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   2017| January-March  | Volume 30 | Issue 1  
    Online since July 25, 2017

 
 
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ORIGINAL ARTICLES
Application of platelet-rich plasma preparation rich in growth factors in knee osteoarthritis
Laila M Montasera, Taher A Eid, Mohamed A Helwa, Marwa K Mesregah
January-March 2017, 30(1):139-146
DOI:10.4103/mmj.mmj_512_15  
Objective The aim of this study was to determine the regenerative properties of intra-articular injections of autologous platelet-rich plasma (PRP) in improving knee osteoarthritic patients and to determine the correlation of platelet count and transforming growth factor-β1 (TGF-β1) with clinical improvement. Background Platelets have an important role in primary as well as secondary hemostasis; however, its regenerative capability is not widely studied. Osteoarthritis (OA) is a cartilage degenerative process. No treatment is available to improve this process. Patients and methods The study was conducted on 28 patients suffering from primary knee OA grades II and III injected with PRP preparation after failure of conservative treatment. Patients received two injections 3 weeks apart, and then were followed up for 6 months using the Western Ontario and McMaster Universities Arthritis Index and radiography. Platelet count and TGF-β1 were measured in PRP to ensure platelet activation and release and to evaluate their role in improvement of the condition. Results At the end of follow-up period, there were no adverse events reported and all Western Ontario and McMaster Universities Arthritis Index parameters were significantly improved. Better results were recorded in patients with a low degree of cartilage degeneration (P = 0.004). Platelets and TGF-β1 showed a highly significant increase in PRP compared with their basal level (P < 0.001). Patients achieving an excellent response had statistically higher platelet counts and TGF-β1 in PRP. To predict excellent response to PRP, platelet count in PRP had a cutoff of 1001.25 × 109/l, whereas TGF-β1 had at a cutoff concentration of 128.25 ng/ml. Conclusion Intra-articular injection with autologous PRP is a safe, minimally invasive, low-cost procedure to deliver growth factors for cartilage healing and regeneration. Hence, it is useful for the treatment of OA of the knee, aiming to reduce pain and improve knee function and quality of life. Platelet count and TGF-β levels in PRP are important predictors of improvement.
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Differentiation of mesenchymal stem cells into vascular endothelial cells: the future revascularization therapy in ischemic tissue
Rawhia H El-Edela, Hala G Metwally, Seham A Khodeer, Rasha I Nor El-Din, Thoria A Abd El-Hameed Omar
January-March 2017, 30(1):147-150
DOI:10.4103/1110-2098.211487  
Objectives The objective of this study was to investigate the in-vitro differentiation of mesenchymal stem cells (MSCs) into cells of the endothelial lineage. Background All tissues depend on the blood supply, and blood supply depends on endothelial cells (ECs). Vascular ECs derived from stem cells could be used in therapeutic strategies for the repair and revascularization of ischemic tissue in patients exhibiting vascular defects. MSCs that can be separated from different tissues have the ability for self-renewal, they can be differentiated into different tissues, and they help in the regeneration of damaged tissue in tissue engineering. Materials and methods This study was carried out on 20 bone marrow samples. A volume of 5 ml of bone marrow was aspirated. Mononuclear cells were separated using Ficoll–Hypaque solution. MSCs were separated from the mononuclear cell fraction using plastic adherence. MSCs were subcultured in 35-mm Petri dishes and then treated with vascular endothelial growth factors. Results MSCs were generated out of mononuclear bone marrow cells. Isolated MSCs were positive for the marker CD44 and negative for CD34. They were able to differentiate into ECs. ECs can be identified by morphology, flow cytometric analysis to detect CD34+, and hematoxylin and eosin staining. Conclusion The present study shows that bone-marrow-derived MSCs can be differentiated in vitro to ECs as future revascularization therapy in ischemic tissue.
  1 566 59
Role of magnetic resonance in evaluation of urinary bladder cancer
Ashraf A Zytoon, Sameh M Azab, Walaa A Abo Samak
January-March 2017, 30(1):104-109
DOI:10.4103/1110-2098.211486  
Objective The aim of this study was to prospectively evaluate the use of MRI as a noninvasive diagnostic tool for staging of bladder tumors using different magnetic resonance (MR) sequences: T2-weighted image (T2WI), diffusion-weighted image (DWI), and precontrast and postcontrast T1-weighted image. Background MRI with its superior resolution and supplemented with new emerging sequences is the optimal imaging modality for accurate local staging of bladder cancer, particularly for differentiation between the muscle-invasive and non-muscle-invasive urinary bladder tumors; it is a cornerstone in treatment decision making. Patients and methods The study protocol received institutional ethical committee approval, and informed consent was obtained. Between November 2014 and November 2015, 50 consecutive patients (44 men and 6 women; mean age: 64.3 years; range: 44–85 years) who presented with gross hematuria or suspected urinary bladder tumors were enrolled prospectively. All patients underwent MR examination followed by conventional cystoscopy. The patients were evaluated using T2-weighted high-spatial-resolution MRI of the urinary bladder, followed by diffusion-weighted-MRI. Precontrast T1 (with or without fat suppression) and immediate postgadolinium injection were performed if there were no contraindications. Results Of all 50 patients, four (8%) were at T1, 12 (24%) were at T2, 23 (46%) were at T3, and 11 (22%) were at T4. The most common symptom was gross hematuria (33 patients; 66%). The overall accuracy of T2WI, DWI, and postcontrast imaging sequences in differentiating stage Tis to T2 tumors from T3 to T4 tumors was 88, 98, and 94%, respectively. DWI has a higher overall accuracy compared with both T2WI and postcontrast T1-weighted image in T staging of bladder cancer. Conclusion MRI with new emerging sequences (diffusion-weighted and contrast-enhanced) is highly reliable for accurate local staging of urinary bladder cancer, which is similar to that of conventional cystoscopy. This noninvasive method could be efficiently used for evaluating patients with hematuria of lower urinary tract origin.
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Iron deficiency anemia among preschool children (2–6 years) in a slum area (Alexandria, Egypt): an intervention study
Gafar M Abdel-Rasoul, Fady M Elgendy, Mostafa L Abd Elrazek
January-March 2017, 30(1):213-220
DOI:10.4103/1110-2098.211534  
Objective The aim of this study was to assess the prevalence of iron deficiency anemia (IDA) among preschool children in a slum area of Alexandria governorate. Background According to the WHO, anemia due to iron deficiency is the most common nutritional disorder in the world. Two billion people – over 30% of the world's population – are anemic, mainly due to iron deficiency. Participants and methods A cross-sectional comparative study was carried out on 90 children living in a slum area in the east district of Alexandria governorate. Results Mother's age, mother's education, socioeconomic standard, and family size were significantly different between healthy and anemic children. Parasitic infestations were significantly higher among anemic children than among healthy children. Conclusion Prevalence of IDA among preschool children was 52.2%. Prevalence of IDA was higher in girls than in boys but did not reach a significant level. On the other hand, there was a significant association between the prevalence of IDA and mother's age and family size.
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Study of demographic and clinical characteristics of bronchial asthma patients in Mahalla Chest Hospital during the period from March 2013 to February 2014
Ali A Mabrouk, Amal A Abd El-Aziz, Mohammed A Agha, Dalia A Kashlana
January-March 2017, 30(1):241-248
DOI:10.4103/1110-2098.211481  
Objectives The aim of this work was to study bronchial asthma patients in Mahalla Chest Hospital during the period from March 2013 to February 2014 as regards the epidemiology, demographic characteristics, clinical characteristics of the patients, and prescription pattern, whenever available. Background Bronchial asthma is a serious global health problem and arising problem in Egypt. Prevalence, morbidity, and mortality in Egypt are still lacking and have to be estimated, and hence studies are needed in all governorates to assess the global burden of bronchial asthma in Egypt. Patients and methods This study was conducted at Mahalla Chest Hospital, and included 212 adult patients who had bronchial asthma with a wide range of asthma severity, from those attending the outpatient clinic and those admitted in Mahalla Chest Hospital during the period from March 2013 to February 2014 to provide adequate epidemiological analysis. Data from patients were collected through a questionnaire. Results In this study, 28.77% of cases were severe persistent cases, 29.72% were mild persistent cases, and 41.51% were moderate persistent cases. The average age was 44.57%. Asthmatic attacks were precipitated by outdoor allergens in about 34.9% of the studied cases. An overall 18.4% of the studied cases suffered from attacks triggered by tobacco smoke, and infection trigger attacks were observed in 15.09% of cases. An overall 52.4% of asthmatic patients were exposed to passive smoking and mainly they were female. Conclusion The mean age of the patients was 44.57 years. The majority of them were female and were exposed to passive smoking at home. The majority of the studied cases were overweight, with an average BMI of 26.7 kg/m2. Family history of bronchial asthma was found in 60.85% of the patients. Outdoor allergens were the most common precipitating factor for bronchial asthma. Only 35.4% of the studied cases were compliant to treatment.
  1 699 96
Biochemical and histopathological changes in the brain of albino rats treated with profenofos and the possible protective effect of vitamins C and E
Samy M Badawy, Samy A Hammad, Safaa A Amine, Amira M El-Seidy, Shireen R Abdou Slima
January-March 2017, 30(1):278-285
DOI:10.4103/mmj.mmj_476_16  
Objective The aim of this study was to evaluate the changes in the brain of albino rats treated with profenofos and the possible protective effect of vitamins C and E against the acute effect of profenofos. Background During the last decades the use of pesticides has increased steadily in developing countries in an effort to increase food production and control vector-borne diseases in plants. Organophosphorus (OP) compounds are widely used in agriculture as insecticides. OP poisoning is common due to its wide availability. Profenofos is a widely used insecticide and has been classified as moderately hazardous. OP pesticides are known to inhibit cholinesterase activity in target tissues. Oxidative stress is one of the possible mechanisms that could be involved in OP toxicity. Patients and methods Eighty adult male albino rats were divided randomly into four main groups: the control group (I), the profenofos toxicity group (group II), the profenofos + antidote-treated group (group III), and the profenofos + antidote + antioxidant-treated group (group IV). Each treated group was divided equally into two subgroups. Ten rats from each subgroup were killed after 24 h to demonstrate the toxicity. The other 10 rats were killed after 7 days to demonstrate the recovery. Brain samples were obtained for biochemical, histopathological, and immunohistochemical studies. Results Acute exposure to profenofos causes biochemical and histopathological changes in brain tissue. These changes were minimized with atropine and oxime treatment. However, this recovery was more prominent in the group administered vitamins C and E. Conclusion Treatment with vitamins C and E exerts an antioxidative effect and this may be responsible for the amelioration of profenofos-provoked toxicity.
  1 924 144
The current situation regarding awareness about female genital mutilation among men working in schools of Benha City, Qaluobia Governorate
Hala M Shaheen, Zeinab A Kasemy, Fatma M Salah Eldeen
January-March 2017, 30(1):23-27
DOI:10.4103/mmj.mmj_542_15  
Objective The aim of the study is to assess awareness among men regarding female genital mutilation (FGM) and practice of circumcision of their daughters. Background FGM is an ancient practice that constitutes an extreme form of discrimination and violation against human rights of female. The prevalence of FGM in Egypt is 91%, and the prevalence of FGM among daughters aged 15–17 years is 74%. Men have an essential role to play in the elimination of violence against women and prevention of FGM, as they play an essential role in decision making regarding circumcision of their daughters. Participants and methods It was a cross-section study. Men who worked in seven governmental schools represented a sample of men working in schools of Benha City, Qaluobia Governorate. Married and unmarried men were included. The sample size was calculated to be 296 males, aged 20–60 years, which was increased to 300. All participants were interviewed using predesigned questionnaire to assess their awareness about different items related to FGM and practicing of circumcision to their daughters. Results This study showed that all participants had heard about FGM. The majority of them had this practice in their families, and 66.7% of them supported the practice. Moreover, this study revealed that the main cause of practicing FGM is tradition. The decision of practicing FGM is made mainly by fathers, and 62% believed that there was no problem regarding uncircumcised women. Approximately half (49%) of the participants believed that men have a role regarding FGM through participation in decision-making process. Three-quarters of participants had daughters, and 63.7% of them had mutilated daughters. Nearly half of those who had no daughters intended to circumcise their future daughters. Conclusion Men have an important role in continuation of FGM. Therefore, program for its prevention should include men in their disciplines, as they play an important role in elimination of circumcision.
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Results of using the Ilizarov method for correction of complex foot and ankle deformities in skeletally mature patients
Hazem El-Tayeby, Khaled Emara, Hesham Ghoneem, Ahmed Zayda, Emad Badawy
January-March 2017, 30(1):310-315
DOI:10.4103/mmj.mmj_6_16  
Objective Our aim was to study the results of correction of complex foot and ankle deformities in skeletally mature patients using the Ilizarov method with either osteotomy or arthrodesis. Background Complex foot and ankle deformity is a multiplanar one with shortening of the foot. Different corrective procedures have been described for correction of these deformities in skeletally mature patients, such as extensive soft tissue release with capsulotomy, tendon transfer, multiple osteotomies, and arthrodesis. Acute correction with internal fixation methods has many disadvantages such as excessive shortening of the foot, risk for neurovascular bundle injury, high risk for recurrence due to extensive scar formation, and high risk for wound complications. Patients and methods In this study, an Ilizarov external fixator was used for correction of 25 complex foot and ankle deformities in 23 patients with either bone osteotomy, which was done in 12 feet, or arthrodesis in another 13 feet. Results Complete clinical correction of all feet to a plantigrade position was obtained, gait was improved in all cases, and pain was the same, improved, or completely eliminated. Partial relapse of the deformity with recurrence of symptoms occurred in three cases. Conclusion The Ilizarov method of external fixation is an effective, safe, and reliable method for correction of complex foot and ankle deformities in skeletally mature patients, where correction is achieved by performing gradual distraction of foot osteotomies or arthrodesis.
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Health-related disorders on occupational exposure to chromium in a leather tanning factory (Menoufia, Egypt)
Gaafar M Abdel Rasoul, Mahmoud E Abou Salem, Heba K Allam, Zeinab A Kasemy, Faten E Younis
January-March 2017, 30(1):92-98
DOI:10.4103/1110-2098.211508  
Objectives The aim of this study was to study health disorders among workers in a leather tanning industry and its relation with workplace environment in the same factory. Background Leather tanning industry wastes pose serious environmental effect on water, land, and air. Leather tanning manufacture processes are also associated with a number of human health risks. Chromium (Cr) is the commonest used tanning agent to stabilize leather against biodegradation. Prolonged exposure to Cr compounds leads to long-term toxic effects in humans. Participants and methods A cross-sectional comparative study was conducted on 304 workers in a leather tanning factory and 304 nonoccupationally exposed subjects as control. Air samples for Cr (VI) were carried out. Biological monitoring of Cr in blood and urine of participants was done. Spirometric measurements and hematological investigations were applied. Results The mean value of airborne Cr (VI) concentration was higher than the international permissible levels. There were higher serum and urinary Cr levels among exposed workers than controls (P = 0.000). Leather tanning factory workers had a higher significant prevalence of respiratory and skin-related manifestations as well as decreased spirometric measurements and abnormal hematological findings (P = 0.000). Conclusion Exposure to high level of Cr is blamed to increase the frequency of skin-related and respiratory manifestations, early spirometric changes, and abnormal hematological findings. Regular wearing of good-quality personal protective equipment, especially masks and gloves, to decrease Cr exposure is highly recommended.
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CASE REPORTS
'Humming bird sign', 'Mickey Mouse sign', and 'morning glory sign' in progressive supranuclear palsy
Muhammed Jasim A Jalal, Murali K Menon
January-March 2017, 30(1):325-326
DOI:10.4103/mmj.mmj_204_16  
Progressive supranuclear palsy (PSP), also known as the Steele–Richardson–Olszewski syndrome, is a form of Parkinson-plus syndrome. Patients with PSP show interesting radiological signs such as the 'Humming bird sign' and the 'Mickey mouse sign'. Here, we report a patient with PSP, in whom the MRI brain demonstrated the 'Humming bird sign', the 'Mickey mouse sign', and the 'Morning glory sign'.
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Peripheral giant cell granuloma: An unusual clinical presentation
Vivek Kumar, Amitandra K Tripathi, Neelu Verma, Charanjit S Saimbi
January-March 2017, 30(1):327-329
DOI:10.4103/1110-2098.211526  
Peripheral giant cell granuloma (PGCG) is a non-neoplastic lesion representing a local hyperplastic reaction to injury or inflammation. Lesions vary in appearance from smooth, regularly outlined masses to irregularly shaped, multilobulated protuberances with surface indentations. Ulcerations of the margin is occasionally seen. The lesions are painless, vary in size, and may cover several teeth. This article reports a case of PGCG arising at the mandibular anterior region in a 45-year-old man. The biopsy specimen revealed features consistent with PGCG. The clinical follow-up revealed uneventful soft tissue healing.
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LETTERS TO THE EDITOR
Viral hepatitis: an unsung killer disease
Raja Danasekaran, Kalaivani Annadurai, Geetha Mani
January-March 2017, 30(1):330-331
DOI:10.4103/1110-2098.211504  
  - 325 37
Exploring the role of color-coding in ensuring delivery of quality-assured healthcare services
Shrivastava R Saurabh, Shrivastava S Prateek, Ramasamy Jegadeesh
January-March 2017, 30(1):331-332
DOI:10.4103/1110-2098.211513  
  - 289 36
ORIGINAL ARTICLES
Disruptive behavior disorders among basic-learning schoolchildren at Quweisna District, Menoufia Governorate, Egypt (2014/2015)
Taghreed M Farahat, Mohammad M AlKot, Nora A Khalil, Eman G Saleh, Safa H Al Kalash
January-March 2017, 30(1):34-38
DOI:10.4103/mmj.mmj_90_16  
Background Disruptive behavior disorders (DBDs) are psychiatric disorders of children and adolescents, including oppositional defiant disorder (ODD) and conduct disorder (CD). It is associated with an increased risk for negative developmental outcomes including substance abuse, school problems, and antisocial or criminal violence. Objective The objective of this study was to assess the prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, its types, and its risk factors. Participants and methods A cross-sectional study was conducted on 348 basic-learning schoolchildren and their parents, as well as their teachers. Children were subjected to mini-kids interview for diagnosis of DBDs and then 'Parenting Manner Scale' for the detection of parenting style. Parents and teachers rated the child's behavior at home and school, respectively, during the past 6 months. Parents were subjected to the socioeconomic status scale. Results Prevalence of DBDs was 14.9%. The prevalence of ODD and CD was 8 and 6.9%, respectively. Mean age was significantly lower among patients (11.69 ± 1.6), with male sex predominance (69.2%). Low socioeconomic level (67.3%), interparental conflicts (36.5%), single parent (51.9%), and family history of neuropsychiatric disorders (65.4%) were significantly higher among cases. Overprotection (28.8 and 28.8%), discrimination between siblings (28.8 and 28.8%), and authoritarian parenting styles (17.3 and 19.2%), were significantly more prevalent among cases. Conclusion Prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, Egypt, was 14.9%. Its types were ODD and CD represented by 8 and 6.9%, respectively. Risk factors for DBDs among the studied group were low socioeconomic status, low parental education, father smoking, parental conflicts, family history of neuropsychiatric disorders, and bad parental styles among fathers and mothers (overprotection, discrimination, authoritarian, and hesitancy).
  - 495 49
Impact of compliance to therapy of congenital hypothyroidism on the neurodevelopmental outcome in Sharkia Governorate
Taghreed M Farahat, Eman A Elshorbagy, Nagwa N Hegazy, Walaa S Mohamed
January-March 2017, 30(1):39-43
DOI:10.4103/1110-2098.211519  
Objective The objective of this study was to evaluate the compliance to congenital hypothyroidism (CH) therapy and the effect of noncompliance on the physical and mental development. Background CH is the most common preventable cause of mental retardation in children. Early treatment and high compliance are important prognostic factors for mental and physical development in children with CH. Patients and methods A prospective study design was conducted in the Endocrinology Outpatient Clinics in Sharkia Governorate health insurance center. The participants were 120 newborns and infants with CH and their mothers (patients), and 120 age-matched volunteers of healthy infants and children and their mothers (control). Data were collected using multistructured questionnaires for determining the socioeconomic state, clinical picture, personal, family and obstetric history, and Morisky Medication Adherence Scale (MMAS 8) to assess compliance. Assessment of physical growth was carried out through anthropometric measurements and assessment of mental development was conducted using Vineland-II scale for infants below 2 years and using Stanford–Binet 5 Intelligence scales for individuals of 2 years and older. Review of the results of investigations at diagnosis and during the follow-up visits are provided. Results Two-thirds of the patient families were highly compliant. There was a very high significant difference between different compliance grades and between patients and control groups as regards the parameters of mental and physical development. No significant difference was found between the highly compliant cases and control. Conclusion Compliance to therapy in our patients and/or their family was reasonable. High compliance to treatment was an important prognostic factor for normal mental and physical development in patients with CH.
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Comparative study between elderly with medical problems living in endwelling houses and with families in Banha City
Hala M Shaheen, Safaa A Badr, Engy A El Sayed Saleh
January-March 2017, 30(1):44-50
DOI:10.4103/mmj.mmj_450_16  
Objectives The aim of the present study was to assess and compare common medical health problems among the elderly living either in endwelling homes or with their families. Background The WHO defines aging as a 'process of progressive change in the biological, psychological and social structure of individuals'. Generally, aging is associated with progressive functional loss in perception, cognition, memory, and deterioration of physiological capacities. Health problems tend to increase with advancing age and very often the problems aggravate because of neglect, poor economic status, social deprivation, and inappropriate dietary intake. Patients and methods This case-controlled study was conducted on 70 elderly cases, aged 60–75 years, recruited from two homes for elderly in Banha City and 140 elderly participants (control group) matched for age, sex, and socioeconomic status recruited from two geriatric clubs. Data collected using a predesigned structured questionnaire included sociodemographic data, common medical history, medication history and health-seeking behavior, health problems affecting nutrition, and reasons of stay in endwelling homes. Results Ischemic heart diseases (50%) and memory disorders and history of falls (37.1 and 52.9%, respectively) had the highest prevalence among geriatric home residents. No significant differences were found regarding different health problems and the number of morbidities or medications. Residence in geriatric homes was associated with a large family size, memory disorder, and nutritional risks. Conclusion Elderly people of both groups are unhealthy. Aged people in geriatric homes have a multisystem morbidity besides memory disorders, falls, depression, malnutrition, elderly abuse, and loss of family support. There is a great need to conduct more research to improve our understanding of elderly populations, their health and psychosocial problems. Social support and medical care of elderly residents in geriatric homes should receive more attention.
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Sexual harassment among female students of Menoufia University
Taghreed M Farahat, Gaafar M Abdel-Rasoul, Zeinab A Kasemy, Nesreen K Mohammed
January-March 2017, 30(1):51-56
DOI:10.4103/mmj.mmj_523_15  
Background Sexual harassment (SH) of students has recently become a topic of interest to researchers and the general public alike. Although numerous studies document its frequency, the development of conceptual models identifying the prevalence and consequences of harassment has proceeded at a slower pace. Objectives The study aimed at studying the prevalence of SH among female students of Menoufia University and its effects. Patients and methods A cross-sectional study was carried out on 1940 female university students (972 students in practical faculties and 968 students in theoretical ones), over a period of 7 months, between 15 March to 30 October 2015. The interview sites included classes of Menoufia University. Results The study shows the effectiveness of community-based targeted questionnaires in identifying SH among 1940 female university students. The prevalence of SH was 65.3% among the total studied number (64.6% in practical faculties and 65.9% among theoretical ones) (P = 0.548). The prevalence of different types of SH was as follows: verbal type, 76.5%; following, 12.8%; touching, 20.3%; and physical violence, 1.1%. A number of risk factors were behind exposure to SH, such as wearing tight clothes (odds ratio = 2.88, 2.01–4.11) and wearing hot colors (odds ratio = 2.11, 1.65–2.70). The effects of SH were as follows: feeling insecure (56.7%), depression (25.0%), self- reproach (15%), revenge desire (9.3), and denial (8.9%). Conclusion SH is prevalent in Menoufia Governorate with many serious effects.
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Mental health among working women in Tala District, Menoufia Governorate
Mahmoud E Abo Salem, Aml A Salama, Noha A Allam Negm
January-March 2017, 30(1):57-62
DOI:10.4103/1110-2098.211518  
Objective The aim of the present study was to estimate the impact of work on the mental health status of working women by using the General Health Questionnaire (GHQ)-28 and the efficacy of the stressor factors. Background Work can affect the general health status of women. Some personal factors as age and marital status and work factors as night shift, odd working hours, and relation with manager and colleagues have been suggested as possible causes of stress that affect significantly the mental health of working women. Patients and methods This cross-sectional study included 600 working women randomly selected from two family health units (Kashtoukh and Zawiatbemam), which were randomly selected from the family health units of Tala District, and from the only family health center in Tala. A sample representing both rural and urban areas of Tala District, Menoufia Governorate, was selected. Working women attended the selected family health units and the center for medical cause or worked with family members during their visits. Results Of the 600 participants, 16% had abnormal GHQ-28 scores of greater than or equal to 5. This abnormal general health status was statistically significant with participant age, residence, marital status, husband's education, family size, family income, number of school-going children, and government financial support. As regards work-related factors, night shift, odd working hours, personal relation with colleagues, and presence of conflict constituted significantly affected the mental health status of working women. Conclusion Mental health of working women can be affected significantly by some personal and some work-related factors. The present study reported that the abnormal GHQ result was prevalent among the studied working women.
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Low back pain among attendants to a Family Health Center in El-Dakahlia governorate, Egypt
Omima A Mahrous, Hala M Shaheen, Mahmoud M Hadhoud, Aliaa F Ahmed
January-March 2017, 30(1):28-33
DOI:10.4103/mmj.mmj_170_16  
Objective The aim of the study was to assess prevalence and degree of disability due to low back pain (LBP) among attendants to a Family Health Center. Background LBP is a serious medical and social problem and one of the most common causes of disability. Nearly everyone at some point suffers from LBP that interferes with work and recreational activity. Risk factors for LBP are multifactorial, including physical, improper social habits, and psychological factors. Patients and methods This was a case–control study nested in cross-sectional study. The study was conducted in Nusa-Gheit Family Health Center (El-Dakahlia governorate, Egypt) and included 154 attendances aged 18–60 years during the period of the study. Every participant was assessed for LBP through history taking and examination. In addition, the participants were assessed for degree of disability due to LBP using the Roland–Morris Disability Questionnaire. Results Prevalence of LBP was 53.2%. It was more among female patients (62.8%) than among male patients (38.3%). There was a statistically significant relationship between LBP and being female (P = 0.003, odds ratio = 2.71), smokers (P = 0.01, odds ratio = 6.5), and with increasing BMI. Furthermore, there was a statistically significant relationship between degree of disability and both different age groups (P = 0.002, odds ratio = 0.19) and marital status (P = 0.009, odds ratio = 0.06). As regards age, it was more common among patients aged greater than or equal to 40 years (86.2%). Regarding the severity of disability, severe disability was noted among male patients (78.3%) and married patients (80.5%). LBP affected the regularity of attending work. Conclusion LBP is highly prevalent among women, divorcees/windows, elderly, smokers, and obese individuals. Recommendation Primary healthcare physicians should use the evidence-based strategy in diagnosing and management of LBP. Integration of topic-related to diagnosis, management referral indication in Egyptian national guideline for family physician. Moreover, LBP prevention programs among patients should focus on improved working environment and decreased risk factors of LBP.
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Effect of exercise and melatonin on fructose-induced hepatic dysfunction in a metabolic syndrome rat model
Hesham A Abdel-Razek, Gergess S Hanna, Elsayed S Abou-Elnour, Suzy F Ewida, Ghada S Amer, Heba R Salem
January-March 2017, 30(1):286-296
DOI:10.4103/1110-2098.211506  
Objectives The aims of this study were to investigate the effect of swimming exercise and/or melatonin administration on liver function as well as certain metabolic aspects in a fructose-induced metabolic syndrome (MS) rat model and to determine whether the combined treatment provides higher protection than each treatment alone. Background MS is a major health challenge that leads to many complications including hepatic dysfunction. This has raised attention to the possible strategies for its prevention. Materials and methods Eighty, adult, male albino rats were equally divided into two main groups: group I received a standard rat chow diet, and group II received a fructose-rich diet for 6 weeks to induce MS. Rats of group I were equally subdivided into four groups: sedentary nontreated control, swimming exercise-trained control, melatonin-administered control, and combined swimming exercise-trained and melatonin-administered control groups. Similarly, rats of group II were equally subdivided into four groups: sedentary nontreated fructose-fed, swimming exercise-trained fructose-fed, melatonin-administered fructose-fed, and combined swimming exercise-trained and melatonin-administered fructose-fed groups. After 6 weeks, body weight change was assessed, and blood samples were collected for biochemical analysis. Next, arterial blood pressure was measured. Finally, rats were killed, and the liver was excised for biochemical and histopathological examination. Results Feeding a fructose-rich diet for 6 weeks induced MS with fatty liver in rats. Swimming exercise and/or melatonin improved most of the harmful effects in fructose-fed rats. Conclusion Both swimming exercise training and melatonin administration may provide a new strategy for MS prevention.
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Surfactant protein D in chronic obstructive pulmonary disease and type 2 diabetes mellitus
Naglaa M Ghanayem, Elsayed S Abou Elnour, Rabab A El Wahsh, Rania M.A. El-Shazlya, Mai A.H. Abou Elenin
January-March 2017, 30(1):297-304
DOI:10.4103/mmj.mmj_525_15  
Objective The objective of this study was to evaluate the role of serum surfactant protein D (SP-D) in chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM). Background SP-D plays a critical role in innate host defense of the lung. SP-D binds bacterial, fungal, and viral pathogens, enhancing their opsonization and their killing by alveolar macrophages. COPD may be considered as a novel risk factor for T2DM via multiple pathophysiological alterations such as inflammation, oxidative stress, administration of glucocorticoids, insulin resistance, and weight gain. On the other hand, diabetes may act as an independent factor, negatively affecting pulmonary structure and function. Diabetes is associated with an increased risk of pulmonary infections, disease exacerbations, and worsened COPD outcomes. Patients and methods This study was carried out on 87 patients classified into the following groups: group I, which included 35 patients with COPD without diabetes mellitus; group II, which included 18 patients with COPD and T2DM; group III, which included 19 patients with T2DM without COPD; and group IV, which included 15 age-matched and sex-matched healthy individuals. All individuals were subjected to full history taking, clinical examination, estimation of BMI, forced expiratory volume in 1 s% (FEV1%) predicted, forced vital capacity% (FVC%) predicted, and FEV1/FVC and laboratory investigations including estimation of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and serum SP-D, which was carried out using the enzyme-linked immunosorbent assay technique. Results There was a significant statistical difference regarding serum SP-D between studied groups. The highest level of it was in group I than in group II, more lower in group IV, and the lowest level was in group III. There was a significant positive correlation between SP-D and each of age and smoking index, whereas there was a significant negative correlation between SP-D and each of BMI, FBG, HbA1c, FEV1% predicted, FVC% predicted, and FEV1/FVC in studied participants. Age, BMI, and FEV1% predicted are good predictors of SP-D in studied patient groups. Age and smoking index are risk factors for COPD in group I and for COPD and diabetes mellitus in group II, and they are not risk factors for T2DM (group III). Conclusion SP-D was significantly higher in COPD either alone or with T2DM, and it was significantly lower in isolated T2DM. Although SPD did not increase significantly with increasing COPD severity in COPD groups I and II, it correlated negatively with spirometric parameters in all studied participants. There was a positive correlation between SP-D and each of age and smoking index, whereas there was a negative correlation between SP-D and each of BMI, FBG, HbA1c, FEV1% predicted, FVC% predicted, and FEV1/FVC. Factors that predicted serum level of SP-D were age, BMI, and FEV1%. Age and smoking index were risk factors for COPD and they were not risk factors for T2DM.
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A comp arative study between successful weaning and weaning failure from mechanical ventilation by using transthoracic echocardiography
Mohammed H Afifi, Elham M El-Feky, Mohammed F Abd El Aziz, Waleed Abdo
January-March 2017, 30(1):305-309
DOI:10.4103/mmj.mmj_57_16  
Background Cardiogenic pulmonary edema has been recognized as a frequent cause of weaning failure. A spontaneous breathing trial (SBT) induced an elevation in the left ventricular filling pressure, which plays a key role in weaning failure. Transthoracic echocardiography (TTE) should be used to identify the cardiac origin of respiratory weaning failure. Tissue Doppler is a technique that directly measures myocardial velocities. The early diastolic mitral annulus velocity (Ea), pulsed Doppler mitral flow in early diastole E, and the resulting E/Earatio closely correlated with the measured invasive left ventricular filling pressure. Objective The aim of this study was to compare the success of weaning from mechanical ventilation (MV) and failure of weaning using TTE. Patients and methods The study included 30 patients who were divided into two groups: group I (the weaned group) (eight patients) included patients who fulfilled the criteria for weaning and the patients were not reintubated within 48 h following extubation, and group II (the weaning group) (22 patients) included patients with failed SBT or those who were reintubated within 48 h following extubation. The following parameters were recorded: demographic data (age, sex, and cause of MV), mean arterial blood and serum creatinine, the left ventricular ejection fraction, the E wave velocity by means of pulsed-wave Doppler analysis of mitral inflow, and the myocardial velocity recorded using the digital trunk interface technique. Eawas measured and E/Eawas calculated. The mean of three measurements was used for calculation. Results The success rate of weaning from MV was 26.7% and the mortality rate was 6.75%. The comorbidities associated with weaning failure were evident in the failure group. TTE parameters before SBT were as follows: left ventricular ejection fraction was comparable between the two groups, whereas E wave and E/Earatio were significantly decreased in the successful group. However, Eawave was significantly decreased in the failure group. Conclusion Measurement of the E/Earatio with TTE could predict weaning failure. Diastolic dysfunction with relaxation impairment is strongly associated with weaning failure.
  - 383 36
Role of interleukin-33 in patients with chronic hepatitis C in Menoufia University Hospitals, Egypt
Ahmed A Salama, Nahed A El-Ragehy, Atef A Ali, Esraa E Elmahdy
January-March 2017, 30(1):249-254
DOI:10.4103/mmj.mmj_13_16  
Objectives The aim of this study was to determine the serum levels of interleukin-33 (IL-33) in chronic hepatitis C (CHC) patients in Menoufia University Hospitals and to detect its relation with degree of liver fibrosis. Background IL-33 is a novel member of the IL-1 family, which has been shown to play an important role in T helper 2-associated immune responses. Recent studies have suggested the role for IL-33 in the pathogenesis of liver damage during acute and chronic hepatitis; furthermore, IL-33 may be involved in the development and progression of liver fibrosis. Materials and methods The study was conducted on 60 patients with CHC and 20 healthy controls who were examined and compared for serum IL-33 levels using enzyme-linked immunosorbent assay technique. Post-treatment IL-33 serum concentrations were evaluated in 20 patients. All studied groups were subjected to history taking, complete medical examination, thorough laboratory investigations, and fibroscan to assess the degree of liver fibrosis. Results Serum IL-33 levels were significantly higher among CHC patients in comparison with healthy controls (P < 0.001). IL-33 levels were correlated positively to the increase in liver enzymes and degree of liver fibrosis (P < 0.001). CHC patients after antiviral therapy had lower post-treatment IL-33 levels in comparison with baseline values (P < 0.001). Conclusion Serum IL-33 was significantly elevated in CHC patients. IL-33 concentrations were significantly reduced following a successful course of antiviral treatment.
  - 478 70
Seroprevalence of human parvovirus B19 immunoglobulin G in children with hematological disorders and healthy children
Amal F Makled, Ahmed A Aly Salama, Mahmoud A Elhawy, Seham A El Shorbagy Eissa
January-March 2017, 30(1):255-261
DOI:10.4103/mmj.mmj_74_16  
Objective The aim of this study was to determine the serum levels of anti-parvovirus B19 immunoglobulin-G (IgG) and its prevalence in children with hematological disorders and in apparently healthy children in Menoufia University Hospitals. Background Parvovirus B19 infections can suppress erythropoiesis and induce acute erythroblastopenia, which is often referred to as transient aplastic crisis in patients with chronic hemolytic anemia such as sickle cell anemia, thalassemia, and hereditary spherocytosis. Patients and methods The study was conducted on 60 children with chronic hemolytic anemia (40 children with chronic hemolytic anemia without a history of aplastic crisis and 20 children with chronic hemolytic anemia with a history of aplastic crisis) and 20 age-matched and sex-matched apparently healthy children. All patients were subjected to full history taking, clinical examination, and laboratory investigations. Serum anti-parvovirus B19 IgG levels were measured using anti-parvovirus B19 ELISA kits. Results The prevalence of anti-parvovirus B19 IgG antibodies in the sera of chronic hemolytic anemia children with and without a history of aplastic crisis was 62.5 and 100%, respectively. Seropositivity of anti-parvovirus B19 IgG antibodies was 20% in apparently healthy children. Seropositivity of anti-parvovirus B19 IgG antibodies in children with β-thalassemia major and sickle cell anemia was 78 and 100%, respectively. Significant positive correlations were detected between age of the children, frequency of blood transfusion, and the level of anti-parvovirus B19 IgG. Conclusion The prevalence of anti-parvovirus B19 IgG antibodies was higher in all chronic hemolytic anemia children, particularly in those with a history of aplastic crisis. Furthermore, all children with β-thalassemia major and sickle cell anemia with a history of aplastic crisis had anti-parvovirus B19 IgG antibodies.
  - 489 58
Protective effect of garlic oil on furan-induced damage in the pancreas of adult male rat
Mostafa M El-Habiby, Neveen M El-Sherif, Gehan El-Akabawy, Sara G Tayel
January-March 2017, 30(1):262-270
DOI:10.4103/1110-2098.211492  
Objectives The aim of this study was to investigate the effect of furan on the pancreas of adult male rat and to evaluate the possible protective role of garlic oil (GO). Background Furan is carcinogenic in rats and mice and possibly carcinogenic to humans. Methods Sprague–Dawley rats were divided randomly into four main groups: control, GO (80 mg/kg/day), furan-treated (2 and 8 mg/kg/day), and protected group (furan and GO). All rats were treated orally by a gavage for 5 days per week for 8 weeks. At the end of the experiment, pancreases were subjected to biochemical (measurement of the level of glucose, amylase, lipase, and oxidative stress indices in pancreatic tissue), histological, and immunohistochemical analyses. Results Our results showed the toxic effects of furan on the pancreas in adult male albino rats. This was indicated by an increase in pancreatic (amylase and lipase levels) and lipid peroxidation biomarker (malondialdehyde), and a decrease in antioxidant enzymes, including catalase, superoxide dismutase, and glutathione. In addition, histopathological alterations were detected, including mononuclear cellular infiltration, congestion of blood vessels, and cytoplasmic vacuolation of the acinar cells. There were significant increases in the number of inflammatory cells and apoptotic expression, whereas cytochrome P450 2E1 expression was significantly decreased after the administration of furan. Furan-induced toxicity was ameliorated by the coadministration of GO. Conclusion The administration of furan-induced biochemical and histopathological changes in the pancreas of adult male albino rats. These changes were improved by the coadministration of GO.
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Light and electron microscopic studies of chronic renal failure using an adenine rat model
Fatma El-Nabawia A El-Safti, Shireen A Mohammed
January-March 2017, 30(1):271-277
DOI:10.4103/1110-2098.211477  
Objectives This work aimed to study chronic renal failure (CRF) in an adenine induced rat model using light microscopic, electron microscopic examinations in addition to morphometric studies. Past studies of adenine induced rat model of CRF did not emphasize on the electron microscopic changes that accompany CRF. Background Long term feeding of adenine to rats produced metabolic changes resembling chronic renal failure in humans. Among the changes happened were loss of weight and accumulation of uremic toxins (urea and creatinine). The pathological findings in the kidneys revealed glomerular and tubulo-interstitial damage. In the current work, we stressed on the changes that happen in the ultra-structural level. Methods Thirty adult male albino rats were divided into 2 groups: Group (I) ten rats, kept without any treatment, and sacrificed after 4 weeks. Group II (chronic renal failure induced group) twenty rats, received adenine powder daily (0.75% w/w for 4 weeks in food i.e., a daily adenine dose of 0.075 grams was added to 10 grams of food for each rat). Initial and final weights were recorded. Blood samples were collected for kidney function tests. Kidney sections were prepared for light and electron microscopic examination. Morphometric and statistical analysis were done. Results In comparison with the control group, the CRF induced group showed a significant decrease in their final body weight (P < 0.001), significant increase in the urea and creatinine levels (P < 0.001) and significant increase in collagen fiber surface area. Conclusion Long term feeding of adenine exerted a marked inflammatory, fibrotic and apoptotic accelerating effect on both the glomeruli and the tubules.
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Evaluation of lymph node harvest using intra-arterial methylene blue injection into ex-vivo colorectal cancer specimens
Olfat I Elsebai, Eman A Ahmed, Mohamed S Ammar, Mahmoud M. H. Khalil
January-March 2017, 30(1):221-226
DOI:10.4103/mmj.mmj_551_16  
Objective The aim of this work was to evaluate the effect of ex-vivo methylene blue injection into the feeding artery (or arteries) of the specimen removed for colorectal cancer to improve lymph node harvest and staging through a randomized controlled trial. Background TNM stage of colorectal cancer with exact nodal staging correlates with survival rates and prognosis estimation and it is the foundation on which all treatment regimens are based. Patients and methods This prospective, clinical, randomized study included 50 patients suffering from colorectal cancer. They were divided into two groups: group I (the study group), in which surgically resected specimens were subjected to ex-vivo methylene blue injection into the feeding mesocolic artery, followed by pathological assessment, and group II (the control group), in which the routine conventional pathological assessment was carried out. Results As regards the total number of harvested lymph nodes, the number of positive metastatic lymph nodes, and the postoperative pathological staging, there was a statistically significant difference between the two groups. There were no statistically significant differences between the two groups with respect to demographic data, tumor anatomical site, histological criteria, preoperative staging, and type of operation. Conclusion Ex-vivo methylene blue injection into the feeding mesocolic artery is a simple, easy, and safe method that significantly improves lymph node harvesting in colorectal cancer leading to a more accurate colorectal cancer staging.
  - 356 35
Evaluation of cases of rickets that presented to the outpatient clinic of rickets in the National Institute of Neuromotor System in Giza
Ali M El Shafie, Mohamed A Samir, Zein O Abd El Latif, Mohamed H El Sabagh, Radwa G Mahmoud
January-March 2017, 30(1):227-233
DOI:10.4103/1110-2098.211491  
Objectives The aim of this study was to assess clinical findings in different types of rickets, nutritional or resistant rickets. Background Rickets is a metabolic disease of growth plate mineralization and ossification commonly occurring in children and adolescents. Vitamin D deficiency may result in bone diseases, such as rickets in children and osteomalacia and osteoporosis in adults. Patients and methods This study included 100 cases that presented with rickets in the rickets outpatient clinic of the National Institute of Neuromotor System. The initial search presented 100 cases of rickets aged from 4 months to adolescence. Cases less than 4 months of age or those above 18 years of age or with other bone diseases such as osteogenesis imperfecta, and hyperparathyroidism cases were excluded from the study. Comparisons were made by means of structured review with the results tabulated. Results Of the 100 cases, 85% of cases were nutritional, whereas refractory rickets represented 15% of our cases. The incidence of refractory rickets was as follows: 26.7% hypophosphatemic rickets, 20% vitamin D-dependent type II, 20% vitamin D-dependent type I, 6.7% renal osteodystrophy, 13.3% renal tubular acidosis, 6.7% Fanconi syndrome, and 6.7% hypophosphatasia. Conclusion We found that the most common nonnutritional form of rickets was hypophosphatemic rickets. These results indicate the necessity to look for the diagnosis of renal tubular acidosis and hypophosphatemic rickets among children with rickets, especially in older-aged children, those with severe clinical features and poor response to therapy.
  - 889 76
Angiogenesis in various endocrinal disorders
Sanna Sayed Gazareen, Ali Zaki Galal, Said Sayed Ahmed Khamis, Menna Allah Khairy Mohammed Rashad
January-March 2017, 30(1):10-14
DOI:10.4103/mmj.mmj_566_16  
Objective The aim of this study was to review the possible role of angiogenesis in the development and/or progression of various endocrinal disorders and its implications. Methods Medline databases and articles available in PubMed, Medscape, and ScienceDirect were searched. The search was performed in 2013, and included all articles with no language restrictions. The initial search presented 150 articles. Among them, ten studies met inclusion criteria. These articles studied the role of angiogenesis in the development and/or progression of various endocrinal disorders and its implications. If the studies did not fulfill inclusion criteria, they were excluded. Study quality assessment included the following – whether ethics approval was gained, had specified eligibility criteria, included appropriate controls, provided adequate information, and defined assessment measures. There was heterogeneity in the collected data, and thus it was not possible to perform a meta-analysis. Significant data were collected, and a structured review was performed. Results The studies review and summarize the role of angiogenesis in the development and/or progression of various endocrinal disorders and its implications. Conclusion We found that the angiogenesis plays an important role in the development and/or progression of various endocrinal disorders, where some endocrinal disorders were characterized or caused by excessive angiogenesis, whereas others were characterized or caused by insufficient angiogenesis. Angiogenesis in endocrinology is a new therapeutic target.
  - 606 83
Magnetic resonance cholangiopancreatography in malignant obstructive jaundice
Zeinab A Ali, Ashraf A Zytoon, Mahmoud A Abdel Hady
January-March 2017, 30(1):110-115
DOI:10.4103/1110-2098.211517  
Objective Theaim of this study was to assess the role of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of malignant biliary obstruction. Background MRCP is an established technique for the evaluation of intrahepatic and extrahepatic bile ducts in patients with known or suspected hepatobiliary disease. It is considered a reliable, noninvasive alternative to diagnostic endoscopic retrograde cholangiopancreatography. Patients and methods This study was conducted on 43 patients (28 male and 15 female) with malignant obstructive jaundice. Their ages ranged between 30 and 85 years with a mean age of 56.86 years. MRCP protocols applied for imaging of the hepatobiliary system were as follows: T2-weighted fast spin echo sequence on the axial and coronal planes; three-dimensional, fat suppressed, heavily T2-weighted fast spin echo sequence with multislab acquisition mode; two-dimensional thick single slab projectional images; and three-dimensional reconstruction algorithms. Results Among the patients, jaundice and biliary colic were the most common clinical complaints. MRCP detected different pathologic entities, including cholangiocarcinoma, hepatocellular carcinoma, pancreatic carcinoma, distal common bile duct stricture, periampullary carcinoma, gallbladder carcinoma, lymphoma, metastasis, and suprarenal carcinoma. The MRCP diagnosis was compared with the final diagnosis reached using histopathologic data, tumor marker, and follow-up imaging. Conclusion MRCP provides a safe, noninvasive, accurate diagnostic tool in the detection of the cause, level of biliary obstruction, and lymph node spread.
  - 740 70
Multislice computed tomography in the evaluation of portosystemic collaterals in cirrhotic patients with portal hypertension
Adel M El Wakeel, Osama L El Abd, Tarek F Abd Ella, Heba S Abdel Ghany Ellaban
January-March 2017, 30(1):116-121
DOI:10.4103/1110-2098.211500  
Objective The aim of the study was to investigate the role of computed tomography (CT) and portography in the evaluation of collaterals in cases of portal hypertension. Background Liver cirrhosis can result in portal hypertension. Portosystemic collaterals are one of the most severe complications. It may cause massive hemorrhage of the upper gastrointestinal tract. Therefore, prompt evaluation of portosystemic collaterals is imperative. Patients and methods This study included 80 patients (63 male and 17 female) aged between 13 and 73 years. It was conducted from May 2012 to February 2014 on outpatients and inpatients of the Hepatology Department, National Liver Institute, Menoufia University. Patients with liver cirrhosis who had findings of portal hypertension on clinical examination underwent multislice CT, and portography images were obtained using the Work Station. Ten patients underwent upper endoscopy for sclerotherapy. We also detected a correlation between the portal vein (PV) diameter and number of collaterals. Results Multislice CT and CT portography have been shown to be useful in the evaluation of portosystemic collaterals in cases of portal hypertension. When compared with upper gastrointestinal endoscopy there is upgrading of collaterals. Further, this study detected a significant correlation between the PV diameter and number of collaterals. Conclusion Multislice CT has become an important tool for investigation of the liver and can detect potentially problematic varices by detailing the course of these tortuous vessels. This knowledge is important in major operations such as liver transplantation for detection of unexpected varices that can result in significant bleeding. CT portography images can replace the endoscope in the detection of varices.
  - 957 103
Preoperative MRI evaluation of mesorectum in cases of rectal carcinoma
Rania A Abd El Samei, Mohammad S Abdullah, Mohammad R El-Kholy
January-March 2017, 30(1):122-127
DOI:10.4103/1110-2098.211484  
Objectives The aim of this study was to evaluate the accuracy of MRI in preoperative staging, in the prediction of negative circumferential resection margin (CRM), and in the planning of surgical management for rectal carcinoma. Background Rectal cancer constitutes about one-third of all gastrointestinal tumors. Preoperative imaging for staging of rectal cancer has become an important aspect of the current approach to rectal cancer management because it helps to select suitable patients for neoadjuvant chemoradiotherapy and determine the appropriate surgical technique. The purpose of this study was to assess the accuracy of MRI in the preoperative staging of rectal carcinoma, in the prediction of negative CRM, and for planning its surgical management. To this end we aimed to study its efficacy in preoperative local staging of rectal carcinoma (T and N stages), in evaluating mesorectal fat and fascia involvement, and in the prediction of negative CRM. Patients and methods Thirty-seven patients with pathologically proven rectal carcinoma underwent pelvic MRI on a 1.5 T magnet with pelvic phased array coil with transrectal gel administration. The MRI protocol was adhered to. All cases were operated upon and their postoperative specimens were compared with preoperative MRI results. Results Comparable to histopathological examination, MRI correctly diagnosed in 34 out of 37 patients in different T stages (accuracy 91.9%) and in 32 out of 37 patients in different N stages (accuracy 86.5%). Accuracy in the evaluation of mesorectal fat invasion was 97.3%, that in the evaluation of mesorectal fascia invasion was 94.5%, and that in the evaluation of CRM was 97.3%. Conclusion MRI of rectal cancer is accurate for preoperative staging, evaluation of mesorectal fat and fascia, prediction of negative CRM, and evaluation of lymph node involvement.
  - 519 59
CD73, a potential diagnostic marker in Egyptian patients with chronic lymphocytic leukemia
Nahla Osman, Eman Ahmady, Manal Monir, Eman Abdelrazek, Iman El-Tonsy
January-March 2017, 30(1):128-132
DOI:10.4103/mmj.mmj_50_15  
Objective This work aimed to study CD73 expression in chronic lymphocytic leukemia (CLL) patients and its correlation with other disease characteristics. Background CLL is a common B-lymphoproliferative disorder, which can be diagnosed in most cases by morphology and flowcytometry. It displays heterogeneity in clinical presentation, course, and response to treatment, which is likely due to the diversity of the biological nature of the disease. Diagnostic difficulty might arise in some patients due to atypical morphology and/or immunophenotype. CD73 is an extracellular enzyme that hydrolyses adenosine monophosphate to adenosine and is expressed on a subset of T and B lymphocytes. A number of studies have shown CD73 as a contributing factor in the multistep process of carcinogenesis by inducing favorable environment for tumor growth. However, it was shown in some studies to induce apoptosis. Patients and methods CD73 expression on both B and T lymphocytes was measured in 25 cases of newly diagnosed CLL and 15 healthy controls. The levels of expression were correlated to other disease characteristics. Results CD73 expression on CD19 + B lymphocytes was significantly lower in CLL patients compared with controls (mean 3.74 vs. 29.35%, respectively, P < 0.001). CD73 expression on T lymphocytes was also significantly lower in patients compared with controls (mean 0.46 vs. 5.10%, P < 0.001). CD73 expression on T lymphocytes was significantly lower in patients with Binet stage C compared with those with earlier stages (i.e., A and B) (mean 0.15 vs. 0.68, P = 0.05). There was no significant correlation between CD73 expression on clonal B cells and B-symptoms, clinical stage, lactate dehydrogenase, or β2microglobulin. Conclusion CD73 expression is a potential diagnostic marker in CLL. This can be particularly relevant in cases with atypical immunophenotype using the current CLL scoring system. CD73 may have a role in CLL pathogenesis as low expression can lead to failure of termination of immune response with subsequent proliferation and clonal expansion of the involved clone.
  - 582 91
Growth differentiation factor 15 as a marker of ineffective erythropoiesis in patients with chronic C virus infection
Omaima M Abbas, Mohamed A Helwa, Ashraf Y El Fert, Iman S Osheba
January-March 2017, 30(1):133-138
DOI:10.4103/mmj.mmj_518_15  
Objective The aim of this study was to determine the expression of growth differentiation factor 15 (GDF-15) in patients with chronic hepatitis C virus and its association with iron-loading anemia in these patients. Background Significant shortened red cell survival has been reported in patients with liver diseases even in the absence of anemia. The mechanism for the observed decreased red cell lifespan is not fully understood, and it is most probably multifactorial. GDF-15, a member of the transforming growth factor-β super family, was first cloned from human monocytoid cell line and was found to inhibit tumor necrotizing factor production by macrophages and negatively regulate hepcidin. Recent studies suggest that GDF-15 levels increase in conditions of cell stress and apoptosis. In bone marrow (BM), GDF-15 increases in case of ineffective erythropoiesis. Patients and methods This study was carried out at Clinical Pathology Department, Faculty of Medicine and National Liver Institute, Menoufia University, in the period from May 2013 to May 2015. The study included 70 individuals: 50 patients with compensated chronic hepatitis C with unexplained anemia and 10 patients with idiopathic thrombocytopenic purpura who had normal red blood cell counts and no signs of erythroid dysplasia, as a control group for BM expression of GDF-15. In addition, 10 unrelated healthy age-matched and sex-matched adult individuals were included as a normal control group. Serum GDF-15 was measured by ELISA, and GDF-15 mRNA was measured by real-time RT-PCR. Results There were significant differences between the different studied groups regarding iron profile, GDF-15 serum level, and BM expression of GDF-15 mRNA, being higher in patients with chronic hepatitis C than other groups. GDF-15 was positively correlated with serum iron indices and negatively correlated with hemoglobin concentration. Conclusion Ineffective erythropoiesis contributes to iron overload and anemia in patients with chronic hepatitis C.
  - 552 57
The role of apolipoprotein E gene polymorphism in psoriatic patients and its relation to disease severity
Shawky M El-Farargy, Ayman K Abd El-Hamid, Ghada H. A. Neanaa
January-March 2017, 30(1):15-22
DOI:10.4103/1110-2098.211527  
Objective The aim of the study was to investigate the relationship between apolipoprotein E (APO-E) gene polymorphism and psoriasis and its relation to disease severity. Background APO-E is a plasma glycoprotein with known functions in plasma lipoprotein metabolism and in lipid transport within tissues. The association between APO-E alleles E2/E3/E4 and psoriasis has been reported by some authors, but others have not confirmed this. Patients and methods This is a comparative cross-sectional case–control study that was carried out on 55 individuals who were divided into two groups: the patient group, consisting of 40 patients who were subdivided into those with early-onset and those with late-onset disease, and the control group, consisting of 15 normal individuals. Both patients and controls underwent history taking, clinical examinations, and laboratory investigations for assessment of APO-E polymorphism by means of PCR, restriction enzymes, and gel electrophoresis, and lipid profile assessment by the colorimetric method. Results APO-E genotypes E2/E3 and E3/E4 and allele E4 were significantly higher among psoriatic patients. There was no significant relation between APO-E genotypes and severity, age at onset, duration, sex, types, and sites involved. There was a highly significant increase in total cholesterol, triglycerides, and low-density lipoprotein and a highly significant decrease in high-density lipoprotein in psoriatic patients. There was a nonsignificant relation between lipid profile of the patients and severity of the disease with a significant increase in the lipid profile with allele E4. Conclusion The apolipoprotein polymorphism is significantly associated with the pathogenesis of psoriasis, with no relation to disease severity, age at onset, duration, sex, types, and sites involved. The lipid profile is significantly different in psoriatic patients compared with normal subjects but with no relation to severity of the disease and with a relation to the gene allele E4.
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Study of the role of allergy diagnosed by immunoglobulin E in the etiology of pediatric otitis media with effusion
Mohammed K. Mohammed El-Sharnoby, Ayman A. Abd-Elfattah Ali, Hosam A. Hussin Omar, Mona S Eldin Habib, Hatem A Hasanin Salama
January-March 2017, 30(1):151-155
DOI:10.4103/mmj.mmj_245_16  
Objectives This study aimed to study the role of allergy diagnosed by immunoglobulin E (IgE) in the etiology of pediatric otitis media with effusion (OME) by detection of IgE in middle-ear effusion using the enzyme-linked immunosorbent assay technique. Background The role of allergy in chronic OME is controversial. Patients and methods This was a prospective study that was carried out on 80 cases; including 60 pediatric patients diagnosed with chronic OME [resistant to medical treatment for >3 months (type B tympanogram) or recurrent after successful medical treatment]. Patients were subjected to a myringotomy with insertion of a tympanostomy tube (grommet tube). Their age ranged from 2 to 15 years. Twenty children had ENT disease other than OME, mostly adenoidal or tonsillar hypertrophy. The serum level of total IgE was assayed in patients and control groups as well as in the middle-ear effusion of patients. Results The results showed that total IgE was higher in the serum of patients with OME than the serum of the control group; there was a high significant correlation between total IgE in serum and total IgE in effusion in patients with OME. Conclusion Allergy is a possible risk factor for the development of pediatric OME.
  - 535 64
Relationship between serum apelin and cardiac parameters in hemodialysis patients
Khaled M.A. El-Zorkany, Mustafa El-Nagar, Mohamed Nouh, Mohamed Helwa, Ibrahim El-Sayad
January-March 2017, 30(1):156-161
DOI:10.4103/1110-2098.211510  
Objectives The aim of this work was to study the apelin level in hemodialysis (HD) patients and assess its association with cardiac parameters among these patients. Background Mortality in end-stage renal disease (ESRD) patients on maintenance HD is higher by several folds compared with that in the general population, and up to 50% of deaths in these patients are caused by cardiovascular diseases. Apelin, which is a recently discovered active peptide, has a broad range of physiological and pathological actions. Patients and methods A total of 80 nondiabetic end-stage renal failure patients on regular HD, in addition to 20 apparently healthy individuals as the control group, were studied. Lipid profile, serum apelin level, and echocardiography were measured in all patients. Results Serum apelin is highly significantly lower in ESRD patients on maintenance HD compared with that in the control group (P ≤ 0.001). Serum apelin was significantly positively correlated with left ventricular end-systolic dimension (r = 0.290, P = 0.038), left ventricular end-diastolic dimension (r = 0.30, P = 0.021), interventricular septum (r = 0.295, P = 0.036), right ventricle (r = 0.271, P = 0.042), left atrium (r = 0.357, P = 0.014), and aorta (r = 0.339, P = 0.023) in ESRD patients. Conclusion The apelin level was highly significantly lower in HD patients and it was significantly positively correlated with echocardiographic parameters. Thus it might be involved in the pathophysiology of cardiovascular disease in ESRD.
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Prolactin contributes to the pathogenesis of thrombocytopenia in patients with hepatitis C virus
Ali Z Glal, Sabry A Shoeib, Mohammed A Abdelhafez, Nahla F Osman, Waleed S Eldin, Alaa E Abdelsala, Walaa M Elgheriany
January-March 2017, 30(1):162-167
DOI:10.4103/mmj.mmj_15_15  
Objective The aim of this work was to explore the role prolactin (PRL) in hepatitis C (HCV)-related thrombocytopenia. Background PRL is involved in the activation of a number of immunological responses. It enhances the progression of the immune process in autoimmune diseases. Autoimmunity is a common finding in chronic hepatitis C, and a significant association between hyperprolactinemia (HPRL) and infection with HCV genotype 4 has been reported. Materials and methods This study was carried at the Internal Medicine Department, Menoufia University Hospital, in the period between May 2014 and December 2014. Three groups were involved: group I, which included 41 chronic hepatitis C patients with thrombocytopenia; group II, which included 35 chronic hepatitis C patients without thrombocytopenia; and group III, which included 25 healthy individuals with matched age and sex. Results Patients with HCV-related thrombocytopenia had HPRL and their serum PRL levels were significantly higher compared with HCV patients with normal platelet count and compared with normal controls (P = 0.02 and 0.001, respectively). We demonstrated negative correlation between HPRL and platelet count (r = 0.32 and P = 0.04). In addition, there was a significant difference in platelet count among different stages of liver fibrosis as the platelet count dropped steadily in line with the stage of fibrosis (P = 0.004). Conclusion This study shows that HPRL is present in a subset of patients with HCV-related thrombocytopenia and can be a contributing factor in the pathogenesis of thrombocytopenia in those patients. Thus, anti-PRL may be a treatment option in this category of patients.
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Measurement of waist circumference as a screening tool for type 2 diabetes mellitus in female patients
Nabil A ElKafrawi, Ahmed A Shoaib, Mostafa H Abd Elaal Elghanam
January-March 2017, 30(1):168-173
DOI:10.4103/1110-2098.211528  
Background Obesity is a major health problem worldwide. Visceral obesity and the pattern of fat distribution have important implications on the risk of developing metabolic diseases, mainly type 2 diabetes mellitus (DM) and heart disease. Objective The aim of this study was to assess the relationship between obesity and central fat distribution (visceral obesity) and development of type 2 DM in women. Patients and methods This study included 200 women of different ages with their BMI more than 25 kg/m2 and waist circumference (WC) over 88 cm with or without a confirmed diagnosis of DM. Fasting blood glucose level, 2-h postprandial blood glucose level, HbA1c, and serum lipid pattern were measured. The approval of the medical ethics committee of El Mahalla and El Minshawi General Hospital and patient consent were taken before laboratory investigations were conducted on the patients. Results The prevalence of type 2 DM in the studied patients was 22%. The study showed statistically significant positive correlation between fasting glucose levels, 2-h postprandial blood glucose levels, total cholesterol, and triglycerides with both BMI and WC. It also proved that WC is a better method than BMI in the prediction of type 2 DM. Conclusion Obesity with a high WC is a major risk factor for the development of type 2 DM in women. WC is considered a better and more convenient method than BMI in the prediction of type 2 DM.
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Evaluation of the role of CD44 as a cancer stem cell marker in colorectal carcinoma: immunohistochemical study
Nanis S Holah, Hayam A Aiad, Nancy Y Asaad, Enas A. B. Elkhouly, Ayat G Lasheen
January-March 2017, 30(1):174-183
DOI:10.4103/mmj.mmj_151_16  
Objectives The aim of this work was to study the immunohistochemical expression of CD44 in colorectal carcinoma (CRC) cases. Background Cancer stem cells (CSCs) have a role in cancer initiation, progression, and metastasis of CRC through their ability of self-renewal and unlimited proliferation, and they seem to be responsible for local relapse and metastasis. Several markers for CSCs have been investigated in CRC, and CD44 was the most likely marker for colorectal CSCs. Materials and methods This retrospective study included 71 colorectal specimens (49 CRC, 13 adenoma, and nine normal cases). The studied cases were collected from the Pathology Department, Faculty of Medicine, Menoufia University, during the period from 2011 to 2015. All cases were stained with CD44 antibody. Survival data were available for 31 of 49 studied CRC cases. Results All cases of normal colonic epithelium and normal colon adjacent to CRC showed no membranous CD44 immunoreactivity; 84.6% of the studied adenoma cases showed no expression of CD44, whereas 57.1% of CRC cases showed positive expression. There was a statistically significant association between positive epithelial expression of CD44 and left-sided tumors (P = 0.01). There was a statistically significant difference between CRC and colorectal adenoma (P = 0.007) and between CRC and normal cases (P = 0.000) as regards CD44 expression. There was a highly statistically significant association between stromal expression of CD44 and absence of lymph node invasion (P = 0.002) as well as early Dukes' stage (P = 0.01). Conclusion CD44 may be involved in the pathogenesis of CRC. Stromal expression only of CD44 is associated with better prognostic factors.
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Assessment of immune response to hepatitis B virus vaccine in chronic hemodialysis patients
Hosam I Mohammed, Sally M El-Hefenawy, Shaymaa F Mohamed
January-March 2017, 30(1):184-189
DOI:10.4103/1110-2098.211523  
Objective This study aimed to assess the immune response to hepatitis B virus (HBV) vaccine in chronic hemodialysis (HD) patients. Background HBV is an important public health problem in humans. Currently available HB vaccines have an excellent safety and immunogenicity profile. Anti-HBs are the only easily measurable correlate of vaccine-induced protection. Dialyzed patients have impaired immune response and lower seroconversion rates compared with the general population. Patients and methods This study was conducted on 50 patients with chronic renal failure on hemodialysis (HD) and 30 healthy persons. These patients were subjected to full history taking, complete clinical examination, complete blood picture, liver function tests, renal function tests, serum Na, K, and Ca, abdominal and pelvic ultrasound, HBsAg, anti-HBs, anti-HBc, and HCV-Ab by ELISA. Results There was a highly significant decrease in the mean value of anti-HBs titer in the HD group when compared with the control group. In addition, there was a highly significant decrease in the mean value of inadequate anti-HBs titer and a significant decrease in the mean value of adequate anti-HBs titer in the HD group when compared with the control group. A significant negative correlation between anti-HBs titer and age was found. There was a highly significant negative correlation between anti-HBs titer and serum creatinine levels and blood urea. A significant positive correlation between anti-HBs titer and serum albumin levels was found. Conclusion Response of HD patients to HB vaccine is inadequate, with significant negative correlation with serum creatinine, blood urea levels, and age, and a significant positive correlation with serum albumin.
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Plasma vitamin C concentration in chronic kidney disease: Comparison between diabetic and nondiabetic patients
Nabil A Elkafrawy, Alaa Eldine A Dawood, Mohammed S Rizk, Saad M Mohammed Elgengaihy
January-March 2017, 30(1):190-195
DOI:10.4103/1110-2098.211501  
Objective The aim of the study is to evaluate the relationship between renal functions and plasma vitamin C concentration in nondiabetic and diabetic patients with chronic kidney disease. Background A decreased plasma level of vitamin C has been reported to be associated with an increased risk of cardiovascular morbidity and mortality. Here, we sought to determine the vitamin C status of patients with chronic kidney disease and the pathophysiological role of vitamin C in these patients. Patients and methods A total of 50 patients were included in the study and classified into two groups: group I, patients with chronic kidney disease with diabetes and group II, patients with chronic kidney disease without diabetes. The relationship between renal function and plasma vitamin C concentration was evaluated, as well as the effect of diabetes on this relationship. Results Statistical comparison revealed a significant statistical increase in the mean value of vitamin C level in the group II compared with group I (P ≤ 0.001). Also, there was a significant positive correlation between vitamin C level and both weight and estimated glomerular filtration rate in the patients, whereas there was a significant negative correlation between vitamin C level and each of serum creatinine level, blood urea level, albumin–creatinine ratio, and glycosylated hemoglobin level in the patients. Conclusion Renal dysfunction was associated with a decreased level of plasma vitamin C in patients with chronic kidney disease. Diabetic patients showed a lower level of vitamin C at any given estimated glomerular filtration rate compared with nondiabetic patients.
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Relation between serum androgen levels and dyslipidemia in acute coronary syndrome
Walaa F Abdelazez, Ibrahim Elmadbouh, Morad B Mena, Amr A Zewain
January-March 2017, 30(1):196-202
DOI:10.4103/mmj.mmj_129_15  
Objectives The aim of this study was to evaluate the value of serum testosterone (total and free) and dehydroepiandrosterone (DHEA) levels in the diagnosis of patients with acute coronary syndrome (ACS) (acute non-ST-segment elevation myocardial infarction; NSTEMI) and to assess the availability of using serum androgen levels as clinical biomarkers in relation to dyslipidemia. Background Testosterone therapy may have beneficial effects on a number of risk factors of atherosclerotic ischemic heart disease. Patients and methods The study included 65 ACS patients diagnosed with acute chest pain and with positive troponin I and ECG changes (NSTEMI) and 25 normal (healthy) individuals as the control group. Serum testosterone levels have crucial roles in the diagnosis of ACS during early hours of symptoms. Results Patients with proven NSTEMI have significantly lower serum levels of androgens (total testosterone, free testosterone, and DHEA) compared with normal controls. There was a highly significant negative correlation between BMI, total cholesterol, and low density lipoprotein and free testosterone, total testosterone, and DHEA. There was also a highly significant positive correlation of the high density lipoprotein, with free testosterone, total testosterone, and DHEA. Also, serum testosterones and DHEA levels are having the same sensitivity to be decreased significantly in the blood of ACS patients. Conclusion Serum androgen levels were found to be decreased significantly in patients with NSTEMI, and this will help in early diagnosis, in making suitable therapeutic decision in few hours, and can be used in follow-up to monitor the progression of the disease.
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Assessment of left ventricular performance in patients with aortic regurgitation: a strain rate imaging study
Walaa F Abd Alaziz, Mohamed F El Noamany, Ghada M Soltan, Mohamed O Taha, Ahmed H Al Sayed Soliman
January-March 2017, 30(1):203-208
DOI:10.4103/1110-2098.211530  
Background Aortic regurgitation (AR) results in left ventricular (LV) hemodynamic changes ranging from maladaptive hypertrophy and dilatation to heart failure. Conventional echocardiography and tissue doppler imaging are unable to reveal the early abnormalities in LV function caused by AR; however, two-dimensional speckle tracking echocardiography (2D STE) provides an objective way to detect subtle LV changes among AR patients. Objective The aim of this study was to assess functional changes in the myocardium in asymptomatic patients with AR using 2D STE-based strain and strain rate measurement, and its usefulness in early detection of subclinical LV dysfunction. Materials and methods Fifty asymptomatic patients with significant AR and 20 age and sex-matched healthy individuals were examined using conventional echocardiography, tissue doppler imaging, and 2D STE-based measurement of global and segmental LV systolic longitudinal strain (εsys), systolic strain rate (SRs), and early strain rate (SRe) and late (SRa) diastolic strain rates. Results The AR group showed significant reduction in global systolic strain (εsys) compared with the control group. Global LV longitudinal systolic SRs, diastolic SRe, and SRa were significantly reduced in the AR group in comparison with the control group. In addition, peak εsys, SRs, SRe, and SRa showed negative correlation with LV mass index in AR. Conclusion Patients with AR had subclinical LV dysfunction using 2D STE-based strain and strain rate imaging. The index where volume was corrected by deformation should form the basis for predicting subclinical LV dysfunction in patients with increasing LV dilatation.
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Study of iron deficiency anemia in children with febrile seizures
Ali M El-Shafie, El-Sayed S Abou El-Nour, Mahmoud A El-Hawy, Zeinab M. M. Barseem
January-March 2017, 30(1):209-212
DOI:10.4103/mmj.mmj_456_15  
Objective Our aim was to study the prevalence of iron deficiency anemia (IDA) in children with febrile seizures (FS). Background FS are the most common type of seizures in children. The relationship between IDA and FS has been examined in several studies with conflicting results. Patients and methods This prospective, case–control study was conducted on 60 children aged 6 months to 5 years who attended the Outpatient Clinics and Emergency Department of Ashmoon Hospital and Menoufia University Hospitals during the period from December 2014 to June 2015. The children were categorized into two groups: case and control groups. The case group included 40 patients and the control group included 20 children. Hemoglobin (Hb), hematocrit, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, serum iron, serum ferritin, total iron-binding capacity, and transferring saturation were assessed for the two groups. Results A total of 21 (52.5%) children in the case group had IDA compared with four (20%) in the control group, which was statistically significant (P < 0.05). Conclusion Based on the result of this study, iron deficiency could be an important risk factor for development of febrile convulsion. Evaluation of iron status is encouraged to be performed in children with FS.
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Role of magnetic resonance imaging in the diagnosis of ankle impingement
Mohamed S El-Zawawi, Osama M Ebied, Eman R Abdou Sileema
January-March 2017, 30(1):99-103
DOI:10.4103/mmj.mmj_323_15  
Objectives This study aimed to a ssess the role of MRI in the diagnosis of ankle impingement. Background Ankle pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. Chronic ankle pain is a common complaint in orthopedic practice. Impingement syndromes are considered one of the most important causes of chronic ankle pain, which occur due to friction of the joint tissues. Patients and methods This prospective study included 86 patients (M/F = 60/26) with chronic ankle pain and clinically suspected to have impingement. MRI acquired on a 1.5 T scanner was applied for all cases. Results Different types of ankle impingement were observed: posterior ankle impingement (n = 34/90), anterolateral ankle impingement (n = 18/90), anterior ankle impingement (n = 8/90), anteromedial ankle impingement (n = 4/90), posteromedial ankle impingement (n = 2/90), entrapment neuropathy (n = 12/90), and sinus tarsi syndrome (n = 4/90). Conclusion With the advent of MRI, detailed examination of the osseous and soft-tissue structures of the ankle is possible. Thus, MRI has opened a new horizon in diagnosis and hence in the treatment of most ankle joint lesions.
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Factors affecting the quality of voice in early glottic cancer treated with radiotherapy
Abds El-Hay R El-Assy, Mohamed A.S. Baraka, Hossam El-Dessouky, Ayman E Abd El-Aziz, Ibraheem A Abd El-Shafy, Hanan A El-Shourbagy Eissa
January-March 2017, 30(1):316-324
DOI:10.4103/1110-2098.211509  
Objective The aim of this work was to prospectively and objectively analyze the factors affecting the quality of voice in early glottic cancer treated with radiotherapy (RT) in order to choose the best factors that can be considered to facilitate the best voice quality after RT. Background Voice preservation is an important component in the management of early glottic cancer. RT has been the traditional treatment approach, and has resulted in both excellent control rates and voice preservation. Patients and methods Patients with cT1-T2-NoMo glottic cancer underwent voice quality assessment before treatment and after radical RT. Post-RT voice quality was compared with the voice at diagnosis and the voice of healthy individuals who served as controls. A comprehensive set of voice parameters were measured. The effects of age, smoking history, T stage, and anterior commissure involvement on pretreatment and post-treatment voice quality were analyzed. Results The voice quality data of 50 patients were analyzed after treatment, and significant improvement was seen in the majority of measured parameters. However, perturbation parameters and harmonic-to-noise ratio remained inferior compared with those of controls. A history of smoking and anterior commissure involvement resulted in poorer voice parameters following RT. There was no significant impact of age alone. T2 tumors had an inferior voice quality before treatment, but it did not remain inferior after RT. Conclusion There is considerable improvement in voice quality after RT. Several factors may have specific effects on pretreatment and post-treatment voice quality.
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Pulmonary complications for predicting mortality among major burn victims
Osama F Mansour, Mohammed A Megahed, Rabab A El-Wahsh, Rana H El-Helbawy, Noha B Abd El-Azeem
January-March 2017, 30(1):234-240
DOI:10.4103/1110-2098.211488  
Objective The aim of this study was to assess the incidence of early and late pulmonary complications among major burn victims and to study their effects on patient's outcome. Background Respiratory complications associated with burn injury are responsible for significant morbidity and mortality. Patients and methods Forty-two patients with major burn with no past history of pulmonary diseases were enrolled in the study. All patients were subjected to medical history taking, general, local (respiratory and burn), and upper airway examination, laboratory investigations, plain chest radiograph, and serial arterial blood gases analysis (initially after admission and then after 48 and 72 h). Results Pulmonary complications developed in 29 of 42 (69%) burned patients. Eleven of 42 (26.2%) patients died; 10 (90.9%) of them died due to pulmonary complications and one (9.1%) patient died due to wound sepsis. Acute respiratory distress syndrome, inhalational injury, pneumonia, acute bronchitis, lung contusion, and hemothorax were early phase (within 48 h of admission) pulmonary complications, whereas pneumonia, lung collapse, and pulmonary embolism were late phase (after 48 h of admission) pulmonary complications. Lower serum albumin and more deep burn were independent risk factors for pulmonary complications, and pulmonary complications, decreased prothrombin time concentration, and lower serum albumin were independent risk factors for mortality in patients with major burns. Conclusion Lower serum albumin and more deep burns were independent risk factors for pulmonary complications, and pulmonary complications, decreased prothrombin time concentration, and lower serum albumin were independent risk factors for mortality in burned patients.
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Medication knowledge as a determinant of medication adherence in geriatric patients, Serse Elian City, Menoufia Governorate, Egypt
Aml A Salama, Abd El-Rahman A Yasin, Walaa Elbarbary
January-March 2017, 30(1):63-68
DOI:10.4103/1110-2098.211476  
Background Adherence to therapies is the corner stone of treatment success. Medication nonadherence in geriatric patients leads to substantial worsening of disease, increased healthcare costs, and death. Knowledge about the drug's indication, side effects, and interactions with other drugs may constitute a barrier to drug adherence. Objective The aim of this study was to assess the effect of medication knowledge as a determinant factor of medication adherence in elderly patients living in their own houses. Participants and methods This is a cross-sectional study of a random sample of 438 geriatric patients aged 70–85 years, living in their own homes in Serse Elian City, Menoufia Governorate. Patients' information was collected from the prescriptions in the file of the patient and home visits were carried out to examine their daily drug consumption. Results Male geriatric patients were found to be more adherent to their medications than female patients (63.9 vs. 36.1%). Correct knowledge regarding the name of the drug, it's timing, the correct dose, and indications constituted a statistically significant difference among adherent and nonadherent groups, whereas awareness about side effects of the drug did not have a significant effect on medication adherence. Conclusion Knowledge about medication in general constituted a significant determinant of medication adherence in elderly patients.
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Prevalence of diabetes mellitus and impaired glucose tolerance among adolescents in Menoufia governorate, Egypt
Rabie E Al Bahnasy, Omiyma A Mahrous, Hewaida M El Shazli, Hala M Gabr, Reda A Ibrahem, Shaimaa S Soliman
January-March 2017, 30(1):69-75
DOI:10.4103/1110-2098.211493  
Objectives The aim of this study was to estimate the prevalence and risk factors of diabetes mellitus (DM) and impaired glucose tolerance among adolescents in Menoufia governorate. Background DM is a group of metabolic diseases characterized by elevated blood glucose levels (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Type 1 diabetes is the most common type of diabetes during childhood and adolescence. Most cases of type 1 diabetes are due to destruction of the pancreatic β-cells by T-cells (white blood cells concerned with the immune system). Patients and methods This cross-sectional study was carried out on 1150 adolescents in two districts in Menoufia governorate. The participants were subjected to fasting glucose, 2 h-postprandial blood glucose testing, and anthropometric measurements. Results This study showed that 0.6% of the studied adolescents had DM, 4.1% had impaired fasting hyperglycemia, and 2.4% of them had impaired glucose intolerance. Overweight and moderate obesity were found in 25% of the participants and were highly correlated (P < 0.01) to abnormal blood glucose level. Conclusion As diabetes among adolescents is a rising epidemic, this work was carried out on 1150 adolescents in Menoufia governorate to study the epidemiology of DM. The study revealed that 0.6% of the studied group had DM, 4.1% had impaired fasting hyperglycemia, and 2.4% of them had impaired glucose intolerance. Overweight and moderate obesity are major risk factors for abnormal blood glucose level. Excessive and nocturnal urination were the most common symptoms encountered by adolescents suffering from diabetes as 57.1% of diabetic adolescents had either one of them.
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Patient satisfaction and compliance in family practice
Mohammad Alkot, Hewida Alshazly, Hany A Abdel Wahab
January-March 2017, 30(1):76-80
DOI:10.4103/1110-2098.211499  
Objective The study was conducted to assess the level of patient satisfaction and compliance with the services provided in family healthcare facilities. Background Patient satisfaction and subsequent compliance are legitimate and important measures for assessing the quality of healthcare services in order to make it more positive, satisfying, and meet patient expectations. Patients and methods A cross-sectional study was conducted between 1 April 2012 and 1 October 2012. Two sites, one urban and one rural, were selected by a multistage random sampling technique. The patients attending the selected sites during the period of the study were invited to fill an Arabic questionnaire to assess and evaluate patient satisfaction and compliance toward medical health services presented in family practice. Results The study showed that 63% of participants in rural areas were satisfied with services in the family unit and 37% prefer hospitals and private clinics, whereas in urban areas only 25% of participants seek medical advice in family healthcare centers. Conclusion Patient satisfaction as a method of evaluating health services is essential and satisfaction with delivered services is important. Many factors affect compliance – for example, the patient, the disease, the regimen, the physician, and the healthcare system.
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Health disorders among workers in a plastic factory in Egypt
Mahmoud E Abu Salem, Gaafar M Abdel Rasoul, Omayma A Mahrous, Olfat M Hendy, Heba K Allam, Aziza Saad M Elbadry
January-March 2017, 30(1):81-86
DOI:10.4103/1110-2098.211495  
Objectives The aims of this study were to assess the hepatic and hemotologic disorders that may arise among workers in a plastic factory and to assess workplace environment in the same factory. Background Occupational exposure to toxic chemicals such as polyvinyl chloride and styrene in plastic manufacturing has deleterious effects on the liver and hematopoietic system after prolonged exposure. Patients and methods In a historical cohort study, the exposed participants (n = 180) were recruited from workers in a plastic factory in Queisna industrial zone, Menoufia governorate, Egypt. The unexposed group (n = 60) was selected from workers' relatives who had never worked in the plastic industry. All participants completed a predesigned questionnaire on personal and occupational histories. Complete blood examination, liver function tests, and abdominal ultrasonography were performed for all participants. Environmental studies were also done. Data were collected, tabulated, and statistically analyzed by SPSS statistical package (version 20). Results The prevalence of elevated liver enzymes, anemia, and low platelet counts were significantly higher among the exposed than the unexposed participants. Also, mean value of environmental polyvinyl chloride and styrene levels were higher than permissible levels in the grinding department of the factory. Conclusion Complete blood count, liver function tests, and abdominal ultrasonography should be included in the periodic medical examination of exposed workers for early detection of hepatic and hematologic disorders.
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Vaginitis among married women attending primary healthcare in Tanta District, El-Gharbia governorate , Egypt
Mahmoud E Abu Salem, Mohammad M Alkot, Aml A Salama, Dina H Abdl-Sameh
January-March 2017, 30(1):87-91
DOI:10.4103/1110-2098.211496  
Objective The aim of this study was to improve women health through studying the causes of vaginitis and evaluating the risk factors causing the infection. Background Vaginitis is an inflammation of the vagina. It affects all age groups from adolescents to postmenopausal women and is the most common gynecological problem faced by the primary care providers. It affects women's daily activities through changes in the amount and odor of vaginal discharge, dyspareunia, dysuria, and may get complicated with cervicitis, salpingitis, endometritis, urinary tract infections, and pelvic inflammatory disease. Patients and methods The study was carried out in two randomly selected family healthcare centers in urban and rural areas in Tanta district, El-Gharbia governorate, conducted from the beginning of May 2014 till April 2015. A cross-sectional analytical study was conducted involving 160 cases, including women who experienced vaginal symptoms during child-bearing and postmenopausal period. Women who had chronic diseases or psychological problem or were taking systemic therapy were excluded. After selecting the cases, 240 women who did not have vaginal symptoms were selected as controls. Questionnaire was designed to obtain full history and analysis of vaginal complaint, speculum vaginal examination, and laboratory examination of discharge. Results The mean age of the studied group was 29.47 ± 6.9 years. Results of the cases showed that 38.8% had fungal infection, 31.3% had bacterial vaginosis, and 8% had trichomoniasis. The study showed a statistical significant difference between cases of different types of vaginitis with regard to age of patients, intrauterine device use, previous attack, vaginal douche, menstrual hygienic pads, drying after vaginal wash, and using of public water closet. Conclusion and recommendation The study showed that there is relationship between bacterial vaginosis, trichomoniasis and the use of intrauterine devices and hormonal contraception and bad menstrual hygiene, and mixed infections and did not dry vagina after wash risk factor. Health education programs are recommended.
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REVIEW ARTICLES
Angiogenesis in liver cirrhosis
Ibrahim M Boghdadi, Tarek E.M. Koraha, Ashraf G Dala, Osama I Oaf
January-March 2017, 30(1):1-5
DOI:10.4103/mmj.mmj_120_15  
The present work aimed at discussing the association between angiogenesis and development of liver cirrhosis. They included medical textbooks, medical journals, and medical websites with updated information. Systematic reviews that addressed angiogenesis and studies that addressed the association of angiogenesis with the development of both cirrhosis and associated complications and the benefit of inhibition of angiogenesis in treatment of complications were included. Web search was performed on the PubMed medical databases, and the full text of the relevant paper was critically analyzed and interpreted. The researcher reviewed each study independently and rebuilt obtained data in his own language according to his needs to know the role of angiogenesis in the development of liver cirrhosis through the article. Angiogenesis and related changes in the angioarchitecture have been proposed to potentiate fibrosis progression toward cirrhosis. The association of fibrogenesis and angiogenesis should be regarded as crucial in the modern evaluation of liver disease progression and in the search for therapeutic targets.
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Liver X receptor α: does it have a role in the pathogenesis of vitiligo?
Mohammed A Shoeib, Ola A Bakry, Noha M Nor-EldinnElkady, Sherin M Atallah
January-March 2017, 30(1):6-9
DOI:10.4103/1110-2098.211507  
The aim of the work was to highlight liver X receptor α (LXR-α) and its role in the pathogenesis of vitiligo. Data were obtained from medical text books, medical journals, and medical websites, which had updated investigations with the keywords (liver X receptors and vitiligo) in the title of the papers. Selection was carried out by supervisors for studying LXR-α and its role in the pathogenesis of vitiligo. A special search was carried out for the keywords liver X receptors and vitiligo in the title of the papers. Extraction was carried out and included assessment of the quality and validity of papers that met with the prior criteria described in the review. The main result of the review and each study was reviewed independently. The obtained data were translated into a new language based on the need of the researcher and have been presented in various sections throughout the article. We now know that LXR-α plays an important role in the pathogenesis of vitiligo through its effect on melanogenesis and also through its role in keratinocyte proliferation and apoptosis that affect growth and/or melanization of surrounding melanocytes. In total 54 potentially relevant publications were included, 34 were human and 20 were animal studies. The studies indicate an association between LXR-α and vitiligo pathogenesis as LXRs affect melanogenesis through its effect on genes involved in melanogenesis and also through its role on keratinocyte death, which leads to a decrease in several keratinocyte-derived mediators and growth factors supporting the growth and/or melanization of surrounding melanocytes.
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