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2022| April-June | Volume 35 | Issue 2
Online since
July 27, 2022
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Comparison between iron compounds as oral treatment for iron deficiency anemia during pregnancy
Nabih I Elkhouly, Medhat E Helmy, Ahmed F Hanafi Mahmoud, Heba M Abo Shady
April-June 2022, 35(2):754-761
DOI
:10.4103/mmj.mmj_196_21
Objective
To compare the efficacy, tolerability, and compliance of iron fumarate, iron bisglycinate, and iron polysaccharides for the treatment of iron deficiency anemia during pregnancy.
Background
Iron deficiency anemia during pregnancy is a significant worldwide health problem. Therefore, routine iron supplementation during the second half of pregnancy has been recommended.
Patients and methods
A double-blind study was carried out at the Obstetrics Department in Wadi-El Natroun General Hospital on 120 pregnant females with confirmed iron deficiency anemia from August 2019 till August 2020. Study medications were supplied in the form of tablets. Group A: 100 mg of iron fumarate, once daily. Group B: 100 mg of iron bisglycinate, once daily. Group C: 100 mg of iron polysaccharide, once daily. Full history taking and complete clinical examination was done. Hemoglobin (Hb), mean corpuscular volume, and reticulocyte count were assessed at day 0, and then at the end of first, second, and third month. Serum ferritin was assessed at recruitment (day 0) and at the end of 3
rd
month.
Results
Our results found that there is high significant difference between the studied groups as regards serum ferritin, Hb and reticulocyte count and serum ferritin (after treatment). However, there was no significant difference regarding mean corpuscular volume.
Conclusion
Ferrous fumarate achieve a faster cure rate and have better results of mean Hb and serum ferritin level than iron bisglycinate and iron polysaccharide in iron deficiency pregnant women.
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Yolk sac size and shape, gestational sac diameter, and embryonic heart rate as prognostic factors of first-trimester pregnancy outcomes
Abd El-Hamid Essam Shahin, Maha Abd El-Satar Elmasry, Mohamed Salama Gad
April-June 2022, 35(2):776-781
DOI
:10.4103/mmj.mmj_223_21
Background
Yolk sac first appears at ~5 weeks of gestation and is visualized by ultrasound and along with embryonic heart rate can be used as prognostic factors for first-trimester pregnancy outcomes.
Aim
To evaluate the correlation between each of the ultrasound parameters that were assessed in the first trimester (the gestational sac size, yolk sac size and shape, and embryonic heart rate) and early pregnancy loss and to correlate between different ultrasound parameters with each other.
Patients and methods
This randomized prospective controlled study included 250 pregnant women with singleton pregnancies during the first trimester from 6 to 8 weeks at the Department of Obstetrics and Gynecology and LogiqP3 at the Department of Radiology of Kotor Central Hospital and Chison at Obstetrics and Gynecology Clinic of Menofia University.
Results
Irregular-shaped yolk sac proved to be an important prognostic factor in pregnancy outcome in our study. In the pregnancies that resulted in normal first trimester, there was a significant association between crown-rump length (CRL) and mean gestational sac diameter (
P
< 0.001) and mean yolk sac diameter (
P
< 0.001).
Conclusion
Measurement of gestational sac diameter, CRL, and fetal heart rate in combination provides a better prediction of the prognosis of the first trimester than when either parameter is used alone.
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FAMILY MEDICINE - ORIGINAL ARTICLES
Knowledge, attitude, and practice regarding postpartum care among mothers attending an Egyptian family health unit
Safa H Alkalash, Osama A El kelany, Heba I Zayed
April-June 2022, 35(2):528-534
DOI
:10.4103/mmj.mmj_238_21
Objectives
To evaluate knowledge and attitude of mothers about postpartum care and to assess postpartum care that was provided for both mothers and newborns.
Background
The postnatal period is critical for the newborn and the mother. All of maternal and neonatal problems could be reduced if women receive appropriate postpartum care. Therefore, it is essential to provide education to mothers regarding appropriate postpartum care, as improved household practices and use of services, often at the community level, will increase newborn survival.
Participants and methods
A cross-sectional study was conducted on a simple random sample of 321 mothers in the reproductive age. The mothers were selected randomly from the Elsafasef health care facility of Damanhur District of El-Behra Governorate, Egypt. A predesigned questionnaire was used to assess sociodemographic data, knowledge, and attitude of the participants regarding postpartum care, and a checklist was used to assess postpartum care services provided for both mothers and their neonates.
Results
Good knowledge was reported among 57% of the studied group, whereas 79.3% of them had a positive attitude, and approximately 51.2% and 64.8% of the studied group had good practice regarding postpartum care services that were provided for them and their neonates, respectively.
Conclusion
More than half of mothers had good knowledge and satisfactory practice regarding postpartum care, and a majority of them had a positive attitude toward postpartum care.
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Effect of metoclopramide in shorting the length of labor: a randomized controlled trial
Ahmed H. S. Khalaf, Hamed El-Sayed El-Lakwa, Mohamed Z. S. Dayer, Nabih I El Khouly
April-June 2022, 35(2):728-733
DOI
:10.4103/mmj.mmj_146_21
Objective
To establish whether metoclopramide plays a role in shorting the length of labor.
Background
The actual role of metoclopramide concerning cervical dilatation to improve labor progress is still controversial.
Patients and methods
A prospective randomized control study was conducted on 100 pregnant women who were admitted to Etay-Elbaroud Hospital. They were divided into two equal groups; each included 50 pregnant women. Each group received a prefilled syringe with either metoclopramide or saline.
Results
The results indicated that there were statistically significant differences between the two studied groups regarding cervical dilation at 2, 4, 6, 8, and 10 h, as
P
values were 0.018, 0.001, more than 0.001, more than 0.001, and 0.043, respectively. Regarding full cervical dilatation, there were statistically significant differences between the two studied groups regarding cervical dilation at 6, 8, and 10 h, as
P
values were 0.037, 0.001, more than 0.001, and more than 0.001, respectively. Kaplan–Meier survival analysis showed a significant difference in the probability of faster delivery among women who were treated with metoclopramide and others who were treated with placebo (
P
= 0.036).
Conclusion
Metoclopramide usage in the first stage of labor significantly enhances cervical dilatation, which subsequently may shorten the duration of labor.
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PHYSICAL MEDICINE RHEUMATOLOGY AND REHABILITATION - ORIGINAL ARTICLES
Platelet-rich plasma injection versus surgical fixation procedure in management of spondylolisthesis grade 1
Mohamed A El tabl, Dalia S Saif, Dina S Fotouh, Ahmed S Ammar
April-June 2022, 35(2):614-619
DOI
:10.4103/mmj.mmj_247_21
Objectives
To compare the efficacy of three ultrasound-guided platelet-rich plasma (PRP) injections into the facet-joint capsule to the surgical procedure in patients with grade-1 degenerative spondylolisthesis, over a 1-year follow-up period, and to assess their effects on chronic low-back-pain alleviation and functional improvement.
Background
Spondylolisthesis is a serious medical condition commonly treated surgically or with lumbar epidural steroids to relieve pain. Patients who continue to have considerable symptoms while receiving conservative treatment options may consider surgery.
Patients and methods
A prospective clinical study was conducted on 100 patients with grade-1 degenerative spondylolisthesis. Patients were randomized into two equal groups. In group 1, 50 patients had three PRP injections into the facet-joint capsule using ultrasound guidance, while group 2 consisted of 50 individuals who had surgical procedure. They were evaluated using primary and secondary outcome measures, including the visual analog scale, Persian functional rating index, Oswestry disability index for low back pain, and Roland–Morris questionnaire.
Results
Both groups of patients revealed improvement in their scores of evaluation tools regarding pain and function that was sustained up to 9 months of the study period in the PRP-injected group and up to 12 months in the second group who went to surgery.
Conclusions
PRP is a safe and efficient treatment option for managing chronic low back pain in degenerative spondylolisthesis grade-1 patients; it can be used as a less-invasive treatment strategy besides medical and physical modalities, especially in patients who are unfit or refusing surgery.
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Intrauterine cleaning versus noncleaning after placental delivery during cesarean section
Sherif M Salam, Mohamed Z. S. Dayer, Samar K. I. Shaalan, Heba M Abo Shady
April-June 2022, 35(2):741-744
DOI
:10.4103/mmj.mmj_151_21
Objective
The aim of this study was to compare postpartum endomyometritis rates after cleaning versus noncleaning of the uterus during cesarean section.
Background
The rate of cesarean delivery has seen a sharp rise in the USA, with more than a million occurring annually. Intrauterine cleaning during cesarean section, that is, wiping the inner lining of the uterus with a dry laparotomy sponge after placental delivery, is intended to remove blood clots and bits of decidua or membranes within the uterine cavity.
Patients and methods
This prospective study was applied at the El-Bagour General Hospital during the period from October 2019 to July 2020. A total of 210 women attending this hospital for elective cesarean section were included in the study.
Results
The current study concluded that uterine cleaning through wiping the uterus after placental delivery is not effective in reducing the incidence of endometritis; furthermore, it can be hazardous and increase the risk of infection.
Conclusion
There was a statistically significant increase in the cleaning group than the noncleaning group regarding the incidence of endometritis (
P
< 0.05). Overall, 40% of cleaning cases had endometritis, whereas 20% of noncleaning cases had endometritis.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Study of fatigue in hypothyroid patients
Mostafa El Najjar, Shaimaa S Soliman, Sherin S EL Naidany, Mohamed F El Sawah, Shimaa K Zewain
April-June 2022, 35(2):553-558
DOI
:10.4103/mmj.mmj_268_21
Objectives
To assess the association between the severity of chronic fatigue and hypothyroidism.
Background
Fatigue is often described as mainly physical and cognitive and emotional discomfort. Persistent tiredness and fatigue-related symptoms are common in many hypothyroidism individuals.
Patients and methods
This case–control study was carried out on overt hypothyroid and subclinical hypothyroid patients attending outpatient clinics and inpatient endocrinology clinics in Menoufia University Hospital. The participants were classified into two groups: group I (control): 48 patients with normal thyroid-function tests (euthyroid) and group II (cases): 45 patients with overt hypothyroid and subclinical hypothyroid patients (autoimmune hypothyroidism). Patients were subjected to full clinical examination such as weight, height, BMI, and waist and hip circumference, and laboratory investigations such as complete blood count, renal-function test, liver-function test, lipid profile, and thyroid profile. Their fatigue level was assessed by Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory.
Results
The cases had significantly higher body weight, BMI, and waist: hip ratio (
P
≤ 0.001). There was a significant positive correlation between FSS and each of thyroglobulin antibodies and thyroid peroxidase (TPO) (
P
= 0.005,
P
< 0.001, and
P
< 0.001, respectively). The univariate linear-regression analysis showed that TPO, free thyroxin, and duration of illness were independently associated with the FSS.
Conclusion
Fatigue is prominent in patients with hypothyroidism. However, TPO, free thyroxin, and duration of illness were independently associated with higher FSS.
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ANATOMY AND EMBRYOLOGY - ORIGINAL ARTICLE
The protective effect of pumpkin seed oil on L-thyroxine-induced rat testicular oxidative stress
Nader Galal Zaki, Fatma M Shabana, Neveen M El-sherif, Mostafa M El-Habeby
April-June 2022, 35(2):351-358
DOI
:10.4103/mmj.mmj_333_20
Objectives
This work aimed to study the effect of exogenously administered L-thyroxine on adult rat testis and to clarify the possible protective effect of pumpkin seed oil.
Background
L-thyroxine is a manufactured form of the thyroid hormone thyroxine. It is used for the treatment of cases of thyroid hormone deficiency. Recently, infertility among men has become a major concern. Pumpkin is an annual herbaceous plant and has been safely used as a natural remedy in many countries. It has a wide range of pharmacological activities and a proposed antioxidant effect.
Materials and methods
A total of 42 adult male albino rats were divided into the control group, pumpkin seed oil-treated group (4 ml/kg) orally for 10 days, L-thyroxine-treated group (0.3 mg/kg) intraperitoneal for 15 days, and both pumpkin seed oil and L-thyroxine-treated group. Specimens from the testes were processed for light microscopy. An immunohistochemical study was carried out using caspase 3.
Results
Specimens from L-thyroxine-treated rats showed a statistically significant decrease in both tubular diameter and thickness of the epithelium of seminiferous tubules. Germinal epithelium showed cellular degeneration, vacuolated cytoplasm, and also there were apoptotic and multinucleated giant cells. The immunohistochemical study of the L-thyroxine-treated group showed intense positive caspase 3 immunostaining. In contrast, minimal changes were observed in rats treated concomitantly with both pumpkin seed oil and L-thyroxine-treated rats, with minimal change in immunoreaction compared with the control group.
Conclusion
Exogenously administered L-thyroxine induced significant testicular damage and germ cell apoptosis, which could be ameliorated by concomitant treatment with pumpkin seed oil.
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CARDIAC SURGERY - ORIGINAL ARTICLES
Intravenous immunoglobulin vs. plasma exchange as preoperative preparations before thymectomy in myasthenia gravis patients
Mohamed S Abdelmotaleb
April-June 2022, 35(2):699-703
DOI
:10.4103/mmj.mmj_84_22
Objective
To investigate the efficacy of intravenous immunoglobulin (IVIG) vs. plasma exchange (PLEX) as a preparation before thymectomy in patients with myasthenia gravis (MG).
Background
MG is an autoimmune disorder. Besides medications, thymectomy is usually used to manage MG patients. Some studies investigated the role of IVIG or PLEX in the preparation of thymectomy in MG patients to control perioperative and postoperative complications. The clinicians have met with a lack of adequate knowledge about superiority of IVIG or PLEX in preoperative preparation before thymectomy.
Patients and methods
This is retrospective study that was conducted on 14 patients with MG referred for thymectomy. Patients were assigned to two groups. The IVIG group (
n
= 7) received IVIG. The PLEX group (
n
= 7) underwent PLEX. Both methods were considered as preoperative preparation before the thymectomy.
Results
The duration of hospitalization preoperatively was significantly different between the two groups. The mean duration of hospitalization preoperatively of IVIG group was 1.86 ± 1.21 days vs. 4.43 ± 2.30 days for PLEX group (
P
value 0.02).
Conclusion
The interpretation of the results of the current study is limited by the retrospective design and low number of patients. However, patients in the IVIG group had less preoperative hospital length of stay.
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ANESTHESIOLOGY AND INTENSIVE CARE - ORIGINAL ARTICLES
A randomized trial with opioid-free versus opioid anesthesia in morbidly obese patients during laparoscopic cholecystectomy
Mohamed Y Al Bahar, Abd-Elazeem A Elbakry, Tarek A El Hennawy, Mohammed R.A. Elnahla
April-June 2022, 35(2):686-693
DOI
:10.4103/mmj.mmj_258_21
Objectives
The present study is scheduled to compare the analgesic and sedative effects of opioid and dexmedetomidine during the perioperative period and also to compare the recovery characteristics and hemodynamics as secondary outcomes.
Background
Obesity is a risk factor for many diseases and complications including general anesthesia-related complications. Opioids have been used as part of balanced anesthesia and have known undesired side effects. Opioid-free anesthesia is an anesthetic technique without intraoperative systemic, neuraxial, or intracavitary opioids.
Patients and methods
This study was conducted during the period from June 2020 till May 2021 to compare the effectiveness of opioid-free anesthesia versus opioid-based general anesthesia on 60 morbidly obese patients of BMI more than 35 kg/m
2
, American Society of Anesthesiologists III, in the age range from 20 to 60 years and were undergoing laparoscopic cholecystectomy under general anesthesia. The patients were divided into two equal groups: group A for opioid-based anesthesia group (OA) (
n
= 30). They received general anesthesia with propofol, muscle relaxant, and fentanyl as the main anesthetic adjuvant and analgesic and group B for opioid-free anesthesia (OFA) (
n
= 30). They received general anesthesia with propofol, muscle relaxant, dexmedetomidine, ketamine and lidocaine as anesthetic adjuvant and analgesic.
Results
Opioid-free anesthesia provided perioperative hemodynamic stability, postoperative pain relief, less incidence of postoperative nausea and vomiting, acceptable patient sedation, satisfaction, and less analgesic consumption postoperatively than that of the opioid-based anesthesia in morbidly obese patients.
Conclusion
Opioid-free anesthesia may be an attractive solution for anesthesia management of the morbidly obese patients undergoing general anesthesia.
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Role of ultrasound assessment of parasternal intercostal muscle thickness during weaning from mechanical ventilation
Ghada A Hassan, Wesam E. A. Sultan, Rabab M Habeeb, Muhammad A Alghorayeb
April-June 2022, 35(2):660-666
DOI
:10.4103/mmj.mmj_176_21
Background
A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successful extubation in patients. Several factors may lead to weaning failure, including respiratory muscle dysfunction. In cases with diaphragmatic dysfunction, there is recruitment of the extradiaphragmatic muscles, including parasternal intercostal muscles.
Objectives
To study the role of ultrasound assessment of parasternal intercostal muscle thickness during weaning from mechanical ventilation.
Patients and methods
This was a prospective observational study carried out on 40 mechanically ventilated patients, who were clinically stable to undergo a SBT. Parasternal intercostal muscle ultrasound was performed before the start of the SBT. Parasternal intercostal muscle thickness was measured at the end of inspiration (Tic-max) and at the end of expiration (Tdi-min), and then parasternal intercostal muscle thickness fraction (TFic%) was calculated.
Results
The parasternal intercostal muscle thickness fraction (TFic%) was significantly higher in patients who passed the SBT successfully (23.45 ± 7.04 vs. 7.38 ± 4.33%,
P
< 0.001). With a cut off value of more than 11.58%, the parasternal intercostal thickness fraction (TFic%) achieved 86.96% sensitivity and 100% specificity (area under the curve = 0.980;
P
< 0.001).
Conclusion
Ultrasonographic evaluation of the parasternal intercostal muscles using the thickness indices could be a good predictor of SBT outcome.
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GENERAL SURGERY - ORIGINAL ARTICLES
Ketorolac use and postoperative complications in colorectal surgery
Alaa M El-Sisi, Mohammed S. A. Ahmed, Mohammed A ELBalchy
April-June 2022, 35(2):722-727
DOI
:10.4103/mmj.mmj_265_21
Objective
To determine if use of intravenous ketorolac in the perioperative period for colorectal surgeries is associated with higher rates of reinterventions, emergency-department (ED) visits, and readmissions.
Background
Injectable NSAIDs, such as ketorolac, have been shown to have an equivalent analgesic effect to morphine in major abdominal surgery and reduce the use of opioid medications. However, NSAIDs have corresponding adverse reactions, mainly on the gastrointestinal tract, and cardiovascular, liver, and kidney injury.
Patients and methods
A clinical trial study was carried out on 50 adult patients who had undergone colorectal surgery in General Surgery Department in Menoufia University and Damanhur Medical National Institute, that aimed to determine if use of intravenous ketorolac in the perioperative period for colorectal surgeries is associated with higher rates of reinterventions, ED visits, and readmissions during the period from March 2019 to March 2021.
Results
Type of operation, duration of operation, and first bowel motion showed significant differences between patients with and without ketorolac in the first bowel motion. While no significant difference was found between both groups regarding outcome. The ketorolac group was associated with higher ED visits (K: 16% vs. no K: 12%), higher rates of readmission (K: 12% vs. no K: 8%), and equal rates of reintervention (K: 4% vs. no K: 4%) with no statistically significant differences between patients with and without ketorolac. However, rates of anastomotic leakage in relation to use of ketorolac during the postoperative period for the ketorolac group show that 4% used ketorolac for 3–5 days and 8% used ketorolac for more than 5 days, it shows statistically significant rates of anastomotic leakage with longer duration of ketorolac use.
Conclusion
Ketorolac as one of the most commonly used NSAIDS was not associated with anastomotic leak or other important postoperative outcomes, however, overuse of ketorolac over a long period may lead to increased rates of anastomotic leakage or postoperative bleeding. Recognizing the significant benefit of ketorolac, its appropriate use in the postoperative period appears safe.
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DERMATOLOGY - ORIGINAL ARTICLES
The effect of topical nano vitamin-C iontophoresis versus the effect of trichloroacetic acid 20% peel in treatment of melasma
Magda M Hagag, Sara S. H Abd Allah
April-June 2022, 35(2):489-495
DOI
:10.4103/mmj.mmj_237_21
Background
Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies, including hydroquinone, tretinoin, corticosteroids, and triple-combination creams.
Objective
This study was designed to assess the efficacy of topical nano vitamin C enhanced with iontophoresis and to compare its effect with topically applied trichloroacetic acid 20% chemical peeling in the treatment of melasma.
Patients and methods
A right–left comparative study included 30 female patients with their age ranging from 20 to 52 years, who participated for treatment of facial melasma, with melasma duration ranging from 1 to 12 years selected from the cosmetology outpatient clinic of Dermatology Department, Menoufia University Hospitals during the period from September 2020 to March 2021. History and clinical examinations were done for each patient.
Results
There was a significant positive correlation between Melasma Area and Severity Index score in the sixth session on right sides and age, disease duration, number of pregnancies, and duration from the last pregnancy. There was a significant positive correlation between Melasma Area and Severity Index score in the sixth session on the left sides and the amount of pregnancy and mean percentage of improvement was more on the right than the left side, 58.9 ± 18.8 versus 51.2 ± 18.8, but did not reach the significance level (
P
> 0.05).
Conclusion
Nanosomal vitamin C with iontophoresis is an easy, safe, effective, painless, and noninvasive method in the treatment of melasma and trichloroacetic acid 20% peel was found as effective in the treatment of melasma.
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CLINICAL LABORATORY - ORIGINAL ARTICLE
Immunoglobulin G and immunoglobulin M positivity in relation to coronavirus disease 2019 severity
Brandon I Esquivel, Luis E. C. Carrillo, Christian I. V. Castro, Hugo M Zeróna
April-June 2022, 35(2):378-384
DOI
:10.4103/mmj.mmj_100_21
Objective
The aim of this study was to evaluate the seropositivity of rapid immunoglobulin G (IgG) and immunoglobulin M tests in patients recovered from coronavirus disease 2019 (COVID-19).
Background
Rapid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen-detection tests can give results in less than 30 min to detect SARS-CoV-2.
Patients and methods
This case–control study was performed in Toluca, Mexico, from September to October, 2020. Rapid test was performed in patients older than 18 years who were diagnosed with COVID-19. Quantitative data were presented as mean ± SD and qualitative in percentages. Pearson correlation was performed between the COVID-19 clinical severity scale and the waist and BMI variables.
Results
Twenty-five patients were included (mean age, 45.24 years). Through the Pearson correlation, a positive relation was found between COVID-19 clinical severity score and waist circumference (
R
2
= 0.161,
P
= 0.046844) and between the first and BMI (
R
2
= 0.157,
P
= 0.049918). The mean COVID-19 clinical severity score of the patients was 23.12 ± 15.23. Sixty-eight percent of positive results were obtained for the detection of IgG antibodies. In patients who exceed a score of 18 in clinical manifestations, all results for the detection of IgG antibodies against SARS-COV-2 were positive after several months.
Conclusion
Patients with comorbidities had a higher predisposition to a more severe COVID-19 disease, the highest intensity of signs and symptoms, the highest immunological response, and the highest probability of having antibodies against SARS-COV-2 over time.
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ANESTHESIOLOGY AND INTENSIVE CARE - REVIEW ARTICLE
Perioperative coagulation management during liver transplantation
Ahmed A Metwally, Emad K Refaat, Abd-Elazeem A Elbakry, Nahla M Gab Alla, Doaa Y. A. A. Sharfeldin
April-June 2022, 35(2):325-330
DOI
:10.4103/mmj.mmj_56_22
Objectives
The aim was to make a systematic review of perioperative coagulation management during liver transplantation (LT).
Data sources
Medline databases (PubMed and Medscape) and all materials available on the Internet were searched., The search was performed on January 2022.
Study selection
The initial search presented 120 articles. The number of studies that met the inclusion criteria was 23. The articles included both sexes, diagnosed patients who needed LT.
Data extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest.
Data synthesis
Significant data were collected. Then a structured review was performed.
Finding
In total, 23 potentially relevant publications were included; it was found that early identification with clinical coagulation tests led to better understanding of coagulopathy using point-of-care viscoelastic coagulation tests as rotational thromboelastometry and thromboelastogram may improve outcomes of cirrhotic patients.
Conclusion
Cirrhotic patients have unstable balance of coagulation. This results in a challenge to prevent risk of bleeding or thrombosis during LT. Recently, clinical coagulation tests have led to better understanding of coagulopathy using point-of-care viscoelastic coagulation tests such as rotational thromboelastometry and thromboelastogram. Future research is needed to better understand the complex coagulation balances and to improve goal-directed transfusion and factor concentrate treatment.
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CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
The risk factor profile in Egyptian patients with acute coronary syndrome: an observational study
Ahmed A Elkersh, Ashraf Reda, Ahmed Samir
April-June 2022, 35(2):359-363
DOI
:10.4103/mmj.mmj_156_21
Objective
To evaluate the pattern of risk factor profile among Egyptian patients with acute coronary syndrome (ACS).
Background
Little is known about risk factors and treatment modalities in Egyptian patients with ACS.
Patients and methods
This cross-sectional study was conducted on 200 adult participants presented to the National Heart Institute, Cairo, Egypt, during May 2017 throughout April 2018. Patients with ACS including ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, or unstable angina were included. All patients were subjected to history taking, clinical examination, 12-lead ECG, and plasma troponin I to confirm myocardial necrosis and to identify ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina.
Results
The percent of current smokers was significantly higher than nonsmokers (63.5 vs. 36.5%,
P
= 0.001). History of hypertension was significantly more frequent among the studied patients (57.5 vs. 42.5%,
P
= 0.034), and the same was observed for diabetes mellitus (60.5 vs. 39.5%,
P
= 0.003). Dyslipidemia (57%) was also significantly higher. Regarding the BMI, a high percentage of the studied patients were overweight and obese (40.5%). The mean low-density lipoprotein and BMI were significantly higher in females than males (
P
= 0.043 and 0.018, respectively).
Conclusion
The findings of the present study revealed a number of modifiable risk factors for ACS among Egyptian patients. These comprised smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. Considering lifestyle interventions and awareness of the public especially among women would contribute toward minimizing ACS.
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DERMATOLOGY - ORIGINAL ARTICLES
Evaluating the efficacy of different treatment modalities in cases of infantile hemangioma
Hesham N K. Al Shami, Aya A A. Ahmed, Reem A A. Hassan
April-June 2022, 35(2):429-434
DOI
:10.4103/mmj.mmj_70_21
Objective
This study aimed to evaluate different treatment modalities of infantile hemangiomas with their benefits and side effects within 3 months of treatment.
Background
The most common vascular tumors in infants are infantile hemangiomas, usually present as a premonitory mark with rapid postnatal growth, followed by slow involution. For those requiring systemic medications, early treatment is critical.
Patients and methods
A randomized-controlled trial was conducted on 120 patients with hemangioma distributed into four treatment groups. The first group was treated by placebo, the second group was treated by topical timolol only, the third group was treated by topical timolol + oral propranolol and the fourth group was treated by topical timolo + intralesional steroid.
Results
Significant response was found in 90.9% of the patients in the topical timolol + oral propranolol group, 78.1% of the patients in the topical timolol-only group and 72.7% of the patients in the topical timolol + intralesional steroid group. In terms of the side effects, the topical timolol + intralesional steroid had the most side effects (54.5%), followed by the topical timolol + propranolol group (45.5%) and the topical timolol-only group (18.8%). There was a statistically significant difference in lesion size, the visual analog scale, side effects, and response.
Conclusion
The combination of topical timolol with oral propranolol is a very rapid, effective, simple, and safe treatment for compound hemangiomas, achieving more remarkable clinical results and fewer side effects than other methods of treatment. Therefore, we can use this combination as the first line of treatment.
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Predictors of placental abruption during expectant management of premature preterm rupture of membranes
Heba Farag Salama, Mohamed Abdelghany Omara, Mohamed Safwat Mohamed Mostafa, Amira Ahmed Fathey
April-June 2022, 35(2):788-795
DOI
:10.4103/mmj.mmj_250_21
Objective
To predict the risk factors of placental abruption during expectant management of preterm rupture of membranes.
Background
A frequency of abruption of 4.0%–6.8% has been reported in patients with preterm premature rupture of membranes (PPROM). Antepartum vaginal bleeding occurs during the period of expectant management, the associated risk of developing placental abruption is high. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors.
Patients and methods
An observational study was conducted on 100 pregnant women. The patients were randomly selected from those attending labor ward at Menoufia University Hospital and Shebin EL-Kom Teaching Hospital. All women included in this study are with PPROM, divided into group I that included 79 without placental abruption and group II included 21 with placental abruption. Full analysis of detailed history and examination and primarily samples are taken during the study period from January 2019 to December 2020.
Results
There were statistically significant differences among patients with placental abruption than those without placental abruption regarding antepartum or intrapartum fetal distress requiring urgent cesarean section and gestational age. The majority of patients with placental abruption had gestational age more than 32 weeks (
P
< 0.05). Most of the patients with placental abruption had latency to its occurrence more than 48 h since the time of admission with PPROM with a percentage of 85.71%.
Conclusion
Placental abruption is a complex disease. Although several risk factors are known, the etiopathogenesis is not fully understood and its occurrence often remained unpredictable or unpreventable. Placental abruption was absent in 79% of our patients.
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ORTHOPEDIC SURGERY - ORIGINAL ARTICLES
Long-term functional outcome of knee after antegrade versus retrograde intramedullary nailing for femoral fracture
Adel I El-Seedy, Elsayed M Zaki, Ibrahim F El-Sheikh, Samy A Sakr
April-June 2022, 35(2):899-904
DOI
:10.4103/mmj.mmj_240_21
Objectives
To evaluate functional outcomes of the knee after antegrade and retrograde intramedullary nailing for femoral shaft fractures in adults.
Background
Antegrade reamed interlocked intramedullary nailing is the treatment of choice for femoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nailing.
Patients and methods
This was a prospective comparative study. A total of 40 patients were divided randomly by a closed envelope technique into two equal group: group A (antegrade nailing) and group B (retrograde nailing). A total of 20 patients with shaft femur fractures had interlocking intramedullary fixation via the antegrade nailing approach (group A), whereas another 20 patients with shaft femur fractures had fixation via the retrograde approach (group B).
Results
The mean age of group A was 25.10 ± 10.41 years and 31.35 ± 10.11 years in group B. There were no significant adverse effects reported in both groups. The mean follow-up duration was 25.20 ± 8.39 months in group A and 25.00 ± 6.91 months in group B (
P
= 0.759). The mean Tegner Lysholm knee scoring scale was 94.05 ± 4.43 in group A and 82.45 ± 8.83 in the group B (
P
< 0.0001). Regarding Tegner Lysholm knee scoring scale categorization, group A recorded 90% as excellent, whereas group B revealed 65% as good.
Conclusion
Our study suggests that antegrade intramedullary femoral nailing fixation is favorable over retrograde nailing in knee function, range of motion, and knee pain for diaphyseal femoral fracture in adults using Lysholm knee function scoring.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Serum level of substance P and stress in acne-vulgaris patients
Mostafa M Soliman, Mohamed S Rizk, Ahmed N Ramadan, Rowida A Khalil Salah
April-June 2022, 35(2):501-506
DOI
:10.4103/mmj.mmj_241_21
Objective
The aim of the study was to evaluate the relationship between stress and serum concentration of substance P (SP) in acne-vulgaris patients.
Background
Acne vulgaris is a multifactorial disorder of the pilosebaceous unit. The clinical picture can vary significantly, from mild comedonal acne to fulminant systemic disease. Although all age groups may be affected by its many variants, the peak incidence is during adolescence. Various studies have proved that neuropeptides affect the activity of the pilosebaceous unit by stimulating proliferation and differentiation of sebaceous glands, lipid synthesis, and induction of neutral endopeptidase expression in sebaceous cells, especially SP.
Patients and methods
A case–control study included 40 patients with acne vulgaris and 40 age-matched and sex-matched controls. Emotional stress was analyzed with the use of Social Readjustment Rating Scale, whereas the methods of coping with stress were assessed with the Coping Inventory for Stressful Situation questionnaire, followed by taking blood samples to assess SP serum levels using the enzyme-linked immunosorbent-assay method.
Results
SP was significantly higher in the acne-patient group versus the control group (
P
< 0.05). A statistically significant difference was observed between acne patients and control groups regarding the Social Readjustment Rating Scale (
P
< 0.05).
Conclusion
There was a statistically significant relation between stress scale and serum SP level in acne vulgaris.
[ABSTRACT]
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UROLOGY - ORIGINAL ARTICLE
Is bipolar superior to monopolar energy for transurethral resection of bladder tumors?
Mohamed S Elgharbawy, Fayez A Elaskary, Mohamed M Abdallah, Rehab M Samaka, Osama A Abdelgawad, Alaa Eldin M. Elmahdy
April-June 2022, 35(2):938-944
DOI
:10.4103/mmj.mmj_155_21
Objectives
To compare bipolar transurethral resection of bladder tumor (B-TURBT) and monopolar transurethral resection of bladder tumor (M-TURBT) in terms of its perioperative clinical and pathological outcomes.
Background
Bladder cancer is the seventh most diagnosed cancer in the male population worldwide. TURBT is considered the initial treatment and the only method to provide specimens for tumor staging and grading.
Patients and methods
This study was conducted at the Urology Department at Menoufia University Hospital during the period of study from April 2018 and April 2020. After consent, newly diagnosed bladder tumor patients who were planned for TURBT at Menoufia University were randomized into two equal groups: B-TURBT and M-TURBT. All patients were evaluated through careful history, physical examination, routine laboratory investigations, ultrasonography, and contrast-enhanced computed tomography. All specimens were examined by a uropathologist who was blinded to the type of energy used.
Results
There were no statistically significant differences between both groups regarding patients' characteristics, obturator jerk, bladder perforation, completed resection of the tumor, and serum sodium drop. Bipolar resection group showed significantly shorter resection time (
P
= 0.009), less hemoglobin drop (
P
= 0.001), less catheterization time (
P
= 0.044), and less hospitalization time (
P
= 0.012). Grade 3 tissue artifact on histopathological examination was 16.6 and 23.5% in bipolar and monopolar groups, respectively, with no statistically significant difference.
Conclusion
Bipolar energy in TURBT is a safe and effective modality as the monopolar one. Bipolar resection is superior to the monopolar one in shortening the resection time, hospital stay and catheterization time and less hemoglobin drop. Both techniques have comparable effects on tissue biopsy, other operative data, and perioperative complications.
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PLASTIC SURGERY - ORIGINAL ARTICLES
Crushed and crushed-avulsion finger replantation/revascularization: is it feasible?
Mohamed A. M. El-Nahas, Hossam H Fawzy, Fouad M Ghareeb
April-June 2022, 35(2):933-937
DOI
:10.4103/mmj.mmj_121_21
Objectives
To evaluate the results of posttraumatic microvascular replantation/revascularization of crushed fingers and establish the prognostic factors that increase the success rate.
Background
Posttraumatic digital amputations are one of the most common injuries in emergency room (ER) that face plastic surgeons with a wide range of options for management. Optimization of the results after digital microvascular surgeries represents a challenge, especially in crushed and crushed-avulsion cases.
Patients and methods
A descriptive, retrospective study of 21 patients who underwent urgent replantation/revascularization digital surgery after crushed/crushed-avulsion injury in our center between January 2018 and March 2019. The data collected were classified into preoperative, intraoperative, postoperative, and follow-up data. The follow-up parameters were esthetic, sensory, and functional outcomes. The follow-up period extended to 1 year postoperative, every patient visited our outpatient clinic every 3 months for assessment of the results and data collection.
Results
During the period of the study, 21 patients of crushed fingers have been subjected to microvascular replantation/revascularization. The patients were 15 (71.4%) males and six (28.6%) females with mean age 27.7 years and their BMI ranged from 22 to 40. From 21 cases, there were 13 (61.9%) cases in which the injured finger totally survived, two (9.5%) cases show partial necrosis of the distal stump, and there were failure of anastomosis in six (28.6%) cases. Excellent esthetic outcomes were reported in 13 (86.5%) cases, while accepted or good outcomes were reported in five (33.3%) cases and poor results in only three (19.9%) cases (
P
= 0.013).
Conclusions
With taking great care to some important factors, the survival rate in crushed and crushed/avulsion is accepted with excellent long-term esthetic, functional, and sensory outcomes.
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DERMATOLOGY - ORIGINAL ARTICLES
Evaluation of glutathione peroxidase enzyme in patients with melasma: a clinical and immunohistochemical study
Hesham N Khaled, Wesam S. A. El Ashkar, Asmaa G Abdou
April-June 2022, 35(2):445-450
DOI
:10.4103/mmj.mmj_183_21
Objective
To evaluate the role of glutathione peroxidase (GPX1) in melasma.
Background
Melasma is a common acquired disorder of hyperpigmentation. GPX1 is an intracellular enzymatic antioxidant, and its levels are used as a major parameter representing oxidative damage that occurs in melasma. However, the clear association between GPX1 expression and melasma remains unknown.
Patients and methods
This prospective case–control study was conducted on 20 cases having melasma and 20 normal age-matched and sex-matched healthy volunteers. All sections were immunohistochemically stained for GPX1 antibody.
Results
There was significant difference between melasma cases and normal skin as regards GPX1 epidermal distribution (
P
= 0.001) and intensity (
P
= 0.005). Also there was a statistically significant association between epidermal intensity and distribution of GPX1 and the severity of melasma assessed by the modified Melasma Area and Severity Index (MASI) score. Moreover, there was statistically significant difference between epidermal intensity and distribution of GPX1 and the degree of dermal inflammation. Also, there was a tendency of melasma cases receiving hormonal therapy to show positive dermal expression of GPX1 than cases not receiving therapy (
P
= 0.07).
Conclusion
GPX1 was expressed diffusely in the epidermis of all control cases (100%), eight of them were of mild intensity and 12 were of moderate intensity while expressed in most of melasma cases in a focal form with mild intensity expression.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Gut lactobacilli profile among a cohort of Egyptian patients with systemic lupus erythematosus
Ahmed Shaaban, Ashraf Alzawawy, Shwikar Mahmoud, Eman Hassan, Marwa Sabry
April-June 2022, 35(2):543-547
DOI
:10.4103/mmj.mmj_55_22
Objective
To evaluate the changes in
Lactobacilli
and
Lactobacillus reuteri
among a cohort of Egyptian patients with systemic lupus erythematosus (SLE) and how these changes affect the state of SLE disease activity.
Background
SLE is a heterogeneous chronic autoimmune disease that affects multiple organs with a variety of clinical manifestations. Gut microbiota dysbiosis has been linked to the development or progression of autoimmune disorders.
Patients and methods
This cross-sectional study was conducted on 40 patients with SLE and 30 healthy adults as a control group. Laboratory investigations included antinuclear antibodies, anti-double-stranded DNA, and complement C3 and C4. SLE disease activity index (SLEDAI-2k) was evaluated. Real-time PCR was applied for quantitative assessment of the
lactobacillus
genus.
Results
The 40 patients comprised 85% females and 15% males, with a mean age of 28.5 ± 7.78 years and disease duration of 11.68 ± 6.8 months. Patients with SLE showed a significant decrease in the abundance of
Lactobacillus
compared with healthy controls (
P
< 0.001), and also
L. reuteri
showed a significant decrease in patients with SLE (
P
= 0.030). An inverse but nonsignificant correlation between SLEDAI-2K scores for disease activity and Lactobacillus (
r
=−0.198;
P
= 0.220) was detected.
Conclusion
There was a significant decrease in the abundance of
Lactobacilli
and
L. reuteri
in patients with SLE, so supplementation of
Lactobacilli
might constitute a future therapeutic target. In addition, an inverse but nonsignificant correlation with SLEDAI-2k was found.
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DERMATOLOGY - ORIGINAL ARTICLES
Cutaneous disorders related to obesity
Mohamed A Gaber, Alyaa A. A. Zahran
April-June 2022, 35(2):435-438
DOI
:10.4103/mmj.mmj_141_21
Objective
To describe the pattern of cutaneous diseases among obese patients.
Background
Obesity is a medical condition in which excess fat has accumulated to the extent that may have an adverse effect on health leading to reduced life expectancy and increased health problems. Obesity results in changes in skin barrier function, sebaceous gland, apocrine and eccrine sweat glands, function, and wound healing.
Patients and methods
This study was done on 212 Egyptian obese patients visiting the Dermatology Outpatient Clinic of Faculty of Medicine, Menoufia University from November 2020 to March 2021.
Results
In the present study, there was a statistically highly significant difference between females and males regarding acne (
P
< 0.001). There was a statistically significant difference between females and males regarding androgenic alopecia, atopic dermatitis, and psoriasis (
P
< 0.05). There was a statistically nonsignificant difference between females and males regarding acanthosis nigricans, skin tags, hidradenitis suppurativa, seborrheic dermatitis, plantar hyperkeratosis, and stretch marks (
P
> 0.05). Stretch marks were found in 81.6% of females and 87.7% of males. Androgenic alopecia was found in 56.5% of females and 33.9% of males. Acanthosis nigricans was found in 30.6% of females and 44.6% of males. Acne was found in 30.6% of females and 6.2% of males. Of the studied group, 19.8 and 12.3% complained of intertrigo and erythrasma and 10.4% of the studied group complained of delayed wound healing by hospitalization.
Conclusion
The results suggest that obesity seems to have numerous complications that affect the skin as it leads to many cutaneous diseases in this sample of Egyptian people.
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Onychomycosis: correlation between the dermoscopic patterns and fungal culture
Mohammed A Basha, Mabrouk M Ghonaim, Sohad I Shalaby
April-June 2022, 35(2):470-476
DOI
:10.4103/mmj.mmj_219_21
Objective
The aim was to correlate the results of fungal investigations (Direct KOH and fungal culture) with dermoscopic findings on clinically suspected cases of onychomycosis and to evaluate dermoscope as an alternative tool in diagnosis of such cases.
Background
Onychomycosis is a fungal infection of the nail plate or nail bed. There are four clinical types of onychomycosis: distal and lateral subungual onychomycosis (DLSOM), proximal subungual onychomycosis (PSOM), white superficial onychomycosis (WSOM), and total dystrophic onychomycosis (TDOM).
Patients and methods
This study was conducted at Menoufia University Hospital on 44 patients with a clinical diagnosis of onychomycosis. Full history taking and complete general examination were performed to detect associated systemic diseases. Dermatological examination was done to exclude any associated dermatological diseases that can affect the nails, such as psoriasis, lichen planus, alopecia areata, eczema and/or melanomas. Photography of the nail using digital camera and dermoscopic examination of the nail also were done to our patients.
Results
Jagged proximal edge, longitudinal white striae and chromonychia were more frequently observed in patients with DLSOM. Straight onycholytic area was observed in 4 cases of DLSOM. Subungual hyperkeratosis was significantly associated with TDOM. Leukonychia was significantly associated with PSOM. Our results reported that, all dermoscopic patterns were significantly associated with positive fungal growth cultures.
Conclusion
Dermoscope may be considered quick, easy, helpful, effective, and inexpensive tool for confirmation the diagnosis of clinically suspected cases of onychomycosis.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Visual outcome after Femtolasik vs. ICL for correction of high myopia
Abdelrahman E Sarhan, Amin F Ellakwa, Islam A Sallam
April-June 2022, 35(2):846-849
DOI
:10.4103/mmj.mmj_269_21
Objectives
To compare visual outcomes between femtosecond Lasik and implantable collamer lens (ICL) in patients with high myopia.
Background
Even though the parameters for optical quality as well as intraocular scattering are valuable for the subsequent satisfaction and postoperative visual performance in myopia, the comparison between patients with Femtolasik (FS-Lasik) and ICL implantation of these parameters is still unclear.
Materials and methods
This study involved 50 high myopic eyes ≥−6.0 D recruited for FS-Lasik (group 1) and another 50 high myopic eyes recruited for ICL (group 2). Both age and sex were matched in the two groups.
Results
Visual acuities (VA) showed significant improvement in FS-Lasik group than ICL group 1 day postoperatively, whereas after 1 week, they had no difference (P > 0.05), but in the third and sixth months postoperatively, there was a statistically significant increase in VA in ICL group than FS-Lasik group. It was observed that there is a stability of VA after FS-Lasik and ICL groups, which indicated that eyes with FS-Lasik group tend to regress by time, whereas in ICL group, the line tends to be more stable. However, both groups showed highly significant improvement in VA (
P
< 0.001).
Conclusion
ICL implantation is a better first choice especially in young adults who had high myopia and need the near vision. ICL seems to be better than FS-Lasik in the long-lasting correction of vision, and also, it has a better durability.
[ABSTRACT]
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ANESTHESIOLOGY AND INTENSIVE CARE - ORIGINAL ARTICLES
Integrative weaning index as a predictor of weaning success
Nagwa M Doha, Hatem A Attalla, Eman A Abdelsatar Abohegazy, Alaaeldin A Alsakka
April-June 2022, 35(2):672-677
DOI
:10.4103/mmj.mmj_273_21
Objective
This study aimed to evaluate the power of integrative weaning index (IWI) in predicting the success rate of spontaneous breathing trial (SBT) in the mechanically ventilated patients.
Background
The use of weaning predictive indicators can avoid early extubation and wrongful prolonged mechanical ventilation. This study aimed to evaluate the effectiveness of IWI in predicting the success rate of SBT in patients under mechanical ventilation.
Patients and methods
In this prospective study, 120 patients undergoing mechanical ventilation for more than 48 h were enrolled. Before weaning initiation, the IWI was calculated and based on the defined cutoff point (≥44), the success rate of SBT was predicted. If they were in the normal range besides the patient's tolerance, the test was considered a success. The result was then compared with the IWI and further analyzed.
Results
The SBT was successful in 96 (80%) and unsuccessful in 24 (20%) cases. The difference between the true patient outcome after SBT, and the IWI prediction was 0.833 according to the Kappa agreement coefficient (
P
< 0.001). Moreover, regarding the predictive power, IWI had high sensitivity (96.87%), specificity (95.83%), positive and negative predictive values (98.8 and 88.5%), and accuracy (96.7%).
Conclusion
The IWI as a more objective indicator has acceptable accuracy and power for predicting the SBT result.
[ABSTRACT]
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Prophylactic measure in women with early recurrent pregnancy loss, polycystic ovary syndrome, and hyperhomocysteinemia
Mohamed S Gad, Samia M Ghonim, Abd EL-Hamid E. Shahin
April-June 2022, 35(2):734-740
DOI
:10.4103/mmj.mmj_147_21
Objective
This work aims to evaluate prophylactic measures against early recurrent pregnancy loss (RPL) in women with polycystic ovary syndrome (PCOS) and hyperhomocysteinemia.
Background
PCOS is the most common endocrine disorder in females; hyperhomocysteinemia is frequently associated with PCO. Mild-to-moderate hyperhomocysteinemia increases the risk of RPL through augmentation of hypercoagulable state of pregnancy and thrombosis in maternal and fetal circulation.
Patients and methods
The study was a randomized prospective comparative study. Patients in this study were 60 patients aged between 20 and 35 years with PCOS that was diagnosed according to the Rotterdam criteria if at least two of the following criteria is present: oligoamenorrhea/amenorrhea, clinical or biochemical hyperandrogenism and PCO on ultrasonography, hyperhomocysteinemia, and a history of early recurrent abortion. Patients were randomly classified into three groups by simple randomization (number generation by computer): group 1 included 20 patients with PCOS, hyperhomocysteinemia, and a history of early recurrent abortion, treated with folic acid 5 mg/day and low-dose aspirin (LDA) 81 mg/day until 20 weeks of pregnancy. Group 2 included 20 patients with PCOS, hyperhomocysteinemia, and a history of early recurrent abortion, treated with folic acid 5 mg/day and low-molecular weight heparin (LMWH) 40 mg/day until 20 weeks of pregnancy and group 3 included 20 patients with PCOS, hyperhomocysteinemia, and a history of early recurrent abortion treated with LDA 81 mg/day, LMWH 40 mg/day, and folic acid 5 mg/day until 20 weeks of pregnancy.
Results
RPL is common in women with PCOS and hyperhomocysteinemia. It was found that combined treatment with folic acid' aspirin, and LMWH in women with PCO and hyperhomocysteinemia improved successful pregnancy rates.
Conclusion
Administration of folic acid and LMWH or folic acid, LMWH, and LDA decreases the rate of early RPL in women with PCO and hyperhomocysteinemia better than folic acid and LDA alone.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Effect of vitamin D on the efficacy of topical artificial tears in patients with dry-eye disease
Marwa A Zaky, Hatem M Marey, Dina G. H. Abd Elmonem, A M. S. Fayed
April-June 2022, 35(2):856-863
DOI
:10.4103/mmj.mmj_245_21
Background
The tear film is a complex mix of electrolytes, proteins (lipocalins, lactoferrin, transferrin, defensin, and lysozyme), phospholipids, oligopeptides, glycopeptides, and immunoglobulins.
Objective
The aim was to investigate the efficacy of topical carbomer-based lipid-containing artificial tears and hyaluronate in patients with dry-eye disease (DED) based on serum 25-hydroxy vitamin D (25HD) levels and cholecalciferol (vitamin D) supplementation.
Patients and methods
A nonrandomized clinical trial study was conducted on 42 patients with DED by Schirmer tear-secretion test (mm) who were examined by Ophthalmology Department, Menoufia University Hospital, Egypt, during the study period from March 2020 to March 2021.
Results
Serum 25HD levels were significantly decreased among vitamin D deficiency (VDD) group than non-VDD group at baseline and after 2 weeks of treatment. International Ocular Surface Disease Index grade was significantly increased among the VDD group after 2 weeks and 4 months of treatment as compare with non-VDD group (
P
< 0.05). Tear break-up time was significantly decreased among VDD group than non-VDD group after 4 months of treatment (
P
= 0.015). Lid hyperemia was significantly increased among the VDD group (2.00 ± 0.853) than non-VDD group (1.29 ± 0.659) after 4 months of treatment (
P
= 0.029). While Schirmer tear-secretion test was significantly decreased among the VDD group (5.75 ± 1.603) than non-VDD group (7.18 ± 1.188) after 2 weeks of treatment (
P
= 0.009). While Schirmer tear-secretion test did not show any significant difference between the VDD group (6.50 ± 1.567) and non-VDD group (7.75 ± 2.066) after 4 months of treatment.
Conclusion
The effect of topical topical carbomer-based lipid-containing artificial tears and hyaluronate was dependent on serum 25HD levels. Cholecalciferol supplementation enhanced the efficacy of topical treatment and may be a useful adjuvant therapy for patients with DED refractory to topical lubricants.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Leptin and metabolic syndrome in alopecia areata
Heba A. S. Bazid, Mostafa A Hammam, Yasmine Gamal, Eman M Abd El Gayed
April-June 2022, 35(2):424-428
DOI
:10.4103/mmj.mmj_175_21
Objectives
The aim of the study was to assess the role of leptin gene polymorphism in alopecia areata with metabolic syndrome (MS).
Background
Alopecia areata is considered an organ-specific autoimmune disease of hair follicles. Leptin, an adipocyte-derived hormone, represents a link between metabolism, nutritional status, and immune response. T helper1-promoting effects of leptin have been linked to develop experimentally induced autoimmune disease.
Patients and methods
This cross-sectional study was carried out on 50 alopecia areata with MS patients. Body mass index, Severity of Alopecia Tool score, blood pressure, serum fasting glucose, triglyceride, and leptin polymerase chain reaction were done for alopecia areata patients.
Results
In this cross-sectional study, the males represent 54% (27) and females 46% (23), their age ranging from 30 to 48 years with mean ± SD 36.7 ± 4.93. In all, 80% had sudden onset and 20% had gradual onset; 54% had progressive course of the disease; And 10% had positive family history. Patchy type was present in all cases. Regarding leptin gene polymorphism, GG genotype was present in 54% of patients. GA and alopecia areata were present in 30 and 16% of patients, respectively. No significant relation between leptin gene polymorphism and demographic and clinical data of alopecia areata with MS patients (
P
> 0.05) was found except for family history.
Conclusions
The study showed significant association between leptin gene polymorphism and susceptibility to alopecia areata with MS patients and ascertained that this polymorphism has a direct relationship with the severity of the disease.
[ABSTRACT]
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FAMILY MEDICINE - ORIGINAL ARTICLES
Predictor of perceived stress among mothers of children with Down syndrome
Aml A Salama, Zeinab A Elkhateeb, Marwa M Mohasseb
April-June 2022, 35(2):522-527
DOI
:10.4103/mmj.mmj_228_21
Objective
To assess stress level among mothers of children with Down syndrome (DS) and to determine its associated predictors.
Background
Having children with an intellectual disability can be a burden for their families. Children with DS are associated with many medical problems that need extra care, follow-up, and even hospitalizations, in addition to cognitive and behavioral problems, so most parents feel stressed and need support. There are very few studies focusing on stress level among parents of children with DS in Egypt. This study focuses on stress level among mothers of children with DS and its associated predictors.
Patient and methods
A cross-sectional study was conducted on 160 mothers of children with DS. A self-administered questionnaire was used to gather data on stress level and its associated risk factors. Parental stress scale was used to evaluate stress among mothers.
Results
Overall, 24% of the studied mothers were highly stressed. Less the number of children in the family, lower the mother's educational level, and higher the age of the child with DS were the most influencing factors that increased parental stress.
Conclusion
Mean parental stress among mothers of children with DS is significantly affected by the increased number of children in the family, the mother's educational level, and the age of their child with DS.
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OTORHINOLARYNGOLOGY - ORIGINAL ARTICLES
Video head impulse test in multiple sclerosis patients
Abd El Mageed H. Kabel, Khaled H Afifi, Maha E Kamh, Asmaa S Moaty
April-June 2022, 35(2):913-918
DOI
:10.4103/mmj.mmj_136_21
Objectives
The aim was to assess the vestibulo-ocular and oculomotor functions in multiple sclerosis (MS) patients using video head impulse test (vHIT) and videonystagmography (VNG).
Background
Vestibular symptoms are common symptoms of MS.
Patients and methods
This study is a case–control study. Participants included in this study were divided into two groups: 30 normal participants not complaining of any vestibular symptoms and 30 MS patients diagnosed according to the McDonald criteria 2017. Vestibular assessment using vHIT and VNG was done to both groups.
Results
VNG abnormalities were reported in 53.3% of MS patients, the abnormalities were reported in the saccade, pursuit, optokinetic, gaze, and positional tests. Half of MS patients (15) (50%) had abnormal low vHIT gain. There was a significant statistical difference between cases and controls as regards anterior and posterior canal gain. Abnormal low gain in vHIT was reported in 16.7% in lateral SCC, 20% in posterior SCC, and 26.7% in the anterior canal. There was a significant statistical relationship between abnormal gain in vHIT and vestibular symptoms (
P
= 0.001 and 0.020 for imbalance and vertigo, respectively). There was a statistically significant relationship between brainstem lesions and vHIT gain of lateral and posterior canals (
P
= 0.006 and 0.002 for lateral and posterior canals, respectively).
Conclusion
The vestibular system may be affected in MS patients, 67% of patients had vestibular symptoms. Abnormal low gain of the vestibule–ocular reflex was reported in half of MS patients. There was a significant association between vHIT gain abnormalities and brainstem lesions.
[ABSTRACT]
[FULL TEXT]
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Biomarker utility for early diagnosis of hepatocellular carcinoma in Egyptians with viral hepatitis C and B
Sara M El-Deeb, Karema A Diab, Marwa M Mohasseb, Mohamed F Elgazzar, Amany S Khalifa
April-June 2022, 35(2):399-405
DOI
:10.4103/mmj.mmj_3_22
Background
There is an urgent need to identify novel biomarkers for hepatocellular-carcinoma (HCC) patients who cannot be diagnosed early as in very small lesions and alpha-fetoprotein (AFP)-negative HCC reported in 40% of HCC cases.
Objective
To investigate the diagnostic efficacy of AFP, lens culinaris agglutinin-reactive AFP fraction (AFP-L3), des-γ-carboxy prothrombin (DCP), and glypican-3 (GPC3) either alone or in combination and the diagnostic efficacy of the GALAD score [sex (
G
) and age (
A
), AFP-L3 (
L
), AFP (
A
), and DCP (
D
)] for early detection of HCC among Egyptian patients with virus-related liver cirrhosis, either hepatitis C or -B viruses.
Patients and methods
This case–control study was conducted on 90 patients that were divided equally into three groups: liver cirrhosis (GI), HCC less than 3 cm (GII), and HCC 3–5 cm (GIII). Assay of AFP, AFP-L3, DCP, and GPC3 was done by enzyme-linked immunosorbent assay. GALAD score was calculated.
Results
The diagnostic value of AFP, AFP-L3, DCP, GALAD, and GPC3 markers to detect HCC lesions less than 3 cm was assessed by the area under the receiver-operating characteristic curve, which was 0.74, 0.8, 0.75, 0.71, and 0.8, respectively. Sensitivity and specificity were calculated for AFP (86.2%, 93.1%), AFP-L3 (97.2%, 95.4%), DCP (93.4%, 86.2%), GALAD (87.2%, 96.2%), and GPC3 (83.6%, 91.4%). On different combinations, the area under the curve was 0.5 with 100% sensitivity and specificity.
Conclusion
Serum biomarkers AFP, AFP-L3, DCP, and GPC3 complement each other and demonstrated the best performance for early HCC detection.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Prevalence and topographical characteristics of keratoconus as a type of corneal ectasia among adult Egyptians with refractive errors
Farid Wagdy, Amira A Elsuofy, Zeinab A Kasemy
April-June 2022, 35(2):832-838
DOI
:10.4103/mmj.mmj_315_21
Objectives
To determine the prevalence of keratoconus (KC) among Egyptian adult population.
Background
Corneal ectasia is a noninflammatory, bilateral, asymmetrical condition, causing progressive corneal steepening and thinning. KC is the most prevalent form of corneal ectasia and affects all ethnicities.
Patients and methods
A cross-sectional study was conducted on 1607 adults at an Egyptian Governorate aged more than 18 years with high myopia of above − 6 D and high astigmatism above − 3 D old at some public and private ophthalmology centers, in Lower Egypt during the period from May 2020 till February 2021. Evaluation of corneal topography (Scheimpflug tomographer imaging system) and detection of any ectatic corneal conditions by corneal topography and analysis of their associated abnormal corneal parameters.
Results
This study included 1607 patients, out of which 173 (10.8%) patients were diagnosed as having KC in one or both eyes. KC was more prevalent in right eyes (12.4%) than left ones (7.09%). The mean thickness of the thinnest corneal location (Mm) was significantly lower in the affected eyes (
P
< 0.001). K1, K2, Kmax, and anterior and posterior cornel maps were significantly increased among patients with KC4 than other different KC types. There was a significant negative correlation between KC grade and the thinnest location (
r
=−0.430,
P
< 0.001), and positive correlation between K1 (
r
= 0.274,
P
< 0.001), K2 (
r
= 0.391,
P
< 0.001), Kmax (
r
= 0.452,
P
< 0.001), anterior cornel map (
r
= 0.307,
P
< 0.001), and posterior cornel map (
r
= 0.306,
P
< 0.001) in eyes with KC.
Conclusion
The KC is prevalent among Egyptian adults. Most cases had bilateral affection. Astigmatism was the most common refractive error being associated with KC with no statistically significant differences regarding sex or age.
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ANESTHESIOLOGY AND INTENSIVE CARE - ORIGINAL ARTICLES
The effect of omega-3 as diet-enhanced immunity on sepsis outcome in critically ill patients
Hatem A Attallah, A Abd El Rhaman, Wesam E Salutan, Marwa M Taha
April-June 2022, 35(2):667-671
DOI
:10.4103/mmj.mmj_272_21
Background
Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of proinflammatory and anti-inflammatory mediators in sepsis and acute lung injury.
Objectives
To evaluate the effect of omega-3 fatty acids as diet-enhanced immunity on sepsis outcome in critically ill patients.
Patients and methods
Sixty patients with early sepsis were divided equally into two groups: group A who received high-dose omega-3 fatty acids for consecutive 7 days besides conventional sepsis treatment, group B: control group who received only conventional sepsis treatment. Both groups were followed up by inflammatory markers, sequential organ failure assessment score monitoring, need for organ-supportive measures, length of ICU stay, mortality rate, final outcome, and complications.
Results
Compared with the control group, the high-dose omega-3 fatty acids exhibited lower levels of white blood cells, C-reactive protein, and procalcitonin at day 5 (
P
= 0.001, 0.012, and 0.001, respectively) and at day 7 (
P
= 0.014, 0.008, and 0.29, respectively). As regards serum lactate, there was an insignificant difference between D1–D5 and D1–D7 (
P
= 0.087 at day 5 and
P
= 0.80 at day 7). Group A showed a significant decrease in the length of ICU stay (
P
= 0.035), with the insignificant difference in sequential organ failure assessment score, the need for vasopressor, days free from mechanical ventilation, and mortality rate (
P
= 0.293, 0.796, 0.201, and 0.781, respectively).
Conclusion
The use of omega-3 therapy is safe and associated with promising effects on inflammatory cascade and may play a role in these patients.
[ABSTRACT]
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CARDIOLOGY AND VASCULAR MEDICINE - REVIEW ARTICLE
Premature coronary atherosclerosis and its relation to familial hypercholesterolemia
Ahmed A Reda, George M Welson
April-June 2022, 35(2):331-336
DOI
:10.4103/mmj.mmj_182_21
Objectives
To review the risk factors of premature coronary artery disease and the importance of early detection, screening, and management of familial hypercholesterolemia (FH) as a major risk factor of premature atherosclerosis.
Data sources
Medline databases (PubMed and Medscape), as well as all materials available on the internet, were searched. The search was performed on August 2021.
Study selection
The initial search presented 120 articles. The number of studies that met the inclusion criteria was 20. The articles included both sex and diagnosed patients with FH and cardiovascular disease.
Data extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest.
Data synthesis
Significant data were collected. Then, a structured review was performed.
Finding
In total, 20 potentially relevant publications were included. It was found that patients with FH are at severe risk for premature cardiovascular disease.
Conclusion
Patients with FH are at severe risk for premature cardiovascular disease and need to be treated early. The biggest difficulty is diagnosing the disorder in the asymptomatic population to commence early treatment.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Role of Toll-like receptor 4 gene expression in psoriasis and its relation to disease activity
Wafaa A Shehata, Mostafa A Hammam, Dalia S Seif, Sherine S Elsayed, Eman M Abd El Maqsoud, Sally M El-Hefnawy
April-June 2022, 35(2):418-423
DOI
:10.4103/mmj.mmj_157_21
Objectives
To evaluate the possible role of Toll-like receptor 4 (TLR4) gene expressions in the pathogenesis of psoriasis and to correlate its level with disease activity and severity.
Background
Psoriasis is a chronic inflammatory skin disease described by unique skin symptoms, most usually manifesting as erythema wrapped through silvery lamellar scales.
Patients and methods
A prospective case–control study was carried out on 120 participants. They were divided into two groups as follows: group 1 included 80 patients diagnosed and evaluated clinically as plaque psoriasis without psoriatic arthritis and group 2 included 40 healthy volunteers matched in age and sex who serve as a control group. All patients were subjected to full history taking, general examination, thorough local examination with determination of the site of lesion and assessing disease severity utilizing Psoriasis Area and Severity Index score. mRNA expression of TLR4 was done using real-time PCR applied Biosystems 7500 for whole blood samples.
Results
Psoriatic patients were 36 (45%) males while 44 (55%) were females. There was a highly significant elevation of mRNA of TLR4 among psoriatic patients compared with the control group. In addition there was a significant positive correlation with Psoriasis Area and Severity Index score, disease duration, and age of patients.
Conclusion
Marked statistical elevation of mRNA of TLR4 gene and its positive correlation with disease severity could explain that TLR4 might have a prominent role in the pathogenesis of psoriasis and its regulation could have a role in treatment.
[ABSTRACT]
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OTORHINOLARYNGOLOGY - ORIGINAL ARTICLES
Audio-vestibular evaluation in vitiligo patients
Abd El Mageed H. Kabel, Ahmed M Zein El-Abedein, Reem A Hassan, Asmaa A Madian
April-June 2022, 35(2):919-925
DOI
:10.4103/mmj.mmj_221_21
Objectives
The aim of the study was to evaluate the auditory and vestibular function in vitiligo patients.
Background
Vitiligo is a systemic disease affecting pigmented cells throughout the body. Some evidence suggests the involvement of melanocytes in the auditory system in the disease process.
Patients and methods
A total of 63 patients with vitiligo and 63 age-matched and sex-matched healthy controls were enrolled in this study. Pure tone audiometry, cervical vestibular-evoked myogenic potential, and videonystagmography were carried out in all participants.
Results
Sixteen cases (25.4%) of the vitiligo patients had vestibular symptoms. Vitiligo patients showed poorer hearing threshold at high frequencies. Cervical vestibular evoked myogenic potential showed a highly significant difference between cases and controls (
P
< 0.001). In videonystagmography test, smooth pursuit test did not show any significant difference between cases and controls (
P
> 0.05). Catch up saccades were detected only in 4 cases (6.3%), spontaneous nystagmus without fixation was detected in only 8 cases (12.7%) with a significant difference (
P
value = 0.006), and caloric test showed a significant difference between cases and controls (
P
= 0.004).
Conclusion
This study highlights the involvement of the audio-vestibular system in vitiligo patients, suggesting that vitiligo is a systemic disease rather than a purely cutaneous problem.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Evaluation of the role of ACT1 gene polymorphism in seborrheic dermatitis: a case–control study
Heba A. S. Bazid, Mostafa A Hammam, Ahmed A Fayad, Eman M. Abd El Gayed
April-June 2022, 35(2):451-457
DOI
:10.4103/mmj.mmj_190_21
Objectives
This study aims to assess the role of ACT1 gene polymorphism in seborrheic dermatitis (SD).
Background
SD is a common inflammatory skin disease. However, the pathogenesis is poorly understood. Recently, some gene mutations had been linked to SD.
Patients and methods
In all, 90 participants were included in a case–control study, which included 45 SD patients diagnosed by history and clinical examination and 45 healthy controls matching the cases in age and sex. Severity of SD was assessed using Seborrheic Dermatitis Area and Severity Index. Assessment of ACT1 (tumor necrosis factor receptor-associated factor 3 interacting protein 2), rs13210247, and gene polymorphism was done by using the TaqMan allelic discrimination assay technique (real-time PCR).
Results
The study revealed a significant difference between SD patients and controls regarding ACT1 (tumor necrosis factor receptor-associated factor 3 interacting protein 2), rs13210247, gene polymorphism as the GG genotype was significantly higher in patients than controls. The presence of G allele had a twofold increased risk for the occurrence of diseases. The presence of GG genotype increased the risk for disease eight times than other genotypes.
Conclusion
This is the first case–control study showing that the ACT1 gene might have a role in the pathogenesis of SD.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Macular thickness assessment in diabetic patients without retinopathy
Adel G Zaky, Asmaa A Askria, Amin F Ellakwa, Saber H El Sayed, Moatz F Elsawy
April-June 2022, 35(2):821-826
DOI
:10.4103/mmj.mmj_320_21
Objective
A comparative study of macular thickness measurements with optical coherence tomography (OCT) in patients with diabetes mellitus without diabetic retinopathy (DR) versus healthy controls.
Background
DR is one of the most common causes of deterioration of vision in the adult population. Recently, some studies showed that the degeneration of the retinal neuronal cells starts before the microvascular changes appear clinically.
Patients and methods
Sixty-five patients with diabetes mellitus (without DR underwent full ophthalmic examination; colored fundus photography, fluorescin fundus angiography, and OCT. Mean macular thickness measured by OCT was calculated for the central fovea, the perifoveal, and the parafoveal area of the macula which compared to healthy controls.
Results
The mean central foveal retinal thickness (RT) of patients without DR shows to be thinnest when compared to the healthy group, which is statistically significant. The perifoveal retinal thickness of patients without DR proves to be the thinnest when compared to the healthy group, which is statistically highly significant. While, in the parafoveal macular zone, no statistically significant difference in RT could be detected between both groups.
Conclusion
This results support the view of neurodegeneration in diabetes in the early stage of retinopathy which show a highly significantly decrease in perifoveal RT in patients without DR compared to healthy controls.
[ABSTRACT]
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INTERNAL MEDICINE - REVIEW ARTICLES
Hemophagocytic syndromes
Emad M El-Sheibeiny, Enaas S Zahran, Rehab K Allam
April-June 2022, 35(2):337-344
DOI
:10.4103/mmj.mmj_160_21
Objectives
The aim was to discuss hemophagocytic syndrome, its clinical presentation, diagnosis, management, and immunological perspectives of its pathogenesis.
Data sources
By searching and reviewing Midline databases (PubMed and MedScape) and all MPs and their role in hemophagocytic syndrome till 2021.
Study selection
All studies were independently assessed for inclusion. The studies were included if they fulfilled the following criteria: (a) published in English language, (b) published in peer-reviewed journal, and (c) discuss the immunological perspectives of hemophagocytic syndrome.
Data extraction
If the studies did not fulfill the inclusion criteria they were excluded. Study quality assessment included whether ethical approval was gained, illegibility criteria specified, and adequate information and defined assessment measures provided.
Data synthesis
Comparisons were made by a structured review with the results tabulated.
Findings
Hemophagocytic syndrome is a life-threatening condition that can occur a primary malignancy or secondary to cancer, autoimmune disease, or infection. Diagnosis is based on lymphocytes and macrophage infiltration of the bone marrow.
Conclusion
Hemophagocytic syndrome is an uncommon hematological disease and life-threatening illness of serious hyperinflammation. Prompt diagnosis is important for good management of these patients.
[ABSTRACT]
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Maternal serum vitamin D level in patients complicated by preeclampsia
Amira A Fathey, Mohammad A El Said, Alaa M Abdelgaied, Esraa A Elsayed Atiah
April-June 2022, 35(2):769-775
DOI
:10.4103/mmj.mmj_218_21
Objectives
To evaluate the relationship between maternal serum vitamin D level and severity of preeclampsia.
Background
Pregnant women with preeclampsia are susceptible to pulmonary edema, coagulation defects, and renal failure. Vitamin D is thought to play a significant role in preeclampsia as an immune modulator. It may help in producing an appropriate maternal immune response to the placenta preventing the release of antiangiogenic factors into the bloodstream and modulating hypertension.
Patients and methods
A case–control study was conducted at Department of the Obstetrics and Gynecology, Menoufia General Hospital and Menoufia University Hospital from June 2019 till October 2020. The study was approved by the Ethics Committee, Faculty of Medicine, Menoufia University. This study included 100 pregnant nulliparae divided into two groups: group A included 50 pregnant women with preeclampsia either mild or severe; their blood samples were drawn at the time of delivery to check maternal serum 25-hydroxyvitamin D levels. Group B included 50 women with normal pregnancy; their blood samples were drawn at the time of delivery to check maternal serum 25-hydroxyvitamin D levels. Full history taking, general examination, vital signs, obstetrical examination, ultrasonography, lab investigations, and maternal serum vitamin D level were done for all studied women.
Results
Vitamin D level was significantly decreased among the preeclampsia group (10.40–31.00 ng/ml) than the control group (15.50–32.00 ng/ml). There were significant positive correlations between vitamin D deficiency level with systolic blood pressure (
r
= 0.420) and diastolic blood pressure (
r
= 0.492).
Conclusion
Vitamin D deficiency has a significant role in the development of preeclampsia. Larger studies including a large sample size are needed to confirm our results about vitamin D deficiency and its relation to preeclampsia.
[ABSTRACT]
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Role of three-dimensional ultrasound and Doppler in differentiating leiomyoma and adenomyosis of uterus
Nasser K Abd El Aal, Hamed E ELLakwa, Shaimaa A Hassanein, Noha F Ahmed, Hesham A Ammar
April-June 2022, 35(2):762-768
DOI
:10.4103/mmj.mmj_214_21
Objective
The purpose of this study is to evaluate the importance of three-dimensional (3D) power Doppler ultrasound (US) in the diagnosis and differentiation of leiomyoma and adenomyosis of the uterus.
Background
The clinical presentation of adenomyosis and leiomyoma overlaps. The 3/4D US imaging has been currently able to produce female pelvis images that are comparable with magnetic resonance imaging and computerized tomography images in both quality and orientation, with the benefit of being without radiation and low cost.
Patients and methods
This study included female patients clinically diagnosed as having uterine leiomyoma and/or adenomyosis and were indicated for hysterectomy. By Doppler velocimetry with the use 3D power Doppler, the waveforms of the ascending main branch of the uterine artery were obtained on both sides of the cervix. Calculation of the resistance index (RI) and pulsatility index (PI) was done in an automatic manner. The averages of arteries on both sides were taken.
Results
The vascularity of most of the leiomyoma lesions was peripheral and of all of the adenomyosis lesions was central. The adenomyosis group showed significantly decreased vascular index, flow index, and vascular-flow index mean values (
P
< 0.01), significantly increased uterine artery RI mean values (
P
< 0.05), and highly significantly increased PI values (
P
< 0.01).
Conclusion
Three-dimensional US imaging with power Doppler can increase the accuracy of differentiation between leiomyoma and adenomyosis cases. Significant differences were noted in the vascularity site and Doppler indices.
[ABSTRACT]
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Magnetic resonance brain imaging findings in epilepsy
Mohamed S ElZawawi, Ibrahem A Abou-Se'da, Yasmin H Hemeda
April-June 2022, 35(2):647-653
DOI
:10.4103/mmj.mmj_235_21
Objectives
The aim was to evaluate the different findings of magnetic resonance brain imaging in epilepsy.
Background
Epilepsy is a common brain disease that affects both pediatrics and adults. The main role of neuroimaging in epilepsy patients is to identify underlying structural abnormalities. MRI has a high spatial resolution, soft tissue contrast and multiplanar capabilities making it the modality of choice in investigating patients with epilepsy.
Patients and methods
This study was conducted at the MRI Unit, Radiodiagnosis Department at Menoufia University Hospital from October 2019 to September 2021 with the approval of the Menoufia Review Board and prospectively performed after obtaining consent from all patients or, in the cases of children, their parent or guardian. Patients were referred/recruited and subjected to brain MRI. The included patients were diagnosed as having epilepsy according to 2014 criteria of the International League Against Epilepsy.
Results
The study included 100 patients (51% adults, 53% males, median age 23.87 years). The MRI was normal in 31 patients (31%) while abnormal in 69 patients (69%) with a wide diffuse range of abnormalities. The most common abnormalities were congenital/developmental lesions (27%) followed by brain tumors (26%). The abnormal MRIs were more common with increased age (median age 33 years,
P
< 0.001), in adults than pediatrics (
P
< 0.001) and in chronic/recurrent seizures than new-onset seizures (
P
< 0.001).
Conclusion
MRI brain assessment of patients with clinically diagnosed epilepsy showed a high prevalence of MRI abnormalities with a diffuse range of etiologies. MRI should be used as an essential tool for assessing patients with epilepsy.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Assessment of retinal ganglion-cell complex using spectral-domain optical coherence tomography in diabetic patients without retinopathy
Mustafa K Nassar, Shaimaa S Helal, Asmaa M Ibrahim
April-June 2022, 35(2):839-845
DOI
:10.4103/mmj.mmj_264_21
Background
Diabetic retinopathy (DR) consists of microvascular changes, although recent investigations have demonstrated that neurodegeneration may occur earlier.
Objectives
To assess ganglion-cell complex thickness using spectral-domain optical coherence tomography in diabetic patients without retinopathy.
Patients and methods
This was a cross-sectional case–control study conducted at Shebin El kom Ophthalmology Hospital and Tiba Ophthalmological Center on 200 patients divided into two groups: group A involves 100 diabetic patients without DR. Group B involves 100 healthy controls. All participants underwent full ophthalmological and medical history, ophthalmological examination with measurement of the macular ganglion-cell layer–inner-plexiform layer (GCL–IPL) thickness, and retinal nerve-fiber-layer (RNFL) thickness using spectral-domain optical coherence tomography.
Results
Macular GCL–IPL and RNFL thickness were thinner in diabetic patients without retinopathy when compared with healthy controls. The average GCL–IPL was 4.17 μm thinner (95% confidence interval: 1.96–6.38) (
P
< 0.001) and the average RNFL was 18.65 μm thinner (95% confidence interval: 16.82–20.47) (
P
< 0.001) in diabetic patients than controls.
Conclusion
There was statistically significant thinning in the GCL–IPL and RNFL thickness in the diabetic patient without retinopathy compared with the control group, indicating that diabetes mellitus causes neurodegenerative changes before vascular changes of DR appear.
[ABSTRACT]
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Changes in the anterior segment after cataract surgery and intraocular lens implantation using ultrasonic biomicroscopy
Hoda M. K. El-Sobky, Mohamed F. H. Ibrahim, Marwa A Zaky
April-June 2022, 35(2):796-801
DOI
:10.4103/mmj.mmj_169_21
Objective
To study changes in the anterior segment after cataract surgery and intraocular lens implantation by means of ultrasonic biomicroscopy.
Background
Cataract surgery is the only treatment for cataract with high success rate in restoring sight. Ultrasonic biomicroscopy is a noninvasive modality that allows for the real-time visualization of anterior-segment tissues with microscopic resolution and provides information about the size and the nature of the lesion, permitting a presumptive diagnosis.
Patients and methods
A prospective nonrandomized and comparative study was conducted on 20 eyes of 20 patients aged 43–72 years who attended the outpatient clinic of Menoufia University Hospital and Zagazig University Hospital in the period from August 2020 to January 2021. Full history, routine, and a thorough ophthalmic examination were done. All surgeries were performed under local anesthesia with or without sedation.
Results
A total of 20 patients underwent phacoemulsification included in our study, most of them aged from 60 to 69 years old, 11 (55%) males and nine (45%) females. The mean increase in anterior-chamber depth is 0.79 mm, 28.11% deeper than before surgery. There is a statistically significant difference between pre and post according to anterior-chamber angle with
P
value less than 0.001. The mean increase in anterior-chamber angle is 8.61°, which represents 27.67% increase of preoperative measurement. There is a high statistically significant difference between pre and post according to angle-opening distance 500 μm with
P
value less than 0.001. The mean increase in angle-opening distance was 0.09 mm, significantly increasing to 21.42% of preoperative value.
Conclusions
There are some positional changes in the anterior-segment structures after cataract surgery. The quantitative changes in anterior-chamber depth and angle may be determined by ultrasound biomicroscopy. The anterior chamber deepens and its angle widens that significantly increased after cataract surgery. Ultrasound biomicroscopy provides quantitative values of angle parameters and maybe of clinical significance in eyes with narrow angle. Numerical values that we detected in our study could provide an anatomical reference for further studies. Based on our findings, we recommend for further studies on larger sample size and on a large geographical scale to emphasize our conclusion.
[ABSTRACT]
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PHYSICAL MEDICINE RHEUMATOLOGY AND REHABILITATION - ORIGINAL ARTICLES
Choroidal thickness affection in patients with rheumatoid arthritis and its relation to disease activity
Alaa A Labeeb, Eman A Abd Allah, Asmaa M Ibrahim, Amira A Moubark
April-June 2022, 35(2):607-613
DOI
:10.4103/mmj.mmj_227_21
Objective
The aim was to evaluate choroidal thickness (CT) in patients with rheumatoid arthritis (RA) and detect the relation between disease activity and joint damage in patients with RA.
Background
RA is a systemic inflammatory disease associated with various extra-articular organ manifestations including ocular manifestations.
Patients and methods
We included 100 eyes of 50 patients with RA and 100 eyes of 50 controls without RA in the study. Subfoveal CT was measured using enhanced-depth imaging optic coherence tomography. Disease activity score 28 (DAS-28) and Larsen score were calculated for each patient with RA and compared with measurements of CT.
Results
Subfoveal CT was statistically thinner in patients with RA than controls. The mean subfoveal CT for the RA group was 291.12 ± 36.48, whereas that for controls was 305.35 ± 24.08, with a
P
value of 0.024. Additionally, upon evaluating whether the DAS-28 score correlated with CT, there was a statistically significant correlation between them (
P
< 0.001). When patients with RA were grouped as having either active RA or RA in remission, subfoveal CT values were statistically significantly lower in the active group. We found a statistically significant correlation between the Larsen score of the patients with RA and the CT measurements (
P
< 0.001). Patients with thinner CT have more joint damage and higher Larsen scores.
Conclusion
Subfoveal CT was significantly thinner in patients with RA than in healthy controls, with a statistically significant correlation of CT measurements with both DAS-28 and Larsen scores.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Outcomes of bicanalicular self-retaining stent versus 3-snip punctoplasty in management of punctal stenosis
Jihad R Ammar, Hatem M Marey, Sameh S Mandour, Ahmed S Fayed
April-June 2022, 35(2):802-807
DOI
:10.4103/mmj.mmj_177_21
Objectives
To evaluate and compare the outcomes of bicanalicular self-retaining stent (SRS) versus rectangular 3-snip punctoplasty in the treatment of acquired lower punctal stenosis.
Background
Punctal stenosis is a common disorder and one of the most commonly encountered diseases that cause tearing. Visual disturbance occurs because of constant epiphora.
Patients and methods
This prospective randomized comparative study was carried on 65 eyes of 39 patients with acquired lower punctal stenosis. Patients were categorized into two groups based on the intervention, such as insertion of bicanalicular SRS (group A) and rectangular 3-snip punctoplasty (group B). Assessment of epiphora, punctal stenosis grading, and fluorescein dye disappearance test were performed preoperatively and postoperatively. Patients were followed up for 6 months postoperatively.
Results
Group A, which included 34 eyes of 20 patients, showed anatomical success in 31 (91.2%) eyes and functional success in 32 (94.1%) eyes, whereas group B, which included 31 eyes of 19 patients, showed anatomical success in 26 (83.9%) eyes and functional success in 22 (71.0%) eyes. The difference in the functional success rate was clinically significant (
P
= 0.013).
Conclusion
Bicanalicular SRS achieves better results than rectangular 3-snip punctoplasty in the treatment of acquired lower punctal stenosis.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Risk factors for hypogonadism in multitransfused thalassemia major male patients
Mohamed A Gaber, Rania E Elbana, Asmaa A Mahmoud
April-June 2022, 35(2):439-444
DOI
:10.4103/mmj.mmj_267_21
Background
Despite the continuous improvement in the treatment of patients with thalassemia, the disease is still associated with many complications.
Objectives
To identify the risk factors associated with hypogonadism in thalassemia major male patients.
Patients and methods
A case–control study included 20 male patients with a prior diagnosis of β-thalassemia major, and 20 age-matched and sex-matched persons as control, from the Hematology Unit, Pediatric and Medicine Department, Menoufia University. Only patients who provided written consent were included in the study. A complete physical and hormonal evaluation was performed on all patients, and data regarding treatment of the hematological disease were collected.
Results
In all, 20 male patients were included in the study (median age: 16 years, range 14–19 years). Of the study participants 80% (16 of 20) had early forms of hypogonadism (delayed or arrested puberty). Patients with hypogonadism had significantly lower average hemoglobin levels (
P
= 0.042), higher levels of serum ferritin (
P
= 0.003), and increased age at initiation of iron chelation (
P
= 0.030) versus patients without hypogonadism.
Conclusion
Our data show that hypogonadism is highly prevalent among male patients with β-thalassemia major, and its presence is associated with higher iron overload and lower hemoglobin values, and the late start of iron chelation therapy.
[ABSTRACT]
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Study of serum level of S100B as a biomarker of vitiligo activity
Magda Mostsfa Hagag, Marwa Elsayed Mohamed El-Showel, Manal Abd EL-Aziz Safan
April-June 2022, 35(2):496-500
DOI
:10.4103/mmj.mmj_239_21
Background
Vitiligo is a common acquired depigmenting skin disorder. Current pathophysiologic insights promote the theory that melanocytes are destroyed by the immune system, leaving persistent areas of depigmentation, other theories have been suggested regarding the causes for depigmentation, including deficient adhesion proteins, an increased presence of oxidative stress, and neurogenic factors.
Objective
The study aims to evaluate the serum level of S100B in vitiligo patients and its correlation with disease activity in comparison with healthy controls.
Patients and methods
This is a case–control study that included 60 patients with vitiligo who were diagnosed with clinical evaluation and 30 healthy individuals as a control group. All patients were assessed for activity by Vitiligo Disease Activity Score (VIDA score) last year and the authors used Vitiligo Extent Score (VES), which is estimated body mass index % and measured serum level of S100B by the enzyme-linked immunosorbent assay system.
Results
There was a significant increase in the serum level of S100Bng/l in the patient group compared with the control (P value < 0.001) and a significant positive correlation between serum level of S100Bng/l and VIDA in the patient group.
Conclusion
Serum levels of S100B in vitiligo were used as a biomarker for activity.
[ABSTRACT]
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91
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FAMILY MEDICINE - ORIGINAL ARTICLES
Predictors of poor knowledge, attitude, and practice among primary care physicians toward end-of-life care
Hala M El Moselhy Shaheen, Aml A Salama, Shimaa M. A. Ammar, Marwa M Mohasseb
April-June 2022, 35(2):516-521
DOI
:10.4103/mmj.mmj_101_21
Background
The prevalence of multiple chronic conditions in elderly people rises recently. Establishing comprehensive end-of-life (EOL) care to improve their quality of life and avoid any unnecessary suffering is mandatory. Being the first point of contact with the health care system, primary care physicians' knowledge, attitude, and practice (KAP) toward EOL care is evidently considered.
Objectives
To assess KAP among primary care physicians and the predictors of poor KAP regarding EOL care.
Aim
To improve the EOL services among primary care physicians.
Patients and methods
A cross-sectional study was conducted on randomly selected 300 primary care physicians from the 1
st
of May to the end of November 2019. The selected participants were interviewed through a semistructured self-administered questionnaire composed of four parts inquiring about their sociodemographic data, KAP level toward EOL care.
Results
The majority of the studied participants had poor knowledge (94.7%) and practice (96.3%) about EOL care. Only 37.7% of them had a negative attitude. Being female (
P
= 0.03) and general practitioner (
P
= 0.02) were the most affecting factors of poor knowledge. General practitioner was the most influencing factor on poor attitude (
P
= 0.04). There was a positive correlation between knowledge score and attitude score (
P
< 0.001), and the same with knowledge score and practice score (
P
< 0.001).
Conclusion
Although more than half of the physicians had positive attitude as regards EOL care, their knowledge and practice levels were poor. Being a female and general practitioner expressed more poor knowledge. Being a general practitioner showed poor attitude, while working in rural areas was the main affecting factor on poor practice.
Recommendation
EOL care should be integrated in both undergraduate and postgraduate studies.
[ABSTRACT]
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95
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Sutureless versus conventional abdominal hysterectomy: a randomized controlled trial
Wael G Eldamaty, Zakaria F Sanad, Hamed E Ellakwa, Asmaa M Khidre, Yasmin I El Masry
April-June 2022, 35(2):782-787
DOI
:10.4103/mmj.mmj_249_21
Objective
This study aimed to compare electrothermal bipolar-vessel sealing (EBVS) with the conventional suturing during the abdominal hysterectomy, as well as to compare the conventional bipolar-sealing system with the advanced one.
Background
Gynecologic surgery is frequently complicated by hemorrhage. Thus, it is mandatory to adopt adequate techniques of hemostasis during surgery.
Patients and methods
The study was conducted on 60 patients with indications for abdominal hysterectomy, they were divided equally into two groups: group I consisted of 30 patients who underwent abdominal hysterectomy with the use of the EBVS, either advanced;
LigaSure
(15 patients), or conventional;
Seal
, and group II consisted of 30 patients who underwent conventional abdominal hysterectomy. The primary outcome was the differences between the study and control group regarding the operative events and postoperative outcome, and the secondary outcome was the differences between the two subgroups of group I regarding the same parameters.
Results
The conventional hysterectomy group showed significantly higher operative time, blood loss, length of hospital stay, the days needed for returning to the usual activities, pain scores, and lower Ht (%). No significant differences were noted between both subgroups of group I, except in the day 3 pain score.
Conclusion
EBVS is an expensive but effective alternative to the conventional sutures in the abdominal hysterectomy for a benign condition. The advanced bipolar system (
LigaSure
) is comparable to the conventional one (
Seal
).
[ABSTRACT]
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92
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CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Ratio of transmitral early filling velocity to early diastolic strain rate predicts obstructive coronary stenosis
Abdulsalam M Algamal, Sherif I Arafa, Adel M Osman, Shady H Elhusseiny, Abdallah M Elshal, Mahmoud A Salem, Hany M Abdel Shakour
April-June 2022, 35(2):371-377
DOI
:10.4103/mmj.mmj_252_21
Objective
The aim was to evaluate the use of ratio of transmitral early filling velocity (E) to left ventricular early global diastolic strain rate (E′sr) (E/E′sr ratio) as a novel noninvasive predictor of obstructive coronary artery disease (OCAD) in patients with chronic coronary syndrome (CCS).
Background
E′sr derived by speckle tracking echocardiography reflected global relaxation and filling pressure. Coronary artery disease caused early impairment of diastolic deformation.
Patients and methods
In all, 90 patients with CCS underwent coronary angiography in Mansoura Specialized Medical Hospital, Mansoura University. Patients were divided into two groups, which were age and sex matched: 55 patients with OCAD and 35 patients with normal coronary angiography. Global longitudinal strain (GLS), systolic strain rate (S′sr), and E′sr were measured by speckle tracking echocardiography.
Results
Patients with OCAD had significantly lower E′sr. On the other hand, they expressed significantly higher E/E′sr ratio, GLS, and S′sr. There was no significant difference between both groups regarding ejection fraction, E velocity, tissue Doppler-derived mitral annular velocity (E′ velocity), and E/E′ ratio. In patients with OCAD, significant positive correlation between E/E′sr ratio and E/E′ ratio, GLS, and Gensini and SYNTAX scores was observed. Independent predictors of OCAD in patients with CCS included diabetes mellitus, S′sr, and E/E′sr ratio. The ideal cutoff value of E/E′sr ratio of more than 154.29 cm predicted OCAD in patients with CCS.
Conclusion
To the best of our knowledge, our study might be the first to show the possibility of use of E/E′sr ratio as a noninvasive predictor of OCAD in patients with CCS.
[ABSTRACT]
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98
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OBSTETRICS AND GYNECOLOGY - ORIGINAL ARTICLES
Association of maternal serum lipids levels at late gestation with large for gestational age and neonatal macrosomia in nondiabetic women
Nehad M Hosny, Tarek M Sayyed, Ayman A M. El-Mesady, Essam A Amin
April-June 2022, 35(2):745-753
DOI
:10.4103/mmj.mmj_178_21
Objectives
To evaluate the relationship between maternal serum lipids at late gestation in nondiabetic women and the risk of large for gestational age (LGA) and neonatal macrosomia.
Background
LGA is defined as an infant with a birth weight greater than the 90
th
percentile for the given week of pregnancy. Maternal dyslipidemia can also induce excessive fetal growth by changes in lipid metabolism during pregnancy.
Patients and methods
A prospective observational study was conducted on 161 pregnant women aged 20–35 years recruited from the Department of Obstetrics and Gynecology of Menoufia University Hospital and Shebin El-Kom Teaching Hospital from January 2020 till December 2020. The patients included in the study were singleton live pregnancy, pregnant at 37–42 gestational weeks, and naturally conceived. For all patients, detailed history taking, including family history of diabetes mellitus among first-degree relatives, complete clinical examination, and measurements of maternal lipid profile, including total cholesterol, triglyceride (TG), high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol (LDL-C), and fasting blood sugar and 2 h postprandial blood sugar, were done. Obstetric ultrasound was performed to assess fetal growth. Accordingly, patients were classified into three groups as follows: group 1, normal group; group 2, LGA; and group 3, LGA and neonatal macrosomia.
Results
Our results reported that cholesterol level, TG, LDL levels, and fasting blood sugar level were significantly higher in the LGA group when compared with the normal group. These significant higher levels were consistent between the neonatal macrosomic group and the normal group, with the exception of LDL level, which showed a nonsignificant difference. A cutoff level of cholesterol more than 214 has a sensitivity of 93.8%, a specificity of 82.2%, and an accuracy of 85%, whereas a cutoff level of TG more than 244 has a sensitivity of 96.6%, a specificity of 55.3%, and an accuracy of 63%.
Conclusions
Elevated TG and cholesterol at late gestation are independent predictors for LGA and neonatal macrosomia in nondiabetic pregnant women.
[ABSTRACT]
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PEDIATRICS - ORIGINAL ARTICLES
Interleukin-1 receptor antagonist gene polymorphisms in children with febrile convulsions
Ahmed T Mahmoud, Maha A Tawfik, Nahla M Said, Mehad I.M. Abd AlKarim
April-June 2022, 35(2):588-594
DOI
:10.4103/mmj.mmj_46_21
Objectives
To study the possible contribution of interleukin-1 receptor antagonist (IL-1Ra) gene polymorphisms to the susceptibility of febrile convulsions.
Background
Febrile seizures (FSs) are considered the most common seizure disorder in childhood. They are considered a major cause of emergency department visits and a source of family anxiety. FSs of children involve an interaction between the immune-inflammatory process, cytokine activation, and genetic factors.
Patients and methods
This was a case–control study and included 55 children diagnosed to have febrile convulsions and 28 healthy children with no history of any type of convulsions or any neurological disorders. IL-1Ra gene polymorphisms were genotyped by PCR and compared in both groups.
Results
The most common genotype for the IL-1Ra gene in both groups was I/I. The IL-1Ra I/I homozygote was significantly more frequent in patients with FSs than in healthy controls (76.4 vs. 46.3%,
P
= 0.01). In addition, IL-1Ra I/II genotype was significantly associated with resistance to FSs (
P
= 0.001). There were no significant differences between the studied groups regarding the distribution of other genotypes of IL-Ra gene. IL-1Ra allele I is associated with higher susceptibility to FSs among members of the case group (
P
= 0.03). However, IL-1Ra allele II is associated with resistance to FSs among the healthy control group (
P
= 0.01).
Conclusion
IL-1Ra I/I homozygous genotype is significantly associated with febrile convulsions.
[ABSTRACT]
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689
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DERMATOLOGY - ORIGINAL ARTICLES
Effect of sildenafil citrate on sperm motility
Abdallah M Attia, Ahmed A Sonbol, Mai M. M. Ghanem, Heba A.S. E. Khalil
April-June 2022, 35(2):507-509
DOI
:10.4103/mmj.mmj_257_21
Objectives
The objective of the study was to evaluate the effect of sildenafil citrate on sperm motility.
Background
Phosphodiesterase type 5 inhibitors are now the first line in the treatment of erectile dysfunction. Many men use sildenafil citrate in their reproductive years. This study aimed to study the effect of the drug on sperm motility.
Patients and methods
This study included a total of 40 patients with erectile dysfunction. Twenty patients received daily 50 mg oral sildenafil citrate for 90 days compared to 20 control patients regarding their sperm motility.
Results
Cases showed higher sperm motility with a mean 61.2 ± 10.6 than control with a mean 59.8 ± 9.4 but with no significant difference between both groups with
P
value 0.615.
Conclusion
This study showed the safety of sildenafil citrate on reproduction with no effect on sperm motility.
[ABSTRACT]
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689
85
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ENDEMIC AND TROPICAL MEDICINE - ORIGINAL ARTICLE
Study the level of selenoprotein
P
in Egyptian patients with nonalcoholic fatty liver
Gamal S EL-Deeb, Nesreen G El-Helbawy, Ayman A Elgamal, Ahmed S ELkhalaly
April-June 2022, 35(2):510-515
DOI
:10.4103/mmj.mmj_27_21
Objectives
The study aims to evaluate circulating selenoprotein
P
levels in patients with the nonalcoholic fatty liver disease compared with healthy controls.
Background
Nonalcoholic fatty liver disease represents a spectrum of liver diseases with key stages consisting of nonalcoholic fatty liver, nonalcoholic steatohepatitis, fibrosis, and eventual cirrhosis. Nonalcoholic fatty liver disease affects more than 20% of the population worldwide.
Methods
This is a case–control, retrospective study that was conducted on 72 patients with nonalcoholic fatty liver disease (cases), and 36 healthy volunteers without nonalcoholic fatty liver disease or any chronic liver disease as controls. Ultrasonography of the liver of all patients will be done and performed by the same operator using a Toshiba Apilo XV scanner equipped with a broadband 3.5-MHz curved array probe to assess the presence of liver steatosis (bright liver), evaluation of the liver size, and focal region.
Results
There was a statistically significant difference between groups regarding serum selenoprotein P with a higher level among healthy controls (
P
value < 0.001).
Conclusion
The present study demonstrated that hepatokine selenoprotein
P
concentrations were decreased in patients with definite nonalcoholic steatohepatitis compared with controls but not different between controls, simple steatosis, and borderline nonalcoholic steatohepatitis.
[ABSTRACT]
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682
80
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Liver Acquisition with Volume Acceleration versus T2 fat suppressed MRI sequences in the evaluation of perianal fistula
Rabab Yasin, Mohamed H Khalifa, Abdelghany M Motawea
April-June 2022, 35(2):633-640
DOI
:10.4103/mmj.mmj_66_21
Back ground
Perianal fistula is an abnormal communication between the anal canal and the outer perineal skin. It is a disease of young adults, being more common in males. MRI is a noninvasive, well-tolerated imaging modality with high resolution of the soft tissues. It is considered the imaging modality of choice for the initial evaluation and follow-up of perianal fistulas as it is more tolerated and less embarrassing for the patient than other imaging techniques.
Objectives
To compare MR sequences fat-suppressed (FS) T2-weighted imaging and Liver Acquisition with Volume Acceleration (LAVA) for better visualization and assessment of the perianal fistulas and sphincters.
Patients and methods
This was a retrospective study done in the period between January 2018 and January 2020 on 100 patients. The patients' age ranged from 15 to 67 years, with a mean age of 35.45 ± 12.35 years. All patients had previously undergone MRI pelvis with intravenous contrast. We considered the operative results as the reference standard.
Results
This study included 36 (36.0%) females and 64 (64.0%) males. LAVA sequence was better than T2 FS MRI sequence for the detection of the internal opening of the fistulous tract as well as secondary fistulous tracts with perfect interobserver agreement (
P
< 0.001). Both LAVA and T2 FS MRI sequences have the same significance for the detection of the abscesses, horseshoe, and supralevator extension of the fistula, with perfect interobserver agreement between both observers and between them and surgery.
Conclusion
Adding LAVA sequence to the protocol of MRI in the evaluation of perianal fistula helps to give better details as compared with T2 FS sequence as regarding the internal opening and the secondary tracts of the fistulous tract, but they have the same results regarding the sensitivity to detect abscesses, horseshoe, and supralevator extension of the perianal fistula.
[ABSTRACT]
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81
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ORTHOPEDIC SURGERY - ORIGINAL ARTICLES
Management of nonunion of diaphyseal femoral fractures using exchange nailing versus plate augmentation
Mahmoud M Hadhoud, Ramzy M. A. Mostafa, Amr A Kandeel
April-June 2022, 35(2):884-889
DOI
:10.4103/mmj.mmj_184_21
Objectives
The aim of this study was to compare the clinical and radiographic outcomes of exchange nailing versus plate augmentation for the management of patients with nonunion of diaphyseal femoral fractures.
Background
Due to its superior biomechanical and biological properties, intramedullary nailing of the femur has enjoyed widespread acceptance in the management of femoral diaphyseal fractures. However, nonunion occasionally occurs secondary to malreduction, inaccurate implant placement, and unfavorable fracture pattern.
Patients and methods
This was an interventional prospective cohort study to evaluate the treatment options, which was conducted at the Department of Orthopedics and Traumatology, Menoufia University Hospital between May 2017 and July 2019.
Results
There was no significant difference between the studied groups as regards postoperative blood loss,
P
value of 0.183. There was no significant difference as regards preoperative versus postoperative range of motion,
P
value of 0.561.
Conclusion
Diaphyseal femoral fracture nonunion can be successfully treated by either exchange nailing and bone grafting or by augmentation plating and bone grafting; however, the later has less operative time and lower reoperation rate.
[ABSTRACT]
[FULL TEXT]
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87
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CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Correlation of blood pressure changes with the functional capacity in patients with heart failure with preserved and midrange ejection fraction
Abdulsalam M Algamal, Adel M Osman, Shady H Elhusseiny, Abdallah M Elshal, Mahmoud A Salem
April-June 2022, 35(2):364-370
DOI
:10.4103/mmj.mmj_168_21
Objective
To assess different blood pressure (BP) parameters and their changes after 6-min walk test (6-MWT) in patients with heart failure with midrange ejection fraction (HFmEF) and heart failure with preserved ejection fraction (HFpEF) and correlate them with the functional capacity (FC) as assessed by 6-min walk distance (6-MWD).
Background
The 6-MWT reflects the daily activity of patients with HF who develop progressive limitation of FC.
Patients and methods
A total of 40 patients with HFmEF and 50 patients with HFpEF were enrolled. The 6-MWT was performed according to the American Thoracic Society guidelines 2002. Different BP parameters were measured before and after 6-MWT, and 6-MWD was recorded.
Result
The mean 6-MWD was 325.3 ± 56.84 m in all patients, 316.1 ± 61.33 m in HFmEF group, 332.66 ± 52.44 m HFpEF group. The 6-MWD and limited FC showed no significant difference between the two groups. Independent predictors of limited FC assessed by the 6-MWD were lower EF, pulse pressure (PP), and proportionate pulse pressure (PPP) and higher diastolic blood pressure in patients with HFmEF and lower EF in patients with HFpEF. Cutoff points for prediction of limited FC as assessed by 6-MWD less than 300 m included PP less than 32.5 mmHg and PPP less than 30.22% in patients with HFmEF, PP less than 37.5 mmHg and PPP less than 32.67% in patients with HFpEF, and EF less than 42.5% in all patients.
Conclution
A simple bedside measurement of BP parameters correlates with the FC and can predict limited FC represented by 6-MWD less than 300 m in patients with HFmEF and HFpEF.
[ABSTRACT]
[FULL TEXT]
[PDF]
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668
89
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Role of magnetic resonance in evaluation of nasopharyngeal tumors in adults
Mohamed S. E. Elzawawi, Hend A Abd Elatty Sherif, Mohamed K Abd Elmageed
April-June 2022, 35(2):654-659
DOI
:10.4103/1110-2098.352180
Objective
To detect the role of MRI in the evaluation of different nasopharyngeal tumors in adults.
Background
Nasopharyngeal tumors are rarely seen in tumors in which diagnosis, treatment, and staging are challenging due to anatomic localization. The most common imaging techniques used in the evaluation of nasopharyngeal tumors are computed tomography (CT), MRI, and positron-emission tomography.
Patients and methods
This study is a prospective study of descriptive and analytical design, including 25 adult patients diagnosed to have nasopharyngeal tumors through clinical, endoscopic, and histopathological evaluation. Then, they were referred to do MRI to evaluate the lesions.
Results
There were statistically significant differences between post-therapeutic follow-up at 3–6 and 12 months among the studied patients regarding lesion, lymphadenopathy, and sinusitis (
P
<0.05). While mastoid opacification was not a significant difference between the studied patient's post-therapeutic follow-up of 3–6 and 12 months (
P
= 0.67). The sensitivity of MRI for diagnosis of pathological neck nodes in the nasopharyngeal lesions was 92%, specificity was 84%, positive predictive value was 75%, negative predictive value was 88%, and accuracy was 87%.
Conclusion
MRI is essential in the diagnosis of primary nasopharyngeal tumors in adults and evaluation of the associated retropharyngeal and cervical lymphadenopathy. It plays an important role in the staging of tumors, especially nasopharyngeal carcinoma, selection of appropriate therapy, and evaluation and follow-up of the patients after the therapy to detect treatment changes such as recurrence and fibrosis.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
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PEDIATRICS - ORIGINAL ARTICLES
Diagnostic value of proadrenomedullin in neonatal sepsis
Fady M El Gendy, Hassan S Badr, Dalia H Abouelela, Dina A Midan
April-June 2022, 35(2):595-600
DOI
:10.4103/mmj.mmj_124_21
Objectives
We aimed to assess the potential role of serum proadrenomedullin (pro-ADM), in the diagnosis of neonatal sepsis.
Patients and methods
Pro-ADM level was assessed in 100 neonates, 50 patients with neonatal sepsis (cases), and another 50 healthy controls. Neonatal sepsis was assessed using the clinical and hematological sepsis scores plus C-reactive protein, and the diagnosis was confirmed by blood culture.
Results
Pro-ADM and C-reactive protein were significantly higher,
P
value less than 0.001, in septic neonates rather than in controls. Pro-ADM levels had a powerful discrimination ability to early differentiate neonates with sepsis, at the cutoff-point value of 145 ng/ml with a sensitivity of 100% and specificity of 100% and area under the curve of 1.
Conclusion
Our study supports the association of neonatal sepsis and the early elevation of serum pro-ADM, which would help in early diagnosis and early initiation of appropriate therapy.
[ABSTRACT]
[FULL TEXT]
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PATHOLOGY - ORIGINAL ARTICLE
The study of immunohistochemical expression of vascular endothelial growth factor in renal-cell carcinoma
Mona Abd El-Halim Kandil, Dalia R Al-Sharaky, Marwa M Dawoud, Alyaa Abou El-Maged Moselhy
April-June 2022, 35(2):578-587
DOI
:10.4103/mmj.mmj_220_21
Objective
To study immunohistochemical expression of vascular endothelial growth factor (VEGF) renal-cell carcinoma (RCC) and correlate its expression with the studied clinicopathologic parameters.
Background
RCC is the sixth diagnosed cancer in males and the tenth in females accounting for 5 and 3% of cancer incidence, respectively. VEGF is a peptide with angiogenic properties. It is thought to have an important role in RCC development and progression.
Patients and methods
This retrospective study was performed on 58 cases of RCC and 31 cases of nonneoplastic kidney tissue. The slides were subjected to VEGF immunohistochemical staining using a streptavidin–biotin–peroxidase technique. The relationships between VEGF expression in RCC cases and nonneoplastic cases, as well as correlation between VEGF expression and clinicopathological parameters in RCC cases, were statistically analyzed.
Results
VEGF showed low expression in 27.6% and high expression in 72.4% of RCC cases versus 48.4 and 51.6% in nonneoplastic cases, respectively. Higher VEGF expression was correlated with female sex, left-sided tumors, low tumor-infiltrating lymphocytes, and higher-grade tumors.
Conclusion
Higher VEGF expression is correlated with RCC development and may be an indicator of poor outcome in RCC patients.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Role of MRI in the prognosis of hypoxic–ischemic encephalopathy
Adel El Wakeel, Aisha S. M. Saad, Rehab Habib
April-June 2022, 35(2):626-632
DOI
:10.4103/mmj.mmj_179_21
Background
Neonatal encephalopathy is a heterogeneous syndrome characterized by signs of central nervous system dysfunction in newborn infants. The main cause of neonatal encephalopathy can be broadly divided into perinatal asphyxia [hypoxic–ischemic encephalopathy (HIE)], perinatal stroke, metabolic encephalopathy from inborn errors of metabolism, congenital neonatal central nervous system infections, and severe birth trauma.
Objectives
To highlight the predictive value of MRI as a safe and superior neuroimaging technique in cases of HIE.
Patients and methods
This progressive study was conducted on 30 neonates with HIE referred to the Radiology Department at Menoufia University Hospitals for advanced magnetic resonance techniques assessment during the period from July 2019 to December 2020. The study received the approval of Ethics Committee of Faculty of Medicine, Menoufia University. A written informed consent was taken from the parents or caregivers and written informed consent was obtained from them.
Results
Apparent diffusion coefficient (ADC) value was significantly increased with hypertonia (1.75 ± 1.21), hypotonia (1.52 ± 1.51), and MRI than flaccid (0.86 ± 0.67). There was no statistically significant relation between ADC value with time of birth, causes of admission, Apgar score, time of birth at 5 min, Tendon reflex, seizures, periventricular leukomalacia, and intraventricular hemorrhage.
Conclusion
MRI findings were significantly related with diffusion-weighted (DW) and ADC value. MRI findings indicated that periventricular leukomalacia and basal ganglia ischemia were significantly related with DW. Moreover, it was noted that MRI is a very efficient tool in evaluating morphometric HIE. It's noninvasiveness and no exposure to ionizing radiation is an added advantage. However, experience and understanding of the principles are essential for accurate diagnosis. Also, DW and ADC values may add value to routine MRI examination. However, there is limitation in our study as regards the small number of cases, lack of clinical data, and long-term follow-up of cases.
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ORTHOPEDIC SURGERY - ORIGINAL ARTICLES
Assessment of fusion rate with transforaminal lumbar interbody fusion in degenerative lumbar spine diseases
Mahmoud M Hadhoud, Mohamed A Faik, Osama A. M. Shireef, Nasser M Abdel-Wahed
April-June 2022, 35(2):871-879
DOI
:10.4103/mmj.mmj_161_21
Objectives
The aim of the study was to assess the fusion rate with transforaminal lumbar interbody fusion (TLIF) in degenerative lumbar spine diseases regarding its advantages, complications, and clinical outcomes.
Background
TLIF should offer the same benefits of circumferential fusion with higher safety than other interbody fusion methods because it avoids the direct traction to dura and nerve roots.
Participants and methods
This study included 30 patients suffering from continuous low-back pain due to degenerative lumbar spine diseases, which were treated by TLIF using PEEK banana cage supplemented by pedicle screw fixation in the Orthopedic Department of Menoufia University Hospital during November 2018 till December 2020, with follow up of at least 9 months. All patients were subjected to full history taking, clinical examination, preoperative and postoperative follow-up.
Results
At preoperative follow-up, all the studied patients had severe Oswestry disability index (ODI). While postoperatively, on the first day all of them cannot be assessed. Also, most of the studied patients (76.67%) had improved to mild ODI after 9 months of follow-up. The ODI showed significantly linear improvement in the studied patients with the greatest improvement observed in at the 3-month follow-up.
Conclusion
TLIF provides good clinical and radiological outcomes in the management of degenerative lumbar spine diseases after a follow-up period of 9 months. Operative complications are less in the TLIF technique, and the risk of dural tear is diminished significantly. TLIF can save much operative time and blood loss.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Diagnostic role of procalcitonin serum level in hepatitis C virus-infected patients with spontaneous bacterial peritonitis
Mohamed Y El Hasafy, Dalal M El Kaffash, Mohammed S. S. Shater, Nehal A Attia
April-June 2022, 35(2):548-552
DOI
:10.4103/mmj.mmj_430_20
Objective
We aimed at the evaluation of the role of quantification of serum procalcitonin (PCT) in the detection of spontaneous bacterial peritonitis (SBP) in hepatitis C-related cirrhosis before and after initiation of antibiotic therapy.
Background
SBP is a lethal consequence of advanced cirrhosis. The outcome is heavily affected by early detection and treatment. PCT has been evaluated during acute bacterial infections and sepsis.
Patients and methods
We included 60 patients with ascites due to hepatitis C-related cirrhosis, who were divided in two groups: group 1 included 40 naïve patients with SBP, and group 2 included 20 patients with sterile ascites as a control. After history taking and clinical examination, full blood count, liver test profile, and renal functions were done. Moreover, C-reactive protein and erythrocyte sedimentation rate levels were measured. Serum PCT was measured by immunoassay. Diagnostic ascitic sample analysis was done for the polymorphonuclear leukocyte (PMNL) count, albumin levels, and ascetic fluid culture.
Results
Serum PCT was significantly elevated in group 1 before treatment than after treatment, as well as when compared with group 2. There was no statistically significant correlation between the change in the C-reactive protein level and that of the serum PCT before and after treatment in group 1. There is no significant correlation between increases in the serum PCT and the results of bacterial growth of ascetic fluid culture group before and after treatment.
Conclusion
PCT levels in the serum appear to provide a good diagnostic certainty in the diagnosis of SBP in cirrhotic patients at a cutoff value of 0.17 ng/ml for patients with either culture-positive or negative SBP.
[ABSTRACT]
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ORTHOPEDIC SURGERY - ORIGINAL ARTICLES
Prevalence of ipsilateral knee ligament injuries associated with femoral shaft fractures in Menoufia University Hospitals
Bahaa Z Hasan, Taher Abdel-Sattar Eid, Khaled Abdel-Mageed Abdel-Sattar Shreef, Emad B Badawy
April-June 2022, 35(2):880-883
DOI
:10.4103/mmj.mmj_234_21
Objective
This study was designed to estimate the prevalence of ipsilateral knee ligament injuries associated with fracture shaft femur in Menoufia University Hospitals.
Background
Ipsilateral knee ligament injuries associated with femoral shaft fractures are a common finding but can be easily missed during early management of initial trauma.
Patients and methods
After femoral fixation with intramedullary rod placement, external fixation, or plate fixation, all patients underwent a thorough physical examination of the involved limb including varus and valgus stress tests, Lachman test, anterior drawer test, and posterior drawer test, under anesthesia. Clinical assessments were performed and compared with the contralateral knee.
Results
The most common mechanism of injury observed was RTA. Of the 44 patients who were studied, 15 (34.1%) patients had a knee ligament injury. Of the 15 patients, 47% had a cruciate ligament injury. The ligament injury was not treated at the time of the osteosynthesis procedure.
Conclusion
We highlight the difficulty of diagnosis of ipsilateral knee ligament injuries at the time of admission and the need for systemic physical examination after surgical treatment of femoral fractures.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Chitinase-3 protein-like-1 as inflammatory marker and disturbed lipid-profile risk in acne vulgaris
Hesham N Khaled, Wessam G Abdel Hamid, Yasser Alghobashy
April-June 2022, 35(2):477-482
DOI
:10.4103/mmj.mmj_271_21
Objective
To evaluate YKL-40 role in acne vulgaris (AV) patients and its potential link to the disturbed lipid profile in AV.
Background
AV is a cutaneous chronic inflammatory disorder. YKL-40 is an inflammatory glycoprotein associated with metabolic syndrome.
Patients and methods
The study was done on 40 AV patients and 40 apparently healthy individuals attending the Outpatient Clinic of Dermatology Department of Menoufia University Hospitals in the period between March 2020 and January 2021. ELISA technique was used to detect YKL-40 level.
Results
In the present study, patients and controls were not smokers (82.5 and 80%). About 90% of patients were married. The studied patients and all controls had no systemic treatment, topical treatment, or obesity (85, 90, and 82.5%). High-density lipoprotein was significantly lower in AV patients than in the control group. Cholesterol, triglyceride, very low-density lipoprotein, and low-density lipoprotein levels were not significantly different between both groups. YKL-40 level was significantly higher in AV patients than controls. There was a significant positive correlation between YKL-40 levels with cholesterol level (
P
= 0.0163), triglyceride (
P
= 0.001), and low-density lipoprotein (
P
= 0.045). YKL-40 level had significant negative correlation with high-density lipoprotein level of AV cases (
P
= 0.008). Receiver-operating characteristic curve analysis shows that more than 9.94 ng/ml was the best cutoff for YKL-40 level to predict the risk of AV patients under an area of 0.711 with sensitivity of 82.5% and specificity of 75.0% with a statistically significant association (95% confidence interval, 0.599–0.807,
P
= 0.001).
Conclusion
It is concluded that higher YKL-40 level was considered as a predictor of AV susceptibility and higher severity.
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Association of tumor necrosis factor superfamily 4 (rs1234315) gene polymorphism and systemic lupus erythematosus susceptibility
Thoria A Omar, Ahmed Abd El-Rahman Sonbol, Dina S Fotoh, Wafaa Y Ahmed Kabil
April-June 2022, 35(2):393-398
DOI
:10.4103/mmj.mmj_185_21
Objective
To detect the association of tumor necrosis factor superfamily 4 (
TNFSF4
;
rs1234315
) with susceptibility of systemic lupus erythematosus (SLE) disease in gene polymorphism Egyptian patients.
Background
SLE is an autoimmune disease characterized by the formation of antibodies against cytoplasmic and nuclear antigens resulting in multisystem inflammatory processes. The
TNFSF4
is an inflammatory factor linked to various inflammatory disorders and cancers.
TNFSF4
gene has been reported to be related to SLE susceptibility because it encodes the OX40 ligand protein, which can stimulate the production of more autoantibodies.
Patients and methods
In this case–control study real-time PCR with allelic discrimination assay was used to genotype the
TNFSF4
gene rs1234315 C/T polymorphism in 286 participants divided into two groups. Group I: 143 SLE patients fulfilling four or more criteria of the updated American College of Rheumatology criteria and group II: 143 healthy controls with matched age and sex with patients.
Results
The CC genotype of
TNFSF4
rs1234315 was highly statistically significant in controls (
P
< 0.001), while TT genotype (
P
< 0.001) and T allele (
P
< 0.001) (odds ratio: 1.759; confidence interval: 1.262–2.450) were highly statistically significant in SLE patients.
Conclusion
There is an association of
TNFSF4
(rs1234315) gene polymorphism and SLE susceptibility in Egyptian patients.
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ORAL MEDICINE AND RADIOLOGY - ORIGINAL ARTICLE
Stress levels in patients visiting for dental treatment: a cross-sectional hospital-based study
Babu J Suresh, Swarnalatha Chandolu, Deivanayagi Muthusamy, Ratnam Modalavalasa Venkata Ramana, Senapathi S Navaneet, Naidu B Ramesh, Abhishek S Nayyar
April-June 2022, 35(2):573-577
DOI
:10.4103/mmj.mmj_212_21
Background
Potentially stressful life events are thought to increase risk for a given disease. In turn, perception of stress might influence the pathogenesis of physical disease by causing negative affective states which, then, exert direct effects on the physiological processes of the individual that influence the predisposing and/or, risk factors for a given disease process.
Objective
To assess stress levels in patients coming for dental treatment using perceived stress scale.
Patients and methods
The present cross-sectional study consisted of 598 individuals randomly selected from the Outpatient Department aged 18 years and above over a period of 6 months, while perceived stress scale was used to measure perception of stress.
Results
In the present study, data collected revealed that unskilled individuals (29.4%) sought dental treatment more than other categories of occupational groups, while a correlation between occupation and the levels of stress revealed that stress levels were considerably lower in professionals with the results being highly significant,
P
value being 0.002.
Conclusion
From the present study, it could be concluded that in most of the cases, stress and dental problems were closely linked with one other with one aggravating the other.
[ABSTRACT]
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PLASTIC SURGERY - ORIGINAL ARTICLES
Comparison study between separation of helix from antihelix and mustarde techniques in the management of prominent ear
Tarek F Keshk, Ahmed A. E.d Taalab, Ashraf M El-Rahawy, Mohamed M Mohamed
April-June 2022, 35(2):926-932
DOI
:10.4103/mmj.mmj_387_20
Objective
This study aimed to assess the outcome of separating the helix from the antihelix as a new concept in the management of protruding ear and compare its result with the Mustarde technique.
Background
The Mustarde technique is one of the most popular approaches to correcting the prominent ear. However, the Mustarde technique is criticized for its temporary results, high rates of recurrences, and the likelihood of suture extrusion.
Patients and methods
The present prospective comparative study was carried out on 40 patients with protruding ears planned to be operated on and managed. The patients were divided into two groups: the first group (group A) included 20 patients, who were managed using separation of the helix from the antihelix technique. The second group (group B) included 20 patients, who were managed with the Mustarde technique.
Results
In the present study, 42.5% of parents were very satisfied, 7.5% were satisfied, and 2.5% were very dissatisfied. Notably, parents of the patients in the Valente group had a significantly higher rate of satisfaction than those in the Mustarde group. All parents were satisfied in the Valente group, except for one parent (5%). In terms of complications, 12.5% of patients had a hematoma and no one had an infection, while 15% of patients had antihelix irregularity, 7.5% had suture extrusion, and 20% had cartilage irregularity. Patients in the Valente group had a significantly lower rate of hematoma and suture extrusion.
Conclusions
Separating the helix from the antihelix technique is a simple, reliable, and good option for correction of a prominent ear.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Serum level of retinol-binding protein 4 in alopecia areata: relation with recurrence and severity
Magda M Hagag, Sherin S El-Naidany, Ola Abd El-Raheem Ahmed ElShaer
April-June 2022, 35(2):483-488
DOI
:10.4103/mmj.mmj_236_21
Background
Alopecia areata (AA) is a common, clinically heterogeneous, autoimmune T-cell-mediated, nonscarring hair-loss disorder. Many researchers hypothesize that several components of the retinoic acid metabolic pathway are present in the hair follicles of healthy controls. The pathogenesis of AA may be related to increased serum retinol-binding protein-4 (RBP4) level.
Objectives
To evaluate RBP4 level in serum obtained from patients with AA in comparison with controls and detect its relation with severity of alopecia areata tool score and recurrence of disease.
Patients and methods
The study included 52 AA patients (26 AA first episode, 26 patients with recurrent alopecia) and 26 patients in the control group.
Results
RBP4 was significantly elevated in serum level of AA patients in comparison with serum level of controls (
P
< 0.001), but there was no significant positive correlation between serum RBP4 and severity of alopecia areata tool score.
Conclusion
AA was associated with increased serum levels of RBP4 in comparison with controls. These results suggested the role of RBP4 in the pathogenic process of AA.
[ABSTRACT]
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NEUROPSYCHIATRY - ORIGINAL ARTICLE
Electroencephalogram activity in attention-deficit hyperactivity disorder
Lamyaa G. E. Elhamrawya, Mohamed S Abdelshafy, Mai A Shalaby
April-June 2022, 35(2):567-572
DOI
:10.4103/mmj.mmj_224_21
Objective
The aim of the study was to apply an evidence-based pharmacotherapy on different groups of attention-deficit hyperactivity disorder (ADHD) patients monitored by electroencephalogram (EEG) before and after 6 months of treatment and to estimate the prevalence of ADHD in a sample of Egyptian governorates (Kafr El Sheik and Menoufia neuropsychiatric clinics). It also aimed to detect the neurobiological basis of ADHD children using EEG.
Background
ADHD is one of the most commonly diagnosed and treated psychiatric disorders in childhood.
Patients and method
A randomized, clinical trial was conducted on 30 children attending our neuropsychiatric outpatient clinic, screened from 255 children diagnostic through
Diagnostic and statistical manual of mental disorders
, 5
th
ed. and Kiddie-Schedule For Affective Disorders And Schizophrenia-Present And Lifetime Version. Psychiatry, Mental Health, (KSADS-PL) scale screening. Then the patients were divided into two equal groups. The first group received the drug Strattera (Eli Lilly Company) at a dose of (0.5: 1.2 mg/kg/day) only. The second group received Concerta (Alza Corporation) at a dose of (18 mg/day). Another 30 children are randomly allocated to control groups (30 children in each). Full history taking and complete clinical examination were done. KSADS-PL rating scale was assessed at baseline and then 6 months after treatment. EEG monitoring of children before and after treatment.
Results
In this study we found that the score of the KSADS-PL rating scale was significantly decreased in ADHD patients after treatment in both pharmacotherapy groups. In addition, there was no significant difference in EEG between both ADHD children before and after treatment.
Conclusion
Pharmacotherapy using drugs as concerta and stratera has beneficial effects in reducing ADHD symptom severity
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Natural killer cell dynamics and its association with response to imatinib-treated patients with chronic myeloid leukemia
Iman A Ahmedy, Fathia Elbassal, Enas Elkhouly, Yasmin A.H.S. Younis, Mohamed A Helwa
April-June 2022, 35(2):385-392
DOI
:10.4103/mmj.mmj_170_21
Objective
This study aims to assess the effect of natural killer (NK) cells and natural killer T (NKT) cells on response to imatinib (IM) therapy in patients with chronic myeloid leukemia (CML).
Background
NK cells and NKT cells play a vital role in innate immunity against tumors. NKT cells recognize tumor cells by receptor-ligand interaction. After contact with the ligand, NKT cells activate NK cells through inflammatory cytokines [interferon-gamma (IFN-γ) and interleukin 2].
Patients and methods
A total of 48 newly diagnosed patients with CML (chronic phase) were included. They were followed up for 1 year after the start of IM therapy and were categorized into IM-responder patients with CML (
n
= 23) and IM-resistant patients with CML (
n
= 25). Flow cytometry was used to measure NK and NKT cells. Serum levels of IFN-γ were determined by enzyme-linked immunoassay.
Results
We found that NK cell% and NKT cell% were increased in the IM-responder group after 1 month of IM therapy. IFN-γ was increased at both presentation and 1 month after the start of IM therapy. Major molecular response was achieved earlier in the IM-responder group, with increased NK cell%, absolute count of NK cell, and IFN-γ.
Conclusion
We conclude that NK cells have a critical role in the response of patients with CML to IM therapy and are a predictor of major molecular response in patients with CML.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Androgen receptor gene polymorphism and female sexual functionin Egyptian women
Azza G Farag, Yasser A Shehata, Sara E Elghazouly, Mustafa E Elshaib, Nesreen G. E. Elhelbawy
April-June 2022, 35(2):463-469
DOI
:10.4103/mmj.mmj_200_21
Background
Androgen receptor (AR) polymorphism in cytosine–adenine–guanine (CAG) repeat has an effect on the functional capacity of AR in males. However, little researches in this field are available regarding female sexual function.
Objectives
To investigate the possible link between polymorphism in CAG repeat of AR gene and female sexual function in a sample of Egyptian women.
Patients and methods
In all, 500 married Egyptian women completed a questionnaire regarding sociodemographic, reproductive, and sexual data. AR CAG repeat length was analyzed for those having female sexual dysfunctions using real-time PCR.
Results
The most sensitive domain to AR CAG repeat length was orgasm domain that showed significant positive correlations with short allele (
P
= 0.001), long allele (
P
= 0.015), biallelic mean (
P
= 0.000), and X-weighted biallelic mean (
P
= 0.000). Satisfaction domain had significant positive correlations with biallelic mean (
P
= 0.035) and X-weighted biallelic mean (
P
= 0.032). However, the pain domain was of significant negative correlations with AR polymorphism of short allele (
P
= 0.002), biallelic mean (
P
= 0.013), and X-weighted biallelic mean (
P
= 0.011).
Conclusions
AR polymorphism could represent a nonnegligible aspect in female sexual function. The lower AR CAG repeat polymorphism was of significant impact on female sexual dysfunction affecting mainly female orgasm, followed by pain disorders that finally reflected on her sexual satisfaction.
[ABSTRACT]
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[EPub]
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Assessment of hepatic steatosis by computed tomography and its relation with coronary artery disease
Waleed A Mousa, Hager K Abdelmonem, Eman Ragab
April-June 2022, 35(2):641-646
DOI
:10.4103/mmj.mmj_195_21
Objectives
To assess the association between nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) frequency and severity using multidetector computed tomography.
Background
Fatty liver disease is a common disorder with an increasing prevalence. It is considered to be an important association with several cardiovascular risk factors and to be a component of metabolic syndrome.
Patients and methods
This study was carried out on 175 patients presented to the Radiology Department at Menoufia University Hospital and some private centers from January 2020 to March 2021 and who were referred from cardiology and internal medicine outpatient clinics. Twenty nine patients were excluded according to the exclusion criteria. All patients were subjected to clinical assessment, coronary CT angiography, and CAD-reporting and data system was used to assess the CAD severity. Nonenhanced CT examination of the liver was used to assess hepatic steatosis.
Results
Among 146 patients enrolled into our study, 54 (37%) patients were diagnosed with NAFLD; 39 (72.2%) of them showed CAD. There was positive significant association (
P
= 0.003) between NAFLD and CAD and positive strong association (
P
= 0.001) between NAFLD and CAD grades by CAD-reporting and data system.
Conclusion
NAFLD is significantly associated with CAD in a grade-dependent manner, and assessment of NAFLD may be helpful for cardiovascular risk stratification.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
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ANESTHESIOLOGY AND INTENSIVE CARE - ORIGINAL ARTICLES
Role of noninvasive imaging techniques as outcome predictors in traumatic brain injury
Ola S Aboebaid, Mamdouh E Lotfy, Mohammad Y Elbahar, Shaima A Hassanein, Asmaa M Sedky
April-June 2022, 35(2):678-685
DOI
:10.4103/mmj.mmj_154_21
Objectives
We aimed to assess the predictive value of early transcranial Doppler (TCD) in patients with traumatic brain injury (TBI) in terms of secondary neurological insult and to establish the comparison between TCD and other diagnostic methods as predictors of outcome in those patients.
Background
Patients with mild to moderate TBI are at risk of grave neurologic outcomes. Early use of TCD for these patients could be a good predictor.
Patients and methods
This prospective cohort study enrolled adult patients with mild and moderate TBI. Early TCD was done, and the peak systolic velocities, end-diastolic velocity, and time-averaged mean velocity in the middle cerebral artery were recorded. The pulsatility index and the resistance index were calculated. Secondary neurological deterioration (SND) was assessed on the seventh day from injury. Prognosis was also assessed by the Glasgow outcome scale (GOS) on the 28
th
day of admission.
Results
In all, 120 patients were enrolled. Of these, 78 patients had SND, and 44 patients developed bad 28-day GOS. Age and severity of trauma (mild and moderate TBI) were significantly associated with both SND and bad GOS. TCD measurements were good predictors to detect patients at risk of SND and the 28-day GOS. Using receiver-operating characteristic analysis, the best threshold limit was found to be 25 cm/s for diastolic cerebral blood flow velocity and 1.2 for pulsatility index. Combination cutoffs of TCD parameters could be good predictors of SND.
Conclusion
Early TCD measurements after mild to moderate TBI could predict patients at risk of SND and bad neurological outcome.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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CARDIAC SURGERY - ORIGINAL ARTICLES
Perioperative effect of acetylsalicylic acid stoppage duration before coronary artery bypass grafting
Mohamed G Hagag, Mohamed S Amar, Ahmed A El-Badie Emara, Islam I Moheb
April-June 2022, 35(2):694-698
DOI
:10.4103/mmj.mmj_187_21
Objective
To assess the effect of timing of preoperative cessation of aspirin therapy on perioperative morbidity and mortality in patients undergoing coronary artery bypass graft (CABG) surgery.
Background
Aspirin is used for primary or secondary prevention of thrombotic complications. It inhibits platelet function and so there is an increased risk of hemorrhage among patients undergoing CABG. Aspirin discontinuation time before CABG surgery has been a controversy for years. We aimed at assessing the effect of timing of preoperative cessation of aspirin therapy on perioperative morbidity and mortality in patients undergoing CABG surgery.
Patients and methods
Sixty patients having coronary artery disease and indicated for CABG surgery were included. Patients were randomly allocated into two groups: group A (32 patients) patients received 100 mg (enteric coated aspirin)/day till the day of surgery and group B (28 patients) patients received aspirin 100 mg daily until 5 days before surgery. We followed postoperative hemodynamics, morbidity, and mortality for 30 days after surgery.
Results
Group A had significantly lesser ICU stay, duration of inotropic support, and duration of mechanical ventilation than the other group. However, the need of intraoperative and postoperative blood transfusion, reopening for bleeding, postoperative myocardial infarction, and 30 days mortality were similar between the two groups.
Conclusions
Late use of aspirin till the day of surgery in small doses was associated with less ICU stay and earlier weaning from mechanical ventilation and was not associated with increased risk of bleeding, increased need for blood transfusion nor increased rates of reoperation for bleeding. Hence, we can conclude that late aspirin use is recommended especially in high-risk patients
[ABSTRACT]
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
STAT4 gene polymorphism as a risk factor for hepatocellular carcinoma on top of chronic hepatitis C
Mai Elashmawy, Ann Abdel Moneim, Gamal Abo-Raia, Mai Abo-Zeid, Karema Diab
April-June 2022, 35(2):406-411
DOI
:10.4103/mmj.mmj_297_21
Background
Single-nucleotide polymorphism in the STAT4 gene was strongly associated with the risk of hepatocellular carcinoma (HCC) progression in patients chronically infected with hepatitis C virus (HCV).
Objective
To study the effect of STAT4 gene (rs7574865) polymorphism on HCC in complicating chronic hepatitis C.
Patients and methods
One hundred and fifty individuals were divided into three groups. The studied participants were divided into three groups. Group I: 50 apparently healthy individuals served as controls. They were completely free clinically with normal laboratory investigations, normal abdominal ultrasonography, and no history of liver and renal disease. Group II: 50 chronic HCV patients confirmed by HCV-antibodies and PCR HCV RNA analysis. Group III: 50 HCV-induced HCC patients confirmed by computed tomography and serum alpha-fetoprotein. Most of the patients are males with a mean age of 54 years. Real-time PCR analysis to determine STAT4 (rs7574865) gene polymorphism was performed on DNA extracted from all the studied participants.
Results
Comparing the three studied groups, there was highly significant statistical difference regarding genotype and allele frequency distribution with a GG genotype of 20% in the control group, 46% in the HCV group, and 56% in the HCC group with a
P
value less than 0.001. GT genotype is 50% in the control group, 44% in the HCV group, and 38% in the HCC group. There were statistically significant differences in STAT4 (rs7574865) allele frequencies between the patient group (HCC and HCV as one group) and the control group (
P
< 0.001) [GG: odds ratio (OR)=9.562, 95% confidence interval (CI)=3.204–28.541, GT: OR = 3.075, 95% CI = 1.141–8.290]. Allele association study revealed a significant risk association between allele type and cancer development (OR = 3.066, 95% CI = 1.861–5.053).
Conclusion
The results suggested that STAT4 (rs7574865) GG genotype is associated with HCC development in Egyptians with chronic HCV infection.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Surgically induced astigmatism following femtosecond laser-assisted cataract surgery compared with conventional phacoemulsification
Abdel R Sarhan, Khaled El-Ghonemy, Sameh El-Gouhary, Hassan M. S. H. Sorour
April-June 2022, 35(2):808-814
DOI
:10.4103/1110-2098.352197
Objective
In the present study, we reviewed surgically induced astigmatism (SIA) in femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification in patients who have cataract.
Background
To assess SIA following clear corneal incisions created manually or with the Catalys femtosecond laser.
Patients and methods
In the present study, patients undergoing FLACS or manual cataract surgery between 2017 and 2019 from a single surgical center in Egypt were considered for inclusion. Postoperative corneal astigmatism values were compared with preoperative astigmatism indices to determine the SIA at 3 months postoperatively using the Alpins vector method.
Results
Refractive and topographic outcomes from 80 eyes of 40 patients (40 eyes in the manual group and 40 eyes in the FLACS group) were included. There was no significant difference in SIA (manual: 0.96 D and FLACS: 0.72 D) after 3 months postoperatively.
Conclusions
There was no significant difference in SIA between FLACS and manual cataract surgery after 3 months of surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
598
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CARDIAC SURGERY - ORIGINAL ARTICLES
Efficacy and safety of thoracoscopic talc pleurodesis in the treatment of malignant pleural effusion
Mohamed S Abdelmotaleb
April-June 2022, 35(2):704-708
DOI
:10.4103/mmj.mmj_50_22
Objective
To evaluate the efficacy and safety of thoracoscopic talc pleurodesis in the management of malignant pleural effusion (MPE).
Background
MPE is a common complication of advanced malignancy. Pleurodesis is a well-recognized treatment for the management of MPE. Talc is considered the most effective sclerosing agents used to produce pleurodesis.
Patients and methods
This is a retrospective chart review of all patients with MPE who underwent thoracoscopic talc pleurodesis for the management of MPE from April 2020 to December 2021.
Results
A total of 24 patients with MPE who underwent thoracoscopic talc pleurodesis for the management of MPE were included in the study. The mean age was 63 ± 8.35 years, and included 12 (50%) males and 12 (50%) females. Overall, low-grade fever was seen in four (16.67%) patients, pleuritic chest pain in three (12.5%) patients, and no complication in 17 (70.83%) patients. No recurrence of pleural effusion happened in 21 (87.5%) patients, recurrence in the form of localized effusion that did not need medical interference happened in two (8.33%), and recurrence in the form of diffuse effusion that needed medical interference happened in one (4.17%) patient. Operative time was 43.75 ± 6.63 min, duration of chest tube insertion was 3.25 ± 0.44 days, and hospital stay was 6 ± 0.72 days.
Conclusions
Thoracoscopic talc pleurodesis for the treatment of MPE is a feasible and effective treatment with short operative time, is a minimally invasive procedure, and has few adverse effects, making it a safe and effective option for managing patients with MPE.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Fibroblast growth factor 23 and carotid intima media thickness in non-diabetic chronic kidney disease patients
Sanaa S Gazareen, Mohamed Abd el Raouf Korany, Mohamed R El-Kholy, Belal A Montaer, Soha A. M. Fawaz, Mohamed Z Nooh
April-June 2022, 35(2):535-542
DOI
:10.4103/mmj.mmj_134_21
Objectives
To clarify the relationship between fibroblast growth factor-23 (FGF23) and carotid intima-media thickness (CIMT) in nondiabetic chronic kidney disease (CKD) patients on conservative treatment.
Background
CIMT is a reliable marker of subclinical atherosclerosis, and it has been associated with increased risk of cardiovascular events among CKD. Vascular calcification in CKD patients was independently correlated with FGF23.
Patients and methods
The study included 75 nondiabetic CKD patients on conservative treatment aged from 20 to 65 years as group 1 and 15 healthy individuals aged from 28 to 61 years, who have no medical history as a control group (group 2). Group 1 was subdivided into two groups: patients with increased CMIT and patients with normal CMIT. The study was conducted from October 2018 to May 2019. The patients were excluded if they have any of the following criteria: acute illness, CKD on dialysis, and patients with diabetes mellitus. The study was a case–control study. All patients and healthy individuals were subjected to the following: full history taking, general demographic data, including age, sex, height, weight, drug history, clinical examination, and laboratory investigations in the form of complete blood count, serum creatinine, and fasting and postprandial blood glucose. Estimated glomerular filtration rate (eGFR) was calculated by the Cockcroft–Gault formula as follows: eGFR=[140 − age (years)]×weight (kg)/serum creatinine (mg/dl)×72 [×0.85 if female], liver function tests (alanine transferase, aspartate transferase, serum albumin level), corrected serum calcium, serum phosphorus, lipid profile, carotid ultrasound, and intact FGF23.
Results
FGF23 levels and CIMT were significantly increasing across all the stages of CKD. The CIMT is significantly increasing in nondiabetic CKD patients with FGF23 levels of above 190 pg/ml. FGF23 levels positively correlated with the levels of creatinine, calcium, phosphrous, eGFR, hemoglobin, and albumin in nondiabetic CKD patients.
Conclusion
Nondiabetic CKD patients had higher levels of FGF23 than controls. Nondiabetic CKD patients with increased CIMT had significantly higher phosphorus, creatinine, and FGF23 levels than those with normal CIMT. CIMT and FGF23 were significantly increased across all the stages of CKD. Increasing FGF23 concentrations across the stages of CKD reflect increasing CIMT and progression in CKD nondiabetic patients on conservative treatment.
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MEDICAL BIOCHEMISTRY - ORIGINAL ARTICLE
The Value of serum Golgi protein 73 as a biomarker for hepatocellular carcinoma
Ashraf A Dawood, Naglaa M Ghanayem, Ahmed K Khamis, Hasnaa M Shibl, Mona S Habieb
April-June 2022, 35(2):559-566
DOI
:10.4103/mmj.mmj_225_21
Background
Hepatocellular carcinoma (HCC) is the most common liver cancer arising from the hepatocytes. The most prevalent noninvasive biological marker for diagnosis of HCC is alpha-fetoprotein (AFP). Golgi protein 73 (GP73) was considered as an impending biological marker for the early diagnosis of HCC.
Objectives
To assess the value of GP73 in serum as a biological marker for HCC comparing its sensitivity and specificity with serum AFP.
Methods
This study included 90 participants (30 patients with hepatitis-C virus (HCV)-related HCC, 30 patients having liver cirrhosis on top of chronic HCV, and 30 healthy controls). The levels of AFP and GP73 in serum were measured by chemiluminescent immune-metric assay and enzyme-linked immunosorbent assay techniques, respectively.
Results
HCC and cirrhotic patients had considerably higher AFP (
P
< 0.001, <0.004) and GP73 (
P
< 0.001, 0.047) levels than controls, whereas HCC patients had significant higher values of AFP and GP73 than cirrhotic patients (
P
= 0.029, <0.001, respectively). Combined AFP + GP73 had the highest sensitivity and specificity (
P
< 0.001) for differentiating HCC patients from controls. In discrimination of HCC patients from cirrhotic patients, serum GP73 had the highest sensitivity and specificity (
P
< 0.001) than AFP (
P
= 0.009) and combined AFP + GP73 (
P
< 0.001). Moreover, in discrimination of metastatic patients from nonmetastatic ones, combined AFP + GP73 had the highest sensitivity (
P
< 0.001) than GP73 alone (
P
= 0.013), whereas AFP alone had the highest specificity (
P
= 0.058) than combined AFP + GP73.
Conclusion
GP73 is a reliable biological marker for early diagnosis and detection of distant metastasis of cancerous liver diseases in patients having liver cirrhosis on top of chronic HCV infection and it would yield better results when used combined with AFP.
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Evaluation of PCR technique as a rapid screening method for detection of
Group B streptococci
colonization in pregnant women
Rawhia H El-edel, Azza M Abd El-Aziz, Amany M Abd El-Maksoud, Dalia I Morsy, Reem M Elkholy
April-June 2022, 35(2):412-417
DOI
:10.4103/mmj.mmj_256_21
Background
Group-B streptococci
(
GBS
) colonization in pregnant women could be a source of serious neonatal infections, such as meningitis and sepsis; therefore, a rapid and accurate method for detection is needed for early prophylaxis. Conventional culture is a common method used for the detection of
GBS
. However, polymerase-chain reaction (PCR)-based assay may be another method for detection of
GBS
colonization.
Objective
To evaluate the performance of the PCR as a method for detection of
GBS
(
Strept. agalactiae
) colonization in the urogenital tract of pregnant women and to detect its prevalence among these women.
Methods
The present study was done at the Department of Clinical Pathology and Department of Obstetrics/Gynecology, Menoufia University Hospitals, during the period from June 2020 to June 2021. In this study, vaginal and perianal swabs were collected from 250 pregnant women, between the 35
th
and 37
th
weeks of pregnancy, who attended the Department of Obstetrics and Gynecology for perinatal care. Their ages ranged from 20 to 40 years. GBS was detected by culture VITEK2 and PCR was done.
Results
The prevalence of colonization in pregnant women with
GBS
was 20%. The sensitivity and specificity of PCR and culture were 99% and 98%, respectively.
Conclusions
PCR technique is a rapid, specific, and sensitive diagnostic tool for
GBS
detection. So, PCR could be used as a rapid test for the detection of GBS colonization in pregnant women. The sensitivity and specificity of automated culture were 99.8% and 89.2%, respectively, so it is also a rapid and specific method for the detection of
GBS
colonization.
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PEDIATRICS - ORIGINAL ARTICLES
Assessment of fibroblast growth factor-23 in children with nephrotic syndrome treated with glucocorticosteroids
Fahima M Hassan, Mohamed S Elharoun, Noran T Aboelkhair, Mahmoud M. K. Ahmed
April-June 2022, 35(2):601-606
DOI
:10.4103/mmj.mmj_305_21
Objectives
To evaluate fibroblast growth factor-23 (FGF-23) levels in children with nephrotic syndrome treated with glucocorticosteroids in comparison with existing markers of bone metabolism.
Background
Nephrotic syndrome is a frequent chronic illness defined by changes of permselectivity at the capillary wall of renal glomeruli, resulting in the glomerular inability to limit protein loss in urine. FGF-23 is an effective phosphaturic hormone secreted by osteocytes, which has a vital role in vitamin D and phosphate homeostasis.
Patients and methods
This case–control study included 80 children of which 40 children with idiopathic nephrotic syndrome were subdivided into three groups: steroid-dependent, steroid-resistant, and frequent relapse, as well as 40 children as the control group. Venous blood samples were taken for estimation of serum phosphorus, calcium, and parathormone hormone (PTH). The level of FGF-23 was assayed by enzyme-linked immunosorbent assay. Correlations of FGF-23 level with serum calcium, phosphorus, and PTH were also investigated.
Results
Serum levels of calcium, phosphorus, and PTH for children in steroid-dependent, steroid-resistant, and frequent-relapse groups were significantly lower than the controls (
P
< 0.001). Serum levels of FGF-23 were significantly higher in steroid-dependent, steroid-resistant, and frequent-relapse groups with a mean of 5.16, 5, and 4.51 ng/l, respectively, compared with the control group with a mean of 0.48 ng/l (
P
< 0.001). There was a significant negative correlation between FGF-23 and each of PTH, phosphorus, and calcium (
P
< 0.05).
Conclusion
FGF-23 could be used as a biomarker for osteodystrophy in nephrotic kidney disease in children.
[ABSTRACT]
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ORTHOPEDIC SURGERY - ORIGINAL ARTICLES
Comparative study of revision hip arthroplasty after short stem versus after conventional stem
Mohamed S. A. Arafa, Elsayed M Zaki, Mohamed E Habib, Yegappan Kalairajah, Harish Parmer, Yasser S Hannout, Sameh M Marae
April-June 2022, 35(2):905-912
DOI
:10.4103/mmj.mmj_243_21
Objective
To compare clinical and radiological outcomes in revision total hip arthroplasty (THA) after short-stem versus conventional-stem THA.
Background
Short-stem THA aims to preserve the proximal bone stock for future revisions, so that the first revision resembles a primary intervention rather than a revision.
Patients and methods
This study included 30 patients with revision THA divided into two groups (15 each); group A: revision after short stem and group B: revision after conventional stem. The studied groups were compared regarding 31 variables including demographic data, details of the primary and revision procedures, postoperative radiological subsidence, hospital stay, time for full weight bearing, and preoperative and postoperative clinical scores.
Results
Early stem subsidence (40%) was the main indication of revision in group A compared with periprosthetic femoral fractures (73.3%) in group B (
P
= 0.021). The mean time to revision was significantly shorter in group A (15 months) compared with 95.33 months in group B (
P
= 0.005). The mean operative time, blood loss, postoperative blood transfusion, and hospital stay were significantly lower in group A compared with group B (
P
< 0.001,
P
< 0.001,
P
= 0.002 and
P
= 0.001, respectively). Revisions in group A were performed using either short stems (13.3%) or conventional stems (86.7%) while 80% of patients needed long stems and 20% of patients needed conventional stems in group B (
P
< 0.001).
Conclusion
The most common cause of failure of short stems is early stem subsidence. Short-stem THA has specific indications, and patient selection is very crucial. Revision of short-stem THA resembled the primary THA.
[ABSTRACT]
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DERMATOLOGY - ORIGINAL ARTICLES
Evaluation of the serum squamous-cell carcinoma antigen 2 in patients with atopic dermatitis and its relation to disease severity
Hesham N Khalid, Gehad G Ibrahim, Yasser A Elghobashy
April-June 2022, 35(2):458-462
DOI
:10.4103/mmj.mmj_194_21
Objective
To study serum squamous-cell carcinoma antigen 2 (SCCA2) in atopic dermatitis (AD) patients compared with controls and question its possible relation to disease severity.
Background
AD is a very common chronic inflammatory skin disease characterized by intense itching, skin dryness among other features with characteristic exacerbations and remissions with unfavorable response to treatment in many cases.
Methods
In total, 60 patients were enrolled in this study and divided into two groups: group A: 30 AD patients, group B: 30 healthy controls. AD patients were diagnosed with AD by a dermatologist. Diagnosis of AD was based on the criteria of Hanifin Rajka. The severity of skin eruption was determined as mild, moderate, and severe according to Eczema Area Scoring Index (EASI) score. All patients were subjected to full history taking and clinical examination. Laboratory investigation: tested for serum level of SCCA2, double-antibody sandwich enzyme-linked immunesorbent assay (ELISA) was used to detect serum level of SCCA2 utilizing commercial Human (SCCA2) ELISA Kits for research use only.
Results
SCCA-2 level was statistically significantly higher in AD patients compared with controls (
P
< 0.001). There was a highly positive significant correlation between SCCA-2 level with EASI in AD patients (
P
< 0.001). SCCA-2 was found to be statistically significantly higher in severe patients compared with moderate and mild patients (
P
< 0.001).
Conclusions
SCCA-2 has a strong link to the pathogenesis of AD. It was found to be closely related to the disease severity.
[ABSTRACT]
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GENERAL SURGERY - ORIGINAL ARTICLES
Endoscopic papillary large balloon dilation with or without sphincterotomy for extraction of large bile duct stones
Mahmoud M Alabassy, Hatem M Soltan, Amany A Amer, Ezzat M Abdalla, Randa M Seddik, Amira M El-Feky
April-June 2022, 35(2):716-721
DOI
:10.4103/mmj.mmj_41_22
Objectives
This work aimed to evaluate the safety and efficacy of endoscopic papillary large balloon dilatation (EPLBD) with or without endoscopic sphincterotomy (EST) in extraction of large common bile duct stones (CBDSs).
Background
EST combined with EPLBD has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that EPLBD alone may be safe and effective in this setting.
Patients and methods
From July 2019 to December 2021, we prospectively compared EPLBD alone (group I,
n
=100) with EST+EPLBD (group II,
n
=100) for the treatment of large CBDSs. CBDS clearance rate, frequency of mechanical lithotripsy usage, total procedure time, and intraendoscopic and postendoscopic complications were analyzed.
Results
Statistical analysis revealed that there were no significant differences between the studied groups regarding the use of mechanical lithotripsy (6 vs. 8%,
P=
0.579), overall and initial stone clearance rates (92 vs. 88%,
P=
0.346; and 81 vs. 76%,
P=
0.389, respectively), procedure-related pancreatitis (3 vs. 1%,
P=
0.312), or other intraendoscopic and postendoscopic adverse events, but there was a significant difference in terms of total procedure time (41.23±10.6 vs. 36.87±8.06,
P=
0.001).
Conclusion
The therapeutic outcomes and complications of sole EPLBD for the removal of large CBDSs were comparable to those of EPLBD with prior EST.
[ABSTRACT]
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ORTHOPEDIC SURGERY - ORIGINAL ARTICLES
Arthroscopic-assisted versus all-arthroscopic massive rotator-cuff repair: a cohort study of postoperative return to work
Taher A Eid, Soliman H Zalalo, Ahmed M. A. Abdelmegid, Mohamed A Samy
April-June 2022, 35(2):890-898
DOI
:10.4103/mmj.mmj_276_21
Objective
To evaluate arthroscopic-assisted versus all-arthroscopic suture-anchor repair of massive rotator-cuff tears (RCTs), especially regarding postoperative patient's return to work.
Background
Massive RCTs represent a challenging problem for shoulder surgeons. Management of RCT aims at pain relief, movement restoration, and improvement of the shoulder function.
Patients and methods
A prospective study of 38 patients having massive RCT, conducted at Menoufia University Hospital and Neurosurgery Hospital between September 2019 and March 2021. Patients were divided into group A, which included 19 patients who were managed by arthroscopic-assisted technique. Group B included 19 patients who were managed by all-arthroscopic technique. Full history taking with complete clinical examination. All patients have completed 6-month postoperative follow-up.
Primary outcome
Postoperative patient's time to return to work.
Results
Our results found that postoperatively, there was statistically highly significant improvement in range of motion and University of California, Los Angles score in each group with a statistically nonsignificant difference between both groups. Comparison between both groups in time to return to work: postoperatively, there was a statistically nonsignificant difference between both groups in time to return to work, but in the all-arthroscopic group (group B), the patient returned to work slightly earlier.
Conclusion
Both arthroscopic-assisted and all-arthroscopic procedures are effective in management of massive RCTs and result in significant improvement in clinical, functional outcomes, and patients' return to preinjury level of activity and work with a statistically nonsignificant difference between them, and both procedures could be used as an alternative repair method for massive RCTs.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Comparative study of refractive outcomes after photorefractive keratectomy and small-incision lenticule extraction in moderate myopia
Shaimaa M Azzam, Abdelrahman Elsebaey, Khaled Elghonemy, Ahmed I Basiony
April-June 2022, 35(2):827-831
DOI
:10.4103/mmj.mmj_60_22
Objectives
To compare the refractive outcomes after photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE) in moderate myopia.
Background
PRK and SMILE are two flapless procedures for the correction of myopia and astigmatism. In PRK, an excimer laser is used for photoablation, whereas in SMILE, a femtosecond laser is used to create the lenticule.
Patients and methods
A retrospective study was conducted on 80 patients (160 eyes) who were classified into two groups: PRK and SMILE. A total of 40 patients (80 eyes) were included in each group. Assessment was between 6 months and 3 years postoperatively comparing the uncorrected distance visual acuity, best-corrected distance visual acuity, and manifest refraction spherical equivalent with the preoperative data in addition to assessing the efficacy, safety, and predictability in each procedure.
Results
The two groups were matched for age, sex, and preoperative characteristics. The mean postoperative uncorrected distance visual acuity in the PRK group was 0.96 ± 0.06 and in the SMILE group was 0.95 ± 0.08 (
P
= 0.621). The mean postoperative best-corrected distance visual acuity in the PRK group was 0.96 ± 0.06 and in the SMILE group was 0.97 ± 0.07 (
P
= 0.735). The mean postoperative manifest refraction spherical equivalent in the PRK group was − 0.24 ± 0.34 and in the SMILE group was − 0.30 ± 0.20 (
P
= 0.186). The mean efficacy index in the PRK group was 0.99 ± 0.05 and in the SMILE group was 0.99 ± 0.07 (
P
= 0.456). The mean safety index in the PRK group of all eyes was 1.00 ± 0.03 and in the SMILE group was 1.00 ± 0.04 (
P
= 0.704). In the PRK group, 90% of all eyes were within ± 0.50 D of intended refraction and 100% were within ± 1.00 D. In the SMILE group, 95% of all eyes are within ± 0.50 D of intended refraction and 100% were within ± 1.00 D.
Conclusion
PRK and SMILE procedures showed excellent efficacy, safety, and predictability in moderate myopia, whereas SMILE was noticed to be better in predictability than PRK.
[ABSTRACT]
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Highlighting multidetector computed tomography capabilities in assessing trauma to the retroperitoneal region: a cross-sectional study
Nashwa R. A. Elwahash, Mohamed R Elkholy, Shaimaa A. H. Hassanein
April-June 2022, 35(2):620-625
DOI
:10.4103/mmj.mmj_166_21
Objectives
The main objective of this study was to evaluate the different injury types of retroperitoneal trauma regarding their multidetector computed tomography (MDCT) findings.
Background
Traumatic injuries of the abdomen are one of the most common causes of morbidities and mortalities worldwide. Retroperitoneal traumatic injuries occur in a minority of abdominal trauma; however, they cause higher mortality rates compared with other types of abdominal trauma.
Patients and methods
We conducted a cross-sectional observational diagnostic study on patients admitted for emergent radiological examination following abdominal trauma. History, clinical examination, laboratory investigations, and MDCT were done to detect retroperitoneal injuries and assess their severity.
Results
A total of 21 (70%) patients had renal injuries, two had ureteric injuries, three had pancreatic injuries, two had vascular injuries, two had psoas muscle injuries, and two had a pelvic bone injury. The MDCT showed that 30 patients had at least one retroperitoneal injury. Perinephric hematoma was the most common MDCT finding (42%) in patients with renal injuries. Associated injuries were seen in around one-third of study participants, including pleural effusion and splenic and hepatic injuries. According to the surgical retroperitoneal zones, zone II showed the highest frequency (80%). The final management of our cases were classified as follows: 13 patients were treated conservatively, whereas 19 patients had surgical management.
Conclusion
MDCT is considered the imaging modality of choice in diagnosing and staging cases with retroperitoneal traumatic injuries. MDCT should be used as a follow-up technique to detect cases missed by the initial CT scan.
[ABSTRACT]
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CLINICAL ONCOLOGY - ORIGINAL ARTICLE
Prognostic value of programmed death ligand-1 expression in breast carcinomas
Hagar A Alagizy, Naser M Abd El Bary, Asmaa S Mohamed, Mohamed T Mohamoud, Suzy F Gohar
April-June 2022, 35(2):709-715
DOI
:10.4103/mmj.mmj_192_21
Objectives
To assess the prognostic value of programmed death ligand-1 (PDL-1) expression in patients with nonmetastatic breast carcinoma patients both in tumor cells and tumor-infiltrating lymphocytes (TILs).
Background
PDL-1 has emerged as important immune biomarkers in breast cancer. It can be targeted with immunotherapy, which represents a significant advancement in the management of this disease.
Patients and methods
Paraffin blocks of patients with breast cancer will be tested for the expression of PDL-1 both on TILs and malignant epithelial cells and correlated with patients and disease features.
Results
This retrospective study included 60 patients. PDL-1 expression was positive in 33 (55%) patients on TILs and was positive in tumor cells in 27 (45%) patients of the studied patients. There was no significant relation between PDL-1 expression on TILs and patients and disease features. There was significant relation between positive PDL-1 expression on epithelial cells and triple-negative breast cancer, estrogen receptor negative, progesterone receptor negative status (
P
= 0.006, 0.006, and 0.006). PDL-1 intensity in intratumoral lymphocytes is significantly related to tumor stage (
P
= 0.006). PDL-1
H
score in malignant epithelial cells was significantly related to disease stage (
P
= 0.021). Tumor size, HER-2neu status, and PDL-1
H
score on malignant epithelial cells were independent risk factors for disease progression.
Conclusion
PDL-1 expression is common in both malignant tumor cells and TILs. A higher PDL-1
H
score on malignant epithelial cells was associated with longer time to progression.
[ABSTRACT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Intravitreal injection of ranibizumab for treatment of macular edema secondary to retinal vein occlusion
Manal M Salah El Deena, Hatem M. G. Marey, Asmaa M Ibrahim
April-June 2022, 35(2):815-820
DOI
:10.4103/mmj.mmj_42_21
Objective
This study aims to evaluate the effect of ranibizumab for treatment of macular edema (ME) secondary to retinal vein occlusion (RVO).
Patients and methods
This is a prospective case series study that included 35 eyes of patients with ME due to RVOs. This study was conducted in Menoufia University Hospital during the period study from March 2018 till February 2020. The study protocol was approved by the medical research ethics committee of Faculty of Medicine, Menoufia University.
Results
There was a significant improvement in the best-corrected visual acuity (VA) value in the fourth month postoperatively than preoperatively, whereas there was no change in the sixth month postoperatively than preoperatively (
P
1 < 0.025,
P
2 < 0.17, and
P
3 < 0.025, respectively). There was a significantly improvement in the central macular thickness (CMT) at 4 and 6 months postoperatively than preoperatively (
P
1 < 0.001,
P
2 < 0.001, and
P
3 > 0.037, respectively). Moreover, there was a significant positive correlation between preoperative CMT and Snellen VA, CMT at fourth month postoperatively, and CMT at sixth month postoperatively (
P
< 0.05).
Conclusions
CMT and best-corrected VA were significantly improvement at 4 and 6 months postoperatively compared with preoperatively. In the current study, during the follow-up, no patients showed any severe local adverse events such as retinal detachment, retinal tears, endophthalmitis, or uveitis, and none showed progression to ischemia or rubeosis iridis. No patients experienced any systemic adverse effects. Finally, evaluation of the short-term effect of intravitreal ranibizumab injection can be used to predict the outcome of the therapy at 1 week and 1 month after injection for the ME secondary to RVO.
[ABSTRACT]
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INTERNAL MEDICINE - REVIEW ARTICLES
A study of bone–vascular axis in health and disease
Sabry A Shoeib, Emad M El-Shebiny, Enas S Zahran, Alaa A. Ali Al Sayedb
April-June 2022, 35(2):345-350
DOI
:10.4103/mmj.mmj_171_21
Objectives
The aim was to study bone–vascular axis in health and disease.
Data sources
Medline databases (PubMed and MedScape) and all materials available in the internet were searched. The search was performed in September 2021.
Study selection
The initial search presented 120 articles. The number of studies that met the inclusion criteria was 21. The articles included both sexes and patients with bone–vascular disease.
Data extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest.
Data synthesis
Significant data were collected. Then a structured review was performed.
Finding
In total, 21 potentially relevant publications were included; it was found that cardiovascular and bone disease are pathophysiologically interrelated.
Conclusions
Cardiovascular and bone disease are pathophysiologically interrelated, even though a full understanding of the mechanisms underlying this relationship is still lacking. A better understanding of the biological link between the two processes could lead to the development of new compounds that act on both vessels and bone. Meanwhile, it would seem reasonable to consider cardiovascular disease screening in patients with advanced bone demineralization, as well as careful monitoring for signs and symptoms of cardiovascular disease in chronic kidney disease patients.
[ABSTRACT]
[FULL TEXT]
[PDF]
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PEDIATRICS - LETTER TO THE EDITOR
Free thyroxine and thyroid-stimulating hormone in preterm neonates with respiratory distress syndrome
Mahmood D Al-Mendalawi
April-June 2022, 35(2):945-945
DOI
:10.4103/mmj.mmj_400_20
[FULL TEXT]
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Correlation between corneal tomography and postphacoemulsification positive dysphotopsia
Hisham M Mazar, Mahmoud G. M. Shrief, Ahmed I Bassiouni
April-June 2022, 35(2):850-855
DOI
:10.4103/mmj.mmj_229_21
Objectives
The aim was to compare between patients who have positive dysphotopsia after uncomplicated phacoemulsification surgery and those who do not have regarding their corneal tomographic findings.
Background
Dysphotopsia is a disturbance of vision and includes light phenomena such as haloes, the subjective perception of a bright ring around a light source. It occurs owing to optical nonconformities in the optical path such as cataract or optical boundaries.
Patients and methods
This is a prospective interventional study that was conducted for 1 year on 20 patients with acquired cataracts. Preoperative corneal tomography and visual assessment were carried out, and then postoperative periodic follow-up for 6 months was done with clinical and visual assessment for dysphotopsia.
Results
This study shows that 40% of eyes (eight eyes) had higher order aberration with preoperative positive dysphotopsia and 60% of eyes (12 eyes) showed no higher order aberration with no preoperative positive dysphotopsia. Postoperative assessment of positive dysphotopsia showed that patients with no higher order aberrations complained of positive dysphotopsia and patients with higher order aberrations complained of positive dysphotopsia but more severe than before.
Conclusion
This study concluded that there is a correlation between corneal tomography and postphacoemulsification positive dysphotopsia, which affects visual satisfaction of patients after phacoemulsification surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
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Correlation of anterior ocular-segment biometry with glycated hemoglobin level in type-2 diabetic patients
Hatem M. G. Marey, Gehan A. A. Elsabrout, Marwa A Zaky
April-June 2022, 35(2):864-870
DOI
:10.4103/mmj.mmj_262_21
Background
Diabetic retinopathy (DR), nephropathy, and peripheral neuropathy are the common complications of diabetes mellitus. DR is one of the causes of blindness worldwide. Although diabetic-eye disease is often thought to refer merely to the retina, the anterior segment of the eye has also been shown to be affected in diabetes.
Objective
To compare the anterior ocular-segment biometry among type-2 diabetes mellitus with no DR, nonproliferative diabetic retinopathy (NPDR), and evaluate the correlation of anterior ocular-segment biometry with glycosylated hemoglobin (HbA1c) level.
Patients and methods
A cross-sectional study was conducted on 48 patients. The patients were randomly selected from the Ophthalmology Outpatient Clinic of Menoufia University Hospital. Also, they were divided into group I that included 16 diabetic patients with no DR group, group II included 16 diabetic patients with NPDR group, and group III included 16 healthy participants of comparable age and sex. The results were collected, tabulated, and statistically analyzed. Descriptive statistics included percentage (%), mean, SD, range, and median, and analytic statistics included
χ
2
test, Student's
t
test, Spearman correlation, Mann–Whitney test, and analysis of variance (
F
).
Results
Numbers of angle-opening distance and anterior-chamber angle were significantly increased among diabetic patients with no DR group (524.69 ± 41.92, 29.75 ± 3.28) than diabetic patients with NPDR group (491.06 ± 40.80, 27.50 ± 2.53) and control group (479.00 ± 49.55, 26.94 ± 2.08). Also, central corneal thickness (CCT) was significantly increased among diabetic patients with the NPDR group (561.50 ± 14.93) than diabetic patients with no DR group (505.31 ± 46.15) and control groups (452.06 ± 32.14) (
P
> 0.05). There were significant positive correlations between HbA1c with age, HbA1c%, CCT, and number of angle-opening distance.
Conclusion
Diabetic patients appear to have significantly thicker CCT, regardless of retinopathy status, whereas anterior-chamber width was significantly narrower in diabetics with the NPDR group compared with a diabetic with no DR. Development of new noninvasive diagnostic technologies has provided a better understanding of corneal-tissue changes related to diabetes.
[ABSTRACT]
[FULL TEXT]
[PDF]
428
75
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PEDIATRICS - LETTER TO THE EDITOR
Comparative study of total serum bilirubin levels measured through blood versus skin in neonates
Mahmood D Al-Mendalawi
April-June 2022, 35(2):947-947
DOI
:10.4103/mmj.mmj_119_21
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
434
68
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Status of vitamin-D deficiency among preschool children and associated factors in a rural area in Upper Egypt
Mahmood D Al-Mendalawi
April-June 2022, 35(2):946-946
DOI
:10.4103/1110-2098.352452
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
346
70
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Online since 31 Jan, 2014