Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
   Table of Contents - Current issue
Coverpage
January-March 2018
Volume 31 | Issue 1
Page Nos. 1-364

Online since Thursday, June 14, 2018

Accessed 480 times.
View as eBookView issue as eBook
Author Institution MappingAuthor Institution Mapping
Access StatisticsIssue statistics
RSS FeedRSS
Hide all abstracts  Show selected abstracts  Export selected to  Add to my list
REVIEW ARTICLES  

New mechanical ventilation strategies in acute respiratory distress syndrome Highly accessed article p. 1
Alaa Al Din A Aiad, Ahmed M Metwally, Ayman A Rady
DOI:10.4103/1110-2098.234223  
Objective The purpose of this paper was to assess the new mechanical ventilation strategies in acute respiratory distress syndrome(ARDS). Data sources Data sources includes Medline databases(PubMed, Medscape, ScienceDirect, and EMF-Portal) and all materials available on the internet from 2003 to 2016. Study selection The search presented articles that met theinclusioncriteria involving the definition, pathophysiology, medical treatment, mechanical ventilation strategies, and prognosis of ARDS. 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 different lines of treatment and new mechanical ventilation strategies of ARDS. Results The studies show that mechanical ventilation is the hallmark of ARDS treatment and a lifesaving intervention for severe hypoxemia that characterizes it. Despite it being used in this setting for several decades, our knowledge about its benefits and potential harm has evolved widely over time. Early ventilation strategies involved volume-controlled ventilation with tidal volume(Vt) of 10–15ml/kg to achieve “normal” arterial blood gases. However, ventilation itself can cause lung injury. Alandmark trial conducted by the ARDS Network compared conventional Vtof 12ml/kg with low Vtof 6ml/kg and permissive hypercapnia. A9% absolute mortality reduction was found in the low Vtventilation group along with reduced pulmonary and circulating inflammatory cytokines. The aim of positive end-expiratory pressures(PEEP) in ARDS is to recruit(or maintain recruitment) ofatelectaticor flooded lung. Initial studies looking at the effects of PEEP described adverse hemodynamic effects at high levels, leading to a reduction in cardiac output and oxygen delivery. Recruitment maneuvers are used to open areas of atelectasis improving lung compliance and oxygenation. The prognosis of ARDS has improved over the past 20years. Overall, 60–70% of patients survive. Patients with poor prognostic factors include those older than 65years and those with sepsis as the underlying cause. The adverse effect of age may be related to underlying health status. Conclusion We found that mechanical ventilation strategies that use lower end-inspiratory(plateau) airway pressures, lower tidal volumes(Vt), and higher PEEPs can improve survival in patients with ARDS, but the relative importance of each of these components is uncertain. The ARDS Network trial showed that a ventilation strategy with a lower tidal volume(4–8ml/kg of predicted body weight) was associated with lower mortality and shorter length of mechanical ventilation. This trial used a combination of volume and pressure limitation.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Maternal anemia with pregnancy and its adverse effects Highly accessed article p. 7
Medhat E Helmy, Nabih I Elkhouly, Rania A Ghalab
DOI:10.4103/1110-2098.234258  
Objectives This article reviews the different types of anemia with pregnancy and its adverse outcome for mother and fetus. Data summary Data sources: Data were obtained from Medline databases (PubMed, Medscape,) and literatures from 2008 until 2014. Study selection: Studies that enabled the investigation of the advancement of early diagnosis and management of different types of anemia were selected. Data extraction: In this review, data from published studies were manually extracted and summarized. Data synthesis: In this review, the data revealed that different types of anemia affect the mother, causing headache, fatigue, weakness, and depression. Outcomes of pregnancy included intrauterine growth restriction, low Apgar scores with a high risk of birth asphyxia, and low birth weight. Conclusion Anemia during pregnancy and its management remains an important issue in perinatal medication. Correct diagnosis and treatment lead to effective management of fetal and maternal risks and improved perinatal outcome.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES Top

Effect of ondansetron on hypotension andbradycardia associated with spinal anesthesia during cesarean section Highly accessed article p. 12
Ayman A Shabana, Nabih I Elkholy, Ashraf M Mohamed, Mai I AbdelHamid
DOI:10.4103/1110-2098.234215  
Objective The aim of the study was to evaluate the efficacy of ondansetron during spinal anesthesia for cesarean section in overcoming the associated nausea, vomiting, bradycardia, and hypotension. Background Ondansetron, a widely used antiemetic and serotonin antagonist, has been safely used to blunt the Bezold–Jarisch reflex, resulting in less bradycardia and hypotension in humans undergoing spinal anesthesia. Patients and methods One hundred parturients scheduled for elective cesarean section were randomly allocated into two groups. Before induction of spinal anesthesia groupI(n=50) received intravenous ondansetron 4mg and groupII(n=50) received normal saline. Blood pressure, heart rate(HR), nausea and vomiting, shivering, vasopressor requirements, and Apgar score at 1 and 5min were assessed. Results Decreases in systolic arterial pressure were significantly lower in groupI than in groupII. Patients in groupI had significantly less requirement for vasopressor(P=0.005), needed lower dose of vasopressor(P=0.01), and had significantly lower incidences of nausea and vomiting (P=0.03). Decreases in HR were significantly lower in groupI than in groupII just after spinal anesthesia(P=0.02), at 20min(P=0.01), and 50min(P=0.02). Decreases in mean blood pressure were significantly lower in groupI than in groupII just after spinal anesthesia(P=0.007). Conclusion In parturient women undergoing elective cesarean section, intravenous 4mg ondansetron significantly decreased the hypotension, HR fluctuation, and vasopressor doses used.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparison between transcervical Foley catheter with oxytocin versus oxytocin alone in inducing labor in women with an unfavorable cervix p. 18
Medhat E Helmya, Said A Saleh, Nabih I Elkhouly, Amany M Mosa
DOI:10.4103/1110-2098.234222  
Objective The aim of our study is to compare the benefit of the use of transcervical Foley catheter with oxytocin if needed and oxytocin alone in inducing labor. Background The use of a transcervical balloon catheter for cervical ripening is considered to be a safe and effective method. Patients and methods Overall, 72patients with unfavorable cervix needing induction of labor after 35weeks of gestational age were enrolled in our study from the Department of Obstetrics and Gynecology of Basyoun Central Hospital between November 2014 and October 2015. Patients were randomlyallocatedinto two groups: group1(n=36) patients were assigned for transcervical Foley catheter with oxytocin infusion, if needed, in case of inefficient cervix dilation by 3 cm, and group2(n=36) patients received oxytocin alone. Results There was a statistically significant difference between group1 and group2 regarding successful induction, dose, and duration of oxytocin used. There was no statistical difference between both the groups regarding maternal or fetal complications. Conclusion Transcervical Foley catheter is probably the most useful method for ripening of cervix before induction of labor. Using transcervical Foley catheter with oxytocin had the highest rate of successful induction with least dose and duration of oxytocin required. No fetal or maternal complications occurred.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

A comparativestudy of intravenous iron versus oral iron supplementation for postpartum anemia Highly accessed article p. 23
Medhat E Helmy, Alaa El Deen Al Halaby, Nabih I El Khouly, Mohamed M Youssef
DOI:10.4103/mmj.mmj_587_16  
Objective The aim of our study was to compare the safety, tolerability, and effectiveness of treatment with either intravenous(i.v.) ferrous sucrose or oral ferrous sulfate on postpartum iron deficiency anemia. Background Iron deficiency anemia is very common in women postpartum and oral ferrous sulfate has been considered the standard of care. However, parenteral iron treatment is expected to be advantageous in cases where oral iron is not possible due to poor compliance or gastrointestinal side effects. Patients and methods The patients of the study(100patients) were randomly divided into two groups(50patients/group) using a computer-generated randomization schedule. The first group consisted of 50 women (i.v. group) who received iron by the i.v. route and the second group consisted of 50 women (oral group) who received iron by the oral route, two capsules daily 150mg twice daily for 6weeks. The serum ferritin level, hemoglobin(Hb) level, and red blood cell indices hematocrit, mean corpuscle volume, and mean corpuscular Hb concentration data were collected at home 0, 5, 14, 40days after treatment. Results The current study showed that i.v. ferrous sucrose significantly increases the mean level of Hb from 7.9mg/dl at pretreatment to 11.5mg/dl at 40days after treatment, whereas oral ferrous sulfate increases the mean level of Hb from 7.8mg/dl pretreatment to 11.2mg/dl; these results showed that i.v. iron is more effective than oral iron regarding the increase of Hb level. Conclusion The present study concluded that i.v. ferrous sucrose increases the Hb level more rapidly than oral ferrous sulfate in women with postpartum iron deficiency anemia; it also appears to replenish iron stores more rapidly without any significant side effects.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effectof sildenafil citrate on uteroplacental perfusion Doppler indices in growth-restricted fetuses Highly accessed article p. 31
Mohamed Adel El-Sayed, Said A Saleh, Mohamed A Maher, Asmaa M Khidre Bayome
DOI:10.4103/mmj.mmj_656_16  
Objective The aim of the paper was to study the effect of phosphodiesterase type-5 inhibitor, sildenafil citrate(SC), on uteroplacental perfusion. Background Fetal growth restriction(FGR) is the second common cause of perinatal morbidity. It is related to an increased risk of perinatal complication such as hypoxemia, low Apgar scores, and cord blood acidemia, with possible negative effects for neonatal outcome. Materials and methods The study was a randomized, double-blind, controlled trial. Atotal of 54 pregnant women whose pregnancy was complicated with FGR were divided into two groups. The first group received single dose of SC and the other received placebo. Doppler indices of umbilical, middle cerebral, uterine arteries were taken before and 2h after medication administration. Results A total of 54 women yielded data for analysis. Of these, 27 women received SC and 27 received placebo. There was significant improvement of fetal Doppler indices by 66.7% among the SC group(P=0.001) and insignificant changes in fetal Doppler indices among the placebo group(P=0.06). Conclusion Doppler velocimetry index values reflect decreased placental bed vascular resistance after sildenafil administration. SC can improve fetoplacental perfusion in pregnancies complicated by intrauterine growth restriction. It could be a potential therapeutic strategy to improve uteroplacental blood flow in pregnancies with FGR.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Letrozole withdexamethasone versus clomiphene citrate with dexamethasone for induction of ovulation in polycystic ovary p. 38
Ayman A Shabana, Alaa El-Deen F. Al-Halby, Abd Hamid E. Shaheen, Ahmed M El-Naggar
DOI:10.4103/mmj.mmj_703_16  
Objective The objective of this study was to compare the effect of letrozole with dexamethasone(DEX) versus clomiphene citrate(CC) with DEX in ovulation induction in polycystic ovarian syndrome(PCOS). Background PCOS is a common endocrinologic disorder in women characterized by chronic anovulation, hyperandrogenemia, and infertility. Patients and methods Sixty women with PCOS were included in this study and subdivided randomly into two groups. GroupI included 30 women who took letrozole 2.5mg tablet times daily starting from day 2 to day 6 of menstrual cycle and DEX2mg/day orally in two divided doses starting from day 3 to day 12 of the cycle. GroupII includes 30 women who took the same protocol of DEX combined with CC 50mg two times daily starting from day 2 to day 6 of the menstrual cycle. Treatment was continued for three consecutive cycles. Main outcome measures are number and diameter of follicles, endometrial thickness, ovulation rate, and pregnancy outcome. Results In groupI, the number of mature follicles was less than three follicles/cycle with monofollicular stimulation, whereas in groupII it was more than three follicles/cycle with multifollicular stimulation. The mean diameter of follicles was 18.73 in groupI and 16.23 in groupII. Difference in endometrial thickness was highly statistically significant(P<0.001), where the mean endometrial thickness was 10.60 in groupI and 6.97 in groupII. Ovulation was more significantly detected after using letrozole than CC–in 20(62.5%) women in groupI and 12(37.5%) women in groupII(P<0.05). Pregnancy was achieved in 11(68.8%) women in groupI, which is significantly higher than that in groupII–five(31.2%) women(P=0.05). Conclusion Letrozole and DEX have more success rates in ovulation induction and pregnancy outcome than CC and DEX.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Routine subcutaneous drains versus no drains in repeated elective and emergent cesarean sections p. 46
Mohamed M Fahmi, Haitham A Hamza, Ibrahim A S. El-Nasr, Mohamed T. Abd Al-Rahman Khalaf Allah
DOI:10.4103/mmj.mmj_14_17  
Objective The aim of this study was to determine whether the routine use of subcutaneous drains can reduce the wound complications following cesarean section(CS). Background CS is one of the most common operative procedures performed in modern obstetrics. One of the most common complications of CS is surgical site complications, including infection, seroma formation, and disruption. One of the common, yet debatable, practices in CS is the use of a subcutaneous drain for the wound. Patients and methods This is a randomized controlled study that was conducted at the obstetrics and gynecology department, Menoufia university hospitals. The study included 200patients who were subjected to CS. They were divided into two groups: group1, which included patients in whom a subcutaneous drain was used, and group2, which included patients in whom no subcutaneous drain was used. The duration of surgery and the duration of hospital stay were recorded. The patients were followed up and the following complications were assessed: wound infection, wound seroma, wound disruption, postoperative pain, and postoperative fever. Results Use of subcutaneous drains significantly reduced wound seroma(21% in the no drain group and 3% in the drain group), wound disruption(38% in the no drain group and 9% in the drain group), the need for redressing(41% in the no drain group and 12% in the drain group), and postoperative pain(a mean±SD of 5.4±0.9 in the no drain group and 2.76±1.17 in the drain group). There was no significant difference as regards wound infection or the duration of postoperative hospital stay. Conclusion We found that the routine use of subcutaneous drain for lean women undergoing CS can only reduce wound seroma, wound disruption, postoperative pain, and the need for redressing. However, there was no added benefit as regards other wound complications such as wound infection and postoperative fever.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Urea and creatinine in diagnosis of premature rupture of membrane Highly accessed article p. 52
Mohamed S Gada, Alaa M Abdel Gaied, Nabih I ElKhouly, Amany M Galal Khalaf
DOI:10.4103/mmj.mmj_74_17  
Objective The aim of this article was to evaluate the reliability of vaginal fluid urea and creatinine levels for diagnosis of premature rupture of membranes(PROMs) and its relation to gestational age. Background PROMs occurs in 8–10% of all pregnant women at term. The risk of maternal and fetal infection increases as the time between the rupture of membrane and the onset of labor increases. It is therefore important to achieve accurate diagnosis by identifying the presence of specific amniotic fluid markers in vaginal environment. Vaginal fluid urea and creatinine levels may be helpful in the diagnosis of PROM because fetal urine is the most important source of amniotic fluid in the second half of pregnancy. Patients and methods A prospective case–control study was conducted. The study was performed on pregnant women in the third trimester between 28 and 42weeks of gestation with a history of possible leakage of amniotic fluid, attending Menoufia University Hospitals and Quesina General Hospital during the period from January 2013 to December 2015. Atotal of 90cases were subdivided into three groups: groupI(30cases)–confirmed PROM, groupII(30cases)–suspected PROM, and groupIII(30cases)–control group. All patients underwent speculum examination, nitrazine paper test, and ultrasonography. Results The creatinine levels were 0.64±0.018, 0.28±0.013, and 0.14±0.006mg/dl in confirmed cases, suspected cases, and controls, respectively. The urea levels were 29.67±3.75, 5.51±0.87, and 1.63±0.50mg/dl in confirmed cases, suspected cases, and controls, respectively. There was a highly significant difference regarding creatinine level and urea level between the studied groups(P<0.001). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for creatinine level as a screening test for PROM were 98, 45, 40, 100, and 60%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for urea level as a screening test for PROM were 100, 100, 55, 100, and 70, respectively, with a cut-off value of 0.52mg/dl for creatinine level and 11.8mg/dl for urea level. Conclusion Urea and creatinine level assays are reliable methods and have a higher sensitivity and specificity to establish accurate diagnosis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Maternal serum dehydroepiandrosterone sulfate as a predictor of labor inhibition in preterm labor p. 57
Mohamed A El Sayed, Osama A El Kelani, Mohamed A Rezk, Ayman E Solyman Attalah, Mohammed S.A. Rawash
DOI:10.4103/mmj.mmj_77_17  
Objective The aim of this study was to assess the relationship between endogenous serum dehydroepiandrosterone sulfate(DHEA-S) levels and success of labor inhibition in preterm labor. Background Preterm birth is the leading cause of neonatal mortality and morbidity. Patients and methods This prospective trial included 43 pregnant women with preterm labor. Labor inhibition was achieved using calcium channel blockers such as nifedipine(epilat 10-mg capsules at a dose of 10mg orally every 20min until uterine contractions are inhibited and maintained regularly by epilat retard tablets every 8h). Serum DHEA-S levels were measured twice, the first just before labor inhibition by tocolytic drugs, and the second sample was obtained after 48h from starting tocolytic drugs. The levels were evaluated by radioimmunoassay. Ultrasound assessment of the cervix was also carried out. Results There was a highly significant statistical difference between cases delivered at full term(n=29) and cases delivered preterm(n=14) regarding post-tocolytic DHEA-S levels(P=0.0009). There was a significant statistical difference in pretocolytic levels of DHEA-S in cases that delivered preterm and failed to respond to tocolytic therapy. The cutoff value of pretocolytic DHEA-S was greater than or equal to 94 μg/dl, at which tocolytic therapy failed. Conclusion Maternal serum DHEA-S concentrations were normal in patients with successful tocolysis compared with elevated levels in patients with failed tocolysis who experienced preterm delivery. Elevated serum DHEA-S levels of more than 94 μg/dl could be used to predict failure of labor inhibition in preterm labor.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Angle of progression in pregnant women before onset of labor in predicting the mode of delivery p. 63
Ayman A Shabana, Said A Saleh, Ayman A Soliman, Haitham A Hamza, Sara M.A. Nassar
DOI:10.4103/mmj.mmj_82_17  
Objective The aim of this study was to assess the efficacy of measuring angle of progress in the prediction of the mode of delivery in primigravida between 37 and 40weeks of gestation. Background Prediction of mode of delivery, particularly identification of pregnant women at risk for cesarean delivery, has the potential to improve pregnancy outcome. Transperineal ultrasound has been suggested to be useful for predicting the mode of delivery. Patients and methods Thestudy included 150 nulliparous women with a gestational age of 37–40weeks, singleton fetus, and cephalic presentation with intact membranes. None of the women were in labor. We excluded women scheduled for elective cesarean section(CS) for a variety of indications. After history taking and physical examination, patients were subjected to transperineal ultrasound imaging to measure the angle of progression, and the mode of delivery was followed up to test the ability of the measured angle to predict the mode of delivery. Results At a cutoff angle of 93.5°, angle of progression correctly identified cases planned to deliver vaginally with a sensitivity of about 83.6% and a specificity of 88.9%. Astatistically significant correlation was found between the angle of progression measured in the antenatal period and the mode of delivery(P<0.0001). Conclusion Translabial ultrasound-converted images to measure the angle of progression in antenatal period accurately predicted the mode of delivery, providing a more scientific basis for assessing labor.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effectivenessofoptimizing lactate clearance versus central venous oxygen saturation as target goals of early resuscitation in sepsis p. 68
Mohammad M Torayah, Hatem A Atallah, Nagwa M Doha, Enas Abdelmohsen
DOI:10.4103/1110-2098.234217  
Objective The aim of this study was to compare the effect of optimizing lactate clearance versus central venous oxygen saturation(ScvO2) as target goals in early sepsis resuscitation. Background Optimal goals for quantitative sepsis resuscitation remain uncertain. It is accepted that hemodynamic targets should include a measure of cardiac preload, such as central venous pressure(CVP), and perfusion pressure, such as mean arterial pressure(MAP). Amore controversial issue is the method of determining oxygen delivery. Lactate clearance potentially represents a more accessible method to assess tissue oxygen delivery. Patients and methods We conducted a randomized prospective observational cohort study in the ICU, Menoufia University Hospital. Forty patients with severe sepsis or septic shock were divided into two groups: group V, resuscitated to normalize CVP, MAP, and ScvO2of at least 70%; and group L, resuscitated to normalize CVP, MAP, and lactate clearance of at least 10%. The study was continued until goals were achieved or for up to 72 h, whereas mortality was followed up for 28days. Results The two groups were matched by demographic and clinical features. As regards lactate clearance in group L, there was a significant difference at hour(h) 6, 12, 24, 48, and 72 compared with h0 (P<0.05). As regards ScvO2in group V, there was no significant difference compared with h0 at any time. Lactate clearance goal was achieved in 75% of patients in group L, whereas ScvO2goal was achieved in 95% in group V. In group V, 45% of patients died, whereas in group L 30% of patients died, with 15% lower in-hospital mortality(P<0.05). Lactate clearance was higher in survivors than in nonsurvivors at h6, 12, 24, and 48(P<0.05). ScvO2in survivors compared with nonsurvivors showed no significant difference. Conclusion Lactate clearance during resuscitation is a more powerful indicator of resuscitative adequacy. Lactate clearance was the best parameter associated with 28-day mortality. Protocol of lactate clearance-directed therapy should be considered in septic patients, even after the golden hours.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Ultrasound-guided double-injection infraclavicular brachial plexus block: Bupivacaine alone or with added dexmedetomidine or fentanyl p. 76
Ahmed A Metwally, Ezzeldin S Ibrahim, Wafiya R Mahdy, Marwa M Al Lahouny
DOI:10.4103/mmj.mmj_586_16  
Objective The aim of this study was to evaluate the effects of adding dexmedetomidine or fentanyl to bupivacaine in ultrasound-guided infraclavicular block(ICB) for upper limb surgeries. These effects include quality and duration of the analgesia and analgesic consumption. Background ICB provides anesthesia and analgesia to the upper limb. Many adjuvants have been used to improve the quality and duration of analgesia in various nerve blocks. Patients and methods A total of 120 adult patients undergoing elective forearm or hand surgeries received ICB with 27ml of local anesthetic mixture, and were randomly allocated according to the local anesthetic mixture into three groups–groupC(control group)(bupivacaine), groupD (dexmedetomidine)(bupivacaine+dexmedetomidine), and groupF(fentanyl) (bupivacaine+fentanyl). The three groups were compared for the time of onset of sensory and motor blocks, postoperative analgesia, hemodynamic changes, and complications. Results The onset of sensory and motor blockade was significantly more rapid in groupD than in groupsC and F. The duration of sensory and motor blockade was significantly longer in groupD than in the groupsC and F. The duration of analgesia was significantly longer in groupD than in groupsC and F. Heart rate levels were also low in D group compared with groupsC and F during the period of anesthesia. Conclusion We conclude that the addition of dexmedetomidine to a local anesthetic mixture in ultrasound-guided infraclavicular brachial plexus block hastens the onset and prolongs the duration of sensory and motor blocks, as well as the duration of postoperative analgesia, compared with the addition of fentanyl or bupivacaine administration alone.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The effect of intraoperative lidocaine infusion on perioperative opioid consumption for laparoscopic cholecystectomy p. 83
Ezzeldin Saleh, Hatem Abo El-Wafa, Mohamed I Abd El-Salam Ahmed
DOI:10.4103/mmj.mmj_626_16  
Objective The aim of this study was to determine the role of intraoperative lidocaine infusion in reducing perioperative pain and analgesia requirement in patients undergoing laparoscopic cholecystectomy. Background An alternative approach to pain relief in laparoscopic cholecystectomy is the use of intravenous (i.v.) lidocaine intraoperatively, which decreases perioperative analgesic requirement. Patients and methods This double-blinded randomized study was conducted on 60patients of both sexes. Patients between 40 and 50years of age, of American Society of Anesthesiologists I and II physical status, and scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly assigned using computerized software to one of the two groups, each containing 30patients. GroupL(the study group) was infused with lidocaine at a rate of 2mg/kg/h, and groupS(the control group) was infused with normal saline at a rate of 2mg/kg/h. Anesthesia was induced with i.v. fentanyl 2mg/kg and propofol 2–3mg/kg. Patients received supplemental i.v. dose of morphine 0.1mg/kg intraoperatively if needed.(Additional morphine intraoperatively was indicated when heart rate and mean arterial blood pressure increased more than 20% of preoperative heart rate and mean arterial blood pressure values.) The total amount of opioid used for patients intraoperatively and postoperatively was recorded. All patients were asked to quantify their pain on a visual analog scale immediately postoperatively and every 4h until hospital discharge. Results In the current study, there was a significant difference as regards postoperative pain; it was significantly lower in the lidocaine group. Total analgesic dose required was significantly lower in the lidocaine group. Conclusion Perioperative i.v. lidocaine provides analgesia and low pain scores after laparoscopic cholecystectomy. The use of lidocaine intraoperatively decreases perioperative opioid consumption.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Caudal versus spinal anesthesia in children undergoing lower abdominal operations p. 87
Abd-Elrahman Ahmed Ahmed, Amany S Ammar, Ahmed Hashem M. Ismail
DOI:10.4103/mmj.mmj_637_16  
Objective The aim of this study was to compare spinal and caudal anesthesia in children undergoing lower abdominal surgeries, as regards efficacy of anesthesia, hemodynamics, and postoperative pain. Background General anesthesia in pediatric patients, especially premature children, is one of the most important risk factors for postoperative apnea. Patients and methods The study was a randomized, double-blind, controlled trial. Totally, 40 children aged 3–12years received either caudal or spinal anesthesia. The outcomes measured were hemodynamics, degree of motor block using Bromage score, pain assessment using Wong–Baker facial grimace scale, degree of sedation, total requirement of postoperative analgesia, complication rate, and parent satisfaction. Results A total of 40 children were included for analysis. Of them, 20 children received caudal and 20 received spinal anesthesia. Heart rate was significantly higher in the caudal group than in the spinal group(P=0.006). The mean score measured using the Wong–Baker facial grimace scale for postoperative pain assessment at 2h in the caudal group was 0.30±0.47, compared with 5.05±3.72 in the spinal group; there was a highly significant statistical difference(P=0.00). The mean score measured using Bromage score at 90min in the caudal group was 3.0±0.00, compared with 2.75±0.44 in the spinal group; there was a significant statistical difference(P=0.021). Therewas no significant statistical difference between the two groups as regards blood pressure changes, oxygen saturation readings, sedation, and complication rate. Conclusion Both caudal and spinal approaches are effective in pediatric patients as anesthesia for lower abdominal operations. However, caudal anesthesia has a relatively longer duration of postoperative analgesia and motor block.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparative study between effects of conventionaland pulsed radiofrequency in the treatment of idiopathic trigeminal neuralgia p. 92
Magda F Yahya, Ayman A Rady, Mohamed E Abdel Shafy, Amany S Ammar, Alaa Eldin A Ibrahim Elsakka
DOI:10.4103/mmj.mmj_653_16  
Objectives The aim of this study was tocompare the effects of conventional radiofrequency(CRF) versus pulsed radiofrequency(PRF) in the treatment of idiopathic trigeminal neuralgia pain. Background The treatment of idiopathic trigeminal neuralgia(ITN) is often a challenge in clinical practice. Nowadays, radiofrequency(RF) is one of the most effective options for treatment. Patients and methods A comparative study was carried out in Menoufia and Zagazig university hospitals. Overall, 40 adult patients suffering from ITN were randomly assigned to two groups(20 in each). The CRF group was treated with CRF and the PRF group was treated with PRF. Results There were significant improvements in both groups as regards Visual Analog Score and Patient Satisfaction Score, which was higher in the CRF group at 6months of follow-up. The possibility of repeating RF was higher in the PRF group than in the CRF group. Conclusion Both CRF and PRF are effective in relieving pain associated with trigeminal neuralgia. PRF appears to be a relatively safe and effective procedure in the treatment of persistent pain of ITN in a shorter duration compared with CRF.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The role of tranexamicacidin improving quality of pediatric tonsillectomy: a double-blinded randomizedcontrolledstudy p. 98
Saad D Elzayat, Ahmed S Elgebaly
DOI:10.4103/mmj.mmj_377_17  
Design This was a prospective, double-blinded, randomized controlled study. Patients and methods The present study included 100patientsrandomized into two groups: groupI included patients who did not receive tranexamic acid and groupII included patients who were given tranexamic acid after induction intravenously as 15mg/kg over10min. Results In groupI, the mean number and weight of gauze used during surgery were 5.1+1.30 pieces and 72±6.334ml, respectively, and in groupII, they were 1.9±0.35 pieces and 41±8.221ml, respectively(P<0.001). In groupI, the mean amount of blood in suction bag was 200±52.36ml, whereas it was 50±10.36ml in groupII(P<0.001). The difference between both groups regarding the number of gauze, weight, and the amount of blood in suction bag was highly significant(P<0.001). Conclusion The present study showed that 15mg/kg of tranexamic acid can reduce intraoperative blood loss in a highly significant manner in children undergoing tonsillectomy and in keeping stability in hemoglobin, hematocrit levels, heart rate, mean arterial blood pressure, and respiratory rate postoperatively.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Prospective randomized comparative study of a Karydakis flap versus ordinary midline closure for the treatment of primary pilonidal sinus p. 102
Mohammed L Badr, Moharm A Mohammed, Sameh M Zahran
DOI:10.4103/1110-2098.234228  
Background There is a high incidence of sacrococcygeal pilonidal disease (SPD) among young males. Despite increasing data on the treatment of SPD, no standard treatment has been established as yet. Karydakis pioneered a procedure that involved raising a flap to overlap the midline with the scar sited to one side to reduce recurrence. Objective This study evaluated the outcomes of the Karydakis flap method versus the ordinary midline closure (OMC) method for the treatment of pilonidal sinus. Patients and methods This was a prospective study that included 40 patients with SPD. They were divided into two groups according to the surgical technique used. Group I was treated by excision and closure using the transposition Karydakis flap technique at one side of the midline and group II was treated by excision and simple closure at the midline. Both groups were compared. Results The duration of the surgery was 12 min longer in the Karydakis group (P < 0.001). Complications were 50% in the OMC group compared with 25% in the Karydakis group. The recurrence rate was 5% for the Karydakis group and 20% for the OMC group. Of the patients who underwent the Karydakis operation, 70.8% were completely satisfied with the procedure, whereas only 32.6% of patients who underwent the OMC reported excellent satisfaction. A significantly higher number of patients in the Karydakis group recommended the same procedure to other patients with SPD. Conclusion The Karydakis method may be a preferable option in the treatment of SPD because of the low rate of recurrence and the excellent satisfaction rates.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Rubber band ligation for bleeding hemorrhoids in hepatic patients p. 108
Ashraf A Zeineldin, Ahmed Gaber, Mohamed M. A. Shabana
DOI:10.4103/1110-2098.234236  
Objectives The aim of this study was to assess the efficiency of rubber band ligation (RBL) in the treatment of symptomatic hemorrhoids in hepatic patients, versus surgical hemorrhoidectomy. Operative (time and blood loss) and postoperative (pain, bleeding, analgesic requirement, urinary retention, discharge, stenosis, fecal incontinence, wound healing and patient satisfaction) outcomes were evaluated. Background The aim of this study was to compare the outcome of hemorrhoidectomy performed using RBL with surgical hemorrhoidectomy. Patients and methods Forty patients with liver disease and diagnosed with grade I, II, or III hemorrhoids were randomized equally to be subjected to either RBL (group A) or surgical conventional hemorrhoidectomy (group B). Operative details were recorded and patients recorded daily pain scores on a linear analog scale. Follow-up was carried out weekly for 2 months and monthly for 6 months to evaluate complications, return to normal activity, ongoing symptoms, and patient satisfaction. Results Intraoperative blood loss was lower in group A, with a mean of 1.2 ± 1.6 ml (range 0–5 ml) versus 22.2 ± 6.58 ml (range 15–35 ml) in group B (P = 0.0001). Operative time was shorter in group A, with a mean of 9.00 ± 2.449 min (range 5–12 min) versus 24.100 ± 3.669 min (range 20–30 min) in group B (P < 0.001). There was significant difference in postoperative pain scores, analgesic requirement, especially during the first week, and wound healing between the two groups, which was remarkable in the RBL group. There was no difference between the two groups with respect to the degree of patient satisfaction or the number of postoperative complications. Conclusion RBL operation is recommended for the treatment of hemorrhoids in hepatic patients especially in the second and third stage, as it results in less blood loss, less postoperative pain, earlier wound healing, and earlier return to work.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Evaluation of lymphadenectomy in patients receiving neoadjuvant radiotherapy for rectal adenocarcinoma p. 114
Alaa A El Sesy, Mohammed S Ammar, Ahmed M Elgarhy
DOI:10.4103/1110-2098.234218  
Objective The objective of this study was to evaluatethe effect of neoadjuvant radiation on total number and number of positive lymph nodes(LNs) inpatientswith rectal adenocarcinoma. Background Colorectal cancer is the third most common cancer worldwide. Treatments for colorectal cancer include combinations of surgery, radiation therapy, chemotherapy, and targeted therapy. Neoadjuvant therapy aims to reduce the size or extent of the cancer before radical-treatment intervention, thus making the procedures easier and more likely to succeed. Patients and methods A total of 20patients with stage 2 and stage 3 cancer were chosen and divided into two groups. The first group included 10patients who received neoadjuvant therapy before radical surgery for rectal cancer. The second group included 10patients who underwent radical surgery for rectal cancer without neoadjuvant therapy. For compression number of LNs in bothgroups before and after course of neoadjuvant and after surgery. Results Neoadjuvant therapy significantly decreased both the number and size of affected LNs in rectal cancer. Conclusion Neoadjuvant therapy was associated with decreased number of affected LNs up to complete clearance. There is a need for more larger randomized trials using preoperative chemoradiotherapy with larger number of patients for better evaluation of response and toxicity in comparison with postoperative chemoradiotherapy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Role of splenectomy inthalassemicpatients p. 118
Hatem A Saleh, Yahia M Alkhateep, Ashraf N Mohammed
DOI:10.4103/1110-2098.234219  
Objective Theobjectiveof this study was to evaluate the role of splenectomy in decreasing the transfusion needs in thalassemia patients. Background Thalassemia can cause significant complications, including iron overload, bone deformities, and cardiovascular illness. In thalassemia, spleen is the most commonlyaffectedorgan as seen from the incidence of splenomegaly, due to excessive destruction of abnormal red blood cells, extramedullary hematopoiesis, and transfusional overload. Patients and methods This investigation is designed as a prospective study in which 15patients with thalassemia major underwent splenectomy under both open and laparoscopic techniques. Patients were selected from the outpatient clinic of the General Surgery Department and were followed up for 1year after surgery. Results Patients underwent open splenectomy(47%) and laparoscopic splenectomy(53%). The operative complications were bleeding(13%) and injury to the spleen during port insertion(6%). After splenectomy, the patients were followed up for 1year. All patients showed an improvement in hemoglobin and hematocrit levels. Also, all the blood elements–red blood cells, white blood cells, and platelets–showed a significant increase after splenectomy in all patients. Conclusion Splenectomy definitively reduced blood requirements for thalassemia patients from twice every month preoperatively to less than once per month, with improved hemoglobin levels. These improvements are sustained over a prolonged period of time.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Intraperitoneal hydrocortisonefor pain relief after laparoscopic cholecystectomy p. 126
Hatem M Sultan, Ahmed Gaber, Mohammed N ShakerNassar, Waleed M Eldessawy Esmaeil
DOI:10.4103/1110-2098.234220  
Background Laparoscopic cholecystectomy(LC) is associated with shorter hospital stay and less pain in comparison with open surgery. The aim of this study was to evaluate the effect of using intraperitoneal hydrocortisone on pain relief following LC. Objectives This study aims to evaluatethe effect of using intraperitoneal hydrocortisone after LC in decreasing postoperative pain and other adverse effects. Patients and methods Fifty patients were enrolled in a double-blind, randomized clinical trial. Patients (randomly assigned) underwent ordinary LC oralong with the operation received 100mg of hydrocortisone in 250ml normal saline after extraction of the gallbladder into the peritoneum. Abdominal pain and shoulder pain were evaluated using the visual analog scale after surgery and at 6, 12, and 24h postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function. Results Forty-eight patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal pain(10.75vs. 12.65,P=0.00) and shoulder pain(5.35vs. 6.74,P=0.008) scores than the control group. There were no significant differences regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than those in the control group(138.55±49.9vs. 69.96±38.69mg,P=0.00). There were no significant differences with respect to return of bowel function, nausea, and vomiting. No adverse reaction was observed in either group. Conclusion Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after LC with no adverse effects.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Bluntvs. penetrating chest trauma in terms of the outcome in Menoufia University Hospital p. 133
Mohamed L Alam El-Din, Medhat R Nashy, Mai T Meshhal
DOI:10.4103/1110-2098.234225  
Objectives The aim of this study was to compare the different presentations, management, and outcomes of blunt and penetrating chest trauma patients who presented to the Emergency Department of Menoufia University Hospital. Background Chest trauma accounts for 10% of trauma admissions and 25–50% of trauma deaths worldwide. Different types and grades of severity of chest trauma along with various associated body injuries result in variable outcomes. Patients and methods This prospective study included 100patients with acute chest trauma who presented to the Emergency Department of Menoufia University Hospitals. All patients were managed according to Advanced Trauma Life Support guidelines in the emergency department, followed up in the Cardiothoracic Surgery Department, or in the ICU according to diagnosed injuries, treatments, and outcomes. Data were described in percentages. Results Out of 100patients, 72patients had blunt chest trauma and 28patients had penetrating trauma. The male: female ratio was 7:1 in blunt trauma patients and 13:1 in penetrating trauma group. The most common mode of blunt trauma was motor vehicle accident(76.4%), whereas stab wound was the most common cause(67.9%) of penetrating trauma. Tube thoracostomy was the most common intervention in blunt and penetrating chest trauma(P=0.013). No mortality was found in penetrating trauma patients, whereas five blunt trauma patients died, mortality rate 6.9%; four of these deaths were associated with traumatic brain injury. Conclusion Thoracic trauma is an important cause of hospitalization, morbidity, and mortality. The incidence of chest trauma was higher in males than females. The ICU stay was significantly longer among patients with blunt chest trauma than penetrating trauma.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Use of human fibrin glue versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty of inguinal hernia p. 140
Ashraf A ZeinElden, Asem F Moustafa, Mohammed N Shaker Nassar, Mohammed A Badr Etman
DOI:10.4103/1110-2098.234229  
Objective Toevaluate the uses of human fibrin glue versus staples for mesh fixation in laparoscopic transabdominal preperitoneal(TAPP) hernioplasty of inguinal hernia as regards postoperative pain, operative time, hospital stay, morbidity, and return to work. Background Inguinal hernia is one of the commonest conditions encountered in clinical practice. This procedure is increasingly performed with laparoscopy. Many surgeons prefer to cover the hernia gap with a mesh to prevent recurrence. During laparoscopic surgery, the mesh is generally fixed with staples or tissue glue. We designed a trial that aims to determine whether mesh fixation with glue might cause less postoperative pain than fixation with staples during TAPP repair. Patients and methods Between August 2015 and August 2016, this prospective randomized study included 40patients presented with inguinal hernia. Patients were randomized into two groups: groupI mesh was fixed by fibrin glue and the groupII mesh was fixed using staples. After TAPP hernioplasty, patients were followed up at 7–10days to assess postoperative pain and within 6–12months to detect recurrence. Results A total of 40patients, 20 in each group, were considered. Two cases in groupII presented with severe pain postoperative, while no cases presented with severe pain in groupI. On the other hand, nine cases in groupII had mild pain in comparison with two cases in group one and this difference was statistically significant. Conclusion There is less postoperative pain in mesh fixation with fibrin glue and less analgesia is needed after the operation compared with mesh fixation with staples.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Laparoscopiccholecystectomy role in the management of acute biliary pancreatitis p. 145
Mohammed L Alameldeen, Galal M Abouelnagah, Tarek M Rageh, Mohammed O Ammar
DOI:10.4103/mmj.mmj_600_16  
Objective The aim of this paper was to evaluate the role of laparoscopic cholecystectomy(LC) in the management of acute biliary pancreatitis before patient discharge from the point of view of availability, advantages, and disadvantages. Background In patients with mild gallstone pancreatitis, cholecystectomyduring the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission cholecystectomy is poor, and concerns exist about an increased risk of cholecystectomy-related complications with this approach. In this study, we aimed to compare same-admission and interval cholecystectomy, with the hypothesis that same-admission cholecystectomy would reduce the risk of recurrent gallstone-related complications without increasing the difficulty of surgery. Patients and methods This is a prospective study carried on 20 consecutive patients in Menoufia University, Faculty of Medicine and Alexandria University, Faculty of Medicine; all of them presented with symptoms of acute biliary pancreatitis from April 2015 to September 2016. Overall, 20cases were included because of limited number of patient who presented to our hospital in this period of time and fulfilled the inclusion criteria. Computed tomography severity index is the mainmethodfor choosing patients in the study then assess operative time and difficulty and postoperative pain and hospital stay and recurrence of attacks. Results A total of 20cases underwent LC at the same time of admission in the hospital, and none of them(0%) were converted to open technique; operative time and difficulty was average, and all of them(100%) hadnorecurrent attacks of pancreatitis in postoperative follow-up. Conclusion LC in mild acute biliary pancreatitis is safe and should be done during the same hospital admission to prevent further attacks of pancreatitis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effect of neurectomy versus ilioinguinal nerve preservation in the Lichtenstein tension-free hernioplasty of inguinal hernia p. 152
Aymen A Omar, Tarek M Rageh, Yasser Z M. Khater
DOI:10.4103/mmj.mmj_606_16  
Objectives The aim of this study was to evaluate the effectiveness of ilioinguinal neurectomy on postoperative pain in the Lichtenstein tension-free hernioplasty of inguinal hernia. Background Chronic pain following tension-free inguinal hernioplasty is a significant clinical problem that can interfere with normal daily activities. Moreover, the condition can sometimes be debilitating, and treatment is often difficult and challenging. Contrary to the previous belief, division of the ilioinguinal nerve prophylactically during mesh repair has been practiced to reduce the incidence and intensity of persistent postoperative pain after hernia repair. Patients and methods Between April 2015 and October 2016, this prospective, randomized, controlled study included 40male patients above 18years of age with unilateral inguinal hernia who were undergoing the Lichtenstein hernia repair. Patients were randomized into two groups–the ilioinguinal neurectomy group and the ilioinguinal nerve preservation group. Twenty patients were included in each group. Patients were followed-up for inguinal postoperative pain at 1 and 6months using a four-point categorical scale. Groin numbness was also assessed at 1 and 6months using a self-administered questionnaire. Results There were no statistically significant differences between the two groups with regard to postoperative pain after 1 and 6months at rest; however, after coughing 10times, walking up three flights of stairs, and cycling for 10min, there were statistically significant differences–postoperative pain in groupA was 5% and in groupB 30%(P<0.05). There were statistically significant differences with regard to postoperative groin numbness after 1month–postoperative numbness in groupA was 15%(P=0.046). However, after 6months, there were no significant differences between the two groups with regard to groin numbness(P=0.156). Conclusion Ilioinguinal neurectomy should be considered a routine surgical step during the Lichtenstein tension-free hernioplasty.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Diagnosticvalue of bronchoscopy in assessing the severity of inhalational lung injury p. 158
Shawky S Gad, Tarek F Keshk, Ahmed A Khames, Sherif M Elkashty, Athar F Abd. Elmegid Lasheen
DOI:10.4103/mmj.mmj_614_16  
Objectives Theaim of this study was to assess the value of using flexible bronchoscopy in the evaluation and management of patients with suspected inhalational lung injury admitted in the Burn Unit, Menoufia University Hospitals, within the first 24–72h of admission. Background Inhalation injury is a major cause of morbidity and mortality in burn patients. It is one of the three most significant predictors of death after thermal injury. The incidence of respiratory failure is significant after inhalational injuries. Patients and methods This study was carried out on 30patients who were admitted with inhalation injury in the Burn Unit, Department of Plastic Surgery. All patients were subjected to history taking, complete medical examination, and thorough laboratory and radiological investigations. Results At the time of bronchoscopy, 12(40%) patients were graded as G1 airway findings, 11(36.7%) cases were graded as G2 airway findings, four(13.3%) patients were graded as G0, and three(10%) patients were graded as G3. About 26patients had undergone bronchoalveolar lavage to remove secretions, sloughs, and carbonaceous materials until the airways became clear. On admission, 21patients showed no pathology in their radiograph(70%), whereas nine patients showed increased bronchovascular markings and pneumonic patches. It was found that 63.6% of patients aged greater than or equal to 45years died and 78.9% of patients aged less than 45years survived. This shows that the mortality rate from inhalational injury increases with increasing age. Conclusion Bronchoscopy is considered the 'gold standard' for early evaluation of upper airway injury and prediction of acute lung injury.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Small-calibertubedrainage and rapid pleurodesis in malignant pleural effusion p. 163
Awatef E Farghaly, Amr M Allama, Medhat R Nashy, Mohammed A El-Hag-Aly, Sarah M Abdel El-Sadek
DOI:10.4103/mmj.mmj_635_16  
Objectives Theaim of this study was to compare between small-caliber catheter rapid pleurodesis and conventional chest tube pleurodesis as regards efficacy and hospital stay in patients with malignant pleural effusion(MPE). Background Chemical pleurodesis can be palliative for recurrent, symptomatic pleural effusions in patients who are not candidate for a thoracic surgical procedure. We hypothesized that pleurodesis as effective as the standard method could be accomplished with a rapid method of pleurodesis. Patients and methods This prospective randomized controlled trial included 30patients with MPE. Patients were divided into two groups: groupA, which underwent rapid pleurodesis with a small-caliber tube(8–14 Fr), and groupB, which underwent conventional pleurodesis. Talc was the sclerosing agent that was used. The small-caliber tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Rapid pleurodesis was performed only after obtaining radiological evidence of complete evacuation of the fluid and the tube was clamped for 1h. The fluid was drained over1h and the catheter removed and the patient discharged. The chest tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Pleurodesis was performed only after obtaining radiological complete evacuation of the fluid, daily drainage of less than 300 l. The tube was clamped for 1h. The fluid was drained over6–12h and the tube was removed and then the patient was discharged from hospital. Results Our study included 15patients in groupA who underwent rapid pleurodesis and 15patients in groupB who underwent conventional pleurodesis. There was a significant difference between the two groups as regards hospital stay and postoperative pain. Conclusion Small-caliber tube drainage and rapid pleurodesis were shown to be efficient and demonstrated a good safety profile in treating MPEs.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Risk factors for venous thromboembolism p. 169
Hesham S Abu Gruidah, Mahmoud S Eldsouky, Walid M Omran, Ahmed E. H Abo Elhassan
DOI:10.4103/mmj.mmj_659_16  
Objective The aim of this study was to describe the risk factors for venous thromboembolism(VTE) in hospitalized patients. Background VTE is a major health issue worldwide. To improve survival, avoid recurrence, and prevent complications, the occurrence of VTE must be reduced. To reduce VTE incidence, persons at risk for VTE must first be identified. Independent risk factors for VTE include patient age, surgery, trauma, hospital or nursing home confinement, active malignant neoplasm with or without concurrent chemotherapy, central vein catheterization or transvenous pacemaker implantation, previous superficial vein thrombosis, varicose veins, and neurological disease with extremity paresis. Materials and methods This hospital-based prospective study included 400patients with VTE. Patients aged above 18years of both sexes were included. The only exclusion criterion was patients younger than 18years. Results There were 400patients diagnosed with VTE. Of all patients, 44% were unprovoked and 56% were provoked. Provoked risk factors included major surgery(4.5%), obesity(12%), hip, femur, and knee surgery(12.5%), history of malignancy(16%), and history of long-term immobility(18%). Conclusion Several risk factors were identified in patients with VTE, and their comprehension may improve appropriateness and efficiency of the different methods available for thromboprophylaxis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparativestudy between Focus harmonic scalpel and conventional hemostasis in open total thyroidectomy p. 175
Hatem M Sultan, Mohamed S Ammar, Ahmed Gaber, Mahmoud G Hagag, Ahmed R Abd El Bary
DOI:10.4103/mmj.mmj_520_15  
Objective The aim was to compare between Focus harmonic scalpel and conventional hemostasis in open total thyroidectomy regarding operative time, postoperative complications(hypocalcemia and recurrent laryngeal nerve injury), postoperative blood drainage volume, postoperative pain, and hospital stays. Background Thyroidectomy is one of the most common operations, and many studies have been done to improve the technique of thyroidectomy. Therefore, the author conducted this study to determine if Focus harmonic scalpel is effective in thyroidectomy or not. Materials and methods This study is a prospective, comparative, randomized, and descriptive study of 40patients having nontoxic multinodular goiter. The patients were divided into two groups: groupA was subjected to open total thyroidectomy with Focus harmonic scalpel(20patients), and groupB was subjected to open total thyroidectomy with conventional hemostasis(20patients). Both groups were compared for age, sex, operative time, postoperative complications(hypocalcemia and recurrent laryngeal nerve injury), postoperative blood drainage volume, postoperative pain, and hospital stays. Results Use of Focus harmonic scalpel in open total thyroidectomy leads to shorter operative time, asP value was highly significant; decrease of postoperative blood drainage volume, asP value was significant; decrease of postoperative pain, asP value was highly significant; and shorter postoperative hospital stays, asP value was significant; however, it does not decrease the rate of postoperative complications(hypocalcemia andtheRecurrent laryngeal nerve (RLN) injury), asP value was nonsignificant. Conclusion In open total thyroidectomy, the Focus harmonic scalpel is a reliable and safe tool. Its use is more effective than conventional hemostasis. The surgical operative time and the hospital stay are shorter. The postoperative blood drainage volume is reduced; furthermore, the postoperative pain is less. However, the rates of transient hypocalcemia and recurrent laryngeal nerve injury are statistically nonsignificant.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparative study between tension-free mesh repair using Lichtenstein technique and Bassini technique to treat incarcerated inguinal hernia p. 181
Mohamed Darwish, Asem Fayed, Ayman Omar
DOI:10.4103/mmj.mmj_662_16  
Objective Theaim of this study was to assess and compare the outcome of mesh repair using Lichtenstein technique with tissue repair using Bassini technique in the treatment of incarcerated inguinal hernia. Background Placement of mesh in incarcerated hernia is presumed to increase the risk for infection. Tension-free repairs have gained popularity not only for primary or recurrent hernias but also for complicated inguinal hernia. Patients and methods Sixty patients with incarcerated inguinal hernia were enrolled. Patients were divided into two groups: groupI, which underwent Lichtenstein hernioplasty, and groupII, which underwent Bassini herniorraphy. Patients with recurrent or strangulated hernia were excluded from study. After preoperative assessment, all patients underwent herniotomy. In groupI, a mesh was trimmed to fit the floor of the inguinal canal. In groupII, the repair of the inguinal canal was performed upon two planes. Postoperatively, assessment of the hospital stay, surgical complications, and recurrence of hernia was carried out. Results No significant difference was found between groups as regards age, prevalence of smoking, the side, type, and duration of hernia, duration of irreducibility, clinical picture of hernia, usage of truss, method of anesthesia, content of hernia, and presence of postoperative complications. The operative time and the length of hospital stay were statistically significant between groups. Conclusion Mesh repair is applicable in patients with incarcerated inguinal hernias with low morbidity rate. Significantly higher rates for mean length of hospital stay and mean length of operation and a higher rate for postoperative chronic pain were found in incarcerated inguinal hernia patients with Bassini repair.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Stented versusstentless open pyeloplasty in children p. 188
Magdy A Loulah, Nehad A Zeid, Mohamed N Dorgham
DOI:10.4103/mmj.mmj_691_16  
Objective The aim of this study was to compare between stenting and nonstenting in dismembered pyeloplasty as regards outcome, early and late postoperative results, and complications. Background Ureteropelvicjunctionobstruction is a common congenital urologic anomaly. Open pyeloplasty is the standard surgical treatment. Drainage following pyeloplasty using a double J stent prevents subsequent stenosis and urine leakage. Patients and methods This study was conducted on 20 pediatric patients(maximum age 16years) with a primary diagnosis of ureteropelvic junction obstruction who were divided into two groups: Group1, the stented group double J(10cases). Group2, the nonstented group(10cases). Classic Anderson–Hynes pyeloplasty was performed for the two groups. Results A total of 20patients were included in the study. 16(80%) cases were male and four(20%) cases were female. Their ages ranged from 6months to 15years. The mean±SD age was 6.75±4.53years. All cases were unilateral; 10(50%) cases were right sided and 10(50%) cases were left sided. Postoperative complications included the following: urinary tract infection in only one case in group1, residual mild hydronephrosis in only one case in group1 and three(30%) cases in group2; clot formation in only one case in group2, and urinoma in only one case in group2. Conclusion Pyeloplasty with a diverting stent is technically feasible and safe. Only risks for multiple anesthesias and economic burden with stent removal are present. The specific indication when stented pyeloplasty needs to be performed is in redo pyeloplasty, solitary kidney, inflamed renal pelvis, and hugely distended renal pelvis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Ligation anopexy in the treatment of hemorrhoids p. 193
Ayman A Omar, Tarek M Rageh, Mohamed A Elmanakhly
DOI:10.4103/mmj.mmj_689_16  
Objective The aim of this study was to compare the preliminary results of traditional transfixion excision versus ligation anopexy in the management of advanced(grades III and IV) hemorrhoidal disease with respect to postoperative pain, bleeding, and short-term follow-up complications. Background Ligation anopexy of hemorrhoids is a simple, cost-effective, and convenient modality for treating gradeIII hemorrhoids. Patients and methods We carried out a prospective, controlled, randomized study including 40patients with hemorrhoidal disease grades III and IV. The participants were divided into two groups: groupI was treated by classical transfixion excision hemorrhoidectomy, and groupII was treated by ligation anopexy. Detailed history of all participants was obtained. Effectiveness, safety, postoperative complications, operative time, length of hospital stay, and time off work were evaluated. Results There was no significant difference between groups regarding age, sex, and preoperative symptoms. The duration of surgery was significantly shorter in patients treated with ligation anopexy(P<0.001). Intraoperative bleeding was significantly decreased in patients treated with ligation anopexy. The postoperative pain score in the ligation anopexy group was significantly lower than that in groupI at 24, 48, 72h, and the second week postoperatively. Time off work in patients treated with ligation anopexy was significantly shorter compared with transfixion excision hemorrhoidectomy. Conclusion Ligation anopexy for prolapsing hemorrhoids is simple and safe with less postoperative bleeding, minimal analgesic requirement, no external wound problems, lower postoperative complications, and earlier return to normal activities.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparisonof thoracic epidural analgesia versus parenteral analgesia for traumatic multiple rib fractures p. 199
Ashraf A Zein Eldin, Moharram A Mohamed, Mohamed S Abdelmotelb, Mohamed M Abdelsabour
DOI:10.4103/mmj.mmj_693_16  
Objective The aim of this study was to compare between epidural analgesia and parenteral analgesia for management of traumatic multiple rib fractures. Background Chest wall trauma is most commonly seen after motor vehicle collision and accounts for 8% of all trauma admissions. It is a marker of severity and contributes to the morbidity and mortality of injured patients, with the elderly and patients with poor respiratory reserve being most vulnerable. Rib fractures are the commonest of all chest injuries and are identified in 10% of patients after trauma. Pain limits one's ability to cough and breathe deeply, resulting in sputum retention and atelectasis. These factors result in decreased lung compliance, ventilation-perfusion mismatch, and respiratory distress. This can result in serious respiratory complications. Patients and methods We conducted a prospective, randomized study of 30patients complaining of multiple rib fractures who were admitted to the thoracic surgery unit in Menoufia University hospitals between December 2015 and July 2016. The patients were randomly divided into two equal groups of 15patients. The first group was subjected to epidural analgesia, and the second group was given ketorolac tromethamine, a NSAID. Results Our study included 21males and nine females, with a mean age of 41.8years. The epidural group showed that the pain score significantly lowered than systemic analgesia group at 6 and 24h after treatment, along with a significant improvement in arterial blood gases, duration of hospital, and ICU stay. Conclusion Thoracic epidural analgesia is more effective regarding pain score, arterial blood gases, hospital stay, ICU stay, and duration of mechanical ventilation but has no significant value in need for ICU stay, need for mechanical ventilation, or improvement in pH.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Sonographicevaluation of testicular hemodynamics after inguinal hernia repair p. 205
Magdi A Lolah, Tamer A Sultan, Mohamed F Ahmed Gafar
DOI:10.4103/mmj.mmj_5_17  
Objective The aim of this work was color Doppler ultrasound assessment of the effect of inguinal hernia repair on testicular blood flow using open approaches. Background Anatomically, a close relation exists between the spermatic cord and inguinal hernias. Inguinal hernias can carry the risk of ischemia of the testis by intermittent mechanical compression (pressure) on the testicular vessels. The spermatic cord structures may be exposed to invasive surgical intervention during inguinal hernia reconstruction. Surgical dissection, division, or mechanical trauma to the spermatic artery and veins accounts for serious trophic changes in the testis. Patients and methods This study was conducted on 20patients, suffering from inguinal hernia, admitted to General Surgery Department in Faculty of Medicine, Menoufiya University and the Department of Surgery, Elamria Hospital in Alexandria. All patients were subjected to preoperative evaluation such as history taking, clinical examination, and laboratory investigations. Results This study was designed on 20patients with primary inguinal hernia(direct and indirect). The age range was between 20 and 50years. All patients included had primary inguinal hernia. Eight patients had right-sided hernia, whereas 12patients had left-sided hernia. All the patients were assessed by Doppler ultrasound preoperatively and 3months postoperatively. Postoperative testicular scan showed no ischemic changes in any patient in our study, and postoperative complications recorded included seroma and mild hematoma. Conclusion Testes are richly supplied by different blood vessels. In the Lichtenstein's hernia repair, there is no significant effect on testicular blood flow.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparative study between tubularized incised plate urethroplasty with and without dorsal inlay graft p. 212
Tarek F Kishk, Yasser M Elsheikh, Sherif M Elkashty, Mohammad R Mansour
DOI:10.4103/mmj.mmj_702_16  
Objectives The aim of this studywasto compare the results of two single-stage hypospadias repairs, namely, tubularized incised plate(TIP) repair with and without dorsal inlay preputial skin graft urethroplasty as regards meatal stenosis, urethral stricture, and cosmetic outcome. Background The most commonly performed operation to repair distal hypospadias is the TIP repair. The key step is midline incision of the urethral plate, which widens a narrow plate and converts a flat groove into a deep plate groove, ensuring a vertical, slitneomeatus and a normal-caliber neourethra. At times in cases of distal hypospadias, the urethral plate is very narrow and needs to be augmented or substituted for further tubularization. We report our experience with primary single-stage dorsal inlay urethroplasty using inner preputial skin grafts. Patients and methods This study included 30patients less than 10years old who presented with primary distal types of hypospadias with narrow urethral plate at the Department of Plastic Surgery, Menoufia University Hospital and were divided into two groups: groupA included 14patients operated by TIP without dorsal inlay graft and groupB included 16patients operated by TIP with dorsal inlay graft. Patients who had undergone circumcision, previous hypospadias repair, or who had a deeply grooved urethral plate were excluded. Results A total of 16 children underwent primary dorsal inlay preputial graft urethroplasty, of whom one(6.2%) child had partial wound dehiscence, two(12.5%) of the children had meatal stenosis, and one(6.2%) of these children developed urethral stricture; 14 children underwent TIP urethroplasty, of whom two(14.3%) children had wound dehiscence, four(28.6%) of the children had meatal stenosis, and four(28.6%) of these children developed urethral stricture. Conclusion Primary dorsal inlay inner preputial graft urethroplasty successfully fulfills all traditional hypospadias repair criteria. It offers a viable, safe, rapid, and easy option in the management of proximal hypospadias with a narrow urethral plate.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparing outcome of scalp tissue expansion for repairing postburn alopecia in adults versus children p. 218
Tarek Kishk, Alaa El Sisi, Mahmoud Hagag, Eman M Fathy
DOI:10.4103/mmj.mmj_710_16  
Objective The aim of this study was to compare the outcome of tissue expansion between adults and children. Background Postburn alopecia of the scalp is a huge surgical challenge. In 1957, Charles Neuman first described the use of gradual tension, leading to the expansion of skin by an inflatable balloon, buried subcutaneously above the ear. In 1975, both Radovan and Austad's group began working on soft-tissue expansion. Patients and methods This study included 40patients divided into two groups–groupA included 20 children aged 5–12years, and groupB included 20 adults aged 16–29years. All patients suffered from postburn scalp alopecia, reconstructed using tissue expanders, with volume capacity ranging from 100 to 550ml. Results Infection occurred in four adults and 10 children, exposed expander was found in three adults and eight children, exposed valve line was found in three adults and three children, and ischemia of the flap in one child. Conclusion Using tissue expanders is a reliable and safe method for reconstructing postburn alopecia with a very good outcome in adult patients compared with young children.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum albumin and base deficit as prognostic factors for mortality in major burn patients p. 225
Mohamed A Megahed, Shawky S M. Gad, Rana H El-Helbawy, Mohamed M Mansour
DOI:10.4103/mmj.mmj_714_16  
Objective The objective of this study was to assess serum albumin and base deficit as prognostic factors for mortality in major burn patients. Background Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Base deficit is routinely calculated on blood gas analysis, and it provides the best estimate of the degree of tissue anoxia and shock at the whole body level, particularly in hemorrhagic shock. Arising base deficit indicates increasing metabolic acidosis, and may stratify mortality in patients after major trauma. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin and base deficit can predict mortality in burn patients. Patients and methods This study included 42patients. All patients were admitted to the burn ICU at Menoufia University Hospital. Serum albumin and base deficit were estimated in patients at admission, after 3days, and after 1week. Results The mean of serum albumin on admission was 3.33±0.44g/dl, after 3days it was 2.85±0.54g/dl, and after 1week it was 2.46±0.67g/dl, and the mean of base deficit was 5.75±2.40, 5.24±2.05, and 5.45±2.76, respectively. These results were significant(P<0.001). Conclusion Statistically, serum albumin and base deficit can be used as prognostic factors for mortality, and colloid therapy should be continued for the first week, not only for the first 3days.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Clinicalassessment of solid cartilage versus diced cartilage in fascia in augmentation rhinoplasty p. 229
Ahmed Fergany S. Abdullah, Ahmed A Khalil, Fouad M Gharib, Ahmed M B. Mostafa, Al-Moddather M El-Hdidi
DOI:10.4103/mmj.mmj_548_15  
Objective The aim was to compare clinical outcome and fate of solid cartilage versus diced cartilage in fascia in augmentation rhinoplasty. Back ground Augmentation rhinoplasty can be achieved through many different techniques and materials. There are many different implantable materials available, both autologous and nonautologous. The major limitation of nonautologous material is the limited biocompatibility, which contributes to allergic reaction, excursion, displacement, and infection. Patients and methods This study was conducted in combination of Plastic Surgery and Burn Department of Mansoura University and Plastic Surgery Department of Menoufia University during the period from December 2012 to November 2015. It included 14patients who underwent augmentation rhinoplasty, aged from 18 to 35years, with mean±SD age of 25.7±6years. In total, five(35.7%) patients were female and nine(64.3%) patients were male. Patients were divided into two groups. GroupI underwent augmentation rhinoplasty by solid cartilage graft (septal, conchal, or rib). It included seven patients, with five(71.5%) male and two(28.5%) female patients, with mean±SD age of 24.5±6years. GroupII underwent augmentation rhinoplasty by diced cartilage graft enveloped in fascia(deep temporal fascia). It included seven patients, with four(57%) male and three(43%) female patients, with mean±SD age of 27±5years. Results A total of five(35.7%) patients were female and nine(64.3%) of them were male. Overall, six(42.8%) patients underwent primary rhinoplasty, six(42.8%) patients secondary rhinoplasty, and two(14.2%) tertiary rhinoplasty. In groupI, 43% of the patients had satisfactory(excellent) results, 14.25% of patients had intermediate results, and 42.75% of patients had unsatisfactory results. In groupII, 71.5% of patients had satisfactory(excellent) results, 14.25% had intermediate results, and 14.25% had unsatisfactory results. Conclusion Diced cartilage graft is becoming a common place in rhinoplasty. The diced cartilage warped in autogenous fascia has good results, with minimal drawbacks, in comparison with solid cartilage.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Computedtomography versus magnetic resonance imaging in the diagnosis of pharyngeal lesions p. 236
Abd El Latif I El Rashedy, Essam A Behiary, Ayman A Abd El Fattah, Anas M El Dahshan
DOI:10.4103/1110-2098.234212  
Objectives The aim of this study was to assess the reliability of computed tomography(CT) and MRI in evaluating pharyngeal lesions by comparing the two imaging modalities. Background The pharynx is a region of considerable anatomical and functional complexity, making the accurate diagnosis of pharyngeal lesion a challenging task. CT or MRI is performed for pretherapeutic assessment of pharyngeal lesions. Both can supply the information needed by the clinician for adequate treatment planning. Patients and methods Forty patients with pharyngeal lesions were evaluated using CT and/or MRI according to the decision of the treating physician. The results of imaging were assessed based on the corresponding histopathological diagnosis to define the true benign, true malignant, false benign, and false malignant results. Statistical analysis was performed to calculate the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of each technique, and the correct results of the two techniques were compared in 28patients subjected to both. Results The study included 40patients with lesions distributed among three anatomical sites: the nasopharynx(15), the oropharynx(nine), and the hypopharynx(16). The lesions included 23 malignant, nine benign neoplastic, and eight inflammatory lesions. CT was performed for all patients, whereas MRI was performed for 28patients. CT revealed a sensitivity of 78.2%, a specificity of 70.6%, a diagnostic accuracy of 75%, a positive predictive value of 78.2%, and a negative predictive value of 70.6%. MRI revealed a sensitivity of 89.5%, a specificity of 77.8%, a diagnostic accuracy of 85.7%, a positive predictive value of 89.5%, and a negative predictive value of 77.8%. On comparing the overall results of CT and MRI, there was a nonsignificant difference(P=0.19). Conclusion Both CT and MRI are effective imaging modalities for evaluating a pharyngeal mass. No significant difference was found between them as regards reaching the correct diagnosis of pharyngeal lesion.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Hyoid suspension versus laser midline glossectomy in the management of obstructive sleep apnea p. 244
Omar A Elbanhawy, Ibrahim A Abd Elshafy, Yasir A Khaleel, Rana H Elhelbawy, Ahmed F Abd Elhameed
DOI:10.4103/1110-2098.234213  
Background The base of the tongueand the hypopharynx are the major sites of obstruction in up to 50% of patients with obstructive sleep apnea(OSA) possibly explaining the cause of failure in palatal surgery. Hyoid suspension and laser midline glossectomy can be used as a surgical treatment for tongue base and hypopharyngeal collapse. Objective The aim of this study was to compare hyoid suspension typeI and laser midline glossectomy in the management of OSA as regards safety, efficiency, and postoperative morbidity and mortality. Patients and methods In this study, 30patients were diagnosed as having OSA by means of polysomnography with retrolingual collapse using Muller maneuver. Fifteen patients were operated upon using hyoid suspension typeI and the other 15patients were operated upon using laser midline glossectomy. Results In hyoid suspension typeI, the incidence of responder patients[50% or more reduction in their apnea–hypopnea index(AHI) plus reduction in the AHI below 20] was 66.67%, with reduction in the AHI by 77.2%, and the incidence of nonresponder patients was 33.33%, with reduction in the AHI by 36.17%. However, in midline laser glossectomy, the incidence of responder patients was 53.34% with reduction in the AHI by 73.87%, and the incidence of nonresponder patients was 46.67% with reduction in the AHI by 40.79%. Complications were higher in laser midline glossectomy compared with hyoid suspension typeI. Conclusion Our data indicate that hyoid suspension typeI may be safer and more effective with lesser morbidity compared with laser midline glossectomy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Assessment of serum iron and zinc levels in rhinoscleroma patients p. 250
Abdel-Hai R El-Asi, Ayman A Abdel-Aziz, Heba A Abu El-Naga, Sohair R Abo Shady
DOI:10.4103/1110-2098.234226  
Objective This study aimed to determine the relation of serum levels of iron and zinc trace elements during the course of rhinoscleroma and stage of disease. Background Several risk factors have been associated with rhinoscleroma such as poor hygiene and nutritional deficiencies. Therefore, iron and zinc deficiencies may be predisposing factors to the disease or may be a sequel of the disease as they are essential for cell-mediated immunity, which affects the pathophysiology of the disease. Patients and methods Seventy-eight participants(39cases diagnosed with rhinoscleroma and 39 controls) were enrolled into the study. Patients were subjected to nasal biopsy and a histopathological examination to diagnose rhinoscleroma, and laboratory assessments of serum levels of iron and zinc to determine the changes in serum levels of iron and zinc in patients diagnosed with rhinoscleroma. Results There was a significant decrease in the serum level of iron in the case group compared with the control group(P=0.00) and a significant decrease in the serum level of zinc in the case group compared with the control group(P=0.00). Also, there was a significant decrease in the serum levels of iron and zinc in the late-stage cases. Conclusion Serum levels of iron and zinc were significantly lower in patients diagnosed with rhinoscleroma than controls, reflecting the crucial role of iron and zinc in cell-mediated immunity in such patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Evaluation of nasal mucosal changes of tracheastomized patients p. 254
Mohammad El-Sharnouby, Yaser Khalil, Ibrahim A El-Shafy, Mervat Khalil
DOI:10.4103/mmj.mmj_10_17  
Objective The aim of this study was to evaluate the changes in the nasal mucosa of tracheostomized patients as a result of decreased nasal airflow. Background The effect of tracheostomy on the chest is well established, but the effect on the nasal mucosa and the upper respiratory tract has not been extensively investigated. Patients and methods Thirty-one participants who underwent total laryngectomy or tracheostomy for prolonged intubation were enrolled in the study. Patients were evaluated at 2 and 6months after tracheostomy endoscopically as regards the color, discharge, crustations, and atrophy of nasal mucosa. The Saccharine test and the methylene blue test were used to assess the mucociliary clearance. Nasal biopsy and histopathological examination with hematoxylin and eosin staining was performed to confirm our findings. Results There was a significant increase in nasal discharge with histopathological increase in mucous-secreting glands by 2months after tracheostomy and a significant decrease at 6months postoperatively. The color of the nasal mucosa became more pink 2months after tracheostomy with no significance, but at 6months it became more pale with significance. There was a significant improvement in the saccharine times and methylene blue movement toward the nasopharyn×2months postoperatively, whereas there was a significant delay in the saccharine times and methylene blue movement at 6months. On histopathological examination, there was a significant incidence of nasal mucosal atrophy at 6months. Conclusion There was an increase in the number of mucous glands with their secretion along with an increase in mucociliary clearance of the nose early after tracheostomy or total laryngectomy. However, with time the reverse occurs due to the long-term effect of airflow deprivation on the nasal mucosa with increased incidence of nasal mucosal atrophy as shown by histopathological examination.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Theassociationof hypolipidemic agents with macular edema in diabetic maculopathy p. 262
Amin F El-Lakwa, Moataz F El-Sawya, Heba A Abd El-Fatah
DOI:10.4103/mmj.mmj_535_16  
Objective Theaimof this study was to assess the effect of lipid-lowering agents on macular edema in patients with diabetic maculopathy guided by optical coherence tomography and fundus fluorescein angiography. Backgrounds The most threatening complication of diabetic retinopathy(DR) is diabetic macular edema.The risk factors for diabetic macular edema are largely similar to those for DR, but dyslipidemia appears to play a more significant role. Serum lipid level has a direct role in the development of macular edema. Lowering of serum lipids has shown a benefit on both proliferative disease and maculopathy besides their lipid-lowering effect. Independentof accompanying macular edema, the severity of retinal hard exudates at baseline was associated with decreased visual acuity. Patients and methods The study included 80patients with DR and hyperlipidemia; 50% of were undergoing treatment with antihyperlipidemic drugs(group I) and other 50% did not receive treatment(group II) (control group) at the Ophthalmology Clinic at the Menoufia University Hospital. Results In patients with DR and dyslipidemia, lowering of serum lipids has shown a benefit on both proliferative disease and maculopathy. Besides their lipid-lowering effect, there was a significant decrease in macular thickness measured using optical coherence tomography after 9 months of treatment with antihyperlipidemic drugs. Conclusion Dyslipidemia appears to play a direct role in the development of clinically significant macular edema. Lowering of serum lipids has shown a benefit on both proliferative DR and maculopathy, besides their lipid-lowering effect.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Prevalence of occult refractive errors in primary school students p. 267
Hassan G Farahata, Hatem M G. Marey, Nermeen M Badawi, Heba K Allam, Mohammed M M. Issa
DOI:10.4103/mmj.mmj_20_17  
Objectives The aims of the present study were to estimate the prevalence of undetected refractive errors among primary school students in Menoufia governorate and to assess possible risk factors such as family history, prolonged near work, etc. Background Early detection of refractive errors in children provides the best opportunity for effective treatment, whereas failure to detect such problems early can have permanent, deleterious effects on long-term visual outcomes, educational achievement, and self-esteem. Patients and methods This was a cross-sectional analytical study that was carried out from the beginning of January 2015 to the end of January 2016 in children between the ages of 6 and 15years(mean age: 8.39±1.85years). After obtaining consent from parents and the school authority, students underwent manifest refraction, vision, best-corrected visual acuity, ocular motility, and cycloplegic refraction tests. Results This study was conducted on 276 students(48.6% of males and 51.4% of females); 83 of them had an occult refractive error, with an estimated incidence of 30.1%. Among the studied group, 37.3% had a family history of using glasses. In addition, 28.6% of the studied group had a history of headache. The most common type of refractive errors was astigmatism(45.8%), myopia(40.4%), and hypermetropia(13.9%) among the studied group. Conclusion The present study concluded that uncorrected refractive error is a common cause of visual impairment among schoolchildren in Menoufia governorate. Therefore, it is recommended that the education authority, together with the health authority, should provide appropriate measures to make eye examination for students in Egypt compulsory.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Evaluation ofvisual field sensitivity and optical coherence tomography in pseudoglaucomatous optic neuropathy p. 273
Moustafa K Nassar, Moataz F Elsawy, Khalid M Esmail Al-Azzony
DOI:10.4103/1110-2098.234232  
Objective The aim of the study was to evaluatethe protocol of optical coherence tomography(OCT) and visual field(VF) sensitivity testing in the diagnosis of pseudoglaucomatous optic neuropathy and avoid misdiagnosis with glaucoma. Background Pseudoglaucoma is defined as false or deceptive glaucoma with or without ocular damage. Multiple entities can produce 'pseudoglaucomatous optic disc' and care should be taken to differentiate it from glaucomatous eyes that, for the present, do not reveal symptoms of glaucoma.Patients who have pseudoglaucomatous optic disc cupping should be invitigated well. Patients and methods This study was conducted on 39 eyes(of 24patients) to assess the protocol of OCT and VF sensitivity testing in the diagnosis of pseudoglaucomatous optic neuropathy. Results In this study the average age was significantly lower in patients with pseudoglaucomatous cupping(24years). Best-corrected visual acuity(BCVA) did not significantly decrease in patients after pseudoglaucomatous optic neuropathy. Patients with nonglaucomatous optic nerve cupping had better VF mean deviation and pattern standard deviation. Eyes with pseudoglaucomatous optic nerve cupping had a lower mean retinal nerve fiber layer(RNFL) in both the nasal and temporal quadrants. Conclusion VF sensitivity and OCT appear to be of value in the evaluation of pseudoglaucomatous optic disc cupping. The pattern of RNFL loss varied on the basis of etiology and appeared more diffuse in nonglaucomatous optic nerve cupping. The nasal and temporal RNFL thicknesses were lower in patients with nonglaucomatous optic nerve cupping compared with the reported results in glaucoma patients. The pattern of VF defect varied depending on etiology and the VF mean deviation and pattern standard deviation were better compared with the results reported in glaucoma patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparison between multispot laser and conventional laser in the treatment of diabetic clinically significant macular edema p. 278
Amin F El-Lakwa, Ghada Z Rajab, Marwa A Zaky, Kareem M.H. El-Sawah
DOI:10.4103/1110-2098.234233  
Objectives The purpose of this study was to assess the safety andefficacy of multispot laser and conventional laser in the treatment of nonproliferative diabetic retinopathy with clinically significant macular oedema (CSME)in relation to the visual outcome, central macular thickness(CMT) using optical coherence tomography, and presence of adverse events. Patients and methods This prospective randomized study included a total of 50 eyes from the research institute of ophthalmology in 2015 that were divided into two groups of 25patients each. GroupA patients underwent focal or modified grid macular laser photocoagulation using green laser 532nm. GroupB patients underwent focal or modified grid macular laser photocoagulation using multispot laser photocoagulation Valon TT. Inclusion criteria were as follows: typeII diabetes and clinically significant macular edema. Best-corrected visual acuity(BCVA), optical coherence tomography readings, intraocular pressure (IOP), and adverse events were recorded preoperatively and at 1week, 1month, and 3months postoperatively. Results The mean preoperative BCVA in conventional laser was 0.294±0.17 decimal and that in multispot laser was 0.30±0.21. The mean BCVA 3months after laser in groupA was 0.4820±0.244 decimal(P=0.001) and that in groupB was 0.50±0.20(P=0.001). The mean preoperative CMT in groupA was 375.92±65.69 μm and that in groupB was 361.0±50.400 μm. The mean CMT 3months after laser in groupA was 314.44±85.94 μm(P=0.001) um and that in groupB was 0322.67±57.50 μm(P=0.001). The multispot system parameters used a higher power of 155±90.1 mW(P=0.001) compared with the conventional laser to produce the same therapeutic visible effect. Conclusion Multispot system was safe, rapid, and effective in the treatment of clinically significant macular edema in short-term follow-up periods and had a short exposure time. Although the short pulse duration of the multispot system necessitated the use of a higher power, it was not associated with adverse effects.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparison of corneal hysteresis in eyes with high cylindrical errors with and without keratoconus p. 283
Khalid E. S. Ahmed, Ahmed El-Hagaa, Abd-Allah M. S. Sokar
DOI:10.4103/1110-2098.234237  
Objective The aim of this study was to compare corneal hysteresis(CH) in normal and keratoconic corneas in high cylindrical astigmatism(≥3 D). Background There is a great interest in corneal biomechanics as it aids in the study of corneal viscoelasticity. The ocular response analyzer(ORA) measures the corneal biomechanics through the analysis of the corneal dynamic behavior when it is deformed by an air puff. Studies using ORA in the evaluation of corneal biomechanics revealed a significant difference between keratoconic and healthy corneas. Patients and methods This study included 22 normal and 24 keratoconic eyes, which were diagnosed by means of clinical examination and corneal pentacam topography. CH and corneal resistant factor were measured using ORA. Results The mean CH was found to be 10.92±1.7 mmHg in normal individuals, whereas in keratoconic patients it was 7.7±1.29 mmHg. However, the corneal resistance factor(CRF) was 11.077±1.96 mmHg in normal individuals compared with 6.3±1.59 mmHg in keratoconic patients. The difference between the normal and affected groups was statistically significant in both CH and CRF(P<0.0001, independent sample t-test). Astrong direct correlation of central corneal thickness(CCT) with CH and CRF was found. The correlation coefficients(r) were 0.729 and 0.793 with CH and CRF, respectively. Conclusion CH and CRF were significantly higher in normal eyes than in keratoconic eyes. The correlation of CCT with CH and CRF when assessing the corneal biomechanics showed that lower CH and CRF implies a significantly reduced viscoelastic response in keratoconus than in normal eyes. Thus, this weakness in corneal viscoelasticity is associated with the lower CCT identified in keratoconus eyes.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Evaluation of macular changes after uncomplicated phacoemulsification surgery in diabetic patients using optical coherence tomography p. 289
Abd El-Khalik I. El-Saadani, Sameh S Mandour, Maged F Laymouna
DOI:10.4103/mmj.mmj_665_16  
Objective The aim of this study was to evaluatethe subclinical influence of uncomplicated cataract surgery on foveal thickness and volume in the early postoperative period in diabetic and nondiabetic patients. Background Diabetic patients pose a particular challenge because of the tendency for early formation of cataract in them and propensity to develop macular edema after cataract surgery. Patients and methods A prospective nonrandomized study was carried out on 50 eyes of 43patients, which were divided into two groups. Group1 included 25 eyes of diabetic patients and group2 included 25 eyes of nondiabetic patients. Optical coherence tomography was performed to measure initial and 1-month postoperative mean foveal thickness(MFT). Exclusion criteria were as follows: dense cataract that did not permit the measurement of the central macular thickness, proliferative diabetic retinopathy(DR), chronic uveitis, and any posterior segment pathologies other than nonproliferative DR. Results MFT increased significantly in both groups. In group1 it increased initially from 254.88±32.53 to 310.52±64.74 at 1month postoperatively(P=0.001). In group2 it increased initially from 228.28±18.65 to 269.16±23.59 at 1month postoperatively(P=0.001). There was no difference in initial logarithm of minimal angle of resolution visual acuity between the two groups: in group1 it was 0.80±0.05andin group2 it was 0.80±0.06(P=0.801). Postoperative logarithm of minimal angle of resolution visual acuity was significantly different: in group1 it was 0.43±0.23 and in group2 it was 0.25±0.11(P=0.001). Conclusion Increase in MFT occurred after uncomplicated phacoemulsification in diabetic and nondiabetic eyes; the range of increased MFT was more in diabetic patients with higher initial MFT or higher grade of DR preoperatively.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Refractionerrors in school children p. 293
Farid M. W. Farida, Hassan G Hassan Farahat, Marian S. S. Salem
DOI:10.4103/mmj.mmj_115_17  
Objective The aim of the study was the detection and estimation of refractive errors among school children in Tanta to allow for early correction of diagnosed children. Across-sectional study was used. Background Refractive error is one of the most common causes of visual impairment and the second leading cause of blindness following cataract. Patients and methods Children aging from 11 to 15years at different public and private schools in Tanta city were included in the study. Twenty-five classes were randomly selected from 10 schools, eight public and two private, in Tanta and they were included in the study. The field work was carried out between December 2015 to March 2016. Atotal of 1272 students were examined at the schools: their visual acuity and autorefraction were assessed; moreover, they underwent an external eye examination. Those diagnosed with any refractive errors were referred to Tanta ophthalmology hospital for glasses prescription. Results The prevalence of refraction errors among school children was 68%. The most frequent error was myopia(55.3%) followed by astigmatism(51%), and hypermetropia(11.4%). Myopia was more frequent in boys(56.5%). Hypermetropia was more frequent in girls(13.3%), and astigmatism also was more frequent in girls(54.1%). Amblyopia represented 12% of total children who had errors, and 8% of all children. Anisometropia was found in 1.8% of children with errors. Conclusion Refractive errors affected approximately more than half of the students. Myopia was the more frequent refractive problem. Most of the children were unaware of their refractive errors. The majority of the students were never examined for visual acuity. Most refractive errors can be corrected early in the life. Therefore, every child should receive eye examination by an ophthalmologist at the time of entry into school.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Evaluation of intraoperative use of mitomycin C in subscleral trabeculectomy surgery p. 299
Mohab M El-Qattan, Ghada Z Rajab, Hany A Khairy, Abd El-Khalek. I El-Saadani
DOI:10.4103/mmj.mmj_84_17  
Objective The aim of the study was to evaluate the effectiveness and complications of mitomycin C(MMC) use in subscleral trabeculectomy surgery. Background MMC is an antimetabolite agent used to limit the scarring process, which is the main cause of failure of subscleral trabeculectomy surgery. However, it may increase the incidence of adverse effects. Patients and methods A prospective interventional study involving 35 eyes of 28patients having glaucoma was conducted. All of them underwent subscleral trabeculectomy with adjuvant intraoperative use of MMC(0.2mg/ml) for 2min, and were followed up for at least 9months recording intraocular pressure(IOP) testing, best corrected visual acuity, Seidel testing, bleb grading according to the Indiana bleb appearance grading scale, and complications if present. Results The mean IOP decreased from 32.03mmHg preoperatively to 13.83mmHg at 9months postoperatively. The mean IOP drop registered was 56.82%. Overall, 29(82.9%) eyes ended with complete success, three(8.6%) eyes ended with qualified success, and three(8.6%) eyes failed. The incidence of complications was 51.5%, and most of them were transient and self-limited conditions. Further management, including both medications and minor procedures, improved the postoperative outcomes. Conclusion MMC of 0.2mg/ml used for 2min intraoperatively is an effective adjunctive treatment in patients with glaucoma; however, with this dose, it is associated with some complications. So it is a double-edged weapon that should be used wisely, only when indicated, with optimum concentration and duration.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Association of macrophage migration inhibitory factor - 173 G/C polymorphism with dilated cardiomyopathy in children p. 306
Rawhia H El-Edel, Rasha I N. El-Din, Rania S El-Zayat, Hanan Abd El-Aziz Mohamed El-Bagoury
DOI:10.4103/mmj.mmj_246_15  
Objective The objective of this study was to detect the relation between macrophage migration inhibitory factor(MIF) −173 G/C genepolymorphism and dilated cardiomyopathy(DCM) in children. Background DCM is the most common cardiomyopathy. Myocardial inflammation is one of the commonest mechanisms in cardiomyopathy. MIF plays an important role in the control of innate immune responses and promotes proinflammatory biological activities; hence, MIF gene polymorphisms may predispose affected hosts to severe inflammatory or infectious disease. Patients and methods This study was conducted on 50patients, 30patients with DCM and 20 age-matched and sex-matched healthy controls. All patients were subjected to history taking, clinical examination, echocardiography, and laboratory measurement of serum sodium and uric acid. Patients and controls were subjected to PCR-restriction fragment length polymorphism to determine MIF 173 G/C polymorphism. Results Our study revealed a significant statistical difference in the distribution of the genotypes and allele frequencies between patients and controls. Studying the relation between different genotypes and echocardiographic parameters(ejection fraction, fractional shortening, left ventricular end-diastolic diameter and left ventricular end-systolic diameter) revealed a highly significant difference between different genotypes among patients. With regard to laboratory characteristics, there was a significantly higher serum sodium level in the CC genotype, while the uric acid level showed no significant difference between different genotypes among patients. Conclusion In our study, we conclude that the CC genotype of MIF gene may be a risk factor for cardiomyopathic patients and that the C allele is associated with severe clinical condition.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Evaluation ofoperativeresults of displaced tibial plateau fractures p. 311
AlSayed M Zakei, Amr S ElSayed, Eid E H. Mohammed
DOI:10.4103/mmj.mmj_721_16  
Objective The aim of this study was to evaluate knee function in patients with displaced tibial plateau fractures treated with open reduction internal fixation and minimally invasive percutaneous plate osteosynthesis techniques. Background Proximal tibial fracture is a common injury; these fractures represent surgical challenge because of the variety of fracture patterns and the associated soft tissue injuries. If not adequately treated, these fractures often cause persistent knee pain, arthritis, stiffness, and angular deformity. Patients and methods This prospective study was conducted on 30 tibial plateau fractures in 30patients who were functionally and radiologically evaluated according to the knee scoring system. The cases were managed with open reduction and internal fixation with plate and screws and using minimally invasive percutaneous plate osteosynthesis. The entire limb(except the foot) and the ipsilateral iliac crest were prepped and draped into the surgical field under complete aseptic technique. Results In this study, the majority of fractures occurred between the ages of 26 and 44years with a mean±SD of 37.6±4.7years, and the majority of fractures were found to be of typeV(23.3%) and typeVI(23.3%) according to the Schatzeker classification. In this study, we had 27(90%) patients with no complications and three(10%) patients with infection who were treated with open reduction internal fixation. In this study according to Oxford and International Knee Documentation Committee knee scores, there was a highly significant difference between results after 1, 3, and 6months. The end results were as follows: 59.3%, excellent; 37%, good; and 3.7%, fair. Conclusion Tibial plateau fractures occur due to high-energy trauma.Theminimally invasive plate osteosynthesis technique is a good method for the treatment of tibial plateau fractures and it results in good clinical and functional outcome. The functional results of this fracture improve with time, reaching the maximum by 6months. Despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Prognosticvalue of AIMS65 score in patients with chronic liver diseases with upper gastrointestinal bleeding p. 317
Gamal S El-Deeb, Moamena S EL-Hamouly, Mahmoud S Abdel-Hakeem
DOI:10.4103/mmj.mmj_724_16  
Objective Thiswork is a prospective study to emphasize the prognostic value of AIMS65 score in chronic liver disease patients presenting with upper gastrointestinal bleeding(UGIB). Background To optimize the management of UGIB, multiple clinical prediction models have been proposed as a tool to identify patients at risk for poor outcome. Patients and methods This prospective study involved 90 adult patients with chronic liver disease presenting with UGIB, selected from patients admitted in Tropical Medicine Department, Faculty of Medicine, Menoufiya University, Shebeen El-Kom, Menoufiya Governorate, Egypt, during the period from November 2015 to July 2016. Eighty-four of them were male and six were female; their ages ranged from 35 to 79years. We excluded patientswhohad melena due to causes other than upper gastrointestinal pathology. AIMS65 score, Glasgow–Blatchford score, Rockall score, Modified Rockall score, Child–Pugh score, and Model for End-Stage Liver Disease score were calculated for each patient. Results The current study showed the following: ICU admission was accurately predicted by AIMS65 score[area under curve(AUC) was 0.946;P=0.0001]. In this study, an AIMS65 score less than 2 excluded ICU admission. Rebleeding was accurately predicted by AIMS65 score (AUC was 0.844;P=0.0001). In the current study, an AIMS65 score less than 1 excluded rebleeding. In-hospital mortality was accurately predicted by AIMS65 score(AUC was 0.973;P=0.0001). AIMS65 score was superior to other scores in predicting mortality. In this study, an AIMS65 score less than 3 excluded in-hospital mortality. Conclusion AIMS65 is accurate, nonendoscopic score for the prediction of ICU admission, rebleeding, in-patient mortality, and cost of hospital stay. Its easy clinical application makes the AIMS65 a good option for some of the clinical outcomes to be predicted in clinical practice.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Effect of vitamin D3 on diabeticnephropathy in rats p. 324
Huda I Abd El-Hafiz, Maha M El Batsh, Wael M. Y. Mohamed, Adel H Omar, Abd El-Rahman A. Yassin, Magda A Mansour, Eman A E. Badr
DOI:10.4103/mmj.mmj_32_15  
Objective This work aimed to investigate the possible protectiveeffects of active vitamin D3(calcitriol) on the kidney of streptozotocin-induced type2 diabetes rats. Background Diabetic nephropathy(DN) is a leading cause of irreversible renal damage. Calcitriol has anti-inflammatory and antiproliferative effects. Kidneys have vitamin D receptors, so calcitriol may modulate DN. Materials and methods A total of 40male Wistar albino rats were fed on high fat and sugar diet for 6weeks. Eight rats were used as a control group(G). Group1 received single dose of citrate buffer and oral coconut oil. Induction of diabetes mellitus was done in the rest(32 rats) by intraperitonial injection of single dose of streptozotocin(30mg/kg/body weight). The diabetic rats were classified into four equal groups(eight/each). Group2 had diabetic untreated rats that received coconut oil orally. Group3 had diabetic rats that received subcutaneous injection of isophane insulin(10IU/kg/day). Group4 had diabetic rats that received calcitriol(0.03μg/kg/day/oral). Group5 had diabetic rats that received both insulin and calcitriol in similar dose and regiment as in groups3 and 4 for 4weeks. The following examinations were done:(a) body weight, kidney weight, and systolic blood pressure;(b) biochemical measurements including serum urea, creatinine, creatinine clearance, microalbuminuria, blood glucose, insulin, advanced glycation end products, and transforming growth factor-β1; and(c) histopathological and immunohistochemical of kidney tissues for caspase-3 expression. Results The results showed significant increase of glucose, insulin, advanced glycation end products, urea, creatinine, creatinine clearance, microalbuminuria, transforming growth factor-β1, and systolic blood pressure of G2. Histopathological results revealed marked changes and increased expression of caspase-3 of G2 compared with G1. In contrast, biochemical, histological, and immuonohistochemical features in groups3, 4, and 5 showed significant improvement compared with G2. Conclusion It is concluded that calcitriol has protective effects against DN in rats.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Theassociationbetween cyclin D1 G870A polymorphism and hepatocellular carcinoma in an Egyptian population p. 333
Maha A El-Bassiounya, Eman A Gawishb, Enas S Eissaa, Gehan A Tawfeeka, Esraa T A Allam
DOI:10.4103/mmj.mmj_348_16  
Objective To study therelationshipbetween cyclin D1 G870A polymorphism and hepatocellular carcinoma (HCC) in Egyptian patients. Background Cyclin D1, encoded by the gene CCND1, is aregulatoryprotein in the cell cycle transition from G1 phase to S phase. Acommon polymorphism(G870A) in the exon 4 of CCND1 gene affects splicing of the CCND1 transcript and may cause uncontrollable cellular growth. Therefore, the CCND1 G870A polymorphism may influence an individual's susceptibility to the development of certain tumors, which may include HCC. Patients and methods This study was carried out on 100 participants: 60patients with HCC and 40 healthy age-matched and sex-matched volunteers. All participants underwent full history, liver profile, α-fetoprotein, and cyclin D1 G870A polymorphism assessment, which was done by PCR-restriction fragment length polymorphism assay. Results The CCND1 genotype distribution among patients with HCC was significantly different from that of healthy controls(P=0.000). Compared with the wild-typeGG genotype, both the variant AA and AA+GA genotype and the A allele were associated with risk of HCC[odds ratio(OR): 64; 95% confidence interval(CI): 6.67–614.2;P=0.000; OR: 19.67; 95% CI: 2.4–160.94;P=0.000; and OR: 4.03; 95% CI: 2.2–7.41;P=0.000, respectively]. Moreover, there is no significant correlation between the different cyclin D1 genotypes and clinicopathologic features of HCC. Conclusion Our results suggest that the CCND1 G870A polymorphism is associated with an increased risk of HCC in our Egyptian population.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Study of prognostic andpredictivefactors in locally advanced breast cancer in Egypt p. 339
Mona A Kandil, Hayam A Aiad, Mohammed A El-Tahmody, Iman L H Abulkheir, Fatma M A Abulkasem, Asma A Elmunsori
DOI:10.4103/mmj.mmj_17_18  
Objective We aimed to evaluate the prognosis in locally advanced breast cancer(LABC), and the efficacy of neoadjuvant chemotherapy in inducing pathological response in LABC. Background Despite efforts at early detection, LABC remains a clinical challenge, as distant metastasis develops in most patients, and they will experience disease relapse and eventual death. Patients and methods To study the hematoxylin and eosin-stained slides of pretreatment and post-treatment specimens and correlate them with prognostic and predictive factors. Results LABC in Egypt showed poor prognostic factors such as a high proportion of the cases have a large tumor size(46%) and axillary lymph node(LN) metastasis(87%) and younger age at time of presentation(median=53year). These results indicate a more aggressive biology of LABC in Egypt compared with the same group in developed countries. Negative preoperative LN predicts complete response in postoperative LN. Prolonged survival wasobservedwithin the triple-negative(P=0.004) and progesterone receptor negative groups(P=0.02). The disease-free survival was shortened in positive lymphovascular invasion(P=0.04) and high histologic grade(0.03). Conclusion LABC in Egypt showed poor prognostic outcome. Triple-negative and progesterone-negative cases that received neoadjuvant therapy showed significant prolonged survival.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Therole of ultrasound elastography as a tool for prediction of hepatocellular carcinoma in Egyptian patients with cirrhosis p. 348
Mohamed A Nouh, Mohsen M El-Khayat, Doaa M. G. Khallaf
DOI:10.4103/mmj.mmj_87_17  
Objective The aim of the work was to study the role of ultrasound elastography as a tool for prediction of hepatocellular carcinoma(HCC) in patients with cirrhosis. Background Fibroscan is a novel, noninvasive, ultrasound technique–based technology that allows measuring liver stiffness. It is a noninvasive method for prediction of HCC. Patients and methods A total of 60patients with cirrhosis were included in a case–control study from January 2014 to January 2015. Patients with obesity and ascites were excluded from the study. Patients underwent clinical examination, laboratory investigations, abdominal ultrasonography, triphasic computed tomography, liver biopsy, and fibroscan. They were divided into groupI(patients with cirrhosis with no HCC) and groupII(patients with cirrhosis with HCC). Results Stiffness range was 2.90–39.80 kPa among patients without HCC with a mean of 8.95±7.27 kPa, whereas among patients with HCC, it was 8.40–75.00 kPa, with a mean of 31.10±16.05 kPa. Fibroscan showed a high sensitivity(100%) and specificity(80%) for detecting HCC at the cut-off level of more than 12 kPa with a positive predictive value of 100 and a negative predictive value of 79%, and the area under the curve was 100%. Conclusion Transient elastography can predict HCC in patients with cirrhosis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Assessment of Echinacea purpurea andmefloquinein treatment of Schistosoma mansoni p. 354
Wafaa M El-kersh, Azza H Mohamed, Amany A Rady, Ismail M Moharm, Ahmed S Mahdy
DOI:10.4103/mmj.mmj_96_16  
Objective To assess the effectofcombined Echinacea purpurea(EP) and mefloquine(MQ) in the treatment of experimental Schistosoma mansoni infection. Background Schistosomiasis is a prevalent parasitic disease in tropical and subtropical areascausedby the flatworm S.mansoni. Several medications are used in the treatment of schistosomiasis. Praziquantel(PZQ) is the drug of choice because of its safety and broad-spectrum activity. Materials and methods The current study was carried out on 120 laboratory-bred Swiss albino female mice. They were classified into six groups: groupI(control), groupII(PZQ treated), groupIII(MQ treated), groupIV(EP treated), groupV(PZQ and EP), and groupVI(MQ and EP). Evaluation was done parasitologically using the worm count technique, ova count technique in intestine and liver, and oogram pattern and histopathological examination of liver sections for assessment of granuloma size and diameter. Moreover, electron microscopic changes of the adult worms were evaluated. Results The highest worm burden reduction of male(79.41%), female(82.28%), couples(86.6%), and total(92%) worms was obtained in the combined MQ and EP treated group. The highest reduction in the mean number of ova count/g tissue in either the intestine(93%) or the liver(89%) was detected in MQ and EP treated group. In combined treated groups, the highest percentage of reduction in the immature and mature eggs was detected in the groupMQ and EP; it was 9.16±4.11 and 5.25±2.56, respectively. Moreover, there was an increase in the percentage of dead eggs(85.58±6.43). The highest reductions in hepatic granuloma diameter and number were seen in the combination of MQ and EP at 67 and 85%, respectively(P<0.001). The scanning electron microscopy examination revealed that the tegument of male worms recovered from MQ-treated mice showed loss of spines, severe corrugation, and extensive blebbing, whereas the tegument of the adult males recovered from mice treated with EP showed flattening of tubercles, loss of spines, and extensive blebbing with start of sloughing. Conclusion MQ has effective schistosomicidal properties through reduction of worm burden and tissue egg load. Moreover, EP extract showed promising antischistosomal activity on S.mansoni-infected mice. It is recommended to study the exact mechanism of action of EP on S.mansoni and its possible effects on other parasitic infections.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ERRATUM Top

Erratum: Paediatric health significance of prevalent stratified indigenous Lactobacillus spp. species in diet-dependent infantile faecal specimens p. 364

DOI:10.4103/1110-2098.234264  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Subscribe this journal
Submit articles
Most popular articles
Joiu us as a reviewer
Email alerts
Recommend this journal