persons as a control group (12 men and 11 women). All cases were subjected to a full assessment of history, clinical examination, laboratory investigations, arterial blood gases, pulmonary function test, plain chest radiography, chest high-resolution computed tomography, and transthoracic US. Results Our results showed that there were bilateral B-lines in combination with a thickened, irregular pleura and subpleural lesions, which are strongly suggestive of the presence of ILD. There was a statistically significant correlation between B-lines distance in millimeter, pleural line thickness in millimeter, pleural line irregularity, and abolished lung sliding that found by chest US and severity grades of high-resolution computed tomography according to the findings of semiquantitative scoring findings in ILDs patient group. Conclusion Bilateral B-lines in combination with a thickened, irregular pleura and subpleural lesions are strongly suggestive of the presence of ILD. These lines are not found in controls.
  125 17 -
REVIEW ARTICLES
Notch signaling in dermatology
Mohammed A Basha, Iman A Seleit, Ola A Bakry, Rehab M Samaka, Heba Allah S K Bazid
July-September 2019, 32(3):829-835
DOI:10.4103/mmj.mmj_716_17  
Objective The aim of this study was to assess the role of Notch signaling in both health skin and pathogenesis and management of skin diseases. Materials and methods PubMed and all materials on the internet from 2000 to 2017 were searched. The initial search presented 101 articles, of which 49 met the inclusion criteria: clinical trial types II and III, published in English language, published in peer-reviewed journals, and focusing on Notch in different skin diseases. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was obtained, eligibility criteria specified, appropriate controls, and adequate information. A structured systematic review was performed. Findings Overall, 49 articles were potentially relevant publications. The studies reported that Notch may have a role in both physiology of the skin and the pathogenesis and treatment of multiple skin diseases. Conclusion Notch signaling has many physiological roles, and understanding its role in the pathogenesis of different skin diseases allows new target for their treatment.
  129 12 -
ORIGINAL ARTICLES
Effect of urokinase plasminogen activator receptor (CD87) on patients with de-novo acute myeloid leukemia
Samia H Kandil, Iman A Ahmedy, Ghada E Soliman, Arwa Abd El Hamed Hijii
July-September 2019, 32(3):983-990
DOI:10.4103/mmj.mmj_135_18  
Objectives The objective of this study was to study the role and the prognostic value of urokinase-type plasminogen activator receptor (uPAR) (CD87) expression in patients with de-novo acute myeloid leukemia (AML). Background The physiological function of the uPAR (CD87) is concerned in various biological processes and signal transduction such as cancer metastasis, angiogenesis, cell migration, and wound healing. The uPAR is expressed in most solid cancer and in several hematological malignancies including myeloproliferative disease, acute leukemia (AML, acute lymphocytic leukemia), and multiple myeloma. Patients and methods This study was conducted on 52 newly diagnosed patients with AML and 20 age-matched and sex-matched healthy individuals as a control group. Full history taking, clinical examination, and laboratory investigations were done for all patients. Expression of CD87 was evaluated by flow cytometric analysis. Results Positive CD87 expression (CD87+) was significantly higher in patients with AML than in healthy individuals. The highest incidence of CD87+ was found in acute myelomonocytic leukemia and acute monoblastic leukemia (M4/M5). High CD87+ expression in patients with AML predicted poor response to therapy, poor outcome, and shorter overall survival rate. Conclusion The high expression of CD87 displays a negative prognostic effect on patients with AML regarding outcome, survival rate, and response to chemotherapy. However, more studies are required to elucidate its role as a target therapy for those patients as its expression is highly restricted to tumor cells.
  124 16 -
Evaluation of serum kisspeptin in infertile men with severe oligospermia
Abdalla M Attia, Hossam A El Hamid Yassien, Bilal A El-Mohsen Montaser, Mohammed M El-Meligi
July-September 2019, 32(3):1009-1012
DOI:10.4103/mmj.mmj_769_17  
Objective The aim of this study was to determine whether an abnormality in the serum levels of kisspeptin is associated with oligospermia and male infertility. Background The study of kisspeptin has yielded a new concept on the physiology of the hypothalamic–pituitary–testicular axis and thus the sexual and reproductive functions of men. Patients and methods Our case–control study included 44 male participants aged 20–45 years divided into two groups: a case group composed of 22 infertile men with severe oligospermia and with normal serum levels of testosterone, luteinizing hormone, follicle-stimulating hormone, and prolactin and an age-matched control group composed of 22 fertile men. Serum kisspeptin levels were evaluated by an enzyme-linked immunosorbent assay in both groups. Results The results of our study showed that the serum levels of kisspeptin in the infertile oligospermic group were significantly lower than those of the fertile group. Conclusion Deficiency of serum kisspeptin might be associated with oligospermia and fertility problems.
  125 15 -
Study of interleukin-6 and its role in hepatic encephalopathy in patients with liver cirrhosis
Ehab A Abd El-Atty, El-Sayed I El Shayeb, Ahmed Abd El-Rahman Sonbol, Abdalaziz M M Salama
July-September 2019, 32(3):906-909
DOI:10.4103/mmj.mmj_704_17  
Objective The aim of this work was to study the role of interleukin-6 (IL-6) in hepatic encephalopathy (HE) in patients with liver cirrhosis. Background IL-6 is an interleukin that acts as both proinflammatory response and anti-immune response. Patients and methods This study included 80 patients divided into three groups: group I represents the control group (20 healthy individuals), group II included patients with liver cirrhosis 'without HE' (30 patients), and group III included patients with liver cirrhosis and HE of different grades (30 patients). Full history taking, clinical examination, and investigations for all cases were done. Results There was significant difference in serum IL-6 level among the three groups: normal, liver cirrhosis, and HE groups (44.63 ± 43.08, 85.57 ± 54.24, and 156.5 ± 93.90, respectively; P ≤ 0.0001). There was a significance difference when comparing the mean values of serum IL- 6 in HE group according to Child classification (P < 0.0001). Conclusion IL-6 serum level is increased significantly in patients with 'liver cirrhosis and HE' and may be used as a confirmatory diagnostic marker of overt HE.
  121 18 -
Role of sonography as an adjunct to mammography in women with dense breasts
Mohamed R El Kholy, Waleed A Mousa, Nagwan R Mishmisha
July-September 2019, 32(3):876-880
DOI:10.4103/mmj.mmj_832_17  
Objective The aim was to evaluate breast lesions using mammography (MG) and ultrasonography (USG) independently and in combination in women with dense breasts. Background Women with dense breasts are at higher risk of developing breast cancer and at greater risk of cancer being not detected because of masking of the radiological signs of cancer by increased density. Therefore, multiple imaging modalities are required. USG is an imaging modality that can overcome limitations of MG and it is important for correct diagnosis. Materials and methods Our study was carried out on 100 female patients with dense breast lesions who attended Menouf General Hospital from October 2015 to March 2017. All of them were examined clinically followed by both MG and USG examinations. Then, we compared the findings with pathology results to assess their diagnostic performance. Results Of all 100 patients included in this study, the benign lesions were 60, whereas the malignant lesions were 40. Considering, MG had a sensitivity of 40%, a specificity of 93%, a positive predictive value (PPV) of 80%, and a negative predictive value (NPV) of 70%, and ultrasound had a sensitivity of 90%, a specificity of 100%, a PPV of 100%, and a NPV of 94%, and the indices of combined MG with ultrasound revealed sensitivity of 100%, specificity of 93%, PPV of 91%, and NPV of 100%. Conclusion USG should be considered as an important screening and diagnostic adjunct to MG to minimize the chances of missing diagnosis of any dense breast lesions.
  117 21 -
Study of serum level of vascular endothelial growth factor in patients with hepatocellular carcinoma
Ashraf G Dala, Mohamed H Badr, Fathia I Elbassal, Mohamed A. A. Al Diyar
July-September 2019, 32(3):938-942
DOI:10.4103/mmj.mmj_901_17  
Objective The aim of this study was to investigate the role of serum vascular endothelial growth factor (VEGF) as a marker for diagnosis and early detection of hepatocellular carcinoma (HCC). Background HCC is one of the most common malignancies. VEGF is a master regulator of angiogenesis in normal and malignant tissues. Participants and methods This was a cross-sectional study that was carried out in the Internal Medicine Department of El Menoufia University Hospital, Menoufia, throughout the period from July 2016 to April 2017. This research included three groups: group 1 included 40 cirrhotic patients with HCC, group 2 included 40 patients with liver cirrhosis without HCC, and group 3 included 10 healthy volunteers as a control group. All patients were clinically analyzed, underwent different biochemical assessments and assessment of VEGF. Results Plotting of receiver operating curve implied that serum VEGF, at a cut-off of 872.5 pg/ml showed a diagnostic sensitivity of 83.3% and specificity of 81.7%. The area under the curve (AUC) was 0.8402. As regards serum α-fetoprotein, the diagnostic performance at the cut-off (320 ng/ml) showed a diagnostic sensitivity of 79.41%, specificity of 60%, and AUC of 0.766. As regards combination of serum α-fetoprotein and VEGF, it showed a diagnostic sensitivity of 82.5%, specificity of 80%, and AUC of 0.8842. Conclusion VEGF is suggested to be a promising diagnostic marker with high sensitivity for HCC, which can be used in screening patients with cirrhosis for early detection of HCC.
  121 16 -
Influence of secondary hyperparathyroidism on left ventricular function in maintenance hemodialysis patients
Hassan A Ahmed, Yassein S Yassein, Khaled M. A. Elzorkany, Ahmad T. H. Abouseriwa
July-September 2019, 32(3):922-927
DOI:10.4103/mmj.mmj_744_17  
Objective The aim of this work was to assess the influence of secondary hyperparathyroidism (SHPT) on left ventricular function in end-stage kidney disease in Egyptian patients under maintenance hemodialysis. Background SHPT is a common disorder in patients with chronic kidney disease. Parathyroid hormone (PTH) is a major uremic toxin and may be responsible for long-term consequences that include renal osteodystrophy, severe vascular calcifications, alterations in cardiovascular structure and function, immune dysfunction, and anemia. PTH has been identified as an important cardiotoxin in end-stage kidney disease and may cause deleterious effects in myocardium metabolism and function. Materials and methods A total of 86 end-stage kidney disease patients on maintenance hemodialysis were recruited from the Hemodialysis Unit in the National Institute of Urology and Nephrology in Cairo, Egypt. Patients were divided into two groups: group I – comprised 39 patients with controlled SHPT (PTH: 150–300 pg/ml) and group II comprised 47 patients with uncontrolled SHPT (PTH: ≥350 pg/ml). Results There was no statistically significant difference between the two groups as regards the systolic function and diastolic dysfunction or with respect to the development of left ventricular hypertrophy. On the other hand, there was a statistically significant correlation between uncontrolled SHPT and the development of valvular calcifications of mitral and aortic valves. Conclusion Uncontrolled SHPT in hemodialysis patients is not associated with the development of left ventricular hypertrophy in our studied patients.
  122 15 -
Evaluation of serum amyloid A protein as a marker in neonatal sepsis
Ghada M Elmashad, Hanan M Elsayed, Zein A Omar, Eman A Badr, Osama M Omran
July-September 2019, 32(3):1094-1098
DOI:10.4103/mmj.mmj_35_19  
Objective To evaluate the serum amyloid A (SAA) as an early and accurate diagnostic marker in neonatal sepsis. Background The early and efficient diagnosis of neonatal sepsis in high-risk neonates remains a difficult task as the clinical signs are nonspecific, complete blood count parameters and C-reactive protein (CRP) have low sensitivity, also difficulty of its diagnosis may be due to decreased positive values of blood culture and long time which is needed for detection of blood culture results. The SAA protein level in the blood increases earlier and up to 1000-fold in response to inflammation. Participants and methods A case–control study was carried out on 50 septic newborns who were admitted to the Neonatal ICU, Benha Specialized Children Hospital. Patients were subdivided into confirmed (35 cases) and clinical (15 cases) septic groups as well as 25 sex-matched and age-matched neonates as a control group during the study period from April to November 2018. Full assessment of history, clinical examination, complete blood count, CRP, blood culture, and SAA protein were performed for all neonates. Results The mean value of SAA in the confirmed septic group (35 cases with elevated CRP and positive blood cultures) was 77.1 ± 5.5 μg/ml and that in the clinically septic group (15 cases with elevated CRP and negative blood cultures) was 18.5 ± 1.32 μg/ml compared with the control group (4.7 ± 1.1 μg/ml), and this represented a highly statistically significant difference (P = 0.000). Conclusion Serum amyloid A increases significantly in neonates with sepsis in comparison with healthy neonates. Therefore, SAA protein could aid the clinicians in diagnosing most cases of neonatal sepsis.
  119 18 -
CASE REPORTS
Laryngeal tuberculosis: a rare presentation in a Nigerian child with disseminated tuberculosis
Rasheedat M Ibraheem, Damilola M Oladele, Salihu S Mohammed, Mohammed B Abdulkadir, Wahab B. R. Johnson, Abdulwasiu G Omotosho
July-September 2019, 32(3):1157-1160
DOI:10.4103/mmj.mmj_236_16  
Tuberculosis (TB) remains a ravaging disease, particularly in the low-income countries, with a protean manifestation in children. Thus, a high index of suspicion is the key to clinching the diagnosis when presentation is in a rare form such as laryngeal TB. In this study, the case report of a 10-year-old female child with laryngeal TB in the setting of other typical clinical presentation associated with TB is highlighted.
  116 20 -
ORIGINAL ARTICLES
Angiogenesis in involved and uninvolved skin of psoriasis highlighted by cluster of differentiation 34: an immunohistochemical study
Mostafa A Hammam, Azza G Antar, Asmaa G Abdou, Reem A. Abd El-Aziz Hassan
July-September 2019, 32(3):1013-1018
DOI:10.4103/mmj.mmj_782_17  
Objective The present study aimed at evaluating microvascular density (MVD) in involved and uninvolved skin of patients with psoriasis. Background Psoriasis is a chronic inflammation skin disease characterized by accelerated proliferation, abnormal differentiation, and increased angiogenesis. The angiogenesis is related to many factors in the pathogenesis of psoriasis. The assessment of angiogenesis using cluster of differentiation 34 can help more understanding of psoriasis pathology. Patients and methods This study was carried out on biopsies of involved and uninvolved skin from 40 patients with psoriasis and 40 apparently healthy volunteers as a control group. Biopsies were processed for immunostaining procedure in the pathology department. Results After assessment of the MVD highlighted by cluster of differentiation 34 immune-staining, the skin of psoriatic cases (involved and uninvolved) was of significantly higher MVD values in comparison with normal skin of control group (P < 0.001). Additionally, the involved psoriatic skin showed significantly higher MVD values compared with uninvolved skin (P < 0.001). Conclusion Angiogenesis has a role in the pathogenesis of psoriasis, as it was accelerated in both involved and uninvolved skin.
  118 18 -
Noninvasive methods for fibrosis assessment in chronic hepatitis C virus infection
Ehab A Abd El-Atty, El-Sayed I El-Shayb, Mohammed O Belal
July-September 2019, 32(3):943-948
DOI:10.4103/mmj.mmj_19_18  
Objective The objective of this study is to compare several noninvasive methods of fibrosis assessment (platelet count, the aspartate aminotransferase/platelet ratio index, the Lok score, and the fibrosis-4 score) versus percutaneous liver biopsy (LB) in chronic hepatitis C virus infection. Background Noninvasive methods for assessment of hepatic fibrosis are increasingly needed. LB is an invasive procedure and includes a risk of complications, such as pain, pneumothorax, puncture of other viscera, and hemorrhage. In addition to the added cost, LB cannot be performed universally in all patients with impaired hemostasis of any origin. Patients and methods Our study included 500 patients with chronic hepatitis C virus infection in which LB and biological tests needed for calculating the scores (according to the classic formulas) were performed. Results There was a highly significant correlation between different stages of fibrosis and all studied markers of fibrosis (P < 0.001). Lok score at a cutoff value of 0.25 had 68.73% sensitivity and 55% specificity for diagnosis of liver fibrosis, fibrosis-4 score at a cutoff value of 1.26 had 55.9% sensitivity and 68.54% specificity, aspartate aminotransferase/platelet ratio index at a cutoff value of 0.66 had 50.0% sensitivity and 74.16% specificity, and platelet count at a cutoff value of 208 (103/mm3) had 67.7% sensitivity and 59.55% specificity for diagnosis of liver fibrosis. Conclusion All studied noninvasive markers of fibrosis are very good markers for detection of fibrosis.
  118 18 -
Fibroblast growth factor 23: a novel biomarker of phosphate retention in patients with chronic kidney disease
Seham Ahmed Zaky Khodair, Yassin S Yassin, Rasha I Noor El-Din, Asmaa A. A. Sabik
July-September 2019, 32(3):967-971
DOI:10.4103/mmj.mmj_822_17  
Objective The objective of this study was to evaluate fibroblast growth factor 23 (FGF23) expression in patients with chronic kidney disease (CKD) and its effect on diagnosis, grading, and prognosis of patients. Background CKD is recognized as a major public health problem in which there is progressive loss in renal function over a period of months or years. FGF23 is a protein that in humans is encoded by the FGF23 gene. FGF23 is a member of the FGF family which is responsible for phosphate metabolism. Patients and methods This study was conducted on 73 patients with CKD (with its five stages) and 15 age-matched and sex-matched healthy individuals as a control group. All patients were subjected to full history taking, clinical examination, and laboratory investigations. FGF23 was measured for all the study participants using enzyme-linked immunosorbent assay technique. Results FGF23 expression increased gradually with increased degree of CKD than in controls. Conclusion There is increased expression of FGF23 in the serum of patients with CKD with its 5°.
  119 16 -
A study of DNA damage in epileptic children treated with valproic acid or carbamazepine
Ahmed T Mahmoud, Maha A Tawfik, Sameh A Abd-El-Naby, Dina Abd El-Aziz Hammad
July-September 2019, 32(3):1078-1082
DOI:10.4103/mmj.mmj_41_18  
Objective The aim of this study was to determine DNA damage in epileptic children due to seizures and/or due to the most widely used antiepileptic drugs (valproic acid or carbamazepine). Background Epilepsy is a common neurological disease that requires early diagnosis and treatment. However, long-term use of antiepileptic drugs has been shown to cause oxidative damage to protein and DNA. Patients and methods We enrolled 15 epileptic patients receiving valproic acid monotherapy, 15 epileptic patients receiving carbamazepine monotherapy, 10 epileptic children with no treatment, and 10 control healthy children. Blood samples were collected from a peripheral vein into heparinized tubes and estimation of DNA damage in peripheral leukocytes by DNA fragmentation assay was carried out by DNA extraction and then gel electrophoresis. Results Epileptic children of both groups receiving carbamazepine or valproic acid monotherapy had significantly higher more DNA damaged cells than that of the control group P = 0.002 and 0.04, respectively. This indicate a significant DNA damaging effect of both CBZ and valproic acid monotherapy on human lymphocytes. No significant correlations were detected as regards the duration of treatment, dose, or serum level of drugs. No significant differences were found between epileptic patients' group not receiving antiepileptic drugs and the control group. Conclusion It can be concluded that patients on either valproic acid or carbamazepine monotherapy are at risk to develop significant DNA damage effects more than those without treatment, while epilepsy itself does not cause DNA damage.
  116 19 -
ADAMTS13 plasma level in maintenance hemodialysis patients: its relation to vascular access thrombosis
Hassan Abd El Hady, Yassin S Yassin, Khaled M El Zorkany, Belal A Montaser, Sara M H. Kashkoush
July-September 2019, 32(3):916-921
DOI:10.4103/mmj.mmj_730_17  
Objective The aim of this study was to evaluate ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) plasma level in patients under maintenance hemodialysis (HD) to determine its relation in the occurrence of vascular access thrombosis (VAT) in such patients. Background An increased thrombotic tendency is an important cause of complications in patients on chronic HD leading to thrombosis of the vascular access. VAT remains the main problem in vascular access for HD. Hypercoagulability in patients on chronic HD can be caused by a variety of factors, mainly consisting of platelet abnormalities and plasma factor abnormalities. Some of the plasma factor abnormalities are ADAMTS13 abnormalities. ADAMTS13 deficiency and/or the presence of antibodies against this enzyme may increase ultra large von Willebrand factor plasma levels, favoring the occurrence of thrombosis in small vessels. Materials and methods This case–control study was conducted on 60 patients on HD for more than 6 months classified into two groups: group I included 30 patients with VAT, and group II included 30 patients without VAT. Moreover, 20 healthy individuals served as a control group. History taking, clinical examination, and investigation were done. Results Mean ADAMTS13 serum level was found to be lower in HD groups of patients, with highly significant decrease in serum ADAMTS13 levels in group I (131.67 ng/ml) compared with group II (310.37 ng/ml) and group III (605.35 ng/ml), with P value of less than 0.001. A cut-off level at 200 ng/ml was accurate (95.00%) for occurrence of VAT in group I patients with sensitivity of 96.67%, specificity of 93.33%, positive predictive value of 93.55% and negative predictive value of 96.55%. Conclusion Low ADAMTS13 serum level was associated with occurrence of VAT.
  119 15 -
Mean platelet volume and its correlation with cardiovascular risk in type 2 diabetic patients
Nabil A El-Kafrawy, Mohamed A El-Said, Mohamed A Abd El-Hafeez, Heba Adel Saleh Omar Saeed
July-September 2019, 32(3):949-954
DOI:10.4103/mmj.mmj_119_18  
Objective To evaluate the mean platelet volume (MPV) and its correlation with cardiovascular risk in type 2 diabetic patients. Background Platelet functions have important roles in the development of vascular complications in diabetic patients. Platelets with increased volume have increased activity compared to smaller ones, therefore, MPV is used as a marker for platelet activity. Patients and methods A cross-sectional analytical study was done on a group of 60 type 2 diabetic patients divided into group I, included 23 cases without cardiovascular disease, group II, included 37 cases with cardiovascular disease, and group III, included 20 healthy people as the control group. All patients attended the Endocrine and Diabetes Clinic in Menoufia University during the period from 2015 to 2016. Comparisons of fasting blood sugar, 2-h post prandial (2HPP), lipid profile, and MPV were tested. Results Diabetic patients with cardiovascular disease had a higher MPV (11.08 ± 1.39) than diabetic patients without cardiovascular disease (10.53 ± 1.33) and healthy group (8.30 ± 1.62). There was a significant difference between the studied groups regarding MPV, fasting blood sugar, 2HPP and low density lipoprotein cholesterol, and hemoglobin A1c. In addition, MPV showed a significant positive correlation with fasting blood sugar, 2HPP, hemoglobin A1c, serum cholesterol, and low density lipoprotein cholesterol. Whereas, MPV was not correlated with serum glyceride and high-density lipoprotein cholesterol. Conclusion Platelet dysfunction occurs in diabetic patients and this is demonstrated by higher than normal MPV. MPV was found to carry a risk of development of cardiovascular disease in these patients.
  118 14 -
Stromal-derived-factor-1 (CXCL12) and its receptor (CXCR4) in pediatric sepsis
Fady M El-Gendy, Hassan S Badr, Hossam S Abd-Elbaki, Mohamed A Soliman, Eslam G. M. Mosa
July-September 2019, 32(3):1083-1089
DOI:10.4103/mmj.mmj_127_18  
Objective To assess the role of serum levels of stromal-derived-factor 1 and its receptor α-chemokine receptor type 4 (CXCR4) as reliable markers for diagnosis of sepsis in the emergency department. Background Pediatric sepsis is a major cause of morbidity and mortality in children admitted to the pediatric ICU. The chemokine CXCL12 and its receptor CXCR4 are now known to play an important role in inflammatory states and mediate lymphocyte migration. Patients and methods In a prospective cohort study, we randomly enrolled 23 critically ill children admitted into pediatric ICU, and 15 healthy children served as controls. Serum levels of CXCL12 and lymphocyte expression of CXCR4 were measured for patients as well as control by enzyme-linked immunosorbent assay technique and flow cytometry, respectively. Results Serum levels of CXCL12 and lymphocytes expression levels of CXCR4 were significantly higher among the all patients with sepsis compared with controls (P < 0.001). The diagnostic accuracy of CXCL12 in diagnosis of pediatric sepsis was 92.1%, with a sensitivity 100% and a specificity 80% at a cutoff point 89.3 pg/ml, whereas the diagnostic accuracy of mean fluorescent intensity of lymphocyte expression of CXCR4 was 92.1%, with sensitivity 95.6%, specificity 86.7%, at cutoff point of 120.2%. Furthermore, serum level of CXCL12 and CXCR4 expression were significantly elevated in nonsurvived compared with survived patients (P < 0.001). Conclusion Overall, the data support the view that measurements of serum CXCL12 and CXCR4 expression result in substantial added value for early diagnosis and prognosis of pediatric sepsis.
  114 18 -
Correlation between serum tumor necrosis factor-α levels and clinicoradiological severity of tuberculosis
Ahmed A Ali, Ibrahim I El-Mahalawy, Samy S El-Dahdouh, Mona S Habib, Fatma S El-Fakharany
July-September 2019, 32(3):1104-1107
DOI:10.4103/mmj.mmj_830_17  
Objective The aim was to assess the level of tumor necrosis factor-α (TNF-α) in patients with active pulmonary tuberculosis (TB) and its relation to BMI; different radiological features whether the lesion is minimally, moderately advanced, and far advanced; and to follow-up the level of TNF-α. Background One of the most important and common complaints of patients with TB, which also affects the immune status, is weight loss. When tuberculous infection occurs, a variety of chemokines and cytokines are secreted from infected cells and tissue macrophages. TNF-α increases early in the disease and takes part in the pathogenesis and prevention of mycobacterial infection. Participants and methods Serum TNF-α was measured in 40 newly diagnosed patients as having active pulmonary TB (group I) and 10 controls (group II). Results Serum TNF-α level was significantly higher in patients with active pulmonary TB than in controls, and there was a highly significant negative correlation between TNF-α level and BMI before and after treatment. Serum TNF-α had insignificant positive correlation with grades of Ziehl–Neelsen stain and chest radiography before and after treatment, and the diagnostic cut-off points of TNF-α was found to be 618.1 pg/ml. Conclusion Serum TNF-α level is higher in patients with TB than in controls. TNF-α plays a role in diminishing appetite, in weight loss, and in increased susceptibility to infection.
  112 20 -
Right liver lobe diameter/serum albumin ratio in the prediction of esophageal varices in cirrhotic patients
Mohamed A Nouh, Moamena S El-Hamouly, Safaa A Mohamed, Ahmad Y. H. Metwally
July-September 2019, 32(3):1113-1118
DOI:10.4103/mmj.mmj_73_19  
Objective This study aimed to assess the role of right liver lobe diameter by ultrasound/albumin ratio in the prediction of esophageal varices (OV) in cirrhotic patients. Background OV often develop in cirrhotic patients. Varices rupture leading to variceal bleeding represents the most lethal complication of cirrhosis. Right liver lobe diameter/albumin (RLLD/Alb) ratio is a noninvasive method to predict the presence of OV. Patients and methods A case–control study was carried out on 200 cirrhotic patients (145 with OV and 55 without OV). Patients were subjected to complete blood picture, liver and kidney functions, viral markers, abdominal ultrasonography, upper gastrointestinal tract endoscopy, and calculation of the RLLD/Alb ratio and the platelet count/spleen diameter (PC/SD) ratio. Results The RLLD/Alb ratio was diagnostic for the prediction of OV with high significance (P ≤ 0.0001). At a cut-off point of 3.7, the sensitivity, specificity, and accuracy to predict OV were 95, 76.4, and 90%, respectively, with area under the curve = 0.88. A highly statistically significant difference was also noted in the PC/SD ratio with a sensitivity, specificity, and accuracy of 83.4, 70.3, and 80.9%, respectively, at a cut-off point of 605. A statistically significant positive correlation was found between both the RLLD/Alb ratio and the PC/SD ratio and grades of OV and the risk of bleeding from varices (P = 0.0001). Conclusion The RLLD/Alb ratio and the PC/SD ratio are useful as noninvasive predictors of OV in cirrhotic patients.
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Use of azacytidine in differentiation of mesenchymal stem cells
Waled M Fathy, Iman A Ahmedy, Shaimaa M Motawe, Rasha A El Morsy
July-September 2019, 32(3):978-982
DOI:10.4103/mmj.mmj_893_17  
Objective We aimed to study the differentiation of mesenchymal stem cells (MSCs) into cardiomyocytes using azacytidine. Background Ischemic injury of cardiomyocytes results in heart failure, as cardiomyocytes do not have the ability to regenerate after death. This has prompted interest in identifying cells capable of replacing the injured myocardium with healthy cells. The ideal candidate for cellular cardiomyoplasty is a less committed cell that can undergo full cardiogenic differentiation which can be found in the adult bone marrow (BM). Now it is believed that the adherent population of cells isolated from BM and expanded in vitro are a potential source of undifferentiated MSCs. Patients and methods The study included 30 cases referred to Clinical Pathology Department. Extra BM sample was collected from patients who already had a benign indications for BM examination as hypersplenism and immune thrombocytopenic purpura. MSCs were cultured from BM aspirate and mononuclear cells were separated using ficoll-hypaque solution. Thereafter, MSCs were separated from mononuclear cells fraction using plastic adherence flasks, and MSCs were subcultured in differentiating media containing azacytidine. Differentiation into cardiomyocytes was detected by morphology of cardiomyocytes and immunophenotyping. Results Vimentin expression on cardiomyocytes treated with azacytidine (82.46 ± 9.04) was significantly higher than on MSCs not treated with azacytidine (15.18 ± 4.11). Statistically significant difference was found between MSCs and cardiomyocytes for presence of vimentin (P < 0.001). Conclusion By using azacytidine, MSCs can be differentiated to cardiomyocytes.
  113 16 -
Left ventricular strain in pediatric patients with end-stage renal disease
Fahima M Hassan, Ahmed A Khattab, Mahmoud A Soliman, Rania S El-Zayat, Marwa G S Feteih
July-September 2019, 32(3):861-867
DOI:10.4103/mmj.mmj_347_18  
Objective To evaluate left ventricular function using speckle tracking echocardiography (STE) in pediatric patients with end-stage renal disease (ESRD) with preserved left ventricular ejection fraction. Background ESRD is considered a leading cause of cardiovascular morbidity and mortality in pediatric patients. With the help of newer echocardiographic modalities such as two-dimensional (2D) STE, an early diagnosis of the cardiac involvement through the detection of subclinical myocardial dysfunction might be possible in pediatric patients with ESRD. Patients and methods This study was carried out on 35 children under regular hemodialysis for at least 3 days weekly owing to ESRD who were followed up at Menoufia University Hospital Nephrology Unit and 27 controls who were recruited from the outpatient clinic. They were subjected to detailed history taking; general and local clinical examination; laboratory investigations, such as complete blood count and serum creatinine level; and 2D STE. Results There was a highly statistically significant difference between cases and controls regarding global strain of four-chamber, two-chamber, and three-chamber views. Moreover, there was a highly statistically significant difference between cases and controls regarding left ventricular mass index, which correlated with global strain but did not correlate with left ventricular ejection fraction. Conclusion 2D STE helps in early diagnosis of the cardiac involvement in pediatric patients with ESRD who have normal ejection fraction through the detection of subclinical myocardial dysfunction.
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The role of portal congestion index in prediction of esophageal varices in hepatitis C virus-infected patients
Mohamed A Nouh, Moamena S El-Hammoly, Safaa A Mohamed, Maha M Hana
July-September 2019, 32(3):1119-1125
DOI:10.4103/mmj.mmj_63_19  
Objective To assess the role of portal congestion index (PCI) in prediction of esophageal varices (EV) in hepatitis C virus (HCV)-infected patients. Background Portal hypertension (PH) often develops in HCV-infected patients. EV rupture leads to variceal bleeding, the most lethal complication of cirrhosis. Duplex Doppler ultrasonography of portal vein is a noninvasive method to assess blood flow velocity and portal vein cross-sectional area as a parameter for PH. Patients and methods This study was conducted on 200 HCV-infected patients (116 with EV and 84 without EV). Patients were subjected to complete blood picture, liver and kidney functions, serum electrolytes, viral markers, abdominal ultrasonography, upper gastrointestinal tract endoscopy, and duplex Doppler evaluation of portal vein with calculation of PCI. Results There was a highly significant difference between HCV-infected patients with and without EV regarding PCI (P = 0.0001). At cutoff point of PCI 0.11, the sensitivity, specificity, and accuracy to predict EV were 93, 85.7, and 90%, respectively, with area under the curve 0.889. There was a statistically highly significant positive correlation between PCI and presence of fundal varices and PH gastropathy (P = 0.0001). There was a statistically significant positive correlation between PCI and grades of EV (P = 0.012). Conclusion PCI is useful as a noninvasive predictor of EV in HCV-infected patients.
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Laparoscopic cystic duct exploration
Hatem M Soltan, Mohammed S Ammar, Mohammed A El Balshy, Ehab S. A. Mahmoud
July-September 2019, 32(3):1132-1136
DOI:10.4103/mmj.mmj_668_16  
Objective To evaluate the benefits of routine cystic duct exploration during laparoscopic cholecystectomy (LC). Background The era of LC has been established as it decreases postoperative pain, shortens the hospital stay, and returns the patient to full activity within 1 week. Cystic duct stones (CDS) especially in patients with multiple tiny gallbladder are implicated in postcholecystectomy pain, failure of insertion of transcystic intraoperative cholangiography catheter, and the subsequent development of common bile duct (CBD) stones. Patients and methods This was a prospective study that included 30 patients with chronic calcular cholecystitis with multiple tiny stones. The patients were operated at the Department of General Surgery, Menoufia University Hospital between December 2015 and August 2016. All patients were scheduled for LC with exploration of cystic duct; intraoperative cholangiogram was done only for five cases. Results CDS were detected in nine cases in different patterns (multiple stones, single stone, gravels). CDS were detected more in patients with elevated liver functions including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase. CDS were detected more in patients with dilated cystic duct. CBD stones were found in one case detected by transcystic intraoperative cholangiography; endoscopic retrograde cholangiopancreaticography was done in the same session. No postoperative complications were found regarding bile leak, obstructive jaundice, and postcholecystectomy pain. Conclusion Cystic duct exploration as a routine step in LC especially in patients with multiple gallbladder stones is a safe and easy to perform procedure that may help in protection against complications after cholecystectomy including postcholecystectomy pain, missed CBD stones, and pancreatitis with no increase in the time of procedure or risk on patients.
  113 13 -
An epidemiological study of abdominal blunt trauma in pediatric population
Dileep Garg, Aditya P Singh, Vinay Mathur, Dinesh K Barolia
July-September 2019, 32(3):1090-1093
DOI:10.4103/mmj.mmj_157_18  
Background The management of abdominal blunt trauma in children has changed considerably. Nonoperative treatment is successful in more than 85% of the appropriately selected cases. Aim To evaluate the incidence of various modes of abdominal blunt trauma and the effectiveness of conservative treatment. Patients and methods A retrospective study of 101 cases of abdominal blunt trauma in children admitted to hospital in a 5-year period has been carried out. Of 101 patients, 67 patients had organ injury. Laparotomy was done in 14 patients based on clinical findings and investigations, and 90 patients were managed conservatively. Results The nonoperative management in abdominal blunt trauma was successful in more than 85% patients. Conclusion Nonoperative management is associated with lower morbidity and less hospital stay in paediatric patients with abdominal blunt trauma.
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Differentiation of umbilical cord Wharton's jelly derived mesenchymal stem cells into cardiomyocytes using 5-azacytidine
Waled M Fathy, Rasha I NourEldin, Gehad H Shalby
July-September 2019, 32(3):991-995
DOI:10.4103/mmj.mmj_136_18  
Objectives The objective of this article was to differentiate mesenchymal stem cells (MSCs) into cardiomyocytes. Background Cardiomyopathies resulted in permanent loss of cardiomyocytes as it had no ability of regeneration. This made MSCs a promising tool for cellular therapy because of their ability of self-renewal and multipotency. MSCs were considered ideal for cellular cardiomyoplasty as they can undergo full cardiogenic differentiation. Now it was believed that isolated cells from umbilical cord and expanded in vitro were a potential source of MSCs. Patients and methods An experimental study included 10 pregnant females due for delivery between October 2015 and April 2017. Umbilical cord samples and cord blood were collected from cesarean section patients, MSCs were cultured from umbilical cord tissue (Wharton's jelly). MSCs were subcultured in differentiating media containing azacytidine. Cardiomyocytes differentiation was detected by morphology of cardiomyocytes and immunophenotyping. Results MSCs were successfully isolated from 10 umbilical cord samples. MSCs showed positive expression of CD44 for umbilical cord mesenchymal stem cells (UCMSCs) mean ± SD (79.72 ± 5.85). It showed negative expression of CD34 for UCMSCs mean ± SD (1.08 ± 0.43). A significant statistical difference was found (P = 3.28 × 10−11) between MSCs and cardiomyocytes with respect to expression of troponin. A significant statistical correlation was seen (P = 0.001) between MSCs that showed positive expression of CD44 and cardiomyocytes. Conclusion By using azacytidine MSCs isolated from umbilical cord Wharton's jelly (UCWJ) can be differentiated into cardiomyocytes.
  110 15 -
Human Chitinase-3-like Protein amarker of hepatic fibrosis in chronic hepatitis C virus infection
Gehan K El-Saeed, Rasha I Noreldin, Ayman A Alghoraieb, Hanan A Ahmed
July-September 2019, 32(3):972-977
DOI:10.4103/mmj.mmj_908_17  
Objective The aim was to evaluate the level of human chitinase-3-like protein (YKL-40) in patients with hepatitis C virus infection and observe its level in hepatic fibrosis. Background Hepatic fibrosis results from long-standing liver damage, and it represents a major health care burden worldwide. In recent years, there has been increasing interest in identifying and describing hepatic fibrosis through the use of noninvasive markers. The serum YKL-40 level has been evaluated as a noninvasive marker of various chronic inflammatory and fibrotic liver diseases, including chronic hepatitis C, chronic hepatitis B, and alcoholic liver disease. Participants and methods This study case–control study was carried out in Clinical Pathology Department, Faculty of Medicine, Menoufia University, in the period from September 2015 to November 2016. It was conducted on 77 patients with chronic hepatitis C infection and 10 age-matched and sex-matched healthy individuals as a control group. Serum level of YKL-40 was measured for all the participants of the study by enzyme-linked immune sorbent assay technique. Results Mean YKL-40 was lower among control than patient groups (28.0 ± 6.7 and 106.6 ± 38.8, respectively; P < 0.001). Moreover, YKL-40 was lower among mild fibrosis cases than marked fibrosis cases (98.1 ± 41.5 and 111.5 ± 36.6, respectively; P < 0.001). Conclusion There is increased serum level of YKL-40 in patients having liver fibrosis than in control group, and its level increases with the degree of fibrosis.
  110 12 -
Evaluation of urinary vitamin D-binding protein in type 1 diabetic children
Maha A Tawfik, Soheir S Abou-El Ella, Sally M El-Hefnawy, Mai A El-Borai
July-September 2019, 32(3):1064-1070
DOI:10.4103/mmj.mmj_900_17  
Objective The aim of the study was to measure the levels of vitamin D-binding protein (VDBP) and microalbumin in the urine of diabetic children (type 1) and to analyze the correlation of VDBP with other parameters. Background Elevated urinary vitamin D-binding protein (UVDBP) level in patients with diabetes indicates that renal tubular damage may be involved in early stages of the development of diabetic nephropathy (DN). Patients and methods A total of 20 type 1 diabetic patients and 20 healthy controls were subjected to full history taken, thorough clinical examination, and laboratory investigation, which included complete blood count, blood glucose profile, glycosylated hemoglobin, parameters of kidney function, liver function, measurement of microalbuminurea, and VDBP in urine by enzyme-linked immunosorbent assay. Results UVDBP level showed significant increases in type 1 diabetic patients with microalbuminuria and macroalbuminuria (mean: 562.990 ± 194.771) when compared with control group (mean: 172. 480 ± 41.856; P = 0.001). There was a positive correlation between UVDBP as a marker of DN and fasting blood glucose, 2-h postprandial blood glucose (2-h PP), glycosylated hemoglobin, duration of the disease, and albumin/creatinine ratio, but no significant correlation between UVDBP as a marker of DN and other laboratory data. Conclusion Our finding indicates that UVDBP level is a potential biomarker for early detection of DN.
  105 17 -
Assessment of corneal biomechanics in young myopic individuals using ocular response analyzer
Hassan G Farahat, Khalid E. S. Ahmed, Omnia A Attia
July-September 2019, 32(3):1149-1153
DOI:10.4103/mmj.mmj_3_19  
Objective The aim of this study was to assess corneal biomechanical properties using the ocular response analyzer (ORA) in myopic young individuals with normal topography. Background The development in corneal refractive surgeries raises the necessity of studying corneal properties in detail. Corneal viscoelasticity, in terms of corneal biomechanics, is measured by ORA through the analysis of the corneal dynamic behavior when it is deformed by an air puff. The important parameters measured are corneal resistance factor (CRF) and corneal hysteresis (CH). Patients and methods This study included 116 myopic eyes, which were assessed by clinical examination, best corrected visual acuity examination, and corneal pentacam topography. CH and CRF were measured using ORA. Results The mean age in our study participants was 23.6 ± 2.9 years, and the mean of the spherical equivalent was −4.56 ± 2.4 (moderate myopia). The mean CRF was 9.7 ± 1.4 mmHg, while the mean CH was 10.0 ± 1.3 mmHg. As regards corneal topography, normal participants were recruited with the following measurements: Kmax (maximum keratometry) 44.3 ± 1.4 and the mean central corneal thickness (CCT) was 529.5 ± 12.7 μm. Correlation of CRF and CH values in this moderate myopic group were negatively correlated with the spherical equivalent. Both CH and CRF had positive linear correlation with CCT and Kmax, and negative correlation with age. Conclusion The ORA is used to measure CH and CRF by which the biomechanical changes of the cornea in different degrees of myopia can be detected. It was found that it is important when evaluating the corneal biomechanical properties to take CCT and myopic status into consideration.
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LETTER TO THE EDITOR
Unusual association of testicular yolk sac tumor with pectus excavatum in an 18-month-old child: a case report
Mahmood D Al-Mendalawi
July-September 2019, 32(3):1161-1161
DOI:10.4103/mmj.mmj_159_18  
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