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Table of Contents
July-September 2014
Volume 27 | Issue 3
Page Nos. 507-622
Online since Wednesday, November 26, 2014
Accessed 91,481 times.
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ORIGINAL ARTICLES
Evaluation of β-catenin expression in muscle-invasive urothelial bladder carcinoma
p. 507
Fatma Ahmed Elserafy, Tarek Mohamed Abdel Elbaky, Eid Abdel-Rasoul Elsherif, Noha Mohamed Nor-Eldin-Elkady, Marwa Mohamed Dawood, Mohamed Sayed El Gharabawy
DOI
:10.4103/1110-2098.145491
Objectives
This study aimed at evaluation of the expression of β-catenin in muscle-invasive urothelial bladder carcinoma and its correlation with other clinicopathological parameters of prognostic importance.
Background
β-Catenin is a protein that is encoded by the CTNNB1 gene that can function as an oncogene. Activation of the Wnt/β-catenin signaling pathway by aberrant accumulation of stabilized β-catenin contributes to the progression of several human cancers. Therefore, inhibition of the Wnt pathway may have a major therapeutic potential.
Patients and methods
This study was conducted as a retrospective study at Urology and Pathology Departments, Faculty of Medicine, Menoufia University, during the period between May 2011 and May 2013. A total of 40 patients were included and divided into two groups. The first one included 10 patients with chronic nonspecific cystitis as a control group and the second one included 30 patients with muscle-invasive urothelial bladder carcinoma who underwent radical cystectomy. The pathological blocks of both groups were investigated for the expression of β-catenin using immunohistochemical staining.
Results
β-Catenin expression was noticed in 100% (30 cases) of muscle-invasive bladder carcinoma and in 70% (seven cases) of nonmalignant cases. In the malignant group, 26 (87%) cases showed nucleocytoplasmic expression and four (13%) cases showed membranous expression only. There was a significant correlation between nucleocytoplasmic localization of β-catenin and some pathological parameters such as tumor grade, stage, and mitosis. Furthermore, the study showed statistically significant correlation between intensity of β-catenin expression and tumor grade, stage, lymph node metastasis, vascular and perineural invasion, mitosis, and microvessel density.
Conclusion
Nucleocytoplasmic expression of β-catenin and high intensity of its expression was associated with poor prognostic parameters.
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Recipient surgical complications of renal transplantation in children: our initial experience
p. 514
Fouad Zanaty, Ahmed Shoman, Ahmed Shoukry, Mohamed El Shemy, Mohamed Marzouk, Hany Abd Roaf, Ahmed G Eldeen, Osama El Gawad, Mohamed Eissa
DOI
:10.4103/1110-2098.145494
Objectives
The aim of the study was to evaluate the operative and early postoperative surgical complications of renal transplantation in pediatric recipients.
Background
Renal transplantation is considered the treatment of choice in children with end-stage renal disease; however, it is still associated with several surgical complications.
Patients and methods
From July 2010 to January 2013, 50 consecutive pediatric kidney transplants were studied. Immediately before transplantation, a thorough history and physical examination with appropriate laboratory and radiological evaluation were performed to search for any medical or surgical problems that contraindicate the transplantation. We removed the kidney from a living donor through an open surgical technique. The kidney graft was placed extraperitoneally in the right iliac fossa. The arterial anastomoses were performed to the lower aorta or right common iliac artery. The venous anastomoses were performed to the lower inferior vena cava or the right common iliac vein. Our ureteral reimplantation technique was an extravesical, Lich-Gregoir technique. A ureteral stent was placed. We evaluated the ischemia time and any intraoperative or postoperative surgical complications.
Results
Our patients included 36 boys (72%) and 14 girls (28%). Kidneys came from live-related donors in all cases (27 mothers, 19 fathers, two aunts, one uncle, and one brother). At transplantation, the mean recipient age was 9.9 years (range 3-17 years) and mean body weight was 20.9 kg (range 11-45 kg). The graft was placed in an extraperitoneal position in the right iliac fossa in all cases (100%). In cases of single arterial anastomoses (94%), the mean ischemia time was 53.51 ± 11.68 min. In cases of double arterial anastomoses (6%), the mean ischemia time was 68.33 ± 5.77 min. There was significant association between single or double arterial anastomosis and ischemia time, where double arterial anastomosis had longer ischemia time (
P
= 0.004). There was no intraoperative surgical complication in most of our patients (98%) except in one case (2%) in which the kidney has been transplanted upside down due to misdirection of the upper pole from the lower pole of the kidney. Postoperatively, there were no surgical complications in most of our patients (92%), but there were three cases with high debit urine leaks (6%), and unfortunately there was a case of graft renal vein thrombosis (2%). The mean serum creatinine at 6 months post-transplant was 0.6 mg/dl (range 0.4-0.9 mg/dl). There were no cases of hyperacute rejection. All donors are alive with a good renal function after first 6 months postoperatively.
Conclusion
Our initial surgical experience with renal transplantation carried a low (but clinically significant) risk for vascular and urological recipient complications that increased morbidity, but improvements in our surgical techniques and experience decreased these complications.
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The effect of body mass index on cervical characteristics and on the length of gestation in low-risk pregnancies
p. 518
Mohamed Samy Kandeel, Zakaria Fouad Sanad, Tarek Mohamed Sayyed, Sheren Gamil Abo Elyazid Elmenawy
DOI
:10.4103/1110-2098.145499
Objective
This study was undertaken to evaluate the effect of different BMIs on the cervical diameter and its relation to the length of gestation among low-risk pregnant Egyptian women.
Background
The effect of BMI on the length of gestation is not clearly documented. There are claims that obese women may have longer gestations and longer cervices compared with normal and underweight women through changes in cervical diameters, which have an effect on the pregnancy outcome.
Participants and methods
This observational cohort study included 100 pregnant women from a total of 120 women at Helwan General Hospital (Egypt). All enrolled women were primigravidae with singleton pregnancies at 20-22 weeks' gestation. Enrolled women were equally allocated into four groups according to their BMIs. A vaginal ultrasonography was performed to measure the cervical length and width. Enrolled participants were followed up until delivery after recording their mean cervical length and width by transvaginal ultrasonography.
Results
There were five preterm births and five post-term births, representing 5 and 5% of the total cohort study. One neonatal death occurred due to prematurity, and four women developed postpartum hemorrhage with no maternal mortality. The incidence of SPTB was high among underweight women (12%) from a total of 25 women, whereas the incidence of post-term delivery was common among overweight and obese women, representing 8 versus 12%, respectively.
Conclusion
Underweight women are more liable to have more preterm delivery and low birth weight. However, overweight and obese women are less vulnerable to preterm delivery. They have a tendency for post-term gestation, increased incidence of cesarean section and macrosomia.
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The effect of zinc supplementation on growth and development in preterm neonates
p. 524
Seham Mohammed Ragab, Hosam Hemdan Hegran, Sameh Ali Kassem
DOI
:10.4103/1110-2098.145500
Objective
This study aimed to show the effect of zinc supplementation on growth and development in preterm neonates in the first 6 months of life.
Background
Preterm infants have impaired zinc status because of low body stores as 60% of fetal zinc is acquired during the third trimester of pregnancy in addition to their limited capacity to absorb and retain micronutrients, coupled with increased endogenous losses associated with organ immaturity.
Patients and methods
The present study was carried out in the Department of Obstetrics in Nasr City Health Insurance Hospital on 80 healthy preterm infants between 32 and 36 weeks of age divided into two groups: a zinc-supplemented group fed with breast milk, and supplemented with multivitamins and zinc (2 mg/kg/day) since the first day of life, and a non-zinc-supplemented group fed breast milk with multivitamins only (without zinc supplementation). Both groups were followed for 6 months for growth with assessment of development by the Age and Stage Questionnaire at 4 and 6 months of corrected age and serum levels of zinc, alkaline phosphatase, and hemoglobin at corrected age of 3 and 6 months.
Results
The zinc-supplemented group showed a significant increase (
P
< 0.001) in both weight and length (figures and centiles) at chronological ages of 3 and 6 months and acquired higher head circumference centiles compared with the non-zinc-supplemented group. There was a highly significant increase in the serum zinc levels of the zinc-supplemented group compared with the non-zinc-supplemented group, in addition to a significant positive correlation between zinc level and both weight and length at 3 and 6 months of age. Also, the developmental score of the zinc-supplemented group was significantly higher (
P
< 0.001) than that of the non-zinc-supplemented group in all tested domains.
Conclusion
Zinc supplementation in the first 6 months of life was found to be an effective enhancer for both the growth and the development of preterm infants.
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Prevalence of obesity in primary school children living in Alexandria governorate
p. 529
Ali Mohamed El-Shafie, Hossam Hemdan Hogran, Abdelhamed Mohamed Dohein
DOI
:10.4103/1110-2098.145502
Objective
The aim of the work was to assess the prevalence of obesity among children of primary schools in Alexandria governorate.
Background
Childhood obesity has more than tripled in the past 30 years. The prevalence of obesity among children aged 6-11 years increased from 6.5% in 1980 to 19.6% in 2008.
Participants and methods
A cross-sectional study was carried out on 3500 Egyptian children to calculate prevalence of overweight and obesity among primary school children at age of 6-12 years living in Alexandria governorate. Four schools from urban areas and two from rural areas including both sexes were selected randomly in this study. They were subjected to physical examination and anthropometric measurements including BMI. Data were expressed in terms of
Z-
scores using the WHO
Z-
score cutoff points.
Conclusion
Pediatric obesity is a prevalent and rapidly increasing problem that poses a serious risk to the health and well-being of the nations' youths. Overweight and obesity were relatively high among age group 6-12 years. It was more common in female individuals than male individuals. It was more common in urban than rural areas. It was common in private schools than in governmental schools. Children of high socioeconomic level were more obese than other children.
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Clinical and immunological features of common variable immunodeficiency: a single center experience
p. 533
Mohammad Abu-Shukair, Zeyad Habahbeh, Raed Alzyoud, Mohammad Mutereen, Adel Wahadneh
DOI
:10.4103/1110-2098.145505
Objectives
The aim of the study was to perform a retrospective investigation describing the clinical and immunological spectrums of common variable immunodeficiency (CVID) at a single center during the period from January 2006 through to June 2013.
Backgrounds
CVID is the most common primary immunodeficiency. The inheritance of CVID is variable; the majority of cases are sporadic, but familial patterns of inheritance are seen in ~10-20% of cases. The hallmark of CVID is reduced serum levels of serum immunoglobulins, IgG, IgA, and or IgM, which leads to recurrent infections. CVID also has noninfectious manifestations such as autoimmunity, granulomatous disease, and malignancy.
Patients and methods
We reviewed the medical records of patients who had been diagnosed with CVID at the Immunology Clinic at Queen Rania Children's Hospital from January 2006 through to June 2013. Collected data included clinical presentation, demographics, associated autoimmune features, allergies, complications, mortality, and immunological workup at the time of diagnosis.
Results
The total number of patients was 17 [12 (71%) male and five (29%) female patients]; the median age at presentation was 5.1 years. Infections were the most common presentation; pneumonia was the most frequent at 71%, followed by sinusitis in 59% of patients. Cytopenias were the most frequent autoimmune association; they were reported in one-third of the patients. Lymphoproliferation was noted in 29%; two of them were due to Epstein-Barr virus infection. Bronchiectasis was diagnosed in four (24%) patients. Fourteen of 17 patients had immunoglobulin IgG, IgM, and IgA levels 2 SD below the mean for age, whereas three patients had low IgG and IgA and normal IgM levels.
Conclusion
Although our study was limited by its retrospective nature and it did not represent the entire population of CVID patients in our country, it emphasizes the importance for awareness of these disorders to improve CVID outcomes.
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Study of serum prolactin in primary immune thrombocytopenic patients
p. 538
Sanaa S Gazareen, Ali Z Glal, Sabry A Shoeib, Ahmed A Sonbol, Mohamed El Hafez, Heba Y Elkholy
DOI
:10.4103/1110-2098.145508
Objectives
The aims of this work were to study serum prolactin (PRL) levels in patients with primary immune thrombocytopenia (ITP) and to investigate its possible correlation with disease activity and manifestations.
Background
ITP is a disorder characterized by immune-mediated accelerated platelet destruction and suppressed platelet production. Hyperprolactinemia (HPRL) has been described in many autoimmune diseases such as systemic lupus erythematosus.
Patients and methods
The study was carried out on 40 cases of primary ITP patients (group I) and 50 healthy controls (group II). PRL was measured directly in the serum samples by VIDAS PRL kits using the ELFA technique for all patients and controls.
Results
Moderate HPRL (serum PRL 30-200 ng/ml) was present in eight (20%) of primary ITP patients, but was not present in any of the 50 controls. Among 22 patients with platelet count below 30 000/μl, eight (36.4%) patients had HPRL and 14 (63.6%) patients had normal PRL levels. HPRL was associated with lower platelet counts.
Conclusion
This study shows that HPRL is present in 20% of patients with primary ITP. Also, patients with HPRL have a lower platelet count than patients with normal PRL levels.
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Serum markers for the early detection of hepatocellular carcinoma in patients with chronic viral hepatitis C infection
p. 544
Ibrahim Baghdady, Farouk Fouad, Mohammed Sayed, Ahmed Shoaib, Yassin Salah, Elsayed Elshayeb, Alaa Efat Hasan
DOI
:10.4103/1110-2098.145509
Objective
The aim of this study was to identify the serum markers and the use of abdominal ultrasound for early detection of hepatocellular carcinoma (HCC) in patients with chronic viral hepatitis C virus infection.
Background
HCC meets the criteria of a tumor that would benefit from a surveillance program, but the poor sensitivity and specificity of currently available tools have prevented widespread implementation of surveillance.
Patients and methods
This study included 110 patients, age from 23 to 70 years, from Menoufia University hospitals during the period from July 2011 to November 2013. They were classified into three groups: group I, non-HCC group (50 patients); group II, HCC group (40 patients with chronic hepatitis C virus infection); and group III, healthy controls (20 individuals). Members of the study were subjected to thorough history taking, complete physical examination, liver function testing (serum bilirubin, albumin, prothrombin time, serum transaminases), serum α-fetoprotein (α-FP), and transforming growth factor β1 (TGF-β1) level. Group I was subjected to serum TGF-β1 at 0-, 9-, and 18-month intervals.
Results
The mean age was 46.72 ± 9.03 years in the non-HCC group (group I), 58.70 ± 5.76 years in the HCC group (group II), and 42.15 ± 11.33 years in the control group (group III). The mean serum level of TGF-β1 was 232.25 ± 70.53 ng/ml in the HCC group, 42.16 ± 13.34 ng/ml in the non-HCC group, and 13.92 ± 7.73 ng/ml in the control group; there was a highly significant difference between all groups (
P
< 0.001). The mean value of α-FP was 334.40 ± 311.30 ng/ml in group II and 4.82 ± 2.18 ng/ml in group I; the HCC group had a shooting serum level of α-FP with a highly statistically significant difference.
Conclusion
This study recommends TGF-β1 as being more accurate than α-FP in differentiating patients with HCC from those with nonmalignant chronic liver disease.
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Hepatitis C virus seroconversion in hemodialysis units with a high prevalence of hepatitis C: do we need isolation?
p. 551
Ahmed M Zahran
DOI
:10.4103/1110-2098.145511
Objective
The objective of this study was to determine whether the isolation of hemodialysis patients with hepatitis C virus (HCV) in hemodialysis units with a high prevalence of hepatitis C is necessary or not.
Background
HCV is one of the most common pathogens leading to serious morbidity and mortality in hemodialysis patients. Despite the quality control measures developed to reduce the risk of HCV transmission, HCV persists, and nosocomial virus transmission remains a concern.
Patients and methods
This study included 514 patients with end-stage renal disease on regular hemodialysis in Menoufia governorate, Egypt. Of them, 303 patients started dialysis with negative HCV, and 44 patients seroconverted to HCV positive during dialysis. Patients were divided into two groups: group 1, which included 259 patients who remained negative for HCV, and group 2, which included 44 patients who seroconverted to HCV positive during dialysis. Risk factors for seroconversion were compared between the two groups.
Results
The duration of dialysis in months (33.72 in group 1 compared with 71.36 in group 2), a positive family history for HCV infection (6.4% in group 1 vs. 20.5% in group 2), and a low socioeconomic level (58.3% in group 1 vs. 72.7% in group 2) were found to be significant among the studied groups. Other factors such as blood transfusion, surgery, dentist visit, a history of bilharziasis and hepatitis B virus vaccination were found to be insignificant. The duration of dialysis was found to be a key predictor of HCV seroconversion
Conclusion
Patients with a long duration of dialysis were more liable to HCV seroconversion in dialysis units with a high prevalence rate of HCV infection, especially in developing countries. Good training on infection control measures with strict supervision of the dialysis staff is required. A controlled randomized study is needed to compare the isolation policy with no isolation of HCV patients on regular hemodialysis in developing countries to determine whether there is any benefit of isolation.
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Study of bone mineral density in patients with systemic lupus erythematosus
p. 556
Hassan Abd El-Hady, Mahmoud Abd-El Aziz Kora, Samar Gaber Soliman, Ahmed Ragheb, Enas Sobhei Zahran
DOI
:10.4103/1110-2098.145512
Objective
The aim of the study was to investigate bone mineral density (BMD) in systemic lupus erythematosus (SLE) patients, either newly diagnosed or treated.
Background
As a consequence of the chronic course of SLE, osteoporosis can be a further clinical challenge in these patients. SLE-related medications can increase bone turnover, which eventually weakens bone architecture, and subsequently reduces bone strength and increases the risk for fractures, but there is good evidence that the disease
per se
can lead to reduced bone mass through several mechanisms such as reduced motility, renal impairment, and the systemic effect of bone-resorbing cytokines.
Materials and methods
In this study, we examined 30 lupus patients diagnosed with SLE. Patients were divided into two groups. Group II included 15 newly diagnosed patients and group III included 15 treated lupus patients. Patients diagnosed with SLE met four or more criteria of the American College of Rheumatology (ACR) for SLE. SLE Disease Activity Index (SLEDAI) and SLE International Collaboration Clinics/ACR (SLICC/ACR) index were calculated for all patients. Ten healthy adults were included as the control group (group I). Dual-energy X-ray absorptiometry was performed in all studied patients in addition to routine investigations.
Results
The total patient number was 30. Ninety-three percent of patients were female and in the age group of 17-30 years. There was a significant reduction in BMD in diagnosed lupus patients (groups II and III) compared with healthy adults of the same age and sex. Forty percent of newly diagnosed lupus patients had osteopenia. Sixty percent of treated patients had osteopenia and 20% had osteoporosis. There was no difference among lupus patients with low BMD as regards steroid dose, SLEDAI, and SLICC/ACR index.
Conclusion
BMD was reduced in SLE patients as compared with healthy age-matched and sex-matched controls. It decreased in both newly diagnosed (40%) and treated lupus patients (80%). BMD in lupus patients was not affected by the duration of disease, corticosteroid doses, or SLEDAI and SLICC/ACR index.
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Assessment of the immune response to hepatitis B virus vaccine as a major factor in the prevention of hepatitis B infection
p. 562
Mohammed Allaa Eldin Nouh, Gamal Saad El-Deep, Ayman Mohammed El-Lehleh, Eman Mohammed Zaher, Ahmed Ali El-Sersy
DOI
:10.4103/1110-2098.145513
Objective
The aim of the work was to study the effect of hepatitis B virus (HBV) vaccine as a major factor in the prevention of HBV infection.
Background
Measuring the level of hepatitis B surface antibodies in different age groups to determine the time of fading of hepatitis B surface antibodies and whether there is a need for a booster dose or not.
Patients and methods
Ninety random persons selected among those attending Menoufia Fever Hospital, Menoufia governorate, who were previously vaccinated with HBV vaccine, were classified into three groups.
Results
Significantly, the seroprotection rate among vaccinated children up to 5 years was 70.0%, with a mean concentration of HBsAb of 139 mIU/ml; of them, 40.0% were over-responders (>100 mIU/ml), 30% were adequate responders (10-100 mIU/ml), and 30.0% were nonresponders. In the second group, the mean concentration of HBsAb was 70 mIU/ml, wherein 43.3% were considered responders; of them, 13.3% were over-responders, 30% were adequate responders, and 56.7% were nonresponders (HBsAb <10 mIU/ml). The HCW of the third group shows that the mean concentration of HBsAb was 639 mIU/ml; 20.0% were adequate responders and 80.0% were over-responders.
Conclusion
The HBV vaccine has a major effect on the prophylaxis and the prevention of HBV infection. The HBV vaccine efficacy decreased with increasing age up to 18 years. There was 100% response in healthcare workers 5 years after vaccination.
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The value of diffusion-weighted imaging in prediction of outcome of transient ischemic attacks
p. 566
M Ezzat Elwan, M Salah-Eldeen Elzawawy, Rasha A El-Kabany, Ibrahim E Alahmar, Eman S Matar
DOI
:10.4103/1110-2098.145514
Objective
The aim of the study was to study the clinical significance of diffusion-MRI in the prediction of outcome of transient ischemic attacks (TIAs) and its relation to the risk factors and TIA clinical presentations.
Background
Diffusion-weighted imaging (DWI) observations in TIA patients led to the proposal for a new definition of TIA, which is called the 'tissue-based' TIA definition, so that patients with clinical symptoms of focal brain with acute DWI-lesions, irrespective of the neurological signs duration, had a stroke rather than TIA.
Patients and methods
The participants in this study were classified into two groups: patient group (group I) and control group (group II) (
n
= 20) of normal individuals. The patients in group I (
n
= 35) were those who had had recent TIAs for the first time for whom an initial brain DWI was performed within 48 h after the onset of TIA and a follow-up one 3 months later for those with initial positive DWI.
Results
Initial DWI lesions were detected in nine (25.7%) patients; it was found that those with TIA duration 1 h or more, with mainly AF or carotid artery stenosis more than 50% and presenting clinically with aphasia or motor manifestations, had lesions on DWI.
Conclusion
TIA patients with duration of symptoms 1 h or more, atrial fibrillation or carotid artery stenosis more than 50% risk factors, and presenting clinically with motor deficits or aphasia had DWI positivity and thus an increased risk of developing stroke.
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Management of coronary insufficiency after coronary artery bypass graft surgery
p. 570
Ahmed Ashraf Reda, Walaa Fareed Abdel Azeez, Mahmoud Kamel Ahmad, Neveen Ibrahim Samy
DOI
:10.4103/1110-2098.145516
Objective
The aim of this work was to study the management of coronary insufficiency in patients with prior coronary artery bypass grafting (CABG) either by medical treatment, by redo-CABG or by percutaneous coronary intervention (PCI).
Background
Coronary insufficiency after CABG is a problem, and there are three different strategies for its management: medical treatment, redo-CABG, and PCI.
Patients and methods
This is a prospective nonrandomized study conducted at ASSALAM International Hospital on 62 patients with prior CABG who were referred for coronary angiography for the evaluation of chest pain and were followed for 1 year to assess the occurrence of major adverse cardiac event and recurrent chest pain after a physician-directed management choice.
Results
Of the patients included, 15 (24.2%) were advised for intensification of medical treatment, six (9.7%) were referred for redo-CABG, whereas 41 (66.1%) patients underwent PCI. Management of post-CABG coronary insufficiency depends on several factors including the date since CABG, the extent of native coronary artery disease, the percentage of venous graft diseased, and the presence of diseased left internal mammary artery supplying LAD. There was no significant difference in the outcome with regard to recurrent chest pain or major adverse cardiac event between these groups. However, procedural success was significantly higher in PCI to native coronary arteries (96.8%) than in PCI to saphenous vein graft (70%).
Conclusion
In patients with coronary insufficiency after CABG, there was no significant difference in the patient outcome between different management strategies including medical treatment, redo-CABG or PCI.
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Effects of regional analgesia versus intravenous morphine on electroencephalographic waves in response to noxious stimuli during general anesthesia
p. 577
Mohammed H Afifi, Ayman A Rady, Hala M Koptan, A Alahmar, Mohammed M Abdalla
DOI
:10.4103/1110-2098.145517
Objectives
We used the unprocessed electroencephalographic (EEG) analysis during general anesthesia (GA) to assess the effects of regional analgesia versus morphine (intravenously) on EEG waves in response to noxious stimuli (endotracheal intubation and skin incision).
Background
Noxious stimuli during GA cause EEG changes that represent the cerebral processing of noxious stimuli. Interpreting these changes could maintain balance between too much and too little anesthetics or using specific techniques (e.g. regional analgesia).
Materials and methods
Sixty consenting ASA I or II adult patients undergoing lower abdominal surgery were randomly assigned into two groups: the epidural group received 15 ml bupivacaine 0.25% epidurally to attain sensory analgesia up to T6 followed by induction of GA and the morphine group received intravenous morphine (0.1 mg/kg), 5 min before induction of GA. Arterial blood pressure, heart rate, respiratory rate, arterial O
2
saturation, and end-tidal CO
2
were monitored. EEG recordings were analyzed for the 10 Hz score, high-frequency variability index (HFVI), and delta power at different time points (1 min before and after the noxious stimuli).
Results
Within the same group, comparing the prenoxious with postnoxious stimuli, EEG changes showed highly significant statistical difference in both groups (e.g. in the epidural group, 10 Hz score changed by intubation from 0.27 ± 0.04 to 0.21 ± 0.03 and by incision from 0.31 ± 0.04 to 0.28 ± 0.03) - that is, marked decrease in its value. Comparing EEG parameters between both groups was insignificant. Comparing the preintubation and postintubation difference between both groups showed significant statistical difference regarding 10 Hz score (epidural = 0.06 ± 0.02 > morphine = 0.05 ± 0.01) and no significance regarding HFVI and delta power. Comparing the preincision and postincision difference between both groups showed significant statistical difference regarding 10 Hz score (epidural = 0.03 ± 0.01 < morphine = 0.05 ± 0.01) and HFVI (epidural = 0.80 ± 0.16 < morphine = 1.0 ± 0.17) and high significance regarding delta power (epidural = 15.0 ± 2.77 < morphine = 25.0 ± 6.64).
Conclusion
Using unprocessed EEG for monitoring the intraoperative adequacy of analgesia showed less response to noxious stimuli with epidural analgesia than systemic opioids as reflected by less EEG changes in the epidural group.
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Study of the heat shock protein 70-1 gene polymorphism and the risk of nephropathy in type II diabetic patients
p. 582
Naglaa M Ghanayem, Maathir K El-Shafie, Eman A.F. Badr, Elsayed Elnour, Said S Khamis, Eman M Abd El Gayed
DOI
:10.4103/1110-2098.145519
Objective
To study whether the heat shock protein 70-1 (HSP70-1) gene polymorphism affects susceptibility to diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM).
Background
Heat shock proteins (HSPs) are molecular chaperones synthesized under stressful conditions and are involved in renal cell survival and matrix remodeling in acute and chronic renal diseases.
Patients and methods
This study was carried out on 80 patients divided into three groups: 30 patients with T2DM with DN (group I), 30 T2DM patients without DN (group II), with duration of diabetes more than 10 years in both patient groups, and 20 healthy individuals who served as controls (group III). All studied participants were subjected to a full assessment of history, general clinical examination, and laboratory investigations including determination of fasting blood glucose, total cholesterol, glycated hemoglobin (HBA1c), serum urea, serum creatinine, and urinary albumin to creatinine ratio. The HSP70-1 gene polymorphism -110 A/C was determined using the PCR-restriction fragment length polymorphism technique.
Results
The results of the present study showed a highly significant statistical difference between group I and group II in family history, systolic and diastolic blood pressure, and duration of diabetes. Significant differences were observed for the -110 A/C genotype distribution on comparing the three studied groups, with increased frequency of the CC genotype in diabetic patients with DN, increased frequency of the AC genotype in diabetic patients without DN, and increased AA genotype frequency in the controls. CC genotypes of -110 A/C might represent a genetic risk factor for DN on comparing group I with group III.
Conclusion
This result indicates that HSP70-1 CC genotypes of -110 A/C are highly associated with renal complications in patients with T2DM and can be a useful marker in identifying patients with an increased risk of DN.
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The potential association of heat shock protein 70-2 + 1267 A/G gene polymorphism with nephropathy in type II diabetic patients
p. 589
Naglaa Mohammed Ghanayem, Said Sayed Ahmed Khamis, Maathir Kamel El-Shafie, Yasser Abd El-Sattar El-Ghobashi, Rania Mohammed Azmy Mohammed El-Shazly, Mona Salah El-Din Mahmoud Habib
DOI
:10.4103/1110-2098.145521
Objective
The aim of the study was to assess the association between heat shock protein (HSP) 70-2 + 1267 A/G polymorphism and diabetic nephropathy (DN) in type II diabetes mellitus.
Background
DN is a life-threatening microvascular complication of type II diabetes. Oxidative stress plays a main role in its pathogenesis. As a consequence, a cellular adaptive response occurs requiring functional chaperones, so that the induction of HSPs is a maintained response in counteracting this oxidative stress. HSP70-2 + 1267 A/G and HSP70-hom + 2437 T/C polymorphisms may play an important role in susceptibility to and/or progression of DN.
Patients and methods
Sixty type II diabetic patients (30 patients with DN and 30 patients free of DN) and 20 healthy individuals, as the control group, were selected. Participants were genotyped for the HSP70-2 + 1267 A/G and HSP70-hom + 2437 T/C polymorphisms by PCR/restriction fragment length polymorphism.
Results
There was significant difference for
HSP70
-
2 + 1267
A/G
polymorphism. GG genotype and G allele were more frequent in the DN group versus other groups, whereas there was no significant difference in genotype and allele distributions among the three studied groups for the
HSP70-hom
polymorphism. On comparing diabetics with nephropathy versus diabetics without nephropathy, the odds ratio of the risk allele (G) of
HSP70
-
2
+ 1267 was 4.60 (95% confidence interval 2.09-10.12) and was 0.45 (95% confidence interval 0.15-1.42) for the risk allele (C) of
HSP70-hom
+ 2437 T/C polymorphism.
Conclusion
HSP70
-
2
+ 1267 A/G polymorphism is associated with renal complications in type II diabetic patients and may be useful in identifying patients with increased risk for DN.
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Interleukin 1β and metalloproteinase 3 gene polymorphisms in hepatocellular carcinoma patients in Egypt
p. 594
Ahmad Abass Rauf, Hatem Mahmoud El-Sebaa, Maathir Kamel El-Shafie, Ashraf Yousif El-Fert, Samar Ebrahim Mohmmed Ghanem
DOI
:10.4103/1110-2098.145523
Objective
The aim of this study was to evaluate the association between interleukin (IL)-1β −31T/C and matrix metalloproteinase 3 (MMP3) −1171 single-nucleotide polymorphisms and the susceptibility of hepatocellular carcinoma (HCC) patients.
Background
IL-1β is an important cytokine. IL-1β −31T/C polymorphism located in the promoter region of IL-1β has been linked to an elevated risk of HCC. MMP3 is a MMP that has proteolytic activity. MMP3 polymorphism at 1171 has been linked to an elevated risk and a highly invasive type of HCC.
Patients and methods
This study included 30 HCC patients, 30 hepatitis C virus (HCV) patients, and 20 healthy controls. IL-1β and MMP3 polymorphisms were genotyped using the restriction fragment length polymorphism discrimination assay technique.
Results
Data revealed that the frequency of IL-1β C/T and MMP3 5A/6A polymorphisms were higher in patient groups (HCC and HCV) compared with healthy controls. Our results indicated a significant association between IL-1β C/T polymorphism and HCC susceptibility; also, a significant association was detected between MMP3 5A/6A polymorphism and HCC susceptibility.
Conclusion
These results suggested that IL-1β C/T and MMP3 5A/6A polymorphisms are associated with an increased risk of developing HCC in Egyptian patients.
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Prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae in Menoufia University Hospitals
p. 602
Amira A El-Hendi, Ayman M El-Lehleh, Abeer H El-Shalakany, Sheriene M Moussa
DOI
:10.4103/1110-2098.145525
Objective
The aim of the study was to evaluate the prevalence of extended-spectrum β-lactamase (ESBLs) in Enterobacteriaceae among patients conducted at Menoufia University Hospitals.
Background
Resistance to β-lactam antibiotics is an increasing problem, and β-lactamase production is the most common mechanism of drug resistance, especially in Enterobacteriaceae. The Clinical and Laboratory Standard Institute (CLSI) interpretive guidelines stated that Enterobacteriaceae that produce ESBLs are resistant to therapy with penicillin, cephalosporins, and aztreonam, despite apparent in-vitro susceptibility to some of these agents. Therefore, detection of ESBLs in Enterobacteriaceae is crucial for optimal treatment of patients and to control the spread of resistance.
Patients and methods
The isolated strains of Enterobacteriaceae are subjected to phenotype detection by screening for ESBLs by disk diffusion test then to confirmatory tests for ESBLs by double disk test.
Results
A total of 97 of 160 (60.6%) isolates were found to be ESBL producers by the CLSI confirmatory method. Of 97 ESBL producers, 45 (46.4%) were
Escherichia
coli
, 28 (28.9%) were
Enterobacter
spp., and 22 (22.7%) were
Klebsiella
spp. Of the various clinical samples, the most frequent ESBLs isolates were from urine samples (27.8%), followed by sputum samples (18.6%).
Conclusion
High prevalence of ESBL producers in our hospital (60.6%) calls for strict policies regarding antibiotic usage and their screening methods, and hospital-based clinical laboratories should screen isolates following hospitalization in patients in need for antibiotics to formulate effective antibiotic strategy and plan a proper hospital infection control strategy to prevent the spread of these ESBL strains.
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A study on the rheumatic manifestations of psoriasis
p. 606
Abd El-Samed I El-Hewala, Samar G Soliman, Jehan D Fayed, Mohammed A Gaber, Yassen S Yassen
DOI
:10.4103/1110-2098.145527
Objectives
The aim of this study was to determine the types of rheumatic manifestations in psoriasis patients and their correlation with psoriasis skin and nail lesions.
Background
The characteristic of inflammatory arthropathy associated with psoriasis is termed psoriatic arthritis (PsA) and is placed in a group known as seronegative spondyloarthropathies.
Materials and methods
In all, 100 patients with psoriasis were included in this study. They were divided according to the presence of rheumatic manifestations: patients with no rheumatic manifestations, patients with PsA, and patients with other rheumatic manifestations. Disease assessment scores such as the Psoriasis Area and Severity Index score for psoriasis severity and the Moll and Wright criteria for the PsA type were used.
Results
Forty-two percent had no rheumatic manifestations, 40% had PsA according to CASPAR criteria, and 18% had other rheumatic manifestations. In the PsA group, 57.5% had spondyloarthritis, 20% had a distal interphalangeal joint, 7.5% had polyarthritis, 10% had oligoarthritis, and 5% had arthritis mutilans. Clinical sacroiliitis occurred in 18% of the psoriasis patients and in 45% with PsA. Axial arthritis occurred in 21% of the psoriasis patients and in 52.5% with PsA. Clinical enthesitis occurred in 27% of the psoriasis patients and in 55% with PsA. Dactylitis occurred in 4% of the psoriasis patients and in 10% with PsA. Peripheral arthritis occurred in 20% of the psoriasis patients and in 42.5% with PsA. Distal interphalangeal arthritis occurred in 7% of the psoriasis patients and in 17.5% with PsA.
Conclusion
The prevalence of PsA was 40% in the studied patients with psoriasis, and the most prevalent type of PsA was spondyloarthritis. PsA occurred most commonly at an older age and with a longer duration of psoriasis. The most prevalent rheumatic manifestations were arthralgia, enthesitis, axial arthritis, sacroiliitis, and peripheral arthritis.
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Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children
p. 612
Fathea El-Nmer, Aml A Salama, Dalia Elhawary
DOI
:10.4103/1110-2098.145529
Objective
The aim of the study was to assess the effect of parental nutritional knowledge, attitude, and practice (KAP) on their children nutritional behavior and growth.
Background
Good nutrition is cornerstone for growing children during early childhood and school-age years; children begin to establish habits for eating and exercise that stick with them for their entire lives. If children establish healthy habits, their risk for developing many chronic diseases will be greatly decreased.
Participants and methods
This was a cross-sectional study through multistage stratified random sampling technique. Bialla district of Kafr-Elsheikh governorate was selected randomly from 10 district of Kafr-Elsheikh governorate. Predesigned questionnaires that assess parents and children (KAP) were then given to parents and children and 120 pairs of completed questionnaires were returned.
Results
There was no significant correlation between nutritional knowledge (KAP) of parents and nutritional practice of their children (
P
>0.05), whereas there was a significant correlation between parent's knowledge score and healthy food intake in general by children (
r
= 0.222;
P
< 0.05). There was no significant correlation between nutritional practice of children and their BMI and height, whereas there was significant correlation between nutritional practice of children and their weight. There was a highly significant correlation between social class of parents and their children nutritional behavior; in addition, there is significant correlation between father's education and mother's education and their children nutritional practice (χ
2
= 15.3 and 14.6;
P
= 0.018 and 0.023, respectively).
Conclusion
There is no relationship between parents knowledge, attitude, and healthy food intake by their children. Parents education and socioeconomic status constituted important determinants of healthy food intake by their children.
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Quality of drinking water in Menoufia Governorate
p. 617
Rabie El Bahnasy, Hewaida El Shazly, Manal Al Batanony, Hala M Gabr, Ghadeer M El Sheikh
DOI
:10.4103/1110-2098.145530
Objectives
The aim of the study was to assess the quality of drinking water of different sources in Menoufia Governorate.
Background
Access to safe drinking water is one of the basic human rights and is essential for healthy life. Failures in water treatment processes and recontamination of treated drinking water are the major causes of morbidity and mortality worldwide. Therefore, monitoring of drinking water from source to tap is an essential step toward hygiene safety.
Materials and methods
A cross-sectional study was carried out in Menoufia Governorate. Five towns and five villages were chosen randomly. Ten samples were taken from the main water stations in these areas and 150 samples were taken around each station. Five samples were taken from private stations, five samples were taken from water carts, and another five samples were taken from home filters.
Results
Parameters of water quality of studied samples were within the Egyptian standards, except for turbidity, iron, manganese, free available chlorine, coliform group, and total bacterial count. Seventeen samples have exceeded the Egyptian standards for turbidity. Regarding manganese and iron, there were 34 and 44% of the samples that exceeded the Egyptian standards for manganese and iron, respectively. Free available chlorine of 41 samples was outside the standards. In all, 22% of the samples showed count above the standard level of total coliforms. In addition, 28% of the samples showed total bacterial count greater than 50 cells/cm
3
.
Conclusion
Parameters of water quality of studied samples were within the permissible limit of the Egyptian standards except for increased levels of turbidity, ammonia, iron, and manganese in addition to presence of residual chlorine concentrations lower than the standards. Similarly, drinking water was also contaminated with coliform bacteria. Therefore, we advocate regular water quality monitoring with special emphasis on water distribution system and private water stations for the safety of public health.
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© Menoufia Medical Journal | Published by
Wolters Kluwer Health
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Online since 31 Jan, 2014