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   2021| October-December  | Volume 34 | Issue 4  
    Online since December 24, 2021

 
 
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OBSTETRICS & GYNECOLOGY - ORIGINAL ARTICLES
Third-trimester fetal kidney dimensions by ultrasound in appropriate and small for gestational age
Heba M Abo-Shady, Mohamed M Fahmy, Ahmed M Abdel-Sadek Aboelmagd, Mohamed Z. S. Dayer
October-December 2021, 34(4):1457-1463
DOI:10.4103/mmj.mmj_19_21  
Objective To determine the strength of association of both fetal kidney dimension measurements with gestational age (GA) in appropriate and small for GA in the third-trimester pregnancies. Background Intrauterine growth restriction (IUGR) is defined as a sonographic estimation of fetal weight below the tenth percentile for a given GA. Usual biometric parameters are not reliable in determination of GA, especially in the third trimester. Patients and methods This prospective study was conducted at El-Menoufia University Hospital on patients who routinely visited the antenatal clinic in the third trimester. The cases were subdivided into two groups: group A included patients in the third trimester with appropriate growth pattern (100 patients), and group B included patients with IUGR (lag >2 weeks between age determined by last menstrual period and that determined by ultrasound) (50 patients). The fetal parameters biparietal diameter, femoral length, abdominal circumference, and head circumference were measured with standard procedures. Renal measurements were obtained. Results Our results found that there was a statistically significant positive correlation between GA and right fetal kidney dimensions. On correlation between GA and fetal kidney dimensions in IUGR group, our results showed statistically significant positive correlation between GA and right length (mm), right transverse (mm), right anteroposterior (mm), right volume (CM3), left length (mm), left transverse (mm), left anteroposterior (mm), and left volume (CM3). Conclusion Fetal kidney dimensions, especially at 38 weeks, are most accurate single parameters in estimation of fetal GA, especially among small-for-gestational-age fetuses.
  2,840 104 -
FAMILY MEDICINE - ORIGINAL ARTICLES
Awareness, attitude, and satisfaction of Egyptian adults by premarital care services
Safa H Alkalash, Safaa A Badr, Asmaa G. M Nasr Eldeen
October-December 2021, 34(4):1284-1291
DOI:10.4103/mmj.mmj_458_20  
Objectives To assess knowledge, attitude, and satisfaction by premarital care (PMC) and its associated factors among attendants of Qweisna Family Health Center. Background PMC is a primary preventive approach for couples before marriage to optimize women's wellness and subsequent pregnancy outcomes. It is one of the most important strategies for prevention of genetic disorders and congenital anomalies. Hence, it will save the society and allow people to enjoy their life. Participants and methods A descriptive cross-sectional study was conducted on 202 participants who attended Qweisna Family Health Center. A predesigned questionnaire was used to assess participants' knowledge, attitude, and satisfaction by premarital healthcare services. Results More than two-third of the participants had good knowledge about PMC (73.8%). The main source of knowledge was healthcare provider (44.0%). Good knowledge was significantly higher among younger spouse (20–30 years) (72.9%), females (65.8%), and who were from urban areas (57.0%). Premarital screening explored that nearly half of the participants (49.0%) had microcytic hypochromic anemia, while 15.8% had urine abnormalities. Participants' attitude was positive by 82.7%, which was significantly higher among females) 63.5%) and who were from urban areas (60.0%). Finally, about 69% were satisfied by PMC and it was significantly higher among younger spouse (20–30, years) (75.9%), and females (57.7%). Conclusion Generally; majority of the participants had good knowledge regarding PMC. The beneficiaries showed a positive attitude toward importance of the PMC program, who were very satisfied with the conducted service. Females showed good knowledge and positive attitude toward PM services. Also, participants from urban areas had good knowledge and positive attitude than rural. The level of satisfaction was higher in females and those from urban areas.
  2,388 178 -
ENDEMIC AND TROPICAL MEDICINE - ORIGINAL ARTICLES
Study of the diagnostic role of fecal M2-pyruvate kinase level in patients with colorectal cancer
Atef Aboelsoud, Aymen Elehleh, Belal Montser, Ahmed Talaat, Mohsen El Khayat
October-December 2021, 34(4):1268-1274
DOI:10.4103/mmj.mmj_318_20  
Objective To evaluate the value of fecal M2-pyruvate kinase (M2-PK) level in patients with colorectal cancer (CRC) and other organic colonic disorders. Background Cancer cells are characterized by a high glycolytic rate, which leads to energy regeneration and anabolic metabolism, producing an abnormal expression of M2-PK. Multiple studies have demonstrated that the expression levels of M2-PK are upregulated in numerous cancer types. Patients and methods This prospective study included 30 patients with inflammatory bowel diseases (IBD), 32 CR polyps, and 31 CRC, who were compared with 42 controls. The quantitative M2-PK level was measured in all patients using a highly sensitive enzyme-linked immunosorbent assay. Results Our study revealed a highly significant increase in fecal M2-PK in the patients with organic colonic disorders compared with the control group. At a cutoff value of 3.95 U/ml, M2-PK was 93% sensitive and 81% specific for detection of CRC. Furthermore, in our study, fecal M2-PK level were significantly increaes in advanced CRC stage according to the Amrican Joint Committee on Cancer TNM system and Dukes staging, where T3 and T4 had increased levels compared with Tis and T1, and N1 and N2 had increased levels compared with N0, also Dukes stages B and C had increased level compared with Dukes A. Moreover, the correlation between fecal calprotectin and M2-PK in patients with IBD is significantly positive. Conclusion In colonic disorders, fecal M2-PK is a good marker for discrimination between functional and organic colonic conditions, and also a good marker for detection of CRC, with a sensitivity and specificity of 93 and 81%, respectively, and has the potential to be an important noninvasive marker of activity in IBD.
  1,523 97 -
GENERAL SURGERY - ORIGINAL ARTICLES
Recurrent varicose veins after surgery
Mahmoud Said, Hatem A Saleh, Wagih M Farahat
October-December 2021, 34(4):1428-1432
DOI:10.4103/mmj.mmj_17_21  
Background Varicose vein surgery is characterized by high recurrence rate of 60% after 5 years of follow-up observation, and this is a disappointing finding, both for the patients and the surgeon. Objective The aim was to study cases of recurrent varicose veins after surgery regarding incidence, causes, and management. Participants and methods This descriptive prospective cohort study was carried out on all patients who underwent surgery for primary varicose veins from June 2017 to June 2020 in our vascular outpatient's clinics. All patients were assessed by a preoperative clinical examination and color duplex imaging to establish the incidence, causes, and management of the recurrent cases. Results During the study period, 120 operative procedures were performed for primary varicose veins. Only 45 patients enrolled in our study showed recurrence. The incidence of recurrence was 37.5%. Regarding the cause of recurrence detected by duplex ultrasound, 33 patients (73.3%) had disease progression, four patients (8.9%) had inadequate surgery, five patients (11.1%) had incompetent perforator, one patient (2.2%) had inadequate surgery and incompetent perforator, and two patients (4.4%) had neovascularization. Regarding the management of recurrence, 28 patients (62.2%) were subjected to conservative treatment, seven patients (15.7%) were subjected to two sessions of injection sclerotherapy with 4 weeks between the sessions, and surgery was needed in 10 patients (22.2%). Conclusion Recurrent varicose veins after surgery are inevitable part of treating venous disease. The common causes of recurrence are disease progression, inadequate surgery, neovascularization, and incompetent perforators.
  1,364 130 -
PEDIATRICS - ORIGINAL ARTICLES
Hypoalbuminemia as a predictor of adverse outcome in critically ill children: a prospective cohort study
Ahmed A Khattab, Abeer Y El-Shamy, Alyaa A Abdelaziz
October-December 2021, 34(4):1381-1386
DOI:10.4103/mmj.mmj_105_21  
Objectives To evaluate the incidence of hypoalbuminemia as a predictor of clinical outcome in critically ill pediatric patients. Background Hypoalbuminemia is a common finding in critically ill patients associated with a high risk of poor outcome, but there is limited data on its role in pediatric patients. The aim of this study was to investigate the effect of low albumin levels in pediatric patients on poor prognosis and high risk of mortality in the pediatric intensive care unit (PICU). Patients and methods This was a prospective cohort study conducted at the PICU at El-Bagour Hospital from November 2018 to November 2020. The aim was to evaluate low albumin level as a predictor of poor prognosis and clinical outcome in 150 critically ill children aged 1 month up to 18 years. Receiver operating characteristic curve was used to assess the discriminatory ability of scoring systems for patients' mortality. Results In total, 148 patients were included in the final analysis where the incidence of hypoalbuminemia in the first 48 h postadmission was 44.6% with an overall mean serum albumin level of 3.34 ± 0.78. Moreover, we found that children with hypoalbuminemia had higher mortality rate (P < 0.001), higher PICU stays (P = 0.016), lower Glasgow Coma score (P = 0.0017), and more need of mechanical ventilation (P < 0.001). Conclusion Hypoalbuminemia may be used as a significant predictor of mortality and risk assessment in critically ill children.
  1,316 139 -
FAMILY MEDICINE - ORIGINAL ARTICLES
Status of vitamin D deficiency among preschool children and associated factors in a rural area in Upper Egypt
Hala M. E. M. Shaheen, Marwa M. R Abd Elsalam, Safa H. A. Alsayed
October-December 2021, 34(4):1292-1297
DOI:10.4103/mmj.mmj_37_21  
Background Vitamin D is a secosteroid hormone that is well known to play a systemic role in calcium homeostasis, skeletal metabolism, cellular differentiation, apoptosis, anti-proliferation, immunosuppression and anti-inflammation. Objectives To estimate the prevalence of vitamin D deficiency and associated factors among preschool children in a rural area in Upper Egypt. Patients and methods A cross-sectional study was carried out on 180 preschool children who attended the selected family health facilities in El-Dakhla District, New Valley Governorate, Egypt. This study was carried out over a timeframe of 24 months (starting from the 1st of February 2019 until the end of January 2021). Data were collected through an interview with mothers on past family and personal history, in addition to the assessment of socioeconomic status, examination and laboratory investigations to assess the serum levels of vitamin D. Results More than half of the studied children had vitamin D deficiency, 54.4% . More than one third of them showed vitamin D insufficiency (37%), while only 8.9% of the children had normal levels of vitamin D. Delayed dental protrusion and profuse head sweats were significantly higher among vitamin D-deficient children than in children with normal levels of vitamin D. There was a statistically significant difference between vitamin D-deficient children and children with normal levels of vitamin D in terms of mother's age, mother's education, breast-feeding and sun exposure. Conclusion The prevalence of vitamin D deficiency among preschool children was 54.4%. Maternal education and duration of breastfeeding significantly affect serum levels of vitamin D of their children. There is a positive significant correlation between serum levels of vitamin D and the height of children.
  1,254 126 -
MICROBIOLOGY - ORIGINAL ARTICLE
Evaluation of the Seroprevalence of Dengue Virus infection among patients visiting a tertiary care center in Indore
Trupti Bajpai, Prachi Shaw, Chandra Pratap Singh Rathore, Bharat Singh, Rituja Prakash, Neelesh Gagrani
October-December 2021, 34(4):1339-1343
DOI:10.4103/mmj.mmj_459_20  
Background Dengue has been emerging as one of the serious public health problems that has played havocs in terms of morbidity and mortality, especially in a developing country like India. Objective To study the seroprevalence of dengue disease and month-wise frequency of dengue virus infection cases among the patients admitted in a tertiary care center located in Central India. Patients and methods The present prospective study was conducted from January 2019 to March 2020 for a period of 15 months. Overall, 3–5 ml of venous blood collected from all the patients suspected of dengue virus infection was subjected to rapid immunochromatographic test (Avantor) followed by enzyme-linked immunosorbent assay test for detection of nonstructural protein 1 antigen, immunoglobulin M, and immunoglobulin G antibodies (Qualisa). Results A total of 953 blood samples were tested for dengue virus infection. Among these, 176 (18.4%) were found to be seropositive for one or multiple serological markers. Among the various seropositive patients, 59.6% were males and 40.4% were females. The most affected age group was 11–20 years (41.4%) followed by 21–30 years (39.7%). Most cases of dengue were seen in the postmonsoon period, that is, in the month of November (33.7%) followed by October (29.4%). Few cases were also reported in dry season. Among the various seropositive cases, 73.2% individuals experienced recent primary infection. Conclusions Moderate seroprevalence was reported in our study, which may be an alarming sign for future epidemics. The study warns toward the male preponderance along with a larger number of seropositive cases among young adult population. It also highlights the importance of vector control strategies even in dry periods and not just the monsoon or postmonsoon seasons. Appropriate seroepidemiological surveillance with a combo of vector control and preventive strategies would help in combating the disease.
  1,210 128 -
ENDEMIC AND TROPICAL MEDICINE - ORIGINAL ARTICLES
Serum immunoglobulin G4 in patients with nonmalignant common bile duct stricture
Hosam M Seleem, Ali S Nada, Mary A Naguib, Omar R Abdelmaksoud, Ahmed R El-Gazzarah
October-December 2021, 34(4):1275-1283
DOI:10.4103/mmj.mmj_464_20  
Objectives The aim of the present study was to assess the levels of serum immunoglobulin G4 (IgG4) in patients with distal common bile duct strictures in patients with benign biliary stricture (BBS). Background Biliary strictures frequently present a challenge in terms of diagnosis, which requires a multidisciplinary approach. Although up to 30% of biliary strictures can be benign, the vast majority are malignant, the two major malignancies being pancreatic adenocarcinoma and cholangiocarcinoma. One of the underdiagnosed causes of BBS is IgG4-associated cholangiopathy. Increased serum IgG4 levels can be observed in most patients with IgG4-related disease. Patients and methods Sixty-two patients with obstructive jaundice attending the endoscopy unit of National Liver Institute, Menoufia University, for endoscopic retrograde cholangiopancreatography in the duration from April 2019 to February 2020, were included in the present study. Twenty seven of them with BBSs, and the other 35 have malignant biliary strictures (MBSs). Another 35 healthy individuals of matched age and sex were included as a control group. Serum IgG4 was determined by ELISA. Results There was a high statistically significant difference regarding serum IgG4 between benign and control group and benign and malignant group. Serum IgG4 level above 134.95 mg/dl has specificity 82.86% and sensitivity 96.3% in distinguishing BBS from MBS. Serum IgG4 level above 129.8 mg/dl has specificity 94.29% and sensitivity 96.3% in distinguishing BBS from control. There was a statistically significant correlation between serum IgG4 level and alkaline phosphatase level (correlation coefficient 0.419). Conclusion A significant proportion of non-MBS could be IgG4-related cholangitis.
  1,137 70 -
OBSTETRICS & GYNECOLOGY - ORIGINAL ARTICLES
Prediction of pelvic adhesions at repeat cesarean delivery by assessing cesarean scar characteristics and striae gravidarum
Ayman E Solyman, Hamed E Ellakwa, Shaimaa S. R. Eissa, Nabih I Elkhouly
October-December 2021, 34(4):1464-1469
DOI:10.4103/mmj.mmj_115_21  
Objectives To investigate the predictive value of striae gravidarum and scar characteristics on the presence of pelvic adhesions at repeat cesarean delivery. Patients and methods The current study was a cross-sectional study conducted in Menoufia University Hospital between November 2019 and November 2020. The study was carried out on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. Preoperatively, abdominal scar characteristics (according to the scar's appearance and color) and striae gravidarum (color and severity using Davey score) were both recorded. Then, at the time of surgery, intra-abdominal adhesions were graded according to the modified Nair's classification. Results The study included 400 women: group I that included 250 women was found to have no adhesions, group II that included 76 women had filmy adhesion, and group III that included 74 women had dense adhesions. Among the skin markers, abdominal scar color (P = 0.010), depressed scar (P < 0.001), striae color grading (P = 0.001), and striae severity (P = 0.009) were found to have significant associations with intraperitoneal adhesions. Also, there was a significant positive correlation between adhesion score with the number of cesarean section (P = 0.012) and severity of striae (P = 0.002). Conclusion Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.
  885 300 -
INTERNAL MEDICINE - ORIGINAL ARTICLES
Studies of natural killer cells in health and disease: a systematic review
Sabry A Shoeib, Emad M El-Shebini, Enas S Zahran, Mohammed M El-Ghamrawy
October-December 2021, 34(4):1207-1213
DOI:10.4103/mmj.mmj_313_20  
Objective To review the role of natural killer cells (NKCs) in health and disease. Data sources A systematic search of MEDLINE (PubMed, Medscape, and Science Direct, EMF-Portal) and Internet was conducted on all articles published from 1982 to 2019. Regarding study selection, English-language reports of NKCs in health and disease were examined. The initial search presented 145 articles, where 30 satisfied the inclusion criteria. Data extraction Articles not reporting on NKCs in health and disease in the title or abstract were not included. Five independent investigators extracted data on methods. Data synthesis Comparisons were made by structured review, with the results tabulated. Nine studies reported about NKC function, 10 studies about NKCs during various phases of human life, and 11 studies emphasized on NKCs in various disease conditions. Findings Approximately 10% of NKCs belong to the CD56bright subset and mostly involved in the production of cytokines. NKCs are considered to have the ability to respond to a variety of stimuli and to participate in immune responses under different pathological conditions. Human NKCs are present in fetal liver as early as gestational week 6 and in fetal spleen at gestational week 15. NKCs are an important regulator of spiral artery remodeling and maintenance of decidual integrity. In most cases, the role of NKCs is found to be either disease controlling or disease enhancing. In many instances of autoimmune disease, a reduction in the number of NKCs along with decreased cytotoxic function has been observed. Conclusion The NKCs play a major role in human health and disease. Although persistent abnormalities in NKC activity or number appear to be associated with a wide spectrum of human diseases, evidence for the causal association of abnormally low NK activity with pathogenesis is so far available only from a limited number of experimental models.
  894 155 -
OBSTETRICS & GYNECOLOGY - ORIGINAL ARTICLES
Vaginal misoprostol and cervical lignocaine administration before intrauterine contraceptive device insertion
Tarek M Sayyed, Alaa Masood, Mostafa M El-Shaboury, Heba M Aboshady
October-December 2021, 34(4):1445-1450
DOI:10.4103/mmj.mmj_427_20  
Objectives To evaluate whether combined use of vaginal misoprostol and cervical lignocaine spray before intrauterine contraceptive device (IUCD) insertion in scarred uteri will improve pain scores or not. Background IUCD is one of contraception methods commonly used worldwide. Pain associated with IUCD insertion is of interest. Misoprostol by its priming effect and lignocaine spray by its local anesthetic action on cervical mucosa may theoretically reduce pain. Patients and methods This randomized controlled clinical trial was conducted at the Department of Family Planning at Al Shohadaa Hospital from December 2018 to January 2020. Our study included nonpregnant women, 18–45 years old, delivered before by only cesarean section and desiring IUCD insertion. Group A included 48 women who received 400 μg misoprostol vaginally 3 h before IUCD insertion and lidocaine spray 10%, three puffs to the cervical surface and one puff to the external cervical os 3 min before IUCD insertion. Group B included 48 women who did not receive any medical interference. Follow-ups with primary and secondary outcomes were recorded. Results Our results showed that pain scores during sounding the uterus and IUCD insertion were of significant lesser level in group A; however, pain sores during Cusco insertion and during grasping the cervix showed nonsignificant difference between the two groups. Group A took significantly shorter duration than group B during IUCD insertion. Uterine length was significantly shorter in group A. Conclusion The combined use of vaginal misoprostol and lignocaine reduces the pain scores during IUCD insertion.
  755 289 -
CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Nonpharmacological treatment of resistant hypertension: a systematic review
Abdallah M Kamal, Mohamed N. W. Hassan
October-December 2021, 34(4):1214-1221
DOI:10.4103/mmj.mmj_298_19  
Objective The aim was to review the studies on nonpharmacological treatment of resistant hypertension (R-HTN). Materials and Methods A systematic search of MEDLINE (PubMed, Medscape, Science Direct, and EMF-Portal) and Internet was conducted on all articles published from 1986 to 2019. English-language reports of R-HTN were searched. The initial search presented 112 articles, where 31 fulfilled the inclusion criteria. Articles not reporting on the R-HTN in the title or abstract were not included. A total of 15 independent investigators extracted data on methods. Comparisons were made by structured review with the results tabulated. A total of seven studies were about R-HTN (epidemiology, prevalence, prognosis, and etiology), nine studies emphasized R-HTN and cardiovascular complications, and 15 studies emphasized nonpharmacological treatments of R-HTN. Findings The recommended lifestyle measures that have been shown to reduce blood pressure (BP) are salt restriction, moderation of alcohol consumption, high consumption of vegetables and fruits, weight reduction and maintaining an ideal body weight, and regular physical activity. In addition, tobacco smoking has an acute prolonged presser effect that may raise daytime ambulatory BP, but smoking cessation and other lifestyle measures are also important beyond BP. Conclusion This review found that nonpharmacological methods for treatment of R-HTN show great promise despite some open questions concerning their long-term effects and procedural safety. There are sufficient data to suggest that certain lifestyle modifications, such as weight loss and sodium intake reduction, are efficacious in lowering BP, reducing progression of pre-HTN to HTN, and perhaps diminishing long-term risk of CV events. However, the effectiveness of such lifestyle modifications needs to be further established in population-based studies, as implementation of healthier lifestyles is challenging.
  876 104 -
DERMATOLOGY - ORIGINAL ARTICLES
Quantification of serum melatonin level and its association with erectile dysfunction
Mohamed A Gaber, Mohamed H. A. Ghoniem, Noha R Bayomy, Reem A Abdelaziz Hassan
October-December 2021, 34(4):1263-1267
DOI:10.4103/mmj.mmj_2_21  
Objectives The work aimed to evaluate the role of melatonin in erectile dysfunction (ED) by measuring its level in the serum of these patients and correlating its level with the clinical data. Background One common issue is ED. It is the persistent inability to obtain or maintain a sufficient penile erection for satisfactory sexual performance. One of the hormones secreted from the pineal gland is melatonin. It has antioxidative and antiinflammatory effects. It plays a role in erectile function. In the etiology of ED, oxidative stress is an essential factor, and promising results have been obtained with melatonin treatment in many experimental models. Patients and methods This case–control study included 60 patients with ED and 30 age-matched healthy controls. The serum melatonin level was measured in all participants by enzyme-linked immunosorbent assay. Results The study results revealed a significant difference between patients with ED and normal persons regarding mean serum melatonin level. It was lower in cases than controls (2.11 ± 1.73 vs. 5.69 ± 4.33 ng/l), with P value of 0.001. There was no significant difference among the three ED classes in the levels of serum melatonin. There was no significant relation between melatonin level and diabetes, hypertension, hepatitis C virus, and smoking (P > 0.05). Conclusion There has been a significant association between ED and low levels of serum melatonin. This relationship indicates that in the etiology of ED, melatonin deficiency may be of significance.
  889 87 -
OPHTHALMOLOGY - ORIGINAL ARTICLES
Effect of treatment of amblyopia in control of intermittent exotropia
Saber H Elsayed, Neama A Fathy, Ghada Z Ragab
October-December 2021, 34(4):1494-1498
DOI:10.4103/mmj.mmj_36_21  
Objective The purpose of this study was to evaluate the effect of treatment of amblyopia in the control of intermittent exotropia. Background Intermittent exotropia X (T) is a common form of childhood exotropia, accounting for about 50%–90% of all the exotropia and affecting about 1% of the general population. Methods This nonrandomized, prospective study was conducted in the Ophthalmology Department, Menoufia University Hospital from December 2018 to March 2020 on 50 patients of both sexes diagnosed with amblyopia and X (T) who were divided into three groups: group A: 20 patients who had bilateral amblyopia had been given spectacles. Group B: 13 patients who had insignificant refractive errors had been given part-time patching of the sound eye. Group C: 17 patients who had unilateral amblyopia with significant refractive errors had been given spectacles and part-time patching of the sound eye. Results Amblyopia improved in 90% of cases. From the improved cases, near and far angles of strabismus were insignificantly improved after 3 and 6 months of treatment. Office control was significantly improved after 3 and 6 months of treatment. Conclusion Treatment of amblyopia in cases of X (T) may improve the control of X (T) but it seems that it does not affect the angle of strabismus.
  899 73 -
CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Prognostic value of renal function in patients with acute coronary syndrome
Waleed A Ibrahim, Asmaa E Al-Beltagy, Mohamed Y Abd Al-Khalek
October-December 2021, 34(4):1222-1227
DOI:10.4103/mmj.mmj_40_21  
Background Worsening renal function has been shown to be associated with poor outcomes in patients with acute coronary syndrome (ACS). Objective To assess the prognostic value of renal function test in patients with ACS. Patients and methods This cross-sectional observational study included 100 patients with ACS. Serum creatinine levels were measured on admission, after 48 h and at the time of discharge. Patients were divided according to the change in serum creatinine into three groups: group I (69 patients), with serum creatinine change less than 0.3 mg/dl; group II (15 patients), with a decrease in serum creatinine more than or equal to 0.3 mg/dl; group III (16 patients), with an increase in serum creatinine more than or equal to 0.3 mg/dl. The relationship between serum creatinine and in-hospital outcomes, complications, and mortality was evaluated. Results The prevalence of diabetes was significantly higher in group III compared with other groups (P < 0.05). Patients in group III had significantly lower ejection fraction (P < 0.001). In-hospital mortality was 13% in group I, 6.7% in group II, and 81.2% in group III (P < 0.001). Acute pulmonary edema, cardiogenic shock, and the need for mechanical ventilation were more prevalent significantly in group III. The cutoff point of peak serum creatinine more than 2.3 mg/dl during admission had 93.3% sensitivity and 97.7% specificity in predicting in-hospital mortality. Conclusion In ACS patients, daily serum creatinine level and its change patterns are strong predictors of in-hospital complications and mortality. Renal function test has a good prognostic value in identifying high-risk patients.
  818 114 -
DERMATOLOGY - ORIGINAL ARTICLES
Association between serum uric acid concentration and clinical features of psoriasis
Shawky M El Farargy, Naglaa M Ghanayem, Heba Y Yehia
October-December 2021, 34(4):1255-1258
DOI:10.4103/mmj.mmj_279_19  
Objective The aim was to assess linkage between serum uric acid (UA) and clinical features of psoriasis. Background Psoriasis is a chronic immune-mediated skin disease. UA is an end product of purine metabolism and is produced endogenously. Patients and methods A case–control study was conducted on 100 patients with chronic generalized psoriasis (group 1) and 100 age-matched and sex-matched healthy individuals (group 2). Patients of group 1 were subdivided into three subgroups with respect to grades of psoriasis: group 1a included patients with mild psoriasis, group 1b included patients with moderate psoriasis, and group 1c included patients with severe psoriasis. In group 1, we found that there was a significant positive correlation between serum UA level and each of age, duration of disease, and psoriasis area severity index score (P = 0.023, 0.017, and 0.002, respectively). All the included participants underwent full history taking, full examination, routine laboratory investigations, and assessment of serum UA. Results Serum UA level in group 1 was significantly increased compared with group 2 (P = 0.000). There was a significant increased value of serum UA in group 1c compared with group 1b and group 1a (P = 0.000). In group 1, there was a significant positive correlation between serum UA level and each of age, duration of disease, and psoriasis area severity index score (P = 0.023, 0.017, and 0.002, respectively). Conclusion There was a strong association between hyperuricemia and psoriasis. Serum UA should be assessed in patients with psoriasis. Moreover, detection of high levels of serum UA may enable earlier use of preventive measures for metabolic disturbances in psoriatic patients.
  832 86 -
OBSTETRICS & GYNECOLOGY - ORIGINAL ARTICLES
Comparison between early delivery versus expectant management for late preterm mild preeclampsia
Ahmed N Abd-Elhamid, Mennat A Shabanah, Essam A Amin
October-December 2021, 34(4):1470-1475
DOI:10.4103/mmj.mmj_432_20  
Objectives To compare initiation of delivery versus expectant management in women with late preterm mild preeclampsia between 34 and 37 weeks of gestation to determine whether planned delivery reduces maternal adverse outcome without substantial worsening of neonatal outcome. Background In women with late preterm preeclampsia (between 34 and 37 weeks of gestation), the optimal time for delivery is less clear, because limitation of maternal disease progression needs to be balanced against complications for the neonate. Patients and methods This prospective comparative randomized controlled study was conducted by an obstetrician in the period of 1 year in Obstetrics and Gynecology Department at Menoufia University Hospital and El-Menshawy General Hospital. It included 92 pregnant women with late preterm mild preeclampsia divided into two groups: 46 for expectant and 46 for termination. Primary and secondary maternal and fetal outcomes were registered and compared for the two groups. Results Of 46 pregnant women managed by termination, three (6.52%) cases only from termination group progressed to severe preeclampsia, whereas 11 (23.91%) cases from the expectant group progressed to severe preeclampsia. There is a statistically significant difference between numbers of cases progressing to severe preeclampsia in both groups (P = 0.020). There is no significant difference in other primary and secondary outcomes. Conclusion Our study showed that the planned early delivery was better for cases with preterm mild preeclampsia between 34 and 37 weeks of gestation.
  817 81 -
RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Role of gray-scale and color Doppler ultrasound in women with chronic pelvic pain
Mohamed S Abdullah, Waleed A Mousa, Mai A Ghobashy
October-December 2021, 34(4):1392-1398
DOI:10.4103/mmj.mmj_281_20  
Objectives To assess the role of the gray-scale and Doppler ultrasound in the evaluation of women with chronic pelvic pain (CPP). Background CPP is a major cause of morbidity among women of different ages. Patients and methods We included in this study 200 female patients. They were referred to the Radiodiagnosis Department at Shebin Elkom Teaching Hospital complaining of CPP. Ultrasonographic scanning of the pelvis was requested to evaluate the cause. Results This study included 200 female patients with clinical signs and symptoms suggestive of CPP. The age of the patients ranged from 19 to 77 years, with a mean age±SD of 34.3±12.2 years. The sensitivity and specificity of ultrasonography in the diagnosis of gynecological causes of CPP in this study were 93.28 and 100%, respectively. The sensitivity and specificity of ultrasonography in the diagnosis of urological causes of CPP in this study were 94 and 100%, respectively. The sensitivity and specificity of ultrasonography in the diagnosis of gastrointestinal causes of CPP in this study were 88.88 and 100%, respectively. Conclusion Ultrasonography is the modality of choice for imaging evaluation of CPP in females.
  814 79 -
Assessment of hepatic and pancreatic iron overload by magnetic resonance in β-thalassemia major
Rehab M Habib, Ramy G El-Sayed Ayad
October-December 2021, 34(4):1410-1415
DOI:10.4103/mmj.mmj_390_20  
Background Thalassemia is a hereditary hemolytic blood disorder that results in abnormal form or inadequate amounts of one of the two globin chains, which are the building blocks of the hemoglobin structure, thus causing anemia, which is mainly treated by blood transfusions, with resultant increased tissue iron overload, which could be assessed noninvasively by MRI. Objectives To evaluate the role of MRI in assessment of pancreatic and hepatic iron overload in patients with β-thalassemia major using transverse relaxation time/gradient-echo imaging sequences, signal intensity ratio, and relaxometry. Patients and methods A prospective study included 25 patients with β-thalassemia major recruited from the hematology clinic, Menoufia University, from September 2018 to September 2019. Results There is remarkably lower signal intensity ratio of the pancreas and the liver in thalassemic patients, both of which have been also strongly correlated with each other (P = 0.002). Thalassemic patients with abnormal glucose tolerance featured a higher proportion of pancreatic hemosiderosis compared with normoglycemic thalassemic patients (P < 0.001). Splenectomized patients have notably increased hepatic and pancreatic iron overload (P = 0.002) than nonsplenectomized patients. Serum ferritin values were also positively correlated with the levels of both hepatic and pancreatic iron overload, especially accentuated in patients having diabetes/impaired glucose tolerance (Spearman's rank correlation coefficient analysis = 0.772, P > 0.001). Conclusions Pancreatic and hepatic hemosiderosis could be reliably detected by transverse relaxation time/gradient-echo MRI in thalassemic patients; this was more pronounced with disturbed glucose tolerance. Moreover, it was found that splenectomy may accelerate parenchymal tissue iron deposition.
  781 87 -
PEDIATRICS - ORIGINAL ARTICLES
Inherited bleeding disorders other than hemophilia in pediatrics: single-center experience
Yasmen A Mohamed, Dina A Ezzat, Rehab M.A. Elkareem, Dalia M Adel
October-December 2021, 34(4):1363-1368
DOI:10.4103/mmj.mmj_123_21  
Objective The aim was to study the inherited bleeding disorders other than hemophilia with special emphasis on clinical spectrum, diagnosis, and management. Background Inherited bleeding disorders are a variable group of disorders that vary in incidence and clinical presentations. They include hemophilia A, hemophilia B, von Willebrand disease (VWD), inherited platelet-function disorders (IPFDs), and rare bleeding disorders (factors I, II, V, combined Vand VIII, VII, X, XI, and XIII deficiencies). Patients and methods It is a prospective follow-up study over a period of 5 years, in which patients suffering from bleeding tendency and referred to the hematology clinic were included and prospectively followed up. They were subjected to detailed history, full examination, and laboratory investigations; complete blood count, prothrombin time, and activated partial thromboplastin time; and accordingly other investigations were done, such as factor assay and platelet-function tests. Results The authors reported 52 patients with inherited bleeding disorders other than hemophilia. Among them, IPFDs were the most common (38.5%), followed by VWD (26.9%). While 34.6% were diagnosed as rare bleeding disorders (FI, V, VII, X, and XIII deficiencies). Conclusion IPFDs were the most common inherited bleeding disorders other than hemophilia followed by VWD. Among the rare bleeding disorders, FI deficiency was the most common, while FXIII and FVII deficiency were the most serious. Also, fresh frozen plasma was the most frequent therapeutic product used to control bleeding episodes in our patients.
  772 90 -
GENERAL SURGERY - ORIGINAL ARTICLES
The effect of apical axillary lymph node dissection on the incidence of upper arm lymphedema
Ahmed S Elgammal, Mohammed N. S. Nassar, Ahmed A Fawzy
October-December 2021, 34(4):1422-1427
DOI:10.4103/mmj.mmj_393_20  
Objectives The aim of this study is to determine the relation between apical axillary lymph node dissection (ALND) and upper arm lymphedema in patients with breast cancer. Background Lymphedema is a swelling that occurs when protein-rich lymph fluid accumulates in the interstitial tissue, and it is the most common complication following axillary dissection. This lymph fluid may contain plasma proteins, extravascular blood cells, excess water, and parenchymal products. Few studies have discussed ALND levels as a possible risk factor of upper arm lymphedema. Patients and methods This is a prospective clinical study that included 70 women with well-established diagnosis of malignant breast tumor. All patients were operated in the Department of Surgery at Menoufia University Hospital between the period of June 2017 and December 2019. All of them were assessed for the development of postmastectomy upper limb lymphedema. Results There is no significant difference between the studied groups regarding age. There is no significant difference between the studied groups regarding the site of tumor. There is a highly significant difference between the studied groups regarding the number of extracted lymph nodes. There is no significant difference between the studied groups regarding the type of surgery. There is a highly significant difference between the studied groups regarding grade of lymphedema. Conclusion The apical ALND has a high rate of postoperative incidence of lymphedema and is better to be avoided, as arm lymphedema results in poor cosmetic outcomes, physical discomfort, and if severe enough, loss of functional ability of the affected arm, with significant reduction in the quality of life among survivors of breast cancer.
  785 72 -
MEDICAL ONCOLOGY - ORIGINAL ARTICLE
Impact of two immobilization systems on geometry, dosimetry, and treatment-related toxicities in rectal radiotherapy
Hager A Alagizy, Nabil A Mobarak, Yasser A Rashed, Noha Khaled Aboelfath, Suzy F Gohar
October-December 2021, 34(4):1331-1338
DOI:10.4103/mmj.mmj_48_21  
Objectives This study aimed to compare the prone position on a belly board device (BBD) immobilization device versus a vacuum bag cushion (VBC) in rectal cancer patients receiving radiotherapy. Background In radiotherapy, it is ideal to adapt to the most favorable, least time-consuming and most cost-effective technique for patient positioning and immobilization with maximum reproducibility. Patients and methods Fifty-five rectal cancer patients scheduled for irradiation were equally randomized to be immobilized with one of the studied immobilization systems and scanned in the prone position. The dose–volume histograms for organs at risk were compared for both immobilization methods and setup accuracy was analyzed by an electronic portal imaging device; treatment-related toxicity was reported. Results There was no significant difference between the studied groups in the volume of planning target volume receiving 95% of the dose (P = 0.42). Volume of the small bowel receiving 45 Gy was higher in the VBC arm than the BBD arm (P < 0.001), but there was no significant difference between the studied groups in the incidence of acute small-bowel toxicities of diarrhea and abdominal pain (P = 0.94 and 0.66, respectively), onset and severity. Setup errors were significantly higher in the belly board arm in the X, Y and Z directions (P = 0.004, P < 0.001, and P < 0.001, respectively). Magnitude was significantly higher in the belly board arm (P < 0.001). Planning target volume margins according to Van-Herck's equation and Stroom's equation in the X, Y and Z directions were larger in the belly board arm, compared to the VBC arm. Conclusion The VBC system was more reproducible than BBD, with comparable acute treatment-related toxicities.
  756 91 -
RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Role of ultrasound-guided injection of corticosteroids and platelet-rich plasma in treatment of supraspinatus tendon injuries
Mohamed K Abd-Elmageed, Doaa Hosny, Mohamed R Elkholy, Eman A Abdallah
October-December 2021, 34(4):1404-1409
DOI:10.4103/mmj.mmj_335_20  
Background The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to therapeutic injection. Therapeutic subacromial injection should be considered after other conservative interventions have been tried. Studies have demonstrated that needle placement is more accurate with image guidance, usually ultrasound (US). Objectives To highlight the role of US-guided injection in the treatment of supraspinatus tendon injuries. Patients and methods This study included 60 patients diagnosed as having supraspinatus tendinosis only or with associated partial thickness tear. All patients were injected under US guidance. A total of 40 patients were injected with corticosteroids, whereas the other 20 patients were injected with platelet-rich plasma. At 4 and 12 weeks, patients were followed up clinically by visual analog scale score and radiologically by US measurement of tendon thickness and tear size and compared with their corresponding preinjection measures. Results There was a statistically significant decrease in visual analog scale score with decrease from a mean ± SD value of 4.98 ± 1.57 (2.0–9.0) (baseline values) till reaching a mean value of 1.98 ± 1.11 (0.0–5.0) after 12 weeks (after injection), with P value less than or equal to 0.001. The supraspinatus tendon thickness decreased from a mean ± SD baseline value of 7.81 ± 0.49 till reaching a mean ± SD value of 7.23 ± 0.46 after 12 weeks, with P value less than or equal to 0.001. A statistically significant decrease in the tear size was noted only after 12 weeks following injection. The tear size decreased from a baseline mean ± SD value of 1.48 ± 0.29 till reaching 1.08 ± 0.22 after 12 weeks, with P value less than or equal to 0.001. The only noted postinjection adverse effect was transient shoulder pain in 24 (60%) patients of the corticosteroid group. Conclusion US-guided injection of corticosteroids and platelet-rich plasma offers a good minimally invasive method for management of supraspinatus tendinopathy.
  740 88 -
CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Plasma circulating cell-free DNA integrity as a noninvasive diagnostic tool in hepatocellular carcinoma
Sara M Eldeeb, Amany I Afandy, Omar Ahmed, Seham Khodeer, Fatma Younes, Dalia Hosny
October-December 2021, 34(4):1244-1248
DOI:10.4103/mmj.mmj_140_21  
Background Hepatocellular carcinoma (HCC) is the world's sixth and Egypt's fourth most common cancer, representing the third leading cause of cancer-related deaths worldwide. Circulating cell-free DNA is a type of cell-free nucleic acid derived from apoptotic, necrotic, and living eukaryotic cells. It carries genetic information consistent with tumor cells and has potential for molecular diagnosis of tumors. Objectives To evaluate the clinical significance of plasma circulating cell-free DNA integrity (cfDNAi) as a diagnostic biomarker in HCC compared with alpha-fetoprotein (AFP). Patients and methods This case–control study was carried out on 90 participants who were equally classified into three groups: benign liver diseases, HCC groups, and a control group of apparently healthy adults with matched age and sex. Serum AFP and plasma cfDNAi assays were performed for all participants. Results Patients with HCC had lower plasma cfDNAi than those with benign liver diseases (P = 0.002) and apparently healthy individuals (P = 0.001). The combination of cfDNAi and AFP in differentiation between the HCC group and healthy individuals revealed a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 97, 100, 98, 100, and 97%, respectively. Conclusion Plasma cfDNAi can be used as a promising biomarker in the diagnosis of HCC where the combination of cfDNAi and AFP improves the diagnostic performance for HCC diagnosis.
  742 85 -
PEDIATRICS - ORIGINAL ARTICLES
Lung ultrasonography to diagnose transient tachypnea of the newborn
Fady M El-Gendy, Dalia M El-llahony, Waleed A Mousa, Amany A El-Banna
October-December 2021, 34(4):1387-1391
DOI:10.4103/mmj.mmj_45_21  
Objective This study aimed to diagnose transient tachypnea of newborn (TTN) and differentiate it from respiratory distress syndrome (RDS) using lung ultrasound. Background TTN is a very common cause of neonatal respiratory distress and must be accurately differentiated from other causes of respiratory distress. Participants and methods A prospective observational cohort study was carried out on 120 newborns at the Neonatal Intensive Care Unit, Menoufia University Hospital, admitted with respiratory distress and subjected to an assessment of full history, clinical examination, arterial blood gas, chest radiography, and lung ultrasound. Results On lung ultrasound, TTN was found in 77.5% of cases (93) and RDS was found in 22.5% of cases (27). Lung consolidation presents only in RDS (100%) and not in any case of TTN. Double lung point presents only in TTN (80%) and not in RDS; thus, it showed a sensitivity of 80% and a specificity of 100% in diagnosing TTN (P < 0.001). Conclusion Lung ultrasonography can accurately diagnose TTN and differentiate between TTN and RDS as lung consolidation presents only in RDS and double lung point presents only in TTN.
  741 75 -
Assessment of serum interleukin.6 level in children with bacterial and viral meningitis
Ghada M Elmashad, Hebatallah M Bahbah, Sherin Sobhy El-Sayed El-Naidany, Sara Abdelfattah Sobh
October-December 2021, 34(4):1358-1362
DOI:10.4103/mmj.mmj_304_20  
Objectives To evaluate the role of serum interleukin-6 (IL-6) in the diagnosis of meningitis and differentiation between bacterial and viral causes. Background Acute bacterial meningitis (BM) is a pediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. Differentiation of BM from viral meningitis (VM) is difficult. Hence, this study was done to evaluate serum IL-6 as a marker to differentiate BM and VM in children and assess its efficacy. Patients and methods This case–control study was conducted on a group of 90 children, comprising 60 with definite acute meningitis diagnosed clinically and confirmed by cerebrospinal fluid analysis and 30 apparently normal children. All were subjected to full history taking, clinical examination, laboratory investigations, and measurement of serum IL-6 level using enzyme-linked immunosorbent assay method. Results Serum IL-6 level at a cutoff value more than 31 pg/ml had a sensitivity of 90% and specificity of 100% as a diagnostic marker for meningitis with area under the curve = 0.99, with positive predictive value of 97% and negative predictive value of 88%, and at a cutoff value of more than 48 pg/ml, it had a sensitivity of 99% and specificity of 98% to differentiate between BM and VM. In BM, mean ± SD serum IL-6 level was 74.93 ± 24.70, and in VM, mean ± SD serum IL-6 level was 34.93 ± 5.07. Conclusion Serum IL-6 level can be used as a diagnostic marker in patients with meningitis. It can also differentiate between BM and VM, as it was higher in BM than VM and control group.
  727 73 -
INTERNAL MEDICINE - ORIGINAL ARTICLES
Diabetes mellitus and hypertension are common comorbidities among COVID-19 hospitalized patients in Egypt: a single-center retrospective study
Ashraf A Askar, Esmail Osman, Tamer Mohamed, Mustafa A Younis, Safaa Khalaf
October-December 2021, 34(4):1323-1330
DOI:10.4103/mmj.mmj_72_21  
Background Since the announcement of the COVID-19 catastrophic release in 2019, several studies had been conducted to investigate all the circumstances accompanied by or that have resulted from this viral infection. Objective The aim was to investigate the most common comorbidities and associated clinical risk factors among COVID-19 hospitalized patients admitted to Sohag Fever Hospital, Sohag Governorate, Egypt. Patients and methods In this study, 250 patients of those registered or admitted to Sohag Fever Hospital, Sohag Governorate, Egypt, were included during the pandemic COVID-19 period between October 2020 and February 2021. A total of 150 patients had positive PCR finding for COVID-19 and another 100 patients acted as a control group, which included medically free individuals with negative PCR finding for COVID-19. The clinical data included the blood pressure, PCR, and chest computed tomography, as well as associated comorbidities. The levels of random blood sugar and liver and kidney function test results were reported. The data were statistically analyzed. Results Male patients represented 70.4% of the study population, and females represented 29.6%. The sex type significantly influenced the PCR results, with P value less than 0.05. Patients in the older age groups (>51 years, 86.7%) had positive PCR and CO-RADS 5 results, despite not showing any significant effect. Overall, 53.2% of the diabetic patients resulted in positive PCR finding for COVID-19 (P = 0.0). Three major symptoms were persistent cough (42%), fever (50.8%), and dyspnea (51.2%), which had a significant relationship with patients with either positive PCR or CO-RADS 5 (P < 0.001), unlike the other comorbidities. Hypertension, higher serum creatinine, and blood sugar levels were significant among patients with positive PCR finding and those with severe CO-RADS five grades. Sex type, diabetes mellitus, and alanine transaminase were significantly incorporated in the estimated elevation of PCR-positive COVID-19 infection, despite only diabetes mellitus showing a significant estimation of the severe infection among the study population. Conclusion The study revealed the COVID-19 was significantly more prevalent among males and older patients (>50 years old) in the Sohag Fever Hospital, Sohag Governorate, Egypt. The symptoms of cough, fever, and dyspnea are specific to COVID-19 infection in the study population. Blood pressure, blood sugar, and serum creatinine are suggested to be clinical indicators for severe COVID-19 infections. Multiple different studies should be conducted to employ other different clinical factors in the diagnosis of COVID-19 infection.
  716 76 -
PEDIATRICS - ORIGINAL ARTICLES
Study of blood levels of lactate, vitamin D, and nucleated red blood cells for hypoxic–ischemic encephalopathy prediction
Ahmed T Mahmoud, Mohamed A Soliman, Ahmed H Saad, Alyaa A Abdelaziz
October-December 2021, 34(4):1375-1380
DOI:10.4103/mmj.mmj_102_21  
Background Perinatal asphyxia is a serious medical condition in which there is a lack of oxygen or blood flow during or even after the labor process. Objective This study aimed to study the serum blood levels of lactate, vitamin D, and count of nucleated red blood cells per 100 white blood cells (nRBC/100 WBC) as early biological predictors of hypoxic–ischemic encephalopathy (HIE) after perinatal asphyxia. Patients and methods A case–control study was conducted on 20 neonates with HIE, comprising the cases, and another 20 neonates, representing the control group, with their gestational age, sex, and weight matched, admitted to a neonatal ICU from March 2020 to the end of September 2020. Venous blood samples for lactate, vitamin D, and nRBCs were drawn during the first 6 h of birth and sent for analysis. Sarnat score was used to assess the severity of HIE. Results Venous blood levels of lactate, with a mean of 71.03, and nRBC/100 WBC, with a mean of 16.6, in HIE neonates were significantly higher than those in the control group, with means of 15.5 and 5.6, respectively (P < 0.001). However, the serum vitamin D was significantly lower in the HIE group, with a mean of 7.11 than that in the control, with a mean of 56.15 (P < 0.001). Conclusion Biomarkers such as serum lactate level, vitamin D level, and nRBCs/100 WBCs might be used in the early prediction of HIE.
  694 95 -
OPHTHALMOLOGY - ORIGINAL ARTICLES
Correlation between anterior segment optical coherence tomography and ultrasonography in the management of white cataract
Hisham M. F. El-Mazar, Ahmed I Basiony, Nadia M. A. Elabd
October-December 2021, 34(4):1476-1480
DOI:10.4103/mmj.mmj_446_20  
Background Despite the availability of advances such as laser-assisted capsulotomy, performing a safe continuous curvilinear capsulorhexis still poses a challenge in mature and intumescent cataracts. Objectives To correlate between anterior segment optical coherence tomography and ultrasonography for better management of white cataract. Patients and methods The study was designed as a cross-sectional study of 30 patients. The study protocol was explained to the patients, and all patients were provided written informed consent from October 2019 to February 2020. This study was conducted on 30 eyes of 30 patients (17 males and 13 females; range 44–75-year-old) with white cataract who were going to have elective unilateral standard phacoemulsification and intraocular lens implantation. Results Axial length ranged from 19.0 to 23.0, with mean ± SD of 20.45 ± 1.29 in cases with subcapsular fluid pockets. In cases with no subcapsular fluid pocket, axial length ranged from 14.0 to 26.0, with mean ± SD of 18.74 ± 4.20. There was no clinical significance between axial length and subcapsular fluid pocket (P = 0.112). There was clinical significance between lens thickness and subcapsular fluid pocket. Conclusion Our study highlights a new method of using anterior segment optical coherence tomography to identify the presence of fluid pockets in mature and intumescent cataract.
  710 77 -
CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Association between COLIA1 gene polymorphism and bone marrow density in children with beta-thalassemia major
Rehab M Abd Elkareem, Waleed M El Malah, Karim I Sobhy, Dalia S Morgan
October-December 2021, 34(4):1233-1237
DOI:10.4103/mmj.mmj_111_21  
Objectives To determine the incidence of SP1 polymorphism in the COLIA1 gene and its correlation to bone mineral density in patients with beta-thalassemia major (TM). Background B-thalassemia is an autosomal-recessive disorder and considered one of the most severe health problems worldwide. Osteoporosis is a devastating bone disease marked by loss of bone mass, microarchitecture, and increased fracture risk. Polymorphism at the Sp1-binding site of the collagen-type I A1 (COLIA1) gene is thought to be an essential factor in the development of osteoporosis. Methods Alleles S and s in the regulatory site of the COLIA1 gene were investigated in 72 children with TM on iron-chelation therapy using PCR–restriction-fragment-length polymorphism. One hundred twenty healthy children were included as a control group. The assessment of bone mineral density in children with TM was done using dual-energy radiograph absorptiometry (DEXA lunar DPX) at the lumbar spine (L2–L4) in A–P projection. Results The homozygous wild genotype (SS) was predominant in the controls (75%). In comparison, the heterozygous mutant genotype (Ss) was predominant in the TM patients. The homozygous mutant genotype (ss) was found only in the TM group (14%) (P < 0.001). The minor s-allele frequency was significantly higher in the TM group (P = 0.006). The Z scores were significantly lower in the mutant genotypes (Ss and ss) when compared with the wild type (SS) in the TM group (P = 0.003). Conclusions Early detection of Sp1-binding-site mutations in children with TM can help in the early prediction of osteoporosis and preventive management initiation to maintain normal bone health.
  702 81 -
OPHTHALMOLOGY - ORIGINAL ARTICLES
Evaluation of surgical outcomes of 23-G versus 25-G vitrectomy for pediatric retinal detachment
Hoda M El-Sobky, Ihab S Othman, Adel G Zaky, Ahmed A Salama
October-December 2021, 34(4):1499-1504
DOI:10.4103/mmj.mmj_44_21  
Objective To compare surgical and clinical outcomes of pediatric retinal detachment repair using 23 G and 25 G vitrectomy. Background The introduction of microincisional vitrectomy surgery induced a paradigm shift in management of vitreoretinal diseases. Vitrectomy in pediatric age group represents a major challenge owing to its unique anatomical and pathological considerations. Patients and methods This was a prospective, comparative case series study. A total of 50 patients were recruited for the study and divided into two groups. The first group included 25 patients who underwent 23-G vitrectomy, and the second group included 25 patients who underwent 25-G vitrectomy. The main outcome measures were the actual vitrectomy time and need to suture a sclerotomy and the early postoperative hypotony rate. Results The actual time for vitreous removal was 22.00 ± 5.71 min in 23-G group compared with 24.13 ± 5.97 min in 25 G group (P = 0.273). A significant difference was noted between both groups regarding suturing at least one sclerotomy at the end of the surgery, with 11 (44%) eyes in 23-G group and only four (16%) eyes in 25-G group; however, no significant difference in early postoperative hypotony rate was observed. The visual and anatomical outcomes were comparable between both groups, with no significant difference. Conclusion Both 23-G and 25-G systems are highly efficient for the treatment of pediatric retinal detachment. However, our research showed that operations performed with the 25-G system were less likely to demand a suture with earlier visual recovery.
  704 76 -
PATHOLOGY - ORIGINAL ARTICLE
Cluster of differentiation 163 expression in breast carcinoma: an immunohistochemical study
Hayam A Aiad, Dalia R Al-Sharaky, Marwa M Dawoud, Enas A El Khouly, Norhan S Kasem
October-December 2021, 34(4):1344-1350
DOI:10.4103/mmj.mmj_397_20  
Objective To determine the expression of the cluster of differentiation 163 (CD163) in invasive breast carcinoma and to correlate it with the clinicopathological parameters, biological markers, and molecular subtypes of breast carcinoma. Background CD163 is a transmembrane scavenger receptor that is specifically expressed by non-neoplastic monocytes/macrophages and by neoplasms with monocytic/histiocytic differentiation. Theory of cell fusion between neoplastic and normal cells has been suggested to play a role in the acquisition of the malignant phenotype. Patients and methods This retrospective case–control study was conducted on formalin-fixed, paraffin-embedded blocks of tissues from 71 patients with invasive breast carcinoma retrieved from the archives of Pathology Department, Faculty of Medicine, Menoufia University, Egypt, from 2015 to 2018. These patients were treated and followed up at Clinical Oncology Department. Immunohistochemistry staining for CD163 antibody was done for all the cases. Results have been correlated with clinicopathological data, biological parameters, and molecular subtypes of breast carcinoma. Results CD163 was positive in 67 (94.4%) of 71 cases of invasive breast carcinoma cases. CD163 expression was significantly associated with the high histological grade (P = 0.024), advanced T staging (P = 0.003), presence of distant metastasis (P = 0.024), poor Nottingham prognostic index group (P = 0.028), estrogen receptor negativity (P < 0.001), and the triple-negative and Her2neu-enriched molecular subtypes (P = 0.004) in invasive breast carcinoma. Conclusion The expression of macrophage antigens by cancer cells may indicate a more aggressive metastatic activity and may have a prognostic effect of clinical importance.
  662 77 -
NEUROSURGERY - ORIGINAL ARTICLE
Assessment of surgical outcome of adolescent idiopathic scoliosis
Hesham Y. A. Rahma, Hossam A. E. A. Habib, Hazem M Negm, Ahmed F Sheha, Mohammud A. A. M. Salim
October-December 2021, 34(4):1439-1444
DOI:10.4103/mmj.mmj_32_21  
Objective This study involved an assessment of surgical outcome of cosmetic parameters of adolescent idiopathic scoliosis and time of surgery and blood loss and possible complications. Background Idiopathic scoliosis is the most common type and accounts for 80% of scoliosis cases. The posterior-only approach is less invasive than combined approaches with comparable outcomes. Patients and methods A retrospective case series study was carried out on 32 consecutive patients with adolescent idiopathic scoliosis in Menoufia University and Alexandria University. All patients had adolescent idiopathic scoliosis and underwent posterior approach surgery. The patients were assessed radiologically and clinically and followed up for 1 year for the cosmetic parameters and the degree of correction and the duration of surgery and complications. Results The preoperative curve magnitude was 96.75° Cobb angle. Flexibility index was 16%. The correction rate was 69%, and the loss of correction percentage was 1% on follow-up. The mean operating time in the study was 318.75 min. The Complications reported in the present study were permanent paraplegia neurological complications 6.3%), superficial infection (infection 6.3%), cosmetic complications (six shoulder imbalance, two coronal imbalance with proximal junctional kyphosis) (cosmetic complications 25.0%), and (respiratory complications 6.3%). Conclusion This study of the posterior approach has comparable outcome with other studies of the posterior-only approach and combined approaches.
  658 79 -
INTERNAL MEDICINE - ORIGINAL ARTICLES
Relationship between vitamin D levels and health-related quality of life in maintenance hemodialysis patients
Mahmoud A Koura, Yassin S Yassin, Heba E Kasem, Mohamed O Sherif
October-December 2021, 34(4):1310-1316
DOI:10.4103/mmj.mmj_35_21  
Objective This study aimed to investigate the relationship between vitamin D levels and health-related quality of life in maintenance hemodialysis patients. Background Several conditions associated with vitamin D deficiency in end-stage renal disease and hemodialysis patients can indirectly or directly affect the quality of life. Patients and methods The present study included 85 end-stage renal disease patients, subdivided into group I, which included 64 vitamin D-deficient patients, and group II, which included 21 vitamin (D)-efficient patients. Every participant was subjected to sociodemographic, clinical, and laboratory evaluations; each patient underwent a full general assessment of health-related quality of life by the Arabic version of the kidney disease quality of life short-form 1.3” questionnaire and measurement of serum 25(OH)D by an enzyme-linked immunosorbent assay. Results The mean 25(OH)D levels were 15.7 ± 6.40 and 36.6 ± 5.99 ng/ml for the vitamin D-deficient group and -efficient group, respectively. The only factor independently associated with symptoms was serum 25(OH)D level (P = 0.044). Sex (female) and vitamin D levels were independent risk factors with the effect of kidney disease (P = 0.001). Independent risk factors associated with the burden of kidney disease subscale were comorbidity index and serum 25(OH)D levels (P = 0.015, 0.023, and 0.001, respectively). Serum 25(OH)D and age were independently associated with the physical component summary (P = 0.001 and 0.016). The independently associated factor with the mental component summary was serum 25(OH)D and albumin levels (P = 0.001 and 0.016). Conclusion Lower serum vitamin D levels were negatively associated with all subscales of quality of life in maintenance hemodialysis patients.
  646 87 -
CARDIOLOGY AND VASCULAR MEDICINE - ORIGINAL ARTICLES
Assessment of right ventricular function in young patients with anterior ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention by speckle-tracking imaging study
Said S Montaser, Mahmoud K Ahmed, Amal A Amin, Karim M Gamal
October-December 2021, 34(4):1228-1232
DOI:10.4103/mmj.mmj_110_21  
Objective To asses s right ventricular (RV) function in patients with anterior ST segment elevation myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI) by speckle-tracking imaging study. Patients and methods A total of 150 consecutive patients less than 40 years with anterior ST segment elevation MI and have a single left anterior-descending artery disease who underwent successful primary PCI were enrolled in the study. Patients with a history of prior MI, PCI, coronary-artery bypass graft, those who had a bundle-branch block, PCI, coronary-artery bypass graft, those who had a bundle-branch block on baseline ECG, pulmonary hypertension (primary and secondary), primary valvular heart disease, lung disease, cardiomyopathy, systemic illness (renal, hepatic, and malignancy), and bad echogenic window all were excluded. Echocardiography was performed during the hospital stay to assess ventricular function. RV function was assessed by RV fractional area change, tricuspid annular plane systolic excursion, tricuspid annular systolic and diastolic velocities, and two-dimensional-derived strain and strain rate of the RV free wall. Results RV free-wall peak systolic strain, systolic strain rate, and early diastolic strain rate were significantly lower in patient groups (−15.36 ± 2.60 vs. −25.07 ± 1.49, P = 0.006, −1.09 ± 0.18 vs. −1.78 ± 0.10, P = 0.005, and 1.45 ± 0.33 vs. 2.19 ± 0.56 with P = 0.004, respectively). Also, systolic and early diastolic tricuspid annular and early diastolic peak velocities were lowered in patient groups than in controls, in addition, there was no significant difference between both groups regarding RV size, dimension, and fractional area changes. Conclusion RV function in patients with anterior MI is significantly affected even after rapid PCI and recanalization of left anterior-descending in young patients. Strain and strain rate are new, useful imaging techniques for detection of early RV dysfunction in patients with anterior MI.
  600 70 -
DERMATOLOGY - ORIGINAL ARTICLES
Religiosity and the sexuality of women
Mohamed A Gaber, Shaimaa E. A. Mousa
October-December 2021, 34(4):1259-1262
DOI:10.4103/mmj.mmj_456_20  
Objective To evaluate the role of religiosity in sexuality of women. Background Religiosity is a characteristic of an individual, and sexual interactions are characteristics of pairs. Sexuality is the constitution or life of the individual as related to 'sex' or exercise of sexual functions. Patients and methods This study was done on 135 married women attending the Outpatient Clinic of Obstetrics and Gynecology in Menoufia University Hospital during the period from May 2020 to August 2020. Results In the present study, most participants were wearing hijab (89.6%) and 5.9% were wearing niqab. Regarding coital frequency in the present study, most of the participants (61.5%) initiated coitus more than 50% of the times, and ~22% of the participants never initiated coitus and never asked their partners for intercourse, where most of them were from group A (18.6%) versus 50% from group B and also group C. Among the participants, 59.3% thought that a wife has not the right to initiate sex, where most of them were from group A (64.4%). Most of the participants (68.1%) considered the purpose of coitus is the pleasure of both partners, whereas 23% perform it for the fear of God (God will punish her for refusing to have sex with her husband), where most of them were from group C (27.9%). Conclusion The results suggest that the degree of religiosity seems to have no effect on sexual behavior in this sample of Muslim Egyptian women.
  586 76 -
GENERAL SURGERY - ORIGINAL ARTICLES
Assessment of clinical response to trauma and burn multiple-casualty patients in Menuofia university hospitals
Shawky S Gad, Hatem M Sultan, Mohamed A Megahed, Mahmoud Abo Salem, Tamer F Abd El- Aziz, Athar F Lasheen
October-December 2021, 34(4):1433-1438
DOI:10.4103/mmj.mmj_460_20  
Objectives To evaluate the level of clinical response of Menuofia university hospitals in the management of trauma and burn multiple-casualty patients according to the guidelines in a major incident. Background Providing clinical care to multiple casualties is the comparatively 'easy' part of in-hospital major incident management. The key is to plan, be flexible within the plan, and to train staff in advance. Patients and methods This prospective study was conducted on two groups consisted of 138 patients presented in trauma and burn major incidents. The clinical response of the emergency department of the hospital was assessed by hospital major incident standby, activation of the plan, triage of the patients, activation of trauma team, and the outcomes of the patients in each incident. Results There was no initial hospital response documented for all major incidents in group I, but in group II, there was response to 80.9% of major incidents, and this was related to the communication from the emergency service. The casualties presented with different types of injuries, such as head, chest, or abdominal injuries. Approximately 13 patients were with no injuries and 12 patients had multiple traumatic critical injuries. More than 50% of patients in group II had met the criteria of trauma team activation, and this affected the length of hospital stay and the outcomes of patients. Conclusion By activating the protocol, modified hospital triage, team work, effective maneuvers, and treatment modification, the immediate resuscitation and stabilization of patients was achieved in less time.
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Limbal versus pars plana approach for removal of congenital cataract: a pilot study
Manar F Dawoud, Saber H ElSayed, Nihal M ElShakankiri, Hatem M Marey, Nader H Bayoumi, Mohammed S AbdElaziz
October-December 2021, 34(4):1487-1493
DOI:10.4103/mmj.mmj_408_20  
Objective A pilot study was conducted to compare the efficacy and safety of limbus versus pars plana approach for the surgical treatment of congenital cataract. Background Bilateral congenital cataract is a common cause of amblyopia, and the surgical treatment is challenging. Patients and methods A pilot study was conducted on children under the age of 2 years with bilateral congenital cataract, stratified into anterior (limbus group) and posterior (pars plana group) surgery approaches. Safety and efficacy were assessed, as well as intraoperative surgeon comments on the ease and feasibility of either technique. Results The study enrolled 34 children with bilateral congenital cataract. The average age of presentation in either group was about 7 months (P = 0.23). The mean ± SD of the duration of surgery was 9.8 ± 0.9 (8–12) and 16.5 ± 3.3 (10–25) min (P < 0.001) in the limbus and the pars plana groups, respectively. The surgeon did not note any specific technical difficulty or negative comments in either group. In the pars plana group, one (2.9%) eye demonstrated intraoperative bleeding (trickle into the vitreous that resolved spontaneously after 2 weeks with no untoward sequelae). In the limbus group, one (2.9%) eye developed secondary glaucoma and one (2.9%) eye developed capsular phimosis. In the pars plana group, one (2.9%) eye developed secondary glaucoma and one (2.9%) eye developed posterior capsule opacification. Conclusions Both approaches were effective and safe for congenital cataract in the first 2 years of life, with the limbus approach being significantly shorter and potentially more advantageous.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Spectrum of renal diseases in patients referred to acute hemodialysis in a tertiary care center
Mohamed S Aboelnasr, Rasha Y Hagag, Omneya M Darrag, Waleed Elrefaey
October-December 2021, 34(4):1317-1322
DOI:10.4103/mmj.mmj_97_21  
Objectives To analyze the causes and epidemiology of patients undergoing acute hemodialysis in our locality. Background Acute kidney injury (AKI) is associated with high morbidity and mortality. It is a major indication for renal replacement therapy in the ICU. An important fraction of renal replacement therapy-treated AKI progresses to chronic kidney disease (CKD), while patients with CKD constitute a large fraction of patients with AKI. Patients and methods This was a retrospective observational cohort study including patients presented to acute hemodialysis at the hemodialysis unit of a tertiary care center over a period of 2 years (from January 2016 to December 2017). Results A total of 167 patients were included. Patients were classified into three groups: group 1 included 76 (45.5%) patients with AKI, group 2 included 28 (16.8%) patients with AKI on top of CKD, and group 3 included 63 (37.7%) patients who were diagnosed with end-stage kidney disease for the first time on presentation to dialysis. The most common causes of AKI in group 1 were infection, obstructive uropathy, and hypovolemia. The most common causes of AKI in group 2 were infection, obstructive uropathy, and toxin/drug-induced. Patients in group 3 were older; 55.56% of them were hypertensive, and one-third of them were diabetic. Conclusions The major causes of AKI-requiring dialysis were infection, hypovolemia, and obstructive uropathy. A significant proportion of patients in this study were either crash or unplanned starters of dialysis; this proportion can be reduced by screening programs for renal disease at a national level.
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Significance of Excision-Repair Cross-Complementation 1 gene polymorphism as a risk for hepatocellular carcinoma
Noran T Aboelkhair, Emad F Abdelhalim, Asmaa I Gomaa, Asmaa El-Ahmady Mohamed, Kamal A Amer
October-December 2021, 34(4):1249-1254
DOI:10.4103/mmj.mmj_103_21  
Objectives To study the clinical significance of rs1046282 polymorphism of excision-repair cross-complementation group 1 (ERCC1) as a risk factor for hepatocellular carcinoma (HCC). Background HCC is considered one of the commonest malignancies in the world. ERCC1 gene is implicated in the base-excision repair of DNA. Different polymorphisms in the ERCC1 gene were associated with ovarian, colorectal, gastric, and lung cancers. Patients and methods This case–control study was performed on 100 patients divided into three groups: HCC group, cirrhosis group, and control group. Genotypes of rs1046282 (T/C) single-nucleotide polymorphism in ERCC1 were evaluated via TaqMan allelic discrimination. Logistic regression analysis and the χ2 test were used to relate between different genotypes and the vulnerability of HCC. Results The genotype distribution was in accordance with the Hardy–Weinberg equilibrium. There was a significant statistical difference between the cirrhosis and HCC group regarding genotype distribution (P = 0.021) as the CC genotype was more represented in the HCC group than the cirrhosis group. Also, C allele was significantly more represented in HCC than the cirrhosis group (P = 0.047). The C allele and CC genotype were considerably related with elevated risk of developing HCC (P = 0.001, 0.043, respectively). Conclusion The CC genotype and C allele of ERCC1 gene single-nucleotide polymorphism rs1046282 confer susceptibility for HCC.
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INTERNAL MEDICINE - ORIGINAL ARTICLES
Effect of diabetes mellitus on direct-acting antiviral drugs in chronic hepatitis C-infected patients
Ashraf G Dala, Sameh M Saif, Mohammad S Abd Allah, El-Arab A Ezz
October-December 2021, 34(4):1298-1304
DOI:10.4103/mmj.mmj_296_20  
Objective To evaluate the role of direct-acting antiviral (DAA) agents used for treatment of hepatitis C virus (HCV) in diabetic Egyptian patients. Background There was a revolutionary reduction HCV epidemic in Egypt. Combinations of DAAs were reported to show high rates of sustained virological response (SVR) and pan-genotypic clinical efficacy in HCV genotypes. Patients and methods A prospective study was conducted on 200 consecutive patients with chronic HCV infection (100 diabetic and 100 nondiabetic) who attended the outpatient clinics of National Hepatology and Tropical Medicine Research Institute and received sofosbuvir plus daclatasvir with ribavirin for 12 and 24 weeks according to HCV treatment protocol issued by the National Committee for Control of Viral Hepatitis. All investigations were done before and after treatment. Results There was no significant difference between both groups regarding rapid virological response (P = 0.226) and SVR (P = 0.106). Overall, 24% of patients developed adverse effects during treatment and 76 (76%) patients were free in the diabetic group, whereas in the nondiabetic group, only eight patients developed adverse effects during treatment and 92 (92%) patients were free. So, the diabetic group had significantly higher adverse effects than the nondiabetic group (P = 0.005). Conclusion There was no significant difference between both groups regarding rapid virological response and SVR. Improvement of glycemic control with DAAs was seen more in younger patients without family history of type 2 diabetes mellitus and short duration of diabetes mellitus. DAAs have proven to be safe and effective. DAAs are well suited for nearly all infected patients, and many countries worldwide have taken on initial treatment scale-up strategies.
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The relationship between nesfatin-1 and grades of diabetic nephropathy in type 2 diabetic patients
Mohammed A Shaaban, Alaaeldin A Dawood, Ahmed R Tawfik, Mohamed Z Nooh, Belal A Montaser, Mohamed E Elnagdy
October-December 2021, 34(4):1305-1309
DOI:10.4103/mmj.mmj_4_21  
Objective To assess the relation between plasma nesfatin-1 levels and grades of diabetic nephropathy. Background Nesfatin-1 may be involved in the pathogenesis of diabetic kidney disease. Our study aimed to determine the relationship of nesfatin-1 levels with different grades of diabetic nephropathy in type 2 diabetic patients and to detect the possible association of nesfatin-1 with some metabolic parameters in such diabetic patients. Patienta and methods The study enrolled 120 age-matched patients selected from the outpatient clinic, Alexandria Police Hospital. Patients were divided into four groups: group I included 30 diabetic patients without albuminuria, group II included 30 diabetic patients with low-grade albuminuria 30–300 mg/dl, group III included 30 diabetic patients with high-grade albuminuria more than 300 mg/dl, and group VI included 30 nondiabetic healthy control groups. All patient groups were subjected to laboratory investigations, which included glycosylayed hemoglobin; kidney function tests including blood urea nitrogen and serum creatinine levels, urinary albumin to creatinine ratio; determination of serum nesfatin-1 levels; and correlation between serum nesfatin-1 and different parameters. Results There was no statistically significant difference in nesfatin-1 level among the four groups. There were no significant correlations between plasma nesfatin-1 and serum creatinine, urine albumin–creatinine ratio, and glycosylated hemoglobin. Conclusion There is no correlation between plasma nefatin-1 level and the grades of diabetic kidney disease. So, plasma nesfatin-1 is not considered for the prediction of developing diabetic kidney disease in previously unaffected patients with diabetes mellitus.
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RHEUMATOLOGY AND REHABILITATION - ORIGINAL ARTICLE
Relation between neuropathic pain and serum levels of vitamin D in Egyptian patients with rheumatoid arthritis
Mervat I Abdelazeem, Shaimaa S Anwar, Rabab A Mohamed, Enas A Abdelaleem
October-December 2021, 34(4):1416-1421
DOI:10.4103/mmj.mmj_62_21  
Objectives This study aims to measure vitamin D serum levels in Egyptian patients with rheumatoid arthritis (RA) and assess its association with neuropathic pain (NP). Patients and methods The present study was conducted on 70 RA patients. NP was evaluated by the Leeds Assessment of Neuropathic Symptoms and Signs, visual analog scale (VAS) was used to assess the degree of pain, disease activity score (DAS-28) was used to assess activity, and modified health assessment questionnaire (mHAQ) was used to assess quality of life. Serum vitamin D levels were measured for all the patients by ELISA. Results RA patients with NP had significantly lower vitamin D levels as compared with patients without NP (P = 0.001). The mean serum levels were 10.34 ± 3.5 versus 25.71 ± 4.8 for patients with NP and patients without NP, respectively. Patients with NP had a significantly higher VAS score, higher DAS-28 score, and higher mHAQ score as compared with patients without NP. The serum level of vitamin D was inversely correlated with VAS (r=−0.422, P = 0.001), DAS-28 (r=−0.268, P = 0.025), and with mHAQ score in the studied RA patients (r=−0.236, P = 0.049). The serum level of vitamin D was inversely correlated with neuropathic symptoms and signs as assessed by Leeds Assessment of Neuropathic Symptoms and Signs (r=−0.268, P = 0.025). Conclusion Our study showed that vitamin D serum level is lower in Egyptian RA patients with NP than those without NP, and was significantly correlated with pain severity.
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Corneal and lens densitometry after corneal collagen cross-linking with conventional versus enhanced protocol
Saber H El Sayed, Mahmoud M. S. Nassar, Ahmed Basyoni
October-December 2021, 34(4):1505-1512
DOI:10.4103/mmj.mmj_381_20  
Objective To evaluate the changes in corneal and lenticular density following corneal cross-linking (CXL) with conventual versus enhanced protocol. Background Corneal stromal haze is common after CXL. This is related to the corneal stromal changes occurring after CXL. This can be detected clinically and graded subjectively at the slit-lamp, or measured objectively using Scheimpflug imaging densitometry. Patients and methods This is a prospective randomized controlled clinical trial including all patients with keratoconus undergoing CXL. It included 20 eyes with conventional versus 20 eyes with enhanced method. All patients attended the outpatient clinic unit of Menoufia University Hospital, Shebin El Kom, during the period study from August 2019 till June 2020. Full history; routine, physical examination; general topography; and Pentacam imaging were done. Results Mean corneal thinnest location thickness was significantly improved after 30 min (462 ± 15.6) than 10 min (431.23 ± 92.94). There were no statistically significant differences between the two studied groups regarding corneal densitometry and lens density (P > 0.05). The correlation between thinnest location and Kmax as well as corneal and lens density did not reach statistical significance level (P > 0.05). There was an exception was in group I, where thinnest location was significantly negatively correlated with Kmax preoperatively (P = 0.008) and 1 month postoperatively (P = 0.046). Moreover, thinnest location was significantly positive correlated with corneal density 180 at 6 months postoperatively (P = 0.001). Conclusion A significant improvement in corneal thinnest location thickness was observed at the final follow-up examination after 30 min (462 ± 15.6) than 10 min (431.23 ± 92.94). Moreover, thinnest location was correlated inversely with Kmax after 1 month postoperatively. However, thinnest location was significantly positively correlated with corneal density at 6 months postoperative. In addition, a significant improvement in contrast sensitivity at the final follow-up examination after 10 min than 30 min, but the different between them did not reach statistical significance.
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PEDIATRICS - ORIGINAL ARTICLES
Value of transforming growth factor-β2 in infant's serum, mother's breast milk, and its correlation with feeding intolerance
Zein A Omar, Walaa A. M Abdel Hamed, Ahmed A Khattab, Dalia M Allahonya, Mohamed S. M. Rizk
October-December 2021, 34(4):1369-1374
DOI:10.4103/mmj.mmj_38_21  
Objective The study value of transforming growth factor-beta2 (TGF-β2) measurement in infant's serum and mother's breast milk and its correlation with feeding intolerance (FI). Background The occurrence of FI remains a concern for care providers in the neonatal intensive care unit and may adversely affect preterm infants. In the intestine, TGF-β2 is involved in regulating inflammatory responses and establishing oral tolerance. The current study was designed to clear whether preterm infants are more susceptible to FI than term infants. Patients and methods A prospective, clinical study on 60 patients admitted to the neonatal intensive care unit and nutritional unit of the pediatric department, 30 preterm and term infants with FI, matched in age and gender with the corresponding 30 healthy preterm and term infants. TGF-β2 levels were measured using enzyme-linked immunosorbent assay technique. Results TGF-β2 levels in breast milk had a significant negative correlation with gestational age (P < 0.001) and weight (P < 0.001). In preterm infants with FI, TGF-β2 levels in breast milk were significantly decreased in the colostrum (P < 0.001) and at the first week (P = 0.037) when compared with preterm infants without FI. There was a significant negative correlation between TGF-β2 levels in breast milk (P = 0.049) and also TGF-β2 levels in infant's serum (P < 0.001) with the occurrence of FI. Conclusion TGF-β2 levels in breast milk had a high significant negative correlation with gestational age and weight, so TGF-β2 levels in breast milk negatively correlate with infant maturity. TGF-β2 levels in breast milk may have a preventive role against FI and breastfeeding has an apparent benefit in reducing the incidence of FI.
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Pulmonary gas exchange and acute neurological complications in nonbypass versus bypass cardiac surgery in children
Mahmoud M El Behiry, Mohamed M Morsy, Aitizaz Syed, Ahmed T Mahmoud, Maha A Tawfik, Sherif S Salem, Mostafa I Elbehery
October-December 2021, 34(4):1351-1357
DOI:10.4103/mmj.mmj_21_20  
Objective The study aimed to compare neurological complications, pulmonary gas exchange, and mortality among children with congenital heart disease after nonbypass versus bypass cardiac surgery. Background Whether off-pump cardiac surgical procedures have less pulmonary gas exchange problems, neurological complications, and less mortality compared with operations involving cardiopulmonary bypass is debatable. We compared these outcome parameters in comparable groups of children who have undergone cardiac surgical procedures with or without cardiopulmonary bypass in our center. Patients and methods A total of 129 patients who underwent congenital heart surgery were allocated into two groups: group 1 underwent nonbypass cardiac surgery (n = 51), and group 2 underwent bypass cardiac surgery (n = 78). Pulmonary gas exchange was assessed using the alveolar-arterial oxygen gradient (A-aO2), partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), and respiratory index (RI). Patients were observed for the development of acute neurologic complications (ANCs) for 30 days after cardiac surgery. Results We found more acute deterioration in A-aO2 gradient (mean ± SD, 114.28 ± 193.77) and RI (mean ± SD, 316.03 ± 506.38) in the bypass group as compared with the nonbypass group (mean ± SD, A-aO2 gradient of 41.63 ± 65.03 and mean ± SD, RI of 113.43 ± 278.51). There was no significant difference in the occurrence of ANCs between the two groups. Conclusion Nonbypass cardiac surgery produces relative beneficial effect on pulmonary gas exchange. However, this does not translate in clinical practice in terms of ventilator time or postoperative hospital stay. There was no beneficial effect of nonbypass cardiac surgery over bypass cardiac surgery regarding postoperative ANCs.
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OPHTHALMOLOGY - ORIGINAL ARTICLES
Ultrasound biomicroscopic changes in anterior chamber angle induced by phacoemulsification versus laser peripheral iridotomy
Amin F Ellakwa, Ahmed M. S. Fayed, Mena S. M. Nicola
October-December 2021, 34(4):1481-1486
DOI:10.4103/mmj.mmj_462_20  
Objectives To make a comparison between the effect of the laser peripheral iridotomy (LPI) and phacoemulsification on the width of the anterior chamber angle by ultrasound biomicroscopy. Background Primary angle-closure glaucoma is a major cause of blindness worldwide. It is a disease of ocular anatomy that is related to pupillary-block and angle-crowding mechanisms of filtration angle closure. Patients and methods A nonrandomized clinical trial was carried out on 36 eyes of 36 patients from October 2019 through October 2020 in Menoufia University Hospital. Results Regarding the comparison between phacoemulsification and LPI groups regarding intraocular pressure (IOP) before and after 1 week and 1 month of procedure, there was no statistically significant difference between the two groups regarding IOP after 1 week and after 1 month of procedure (P = 0.428 and 0.911, respectively). There were highly significant changes regarding IOP in phacoemulsification and LPI groups after 1 week and 1 month from the procedure as compared with before it (P < 0.001). Conclusion This study proved that phacoemulsification with posterior chamber IOL implantation is a safe and equally effective procedure in lowering IOP and preventing its increase. This success is achieved by improving anterior chamber morphology in patients with chronic primary angle closure and cataract.
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RADIOLOGY AND IMAGING SCIENCES - ORIGINAL ARTICLES
Recent advances in multidetector computed tomography in diagnosis and staging of pancreatic head cancer
Shimaa A Hussanein, Doaa M. Abd El Sammee Mohamed, El Sayed E El Sayed
October-December 2021, 34(4):1399-1403
DOI:10.4103/mmj.mmj_330_20  
Objective The purpose of this study was to diagnose and stage pancreatic head cancer using recent advances in multidetector computed tomography (MDCT). Patients and methods The study included 40 patients (30 males and 10 females) who had pancreatic head masses either as first presentation or as a follow-up study for pancreatic head cancer referred to the CT unit. Results Adenocarcinoma as reported by pathological studies was found in all patients. According to MDCT criteria, 82.5% of patients had no metastasis, and others had positive metastasis in liver metastasis in 12.5%, pulmonary metastasis in 2.5%, and right suprarenal metastasis 2.5%. In this study, we found that there were insignificant differences between pancreatic mass size and occurrence of metastasis. Regarding pancreatic head cancer staging, we found that 42.5% of patients are of stage III, 30% of stage II, 17.5% of stage IV, and 10% of stage I. We found that 95% of masses were detected using axial-sagittal series, and the remaining 5% not detected by them were detected using coronal reformatting technique. Coronal reformatting technique was also excellent in identifying vascular invasion, as it had the ability to identify all cases of vascular invasion (100%). Curved planar reformations and three-dimensional volume rendering techniques had the ability to detect 90% of cases with ductal involvement and biliary obstruction. Conclusion Contrast-enhanced multiphase pancreatic imaging by MDCT with its postprocessing techniques represents the image of choice for diagnosis and predicting pancreatic head masses and resectability.
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CLINICAL PATHOLOGY - ORIGINAL ARTICLES
Expression signature of long noncoding RNA growth-arrest-specific 5 during induction therapy in adult B-cell acute lymphoblastic leukemia
Khaled A Khalifa, Raafat M Abdlfattah, Hanan H Elsheity, Amira M. F. Shehata
October-December 2021, 34(4):1238-1243
DOI:10.4103/mmj.mmj_158_21  
Background Several studies have highlighted long noncoding RNA growth-arrest-specific 5 (GAS5) as a key player in various normal and pathological conditions. Overall, GAS5 acts as a tumor suppressor, whose downregulation is directly connected to tumor proliferation, tumor progression, and therapy-related resistance across different types of tumors. To date, its importance in acute leukemia has not been widely investigated. Objectives To investigate the changes in the expression levels of long noncoding RNA GAS5 during induction chemotherapy of adult patients with B-cell acute lymphoblastic leukemia (B-ALL). Patients and methods Peripheral blood samples were obtained before starting therapy from 35 adult patients with B-ALL and then on day 15 and day 33 of induction therapy. Twenty control samples were collected from healthy donors. GAS5 expression was estimated using reverse-transcription quantitative PCR technique. Results Pretreatment GAS5 expression of B-ALL patients was significantly decreased when compared with that of healthy controls (P = 0.002). Analysis demonstrated that GAS5 expression was significantly increased on day 15 as compared with its level at diagnosis (P < 0.001). On day 33, GAS5 expression was significantly increased in comparison with its level on day 15 (P < 0.001). Moreover, our results showed that low GAS5-expression levels at diagnosis were significantly associated with initial leukocyte count more than 30 × 103/μl and BCR–ABL1-positive B-ALL (P = 0.01, P = 0.015, respectively). Conclusions We reported a downregulation of circulating GAS5 in B-ALL patients, which showed elevation after initiation of induction therapy. Downregulation of GAS5 was associated with unfavorable prognostic factors, denoting its prognostic potential in B-ALL.
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OBSTETRICS & GYNECOLOGY - ORIGINAL ARTICLES
Correlation between circulating tumor cells and ovarian tumors' histopathology
Mohammed S Gad, Mohamed L Salem, Alaa El Dein F. A. Alhalaby, Mohammed H Sheleby
October-December 2021, 34(4):1451-1456
DOI:10.4103/mmj.mmj_88_21  
Objective To determine the correlation between the ovarian masses' histopathology and circulating tumor cells (CTCs). Background Ovarian cancer is the most frequent cause of death among gynecological cancer cases worldwide. Patients and methods This is a prospective study that was carried on 66 patients in Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University and Centre of Excellence in Cancer Research between December 2018 and March 2021. The patients included in the study were with a previous diagnosis of suspected ovarian malignancy depending on history, ultrasound criteria, and tumor markers and prepared for exploratory laparotomy for debulking surgery. For all patients, detailed history taking, complete clinical examination, abdomen and pelvic ultrasound, cancer antigen 125 and risk of malignancy index (RMI) were done. Results Our results reported that there was a highly statistically significant positive correlation between CTCs and RMI in the studied patients and a highly statistically significant positive correlation between CTCs and cancer antigen 125 in the studied patients. There was a highly statistically significant positive correlation between CTCs and International Federation of Gynaecology and Obstetrics (FIGO) staging in the studied patients; however, no statistically significant correlation between RMI and FIGO staging was found in the studied patients. There was a statistically significant difference (P < 0.05) between the studied cases (CTCs) regarding histopathological grades. Conclusion CTCs allow differentiation between malignant and nonmalignant ovarian masses, and CTCs are well correlated with the FIGO stage.
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ERRATUMS
Erratum: Study of serum microRNA-21 and alpha-fetoprotein in patients with hepatocellular carcinoma secondary to viral hepatitis

October-December 2021, 34(4):1513-1513
DOI:10.4103/1110-2098.333271  
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Erratum: Relation of phosphatase and tensin homolog gene polymorphism with hepatocellular carcinoma among hepatitis C-infected patients

October-December 2021, 34(4):1514-1514
DOI:10.4103/1110-2098.333270  
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