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2021| July-September | Volume 34 | Issue 3
Online since
October 18, 2021
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Evaluation of cerebrospinal fluid flow by phase-contrast technique
Mohamed S Abdulla, Hala H Mohamed, Mohamed B Alghannam
July-September 2021, 34(3):1041-1047
DOI
:10.4103/mmj.mmj_175_20
Objective
The objective of this study was to evaluate cerebrospinal fluid (CSF) flow by phase-contrast technique.
Background
Multiple CSF flow disorders are present like normal pressure hydrocephalus (NPH), atrophic brain changes, communicating hydrocephalus, aqueductal stenosis, and others. Routine MRI as well as new techniques like steady-state free precession sequence, 2D phase-contrast cine MRI, and 2D time spatial labeling inversion pulse can be used to evaluate these CSF flow disorders.
Patients and methods
This was a case–control study and included 50 patients and 10 healthy volunteers as a control group. All were referred to the radiodiagnosis departments at Menoufia University Hospital and Tanta University Hospital from July 2017 to August 2019.
Results
This study revealed that CSF flowmetry can differentiate between NPH and atrophic brain changes by the value of stroke volume, where the normal range was 10–21 μl, and all cases of atrophic brain changes showed stroke volume less than 10 μl, where all cases of NPH showed stroke volume more than 21 μl. This study can also confirm the diagnosis of aqueductal stenosis and differentiate it from communicating hydrocephalus (cases of aqueductal stenosis showed stroke volume less than 10 μl, where communicating hydrocephalus showed stroke volume is between 10 and 1 μl). It was also useful in follow-up of patients with endoscopic third ventriculostomy by detection of stroke volume through the third ventricular floor stoma.
Conclusion
The study showed usefulness of this investigation for confirmation of diagnosis of various CSF disorders. Cine phase-contrast MRI studies, however, should be interpreted in conjunction with the clinical manifestations and the conventional MRI findings in cases of ventriculomegaly. The technique enables measuring aqueductal flow parameters in a reliable and reproducible way and predicts response to shunting and also allows accurate follow-up results.
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PEDIATRICS - ORIGINAL ARTICLES
Pediatric respiratory assessment measure in evaluation of the severity of bronchial asthma exacerbation in children
Ghada M El Mashad, Amr M Elewa
July-September 2021, 34(3):991-997
DOI
:10.4103/mmj.mmj_102_20
Objective
The aim was to study the role of pediatric respiratory assessment measure (PRAM) score in evaluation of acute asthma exacerbation in children.
Background
Acute severe asthma is one of the most common medical emergency situations in childhood, where accurate assessment and management is of extreme importance and may be lifesaving. PRAM score has been used to classify asthma severity and treatment.
Patients and methods
A prospective cohort study was adopted by applying the PRAM score on 108 asthmatic children presented to the Emergency Department of Elraml Pediatric Hospital in Alexandria by acute asthma exacerbation in the period of the study.
Results
The study included 66 (61.1%) boys and 42 (38.9%) girls, aged from 2 to 12 years, with mean age of 5.07 ± 2.68 years. The most common triggering factor according to our study was viral infection or common cold (90.7%). Increasing severity of acute asthma exacerbation was associated with increasing initial PRAM score. There was significantly increased severity of grade of PRAM score after initial bronchodilator therapy in relation to young aged children (<3 years). Most of the cases were mild intermittent (49.1%), and most of the patients were discharged (74.1%). The admitted cases were younger in age than those who were discharged from the emergency room. There was a positive correlation between PRAM score at triage and duration of hospital stay.
Conclusion
PRAM score in this study is useful for predicting fate of patients in emergency room, and after initial bronchodilator therapy, it is an excellent sensitive and specific tool to predict the admitted patients from the discharged patients.
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FAMILY MEDICINE - ORIGINAL ARTICLE
Effectiveness of a patient educational program on rheumatoid arthritis disease activity
Zeinab A Kasemy, Saga F El Gazar, Ismail T Badr, Nagwa A Farag, Dina S Fotoh
July-September 2021, 34(3):1115-1125
DOI
:10.4103/mmj.mmj_8_21
Objectives
To validate Arabic version of rheumatoid arthritis disease-specific patient's knowledge and attitude questionnaire (PKAQ-RA) and to assess the effect of health education on RA disease activity.
Background
RA is a disease requiring a change in patient's behavior, and hence preventing disability.
Patients and methods
A quasi-experimental pretest and posttest interventional study was conducted on 403 patients with RA. An equal number of matched controls were recruited. Patient's knowledge questionnaire on RA and authors' designed attitude questionnaire (PKAQ-RA) were delivered. All patients were assessed regarding disease duration and disease activity score 28. Laboratory investigations including fibrinogen, albumin, rheumatoid factor titer, and anti-cyclic citrullinated peptide antibodies in addition to gray-scale ultrasonography were conducted.
Results
Patients with RA (
n
= 403) had significantly higher laboratory investigation values than healthy controls (
n
= 403). Cronbach's alpha of the Arabic version of PKAQ-RA was 0.75 and 0.82, respectively. The total knowledge and attitude scores were significantly higher in posthealth than prehealth education implementation period (13.11 ± 1.93,
R
: 9–19 and 5.79 ± 1.44 vs. 15.18 ± 1.91 and 7.78 ± 1.50, respectively) (
P
< 0.001). Unsatisfactory knowledge was associated with male patients [odds ratio (OR)=2.02, 95% confidence interval (CI): 1.19–3.43], being of low education (OR = 2.03, 95% CI: 1.29–3.19), and having increased medications (OR = 2.03, 95% CI: 1.29–3.19). Negative attitude was associated with low education (OR = 3.15, 95% CI: 1.97–5.02) and increased number of medications (OR = 0.18, 95% CI: 0.10–0.34). Patients showed some improvement but still significantly different from controls. Biomarkers like albumin/fibrinogen ratio were significantly increased, whereas grayscale ultrasonography was significantly decreased after health education in active and inactive groups (
P
< 0.001).
Conclusion
The Arabic version of the PKAQ-RA was created and proved to be a reliable and valid tool. Patients' knowledge of RA was poor. RA disease activity got improved when upgrading patients' knowledge and modifying their attitude. Integration of patient-directed education programs in the treatment of RA to raise the patients' awareness, increase compliance, and improve the disease condition is required.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Serum calprotectin level: is it a novel diagnostic biomarker for chronic inflammatory bowel diseases?
Elsayed I Elshayeb, Ahmed E. E. A. Moustafa, Mohamed A Helwa, Abdulmohsen I Marey
July-September 2021, 34(3):768-773
DOI
:10.4103/mmj.mmj_29_20
Objective
This study aims to evaluate serum calprotectin level and its utility as a novel biomarker and its relation to endoscopic and other biomarkers for the diagnosis of inflammatory bowel diseases (IBDs).
Background
Calprotectin is a marker of neutrophil activation that has been reported to be elevated in the blood and feces of patients with active IBD. Fecal calprotectin has been studied as a potential biomarker for IBD due to its noninvasive nature and low cost.
Patients and methods
This study was conducted on 80 subjects recruited from the gastrointestinal endoscopy unit, outpatient clinic of gastroenterology of Menoufia University Hospitals and El Mahalla General Hospital during the period from March 2017 to September 2018. Full history taking, full examination, and laboratory investigations were done.
Results
Serum calprotectin levels were significantly increased in Crohn's disease than each of the ulcerative colitis group and were significantly higher in ulcerative colitis than each of inflammatory bowel syndrome and healthy control groups. Also, it was significantly higher in IBD than inflammatory bowel syndrome and healthy control groups. In IBD patients, serum calprotectin levels showed significant negative correlations with serum albumin and creatinine and positive correlations with C-reactive protein (CRP) and disease activity index (DAI). Also, serum albumin showed significant negative correlations with CRP and DAI and positive correlation with serum creatinine. Also, CRP levels showed significant positive correlation with DAI. According to the area under the receiver operating characteristic curve, serum calprotectin was the most sensitive and specific markers for the diagnosis of IBD patients, followed by serum CRP at the corresponding cutoff points. The least sensitive marker was serum albumin.
Conclusion
Serum calprotectin is a promising blood-based biomarker for the diagnosis of IBD and mainly in Crohn's disease patients particularly in addition to another biomarkers like CRP and Fecal calprotectin (FC).
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PEDIATRICS - ORIGINAL ARTICLES
Effect of phototherapy on serum magnesium level in newborn with hyperbilirubinemia
Ahmed A Khatab, Noha M Ashour, Mahmoud L Shehata
July-September 2021, 34(3):1004-1008
DOI
:10.4103/mmj.mmj_250_20
Objective
To screen neonates with hyperbilirubinemia who received phototherapy to determine the effect of phototherapy on the serum magnesium level.
Background
Hyperbilirubinemia is one of the most prevalent problems in neonates. Phototherapy remains the main primary management in neonatal jaundice. However, it has many adverse effects, and hypomagnesemia is one of them.
Patients and methods
A prospective hospital-based comparative study was conducted on 70 eligible neonates admitted in Neonatal Intensive Care Units of Menoufia University Hospital receiving phototherapy from May 2019 to February 2020. Serum bilirubin and magnesium (total and ionized) were determined before starting phototherapy, and it was considered as control. Then serum bilirubin and magnesium were measured after 48 h of phototherapy and after termination of phototherapy. The plasma magnesium level was measured spectrophotometrically using ready-for-use kit supplied by Quimica Clinica Aplicada S.A. Company.
Results
The total serum magnesium level before phototherapy was 2.7 ± 0.3, 2.1 ± 0.30 mg/dl 48 h after phototherapy, and 1.85 ± 0.28 mg/dl after termination of phototherapy. Serum ionized magnesium level before phototherapy was 0.58 ± 0.02, 0.53 ± 0.02 mmol/l 48 h after phototherapy, and 0.51 ± 0.01 mmol/l after termination of phototherapy. So, there was a significant decrease in serum magnesium level (total and ionized) after phototherapy.
Conclusion
Our study concluded that there was a significant negative correlation between the duration of phototherapy and serum magnesium level (total and ionized).
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DERMATOLOGY - ORIGINAL ARTICLES
Estimation of awareness of sexually transmitted diseases among married women of Menoufia governorate, Egypt
Mohamed A Gaber, Salma E. Abdelmagid Abouelkomsan
July-September 2021, 34(3):863-867
DOI
:10.4103/mmj.mmj_347_19
Objective
The aim of this study was to explore the awareness about common sexually transmitted diseases (STDs) among a sample of married women of Menoufia governorate and to educate those who lack information about STDs. Furthermore, it could be used to serve as a tool to prevent and minimize the problems of STDs.
Background
Sexually transmitted infections are a major global cause of acute illness, infertility, long-term disability, and death, with serious medical and psychological consequences to millions of men, women, and infants.
Patients and methods
This was a cross-sectional study by interviewing participants using a questionnaire. The study was carried out on 200 women. Cases were recruited from the outpatient clinic of Menoufia University Hospital.
Results
Regarding modes of transmission and complication of STDs, there was good knowledge among the participants. Overall, 85.95% of the participants, comprising 29.7% of the noneducated versus 56.25% of the educated group, knew all modes of transmission like multiple partners, infected syringe, from mother to fetus, and blood transfusion).
Conclusion
The knowledge and awareness about STDs in Menoufia governorate has been a topic of interest in population research because of its apparent direct relationship with the lack of health facilities and indirectly, with poverty.
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CLINICAL PHARMACOLOGY - ORIGINAL ARTICLES
The protective effect of metformin and exenatide on doxorubicin-induced nephrotoxicity in rats
Eman A Ali, Safa R El Fiky, Maha M El-Batsh, Marwa M. Serag El-Dien, Manal A. E. Safan
July-September 2021, 34(3):1060-1067
DOI
:10.4103/mmj.mmj_217_20
Objective
The aim was to study the protective effect of metformin and exenatide on doxorubicin (DOX)-induced nephrotoxicity in rats.
Background
DOX is an effective chemotherapeutic agent used for treatment of various solid as well as hematological neoplasms. Its use is limited owing to well-documented nephrotoxicity. Treatment with metformin and exenatide ameliorates nephrotoxicity in rats through antioxidant and antiapoptotic effects.
Materials and methods
In this experimental study, rats were divided as follows: group 1 was injected with saline intraperitoneal and orally, group 2 was injected with intraperitoneal DOX (15 mg/kg) and oral saline, group 3 was injected with intraperitoneal DOX and received metformin (250 mg/kg/day) orally, group 4 was injected with intraperitoneal DOX and received exenatide (10 μg/kg twice daily) Sc, and group 5 was injected with intraperitoneal DOX and metformin + exenatide. Basal body weight (Wt.), final body Wt., kidney Wt., kidney index, kidney malondialdehyde (MDA), reduced glutathione (GSH), serum tumor necrosis factor-α (TNF-α), serum albumin, serum urea and creatinine, urinary proteins, histopathological examination of hematoxylin and eosin, and caspase-3 immunostaining were evaluated.
Results
DOX group showed a significant decrease in body Wt, GSH levels, and serum albumin, with an increase in kidney Wt., kidney index, serum TNF-α, kidney MDA levels, urine proteins, serum urea and creatinine, and caspase-3 immunoexpression compared with the control group. In contrast, metformin-, exenatide-, and metformin + exenatide-treated groups showed significant increase in body Wt. and kidney GSH levels, with a decrease in kidney Wt., serum TNF-α, kidney MDA levels, and caspase-3 immunoexpression compared with DOX group.
Conclusion
Metformin and exenatide improved DOX nephrotoxicity in rats.
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Diagnostic accuracy of computed tomography angiography compared with catheter angiography in coronary artery disease
Tarek F. Abd Ella, Elsayed E Elsayed, Ahmed M ELkersh, Mahmoud M Moawad
July-September 2021, 34(3):1034-1040
DOI
:10.4103/mmj.mmj_30_20
Objectives
To assess the diagnostic accuracy of the computed tomography-coronary angiography (CT-CA) in detecting coronary artery disease compared with catheter coronary angiography (CCA).
Background
CT-CA is now considered an alternative tool of accurate and safe detection of coronary artery disease as it is rapid and noninvasive.
Patients and methods
This prospective study was conducted during the period between January 2017 and October 2018, including 121 patients (74 male and 47 female; mean age, 57.5 + 10.5 years) complaining of chest pain referred from cardiology outpatient clinics, Menoufia University Hospitals, for CT-CA. Patients were classified into two groups: group A underwent both CT-CA and CCA and included 41 patients (24 without previous coronary intervention, 11 had undergone previous coronary artery bypass graft, and six with previous coronary stenting), and group B included 80 patients and underwent only CT-CA, as another cause of chest pain was diagnosed or coronary significant stenosis was excluded, so patients were not candidates for CCA.
Results
Compared with CCA, CT-CA demonstrated sensitivity, specificity, and accuracy for detecting significant stenosis in coronary arteries of 97.1, 96.8, and 96.8%, respectively. The included 33 grafts CT-CA confirm the patency of additional five (15%) grafts that failed to be cannulation by CCA. The included nine stents showed six patents and three occluded by both CCA and CT-CA. CT-CA visualized extracoronary findings were not visualized by CCA.
Conclusion
CT-CA is a reliable coronary artery stenosis evaluation tool for assessment of grafts and stent patency, as well as detection of extracoronary pathology; it can reduce the number of invasive CCA studies for those patients.
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Role of ultrasonography in evaluation of knee osteoarthritis
Shaimaa A Hassanein, Esraa A Zahra, Mohamed R El Kholy
July-September 2021, 34(3):1028-1033
DOI
:10.4103/mmj.mmj_2_20
Objective
To evaluate the role of ultrasonography (US) in assessing knee osteoarthritis (OA) compared with radiograph.
Background
Similar to renal or cardiac failures, OA is considered a common disorder in the joint as an organ. High-resolution US is used increasingly in musculoskeletal medicine owing to its value in the morphological and structural assessment of soft tissue in patients with arthritis.
Patients and methods
This study included 50 symptomatic knee joints from 50 patients (male/female24 / 26) with the clinical diagnosis of OA; all of them had knee pain and/or swelling. All patients underwent US examination on their knees. Weight-bearing anteroposterior and lateral knee radiographs were assessed for the Kellgren and Lawrence grading along with the potential presence of patellofemoral degenerative signs.
Results
US findings showed irregular articular surface and narrow joint space (72.0%), marginal osteophytes (64.0%), joint effusions (88.0%), decreased cartilage thickness (32.0%), synovial thickening (20.0%), meniscal lesions (70.0%), Baker's cyst (20.0%), and ligament and tendon injury (24.0%). Soft tissue changes could not be detected in radiograph (0.0%) but were identified clearly by the US in our study, with
P
value less than 0.001. Joint effusion, which was detected in 44 (88.0%) knees in the US only was detected in six (12.0%) knees in radiograph, with a
P
value less than 0.001. Kellgren and Lawrence grades (1–3) showed an increased incidence of joint effusion and meniscal lesion in the US, where all the grade 3 cases showed joint effusions and meniscal lesions.
Conclusion
US is a simple and reproducible technique for the assessment of periarticular and intra-articular abnormalities involved in the pathophysiology of knee OA.
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PEDIATRICS - ORIGINAL ARTICLES
The effect of iron overload on pulmonary function tests in children with thalassemia major
Heba M Ahmed, Mohamed H Meabed, Hebaullah K Ibraheem, Heba M Elsherif
July-September 2021, 34(3):1009-1013
DOI
:10.4103/mmj.mmj_52_21
Objective
The aim was to determine pulmonary function abnormalities in children with thalassemia major (TM) and assess the relation between these abnormalities and iron overload.
Introduction
Regular blood transfusion program is among the most important factors that help in improving the survival of patients with TM; however, it leads to iron deposition in many organs such as lung. Most studied concerned about effect of iron on lung functions, revealed abnormalities, but limited data were observed.
Patients and methods
This cross-sectional study had included 50 children aged between 6 and 18 years (34 males and 16 females) with TM. All included children were subjected to full clinical examination and laboratory investigations including complete blood counts and serum ferritin. Pulmonary function tests (PFTs) were assessed in all included children using spirometry.
Results
Overall, 82% of the study group had abnormal pattern of PFTs. The majority of them were restrictive and of mild severity. Moreover, serum ferritin levels were found to be significantly higher in patients with thalassemia with abnormal PFTs (1456.65 ± 650.39) than patients with thalassemia with normal PFTs (744.34 ± 541.27) (
P
= 0.03).
Conclusion
Most children involved in the study had abnormal pattern of PFTs, and most frequent abnormality is restrictive pattern. In addition, there was a strong relationship between serum ferritin level and lung affection.
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DERMATOLOGY - ORIGINAL ARTICLES
Acne keloidalis nuchae treatment
Magda M Hagag, Marwa H. E. Khalil
July-September 2021, 34(3):955-959
DOI
:10.4103/mmj.mmj_218_20
Objectives
To compare the efficacy of 1064-nm Nd : YAG laser and intralesional corticosteroid in the treatment of acne keloidalis nuchae (AKN).
Background
AKN is a chronic inflammatory condition that leads to scarring of the hair follicles, development of keloid-like papules and plaques, and scarring alopecia on the nape of the neck and occipital scalp.
Patients and methods
The study was conducted on 20 patients with AKN and was studied through the following regimens: group I included 10 patients treated by long pulsed Nd : YAG laser of 1064-nm wavelength, and group II comprised 10 patients treated by intralesional corticosteroid. Sessions were performed every 2 weeks for six sessions. Evaluation included papule count, keloidal plaque size assessment, and patient satisfaction before, at every session, and at the end of treatment.
Results
Patients' papule and pustule count in Nd : YAG group before treatment ranged between 3 and 30 (10.70±8.43), and after treatment, it was decreased significantly (3.70±3.37), whereas in intralesional corticosteroid group before treatment, it ranged between 2 and 9, and after treatment, it decreased significantly. There were no significant differences before treatment and after treatment, where P=0.218.
Conclusion
Treatment of AKN by Nd : YAG 1064-nm laser is much more promising than intralesional injection of corticosteroids and much more tolerated by patients.
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CLINICAL PHARMACOLOGY - ORIGINAL ARTICLES
Antifibrotic potential of carvedilol and cilostazol on liver fibrosis in rats
Ahmed B Ahmed, Abdelrahman A. F. Yassin, Maha M Elbatsh, Safaa I Tayel, Mahmoud A. R. Fathy
July-September 2021, 34(3):1054-1059
DOI
:10.4103/mmj.mmj_8_20
Objective
The aim was to investigate possible prophylactic and therapeutic effects of carvedilol and cilostazol on liver fibrosis induced by thioacetamide in rats.
Background
Liver fibrosis is a major public health problem worldwide.
Materials and methods
A total of 50 adult male rats weighing 200–250 g were used and distributed in five groups (10 rats each): group I (control), group II (thioacetamide), group III (carvedilol + thioacetamide), group IV (cilostazol + thioacetamide), and group V (carvedilol + cilostazol + thioacetamide). At the end of the experiment, rats were killed, and blood samples were used for measuring serum levels of aspartate aminotransferase, alanine aminotransferase, tumor necrosis factor-α, malondialdehyde, and glutathione peroxidase.
Results
Carvedilol, cilostazol, and their combination significantly decrease elevated liver enzymes alanine aminotransferase and aspartate aminotransferase by 18, 24, and 29% (
P
= 0.003 for all) and 25, 27, and 29% (
P
= 0.034 for all), respectively; decrease biomarkers of oxidative stress such as malondialdehyde and tumor necrosis factor-α by 62, 65, and 68% (
P
< 0.001 for all) and 16, 21, and 22% (
P
= 0.028 for all), respectively; and significantly increase glutathione peroxidase by 111, 121, and 128% (
P
< 0.001 for all) caused by thioacetamide.
Conclusions
Carvedilol and cilostazol may play a role in hepatic protection in thioacetamide-induced hepatic fibrosis. Combined treatment showed a better hepatoprotective effect than either treatment alone did.
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
The prognostic significance of cyclin D1 expression in bladder urothelial carcinoma and correlation with clinicopathological parameters
Moshira M Abdelwahed, Dalia R Al-sharaky, Abdelnaby S Abdelnaby, Hend A. Abdo Kassem
July-September 2021, 34(3):1087-1094
DOI
:10.4103/mmj.mmj_138_20
Objective
To determine the expression of cell cycle protein cyclin D1 in urothelial carcinoma and to correlate it with clinicopathological parameters and overall survival.
Background
Dysregulation of the cell cycle is a key mechanism for the occurrence of various types of tumors, including urinary bladder carcinoma (UBC). Cyclin D1 critically targets the proliferative signals and has been implicated in progression of UBC.
Materials and methods
This retrospective control study was conducted on 80 cases of urothelial carcinoma, which were classified according to muscularis propria invasion into 50 cases of muscle invasive bladder carcinoma and 30 cases of non-muscle-invasive bladder carcinoma (NMIBC). Immunohistochemistry staining for cyclin D1 antibody was done for all cases.
Results
Cyclin D1 was positive in 61 (76.2%) of 80 urothelial carcinoma cases. Cyclin D1 expression is significantly associated with early stage group (
P
= 0.031), early lymph node staging (
P
= 0.001), and absent perineural invasion (
P
= 0.037) in infiltrating urothelial carcinoma. NMIBC cases showed significant association with cyclin D1 expression (
P
= 0.025) and strong intensity (
P
= 0.018). Moreover, high immunoreactive score of cyclin D1 was significantly associated with NMIBC group (
P
= 0.001).
Conclusion
Cyclin D1 expression implies a good prognostic effect in UBC, as an inverse correlation between cyclin D1 expression and poor prognostic pathologic features (muscle invasive bladder carcinoma, advanced stage, perineural invasion and lymph node involvement) was displayed in the current study.
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NEUROSURGERY - ORIGINAL ARTICLE
Comparison between preoperative sublingual and rectal misoprostol on blood loss in elective cesarean delivery
Nehad M Hosni, Nasser K Abd El-Aal, Rania E. Mohammad Abdul Gawwad, Mohammad E Anter
July-September 2021, 34(3):1189-1194
DOI
:10.4103/mmj.mmj_11_21
Objectives
To compare between the effect of preoperative sublingual versus rectal misoprostol on blood loss during and after elective cesarean section.
Background
Cesarean delivery is the commonest major women's surgery worldwide. Postpartum hemorrhage is a major cause of maternal mortality, mainly in developing countries. Misoprostol is one of the synthetic PGE1 analogs with strong uterotonic activity.
Patients and methods
This randomized controlled clinical trial was conducted in the Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University Hospital, in the period from September 2019 to July 2020. The study included 135 term pregnant women randomized into three equal groups (rectal, sublingual, and control). Full history, general examination, obstetric examination, routine investigation, and obstetrics ultrasound were done. All participants underwent elective cesarean delivery under spinal anesthesia. The patient was catheterized then the rectal or sublingual misoprostol tablets (400 μg) were administered according to a randomization plan. All cases received 10 IU of oxytocin by slow intravenous injection after cord clamping.
Results
Intraoperative blood loss was lowest in sublingual group (352.5 ± 116.91) followed by rectal group (438.2 ± 190.19) and was highest in control group (621.2 ± 207.25). Postoperative hematocrit was lowest in the control group (33 ± 3.44) followed by the rectal group (35.09 ± 4.58) and was highest in the sublingual group (35.5 ± 3.46).
Conclusion
Misoprostol with oxytocin is an effective drug combination to prevent postpartum hemorrhage and decrease intraoperative blood loss during cesarean section with better results through sublingual than rectal route.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Relationship between proton-pump inhibitor use and spontaneous bacterial peritonitis in cirrhotic patients with ascites
Mostafa M Farrag, Abdullah A Bahnacy, Ashraf Gharieb Dela, Mohamed H Badr, Belal A. E. Montaser
July-September 2021, 34(3):774-778
DOI
:10.4103/mmj.mmj_48_20
Objective
The aim of this study was to assess the occurrence of spontaneous bacterial peritonitis in cirrhotic patients with ascites and is relationship to proton-pump inhibitor (PPI) use.
Background
Gastric acid plays an important role in resisting intestinal pathogens. Changes in gastric pH induced by antacids may damage the gastric protective barrier.
Patients and methods
This prospective cohort study was conducted on 100 patients of 18 years old or more, both sexes with liver cirrhosis and ascites. Patients were divided into two groups (50 patients in each); group (PPI use positive) with a history of PPIs use in the last 15 days at a dose of more than 20 mg and group (PPI use negative) without a history of PPI use.
Results
White blood cells in the blood and in the ascitic fluid showed significant increase in the PPI group than in the second group. Cultures of ascitic fluid were positive in 28 (56%) patients with PPI use, and 15 patients in the negative PPI use group and comparison showed significant increase in the positive PPI use group. The hazardous ratio of developing positive cultures in the PPI group is 1.687 times than the second group (95% confidence interval: 1.1–2.502).
Conclusion
The use of PPIs in cirrhotic patients who have ascites has a risk for developing spontaneous bacterial peritonitis; therefore, it is recommended to avoid their use in this category of patients.
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DERMATOLOGY - ORIGINAL ARTICLES
Correlation between psoriasis area severity index score and metabolic syndrome in psoriatic patients in Menoufia University
Aliaa I. A. Mohaseb, Shawky M El-Farargy, Hossam A Yasien, Naglaa M Ghanayem
July-September 2021, 34(3):896-901
DOI
:10.4103/mmj.mmj_46_20
Objective
This study was to assess the association between psoriasis and metabolic syndrome (MBS) and to determine if there is an association between psoriasis severity and MBS.
Background
Background: Psoriasis is a chronic inflammatory disease that affects not only the skin but also other organs. Genetic factors play an important role in individual predisposition. Lately, a positive association has been confirmed between psoriasis and MBS, in Western as well as in Middle Eastern countries.
Patients and methods
This case–control study was conducted at the Dermatology, Andrology and Sexually Transmitted Disease and Medical Biochemistry and Molecular Biology Departments, Faculty of Medicine, Menoufia University. It included 120 patients: 60 psoriatic patients and 60 age-matched and gender-matched healthy controls. Patients were collected from Dermatology Outpatient Clinics, Menoufia University Hospitals. Clinical, biometric, and necessary laboratory evaluations were performed. Statistical analysis was performed by using the Statistical Package for the Social Sciences (SPSS version 16.0).
Results
The patients with psoriasis were two times more likely to have MBS as compared with controls (38.3 vs 18.0%,
P
< 0.001) with an odds ratio of 2.4. All components of MBS were more prevalent in psoriasis patients than in controls. The psoriasis area severity index score was greater in patients with MBS than those without MBS (10.5 11.5 vs 7.0 8.1,
P
= 0.05). MBS prevalence tended to be higher in the inverse type than in others (52.2 vs 32.3%;
P
= 0.06) and in patients with nail pitting versus those without (45.3 vs 28.2%;
P
= 0.03).
Conclusion
This study concluded that there is an association between psoriasis and MBS.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Is a single dose of prophylactic antibiotics sufficient in patients with acute noncomplicated appendicitis?
Tarek M Rageh, Mohamed A Elbalshy, Mahmoud M Elplasy
July-September 2021, 34(3):807-812
DOI
:10.4103/mmj.mmj_172_20
Background
Antibiotics prescription before surgery is considered to be effective in reducing the infectious complications of appendectomy. As a result, most surgeons prescribe antibiotics before surgery for patients diagnosed with appendicitis.
Objective
The aim of study was to evaluate the effect of a single antibiotic dose compared with the concurrent regimen on the outcome of appendectomy, especially infective complications.
Patients and methods
A total of 60 cases diagnosed with appendicitis were included, and they were divided into two groups: group A (single dose of cefotaxime 1 g and metronidazole 500 mg before surgery) and group B (the same regimen was received, and it was repeated twice daily for 4 days). All cases were subjected to history taking, physical examination, and routine investigations. At follow-up, all cases were clinically assessed.
Results
There were no significant statistical differences between groups in age, sex, and BMI variables. No significant statistical differences were observed during the surgery and hospitalization period between two groups. Wound infection occurred in 10 and 6.67% of cases in both groups, respectively (P > 0.05). However, the cost was significantly higher in group B.
Conclusion
A single dose preoperative antibiotics appears to be as efficacious as concurrent regimen in preventing wound infections after appendectomy. Continuing antibiotic prophylaxis in the postoperative period was not necessary, and it added additional unnecessary financial costs.
[ABSTRACT]
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Relation of phosphatase and tensin homolog gene polymorphism with hepatocellular carcinoma among hepatitis C-infected patients
Iman Eltounsi, Olfat M Hendy, Nahla Osman, Amira Shehata, Mohamed Abdel-Samiee, Isis S. El-morsy Bedira
July-September 2021, 34(3):1074-1080
DOI
:10.4103/mmj.mmj_305_20
Objective
To study the significance of two phosphatase and tensin homolog (
PTEN
) gene polymorphisms,
PTEN IVS4 rs3830675
and
rs701848
, as a risk factor for hepatocellular carcinoma (HCC) in chronic hepatitis C-infected patients.
Background
PTEN
polymorphisms have been reported to be involved in multiple cancers. There are few reports concerning the linkage between the
PTEN
gene and liver cancer risk.
Patients and methods
The study was conducted on 200 participants. Of them, 80 had proven HCC, 60 were cirrhotic patients with no evidence of focal lesion, and 60 were healthy age-matched and sex-matched volunteers, enrolled in the study as a control group.
PTEN IVS4 rs3830675
and
rs701848
assessments by PCR-restricted fragment length polymorphism technique were done for all participants.
Results
The frequency of
IVS4 rs3830675
(––) genotype in patients with HCC was 56%, which is significantly increased compared with cirrhotic group (11.7%) and control group (10%). The combined dominant model (––/–+) was significantly higher than (++) genotype in patients with HCC compared with cirrhotic and control groups. The
PTEN rs701848
polymorphisms (TT, TC, or CC) showed no significant difference among the three studied groups as well as allele distributions (T or C).
Conclusion
PTEN
(
IVS4 rs3830675
) deletion (––) genotype may be a risk factor for HCC in chronic hepatitis C-infected patients more than (++) genotype. However,
PTEN
polymorphism (
rs701848
) was of no significance.
[ABSTRACT]
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OBSTETRICS AND GYNECOLOGY - CASE REPORT
Radiological evaluation of small-size solitary intraductal papilloma
Dhayihi Turki
July-September 2021, 34(3):1195-1198
DOI
:10.4103/mmj.mmj_50_21
Detection of intraductal papilloma can be difficult; however, conventional ductography, MRI, ultrasound, and ductoscopy play important roles in the diagnostic process. Intraductal papilloma is usually benign in nature, with a small parentage being malignant. When evaluating the average size of a papilloma, which is between 1 and 3 cm, both conventional ductography and MRI have high sensitivity in detection. However, MRI has slightly better sensitivity and less invasiveness in comparison with conventional ductography and is considered the state of art in evaluation of normal-size intraductal papilloma. A 40-year-old female patient presented with a history of clear nipple discharge from the left breast. Left breast had no palpable mass, and there were no skin changes. From the center part of the nipple, there was watery clear discharge (serous) from a single duct. No bloody nipple discharge was expressed from either nipple. Mammography was negative for masses or nipple retraction. Ultrasound demonstrated dilated duct with no intraductal mass. Conventional ductogram demonstrated dilated duct with abrupt cutoff and no filling defect. MRI did not demonstrate any mass except dilated duct. Owing to concavity seen in the ductogram, mammography-guided wire placement was done for the dilated duct and then surgically removed. Pathology revealed 2-mm intraductal papilloma, with no atypia or carcinoma
in situ
. Neither the conventional ductogram nor the MRI ductography proves to be a better method of diagnosing miniscule intraductal papilloma. Individually, both methods have the potential to emphasize various aspects of the ducts in a way that would be valuable to the reader.
[ABSTRACT]
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PATHOLOGY - ORIGINAL ARTICLES
Sexually transmitted diseases knowledge among andrology clinic attendants in Menoufia University and Shebin El-Kom Teaching Hospitals
Hala M. El-Moselhy Shaheen, Mohamed A Gaber, Aml A Salama, Samar A. M. Bolty
July-September 2021, 34(3):1108-1114
DOI
:10.4103/mmj.mmj_107_20
Objective
The aim was to assess knowledge regarding sexually transmitted diseases (STDs) among attendants in Dermatology and Andrology Clinics in Menoufia University Hospital and Shebin El-Kom Teaching Hospital.
Background
Knowledge of STDs and their complications is important for adequate prevention and treatment, as people who do not know the symptoms may fail to recognize their need and so may not seek help.
Patients and methods
A case–control study was conducted. Cases were patients who were diagnosed to have current symptomatic STDs. Control group was selected from attendants of both clinics, who were not complaining of any symptoms of STDs. Control group was age and sex matched. The selected sample with the help of the researcher was interviewed using predesigned questionnaire asking about different types of STDs, the causative agents, transmission routes, protective measures, symptoms, and complications of STDs.
Results
More than half of the studied group (∼64.5%) had satisfactory level of knowledge about STDs. Most of them, ∼84.2%, were from the control group, and only ∼4.2% represented the cases. Proper knowledge about STDs was statistically significant higher in the control group than the case group in STD knowledge parameters (types, complications, symptoms, the causative organisms, the routes of transmission, and the effect of contraceptive pills or condom on the presence of STDs). There was a highly statistically significant relation between the level of knowledge and presence of STDs. Moreover, there was a significant relation between participant education and level of knowledge about STDs.
Conclusion
The level of STD knowledge is satisfactory among the control group more than the cases. There is a highly statistically significant relation between level of knowledge and presence of STDs. There is a significant relation between participant higher level of education and level of STD knowledge.
[ABSTRACT]
[FULL TEXT]
[PDF]
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ENDEMIC AND TROPICAL MEDICINE - ORIGINAL ARTICLES
Study of serum microRNA-21 and alpha-fetoprotein in patients with hepatocellular carcinoma secondary to viral hepatitis
Atef A Ali, Sally M El-Hefnawy, Ahmed A Teima, David M Metry
July-September 2021, 34(3):845-851
DOI
:10.4103/mmj.mmj_24_20
Objective
To evaluate the significance of plasma microRNA-21 (miR-21) level as a noninvasive marker for diagnosis and prognosis of hepatocellular carcinoma (HCC) and comparing the diagnostic accuracy of serum miR-21 with alpha-fetoprotein.
Background
In Egypt, HCC is the third most frequent cancer in men with more than 8000 new cases predicted. Early detection of HCC opens doors for various effective treatments such as surgical resection, radiofrequency ablation, and transplantation. Alterations of cancer tissue and circulating miRs have been shown in patients with HCC.
Patients and methods
This is a prospective study that was carried out at Cardiac and Digestive Institute, Sohag. The study group I included 20 patients with liver cirrhosis and HCC, aged 54–81 years, group II included 20 patients with liver cirrhosis only, aged 56–78 years, and group III included 20 healthy volunteers, aged 52–80 years.
Results
miR-21 was significantly higher in group I (18.69 ± 6.57) than group II (3.43 ± 2.0) and group III (1.0 ± 0.0), with highly statistically significant difference between the three groups (
P
< 0.001), and also, at area under the curve of 0.985, miR-21 had 95% sensitivity, 85% specificity, 86.4% positive predictive value, and 94.4% negative predictive value between group I and group II.
Conclusion
The current study showed that circulating miR-21 could be a novel early diagnostic and prognostic biomarker for detection of HCC in comparison with alpha-fetoprotein and abdominal ultrasound, which are not highly sensitive for early diagnosis of HCC, and hence eradication, and this is the novelty of this study.
[ABSTRACT]
[FULL TEXT]
[PDF]
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Value of serum tumor necrosis factor-α as an early predictor of diabetic nephropathy
Sanaa S Gazareen, Alaa E. A. E. Dawood, Nesreen G. E. Alhelbawy, Rasha A. E. M. A. Elsasmad
July-September 2021, 34(3):763-767
DOI
:10.4103/mmj.mmj_7_20
Objective
This study was designed to evaluate serum tumor necrosis factor-α as an early predictor of diabetic nephropathy (DN).
Background
Owing to the high morbidity and mortality associated with DN, it is important to establish marker used as an early prediction of DN to overcome its complication.
Patients and methods
This study was conducted on 70 patients selected from the Inpatient Department and Outpatient Clinics of Internal Medicine Department and Medical Biochemistry and Molecular Biology Department at Menoufia University Hospital. All patients were investigated regarding urine analysis, blood urea and serum creatinine, HBA1C, lipid profile, and urine albumin-creatinine ratio.
Results
The 70 patients (55 males and 15 females) with diabetes mellitus were divided into 35 patients with normoalbuminuric and 35 patients with albuminuria (30–299 mg/g Cr). Ten healthy individuals (seven males and three females) were selected as a control group. The patients fulfilled the following criteria: age greater than 18 years, initial diagnosis of diabetes at greater than 30 years of age, no signs of renal diseases, no history of cardiovascular diseases, including stroke, heart diseases, and arteriosclerosis, and no symptoms of acute inflammatory diseases. All patients and control personnel enrolled in this study gave oral and written consent to see all of their investigations.
Conclusion
Tumor necrosis factor-α, one of the main proinflammatory cytokines, is overexpressed in DN, and this overexpression is significantly associated with evidence of renal damage.
[ABSTRACT]
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PEDIATRICS - ORIGINAL ARTICLES
Association between thyroid function and lipid profile parameters among obese children and adolescents
Maha A Tawfik, Naglaa F Barseem, Marwa M Mohasseb, Reem M. F. Shalaby
July-September 2021, 34(3):984-990
DOI
:10.4103/mmj.mmj_50_20
Objectives
In this study, we evaluated free thyroxine and thyroid-stimulating hormone (TSH) concentrations between normal children and those with obesity and possible correlations between BMI and these markers.
Background
Evaluation of thyroid function determines the cause of obesity in children and adolescents. In children with obesity, TSH and thyroid hormone concentrations are shown to be high, which is accompanied by weight gain, increased cholesterol levels, and impaired growth velocity.
Patients and methods
This study was done on 200 Egyptian children and adolescents in the age of 5–18 years, comprising 71 overweight, 29 obese children and adolescents, and 100 nonobese children and adolescents.
Results
Our study revealed statistically significant differences between the studied patients regarding age, weight, height, BMI, waist circumference, hip circumference, and waist-to-hip ratio, as well as serum triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein-cholesterol (LDL-c), fasting and random blood sugar, and hemoglobin A1C (HbA1C). There is a significant positive correlation between serum TSH of the studied patients and body weight, BMI, waist and hip circumferences, waist-to-hip ratio, serum triglycerides, total cholesterol, LDL-c, fasting and random blood sugar, and HbA1C. Moreover, there is a significant positive correlation between BMI of the studied patients and body weight, waist and hip circumferences, waist-to-hip ratio, serum triglycerides, total cholesterol, LDL-c, fasting and random blood sugar, and HbA1C. Total cholesterol and hip circumference were significantly associated with TSH.
Conclusion
TSH could contribute to increases in total cholesterol, LDL-c, and triglycerides, but not high-density lipoprotein, irrespective of obesity.
[ABSTRACT]
[FULL TEXT]
[PDF]
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CARDIAC SURGERY - ORIGINAL ARTICLES
Duct-dependent cyanotic neonates with patent ductus arteriosus stenting pose a unique challenge for the next stage of surgical intervention
Ayman R Abdelrehim, Syed Aitizaz, Saad Q Khoshhal, Mansour B Almutairi, Mustafa A Al-Muhaya
July-September 2021, 34(3):1179-1183
DOI
:10.4103/mmj.mmj_12_21
Objective
To study the role of patent ductus arteriosus (PDA) stenting in the management of single-ventricle patients and the surgical difficulties facing the surgeons in the next stages of surgical procedures.
Background
Thirty consecutive neonates with cyanotic duct-dependent lesions were initially palliated with (PDA) stenting in our center. Eighteen of them had undergone one or more surgical procedures. We retrospectively assessed the indexed growth of pulmonary arteries (PA) over a period of time and the requirement of further rehabilitation of PAs in these patients.
Patients and methods
From January 2014 to December 2018, 30 neonates with cyanotic congenital heart diseases underwent PDA stenting as initial palliation; 60% were ventilated before the procedure, which resulted in 100% success. All patients were followed up regularly by monitoring of PA size imaging. Eighteen patients of this group underwent further surgical procedures.
Results
Ninety percent of the neonates had stenosis of the PA branches before PDA stenting. The indexed PA branch size was significantly smaller, which increased after stenting of PDA. At the time of the next surgical procedures (Glenn, etc.), stent division/ligation was required in addition to PA plasty in 90% of patients.
Conclusions
PDA stenting provides efficient palliation in cyanotic neonates. Despite the origin of stenosis, the stent allowed growth in the size of both PAs. However, the majority required surgical augmentation and further stenting of PAs in the mid-term follow-up.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Effect of hormonal contraceptive on female sexual dysfunction
Yasmin H Ellithy, Mohammed A Gaber
July-September 2021, 34(3):932-935
DOI
:10.4103/mmj.mmj_139_20
Objective
The aim was to determine the effect of hormonal contraceptives (HCs) on female sexual desire, arousal, lubrication, orgasm, and pain during penetration.
Background
Contraception is a common practice among women during their childbearing periods. Contraception may affect female sexual function both positively and negatively.
Patients and methods
This study was done on 250 married Egyptian women receiving HCs. They were recruited from family medicine in Faculty of Medicine Menoufia University during the period from 2019 to 2020.
Results
In the present study, 34% of women receiving HCs used pills. Majority of them (68%) using the contraception in continuous state. In majority (70%) of the cases, the degree of sexual desire was moderately decreased and in 22% highly decreased. Overall, 64% did not feel sexual arousal during sexual activity, 58% reported the degree of vaginal lubrication is decreased, 68% reported very difficult to reach orgasm after usage of contraception, and 72% reported having high level of pain during penetration. Moreover, 64% reported not feeling sexual arousal during sexual activity, and 68% reported it was very difficult to reach orgasm.
Conclusion
Female sexual dysfunction is commonly seen in women using HCs.
[ABSTRACT]
[FULL TEXT]
[PDF]
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Study of serum obestatin level in type 2 diabetic patients with diabetic kidney disease
Mohamed A. E. R. Korany, Mai A Kamel, Reham S El-Zaiat, Reda F. A. Sanior
July-September 2021, 34(3):779-785
DOI
:10.4103/mmj.mmj_59_20
Objective
The aim was to evaluate serum obestatin level in type 2 diabetic patients with diabetic kidney disease as a diagnostic and a prognostic marker.
Background
Obestatin has been reported to have important effects on endothelial cells as decreasing vascular cell adhesion molecule-1 expression and increasing oxidized low-density lipoprotein binding to the macrophage.
Participant and methods
A cross-sectional study was carried out on 100 patients sin the Department of Internal Medicine, Menoufia University Hospitals. A total of 100 patients was divided into different groups. Group I: 25 type 2 diabetic patients with normoalbuminuric; group II: 25 type 2 diabetic patients with microalbuminuria; group III: 25 type 2 diabetic patients with macroalbuminuria; and group IV: 25 healthy individuals as a control group. All participants were subjected to history taking, complete physical examination, anthropometric measurement, waist circumferences, fasting blood glucose, 2h-postprandial blood glucose, glycated hemoglobin, kidney function tests, estimated glomerular filtration rate, urine analysis, abdominal ultrasound, liver profile, lipid profile, complete blood count, and serum obestatin level by ELIZA kit.
Results
Obestatin was 2.9 ± 0.4 ng/dl in group I, 3.7 ± 0.7 g/dl in group II, 5.5 ± 0.9 g/dl in group III, and 2.4 ± 0.6 g/dl in group VI. These results were significantly higher in group III than in groups I, II, and VI (
P
< 0.001). At cutoff greater than 4.4 obestatin level was a significant excellent power of discrimination between microalbuminuria and macroalbuminuria (area under the curve = 0.970,
P
< 0.001) with a sensitivity of 96.0% and a specificity of 84.0% and at a cutoff greater than 3.3; obestatin significant good power of discrimination of microalbuminuria from macroalbuminuria (area under the curve = 0.829,
P
< 0.001) with a sensitivity of 72.0% and a specificity of 92.0%.
Conclusion
Higher serum levels of obestatin were associated with macroalbuminuria, suggesting that obestatin may have a role in the underlying pathogenic mechanisms that lead to diabetic kidney disease.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
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DERMATOLOGY - ORIGINAL ARTICLES
Sexual dysfunction in partners of men with premature ejaculation
Salma D Raslan, Mohamed A Gaber
July-September 2021, 34(3):852-857
DOI
:10.4103/mmj.mmj_331_19
Objective
The aim was to explore sexual dysfunction in partners of men with premature ejaculation (PE).
Background
Female partners of men with PE report significantly greater sexual problems.
Patients and methods
This cross-sectional study included 200 married women. This study was performed on married women in Menoufia Governorate in the period from June 2019 till September 2019.
Results
The finding of the study indicated that female partners of men with PE reported significantly greater sexual problems. The majority of them (36.0%) had sexual intercourse for pleasure of their husband. Overall, 40.0% of cases infrequently felt sexual desire or interest during sexual intercourse. Moreover, 39.5% of cases infrequently (less than half the time) felt sexually aroused during sexual activity or intercourse. The majority of the cases (75.5%) had moderate satisfaction of their sexual life. In addition, 55% of them frequently felt dissatisfied with their sexual life, and 46.0% of them frequently felt bothered by their partner's PE. In 64.5% of cases, lack of control of their partner over his ejaculation causes distress in both of them. Furthermore, 45.0% of cases were moderately distressed because of his lack of ejaculatory control, and 40.0% of cases stated their partner was very focused on delaying his ejaculation that he ignores their other sexual needs. Overall, 40.5% considered ejaculatory pattern very much affected their levels of intimacy.
Conclusion
Female sexual dysfunction is commonly seen in women with male partners who have PE, and female sexual functions may be affected by male erection status.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Evaluation of the role of hypoxia-inducible factor 1 alpha-gene polymorphism in Egyptian rheumatoid arthritis patients
Thoria A Omar, Maha A El-Bassuoni, Dina S Soliman, Asmaa I Nour Eldin, Ahmed A Sonbol
July-September 2021, 34(3):1081-1086
DOI
:10.4103/mmj.mmj_39_21
Objective
To evaluate the role of hypoxia-inducible factor 1 alpha (HIF-1α)
rs12434438
gene polymorphism in susceptibility to rheumatoid arthritis (RA) in Egyptian patients and its relation to the severity of the disease.
Background
RA is a systemic autoimmune inflammatory disease, has remission and exacerbation cycles with a genetic and environmental predisposition. Synovial hypoxia of the inflamed joints has a role in reinforcing synovial inflammation and in a synovial prearthritic stage. HIF-1α participates in the pathogenesis of RA through its overexpression in the synovial lining and stroma cells and initiation of major changes in gene expression associated with arthritis processes like angiogenesis or T-cell differentiation.
Patients and methods
In this case–control study, real-time PCR allelic discrimination assay was used to genotype the HIF-1α gene
rs12434438 A/G
polymorphism in 180 subjects divided into two groups. Group I: 90 RA patients and group II: 90 healthy controls.
Results
GG genotype of
HIF-1
α
rs12434438
was significant in controls (
P
< 0.001). While AA genotype and A allele were frequent in RA patients. The parameters of disease activity were higher in the
HIF-1
α
rs12434438 AA
genotype compared with RA patients with GG genotype.
Conclusion
Current findings indicated that the AA genotype of
HIF-1
α (
rs12434438
) could play a role in susceptibility to RA in Egyptian patients and related to disease severity. While the GG genotype may have a protective effect.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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DERMATOLOGY - ORIGINAL ARTICLES
Assessment of serum vascular endothelial growth factor receptor-3 in psoriatic patients
Alaa H Maraee, Reem A Hassan, Rania M Azmy, Hadiel O El Banhawy
July-September 2021, 34(3):868-872
DOI
:10.4103/mmj.mmj_9_20
Objective
This study aimed to assess serum vascular endothelial growth factor-3 (VEGFR-3) as a potential biomarker of psoriasis and correlate its expression with the clinical parameters.
Background
VEGFR-3 has gained a lot of interest in psoriasis research owing to its role in disease progression. Psoriasis biomarkers could potentially aid in the diagnosis, tracking disease progression, and monitoring response to treatments.
Patients and methods
This prospective case–control study was conducted on 40 patients with psoriasis and 40 age-matched and sex-matched healthy controls. Patients were selected from the Dermatology Outpatient Clinic at Menoufia University Hospital. Enzyme-linked immunosorbent assay validation studies were conducted on psoriatic patients to assay the level of human VEGFR-3 compared with healthy controls.
Results
This study showed that psoriasis area and severity index score ranged from 0.60 to 32.5 with a median of 4.5 and was divided to mild (37 patients, 93%), moderate (two patients, 5%), and severe (one patient, 2%). On studying the relation of serum VEGFR-3 levels among psoriatic patients, there was no significant correlations observed regarding age (
r
=−0.26,
P
= 0.873), BMI (kg/m
2
) (
r
= 0.073,
P
= 0.654), duration of disease (
r
=−0.106,
P
= 0.515), and psoriasis area and severity index score (
r
= 0.177,
P
= 0.276). In the psoriasis group, the VEGFR-3 level ranged from 5.03 to 72.34 ng/ml with a median of 8.78 and in the control group ranged from 2.56 to 73.87 ng/ml with a median of 6.33. There was a significant difference regarding serum VEGFR-3 levels between cases and control groups (
P
= 0.001).
Conclusion
This study showed that serum levels of VEGFR-3 could demonstrate the disease activity in psoriatic patients. Measuring VEGFR-3 may help predict psoriasis 'flare' early on. Also, it could be used to detect drug responses according to observable symptom changes.
[ABSTRACT]
[FULL TEXT]
[PDF]
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Granzyme B gene polymorphism in vitiligo: does it have an association?
Wafaa A Shehata, Alaa Maraee, Maha A El-Kheir, Nermin Tayel, Sally M El-Hefnawy
July-September 2021, 34(3):960-965
DOI
:10.4103/mmj.mmj_229_20
Objectives
To study the role of granzyme B (
GZMB
) gene polymorphism (rs8192917) in patients with nonsegmental vitiligo and to correlate the results with the available clinical information.
Background
Vitiligo is considered the most common acquired disease of depigmented skin characterized by depigmented patches of the skin, hair, and mucous membranes owing to destruction of melanocytes. Vitiligo is a multifactorial polygenic condition with a multifaceted pathogenesis, linked to both genetic and nongenetic aspects, such as autoimmune, cytotoxic, oxidant–antioxidant, and neural therories working in performance.
Patients and methods
GZMB
gene polymorphism (rs8192917) was identified using real-time PCR technique in 40 patients having nonsegmental vitiligo and 40 age-matched and sex-matched healthy controls. Assessment of disease severity was done using Vitiligo Area Severity Index score, and disease activity was assessed using Vitiligo Disease Activity score.
Results
CC and TC genotypes were significantly higher in the patients' group [
P
= 0.005; odds ratio (OR) = 7.2, 95% confidence interval (CI) = 1.61–32.2 for CC and OR = 1.86, 95% CI = 0.42–8.15 for TC], with significant statistical preponderance of C allele in cases (
P
= 0.001; OR = 3.05, 95% CI = 1.55–6.01).
Conclusion
GZMB
gene polymorphism (rs8192917) is associated with the susceptibility to nonsegmental vitiligo in a sample of Egyptian population.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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Serum paraoxonase 1 activity reflects the disturbance of antioxidant system in patients with alopecia areata
Shawky M El-Farargy, Naglaa M Ghanayem, Walaa M. F. El-Nabawy
July-September 2021, 34(3):878-883
DOI
:10.4103/mmj.mmj_18_20
Objectives
The aim of this study was to investigate the role of serum paraoxonase 1 (PON1) activity in the antioxidant system defect in alopecia areata (AA), which may help in the management of the disease.
Background
AA is an autoimmune disease of the hair follicle, resulting in acute or chronic patches of hair loss, total hair loss of the scalp (alopecia totalis), or complete hair loss of entire body and scalp (alopecia universalis). It is a disease with significant effect on health-related quality of life, in particular to the domains of role emotional, mental health, and vitality.
Patients and methods
This case–control study was conducted at Dermatology, Andrology, and Sexual Transmitted Diseases and Medical Biochemistry and Molecular Biology Departments, Faculty of Medicine, Menoufia University. It included 50 participants: 25 patients with AA and 25 age-matched and sex-matched healthy controls.
Results
There was a significant statistical decrease in serum PON1 level in patients compared with control (
P
< 0.001). There was a nonsignificant positive correlation between serum PON1 and each of age (
P
= 0.445), duration of disease (
P
= 0.886), total cholesterol (
P
= 0.769), and low-density lipoprotein cholesterol (
P
= 0.867), whereas a nonsignificant negative correlation existed with serum triglycerides (
P
= 0.815) and high-density lipoprotein cholesterol (
P
= 0.185).
Conclusion
This study concluded that there is an association between oxidant/antioxidant imbalance and AA.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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PEDIATRICS - ORIGINAL ARTICLES
Serum selenium level in children with febrile seizures
Ahmed T Mahmoud, Maha A El Bassuoni, Sameh A. Abd El Naby, Hend M. E. K. Terad
July-September 2021, 34(3):979-983
DOI
:10.4103/mmj.mmj_19_20
Objective
The aim of the study is to assess serum level of selenium in children with febrile seizures (FSs) in relation to clinical findings.
Background
FSs are the most common form of childhood seizures. The exact etiopathogenesis is unknown. There were various hypotheses about the role of selenium deficiency in FSs.
Patients and methods
This case–control study involved 80 Egyptian children (6 months to 5 years), divided into four groups: group A included 20 children with FSs, group B included 20 children with afebrile seizures, group C included 20 children with fever without seizures, and group D included 20 healthy children. They were enrolled from emergency room and pediatric departments of Menoufia University Hospital, from February 2017 to February 2018. Detailed history, thorough physical examination, routine investigations, and serum selenium level were assessed. Selenium assay depended on measurement of serum SELENBP1 concentration by enzyme-linked immunosorbent assay technique.
Results
Mean serum selenium levels were 0.25 ± 0.05, 0.53 ± 0.13, 0.70 ± 0.15, and 4.02 ± 0.86 in children with FSs, afebrile seizures, fever only, and healthy children groups, respectively. Serum selenium level in children with FSs was significantly low in comparison with children with fever only and healthy children (
P
= 0.024 and 0.002, respectively), but there was no significant difference in serum selenium level between children with FSs and those with afebrile seizures (
P
= 0.275).
Conclusion
Serum selenium levels were significantly low in both children with FS and afebrile seizure. Low serum selenium levels play an important role in FS and afebrile seizure.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Role of regulatory T cells in type 2 diabetic nephropathy in an Egyptian population
Rasha I. A. Gawish, Amr M Ebied, Basma E Mohamed, Salma A. E. Imbaby
July-September 2021, 34(3):825-831
DOI
:10.4103/mmj.mmj_18_21
Objective
The objective of the study was to assess the role of regulatory T cells (Tregs) in type 2 diabetic nephropathy (DN), particularly the contribution of Tregs to the degree of albuminuria as a marker of renal damage.
Background
Treg cells have immunoregulatory roles that might be involved in the pathogenesis of DN. Self-tolerance and allogeneic tolerance are mediated by Treg cells, and expression of this category of lymphocytes may be supposed to mediate the development of type 2 DN.
Patients and methods
We conducted a cross-sectional study on 45 patients with type 2 diabetes mellitus who were classified into three groups according to the degree of albuminuria, with group I representing normoalbuminuric patients, group II representing patients with moderately increased albuminuria (microalbuminuria), and group III representing patients with severely increased albuminuria (macroalbuminuria). Demographic data were recorded. Blood samples for laboratory variables were collected and measured using the standard methods. Flow cytometry analysis was used to assess the expression of Treg cells in the peripheral blood samples obtained from the three groups.
Results
CD4+CD25+Foxp3+ Treg cells expression in peripheral blood by flow cytometry analysis was significantly decreased among microalbuminuric patients when compared with normoalbuminuric patients and also macroalbuminuric patients showed a significant lowered expression of CD4+CD25+Foxp3+ Treg cells when compared with normoalbuminuric patients. There were statistically significant correlations between the median of Treg/lymphocyte percent and the following parameters: urinary albumin–creatinine ratio, duration of diabetes mellitus, and glomerular filtration rate among the three studied groups. Multivariate analysis showed that only Treg percent was an independent predictor of albuminuria (
P
= 0.046).
Conclusion
The results of this study suggest that Tregs might have a correlation with diabetic kidney disease development.
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DERMATOLOGY - ORIGINAL ARTICLES
Association between serum level of desnutrin and acne vulgaris
Sarah G Abdel-Mohsen, Shawky M El-Farargy, Naglaa M Ghanayem
July-September 2021, 34(3):966-972
DOI
:10.4103/mmj.mmj_259_20
Objectives
To assess the association between serum levels of desnutrin enzyme and the development of acne vulgaris.
Background
Acne vulgaris is commonly associated with hyperglycemia, which probably results in serum desnutrin suppression and abolishment of its function.
Patients and methods
A case–control study was conducted on 30 patients with acne vulgaris (group I) and 10 age-matched, sex-matched, and BMI-matched healthy volunteers who had no present and past history of acne as controls (group II). In all, blood glucose, serum total cholesterol, serum triglycerides, and serum desnutrin were assessed. According to severity, patients were divided into three subgroups: group Ia included 10 patients with mild acne vulgaris, group Ib included 10 patients with moderate activity, and group Ic included 10 patients with severe activity.
Results
There was a significant statistical decrease in serum desnutrin level in patients with acne (41.56±9.35) than controls (208.38±61.87), with P value less than 0.001. Moreover, there was a significant statistical increase in fasting blood glucose level in acne patients (88.71±4.26) than controls (83.28±4.61), with
P
value=0.001. There was a nonsignificant positive correlation between serum desnutrin and each of acne severity and fasting blood glucose.
Conclusion
Serum desnutrin levels were significantly decreased in patients with acne vulgaris but were not correlated with acne severity and not affected by sex.
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Serum elafin concentration as a potential marker of inflammation in psoriasis diagnosis and severity estimation
Reem A. Abd El-Aziz Hassan, Mostafa A. M. Hammam, Noha R. M. Bayomy, Yasmin S Abd Elrasoul, Heba S Khalil
July-September 2021, 34(3):947-954
DOI
:10.4103/mmj.mmj_197_20
Purpose
To estimate serum elafin concentration in patients with psoriasis for psoriasis diagnosis and to correlate its levels with psoriasis severity and other inflammatory markers, that is, high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate (ESR).
Background
Psoriasis is a chronic, immune-mediated, multisystem disease with keratinocyte hyperproliferation. Elafin is a serine elastase inhibitor, produced by epithelia, that is upregulated by inflammatory stimuli. Serum elafin concentration increases significantly in the presence of inflammation.
Patients and methods
This prospective case–control study was carried out on 20 patients with psoriasis and 20 age-matched and sex-matched healthy controls. All enrolled participants were subjected to a full history taking, general and detailed dermatological examination, and laboratory investigation of ESR, serum elafin, and hs-CRP concentrations.
Results
Serum elafin concentration was statistically significant (
P
= 0.001) higher in the patient group (2.54 ± 1.54) when compared with the controls (0.85 ± 0.39). There was a statistically significant (
P
= 0.001) difference among subgroup patients according to disease severity regarding serum elafin concentration. There was a highly significant positive correlation between serum elafin concentration and disease severity, ESR, and serum hs-CRP among studied patients with psoriasis (
r
= 0.876,
P
= 0.000;
r
= 0.689,
P
= 0.000; and
r
= 0.726,
P
= 0.000, respectively). The serum elafin concentration could be used to diagnose psoriasis with cutoff points higher than 1.35 ng/ml (with 88.24% sensitivity and 78.26% specificity) and also can detect its severity with cutoff points higher than 1.75 ng/ml, with 93.33% sensitivity and 100% specificity, to differentiate the mild cases from moderate and severe ones.
Conclusion
The serum elafin concentration represents a useful tool for diagnosis of the inflammatory nature and monitoring the disease activity in patients with psoriasis.
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Influence of various methods of contraception on female sexual functions
Mohamed A Gaber, Amany A Salama
July-September 2021, 34(3):902-908
DOI
:10.4103/mmj.mmj_47_20
Objective
The aim was to evaluate female sexual functions in women using different methods of contraception.
Background
Contraception is a common practice among women during their childbearing periods. Contraception may affect female sexual function both positively and negatively.
Patients and methods
A cross-sectional study was done on 200 married women in the childbearing period, who were recruited from different health care centers at Menoufia Governorate, Egypt, between October 2019 and January 2020.
Results
In the present study, 56.5% (more than half) of the participating women who used contraception were at high risk for sexual dysfunction. Women using nonhormonal contraceptives reported the highest mean scores (26.99 ± 4.13), with statistically significant difference between them and those using combined hormonal contraceptives and progesterone-only hormonal contraceptives, who reported lower mean scores (24.34 ± 4.94 and 24.13 ± 4.27, respectively). Nonhormonal contraceptive users reported the highest scores of female sexual function index regarding total, desire, arousal, lubrication, orgasm, satisfaction, and pain scores.
Conclusion
Female sexual dysfunction is commonly seen in women using contraception and the nonhormonal methods have the least effect on female sexual function.
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PHYSICAL MEDICINE - ORIGINAL ARTICLE
Tumor necrosis factor-alpha-induced protein 3 gene polymorphism and systemic lupus erythematosus susceptibility in Egyptian population
Thoria A Omar, Maha A El Bassuoni, Ahmed A Sonbol, Dina S Fotoh, Ahmed E Abd Almonem
July-September 2021, 34(3):1014-1020
DOI
:10.4103/mmj.mmj_79_21
Objectives
To clarify the association of tumor necrosis factor-alpha-induced protein 3 (TNFAIP3) rs5029939 polymorphism with systemic lupus erythematosus (SLE) susceptibility and pathogenesis in the Egyptian population.
Background
TNFAIP3 is a single nucleotide polymorphisms coding for the ubiquitin-modifying enzyme, associated with autoimmune diseases like SLE.
Patients and methods
A case–control study included 80 patients with SLE as well as 80 controls. Clinical assessment, renal biopsy, and full laboratory investigations were done. DNA samples were tested for TNFAIP3 using PCR-restriction fragment length polymorphism assay.
Results
TNFAIP3 (rs5029939 C > G) genotype distribution showed no statistically significant difference between patients with SLE and controls (
P
= 0.226); odds ratio (95% confidence interval) of C/C, C/G, and G/G genotypes was 0.89 (0.68–1.04), 1.38 (0.92–1.82), and 1.02 (0.71–1.1), respectively. The most frequent allele in the two groups was C allele in group I and group II (85 and 90%, respectively).
Conclusions
The studied sample of the Egyptian population carrying TNFAIP3 polymorphism has no susceptibility to developing SLE. Further studies are still needed to verify these results, including a larger number of patients to illuminate the potential role of the TNFAIP3 (rs5029939 C > G) gene polymorphism in SLE pathogenesis in Egypt. Further studies are recommended to detect other polymorphisms in the TNFAIP3 gene like rs2230926 in the Egyptian population, investigating the specific ethnic patients' contribution.
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DERMATOLOGY - ORIGINAL ARTICLES
Serum level of apelin-36 in psoriatic patients
Azza G Farag, Reem A Hassan, Shimaa E Soliman, Mona A Mohamed
July-September 2021, 34(3):926-931
DOI
:10.4103/mmj.mmj_115_20
Objective
To shed light on the possible role of apelin-36 in psoriasis and to evaluate the propensity of the psoriatic population to a prediabetic condition through determining the serum level of apelin-36 in psoriatic patients.
Background
Psoriasis is a chronic, inflammatory skin disease characterized by the formation of sharply demarcated, scaly, erythematous plaques. Research over the last few decades has shown the relation of psoriasis pathogenesis to systemic diseases and metabolic syndrome (obesity, hypertension, dyslipidemia, and diabetes).
Patients and methods
This case–control study was carried out on 60 cases with psoriasis and 60 age-matched and sex-matched healthy individuals as a control group. All were subjected to full history taking, general examination, local examination with determination of site of lesions and assessment of psoriasis area and severity index score. Serum apelin-36 and glycosylated hemoglobin (HbA1c) was done for all cases and control (
P
< 0.001).
Results
The serum level of apelin-36 was lower in psoriatic patients than controls (mean: 37.17 ± 75.93 vs. 221.85 ± 483.40 ng/ml;
P
= 0.028), while the blood level of HbA1c was higher in psoriatic patients than controls (mean: 5.98 ± 0.62 vs. 5.55 ± 0.54%;
P
< 0.001). The best cutoff value of apelin-36 in the prediction of prediabetic cases in psoriatic patients was lesser than or equal to 37.50 ng/ml, with a sensitivity of 94.4%, specificity of 66.7%, and total accuracy of 91.7%.
Conclusion
Apelin-36 serum level was decreased and HbA1c was increased in psoriasis patients that indicated impairment in glucose metabolism in psoriatic patients.
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Effect of multiple genital and extragenital warts on quality of social life
Marian S. R. Samaan, Mohammed A Gaber
July-September 2021, 34(3):920-925
DOI
:10.4103/mmj.mmj_96_20
Objective
The aim was to evaluate and analyze the effect of genital and extragenital warts (E-GWs) on social life.
Background
Genital warts (GWs) and E-GWs are common skin lesions caused by the human papillomavirus. GWs have been frequently reported to exhibit a strong negative effect on the quality of social life. Few studies have reported about E-GWs and their effect on life quality.
Patients and methods
This cross-sectional study investigated the effect of multiple GWs and E-GWs on quality of social life, including sexual life. This study involved 100 patients with multiple GWs (53 females and 47 males) and 100 patients with multiple E-GWs (45 females and 55 males).
Results
There was a significant statistical difference regarding age between the two groups (
P
< 0.001), which reflects the fact that GWs are more common in more sexually active younger age groups. There was a significant difference (
P
< 0.001) between the two groups regarding interference with personal relationships. There was a significant difference (
P
= 0.045) between the two groups regarding pain. There was a significant difference (
P
< 0.001) between the two groups regarding a decrease in sexual drive. There was a significant difference (
P
= 0.011) between the two groups regarding avoidance of sexual relations.
Conclusion
GWs and E-GWs can have a very strong negative effect on patients' daily life. They impair the quality of social life, including sexual life. Subsequently, we highly recommend the treating physicians the use of the 'bio-psycho-social' model when facing patients with multiple warts.
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PATHOLOGY - ORIGINAL ARTICLES
Role of fatty acid synthase in colorectal carcinoma
Rehab M Samaka, Dalia R Al-Sharaky, Aya Y Abu-Zeid, Marwa M Dawoud
July-September 2021, 34(3):1095-1100
DOI
:10.4103/mmj.mmj_193_20
Objectives
To assess the role of fatty acid synthase (FASN) in pathogenesis, diagnosis, and treatment of colorectal carcinoma.
Background
Colorectal cancer (CRC) is the second most frequent cancer in women and the third one in men worldwide and constitutes ∼6.5% of all malignancies in Egypt. FASN is a valuable lipid enzyme involved in lipid biosynthesis and suggested to contribute in carcinogenesis in several tumors including CRC.
Patients and methods
The retrospective study included 87 CRC cases, 38 adenoma cases, and 58 normal cases. The slides were subjected to FASN immunohistochemical staining using a streptavidin-biotin-peroxidase technique. The relationships between FASN expression and clinicopathological parameters were statistically analyzed.
Results
The expression rate of FASN was 95.4% in the studied CRC cases versus 100% and 58.6% in adenoma and nonneoplastic cases, respectively. FASN expression was significantly associated with high-tumor grade (
P
= 0.01), nodal metastasis (
P
= 0.003) and lymphovascular invasion (
P
= 0.018) and highly associated with high grade of tumor budding and advanced pathological stage grouping (
P
= 0.001 for both).
Conclusion
FASN seems to act as an oncoprotein and is associated with parameters of poor prognosis and tumor progression. Thus, FASN inhibitors can be used to suppress tumor progression in CRC.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Clinical characteristics and mortality rates associated with MERS-COV-2 infection among patients from Sohag Governorate, Egypt
Ashraf A Askar, Tamer Mohamed, Mustafa A Younis, El-Zahraa M Meghezel
July-September 2021, 34(3):832-838
DOI
:10.4103/mmj.mmj_71_21
Objective
This study aimed to investigate the impact of different clinical characteristics associated with MERS-CoV2 infection and mortality among patients from Sohag Fever Hospital, Sohag Governorate, Egypt.
Background
Currently, coronavirus disease 2019 (COVID-19) is one of the dangerous life-threatening diseases prevalent worldwide. Different clinical studies were carried out to increase the range of diagnosis level and predict its mortality rates in terms of different clinical and nonclinical characteristics.
Patients and methods
In the current case–control study, a hundred patients, hospitalized in Sohag Fever Hospital, Sohag Governorate, Egypt, were recruited in the period from October 2020 to December 2020. Sixty-four patients were positive PCR for COVID-19, while the other 34 were negative and were recruited as controls. Data included the demographic and clinical information such as their ages, place of residence, and infection symptoms in addition to laboratory investigation results such as complete blood count, differential blood count and hemoglobin (Hb) level, and clinical data such as %O
2
saturation, respiration rates per minute, and body temperature were collected. The data were statistically interpreted.
Results
PCR positivity was more prevalent among females (73.2%) and urban residents (67%). Lower %O
2 (
45.2%, 52.8%), higher white blood cell counts (72.2%, 27.8%), and lower Hb levels (69.8%, 31.2%) showed significantly different distributions among male and female participants, respectively. PCR results and chest computed tomographic scan were significantly affected by %O
2
saturation (87.1%, 45.2%), body temperature (100%, 53.3%), respiration rate (100%, 47.3%), and increase in the number of symptoms (100%, 22.2%), respectively. It was found that Hypertension (95% confidence of intervals (CI)= 0.061–0.245) and %O2 saturation values (95% CI= 0.077–0.523) are significantly related to the higher mortality rates due to MERS-COV-2 infection.
Conclusion
The study revealed the impact and correlation between the severity and risk of mortality of COVID-19 with different clinical markers such as lower %O
2
saturation, high body temperature, higher respiration rate, higher white blood cell count, and lower Hb levels. Further studies might be required to investigate the effect of more clinical data and comorbidities associated with the viral infection.
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Prediction of hepatocellular carcinoma using fibro markers in Egyptian patients with chronic liver disease
Ehab A. A. Elatty, Abd E. M. A. Sallam, El-Arab A Ezz
July-September 2021, 34(3):786-791
DOI
:10.4103/mmj.mmj_71_20
Objective
The aim was to evaluate inflammatory and fibrosis markers as predictors for hepatocellular carcinoma (HCC) development among patients with chronic liver disease (CLD).
Background
Progression of liver fibrosis in chronic hepatitis C is closely associated with the high risk of HCC development.
Patients and methods
This study was conducted on 100 patients suffering from liver cirrhosis as group A and 100 patients suffering from liver cirrhosis with HCC as group B from January 2018 to April 2019. Diagnosis of CLD was based on clinical, laboratory, and imaging evidence of CLD with and without hepatic decompensation or portal hypertension.
Results
Child–Pugh C patients was significantly more prevalent in HCC (37 vs 10% in liver cirrhosis cases). Serum hemoglobin, albumin, and leukocytic count were significantly lower in HCC cases. Also, α-fetoprotein, bilirubin international normalized ratio, and blood urea were highly significantly higher in the HCC group than the non-HCC group. King's score, fibro-quotient (Fibro Q), and FIB-4 scores were significantly higher in HCC than in cirrhotic cases, while blood red cells and Fibro-α scores were highly significantly higher in group B than in group A.
Conclusion
Our findings have shown the possibility to predict HCC development in Egyptian patients suffering from chronic hepatitis C by using noninvasive scores, (Fibro markers) as they performed well, cheap, and easy to perform.
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Evaluation of serum and ascitic monocyte chemotactic protein-1 level in patients with and without spontaneous bacterial peritonitis
Elsayed I Ellithy Elshayeb, Mohamed A Helwa, Mohamed E. Mohamed Abo Elenin, Mohamed H Badr
July-September 2021, 34(3):798-806
DOI
:10.4103/mmj.mmj_150_20
Objectives
To evaluate the diagnostic value of serum and ascitic fluid monocyte chemotactic protein-1 (MCP-1) level in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP).
Background
SBP is one of the potential life-threatening complications in ascitic cirrhotic patients, with a mortality rate ranging between 30 and 50%.
Patients and methods
This study was conducted on 40 patients with cirrhotic ascites with and without SBP admitted to Internal Medicine Department, Menoufia University Hospital, and El Sahel Teaching Hospital from October 2017 to October 2018. All patients included in this study were divided into two groups as follows: group I included 10 ascitic patients without SBP, and group II included 30 ascitic patients with SBP.
Results
Mean level of MCP-1 was significantly higher in SBP group than non-SBP group. For MCP-1, the cutoff point that gives an area of 91% was 122.5 ng/ml, with sensitivity of 86% and of specificity 95%. For serum MCP-1, the cutoff point that gives an area of 91% was 100.5 ng/ml, with of sensitivity 85% and specificity of 94%. For polymorphonuclear cell count, the cutoff point that gives an area of 78% was 62.5 cell/cm
3
, with a sensitivity of 100% and specificity of 41%.
Conclusion
MCP-1 is a good diagnostic marker for SBP with its high sensitivity (86.7%) and specificity (95.4%) with high reliability (91%) in patients with SBP. Moreover, MCP-1 is a good prognostic marker owing to its positive relation with the severity of liver disease, which is indicated by high model for end-stage liver disease scores.
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NEUROPSYCHIATRY - ORIGINAL ARTICLES
Is deep hypothermic circulatory arrest inferior to antegrade cerebral perfusion for brain protection?
Ayman R Abdelrehim, Yasser Mubarak, Hasan Sandogji, Saed Farkooh, Rafik F Soliman
July-September 2021, 34(3):1170-1175
DOI
:10.4103/mmj.mmj_29_21
Objective
This study aims to compare the deep hypothermic circulatory arrest (DHCA) and antegrade cerebral perfusion (ACP) with moderate hypothermia for cerebral protection during aortic arch surgery.
Background
Aortic arch surgery is a complicated technical operation due to the risk of cerebral insults and the need for cerebral protection.
Materials and methods
Forty patients performed aortic arch surgery with cerebral protection either by, DHCA (18°C) in 20 patients and ACP (22 °C) in the others. Data were collected including; preoperative risks factors, intraoperative finding and postoperative neurological examination and brain computed tomography (CT)when indicated.
Results
Neurological insults were higher in ACP group (30%) than in DHCA group (10%) without statistical significance. Cardiopulmonary bypass (CPB) time was lower in DHCA group (133.05 ± 28.04) than in ACP group (177.65 ± 53.3), and significantly p-value is (< 0.01).
Conclusion
Techniques for cerebral protection (DHCA or ACP)during aortic arch surgery have no statistical significant difference, and each technique has its own advantages and disadvantages.
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CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Paroxysmal atrial fibrillation incidence in acute ischemic stroke or transient ischemic attacks detected by 48-h Holter monitoring
Ahmed I Elbarbary, Ayman Kilany, Mohamed B Salem, Mohamed A Sakr
July-September 2021, 34(3):1152-1156
DOI
:10.4103/mmj.mmj_122_21
Objective
To examine the feasibility of early use of 48-h Holter monitoring to detect the incidence of paroxysmal atrial fibrillation (AF) in patients presenting with acute stroke or transient ischemic attack (TIA) and without present evidence of AF in the Neurology Department (MUST University).
Background
Many ischemic stroke patients have undiagnosed paroxysmal AF. Paroxysmal AF diagnosis is relevant in individuals who present with cerebral stroke and without AF on admission. Diagnosis of paroxysmal AF is essential because it is a strong risk factor for stroke recurrence and also because oral anticoagulation has an advantage over antiplatelet treatment.
Patients and methods
The study included 200 consecutive patients who had acute ischemic stroke or TIA symptoms. Each of them had no evidence of AF at the time of presentation, and within 1 week, they performed Holter monitoring for 48 h.
Results
Two-hundred patients with mean age 65.27 ± 13.61 years old with TIA and acute ischemic stroke were found in 41 (20.5%) patients and 159 (79.5%) patients, respectively. All 200 patients were monitored by 48-h Holter. Among 200 cases, 13 (6.5%) patients had paroxysmal AF. All 13 patients had acute stroke and were older than age 60 years. It represented 8.17% of patients with acute cerebrovascular stroke (13 patients out of 159 patients with acute cerebrovascular stroke). The only factor related to an increased risk of paroxysmal AF was stroke type. AF was responsible for 50% of clinically suspected cardiac embolic stroke cases.
Conclusion
Paroxysmal AF was diagnosed in ~ 6.5% of acute-stroke or TIA patients having normal ECG rhythm by early use of 48-h Holter monitoring. In acute cerebrovascular stroke patients, AF represented 8.17%. Holter monitoring is a feasible and simple tool for paroxysmal AF diagnosis in TIA or acute-stroke patients, thus allowing proper treatment and better secondary prevention.
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Gene polymorphism and serum levels of interleukin-18 in patients with coronary artery disease and type 2 diabetes mellitus
Waleed Abdou Ibrahim Hamed, Walaa Farid, Mohamed Noamany, Mohamed Hamdy, Ashraf Dawood, Rehab Yaseen
July-September 2021, 34(3):1145-1151
DOI
:10.4103/mmj.mmj_15_21
Background
Circulating concentrations of interleukin-18 (IL-18) were shown to be correlated with the vascular events in patients with coronary artery disease (CAD).
Objectives
To assess the serum levels of IL-18 and its gene polymorphism in CAD and diabetic patients and correlate these findings with clinical, echocardiographic, laboratory, and coronary angiographic findings.
Patients and methods
This cross-sectional observational study included 180 patients, who were divided according to presence or absence of CAD and type 2 diabetes mellitus into four groups: group I (41 patients), nondiabetic patients without CAD; group II (51 patients), nondiabetic patients with CAD; group III (40 patients), diabetic patients without CAD; and group IV (48 patients), diabetic patients with CAD. Serum levels of IL-18 and its genotyping distributions were measured in all groups and correlated with the angiographic coronary scoring systems.
Results
Serum IL-18 level was higher significantly in patients with CAD (groups II and IV) than in patients without CAD (groups I and III) (
P
< 0.001). Regarding the distribution of the three genotypes of 137 G/C (CC, GC, and GG), there were significant differences among the groups with predominance of GG genotype and G alleles in patients with CAD (
P
< 0.001). Angiographic coronary scores along with serum IL-18 were significantly higher in patients with GG allele predominance (
P
< 0.001). Serum IL-18 level was correlated directly with angiographic coronary scores (
P
< 0.001) and was inversely correlated with ejection fraction (
P
< 0.003).
Conclusion
IL-18 is a novel and independent risk factor for CAD, and it is associated with its extent and severity. IL-18 gene polymorphism at 137 G/C site could be a risk factor for development of CAD, presumably by increasing serum IL-18 levels. Individuals carrying the G allele and the G/G genotype of IL-18 have an increased risk to develop CAD.
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DERMATOLOGY - ORIGINAL ARTICLES
Association of vascular endothelial growth factor gene polymorphism with psoriasis
Wafaa A Shehata, Mohamad A Shoeib, Amany S. A. Swan, Sherin S El-Nidany
July-September 2021, 34(3):884-889
DOI
:10.4103/mmj.mmj_20_20
Background
Psoriasis is an immune-mediated complex cutaneous disorder. In its pathologic process, there is abnormal keratinocyte differentiation and proliferation, as well as inflammation, besides abnormal vascular expansion. Vascular endothelial growth factor (VEGF) acts as a potent mediator of inflammation and angiogenesis in psoriasis.
Objective
This work aimed to study the role of
VEGF
gene polymorphism (rs2010963) in psoriasis vulgaris.
Patients and methods
This case–control study covered 45 patients with psoriasis vulgaris and 45 age-matched and sex-matched healthy participants as a control group, and had been checked to discover C-G transition polymorphism at position +405 of the
VEGF
gene by a real-time PCR.
Results
There was a significant difference between cases and controls concerning the distribution of
VEGF
gene polymorphism (
P
= 0.046), and also, there was a statistically significant difference between cases and controls concerning
VEGF
alleles (
P
= 0.036).
Conclusion
There was a significant association between the genotypes of the
VEGF
gene polymorphism and psoriasis vulgaris, suggesting that the
VEGF
gene polymorphism may have a possible active role in the etiopathogenesis of psoriasis vulgaris.
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Role of signal transducer and activator of transcription 3 in cutaneous squamous cell carcinoma
Rehab M Samaka, Mohammed A Basha, Aya S Serag
July-September 2021, 34(3):890-895
DOI
:10.4103/mmj.mmj_22_20
Objective
To assess the role of signal transducer and activator of transcription 3 (STAT3) in cutaneous squamous cell carcinoma (cSCC).
Background
cSCC is considered the second most frequent type of nonmelanoma skin cancer. The Janus kinase-STAT pathway plays a significant role in the proliferation and survival of various cancer cells. Between seven mammalian STAT proteins, continuous activation of STAT3 is commonly observed in several cancer cells.
Patients and methods
This prospective and retrospective case–control study was conducted on 48 cases with cSCC and 47 age-matched and sex-matched apparently healthy participants. All sections were immunohistochemically stained for the STAT3 antibody.
Results
All controls showed significant STAT3 nucleo-cytoplasmic localization in the epidermis and the dermis, whereas in cSCC, most cases of nonmelanoma skin cancer showed cytoplasmic STAT3 expression in the epithelium and the surrounding stroma (
P
< 0.001 for both). STAT3 overexpression was noted in cSCC in comparison with the control group (
P
= 0.007). A significant relationship between the STAT3 epithelial Histo-score and high grade (
P
= 0.001) and advanced stage (
P
< 0.001) of cSCC was noted.
Conclusions
Cytoplasmic localization of STAT3 could play a tumor-promoting role in the pathogenesis of cSCC. Moreover, STAT3 overexpression might be incriminated in the progression of cSCC. This could be very attractive in the development of new anticancer therapy using STAT3 inhibitors.
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Psoriasis and sexual dysfunction in women
Sara M Abd Elazeem, Mohammed A Gaber
July-September 2021, 34(3):914-919
DOI
:10.4103/mmj.mmj_95_20
Objective
The aim of the present study was to analyze the effect of psoriasis on sexual function in Egyptian women.
Background
Psoriasis has a significant effect on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25–70% of patients.
Patients and methods
A case–control study was performed with a convenience sample of 300 participants, consisting of patients with a diagnosis of psoriasis (psoriasis group) treated at the psoriasis unit, Al-Houd Al-Marsoud Hospital, and healthy volunteers (healthy control group).
Results
The results revealed that the mean score for women with genital lesion was 12.4 ± 5.03, and the mean score for psoriatic women without genital lesion was 15.3 ± 5.8, with a statistically significant difference (
P
= 0.003). Moreover, we demonstrated that the overall scale of female sexual function index, except satisfaction, was lowered in women with genital lesion than those who do not have.
Conclusion
Psoriasis is a stigmatizing disease that impairs QoL and harms self-esteem through its effect on social relationships and self-perception, with a negative effect on physical, mental, and sexual health. The high prevalence of sexual dysfunction in our patients highlights the need for a more comprehensive approach to the health of women with psoriasis beyond assessment of their skin condition and the extent of the disease, including other QoL issues and specifically sexual function.
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Genetic association between
NLRP3
gene and patients with acne vulgaris
Magda M Hagag, Eman S. E. Elsayed Arafat, Sara F. A. Zekrallah
July-September 2021, 34(3):858-862
DOI
:10.4103/mmj.mmj_338_19
Objective
The aim was to investigate the genetic association between NACHT, LRR, and PYD Domains-Containing Protein 3 (
NLRP3
) gene and acne vulgaris among patients.
Background
Acne vulgaris is a common chronic skin disease. Inflammation is an important pathogenic mechanism of acne, and
NLRP3
polymorphisms have been reported to be involved in the mediation and occurrence of the inflammation. However, only a few studies on
NLRP3
and acne have been reported, and the mechanism remains unclear.
Participants and methods
To reach the goal of this research, a case–control study was designed. The study sample included 50 participants divided into two groups: patient group included 40 patients with acne vulgaris having comedones, papules, and nodules, and the control group included 10 healthy age-matched and sex-matched participants. All candidates were subjected to full history taking, clinical examination, BMI, and laboratory investigations for detection of
NLRP3
gene single nucleotide polymorphism in DNA extracted from blood samples by real-time polymerase chain reaction.
Results
We found that taking CC genotype and C allele as references,
NLRP3
CG, GG, and CG + GG genotypes and G allele showed significantly higher frequency in all cases compared with control groups (
P
= 0.030, 0.003, 0.004, and 0.001, respectively). Regarding severity, it was increased significantly in patients carrying CC, CG, and GG, respectively. Most of the severe cases had GG genotype (66.7%), whereas GG genotype was seen in moderate cases (17.6%). GG genotype was significantly associated with severe grades.
Conclusion
Our study suggests that the
NLRP3
SNP rs10754558 is associated with the incidence of (atrioventricular) AV. The G allele might be a genetic risk factor for AV.
[ABSTRACT]
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Study the relation of protein S and portal vein thrombosis in patients with liver cirrhosis
Ehab A Abdel Atty, Reem M Elkholy, Ahmed N Talkhan, El-Arab A Ezz
July-September 2021, 34(3):813-818
DOI
:10.4103/mmj.mmj_186_20
Objective
The aim was to investigate serum protein S (PS) levels in cirrhotic patients with portal vein thrombosis (PVT).
Background
PS is an important guardian in controlling thrombin generation and fibrinolysis, although the contribution of these properties to the anticoagulant functions of PS is still unclear.
Patients and methods
The present study was conducted on 90 subjects who were classified as follows: 36 cirrhotic patients without PVT, 34 cirrhotic patients with PVT, and 20 healthy persons as a control. The study was conducted in the period between December 2010 and March 2012. Complete blood picture, liver function tests, and renal function test were done. PS was measured by enzyme-linked immunosorbent assay. Abdominal ultrasonography was done to confirm diagnosis of liver cirrhosis (LC) by giving idea about liver echogenicity, irregularity of liver outline, liver size, presence of liver nodules, and also portal vein diameter and presence of PVT.
Results
The mean PS level in the LC group was significantly lower than the mean level in the control group (
P
1
= 0.0123) and the mean PS level in LC with PVT group was highly significant lower than the control group (
P
2
< 0.0001). Moreover, the mean PS level in LC with PVT group was highly significant lower than in the LC group (
P
3
= 0.0001).
Conclusion
PS concentration is a potential biochemical marker in the diagnostic strategy of PVT in patients with cirrhosis. PS less than 3.15 is highly indicative of PVT in cirrhotic patients with high sensitivity but low specificity.
[ABSTRACT]
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PEDIATRICS - ORIGINAL ARTICLES
Fibroblast growth factor-23 for diagnosis of neonatal sepsis
Fahima M Hassan, Rania S El Zayat, Karema A Diab, Aliaa A Sharf El-Din
July-September 2021, 34(3):998-1003
DOI
:10.4103/mmj.mmj_212_20
Objective
This study aimed to test whether clinical characteristics, laboratory parameters, and measurements of serum fibroblast growth factor-23 (sFGF23) can discriminate between babies with neonatal sepsis and normal babies.
Background
Neonatal sepsis is associated with severe morbidity and mortality in the neonatal period, especially in developing and underdeveloped countries.
Patients and methods
This was a prospective (case–control) study conducted between April 2018 and November 2018, at the Neonatal ICU, Menoufia University Hospital, Menoufia, Egypt. The study comprised 79 full-term neonates. The neonates were categorized in two groups based on International Pediatric Sepsis Consensus Conference and Biochemical Markers, including complete blood count, C-reactive protein, and blood culture: first, control group included 30 neonates with routine screening; and second, sepsis group comprised 49 neonates with clinical sepsis (32 with sepsis and 17 with severe sepsis) (clinical and laboratory signs of infection with or without positive blood culture). Receiver operating characteristic curves were used for the determination of thresholds for the infection group vs healthy neonate group.
Results
A total of 79 neonates were enrolled in this study. sFGF23 increased in order of infection severity, being higher in patients with clinical sepsis than healthy subjects. Sensitivity, specificity, positive predictive value, and negative predictive value for sFGF23 levels were 89.8, 76.67, 86.3, and 82%, respectively. sFGF23 (cutoff point for sFGF23 >21.68 pg/ml) (
P
< 0.001), and there was a positive correlation between sFGF23 level and severity of sepsis (
r
= 0.37,
P
= 0.004).
Conclusion
sFGF23 may be a valid and early diagnostic marker of neonatal infection. Moreover, sFGF23 is associated with severity of sepsis.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Interleukin-6 levels in the serum and saliva in patients with oral lichen planus
Mohamed A Basha, Shaymaa A. E Abd Elatef, Eman M. Abd El Gayed
July-September 2021, 34(3):909-913
DOI
:10.4103/mmj.mmj_64_20
Background
Oral lichen planus (OLP) is a chronic inflammatory and autoimmune disease that affects ~1.9–4% of the population. It occurs more frequently in women, and the immunological system is believed to play a significant role in it. Interleukin-6 (IL-6) is a cytokine that contributes to the pathogenesis of OLP.
Objectives
The objective of the study is to evaluate IL-6 levels in the serum and saliva in patients of OLP compared with healthy controls, aiming to help in the future treatments of OLP.
Patients and methods
This case–control study was conducted on 20 patients with OLP, and 20 age-matched and sex-matched healthy volunteers, as a control group.
Results
The results have shown that there was highly statistically significant difference between groups regarding serum IL-6 levels with higher levels among cases (
P
< 0.001).
Conclusion
Higher levels of IL-6 in the saliva compared with the serum suggest that measurement of this marker in the saliva may be more useful than the serum for diagnostic and therapeutic aims.
[ABSTRACT]
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Comparative study on therapeutic effects of human stem cells sin experimental diabetic nephropathy
Rasha A Ragab, Yaseen S Lasheen, Mahmoud M Emara, Yahya M Naguib, Mahmoud A Kora
July-September 2021, 34(3):819-824
DOI
:10.4103/mmj.mmj_255_20
Background
Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease. The pathophysiology of DKD includes oxidative stress, the formation of advanced glycation end-products, cellular signaling, and renewal processes, so they are potential targets for future drug therapy. One of these therapies is stem cells, as there is no specific treatment for diabetic nephropathy.
Objective
This study aimed to compare the therapeutic effects of human hematopoietic or mesenchymal stem cells in the treatment of experimentally induced diabetic nephropathy in rats.
Materials and methods
A total of 40 Swiss albino male rats were used in the present study. The animals were randomly divided into four groups: group I, control group (10 rats); group II, DKD group (10 rats), where streptozotocin-induced DKD rat models were used; group III, DKD group (10 rats), where streptozotocin-induced DKD rat models were used; group III, DKD treated with mesenchymal stem cells (MSCs); and group IV, DKD treated with hematopoietic endothelial progenitor stem cells (EPSCs). The four studied groups were assessed for renal function tests, serum CD44, interleukin 6, interleukin 18, intercellular adhesion molecule-1), neutrophil gelatinase-associated lipocalin, total antioxidant capacity, and serum rat malondialdehyde.
Results
There were significant differences between both DKD treated with MSCs and those treated with hematopoietic EPSCs groups and the DKD group without treatment, whereas there was no statistically significant difference between both stem cells-treated groups and the control group.
Conclusion
This study showed that hematopoietic EPSCs have the same renoprotective effect when compared with MSCs.
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CLINICAL PHARMACOLOGY - ORIGINAL ARTICLES
Human equilibrative nucleoside transporter-1 gene expression in acute myeloid leukemia patients treated with cytarabine
Rehab M. Abd Elkareem, Mohamed A Samra, Heba M Ahmed, Yasmin M ELTalawy, Seham M Omar
July-September 2021, 34(3):1068-1073
DOI
:10.4103/mmj.mmj_65_21
Objectives
This study aimed to demonstrate human equilibrative nucleoside transporter-1 (HENT1) gene expression patterns in acute myeloid leukemia (AML) patients and its role in disease progression.
Background
Cytarabine is the primary drug in different treatment schemas for AML and requires the HENT1 to enter cells.
Patients and methods
In this study, we analyzed HENT1 expression levels in 40 AML patients and 20 controls using the real-time quantitative reverse-transcriptase PCR.
Results
HENT1 was expressed in 42.5% of AML cases and 36% of controls. Our results showed a correlation between the HENT1 gene expression and the overall survival (OS), where HENT1-positive patients had a higher survival rate than HENT1-negative patients (
P
= 0.04). The results also showed a correlation between gene appearance and the response rate of treatment, as patients with positive HENT1 gene expression had a higher rate of complete recovery (58.8%) than the patients with negative HENT1 gene expression (30.4%). HENT1 expression was significantly correlated with OS and complete remission.
Conclusion
HENT1 gene expression is associated with better response to cytarabine treatment, with better OS in AML patients, both children and adults. HENT1 signaling may represent a novel therapeutic approach for the treatment of AML.
[ABSTRACT]
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CLINICAL PHYSIOLOGY - ORIGINAL ARTICLE
Therapeutic effect of sodium 2-mercaptoethanesulfonate on dextran sulfate sodium-induced ulcerative colitis in rats
Maha M ELbatsh, Emad-Eldeen M ELhenawy, Rehab M Samaka, Samah M Wadan
July-September 2021, 34(3):1048-1053
DOI
:10.4103/mmj.mmj_340_19
Objective
The aim of the study was to investigate the possible therapeutic effects of sodium 2-mercaptoethanesulfonate (MESNA) on dextran sulfate sodium (DSS)-induced ulcerative colitis (UC) in rats.
Background
Incidence of UC is high worldwide and has started to increase more and more specifically in the middle-east in the past few years. The established treatment of UC is still unsatisfactory, so the authors seek to develop new therapeutic modalities for UC.
Materials and methods
A total of 40 adult rats were divided into five groups (
n
= 8). Group 1 (control) is vehicle-treated group. Group 2 (DSStreated) received DSS 5% in drinking water for 7 days. Group 3 (DSS–Mesna-treated) received DSS 5% in drinking water for 7 days followed by Mesna 400 mg/kg/day intraperitoneal for 10 days. Group 4 (DSS–sulfasalazine-treated) received DSS 5% in drinking water followed by sulfasalazine (100 mg/kg/day; orally for 10 days). Group 5 (DSSMesna and sulfasalazine treated) received DSS 5% for 7 days followed by combined drugs for 10 days. Colonic tissue was used for estimation of reduced glutathione and superoxide dismutase. In addition, histopathological changes of rat colon were assessed.
Results
Mesna, sulfasalazine, and their combination significantly reduced body weight loss. They significantly increased the antioxidant defense (superoxide dismutase and reduced glutathione). They improved histopathological changes of UC.
Conclusion
Mesna may play a role in treatment of DSS-induced UC. Its combination with sulfasalazine showed better therapeutic effect than Mesna used alone.
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ENDEMIC AND TROPICAL MEDICINE - ORIGINAL ARTICLES
Study of von Willebrand factor as a risk for thrombotic cerebrovascular stroke in cirrhotic patients
Hossam I Mohammed, Khaled H Afifi, Reham S El Zaiat, Yousra A Alghalban, Mai K. Abd El khalek, Ayman A Sakr
July-September 2021, 34(3):839-844
DOI
:10.4103/mmj.mmj_403_20
Objective
This work aimed to assess the risk of von Willebrand factor (vWF) in ischemic stroke (IS) among cirrhotic versus noncirrhotic patients and its relation to IS severity and outcome.
Background
Liver cirrhosis is complicated by extensive hemostatic dysfunctions. vWF is found to be elevated and may expose these patients to thrombosis. Therefore, cirrhosis may be associated with bleeding or thrombotic events.
Patients and methods
This study included 22 cirrhotic patients without IS, 18 noncirrhotic patients with IS, 33 cirrhotic patients with IS (mixed group), and 20 healthy control. They were subjected to vWF measurement by ELISA, imaging (abdominal ultrasonography, computed tomography, and/or MRI brain, echocardiography, and duplex Doppler ultrasound on carotid arteries), National Institute of Health Stroke Scale (NIHSS), and modified Rankin Scale (MRS).
Results
Serum vWF levels were highly significantly increased in IS (94.6 ± 6.3) and mixed groups (115.9 ± 42.1) compared with other groups (
P
< 0.001). vWF was statistically significant in correlation with NIHSS and Child's score (
P
= 0.016 and 0.041, respectively). There was no significant correlation between Child's score and NIHSS (
P
= 0.558) or MRS (
P
= 0.526) or between vWF and MRS (
P
= 0.194), IS subtypes, or outcome (
P
> 0.05). Longer hospital stay was reported in mixed (14.8 ± 3.3) compared with IS group (8.5 ± 1.7) (
P
< 0.001). Mixed group encountered a higher morbidity and mortality (44.4 and 22.22%, respectively) than IS group (51.5 and 24.24%, respectively), though was nonsignificant. Hypertension was the only highly significant risk factor for stroke among IS group.
Conclusion
Serum vWF was higher in cirrhosis and mixed groups than in IS, but had no role in increased morbidity and mortality in all groups. There was no significant correlation between the severity of liver cirrhosis and the severity of IS.
[ABSTRACT]
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PATHOLOGY - ORIGINAL ARTICLES
Prognostic significance of Ezrin expression in colorectal carcinoma
Amany M Omar
July-September 2021, 34(3):1101-1107
DOI
:10.4103/mmj.mmj_34_21
Objectives
This study aimed to evaluate the immunohistochemical expression of Ezrin in various histopathological types of colorectal carcinoma, and to examine its association with various clinicopathological features and so evaluate its prognostic significance.
Background
Colorectal cancer is considered one of the most common cancers worldwide, it developed because of the cumulative effect of sequential genetic alterations. Thus, more extensive studies are needed to demonstrate the molecular mechanism of colorectal cancer initiation and progression. Ezrin gene has an important role in cell movement, migration, mitosis, and other physiological functions, and is involved in maintaining cell structure and cell motility. Its expression correlates with many human malignancies.
Patients and methods
Ezrin antibody immunostaining was performed using the avidin–biotin–peroxidase complex method in 204 cases of primary colorectal carcinomas, including 118 (57.8%) cases of adenocarcinoma, 56 (27.5%) cases of a mucoid carcinoma, and 30 (14.7%) cases of signet ring cell carcinoma.
Results
Cytoplasmic Ezrin expression was significantly higher in lymph-node-positive cases (
P
< 0.0001), in cases with lymph–vascular invasion (
P
= 0.037), and with advanced tumor stage (
P
< 0.0001).
Conclusion
High Ezrin expression is considered a poor prognostic factor for colorectal adenocarcinoma.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Relationship between metabolic syndrome and acquired premature ejaculation
Abd Allah M. Attia, Haitham F Dawoud
July-September 2021, 34(3):936-940
DOI
:10.4103/mmj.mmj_146_20
Objectives
The aim of the study was to investigate the relationship between metabolic syndrome (MetS) with its components and acquired premature ejaculation (APE).
Background
PE has recently received considerable attention. It adversely affects the quality of life of both partners. PE represents the most common sexual dysfunction in sexually active men. Studies proved higher incidence of erectile dysfunction among patients with MetS, but the relation of the latter to APE has not receive much attention yet.
Patients and methods
Our case–control study included 50 individuals who were classified into two groups, with 25 individuals each: MetS group and control group. Both groups are age matched (30–60 years old). All men in both groups were in continuous stable marriage with no marital conflict. They are free of diseases, taking no drugs, did not have operations before, and did not have congenital anomaly that might affect their sexual function (except the manifestations of MetS in the case group). All the participants underwent the intravaginal ejaculatory latency time (IELT) assessment and did MetS component measurements.
Results
The results of our study showed significantly lower IELT in the MetS group compared with the control (2.80 ± 1.384 vs. 4.52 ± 1.782 min, respectively,
P
= 0.0001). Arabic index of premature ejaculation score was found to be significantly lower in cases (18.32 ± 7.663) compared with controls (30.32 ± 6.46), confirming the presence of APE caused by MetS. IELT was found to be negatively correlated with BMI, fasting blood sugar, and triglycerides, but not high-density lipoprotein.
Conclusion
MetS can be considered as an independent predisposing factor for development of APE. Effective prevention and treatment of MetS could be important for APE prevention.
[ABSTRACT]
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PEDIATRICS - ORIGINAL ARTICLES
Association of cytotoxic T lymphocyte 4 gene with auto-antibodies in children with type 1 diabetes
Maha A Tawfik, Soheir S. Abou El-Ella, Naglaa F Barseem, Neama H Zeariban, Gamila S. Abdel Moaty
July-September 2021, 34(3):973-978
DOI
:10.4103/mmj.mmj_344_19
Objective
The aim of the study was to detect the association of CTLA4 gene with anti-insulin antibodies in type 1 diabetes in children.
Background
The objective was to evaluate the diagnostic workup done for diabetic children in its relation to clinical findings and diabetic control, and to study association of CTLA4 gene and anti-insulin antibodies in type 1 diabetes in children.
Materials and methods
The results showed no significant difference between male and females regarding serum anti-insulin antibodies and CTLA4 gene. There was a significant positive correlation between serum anti-insulin antibody and duration of disease of type 1 diabetes, but there was an insignificant association between CTLA4 gene and anti-insulin antibodies and type 1 diabetes.
Results
The study was carried out in the Pediatric Endocrinology and Genetic Units in Menoufia University Hospital and Damnhour Medical Institute. One hundred children with type 1 diabetes were enrolled (44 males and 56 females). Their age ranged from 2 to 17 years, with a mean of 9.3 ± 13.6 years. Data were collected including detailed history and thorough clinical examination, including anthropometric measures (body weight, standing height, BMI, and laboratory data). Assessments of serum anti-insulin antibodies and CTLA4 gene were done for all cases and for 100 apparently healthy control children (51 males and 49 females), whose age ranged from 3 to 16, with mean of 8.45 ± 3.48 years.
Conclusion
This study concluded that serum anti-insulin antibodies can be used as a marker in diagnosis of new cases of type 1 diabetes in children.
[ABSTRACT]
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CARDIAC SURGERY - ORIGINAL ARTICLES
Position of the surgeon and its importance during the repair of tetralogy of Fallot in situs inversus totalis
Ayman R Abdelrehim, Mansour B al Mutairi, Syed Aitizaz, Amal A Sakrana
July-September 2021, 34(3):1176-1178
DOI
:10.4103/mmj.mmj_13_21
Background
Situs inversus totalis is a rare condition that is occasionally associated with congenital heart defects. A few sporadic cases have been reported in the past.
Objectives
The authors present a case of tetralogy of Fallot repair in a child with situs inversus totalis. Imaging studies conclusively proved mirror-image reversal of abdominal and thoracic organs.
Conclusion
The intracardiac repair was only possible when the operating surgeon changed to the opposite (left side) of the operating table. The mirror-image reversal of cardiac structures may require a shift in the position of the operating surgeon to the opposite (left) side of the table to visualize intracardiac defects properly.
[ABSTRACT]
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Study of interferon regulatory factor-1 in patients with hepatitis C virus-related hepatocellular carcinoma
A Ezz El-Arab, Ashraf G Dala, Mohammad Alhelbawy, Marwa H Hekal
July-September 2021, 34(3):792-797
DOI
:10.4103/mmj.mmj_100_20
Aim
To investigate the expression of serum interferon regulatory factor-1 (IRF-1) in patients with hepatocellular carcinoma (HCC) and patient with chronic hepatitis C and to determine its efficacy in early detection of HCC.
Background
Infection with hepatitis C virus (HCV) frequently results in a persistent infection, suggesting that it has evolved efficient mechanism(s) for blocking the host cell's innate antiviral response.
Patients and methods
This a case–control study that included 70 patients with HCV infection, with and without HCC, as well as 15 apparently healthy age-matched and sex-matched patients. The studied individuals were divided into three groups. Group 1 consisted of 15 individuals as control controls. There were seven males and eight females, with ages ranged from 42 to 78 years. Group 2 consisted of 35 patients with chronic HCV without HCC. There were 19 males and 16 females, with ages ranged from 43 to 80 years. Group 3 consisted of 35 patients with chronic hepatitis C-related HCC.
Results
Mean IRF-1 level was 0.58 ± 0.38 × 10
9
/μl in HCC group, in cirrhotic group was 7.48 ± 4.92 × 10
9
/μl, and in control group was 134.93 ± 89.27 × 10
9
/μl, so the mean IRF-1 level in HCC group was highly significant lower than cirrhotic group (
P
3 > 0.001), the mean IRF-1 level in HCC group was highly significant lower than control group (
P
2 > 0.001), and the mean IRF-1 level in cirrhotic group was highly significant lower than control group (
P
1 > 0.001).
Conclusions
The expression of IRF-1 is suppressed in HCC. IRF-1 is considered to be an important tumor-suppressor gene in human malignancies, including HCC.
[ABSTRACT]
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CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Relationship between aneurysmal location in subarachnoid hemorrhagic patients and both blood clot thickness and radiological vasospasm
Esraa S Essa, Mohamed A Okda, Ibrahim E. S. Elhmar, Gelan M Salem
July-September 2021, 34(3):1157-1162
DOI
:10.4103/mmj.mmj_73_20
Objective
The aim was to detect the relationship between site of cerebral aneurysms and the amount of blood in computerized tomography and liability for early vasospasm using transcranial Doppler (TCD).
Background
The mortality with subarachnoid hemorrhage (SAH) is associated with cerebral vasospasm, rebreeding hydrocephalus, and seizures.
Patients and methods
This randomized controlled clinical trial recruited 30 patients from both sexes with acute aneurysmal SAH. Patients were recruited from Matarya Teaching Hospital during the period from October 2018 to June 2019. Outcome was assessed by Glasgow coma scale, Hunt and Hess scale (HHS), and modified Fisher scale (MFS). Patients were followed up by TCD on first, third, fifth, seventh, and 10
th
day of appearance of symptoms.
Results
There was no significant difference between cases with positive vasospasm vs negative vasospasm regarding age and sex. There was a significant association between early vasospasm and hypertension (P = 0.001), as well as smoking (P = 0.007). There was a significant difference between cases with positive vasospasm vs negative vasospasm regarding systolic blood pressure and diastolic blood pressure and glycosylated hemoglobin. There is a significant association between early vasospasm and symptomatic to vasospasm (P = 0.018). There was a significant difference between cases with positive vasospasm vs negative vasospasm regarding Glasgow coma scale, HHS, and MFS (P = 0.001 for all).
Conclusion
Continuous TCD measurements are valuable methods for early detection of vasospasm following SAH. Glasgow coma scale, HHS, MFS, aneurysmal size, aneurysmal site, systolic blood pressure and diastolic blood pressure, and glycosylated hemoglobin seem to be important predictors for vasospasm severity.
[ABSTRACT]
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CARDIAC SURGERY - ORIGINAL ARTICLES
Outcomes of the surgical resection of intradural extramedullary tumors
Ahmed Saro, Ahmed K Abdelhameid
July-September 2021, 34(3):1184-1188
DOI
:10.4103/mmj.mmj_109_21
Aim
To evaluate the postoperative status after the tumor resection and compare it with the preoperative status.
Background
The intradural extramedullary tumors remain curable diseases and carry a favorable outcome. Early diagnosis is crucial to improve the outcome. Resection of the intradural extramedullary tumors improves the pain and the functional outcome of the patients.
Patients and methods
A retrospective study was done in the Neurosurgery Department, Sohag Faculty of Medicine, to patients diagnosed with intradural extramedullary tumors confirmed by MRI spine between April 2014 and April 2018. Forty-two cases were presented with female predominance, with mean age 46.6 ± 17 years with different presentations. They were operated and follow-up was done for 1 year postoperatively. They were evaluated preoperatively regarding pain, motor, and sphincteric function.
Results
The most frequent symptom was back and leg pain (88.1%), followed by paraparesis (23.8%), sensory disturbances in seven (16.7%) patients, and urinary incontinence in seven (16.7%) patients. The most common pathology was schwannoma (61.9%). Surgical resection improves the outcome in 35 (83.3%) patients. The dorsal spine was mostly affected in 30 patients followed by the lumbar spine in nine patients. The most effective prognostic factor was the early surgical intervention. Complications were reported in 19 patients, including cerebrospinal fluid leak, urinary incontinence, and wound infection.
Conclusion
These types of tumors have excellent results after excision. We recommend early intervention, irrespective of the tumor location or the pathology. After total excision, marked improvement regarding pain and neurological function was reported, while the recurrence rate was less than 2.5%. Prognostic factors include tumor extension, time of intervention, and Simpson grade of excision.
[ABSTRACT]
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RHEUMATOLOGY AND REHABILITATION - ORIGINAL ARTICLE
Role of PET/computed tomography and biopsy guidance in characterization of malignant biliary obstruction
Mohamed S Elzaway, Mohamed M Hoseiny, Waleed A Mousa, Eslam I Ayoub, Ashraf B Abdallah
July-September 2021, 34(3):1021-1027
DOI
:10.4103/mmj.mmj_162_19
Objective
This prospective study was conducted to evaluate the diagnostic effect of PET/computed tomography (PET/CT) in patients with malignant biliary obstruction and if the metabolic information provided by PET/CT scan adds an incremental benefit while performing image-guided biopsies.
Background
Malignant biliary tract obstruction is a frequent cause of jaundice. PET/CT is used to evaluate such patients, and information delivered by PET images is used to guide biopsy procedure.
Patients and methods
This study was carried out from March 2016 to March 2018 on 52 patients diagnosed/suspected to have MTBO. They all were investigated by PET/CT. Results were compared with the results of contrast-enhanced CT in ∼42 cases and with magnetic resonance cholangiopancreatography (MRCP) in ∼15 cases. A group of patients had undergone PET/CT-guided biopsy (15 patients).
Results
This study revealed that sensitivity, specificity, positive predictive value, and negative predictive value for PET/CT were 92, 75, 96, and 60%, respectively, whereas for CT and for MRCP were 68, 60, 85, and 20% and 60, 50, 85, and 20%, respectively. PET/CT has sensitivity of 90% for detection of lymph nodal metastases compared with 37% for CT and 20% for MRCP. PET/CT is more sensitive than CT and MRCP for distant metastases detection.
Conclusion
PET/CT is more sensitive and specific than CT and MRCP in primary detection and staging of tumors causing malignant biliary tract obstruction. PET/CT-guided biopsy increases the chance of obtaining a definitive diagnostic result.
[ABSTRACT]
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58
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DERMATOLOGY - ORIGINAL ARTICLES
Erectile dysfunction in psoriatic patients
Abdalla M Attiaa, Ahmed S Rashed
July-September 2021, 34(3):873-877
DOI
:10.4103/mmj.mmj_15_20
Objective
The aim of this study was to determine the role of psoriasis
per se
in erectile dysfunction (ED).
Background
An association between psoriasis and ED has been explored and proved in several studies. However, not much is known about the role of psoriasis
per se
in the pathogenesis of ED in these patients.
Patients and methods
This case–control study included 40 male participants aged 25–50 years who were divided into two groups: a case group composed of 20 psoriatic patients with moderate to severe psoriasis and an age-matched control group composed of 20 healthy men. All participants completed the International Index of Erectile Function version-5 questionnaire and the hospital anxiety and depression scale (HADS).
Results
The results of the study showed that there was no significant difference in ED percentage in the psoriasis group compared with the control group (25 vs 5%,
P
= 0.076) and there were significant differences in anxiety and depression indices in the psoriasis group compared with the control group (HADS score for anxiety 55% normal, 15% borderline, and 30% abnormal vs 85% normal, 15% borderline,
P
= 0.026 while the HADS score for depression was 50% normal, 25% borderline, and 25% abnormal vs 80% normal, 20% borderline,
P
= 0.039).
Conclusion
Psoriasis
per se
has no role in ED.
[ABSTRACT]
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70
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NEUROPSYCHIATRY - ORIGINAL ARTICLES
Association between serum apolipoprotein E and cognitive functions in temporal lobe epilepsy
Rasha A Elkapany, Aktham I Alemam, Afaf Z Ragab, Khald H Afifi, Ahmed R Rady
July-September 2021, 34(3):1163-1169
DOI
:10.4103/mmj.mmj_147_20
Objective
The aim was to estimate serum level of apolipoprotein E (Apo E) in patients with temporal lobe epilepsy (TLE) and to investigate the association between Apo E and cognitive functions in patients with TLE.
Background
There is a relation between Apo E and TLE, which has led to increased attention for examination. Apo E may exacerbate epilepsy and promote memory impairment in patients with long-standing TLE.
Patients and methods
A total of 40 patients with TLE and 40 normal participants were included. Interictal electroencephalogram and magnetic resonance imaging were done. Brain cognitive assessment was done using minimental state examination and Addenbrooke's cognitive examination revised (ACE-R). Serum Apo E was done using enzyme-linked immunosorbent assay technique.
Results
Minimental state examination and ACE-R scores were significantly less in the patients with TLE compared with the controls (
P
< 0.001 and < 0.001). Serum Apo E levels were significantly higher in patients with TLE compared with the control group (
P
< 0.001). Serum Apo E was significantly correlated with total ACE-R, as well as memory, verbal fluency, and visuospatial subsets of ACE-R (
P
< 0.001, <0.001, <0.001, and < 0.001, respectively).
Conclusion
There is a cognitive impairment in patients with TLE especially for memory, verbal fluency, and visuospatial activity. Serum Apo E was associated with cognitive impairment in TLE, which may suggest its possible role in cognitive impairment in patients with TLE.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Immunohistochemical expression of myxovirus resistant protein 1 in squamous cell carcinoma
Rehab M Samaka, Mohamed A Basha, Walaa W Fayed
July-September 2021, 34(3):941-946
DOI
:10.4103/mmj.mmj_148_20
Objective
The aim was to evaluate the role of myxovirus resistant protein 1 (MxA) in cutaneous squamous cell carcinoma (CSCC).
Background
CSCC is the second most common skin cancer. MxA has the potential importance in tumorigenesis and metastasis as well as in the treatment and prognosis of different cancers such as CSCC. However, the clear association between MxA expression and cancer remains unknown.
Patients and methods
This prospective and retrospective case-controlled study was conducted on 48 cases with CSCC and 43 age- and sex-matched apparently healthy participants. All sections were immunohistochemically stained for MxA antibody.
Results
Significant differences between control and CSCC groups regarding MxA positivity in both tumor and stroma were identified. All CSCC cases were positive in tumor and stroma, whereas 44.2% of control cases showed positivity (
P
< 0.001 for both). Overexpression of MxA in tumor was significantly associated with high grade and advanced stage (
P
= 0.02 and 0.03, respectively). Overexpression of MxA in stroma was significantly associated with low grade and early stage (
P
= 0.02 and 0.02, respectively).
Conclusion
The role of MxA is complex and controversial in tumor and stroma of CSCC. Tumor MxA expression is responsible for tumor progression, whereas stromal expression is responsible for regression.
[ABSTRACT]
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COMMUNITY MEDICINE - ORIGINAL ARTICLES
Epidemiology of fungal infection after hepatobiliary surgeries at National Liver Institute Hospital (Menoufia University)
Mahmod E. Abu Salem, Omaima A Mahrous, Wesam S Morad, Hala M Gaber, Iman M El Kholy, Sally W El-Khadry
July-September 2021, 34(3):1126-1131
DOI
:10.4103/mmj.mmj_130_16
Objectives
To estimate the incidence rate of fungal infections after hepatobiliary surgery and identification of the risk factors.
Background
Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients, especially in the ICU, the incidence of invasive candidiasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs.
Participants and methods
A prospective cohort hospital-based study was carried out at the National Liver Institute, Menoufia University. The studied group was 210 patients, all of them were examined thoroughly, their data were registered and sampled two times, one at the day of admission to be sure that they are free of fungal infection and the second was after hepatobiliary surgery. A predesigned questionnaire was used, which includes data about personal history, medical history, and suggested risk factors for fungal infections.
Results
In the present study, the incidence rate of fungal infection among patients who had hepatobiliary surgeries in National Liver Institute was found (45.2%) and by logistic regression analysis of data indicated that the most relevant factors for fungal infection were age (
P
< 0.001), antibiotic use (
P
< 0.05), liver disease (
P
< 0.05), central venous catheter (
P
< 0.05), urinary catheter (
P
< 0.05), and ICU hospitalization more than 48 h (
P
< 0.001).
Conclusion
High incidence of fungal infection after hepatobiliary surgeries is considered a great health problem. The main risk factors of fungal infection are low immunity, chronic disease, diabetes, hepatitis B virus and/or hepatitis C virus infection, cancer, anemias, organ transplantation, blood transfusion, had central venous catheter, intravenous catheter, had abdominal drain, urinary catheter, parenteral nutrition, history of past operations, and hospitalized in the ICU more than 48 h.
[ABSTRACT]
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Prognostic utility of significant ischemia on myocardial perfusion imaging studies among patients with stable coronary artery disease
Ahmed A Reda, Adel H Allam, Mahmoud A Soliman, Mourad B Mena, Amr ElSayed Yahia
July-September 2021, 34(3):1132-1138
DOI
:10.4103/mmj.mmj_189_20
Objective
To compare the long-term outcomes in patients with a large perfusion defect and predominant ischemia who have revascularization and those who had medical treatment.
Background
Revascularization requires demonstration of its clinical benefits via studies evidencing interaction between the presence of ischemia and the efficacy of myocardial revascularization and the best way to prove that is stress imaging particularly stress myocardial perfusion imaging (MPI). Stress MPI has a well-established rule in the diagnosis of physiologically significant lesions.
Patients and methods
Between March 2012 and December 2012, this single-center prospective study included 213 patients with large perfusion defects with a predominant ischemia who underwent Technetium-99m Sestamibi MPI under both stress and rest conditions. The patients were followed up for hard events for 5 years for nonfatal myocardial infarction or cardiac death.
Results
Much harder events happened in patients with large perfusion defects with a predominant ischemia of at least 8% who had medical management only. There was no significant difference between patients with and without follow-up regarding clinical characteristics and MPI results (
P
> 0.05), except hypertension and dyslipidemia (
P
= 0.05 and 0.001, respectively). There was no significant difference between patients on medical treatment versus patients on medical treatment plus interventions regarding clinical characteristics and MPI results (
P
> 0.05), except age (
P
= 0.001), hypertension (
P
= 0.04), and previous myocardial infarction (
P
= 0.007).
Conclusion
In patients with chronic ischemic heart disease, patients with large perfusion defect (>10%) and predominant ischemia (>8%) will gain benefit from revascularization.
[ABSTRACT]
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CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Coronary atherosclerotic plaque extent in hypertensive patients detected by computed tomographic angiography
Ehab M Elewa, Ahmed A Mostafa, Abdalla M Kamal
July-September 2021, 34(3):1139-1144
DOI
:10.4103/mmj.mmj_190_20
Objective
To evaluate the extent of coronary artery calcium in hypertensive patients using multislice computed tomography.
Background
Uncontrolled hypertension is one of the most common determinants for hospital admissions owing to acute coronary events. Computed tomographic (CT) coronary calcium scoring has been established as the best noninvasive predictor of atherosclerotic cardiovascular risk available today.
Patients and methods
The present study was conducted on 90 patients with recurrent chest pain referred for coronary multislice computed tomography angiography at Kobry El-Kobba Military Hospital. Patients comprised 69 hypertensive patients and 21 normotensive patients. Full history taking, laboratory investigation, coronary CT angiography, coronary plaque distribution, and coronary artery calcium scoring (CACS) were done.
Results
There was no statistically significant difference between the studied groups regarding mid left anterior descending (LAD) obstruction, distal LAD obstruction, proximal left circumflex (LCX) obstruction and distal LCX obstruction, proximal right coronary artery (RCA) obstruction, mid RCA obstruction, and distal RCA obstruction. However, hypertensive patients had significantly higher rate of 1–49% proximal LAD obstruction (
P
= 0.015) and mid LCX 1–49% and more than or equal to 50% obstruction (
P
= 0.034). Moreover, nonhypertensive patients had significantly higher number of patients with nonaffected vessels. Hypertensive patients had significantly higher rate of two-vessel affection. Moreover, hypertensive patients had significantly higher CACS, atheroma burden obstructive score, segment involvement score, and segment stenosis scored syntax I score compared with nonhypertensive patients.
Conclusion
Hypertension is associated with higher rate of coronary artery stenosis as shown by CT angiography. Hypertension is associated with increasing CACS.
[ABSTRACT]
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RADIOLOGY AND IMAGING SCIENCES - LETTER TO EDITOR
Prevalence of rheumatic heart disease in school children aged 6–15 years
Mahmood D Al-Mendalawi
July-September 2021, 34(3):1199-1199
DOI
:10.4103/mmj.mmj_109_20
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PEDIATRICS - LETTER TO EDITOR
The World Health Organization leads the battle against coronavirus disease 2019 pandemic
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
July-September 2021, 34(3):1200-1201
DOI
:10.4103/mmj.mmj_125_20
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ERRATUMS
Erratum: Different aspects of colorectal polyps in a cohort of elderly Egyptian patients: monocentric experience
July-September 2021, 34(3):1202-1202
DOI
:10.4103/1110-2098.328357
[FULL TEXT]
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50
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Erratum: Prognosis of vascular endothelial growth factor gene polymorphism in Egyptian patients with acute myeloid leukemia
July-September 2021, 34(3):1204-1204
DOI
:10.4103/1110-2098.328358
[FULL TEXT]
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48
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Erratum: Maternal sociodemographic and antenatal factors as predictors of low-birth weight in Ghana
July-September 2021, 34(3):1205-1205
DOI
:10.4103/1110-2098.328359
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Erratum: Health care-associated infections at an Egyptian tertiary care hospital: a 2-year prospective study
July-September 2021, 34(3):1203-1203
DOI
:10.4103/1110-2098.328356
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Online since 31 Jan, 2014