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   Table of Contents - Current issue
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April-June 2020
Volume 5 | Issue 2
Page Nos. 121-236

Online since Saturday, May 16, 2020

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ORIGINAL ARTICLES  

Postoperative complications in pediatric cardiac surgery patients done in a tertiary hospital Highly accessed article p. 121
Ahmed H Gamal, El-Minshawy K Ahmed, Ismail E Ahmed, Sadek A Omar
DOI:10.4103/JCMRP.JCMRP_130_19  
Introduction Postoperative complications can involve several organs and have a major effect on in-hospital stay length and quality of life of the children after discharge from the hospital. Although the complications are strictly related to the surgical procedure, postoperative pulmonary complications represent an important and probably underestimated cause of morbidity and mortality in postoperative pediatric heart surgery. Aim The aim of this study was to evaluate the relation between complication and the overall outcome. Patients and methods This retrospective descriptive study included 100 children (ages from 0 to 18 years old, excluding preterm babies) who underwent open heart surgery in Cardiothoracic Surgery Department of Assiut University in a 1-year period. The preoperative and intraoperative parameters included technique of operation, cardiopulmonary bypass time, and aortic cross-clamp time. The postoperative parameters included occurrence of postoperative complications, such as arrhythmias, heart failure, pulmonary congestion with chest infection, wound infection, and bleeding, and hospital stay of the patients. Results The occurrence of complications after congenital heart surgeries using cardiopulmonary bypass has significant relation with the cardiopulmonary bypass time; therefore, the longer the cardiopulmonary bypass time, the more the probability of cardiac and extracardiac complications. This study shows the same result as studies in adult surgery, demonstrating that complications after heart surgery significantly are associated with increased hospital stay time. Conclusion Surgery is the optimal and the final treatment for congenital heart diseases; nearly a quarter of the patients who undergo congenital heart surgery experience postoperative complications, complex congenital heart diseases with different degrees of heart failure, or respiratory failure, and carry more risk for complications. So close monitoring and timely intervention and treatment are very critical to avoid occurrence of multiple complications as reported in our study.
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Diagnosis of carpal tunnel syndrome using ultrasonography p. 126
Nagham N Omar, Gehan S A. Hassan, Marwa A A. Galal, Wafaa A Abdelwahab
DOI:10.4103/JCMRP.JCMRP_88_18  
Background The carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Therefore, this study aimed to determine the diagnostic efficacy of the gray-scale and Doppler sonography in the diagnosis and grading of patients with CTS. Patients and methods This is a prospective study conducted on 40 adult patients (28 women and 12 men; 76 wrists). Twenty were suffering from CTS, and the other 20 were healthy controls. All of them were examined using a 7–12 MHz linear transducer. Presence of median nerve edema, swelling, flattening ratio of the median nerve, and bowing of the flexor retinaculum were evaluated by gray-scale sonography while Doppler sonography evaluated intraneural hypervascularity. Sensitivity and specificity were calculated considering the nerve conduction studies as a gold standard. Results Cross-sectional area (CSA) inlet has the highest sensitivity and accuracy in the diagnosis of CTS (92 and 90%, respectively) in addition to subjective ultrasonography findings such as nerve edema and nerve mobility which had a100% specificity. Doppler examination findings also had a high specificity of 92%. Combined CSA inlet and the swelling ratio have a higher diagnostic accuracy of 95% in diagnosing CTS compared with CSA inlet alone. The CSA inlet used in the grading of CTS with cutoff values of 9–15 mm2 for mild CTS, CSA more than 15 mm2 for moderate CTS, and CSA more than or equal to 16 mm2 for severe CTS. Conclusion A combination of CSA inlet and swelling ratio have the highest sensitivity and accuracy than CSA inlet alone in diagnosing CTS.
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Verification of aberrant expression of CD7 in acute myeloid leukemia p. 133
Maged S Mahmoud, Heba A Abd Elhafeez, Shaimaa M Abd Elmouez
DOI:10.4103/JCMRP.JCMRP_115_18  
Introduction Acute myeloid leukemia (AML) is an aggressive disorder characterized by accumulation of blast cells in bone marrow. The heterogeneous phenotype of AML is based on cytogenetic mutations and molecular aberrations. Immunophenotyping is a convenient method for quick and reproducible diagnosis of most hematological malignancies. The higher frequency of aberrant expression of lymphoid markers in AML may be related to environmental changes and accumulation of biological defects. The CD7, a T-cell antigen, is expressed in a minority of patients with AML, and it is the most common aberrant marker found in AML in most studies. Aim We aimed to determine the frequency of CD7 expression in AML and to verify if this aberrant expression is true or false. The study included 32 newly diagnosed patients with AML. Detection of CD7 in AML was done by using an independent method to check the gene expression, namely, reverse transcriptase-PCR, besides the usually used monoclonal antibody-based flow cytometric measurements. Patients and methods The study revealed the frequency of CD7 expression in newly diagnosed AML cases to be 18.1% by flow cytometry. The AML cases with positive CD7 expression by flow cytometry were subjected to reverse transcriptase-PCR to determine gene expression. All cases with positive CD7 expression by flow cytometry were found to be negative for CD7 gene expression by PCR. Conclusion This study raises a reasonable possibility of a false-positive detection of aberrant CD7 expression in AML using immunophenotyping by flow cytometry.
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Evaluation of serum hepatitis B surface antigen quantification kinetics in different patterns of chronic hepatitis B infection Highly accessed article p. 141
Mohamed A Mekky, Zainab G Mahraan, Aya A S. Riad, Ahmed M Abu Elfatth, Youssef M Swifee
DOI:10.4103/JCMRP.JCMRP_152_19  
Background and aim Management of chronic hepatitis B (CHB) infection is challenging owing to its wide immunologic phases and pathologic patterns. Quantification of serum HBs-Ag (qHBsAg) has been used as a mirror of intrahepatic viral replication, and therefore, its kinetics in these patterns may reflect diseases severity and hence may help in tailoring the management plan. So, this study was designed to assess the patterns and kinetics of qHBsAg among Egyptian patients presented with different forms of CHB. Patients and methods Between December 2016 and December 2017, patients with CHB were enrolled and categorized into three groups. Group I included naive aviremic patients [those with negative hepatitis B virus (HBV)-DNA-PCR without treatment]. Group II included naive low viremic patients (those with HBV-DNA-PCR <2000 IU/ml without treatment). Group III included treatment-experienced aviremic patients (those with negative HBV-DNA-PCR after 6 months of nucleotide analog treatment). All patients were checked for alanine aminotransferase (ALT), qHBsAg, and HBV-DNA-PCR at a regular intervals: at baseline (W0), week 12 (W12), and week 24 (w24). Results A total of 90 patients were enrolled, with 30 patients in each group. In group I, qHBsAg and ALT levels exhibited relatively stable detectable positively correlated levels from W0 to W24. In group II, qHBsAg and ALT levels were the same as group I. In group III, qHBsAg, ALT levels, and HBV-DNA exhibited a significant decrease during the follow-up with the use of nucleotide analog therapy. Conclusion qHBsAg measurement, which is a cheap and easy test, can replace HBV-DNA and may help in reflection of disease activity and assessment of follow-up.
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Renal anemia refractory to erythropoietin p. 146
Zaher A. H Mola Aldwilla, Mohammed A Sobh, Ahmad F Thabet
DOI:10.4103/JCMRP.JCMRP_174_19  
Background Anemia is a common feature of chronic kidney disease and is associated with poor outcomes. Renal anemia has a multifactorial etiology, and the major cause is decreased production of erythropoietin (EPO). The standard of care for the treatment of the renal anemia is EPO for achieving target of hemoglobin levels (11gm /dl), but some causes lead to inadequate response to EPO. Aim The study aimed to determine the frequency and various factors contributing to the etiology of renal anemia refractory to EPO in patients with end-stage renal disease (ESRD) on hemodialysis (HD). A descriptive longitudinal study was performed. The study was carried out on 30 patients with ESRD on HD selected randomly and received EPO drug at the Nephrology Unit and Outpatient Clinic at the Department of Internal Medicine of Assiut University Hospital. The data were obtained from full medical history and clinical examination, such as general data concerning patients (age, sex, comorbidities, and used medications), which were recorded directly from the patients or from their hospital files, laboratory investigations, and follow-up of patients for 4 months, with complete blood count examination every month. Patients and methods The study found that of 30 studied patients, 23 (76.7%) had partial response to reach the targeted hemoglobin level and seven (23.3%) had complete response to reach the targeted hemoglobin level of 11 g/dl. The 23 patients who had partial response had poor nutrition, iron-deficiency anemia (IDA), inadequate dialysis, arteriovenous fistula and chest infections, drugs containing aluminum, acute blood loss, hypocalcemia, hyperphosphatemia, and hyperparathyroidism. These may be possible risk factors of renal anemia refractory to EPO. Results Anemia is a common complication of uremia and a major contributor to morbidity and mortality in HD patients. The availability of recombinant human EPO has led to almost complete disappearance of severe anemia in HD patients; however, despite an increase in its use and average dose, a substantial percentage of patients still fail to achieve the Hb targets recommended by the international guidelines. Anemia refractory to EPO is common in HD patients (76.6%), which may be owing to several factors such as bad nutrition, IDA, inadequate dialysis, arteriovenous fistula and chest infection, aluminum-containing drugs, hypocalcemia, hyperphosphatemia, and hyperparathyroidism. Conclusions The study recommends to monitor serum levels of iron, calcium, phosphate, and parathyroid hormone at the start, with follow-up by complete blood count monthly, as well as treatment of the possible causes, that is, iron for IDA, antibiotic for infections, calcium therapy for hypocalcemia, and management of hyperphosphatemia and secondary hyperparathyroidism, during treatment of renal anemia by erythropoietin (EPO) drug to responded to it. Moreover, the study recommends performing more studies on a larger number of patients with ESRD having renal anemia for more demonstration of the possible causes of this condition.
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Role of platelet-associated immunoglobulin G in hypersplenism-associated thrombocytopenia p. 152
Hesham A Abdel-Baset, Mohamed A.Y. Abdel-Malek, Mahran M H. Mahran
DOI:10.4103/JCMRP.JCMRP_139_19  
Introduction Hypersplenism is characterized by cytopenia, splenomegaly, and increased or normal bone marrow cellularity. Platelet-associated immunoglobulin G (PAIgG) is a class of platelet autoantibodies bound to the surface glycoprotein of the platelet and is mainly produced by the spleen. Significant higher PAIgG levels were found in patients with thrombocytopenic purpura and cirrhotic hypersplenism. Aim The aim was to assess the antiplatelet immunoglobulin G antibodies level in patients with hypersplenism-associated thrombocytopenia before and after, first, medical treatment (growth factors and corticosteroids) and second, surgical treatment (splenectomy). Patients and methods This study included 40 patients with hypersplenism and 10 age-matched and sex-matched healthy controls. Serum antiplatelet IgG was measured by ELISA technique using Human antiplatelet IgG (anti-PA IgG) ELISA Kit. Results In both the splenectomized and the medical groups, PAIgG had insignificant decrease during follow-up in comparison with baseline level (in case of the splenectomized group, 224.50 ± 51.32 vs 206.30 ± 69.82 μg/ml, P = 0.33, and in case of the medical group, 200.81 ± 55.41 vs 186.60 ± 72.29 μg/ml, P = 0.07). Conclusion An immune process may be mediated by PAIgG, and secondary hypersplenism due to portal hypertension is associated with thrombocytopenia in patients with liver cirrhosis. The authors also found that patients with splenomegaly subjected to splenectomy had a significant elevation of platelet counts and insignificant reduction in PAIgG levels.
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Acute mechanical performance of bioresorbable scaffolds compared with everolimus-eluting stents under optical coherence tomography guidance p. 158
Nagwa A Abdelrahman, Arif A Al Nooryani, Hatem A Helmy, Yehia T Kishk, Ayman K M. Hassan
DOI:10.4103/JCMRP.JCMRP_155_19  
Objective The aim was to compare the acute mechanical performance of the ABSORB bioresorbable scaffold (BRS) with the everolimus-eluted stents (EES) after optical coherence tomography (OCT)-guided deployment. Background The intrinsic differences in biomechanical properties between BRS and EES and the thicker BRS struts can affect the BRS acute mechanical performance in terms of scaffold expansion and struts apposition. Materials and methods The authors compared the acute mechanical performance of 245 scaffolds with that of 82 everolimus-eluted EES. All scaffolds/stents were deployed under OCT guidance. OCT was used to assess the following acute mechanical performance indices: residual area stenosis, device underexpansion, struts malapposition, edge dissection whether covered or uncovered, and strut fracture. Results Two hundred forty-five scaffolds implanted in 162 patients in the BRS arm were compared with 82 stents implanted in 61 patients in the EES arm. Final OCT acquisitions showed no statistically significant difference in the acute mechanical performance indices between both arms, in terms of residual area stenosis, device underexpansion, struts malapposition, and struts fracture. The only significant difference was noted in the higher rates of both covered and uncovered edge dissections in the BRS arm. Conclusion Under OCT guidance, there was no significant difference in the acute mechanical performance of BRS vs EES, apart from higher rates of both covered and uncovered edge dissections in the BRS arm.
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Percutaneous cystolithotripsy in the management of pediatric bladder stone p. 164
AA Kamel, AA Shahat, AS Safwat, AK Abdaallah
DOI:10.4103/JCMRP.JCMRP_131_19  
Background Bladder stones in children represent up to 15% of all pediatric urolithiasis. Variant methods of managing vesical stones in children are available now with comparable success rates. Percutaneous cystolithotripsy (PCCL) was introduced to our department to be offered for male children on a routine basis. Aim To evaluate our experience in managing bladder stones in male children less than 14 years of age via PCCL regarding safety and efficacy. Patients and methods A total of 37 children underwent PCCL for their bladder stones in the period between November 2016 and November 2017 in Assiut Urology and Nephrology Hospital. Their median age was 36 (12–144) months and median stone size was 11 (7–26) mm. Initial diagnosis was urethral stones in 26 (70.3%) patients and bladder stones in 11 (29.7%) patients. Patients were followed up for periods ranging from 5 to 33 months (median 18 months). Results The median operative time was 14 (5–45) min. Twenty-one (56.8%) patients underwent direct stone extraction without disintegration of their bladder stones. Sixteen (43.2%) patients needed disintegration of their stones, of which 13 (81.25%) had pneumatic disintegration of their stones, whereas three (18.75%) had laser disintegration. Success was achieved in 36 (97.3%) patients. Complications were reported in three (8.1%) cases, and prolonged catheterization was reported in two (5.4%) patients. Conclusion PCCL is a safe and effective minimally invasive method for treating bladder stones in children.
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Visual outcomes of topography-guided photorefractive keratectomy for treatment of patients with irregular cornea p. 168
Ahmed A Mohammed, Hassan L Fahmy, Hany O El Sedfy, Dalia M El Sebiaty
DOI:10.4103/JCMRP.JCMRP_96_19  
Background Irregular corneal astigmatism has caused a challenge to the refractive surgeons for a long time. Conventional laser ablation is usually not useful in treatment of corneal irregular astigmatism. Advanced topography-guided ablation which deals with the corneal irregularity has shown good results in the past few years. Aim To evaluate the efficiency of the topography-guided photorefractive keratectomy (PRK) for the treatment of irregular corneas with respect to the visual acuity and quality. Settings A prospective interventional case series study was performed at El Noor Ophthalmology Center from March 2017 to March 2018. Patients and methods This study included 20 consecutive eyes of 12 patients with irregular cornea who were deemed candidates for PRK correction. All patients underwent advanced topography-guided PRK. Visual acuity and refractive errors were assessed. Topographic examination with asphericity and regularity were evaluated using Pentacam. Results At 3 months, the mean uncorrected visual acuity improved from preoperative 0.13±0.12 (Decimal) (range: 0.05–0.5) to 0.79±0.12 at 3 months postoperatively (Decimal) (range: 0.6–0.9). The refractive error improved from preoperative sphere of −3.1±1.7 D (range: −5.75 to +3.00 D) to −0.03±0.36 D (range: −0.25 to +1.25 D) at 3 months postoperatively and from preoperative cylinder of −1.32±1.1 D (range: −4.5 to −0.5 D) to −0.28±0.4 D (range: −1.75 to 0.00 D) at 3 months postoperatively. Corneal asphericity, as measured by the Q value, improved from 0.34±0.31 preoperatively to −0.45±0.28 at 3 months postoperatively. Index of surface variance showed a decrease from 25.2±12.3 to 20.4±3.8. Conclusion Advanced topography-guided PRK using OCuLink is a good method in the treatment of irregular cornea owing to different reasons, with improvement of both visual acuity and quality.
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Perioperative pain alleviation of forearm fractures using a combination of hematoma block and intravenous regional anesthesia with the addition of ketamine and lidocaine p. 174
Hany A Ibraheem, Wesam N Ali, Mohamed M Mohamed
DOI:10.4103/JCMRP.JCMRP_123_19  
Introduction Forearm fractures usually require reduction before fixation. Hematoma block (HB) is easy and efficient for the reduction of those fractures with instantaneous pain release. Intravenous regional anesthesia (IVRA) is proper for forearm surgeries; unfortunately, it is painful during lifting and wrapping the arm. A combination of HB and IVRA can bring the benefits of them both. We assessed the effect of adding ketamine to IVRA versus to HB in patients receiving both blocks for forearm fractures. Patients and methods This study was a prospective, double-blinded, randomized controlled trial, performed in Assiut University Hospital. Forty-four patients with closed forearm fractures needing closed reduction and internal fixation with k-wires were involved to receive combined HB and IVRA, with ketamine (0.5 mg/kg) either within the HB group A (n=22) or within the IVRA group B (n=22). Data collection involved the evaluation of hemodynamics, the onset of HB and IVRA, tourniquet discomfort, numerical rating scale score, first analgesia demand time, and total analgesic time. Results The median (range) of preoperative and intraoperative numerical rating scale scores was significantly lower in group A at the 3rd, 5th, and 10th minutes. The average time (min) with regard to first rescue analgesia was significantly higher in group A (154.5±8.169) than in group B (121.2±12.25). No significant hemodynamic changes were noticed. Conclusion Adding ketamine to HB in patients with forearm fractures receiving a combination of HB and IVRA can afford better analgesia throughout the conduction of IVRA and prolongs postoperative analgesia better than adding it to IVRA.
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Role of MRI in evaluation of wrist ligament injury p. 180
Fatma R A. Sedeek, Moustafa H M. Othman, Abolhasan H Mohammad
DOI:10.4103/JCMRP.JCMRP_117_19  
Aims The aim of the study was to evaluate the role of MRI in detection of wrist ligament injury. Patients and methods We performed coronal PDW, coronal PDWSPIR, coronal T2-weighted, coronal gradient, and coronal STIR in 20 patients complaining of wrist pain. The authors assessed images for the integrity of lunotriquetral ligament (LTL), scapholunate ligament (SLL), and TFCC tears. Then the authors compared imaging findings with arthroscopic data in 16 patients who underwent arthroscopy (gold standard). Results A total of 12 TFCC tears were detected arthroscopically, whereas nine were found on MRI. MRI sensitivity in the diagnosis of TFCC tears was 92.31%. Eight SLL tears were found arthroscopically, whereas three tears were detected on MRI. MRI sensitivity in detecting SLL tears was 42.86%. Three LTL tears were diagnosed arthroscopically, whereas we found two LTL tears on MRI. MRI sensitivity in detecting LTL tears was 33.33%. Conclusion MRI has an excellent role in the diagnosis of the TFCC tear with high sensitivity and specificity but less accurate in the evaluation of SLL and LTL injuries.
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Magnetic resonance imaging assessment of temporomandibular joint disorders p. 185
Hassan Ibrahim Meggaly, Abolhasan Haseib, Mohamed Hasan Osman, Abeer M Salah
DOI:10.4103/JCMRP.JCMRP_132_19  
Background This prospective study aimed to detect the temporomandibular joint (TMJ) disk position in patients with TMJ dysfunction and asymptomatic patients using MRI. Results Out of 40 joints clinically diagnosed as internal derangement, MRI showed anterior disk displacement without reduction in five (12.5%) joints, anterior disk displacement with reduction in 12 (30%) joints while 23 joints showed no disk displacement (57.5%). MRI results of 20 asymptomatic joints showed ADDWR in two (10%) joints and no dis displacement in the remaining 18 (90%) joints. The associations of clinical diagnosis with MRI scan findings in both symptomatic and asymptomatic groups were statistically highly significant (P < 0.001). Conclusion From our study, we could conclude that in most of asymptomatic normal TMJs, the disk will be in the normal position with few exceptions. Among displaced disks, ADDWR is the most frequent MRI diagnosis in patients with internal derangement.
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An audit on preoperative noncardiac surgery fitness evaluation in Assiut University Hospital for Children p. 191
Hekma S Farghly, Yasser F A. El Rahim, Mina E Fely
DOI:10.4103/JCMRP.JCMRP_127_19  
Background Surgery is a main event in an individual's life. The full surgical episode is known as perioperative interval. Perioperative process in general includes three stages: preoperative, intraoperative, and postoperative. The first stage (preoperative) includes giving of nursing care to the patients who are planned to undergo surgery. It was evident that through this stage, evaluation and education of the patient are the main responsibility of health service providers to have better results of the patients. Objective The purpose of the study was to assess the methods of performing preoperative fitness assessment for noncardiac patients in Assiut University Hospital for Children, to compare these methods with the standard methods, to confirm what is necessary and bypass needless investigations, and to provide a reference framework for the preoperative evaluation of children. Patients and methods The study was conducted at Assiut University Children Hospital. Data of children who attended the outpatient fitness assessment clinic during a 6-month period were collected and analyzed, and their management was compared with the standard management guidelines. All patients attended the outpatient fitness clinic during 6 months from 1 November 2017 to 30 April 2017. The authors collected all cases that attended the outpatient fitness clinic for surgery except cardiac surgeries. Conclusion It was concluded that preoperative blood tests are unnecessary in American Society of Anesthesiologists grade-1 patients undergoing minor/moderate surgery. A main cause of overtesting is the belief between junior staff that consultants wanted them or simply by habit. When compared with surgeon-ordered testing, anesthesiologist-ordered testing was more focused and less costly. There is a requirement to have guidelines for indicated tests in different groups of diseases and procedures to be ordered by the physicians to prevent unnecessary loss of time, money, and resources and to bypass overburdening laboratory staff.
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Management of nonconvulsive status epilepticus p. 197
Rewaa M I. Hussien, Gamal A. A E. Askar, Eman F G. Mohammed
DOI:10.4103/JCMRP.JCMRP_114_19  
Background Nonconvulsive status epilepticus (NCSE) represents an important challenge to modern neurology and epileptology. It occurs in 8–37% of the general ICU population. The diagnosis and treatment of NCSE are not straightforward and depend on many variables, including the clinical setting, etiology, electroencephalographic (EEG) findings, and the clinical status of the patients. It has a wide range of differential diagnosis including posthypoxic and metabolic encephalopathies. The current treatment options are still unsatisfactory, and mortality and morbidity rates remain high. The aim of this study was to determine which cases of convulsive status epilepticus (CSE) are more prone to proceed to NCSE. Objective A case series clinical study was undertaken in the Inpatient Pediatric Neurology and Emergency Units, Assiut University Hospital, Assiut City, Egypt. The study included 114 patients between the ages of 1 month and 18 years who had CSE (seizures lasting >5 min). Patients were grouped using EEG results into those with and without NCSE, and retrospectively, the clinical risk factors were studied. Patients and methods Our study revealed that the incidence of NCSE after control of CSE is 18.4%. The most common age group affected was from 6 to 10 years (52.4%). Mixed type of convulsions (47.6%), convulsions lasting more than 10 min (52.4%), and prolonged postictal period more than 30 min (80.9%) were common among patients with NCSE. Tachycardia (57.1%), dilated pupils (81%), and impaired level of consciousness were commonly found in NCSE group. Brain atrophic changes (28.6%), hydrocephalus (4.8%), cerebral edema (9.7%), and intracranial hemorrhage (5.4%) were detected in computed tomography brain of patients with NCSE. On the contrary, normal computed tomography brain result was found in 28.6% of patients. Midazolam was used to stop convulsions in 47.6% of patients with NCSE, each of phenobarbital and phenytoin was used in 9.5%, and a combination of anticonvulsants were used in 28.57% of patients with NCSE. Conclusion We found that in patients with suspected NCSE in whom an EEG is requested, several clinical risk factors–seizures in the acute setting, age more than 6 years, mixed seizures, prolonged seizures (>5 min), persistent tachycardia after control of convulsions, impaired consciousness, dilated pupils, the use of benzodiazepines for control of convulsion and ongoing central nervous system infection –influence the risk of NCSE. The risk of NCSE rises as the number of risk factors increases. By focusing on these risk factors at the bedside, the clinician can prioritize patients for EEG.
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Most frequent causes of chest pain in children and adolescents attending Assiut University Children Hospital p. 202
Abdellatif M Abdel-Moez, Faisel E A. Abd Allah, Zeinab Ahmed Ali
DOI:10.4103/JCMRP.JCMRP_150_19  
Purpose Chest pain is common in children and adolescents and is a reason for referral to Pediatric Emergency Unit. Although most cases of chest pain in these age groups are benign and do not require treatment, timely diagnosis is important not to miss life-threatening diseases requiring prompt treatment. The authors investigated characteristics of frequent causes of chest pain in children and adolescents attending Assiut University Children Hospital. Materials and methods A total of 84 991 patients attending Assiut University Children Hospital between 1 January 2017 and 31 December 2017 were evaluated for presence of chest pain. All patients complaining of chest pain were studied for causes, clinical characteristics, precipitating factors of chest pain, and signs on physical examination. Results Overall, 400 patients presented with chest pain with an incidence of 0.4%. Most cases of chest pain were musculoskeletal in origin (42.2%), followed by cases with respiratory (17.2%), psychiatric (10%), cardiac (12.5%), gastrointestinal (8.7%), miscellaneous (8%), and idiopathic (1.2%). Conclusion Through this study, we would like to emphasize a careful diagnostic approach for chest pain. A careful history and physical examination must guide the assessment of children and adolescents presenting with chest pain.
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Testicular malondialdehyde level in azoospermic patients p. 207
Alaa E Moubashera, Hanan A Morsy, Aya H Younis, Mickel E Fakhry, Emad A Taha
DOI:10.4103/JCMRP.JCMRP_135_19  
Objective This study aimed to evaluate malondialdehyde (MDA) levels in human testicular tissue of azoospermic patients. Design This was a cross-sectional study. Patients and methods Azoospermic patients with obstructive (OA) and nonobstructive (NOA) were subjected to surgical sperm retrieval with needle aspiration using a 14 G cannula. Assay of MDA level was performed using colorimetric methods in testicular samples. In addition, assessment of the number of retrieved sperm in the samples was performed. Results The study included 21 OA (group A), 16 positive NOA (group B with positive sperm retrieval), and 21 negative NOA (group C with negative sperm retrieval). The MDA level was significantly higher in the positive and negative NOA (31.50 ± 15.81 nmol/g) (40.38 ± 14.42 nmol/g) groups than the OA group (21.33 ± 9.61 nmol/g) (P = 0.043, P = 0.000), respectively. The MDA level correlated negatively with the mean number of retrieved sperm (in groups with positive sperm retrieval A and B) (r=−0.261, P = 0.048, r=−0.402, P = 0.002), respectively. Conclusion Men with NOA seem to have increased basal testicular oxidative stress compared with those with OA as indicated by increased MDA levels in testicular samples. The MDA level correlated negatively with sperm concentration; thus, it may be considered a predictor marker for sperm retrieval in NOA cases.
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Comparative study between the efficacy of using sofosbuvir/daclatasvir and sofosbuvir/ledipasvir in treatment of hepatitis C virus in Egypt p. 212
Esraa Y M. Swifee, Ahlam M A. Farghaly, Sahar M H. Mohamad, Mohamed A M. Mekky
DOI:10.4103/JCMRP.JCMRP_129_19  
Background Hepatitis C virus (HCV) infection is a global health care problem, with more than 170 million people infected worldwide. With the discovery of new direct-acting antiviral drugs, a new hope to get HCV cure has arisen. This work was designed to compare the efficacy between the use of sofosbuvir (SOF)/daclatasvir (DCV) and SOF/ledipasvir (LDV) in treatment of HCV. Patients and methods A total of 430 patients were enrolled into two groups: SOF/DCV group included 340 patients and SOF/LDV group included 90 patients. Each patient received treatment for 12–24 weeks. All patients were checked at each visit (at weeks 4, 8, 12, and 24) for the potential adverse events by a check-list questions, examinations, and laboratory tests. Check-list questions include headache, gastric upset, skin rash, and sleep disturbance. Results A total of 419 (97.4%) patients achieved sustained virologic response (SVR), and only 11 (2.5%) patients failed to achieve SVR. In SOF–DCV, 97.4%, and in SOF–LDV, 97.8% achieved SVR. Minor adverse events were mainly headache, sleep distribution, gastrointestinal tract disturbance, and skin rash, which were observed in 13.8% of patients in SOF–DCV group 20% in SOF–LDV group. Conclusion The use of the two regimens SOF/DCV and SOF/LDV yielded high success ratio for viral eradication with minimal tolerable adverse effects. These regimens of therapy have a great margin of safety with high efficacy.
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Psychological status of school-aged children and adolescents with dyslalia p. 217
Eman S Hassan, Alaa El-Din M. Darweesh, Reham A Ibrahim, Walaa M Zareh
DOI:10.4103/JCMRP.JCMRP_133_19  
Background Many researches cited that dyslalia is often associated with behavioral problems. However, the exact behavioral problems in the dyslalia children needs more researches. Aim The present study aimed to assess the different behavioral and psychological problems among children with dyslalia to help to provide an effective therapeutic strategy for these children. Methods The study was conducted on 80 children with different types of dyslalia diagnosed by Arabic Articulation Test (study group) and on 50 normal children (control group). The children's behavioral profile was assessed via the Child Behavior Check List (CBCL). Conclusion Results of the study showed that there were significantly higher percentage of children with dyslalia had delinquent behavior, lower competence level, activities level and school performance level. Also, there were significantly higher mean scores in nearly all the domains of the CBCL except for anxious/depression and social scores in the dyslalia group however, their scores did not reach the abnormal range. Articulation problems showed broad relations to behavioral problems (especially externalizing problems and competence levels). These findings suggests that psychologists and other mental health professionals can play many roles in working directly with families of children with dyslalia. Increased collaboration with phoniatricians and specialists can facilitate effective phoniatric and psychiatric care.
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Trichoscopic findings and quality-of-life assessment in Egyptian patients with noncicatricial alopecia p. 225
Eman R Hofny, Hanan Morsy, Christine Wasfy
DOI:10.4103/JCMRP.JCMRP_142_19  
Background Trichoscopy has become a routine technique in dermatology practice. It is a simple, rapid, and noninvasive technique that allows early diagnosis and management, especially, of hair disorders. Aim This study aimed to evaluate the role of trichoscopy in diagnosis of noncicatricial alopecia (alopecia areata, androgenic alopecia, and telogen effluvium), clinical severity, and assessment of quality of life (QoL) in these disorders. Patients and methods One hundred and fifty patients with noncicatricial alopecia were divided according to their clinical diagnosis into three groups: alopecia areata (55 patients), androgenic alopecia (35 patients), and telogen effluvium (60 patients). Patients were assessed by clinical diagnosis, trichoscopy, and the Arabic version of Dermatology Life Quality Index (DLQI). In alopecia areata, patients were assessed clinically by severity of alopecia tool (SALT) score. Results The study revealed that the three types of alopecia had very large effect on QoL in most of the patients measured by DLQI. In alopecia areata, SALT score was very effective tool to evaluate AA severity, which revealed mild to moderate degree of severity, and there was a positive significant correlation between DLQI and SALT score. Trichoscopic examination revealed yellow dots, black dots, broken hairs, exclamation marks, and short vellus hairs. In androgenic alopecia, hair diameter diversity greater than 20% was the most significant sign, and also there was presence of yellow dots and vellus hair but in number less than that in alopecia areata. Stress was the most common provocative factor in telogen effluvium. Conclusion The clinical and dermoscopic features were matched among diagnosis in the three types of noncicatricial alopecia (telogen effluvium, alopecia areata, and androgenic alopecia).The observed correlation between DLQI findings and the clinical severity of alopecia areata suggests that alopecia has a negative effect on a patient's QoL.
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Role of multidetector computed tomography findings in grading renal injuries at Assiut University Hospital: a clinical audit study p. 231
Marwa M H. Almeldin, Hassan I Megally, Abolhasan H Mohammad
DOI:10.4103/JCMRP.JCMRP_140_19  
Aim To assess the performance of our Radiological Department and value of multidetector computed tomography (MDCT) in renal injured patients at Assiut University Hospital during 1 year. Patients and methods This prospective study was done in the period from April 2017 to March 2018 in Assiut University Hospital on all patients with renal trauma who presented to the trauma unit diagnosed as having renal trauma by CT with contrast and to correlate the findings seen in the MDCT with clinical and operative data of patients with renal injuries. Results Of the 61 traumatized patients who came to the trauma unit of Assiut University Hospitals with different forms of renal injuries, 48 (78.7%) were males and 13 (21.3%) were females. The range of age of those patients was between 1 and 70 years, with a mean age of 23.18 years. Conclusion The cause of injury in 55 (90.2%) patients was blunt trauma, whereas penetrating trauma (firearm and stab wound) was present in six (9.8%) patients. Of the enrolled patients, 13 (21.3%) patients were hemodynamically unstable. Hematuria was present in 37 (60.7%) patients and 24 (39.3%) patients had clear urine. Conservative management was the main line for renal injuries in the current study, where 44 (72.1%) patients were followed conservatively. Nephrectomy was done in 12 (19.7%) patients, whereas renal repair was done in three (4.9), and angioembolization and double J stent were required in one patient each. Of the enrolled patients, 56 (91.8%) patients improved and survived. Contrast-enhanced MDCT may be the best imaging modality for the assessment of renal trauma and other involved organs, as it provides significant anatomic and functional details essential to establish the type and extent of vascular, collecting system, or parenchymal injuries. Developments in CT techniques are useful for the patient choice for the best treatment and to prevent failure of conservative treatment.
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