Hair loss can have significant effects on patients' quality of life, and a prompt diagnosis of the different types of alopecias and early intervention are needed. This review highlights the main dermoscopic findings in the different types of alopecia, such as androgenetic alopecia, alopecia areata, trichotillomania, lichen planopilaris, and discoid lupus erythematosus of the scalp. We believe that this important tool has been demonstrated to help dermatologists in finding the right site for the biopsy or, furthermore, avoiding unnecessary biopsies. Data sources were medical text books, medical journals, and medical websites that have updated research with the key word Dermoscopy in the title of the paper. Systematic reviews that addressed dermoscopy, its impact on dermatological lesions, and the role of physicians in prevention and management were selected. A special search was conducted at midline with the key word Dermoscopy in the title of the papers; extraction was made, including assessment of the quality and the validity of papers that met the prior criteria that describe Dermoscopy and its use in the diagnosis of hair disorders. Each study was reviewed independently, and the data obtained were rebuilt in new language according to the need of the researcher and arranged into topics through the article. Hair and scalp dermoscopy (trichoscopy) is a fast and noninvasive technique that allows the identification of hair and scalp diseases on the basis of analysis of trichoscopy structures and patterns without the need for removing hair for diagnostic purposes or unnecessary biopsies. Dermoscopy may be useful in the differential diagnosis of various hair and scalp disorders such as alopecia areata, androgenetic alopecia, and tenia capitis and also in the differential diagnosis between discoid lupus erythematosus and lichen planopilaris.

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Objectives The aim of this randomized prospective trial was to compare both the results of direct closure and local flaps in management of pilonidal sinus. Background The best surgical technique for sacrococcygeal pilonidal disease is still controversial in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. Materials and methods From February 2012 to February 2013, 30 consecutive patients with chronic pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group 1, n = 15 patients) or excision and flap reconstruction [group 2, n = 15 patients; classic Limberg flap ( n = 5), modified Limberg flap ( n = 5), and V-Y advancement flap ( n = 5)]. Demographic data, operative time, postoperative pain, hospital stay, duration of incapacity for work, postoperative complications (infection, flap edema, wound dehiscence), patient satisfaction, and postoperative recurrence were recorded. Results The mean follow-up was 12 months. A significant difference was observed between the two groups in terms of operative time (min), postoperative complications, and patient satisfaction (P < 0.05) for all comparisons. There were no significant differences among the two groups with respect to age, sex distribution, postoperative pain, length of hospital stay (in days), duration of incapacity for work (in days), and frequency of recurrent disease (P>0.05) for all comparisons. In the modified Limberg flap, no wound infection or recurrence of the disease occurred. Conclusion Flap reconstructions were superior to primary closure after excision of pilonidal sinus, and modified Limberg flap was superior with respect to wound infection and recurrence.

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Objectives The aim of the study was to assess the knowledge, the attitude, and the practice of healthcare providers in family health settings regarding infection control measures in Shebin El-kom district. Background Hospital-acquired infections are among the leading causes of death; prevention of hospital-acquired infection therefore must be cost effective, but achievable even with the limited resources for infection control programs in primary healthcare. Participants and methods This was a cross-sectional study conducted in two urban and two rural family health settings in Shebin El-kom district, Menoufia Governorate. Four different settings were selected from cluster sampling followed by stratified random sampling. The self-administered anonymous questionnaire was administered to 412 participants including physicians, nurses, and paramedical personnel. Each healthcare facility was observed for infection control measures by an observation checklist, followed by comparative analysis of different categories of participants. Results The knowledge scores were low to moderate among all participants; only 32.5% had a high level of knowledge, in comparison with 96.6% of the participants who had a positive attitude towards infection control measures. However, 54.3% of the physicians showed a high practice score in comparison with 32.6% of the nurses. Conclusion Standards of infection control practices were not optimum at family healthcare settings, although the reported practice was better than the reported knowledge. Further studies are required to determine the other factors associated with compliance of infection control practices, and training courses on hospital-acquired infection for such personnel would be required.

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Objective The aim of this study was to determine the histological, histochemical, and immunohistochemical effects of monosodium glutamate (MSG) on the ovaries of adult female albino rats and the possible protective role of green tea. Background MSG is a commonly used food additive. It plays an important role in the pathogenesis of anovulatory infertility. Materials and methods A total of 35 female adult albino rats were used in this study. The rats were divided into four groups: groups I-IV. Group I was the control group. In group II (MSG treated) 10 rats were treated with MSG at a dose of 4 mg/g body weight by subcutaneous injection daily for 14 days. The rats were killed 24 h after MSG treatment. In group III [combined green tea extract (GTE) and MSG treated] 10 rats were treated with GTE and MSG for 14 days. MSG was given at the same dose as that in group II and GTE was given at 300 mg/kg body weight orally daily. The rats were killed 24 h after MSG and GTE treatment. In group IV (GTE treated) five adult rats were treated with GTE only for 14 days and then killed. Results MSG-treated rats showed degenerative changes of the ovary with many atretic follicles. The stroma appeared vacuolated. The medulla showed multiple vacuoles with congested blood vessels. However, combined treatment of GTE and MSG in group III showed amelioration of the histological changes in the ovary. Conclusion It has been concluded that GTE improves the histological changes caused by MSG in the ovary.

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Objectives The goal of this study was to report the role of bone marrow injection in treatment of nonunited long bones fractures and to evaluate the relationship between bony union and bone marrow. Background Bone marrow injection has been used for the management of fracture nonunion since a long period of time. The main advantages for this technique are: it can be used in patient unfit for open grafting, is safe, uses osteogenic cells, has no complications in graft site, and can prevent nonunion development. Other advantages include: it is simple, quick, inexpensive, and causes minimal surgical trauma. Patients and methods From November 2009 to February 2013, 20 patients, 16 male patients and four female patients, mean age 36.5 years, suffering from nonunited lower limb fractures were treated in the Orthopedic Department, El-Menoufiya University Hospital by bone marrow injection in site of fracture nonunion. Results Of the 20 patients who had bone marrow injection for nonunion, 16 (80%) patients achieved union and four (20%) patients failed to achieve union. Of the four patients who were not healed, one patient had received three bone marrow injections, whereas three patients had received four bone marrow injections. Conclusion In our study, the patient's age and smoking were inversely proportional to healing after bone marrow injection. In addition, patients who had closed fracture at the time of initial injury achieved union more than patients who had open fracture at the time of initial injury.

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Objective The aim of this study is to assess whether procalcitonin (PCT) can distinguish between bacterial and viral lower respiratory tract infections (LRTIs). Background LRTIs are common diseases in children and are common causes of antibiotic prescription, especially in primary care. It is difficult to distinguish viral from bacterial disease because the clinical presentations of LRTIs because of different causative agents may be similar. Inappropriate use of antibiotics contributes toward the development of antibiotic-resistant bacteria, and increases both the length of stay and the costs of hospitalization. Therefore, a routine test that can safely discriminate between viral and bacterial infection is needed. Methods This prospective single study included 45 patients diagnosed clinically with LRTIs (pneumonia and bronchiolitis) and confirmed by radiological laboratory and microbiological investigations and 10 patients as a control group. The participants were categorized into group 1 bacterial infection (pneumonia, 15 patients), group 2 viral infection (bronchiolitis, 30 patients), and group 3 control (10 individuals). Serum PCT levels were determined for the three groups; complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were determined only for group I and group II. Radiological and microbiological investigations were performed for group I and group II. Results Although CRP, ESR, and PCT concentrations were significantly different between patients with bacterial and viral LRTIs, the sensitivity and specificity of PCT were higher. PCT had an area under the curve of 0.995 (95% confidence interval, 0.98-1). Conclusion LRTI is a major health problem. Serum PCT can improve differentiation between patients with a bacterial or viral LRTI compared with CRP and ESR.

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Objective The aim of the study was to compare the effect of permeability of low-flux versus high-flux dialysis membranes on control of metabolic abnormalities in chronic hemodialysis patients. Background End-stage renal disease is associated with multiple physiological and metabolic disturbances, including hypertension, anemia, hyperparathyroidism, dyslipidemia, malnutrition, and other serious problems that markedly and negatively affect prognosis and the quality of life of uremic patients. New dialyzers have large pores and they are more compatible than pure cellulose membranes; thus, they provoke less inflammatory reaction and are more efficient in removal of uremic toxins. Materials and methods Forty adult patients on regular hemodialysis were enrolled in a prospective study. Low-flux polysulfone membranes were used for at least 6 months and then patients were switched to use high-flux polysulfone membranes for 1 month. Serum electrolytes and intact parathyroid hormone (PTH) before and after dialysis were compared before and after changes in dialysis membrane. Results At the end of the 1-month use of high-flux filters, a highly significant increase in the mean of hemoglobin levels from 9.50 ± 1.08 to 10.29 ± 1.04 (P = 0.001) was evident. Postdialysis mean arterial blood pressure decreased significantly after use of high-flux dialysis (P = 0.002). There were highly significant decreases in predialysis blood urea nitrogen, phosphorus, sodium, and potassium after the use of high-flux filters. Predialysis intact PTH level (415.96 ± 226.72 ng/dl) showed a significant decline (P < 0.05) compared with the predialysis intact PTH (312.28 ± 191.98 ng/dl) with low-flux membranes. Conclusion High-flux dialysis membranes are more efficient in control of metabolic abnormalities in chronic hemodialysis patients than low-flux membranes.

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Objective The aim of this study was to evaluate the possible role of intraoperative intravenous calcium injection in avoidance of unexplained postoperative hypocalcaemia. Background Thyroid surgery has always been the most common endocrine surgical operation. Total thyroidectomy is generally reserved for patients with thyroid malignancy, toxic thyroid, clinically significant goiter and less commonly for thyroiditis. The complications include recurrent laryngeal nerve injury, external branch of superior laryngeal nerve injury, neck hematoma, and hypocalcaemia. Post-thyroidectomy hypocalcaemia can occur in about 9.5-15.4% of the patients. The prevention of hypocalcaemia is the main concern, as some patients may experience hypocalcaemia despite preservation of the parathyroid glands during surgery. Patients and methods This prospective study on 40 consecutive patients was conducted from March 2011 to January 2013. The patients were randomly divided into two groups: group I (20 patients) received intraoperative intravenous 10 ml of calcium gluconate containing 500 mg of calcium and group II (20 patients) received no injection. Serum calcium level was measured for all patients preoperatively, 6 h and 5 days postoperatively. Results The incidence of postoperative hypocalcaemia was lower in group I than in group II (40 and 65%, respectively); in addition, 35% of the patients in group I suffered from perioral numbness, tingling, and positive Chvostek's sign compared with 50% in group II. In all, 5% of the patients in group I suffered from tetany compared with 15% in group II. Serum calcium levels on the first postoperative day in group I patients were significantly higher than those in group II patients, with mean range of 8.1 ± 0.3 in group I and mean range of 7.8 ± 0.4 in group II. Conclusion The prophylactic intravenous injection of calcium gluconate during total thyroidectomy is effective in minimizing risk for postoperative symptomatic hypocalcaemia.

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Objectives This study aimed to show the role of diffusion-weighted MRI (DWI) in the diagnosis of acute stroke. Background DWI is highly sensitive in detecting early cerebral ischemic changes in acute stroke patients. In this study, we compared the role of DWI with that of conventional MRI techniques. Furthermore, we compared the size of ischemic lesions on DWI scans with the fluid-attenuated inversion recovery (FLAIR) images. Materials and methods We performed T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), FLAIR, and DWI MRI in 30 patients who presented with acute stroke. T1WI, T2WI, FLAIR, and DWI were performed for all patients and an apparent diffusion coefficient map on only 10 patients. The size of ischemic lesions was measured on DWI and FLAIR images. Results With DWI, 100% of the ischemic lesions were detected, with FLAIR recovery 83% were detected, whereas with T1-weighted and T2-weighted images, only 63% of lesions were identified. The size of the lesion on DWI scans was larger than the FLAIR images, particularly in patients examined within the first 6 h of stroke onset. Conclusion DWI is more sensitive than conventional MRI in detecting early ischemic lesions in acute stroke patients. The size of the lesions measured on DWI and FLAIR images in the first 6 h was larger than those measured between 6 h and 3 days. MRI is recommended strongly for the accurate diagnosis of acute stroke.

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Objective The aim of the study was to assess vancomycin-resistant Staphylococcus aureus (VRSA) in the National Liver Institute. Background VRSA refers to the strains of S. aureus that have become resistant to vancomycin. Three classes of VRSA have emerged: vancomycin intermediate-resistant S. aureus, heterogenous vancomycin-intermediate S. aureus, and high-level VRSA. Materials and methods The study was carried out on 705 samples that were collected from patients, personnel, and hospital environments. Group I (the patient group) included samples from 555 patients. From them different microbiological samples were collected (blood, urine, sputum, wound aspiration, nasal swab, throat swab, drains, and endotracheal tubes). Group II (the personnel group) included 45 samples from staff members who were in contact with the patients. Swabs were taken from their noses, throats, and fingertips. Group III (the hospital environment) included samples from 105 swabs. Samples from all groups were subjected to culture and isolation of the bacteria and identification of S. aureus isolates. These isolates were subjected to an antibiogram using the disc diffusion method, and testing for vancomycin susceptibility by the disc diffusion method, an E-test (E-test strip is Hi Media laboratories Pvt. Limited, Mumbai, India), and Vitek-2 compact (Vitek-2 is bioMιrieux, Inc., Durham, NC). VRSA isolates were subjected to analysis of plasmid DNA profile and restriction fragment length polymorphism (RFLP) PCR of isolated plasmids to detect the vanA gene. Results This study showed that, of 145 isolated S. aureus strains, 58.64% were vancomycin-sensitive S. aureus, 20.68% were vancomycin intermediate-resistant S. aureus, and 20.68% were VRSA. Their plasmid profile showed that 10% had no plasmid, 26.7% had one plasmid, 50% had two plasmids, and 13.3% had three plasmids. The molecular weight of most plasmids was 100 kb (36%). RFLP PCR for detection of the vanA gene in the isolated plasmids was positive in 51.9%. Conclusion VRSA prevalence in the National Liver Institute is 20.68%. The majority (90%) carried plasmids. Most plasmids had a molecular weight of 100 kb, and the vanA gene, as detected by RFLP PCR, was positive in 51.9%.

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Objective To investigate the effect of pentoxifylline (PTX) and pioglitazone (Pg), each alone and in combination with methotrexate (MTX), on rheumatoid arthritis (RA) induced experimentally in male albino rats. Background Individuals have long feared RA as one of the most disabling types of arthritis. It is estimated that over 46 million individuals have arthritis, ~1% worldwide. Material and methods One hundred and eighty adult male albino rats were used in the present study. MTX was administered intraperitoneally at a dose of 0.25 mg/kg daily. PTX was administered intraperitoneally at a dose of 150 mg/kg/rat/day, whereas Pg was administered orally at a dose of 3 mg/kg/day. All doses were administered for a period of 2 weeks. RA was induced by two methods: adjuvant-induced arthritis and pristane-induced arthritis (PIA). Adjuvant-induced arthritis was induced by an intradermal injection of 0.1 ml of complete Freund adjuvant. This type of arthritis appears about 8-12 days after injection. PIA was induced by a single intradermal injection with 0.2 ml pristane at the base of the tail. PIA develops in 2-3 weeks after injection and progresses with a relapsing course that persists for months. Results The anti-inflammatory properties of these drugs were confirmed by reduction of erythrocyte sedimentation rate, serum rheumatoid factor level, serum C-reactive protein level, serum tumor necrosis factor-a level, serum nitrite level, and blood superoxide dismutase level, whereas antioxidant activities were confirmed by an increase in the blood reduced glutathione level. Our study showed that Pg alone exerts portentous effects in the treatment of RA. However, it was more active in combination with MTX. Conclusion Our study showed that Pg was the most potent drug in treating arthritic rats, followed by PTX, with lesser potency in treating arthritic rats. When comparing the two combinations, the combination of Pg with MTX was the most potent one. The second combination was the combination of PTX with MTX.

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Objective The aim of this study was to determine the histological changes of l-arginine-induced acute pancreatitis and the possible protective effect of pentoxifylline on pancreatic acini in adult male albino rats. Background Acute pancreatitis is a reversible inflammation that is either localized to the pancreas or may spread to adjoining tissues. Materials and methods Forty adult male albino rats weighing 180-200 g each were used in this study. The rats were divided into four equal groups (10 rats each). Group I was the control group. In group II (l-arginine-treated), rats were administered two intraperitoneal injections of l-arginine at a dose of 200 mg/100 g/body weight with 1-h interval. They were randomly subdivided into two equal subgroups: in IIA, rats were killed after 24 h of the last l-arginine injection and in IIB, rats were killed after 1 week of the last l-arginine injection. In group III (l-arginine and pentoxifylline-treated), rats were administered l-arginine and pentoxifylline. l-arginine was given similar to group II and pentoxifylline was given as a single intraperitoneal injection at a dose of 12 mg/kg body weight/day. They were randomly subdivided into two equal subgroups: in IIIA, rats were given a single dose of pentoxifylline then were killed after 24 h and in subgroup IIIB, rats were given pentoxifylline daily for 1 week then were killed. In group IV (pentoxifylline-treated), rats were administered pentoxifylline as a single intraperitoneal injection of 12 mg/kg body weight/day for 1 week then rats were killed. Results l-arginine-treated rats for 24 h showed pancreatic edema, degenerative changes of pancreatic acini, and inflammatory cell infiltration. These changes were marked after 1 week; however, pentoxifylline supplementation in group III showed amelioration of the histological picture, which was marked after daily pentoxifylline treatment for a week. Conclusion It is concluded that pentoxifylline was found to improve the histological changes of pancreatic acini caused by l-arginine.

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Objectives The aim of this study was to detect the YMDD mutation responsible for lamivudine resistance in chronic hepatitis B virus (HBV)-infected patients. Background HBV infection is a major global public health problem. The aim of this work was to study the relation between the detection of YMDD mutation and lamivudine resistance in chronic HBV patients. Participants and methods This study included 50 chronic hepatitis B-infected individuals classified into two groups: group I included 25 chronic HBV patients responding to lamivudine (five female and 20 male). Group II included 25 chronic HBV patients resistant to lamivudine (one female and 24 male). All participants were selected from the National Liver Institute, Menofia University. All participants were subjected to full history taking, general examination, clinical examination, abdominal ultrasonography, laboratory investigations including serum alanine aminotransferase and aspartate transaminase, serum bilirubin, serum albumin, and detection of the YMDD mutation by PCR-RFLP. Results Chronic hepatitis B cannot be classified correctly with reliability on the basis of a single assessment. Serial testing for serum enzymes and HBV DNA are almost always helpful. On comparing results of the HBV DNA level and other laboratory investigations among the studied sensitive and resistant groups, it was found that the levels of HBV DNA in the pretreatment, the first, and the post-treatment PCR and the pretreatment and the post-treatment alanine aminotransferase were significantly higher in the resistant group when compared with the sensitive group (P<0.05). In the current study of 20 PCR-RFLP-tested cases, the wild type was detected in 13 cases, and the mutant type was detected in seven cases. The prevalence of mutations in the tested group was thus 35%. Mutation of codon 552 from methionine to valine (rtM204V) and from methionine to isoleucine (rtM204I) was detected in 42.9 and 28.6% of the patients, respectively, and mutation of codon 528 from leucine to methionine (rtL180M) was detected in 28.6% of the patients. Conclusion It could be concluded that antiviral therapy with lamivudine for chronic HBV-infected patients can be effective. However, some patients may experience resistance to lamivudine with the emergence of YMDD mutants, resulting in progressive worsening of liver disease. In this respect, detecting the YMDD mutation during therapy will help to guide antiviral treatment and to establish early stopping rules or add-on strategies to avoid antiviral resistance.

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Objective This study aimed to enhance the diagnostic and therapeutic options for familial Mediterranean fever (FMF) in children. Data summary Data sources : medical textbooks, medical journals, and medical websites with updated information. Study selection: systematic reviews that discussed the various aspects of FMF epidemiology, etiology, and management. Data extraction: web search was performed on the PubMed medical databases and the full text of the relevant paper was critically analyzed and interpreted. Data synthesis: the results of the included studies were summarized and incorporated into the review article's main text, with a focus on the various conclusions studied and comparison with similar studies. Conclusion FMF is not an uncommon disease. The disease has many presentations and fever is not an essential component in the diagnosis. Amyloidosis is the most devastating complication of FMF. Colchicine treatment can reduce the frequency and severity of attacks and prevent complications including amyloidosis.

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Objectives This study aimed to evaluate the importance of MRI as a noninvasive diagnostic tool in patients with spinal tumors and to correlate the MRI findings with the patients' neurological outcome. Background Radiographic evaluation is crucial in patients with spinal tumor. A correct investigation can establish the diagnosis and early surgery gives a better chance for full recovery. MRI became the gold standard for imaging neurological tissues including the spinal cord. MRI serves as a problem-solving technique to assess the cause of neurological deficits. Materials and methods This prospective study included 50 patients with neurological deficit. The following MR sequences were performed to all patients: sagittal T1WIs and T2WIs, axial T1WIs and T2WIs, axial T1WI, and sagittal T1WI after contrast injection. Data of spinal symptoms were collected, analyzed, and correlated with findings on neurological examination. Results The total number of patients was 50 and male-to-female ratio was 32 : 18; the age ranged between 3 and 75 years. Lumbar spine was the commonest site of injury (40%). The commonest type of spinal tumors was metastasis (42%). Vertebral bone involvement was in more than half of the patient (54%). Most of the tumors show hypointense signal on T1WI (70%), hyperintense signal on T2WI (86%), and postcontrast homogeneous enhancement (60%). Conclusion MRI is strongly recommended for accurate diagnosis of spinal tumors because of its many advantages such as higher contrast resolution, absence of bony artifacts, and multiplanar capability. More information about neural and extraneural lesions can be obtained.

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Objectives The aim was to study the epidemiology, pathophysiology, and risk assessment of osteoporosis among adults as a major health problem and clarify the role of the family physician in the prevention, screening, early detection, and management of osteoporosis. Data analysis Osteoporosis is a multifactorial skeletal disease characterized by reduction in bone mass and deterioration of the microarchitectural structure of bone tissue, with resulting increase in bone fragility and fracture risk. A decline in bone mineral density with age increases bone fragility because it reflects the progressive loss of bone mass and changes in the architecture of the bone, such as cortical thinning, cortical porosity, and thinning and loss of trabeculae with loss of connectedness of trabeculae. Bone loss is progressive and is not associated with symptoms until a fracture occurs - the main clinical feature of osteoporosis. Recent finding Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 s. Osteoporosis is estimated to affect 200 million women worldwide. Egyptian studies show that 53.9% of postmenopausal women have osteopenia, whereas 28.4% have osteoporosis, and 21.9% of men aged 20-89 years have osteoporosis. Conclusion As the clinical outcome of osteoporosis is bone fracture, attention is now increasingly focused on the identification of patients at high risk for fracture rather than the identification of people with osteoporosis as defined by bone mineral density alone.

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Objectives This work aimed to determine the seroprevalence and the risk factors for acquiring hepatitis B virus (HBV) among pregnant women in Shebin El-Kom district, Menoufia governorate. Background HBV infection is a major global health problem. Egypt is among the countries with an intermediate endemicity of hepatitis B surface antigen (HBsAg) (range 2-8%). In areas with high/intermediate endemicity, the most common route of infection is still the vertical transmission from mother to child. Passive immunoprophylaxis with hepatitis B immunoglobulin and active immunoprophylaxis with hepatitis B vaccine in the infants of HBV-positive carrier mothers are necessary for the protection of newborns. Participants and methods A cross-sectional study was carried out on 397 pregnant women, who were randomly selected from pregnant women attending maternal and child health centres in Shebin El-Kom district, Menoufia governorate, and were subjected to a personal interview with a predesigned questionnaire and screened for HBsAg in the serum using enzyme-linked immunosorbent assay. Results The seroprevalence of HBV among pregnant women in Shebin El-Kom district, Menoufia governorate, was 2.3%, and the main risk factors for acquiring infection were the habit of one-syringe multiple use [odds ratio (OR) = 12.03], a family history of HBV infection (OR = 8.73), and HBV infection in the husband (OR = 96.5). Conclusion HBV is of intermediate endemicity among pregnant women in Shebin El-Kom district, Menoufia governorate, and the Ministry of Health and Population should adopt a program for the screening of all pregnant women for HBsAg at maternal and child health centres and for health education of the public about the modes of transmission of HBV and the application of infection control measures at health facilities to control the spread of HBV.

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Objective The aim of this study was to conduct clinicopathological, treatment, and survival analysis of epithelial ovarian cancer patients treated at the Clinical Oncology Department, Menoufia University. Background Epithelial ovarian cancer constitutes the majority of ovarian neoplasms (about 80%). Predisposing factors may be genetic, personal history of breast or endometrial cancer, nulliparity, endometriosis, and postmenopausal estrogen. Symptoms are often vague, and until now there are no effective screening programs. Typically, treatment depends on a combination of surgery and chemotherapy in most of the patients. Patients and methods This study included 83 patients diagnosed with epithelial ovarian cancer presented to the Clinical Oncology Department, Menoufia University, from January 2006 until December 2011. Data were collected regarding clinicopathological characteristics, treatment modalities including surgery and chemotherapy, response to treatment, and survival analysis including progression-free survival and overall survival. Results This study included 83 patients; the mean age of the patients was 55 years. Most of the patients presented at advanced stages (stages III and IV were seen in 84.3% of the patients). Serous cystadenocarcinoma was the predominant type of tumor seen in 68.7%. Surgery was the initial step in 86.7% of the patients. Paclitaxel-carboplatin was the most commonly used regimen as first-line chemotherapy. Response rate to first-line chemotherapy reached 80.2% (35% complete response). Conclusion In our study, the age incidence of ovarian cancer was 55 years. For most of the patients, typical presentation was late. Progression-free survival was nearly the same as that reported in the western literature. There was significant correlation between response and stage. There was significant correlation between overall survival, progression-free survival, and debulking type.

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Objectives The aim of the study was to evaluate the progression of diabetic retinopathy (DR) after phacoemulsification in cataractous diabetic patients and determine whether complicated cases of phacoemulsification with opening of the posterior capsule during surgery affect the progression of DR. Background Diabetes is the most common risk factor for development of cataract. The visual outcome of cataract surgery in diabetic patients depends on the severity of retinopathy. Cataract may prevent the recognition or treatment of sight-threatening retinopathy before surgery, and, after surgery, vision may be impaired by severe fibrinous uveitis, capsular opacification, anterior segment neovascularization, macular oedema and deterioration of retinopathy, probably due to interruption of the blood-retinal barrier. Materials and methods This study includes 40 cataractous diabetic patients, who underwent detailed history taking, full ophthalmic examination, fundus fluorescein angiography and optical coherence tomography before and after phacoemulsification. The patients were divided into two groups. Group A: this group included 20 patients selected from among uncomplicated phacoemulsification surgeries with polymethyl methacrylate or acrylic posterior chamber intraocular lens implantation. Group B: this group included 20 patients selected from among phacoemulsification surgeries with accidental opening of the posterior capsule during surgery and subsequent removal of the anterior vitreous face with or without intraocular lens implantation in the same session. Results DR showed a progression rate of 10% in group A compared with 20% in group B. The difference between groups as regards DR progression was highly significant. The statistically significantly higher progression rate in DR observed in complicated cases (group B) may be explained by interruption of the blood-retinal barrier. Conclusion Uncomplicated phacoemulsification does not cause acceleration of DR postoperatively. Any progression that is observed postoperatively represents the natural history of the disease. Posterior capsular tear during cataract surgery in diabetic patients leads to statistically significant higher rates of macular oedema, progression of DR and increase in foveal thickness. These events may be related to interruption of the blood-retinal barrier after a posterior capsular tear and the subsequent increased incidence of postoperative inflammation in diabetic patients with diffusion of inflammatory mediators from the anterior segment to the posterior segment. These inflammatory mediators increase the vascular permeability of the retinal capillaries with subsequent macular oedema and increase in foveal thickness.

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Objective The aim of this study was to compare the results of intravitreal injection with subtenon injection of triamcinolone in diabetic macular edema (DME). Background Triamcinolone injection for DME. Patents and methods The study is a prospective randomized clinical trial including 80 eyes of patients with DME. Patients were divided into two groups: group I and group II. Group I (73.1% men and 26.9% women; mean age 55.7 ± 7.2 years) included 40 eyes that received 4 mg of intravitreal triamcinolone acetonide injection. Group II (65.5% men and 34.5% women; mean age 55.8 ± 7.9 years) comprised 40 eyes that received 40 mg of subtenon triamcinolone acetonide injection. The patients were followed up after 1 week and 1, 3, and 6 months later to assess best-corrected visual acuity, intraocular pressure, and macular thickness. Fluorescein angiography and optical coherence tomography were used to evaluate the improvement. Results There was a statistically significant difference between the studied groups at 1 week and 1 month (P < 0.05) and no significant difference at 3 and 6 months (P > 0.05) as regards their post-treatment outcome for visual acuity, and there was no statistically significant difference between the studied groups at 1 and 6 months (P > 0.05) as regards their post-treatment outcome for macular thickness. Conclusion Both intravitreal and subtenon triamcinolone injections cause a significant increase in visual acuity; the effect is early and more pronounced in the intravitreal group but subtenon injection is safer.

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Objective The present work aimed to discuss the association between intercellular adhesion molecule 1 (ICAM1) and development of both diabetes mellitus and diabetic nephropathy. Data sources They included English language citation in the last 20 years from the database of abstracts of reviews from 2005 to 2013 updates from expert reviews and literatures surveillance. Study selection Systematic reviews that addressed ICAM1 and studies that addressed the association of ICAM1 with development of both diabetes mellitus and diabetic nephropathy and mechanism of the benefit of inhibition of ICAM1 in treatment of diabetes mellitus and diabetic nephropathy were included. Data extraction Special search was performed at midline in the title of papers; all articles including review articles in the last 20 years were reviewed. In addition, a special search was performed at specific databases including science direct and genetic association studies of ICAM1 gene in diabetes mellitus and diabetic nephropathy used in midline search, and also studies in the last 20 years were included. Data synthesis The researcher reviewed each study independently and rebuilt obtained data in his own language according to his needs to know the role of ICAM1 in development of both diabetes mellitus and diabetic nephropathy through the article. Conclusion ICAM1 is most likely a useful biomarker for prediction of endothelial dysfunction in diabetes and diabetic nephropathy.

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Objective This study was designed to identify whether visceral adiposity, anti-Mόllerian hormone, and ovarian stromal Doppler assessed during initial screening could predict the response to ovulation induction with clomiphene citrate in patients with polycystic ovary syndrome. Background The first choice of drug in women with polycystic ovary syndrome is clomiphene citrate. Three-quarters of women with polycystic ovary syndrome will ovulate with clomiphene citrate. Patients who do not ovulate on the maximum dose of 150 mg are considered to be clomiphene citrate resistant. Several parameters have been used to predict ovarian response in polycystic ovary syndrome patients. Patients and methods The study was carried out on 150 patients with polycystic ovary syndrome. Initial clomiphene citrate doses were 50 mg daily for 5 days starting on cycle day 3. In the absence of response, doses were increased to 100 and 150 mg daily in subsequent cycles. First ovulation with clomiphene citrate was used as the endpoint. Results At the end of the follow-up period, 110 (73.3%) patients had ovulated. Anti-Mόllerian hormone, visceral fat area assessed with computed tomography, and ovarian stromal pulsatility index were significantly different between responders and nonresponders. The cutoff levels for visceral fat area, anti-Mόllerian hormone, and ovarian stromal pulsatility index for predicting clomiphene citrate resistance were 83.6 cm ² or more (area under the curve 0.79), 3.2 ng/ml or more (area under the curve 0.79), and 0.92 or less (area under the curve 0.66), respectively. Area under the curve for a multivariate prediction model was 0.87. Conclusion Clomiphene citrate-resistant polycystic ovary syndrome patients can be predicted on the basis of initial characteristics such as visceral fat area, anti-Mόllerian hormone levels, and ovarian stromal pulsatility index. This can help in patient selection and counseling regarding the success of ovulation induction.

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Objective The aim of this work was to study the relationship between echocardiographic parameters and the CHA ₂ DS ₂ -VASc score in patients with nonvalvular atrial fibrillation (AF). Background Strain and strain rate imaging using two-dimensional speckle-tracking echocardiography is a new modality that has emerged recently to estimate myocardial function accurately. Left atrial (LA) strain analysis is a new tool that can be used to evaluate LA function. LA strain may correlate with the CHA ₂ DS ₂ -VASc score. Patients and methods We prospectively identified 30 patients with AF, and 20 normal individuals served as controls. All 50 participants underwent standard two-dimensional Doppler and speckle-tracking echocardiography. Results The LA diameter was greater in patients with AF when compared with the control group (5.03 ± 0.85 vs. 3.30 ± 0.57, P < 0.001). The peak LA longitudinal strain in both the apical four-chamber (AP4) and the apical two-chamber (AP2) views was reduced in patients with AF when compared with controls (12.42 ± 7.17 vs. 49.89 ± 8.45 in the AP4 view and 11.85 ± 7.32 vs. 49.17 ± 7.97 in AP2, P < 0.001), and it was negatively correlated with the CHA ₂ DS ₂ -VASc score, but without statistical significance (P > 0.05). Conclusion LA strain, which is a marker of dynamic LA function, is significantly reduced in AF patients. The correlation between the peak LA strain and the CHA ₂ DS ₂ -VASc score was negative, but it did not reach statistical significance.

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Objective The aim of this study was to assess the value of serum lipoarabinomannan (LAM) in the diagnosis of pulmonary tuberculosis (TB). Background The accurate diagnosis of TB is difficult. Recent studies indicate that a LAM assay (ELISA) may have some utility in the diagnosis of TB. Material and methods Sera from 40 individuals with confirmed pulmonary TB and 20 healthy individuals were tested for the presence of LAM by means of ELISA assay. Culture positivity for Mycobacterium tuberculosis was used as the reference standard for TB diagnosis. Results The serum LAM ELISA test showed high positivity in confirmed TB patients; sputum smear combined with LAM diagnosed 95% of the confirmed cases; tuberculin skin test, elevated erythrocyte sedimentation rate, immunocompetent state, and radiological tests have shown significant differences from qualitative and quantitative serum LAM. Serum LAM sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90, 100, 93.3, 100, and 83.3%, respectively. Conclusion The LAM test is a simple and reliable test for the diagnosis of pulmonary TB.

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Objectives The aims of the study were to estimate the antibodies prevalence and to determine risk factors of hepatitis C virus (HCV) infection in the population of Kafr El Sheikh Governorate. Background HCV infection is a major public health problem worldwide. Persistent HCV infection is a leading cause of serious liver disease, including cirrhosis and hepatocellular carcinoma. Patients and methods This study included 1000 participants; they were randomly selected from different districts at Kafr El Sheikh Governorate. All participants were subjected to thorough history taking, clinical assessment, and detection of HCV antibodies by one-step test device. Results The prevalence of HCV antibodies seropositive individuals in the study was 16.7% and it is higher among men and in rural areas than in women and in urban areas, respectively. Conclusion The prevalence of HCV infection in the population of Kafr El Sheikh Governorate is considered as public health problem. The evaluation of chronic HCV prevalence and risk factors for transmission represents a great challenge, which will pay off in achievement of efficient measures for HCV prevention.

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Background Coronary artery disease (CAD) is a complex disease with well-documented genetic and environmental components. Lipoprotein lipase (LPL) is considered a potential target as the variations in the LPL gene have been implicated in a number of pathophysiologic conditions associated with CAD. Objectives The aims of this study were to determine the relationship between LPL gene polymorphisms (PvuII and S447X) and lipid profiles in patients with CAD, and to determine its role in the prediction of the severity of coronary atherosclerosis. Patients and methods A total of 100 individuals were classified by coronary angiography: 80 patients with CAD and 20 controls (normal coronary angiography). Clinical data, carotid sonography, blood lipid profiles, and LPL genotyping for PvuII and S447X using PCR-RFLP were assessed. Results Plasma lipid profiles and carotid intima-media thickness were significantly increased in CAD patients compared with controls. LPL polymorphisms were distributed for PvuII genotypes and alleles in CAD patients versus controls as follows: CC (2.5 vs. 15%), CT (76.25 vs. 75%), and TT (21.25 vs. 10.0%) genotypes; T (59.4 vs. 47.5%) and C (40.6 vs. 52.5%) alleles. LPL S447X genotypes and alleles showed no significant difference between CAD and controls. CT genotypes of LPL PvuII were the highest in number and percentage compared with CC and TT among the CAD patients (P<0.05). However, there was a significant decrease in the systolic and diastolic velocity in CC versus CG genotypes of S447X among CAD patients (P < 0.05). Other carotid ultrasound, lipid profiles, or coronary angiography parameters were not significant in both genotypes of LPL among CAD patients. Conclusion Atherosclerotic ischemic patients showed a higher association in the number and percent of CT genotypes of PvuII LPL that may be an important diagnostic risk biomarker and may implicate a therapeutic intervention in CAD.

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Objective This study aimed to determine p53 protein expression by immunohistochemistry in the esophageal mucosa of patients with gastroesophageal reflux disease (GERD). Background GERD is a common clinical disorder that can significantly impact the patient's quality of life and pose a significant burden on healthcare systems worldwide. The incidence of esophageal adenocarcinoma has been increasing rapidly over the past few decades. The major risk factors predisposing to the development of adenocarcinoma are long-standing GERD and Barrett's esophagus. P53 protein expression in esophageal carcinogenesis is still being studied. The identification of tumor markers in patients with GERD may enable recognition of subgroups of patients who are more at risk of developing dysplasia and/or cancer. Patients and methods This study was carried out on 200 patients with symptoms of GERD. They were recruited from the endoscopy unit of Menoufia University Hospital between August 2010 and March 2013, and were included in group 1. According to the results of upper endoscopy and histopathology, they were subdivided as follows: group 1a included patients with GERD with erosive esophagitis ( n = 180), group 1b included patients with GERD and Barrett's esophagus ( n = 20), and group 2 included 20 patients with other GIT symptoms with no reflux and normal esophageal squamous epithelium; this was the control group. Written valid consent was obtained from every patient for examination and upper endoscopy; the clinical sheet for every case was completed, including assessment of history, examination, and the investigations required. Results We found negative reactivity for p53 in 20 histologically normal patients (0%), and positive p53 protein expression in 76 patients (40%) in the esophagitis group and in 14 patients (70%) with Barrett's metaplasia ( n = 20). According to the Los Angeles classification grade, p53 was overexpressed in 33.3% ( n = 24) of esophagitis grade A (mild esophagitis) patients, 46.3% ( n = 32) of esophagitis grade B (moderate esophagitis) patients, 56.4% ( n = 22) of esophagitis grade C patients, and 60% ( n = 12) of esophagitis grade D (severe esophagitis) patients. Conclusion GERD grades C and D were more prevalent in Barrett's esophagus. P53 expression was higher in Barrett's esophagus than in erosive esophagitis compared with the normal group. P53 protein expression increases gradually with the severity of esophagitis caused by GERD.

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Objectives This study aimed to investigate the impact of clinical and histopathological changes in liver tissue of responders and nonresponders to standard pegylated interferon (Peg-IFN) and ribavirin (RBV) therapy and to determine whether they could predict treatment outcome or not. Background Hepatitis C virus (HCV) infection is a major health problem worldwide. Combination therapy of Peg-IFN and RBV has been recognized as a standard treatment for HCV infection. Unfortunately, this standard therapy produces a sustained virological response in only 50% of HCV-infected patients. Clinical and histological findings may play a role in predicting response to standard Peg-IFN/RBV therapy. Patients and methods This retrospective study included 64 patients with chronic HCV who were treated with Peg-IFNa/RBV. According to their response to treatment, they were classified into responders (n = 34) and nonresponders (n = 30). Pretreatment liver biopsies were evaluated histopathologically for necroinflammatory grade and fibrosis stage according to the modified Ishak and Metavir scoring systems for chronic hepatitis. Other pathological findings were also reported. Demographic, laboratory, and histopathological results were subjected to a statistical analysis. Results The current study showed that the age of the patients (P = 0.003), sex (P = 0.027), and serum a-fetoprotein level (P = 0.046) were the parameters that showed a statistically significant difference between responders and nonresponders to interferon therapy. However, the grade of necroinflammation, stage of fibrosis as well as other pathological changes did not show a statistically significant difference between both groups. Conclusion The current study showed that young age, female sex, and the baseline serum level of a-fetoprotein are the parameters that favored response to interferon and RBV therapy in chronic HCV Egyptian patients, whereas histopathological changes played no role in predicting response to treatment.

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Objective The aim of this study was to assess CD95 expression on peripheral blood lymphocytes in patients with chronic hepatitis C virus (HCV) infection, both under interferon treatment and without interferon treatment, in comparison with a control group to assess its role in the pathogenesis of chronic hepatitis C disease. Background Egypt has the highest prevalence of HCV in the world, estimated nationally at 14.7%. Fas (APO-1/CD95)-mediated apoptosis plays an important role in liver cell destruction in viral hepatitis. Participants and methods Peripheral blood lymphocytes were isolated from 15 patients with chronic HCV under interferon treatment and from 20 patients with HCV without interferon treatment, and CD95 expression was analyzed by flow cytometry. The results were compared with those of normal control volunteers. Results The percentage of CD95 expression was significantly higher in patients with HCV without interferon treatment and in patients with HCV under interferon treatment compared with normal controls (27.09 ± 12.89 vs. 22.33 ± 11.42 vs. 11.09 ± 5.96, respectively). The percentage of CD95 expression did not differ significantly between patients with HCV without interferon treatment and patients with HCV under interferon treatment. Conclusion The increase in CD95 expression on PBMCs among HCV patients supports its role in the pathogenesis of chronic hepatitis C disease.

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Objective A review of changes in stomach hemodynamics in patients with liver cirrhosis. Data analysis Data sources: medical text books, medical journals, and medical websites that have updated researches with key words (stomach hemodynamics) in the title of the paper. Study selection: systematic reviews that addressed stomach hemodynamics and studies that addressed gastric vascular changes in liver cirrhosis. Data extraction: a special search was conducted at midline with the key words stomach and hemodynamics in the title of the paper; extraction was performed, including the assessment of the quality and the validity of the papers that met with the prior criteria that describe the review. Data synthesis: the main result of the review. Each study was reviewed independently; the data obtained were rebuilt in a new language according to the need of the researcher and arranged into topics through the article. Recent findings Transjugular intrahepatic portosystemic stentshunt or surgically created shunts are excellent salvage procedures. Over the next decade, the management of patients with varices may improve with the availability of additional pharmacological agents that specifically target intrahepatic circulation, improved endoscopic techniques, and a greater availability of liver transplantation. Conclusion Gastroesophageal varices should be treated as for esophageal varices, whereas fundal varices do not respond well to therapeutic modalities used in esophageal varices. Pharmacological therapies, presumably reducing portal pressure and gastric blood flow, have been used to treat acute bleeding. Transjugular intrahepatic portosystemic stentshunt and shunt surgery have not been analyzed extensively as a treatment for acute or chronic portal hypertensive gastropathy bleeding. Secondary prophylaxis of portal hypertensive gastropathy bleeding with nonselective b-blockers is recommended.

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Objective The aim of this study was to compare different forms of zinc supplementation in acute diarrhea. Background Diarrheal diseases pose a public health problem on a global scale, especially in developing countries. In 2004, zinc and oral rehydration solution (ORS) were recommended by WHO for the treatment of diarrhea. Materials and methods This study was conducted on 40 patients with acute diarrhea, who were able to accept oral fluids or feeds (both sexes, aged 3-53 months), hospitalized in the pediatric department of Aga Hospital, between May 2012 and May 2013, and 20 healthy infants/children as controls. The study included three groups: group 1 comprised 20 infants/children with acute diarrhea who received zinc syrup and were rehydrated with ORS only; group 2 comprised 20 infants/children who presented with diarrhea and received zinc incorporated in ORS; and group 3 comprised 20 normal infants/children. Venous blood samples were collected before and after zinc supplementation in groups 1 and 2 and only one sample was collected for control group 3. All patients had some level of dehydration. Colorimetric test for the determination of zinc level in serum was used, and statistical analysis of the data was carried out using Excel for figures and SPSS version 16. Results No significant difference was found in the zinc effect between zinc syrup and zinc incorporated in ORS in acute diarrhea treatment. Zinc level in the group that received zinc syrup was 79.7 ± 14.4 and that in the group that received zinc powder was 73.5 ± 13.2. Conclusion The study concluded that there was no significant difference in zinc effect between zinc syrup and zinc incorporated in ORS in cases with acute diarrhea.

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Objective The aim of the present study was to investigate the traditional and nontraditional risk factors in chronic kidney disease (CKD) patients with stroke and the role of renal function in the short-term outcome of stroke. Background Over the past decade, considerable evidence has accumulated on the increased incidence of stroke and mortality associated with CKD. Patients and methods A total of 67 patients with first ever stroke, either ischemic or hemorrhagic, with CKD were compared with 30 first ever stroke patients who were free from the signs and symptoms of CKD. All patients were assessed on admission (day 0) and then followed up at day 7 and day 30. Motor and functional disability was assessed using the National Institutes of Health Stroke Scale, and stroke outcome was assessed using the Barthel index scale. Results CKD patients had a significantly higher rate of hemorrhagic stroke than the control group (37.3 vs. 16.6%; P < 0.05). In the hemodialysis population in group II CKD ischemic stroke showed a predominance of vertebrobasilar arterial territory infarcts (P < 0.05). Patients with estimated glomerular filtration rate less than 15 ml/min/1.73 m ² had the highest motor and functional disability, with a mean National Institutes of Health Stroke Scale score of 16.3 ± 5.9. Patients with CKD had a significantly higher risk of case fatality rate, reaching 41.7%, compared with the control group (30%). Conclusion CKD patients with stroke had a significantly higher risk of case fatality rate; reduced estimated glomerular filtration rate on admission is related to poor stroke outcome. In CKD patients, as serum albumin and hemoglobin level decrease, the severity of stroke increases.

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Objectives To determine whether prophylactic nasal continuous positive airway pressure (CPAP) applied soon after birth, regardless of the respiratory status, in very-low-birth-weight (VLBW) neonates reduces the use of mechanical ventilation and its hazards. Background Using nasal CPAP early in VLBW neonates is highly beneficial and associated with lower complications compared with mechanical ventilation. Patients and methods This prospective clinical trial was performed on 40 preterm neonates less than 37 weeks old and with body weight greater than 1000 g and less than 1500 g, who were admitted to the neonatal intensive care unit of Shibin El-Kom teaching hospital because of VLBW. Patients were randomly allocated into the following treatment groups. Group I included 20 preterm neonates supported by nasal CPAP immediately after birth regardless of their respiratory status. Group II included 20 preterm neonates receiving routine neonatal care. Survival analysis was applied to estimate and compare survival rates, the duration of oxygen therapy, and the hospital stay using the independent sample t-test. Results Regarding the initial and the final arterial blood gases in the CPAP group, there was a statistically significant difference with respect to the PO ₂ . In contrast, there were no statistically significant differences in the initial and the final arterial blood gases in the non-CPAP group. There was a statistically significant difference between the CPAP group and the non-CPAP group with regard to the whole duration of stay in the neonatal intensive care unit (the duration was 19.60 ± 3.44 and 32.10 ± 12.28, respectively) and the whole duration of ventilation (the duration was 4.0 ± 5.32 and 24.70 ± 13.0, respectively). Conclusion The use of nasal CPAP was associated with a lower duration of stay, a lower incidence of complications (pneumothorax, bronchopulmonary dysplasia, pulmonary hemorrhage, and sepsis), and a decreased need for mechanical ventilation.

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Objectives This work aimed to detect the level of free testosterone (FT) hormone in type II diabetic men. Background Testosterone is a cholesterol-based steroid hormone that plays a critical role in numerous biological functions throughout the male life cycle. Diabetes mellitus type 2 is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Low serum testosterone is associated with a variety of comorbidities, including insulin resistance, type 2 diabetes, obesity, and metabolic syndrome. Materials and methods This study was carried out on 50 diabetic men aged from 25 to 65 years and 20 apparently healthy men, who attended the outpatient clinic of Dermatology, Andrology, and Sexually transmitted diseases. Results The lower levels of FT were found in older diabetic persons; diabetic men were markedly obese and showed higher BMI. They showed low International Index of Erectile Function scores, but higher scores were observed in young patients. The lowest FT levels were found in patients with the highest random blood sugar levels. Conclusion FT levels decrease as a man ages and if he is obese, his testosterone levels decrease even more. Diabetes accentuates these effects. Low testosterone level is a biomarker for diabetes development and high BMI is also highly predictive for development of diabetes.

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Objective Our aim is to evaluate the expression of interleukin-17-producing CD4 ⁺ T cells (Th17) in peripheral blood of patients with chronic hepatitis B (CHB) and whether these cells show a potential to exacerbate liver damage during chronic hepatitis B virus (HBV) infection. Background Interleukin-17-producing CD4 ⁺ T cells (Th17)-mediated immune response has been shown to play a critical role in inflammation-associated disease; however, its role in chronic HBV infection remains unknown. Here, we characterized peripheral Th17 cells and analyzed their association with liver injury in HBV-infected patients. Participants and methods This study included 15 patients with CHB without cirrhosis (11 men and four women), 15 patients with CHB with cirrhosis (eight men and seven women), and 15 healthy controls (10 men and five women). Laboratory investigations including complete blood picture, liver function tests, hepatitis viral markers (HBsAg, anti-HCV-Ab), a-fetoprotein, and HBV DNA PCR were performed for all participants. Evaluation of the level of Th17 cells in the peripheral blood was carried out using the flow cytometry technique. Results The data showed that the frequency of circulating Th17 cells was increased in patients with CHB viral infection compared with the healthy controls, and was significantly higher in patients with CHB-associated cirrhosis. In addition, the increasing levels of circulating Th17 cells were correlated positively with serum alanine transaminase levels. Conclusion Our results showed that Th17 cells were highly enriched in the peripheral blood of CHB patients, and their levels were related to disease progression, suggesting its role in exacerbation of liver damage during chronic HBV infection.

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Objective The aim of the study was to assess the predictors of cardiovascular risks in obstructive sleep apnea (OSA) syndrome. Data sources They included medical text books, medical journals, and medical websites that have updated research with keywords 'cardiovascular risks' in the title of the paper. Study selection Systematic reviews that addressed OSA syndrome and studies that addressed cardiovascular risks in OSA syndrome were included. Data extraction Special search was performed at midline with keywords 'cardiovascular risks' in the title of the papers; extraction was made, including assessment of the quality and validity of papers that met with the prior criteria that describe cardiovascular risks in OSA syndrome. Data synthesis Each study was reviewed independently; obtained data were rebuilt in new language according to the need of the researcher and arranged in topics through the article. Recent findings There is also strong evidence supporting the association between sleep apnea and hypertension, arrhythmias, and coronary heart disease, as well as overall cardiovascular mortality. OSA is accompanied by activation of multiple cardiovascular disease mechanisms. Conclusion OSA, presumably mainly through intermittent hypoxia, is associated with oxidative stress, systemic inflammation, and vascular endothelium damage and dysfunction. Both systemic inflammation and endothelial dysfunction are aggravated when sleep-disordered breathing is associated with other comorbid conditions, such as morbid obesity. There are new directions regarding upper airway collapse mechanisms, such as pharyngeal denervation. There is also strong evidence supporting the association between sleep apnea and hypertension, arrhythmias, and coronary heart disease, as well as overall cardiovascular mortality.

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Objective The aim of this study was to determine the value of glycosylated hemoglobin (HbA1c) as an early diagnostic marker for diabetes mellitus in high-risk groups such as relatives of diabetic patients (siblings) and obese children. Background Diabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and reduce the risk of long-term complications. Patients and methods This study was conducted on 60 children attending the Genetic and Endocrine Unit of the Pediatric Department, Faculty of Medicine, Menoufia University. They were divided into two groups: group I [45 children who were relatives of diabetic patients (siblings)] and group II (15 obese children). The studied groups were subjected to detailed history taking, thorough clinical examination, anthropometric measurements, investigations (routine and special investigations through the estimation of HbA1c), and family counseling. Results At the start, five (8.3%) children were in prediabetic stage (HbA1c level ranging between 5.7 and 6.4%); of them, two (4.4%) were relatives of diabetic patients and three (20%) children were from the obese group. At the end of the 3-month follow-up, with proper family counseling, a child from among the relatives of diabetic patients (2.2%) and another from the obese group (6.7%) were seen to have HbA1c within the normal range. At the end of 6 months of follow-up, one (6.7%) obese female patient was still in prediabetic stage. Conclusion The HbA1c test is an early detector of diabetes mellitus among high-risk groups. Prediabetes occurs because of the interaction between genetic and environmental factors. Controlling the environmental factors by proper family counseling can delay and even inhibit the emergence of diabetes.

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