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Laryngopharyngeal reflux: an overview on the disease and diagnostic approach
Asmaa M Hassan, Ashraf M Osman, Mohamed A. A Ghaliony, Emad K. Abd Elhaleem, Khaled A. M Elbeh
January-April 2017, 2(1):67-72
Background Laryngopharyngeal reflux (LPR) can be defined as chronic symptoms or laryngeal mucosal damage caused by the abnormal reflux of gastric contents into the upper airway. LPR plays an important role in up to 50% of laryngeal complaints that present in the otolaryngeal clinic, and the symptomatology of LPR has more different presentation. LPR is suspected in the presence of symptoms of hoarseness, dysphagia, cough, globus, excessive mucus, throat pain, throat clearing, and laryngospasm. Diagnosis of LPR is confirmed using the following: reflux symptom index (RSI), laryngoscopic examination [reflux finding score (RFS)], and esophagogastroduodenoscopy. Patients and methods A cross-sectional study was conducted on 60 patients with typical gastroesophageal reflux disease (GERD) symptoms and laryngeal complaints; these studied patients were recruited from patients who attended the outpatient clinic of Tropical Medicine and Gastroenterology, and Phoniatric Unit, Assiut University Hospital. The symptom questionnaire and the classification proposed by Belafsky and his colleagues (RSI) are used and upper endoscopy is performed for the diagnosis of GERD patients. Nasofibrolaryngoscopy for all these patients was performed to compare the results (RFS). Psychiatric assessment was performed by a psychiatric specialist using symptoms checklist revised 90. Patients with a score more than 60 will be re-evaluated using the following questionnaires: Hamilton checklist of symptoms of depressive illness and Hamilton rating scale for anxiety. Results All studied patients showed positive RSI (100%) and diagnostic endoscopy showed GERD in 58 (96.7%) patients, and 32 (53.3%) of them were found to have a positive finding in laryngoscopy; the findings were as follows: vascular congestion and vocal cord hyperemia in 32 (100%) patients, vocal cord edema in 26 (81%), phonatory gap in 13 (40%), subglottic edema in 12 (37%), vocal cord swelling in 10 (31.25%), and contact granuloma in eight (25%). A positive significant correlation was detected between phonasthenia symptoms, mostly lump sensation, hoarseness, throat clearing, and dry mouth (symptoms), and laryngeal finding (RFS), except for difficulty in swallowing saliva. There is a strong association between psychological symptoms and the presence of LPR; the most commonly detected manifestation was anxiety, and there was a positive significant correlation with anxiety and a negative significant correlation between depression and reflux symptoms. Conclusion RSI and RFS could be useful for the diagnosis and evaluation of LPR in patients with GERD complaining of laryngeal symptoms. Psychological intervention can improve the general well-being and quality of life of patients with gastrointestinal symptoms.
  5,483 216 -
Complications of arteriovenous fistula in dialysis patients at Assiut University Hospital
Bahgat Abd El-Hamed Thabet, Mohamed O Ewas, Haitham A Hassan, Magy N Kamel
May-August 2017, 2(2):119-124
Background Repeated access to the circulation is essential to perform adequate maintenance hemodialysis. Dysfunction of fistulas is the most common reason for secondary intervention and recurrent hospitalization. Aim The aim of this study was to report our experience regarding incidence, diagnosis, and different modalities of treatment of complications of arteriovenous fistula. Patients and methods This study was conducted prospectively on 239 end-stage renal disease patients who presented to the Department of Vascular Surgery of Assiut University Hospital with complicated arteriovenous (AV) accesses from January 2014 to January 2015. All patients underwent detailed history taking, and data were collected on age, sex, cardiovascular risk factors, history of previous accesses, and any complications that developed since the use of the access. Patients were further evaluated using clinical examination, duplex ultrasound, and fistulography if needed. Results There were 137 (42.7%) males and 102 (42.7%) females with a mean age of 57 ± 4 years. Hypertension was the risk factor in 103 (43.1%) patients, whereas diabetes mellitus was present in 45 patients. Of the 239 patients, 57 (23.8%) presented with infected AV access, 42 (17.6%) with thrombosed AV accesses, 33 (13.8%) with bleeding, and 31 (12.9%) with pseudoaneurysms. Venous hypertension was the presenting complication in 26 (10.9%) patients, whereas aneurysmal dilatation, hematoma, and ischemic steal were the presenting complications in 25 (10.5%), 20 (8.4%), and 5 (2.1%) patients, respectively. Conclusion Complications of hemodialysis access create significant problems for nephrologists and the healthcare system. Access interventions are often costly, challenging, and may require specialized surgical expertise. Management of complications associated with AV access is an integral part of planning individual hemoaccess procedures.
  3,532 366 -
Comparison of chirp and click-evoked brainstem response stimulus in children with moderate and severe sensorineural hearing loss
Amal M El-Attar, Sayed M Enass, Mossa M Hoda Abu, Mahran M Sanaa
May-August 2017, 2(2):99-104
Introduction Auditory brainstem response using click stimuli enable global objective estimation of hearing threshold. Recently, it has been suggested that a chirp stimulus may produce a synchronous response from a large portion of basilar membrane. The chirp was designed to produce simultaneous displacement maxima along the cochlear partition by compensating for frequency-dependent traveling-time differences. Material and methods In this study, response characteristic of both click and chirp stimuli are compared in children. We compared latency and amplitude of wave V at different intensity levels and waves I and III at high level. Results and conclusion Results show that wave V on using chirp stimuli could be detected easier with shorted in latency and larger in amplitude than in click auditory brainstem response. However, click stimulus was better than chirp stimulus at high-intensity levels with respect to the identification of waves I and III.
  2,481 340 -
Relationship between serum leptin concentration and insulin resistance syndrome in patients with type 2 diabetes mellitus
Tamer H Shebl, Noor El Deen A Azeem, Hosny A Younis, Ahmed M Soliman, Ahmed M Ashmawy, Mohamed M Nuseir Ali
May-August 2017, 2(2):125-132
Introduction Type 2 diabetes mellitus is known for its morbidity and mortality worldwide. It has been demonstrated in recent studies that abnormal levels of adipocytokines may contribute to insulin resistance and type 2 diabetes. Objective The aim of the present study was to assess the relationship between serum leptin levels and insulin resistance syndrome in type 2 diabetic patients. Patients and methods A total of 80 individuals were enrolled into this study, and were divided into two groups –20 healthy persons comprised the control group and 60 patients with type 2 diabetes mellitus comprised the disease group. The disease group was further divided into those with evidence of metabolic syndrome (30 patients) and those without (30 patients). Parameters such as age, sex, and anthropometric measures and biochemical indicators such as fasting and postprandial blood sugar, HbA1c, lipid profile, leptin, and fasting insulin were determined. Results Higher leptin and insulin levels were observed in patients with metabolic syndrome (P < 0.001). Conclusion High serum leptin is a good indicator and can act as a minimally invasive marker for early detection of insulin resistance syndrome.
  2,439 330 -
Prevalence of occult hepatitis C virus in patients with HCV-antibody positivity and serum HCV RNA negativity
Hani A Aboalam, Hebat-Allah G Rashed, Mohamed A Mekky, Hanan M Nafeh, Osman A Osman
May-August 2016, 1(2):12-16
Introduction and aim Chronic hepatitis C infection is a global problem with an increasing burden on healthcare, particularly in Egypt. Even with the advent of highly sensitive techniques, a subset of patients with positive hepatitis C virus antibody (HCV-Ab) and negative HCV-viremia remain challenging to treat. Therefore, we tried to determine the prevalence of occult HCV infection (OCI) in peripheral blood mononuclear cells (PBMCs) of patients presenting with a positive serologic test for anti-HCV-Ab and negative serum HCV-RNA-PCR (spontaneously cleared patients) and followed up those patients. Patients and methods Between March 2010 and March 2015, a prospective study was designed to include all consecutive patients with HCV-Ab positivity and HCV-RNA negativity who attended the Assiut Unit for treatment of viral hepatitis - the National Committee for Control of Viral Hepatitis. A total of 25 patients were recruited. Spontaneous clearance of serum HCV infection was approved on the basis of HCV-Ab positivity using two third-generation enzyme-linked immunosorbent assay tests and serum HCV RNA negativity on three consecutive occasions, each 6 months apart. Follow-up serum HCV RNA levels were evaluated for patients with OCI every 6 months. The RNA extraction step was performed by a protocol modified from that of the QIAamp viral RNA kits. Blood samples for separation of PBMCs were collected from all patients. PBMCs were obtained using Ficoll-Hypaque density gradient of EDTA anticoagulated blood according to the manufacturer's instructions (Lymphoflot). Detection of HCV viral load was performed with the kit supplied by Applied Biosystem (HCV RT-PCR Kit lot No.). Results A total of 25 patients (21 men, mean age 36.2 ± 9.1) cleared HCV spontaneously (HCV-Ab positive and serum HCV RNA negative). Genomic HCV RNA was detected in PBMCs of three (12%) of 25 patients. These three patients with OCI were followed up for 18 months by measuring their serum HCV RNA using highly sensitive real-time PCR every 6 months. Only one patient became overt HCV with a low level of viremia. Conclusion OCI was detected in a considerable prevalence in patients who cleared HCV spontaneously, that entails corporations of HCV-viral assay in PBMCs into the diagnostic algorithm.
  2,411 294 2
Peripheral neuropathy in chronic obstructive pulmonary disease
Olfat M El-Shinnawy, Eman M. H Khedr, Mohamed M Metwally, Alaa El-Din Thabiet Hassan, Ahmad M Shaddad
January-April 2017, 2(1):17-24
Introduction Peripheral neuropathy in chronic obstructive pulmonary disease (COPD) has received scanty attention. The purpose of this study was to evaluate objectively the functional changes in the peripheral nervous system in COPD by different electrophysiological parameters and to determine the frequencies of these changes in patients with COPD. Aim Assessment of peripheral nerve conduction by evaluation of the motor and sensory nerve conduction (SNC) in COPD patients. Patients and methods In this case–control study, we recruited 25 COPD patients and matched 25 healthy controls. Motor and SNC studies for ulnar and median nerves were evaluated by means of electrophysiological nerve study. Motor nerve conduction velocity and sensory nerve conduction velocity (SNCV), distal latencies (DLs), and amplitude of compound motor action potential were recorded. Arterial blood gases including partial pressure of oxygen and carbon dioxide (PaO2and PaCO2), oxygen saturation (SaO2), and arterial pH were measured. Pulmonary function test was done and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured. Results There was a significant difference between COPD patients and the control group in all spirometric and gasometric parameters recorded, except for the arterial pH. On studying motor nerve conduction through median and ulnar nerves, there was an increase in DL, decrease in motor nerve conduction velocity, and longer F-wave latency in the COPD group than in the control group in both nerves. SNC study of the median nerve revealed a decrease in SNCV and an increase in DL in the COPD group than in the control group. Median nerve motor neuropathy was proved in 28% of patients, ulnar nerve motor neuropathy was proved in 36% of patients, whereas sensory nerve study of median nerve proved that 68% of patients have sensory axonal neuropathy and 12% have demyelinating sensory neuropathy. Median nerve Distal Latency (DL) shows negative correlation with FEV1and FEV1/FVC ratio. SNCV of the median nerve was positively correlated to oxygen tension level. Conclusion The incidence of neuropathy is high. The rate of axonal neuropathy was significantly higher than other types. Our study showed a significant positive correlation between the degree of hypoxemia and severity of neuropathy, whereas it showed negative correlation between spirometry parameters (FEV1and FEV1/FVC ratio) and median nerve DL.
  1,936 222 -
The nephroprotective effects of ginkgo biloba extract (EGb761) against l-NG-nitroarginine methyl ester-induced hypertension in rats: role of oxidative stress and inflammatory markers
Ahmed M Abd-Eldayem, Hanan S. M. Farghaly, Ahmed O Abdel-Zaher
September-December 2016, 1(3):79-85
Background Ginkgo biloba extract 761 (EGb761) was studied for its nephroprotective effects in experimentally induced hypertension. Hypertension is increasingly a cause of end-stage renal diseases. Increased cytokine release and oxidative stress are mechanisms that appear to be involved in the pathogenesis of hypertensive renal damage. EGb has antioxidant and anti-inflammatory effects and can attenuate hypertensive renal damage. Methods and results Male adult Wistar rats were used in this study. Hypertension was induced in these rats by administering l-NG-nitroarginine methyl ester (l-NAME) (10 mg/kg/day, intraperitoneal) for 12 weeks. Another group of rats received l-NAME and EGb761 (100 mg/kg/day, orally) starting from the ninth week to the end of treatment. It was found that the blood pressure was reduced at the end of 12th week in rats treated with EGb761 compared with l-NAME-treated (hypertensive) rats. EGb761-treated rats showed lower renal tissue malondialdehyde level and renal tissue tumor necrosis factor-α level when compared with l-NAME-treated rats (hypertensive). Conclusion EGb761 has antihypertensive effect; it can protect the kidney from hypertension through the reduction of renal inflammation and oxidative stress.
  1,891 190 -
Risk factors of upper-arm lymphedema after breast cancer treatment
Yehia Safwat, Mohammed Shaalan, Mohsen Mokhtar, Mokhtar Hamood
January-April 2017, 2(1):73-78
Background Lymphedema is one of the most problematic complications after breast cancer treatment. The risk factors (RFs) for breast cancer-related lymphedema (BCRL) are multifactorial and are not fully understood. Aim The aim of this study was to determine the RFs for breast cancer-related upper-arm lymphedema. Patients and methods This is a case–control study including patients with arm lymphedema as cases and patients without arm lymphedema as controls. The included patients had breast carcinoma (n = 128) and all had operable breast cancer that could undergo locoregional therapy (surgery ± radiotherapy). Diagnosis of lymphedema was made by the measurement method, in which a difference of up to 2 cm either above or below the olecranon process between the two arms is generally accepted for diagnosis of lymphedema. Assessment of lymphedema and RFs was performed by logistic regression. Results Univariate analysis showed significant difference between the groups of patients with and those without lymphedema with respect to older age (0.016), BMI greater than 30 (0.007), hard work (0.004), ipsilateral dominant arm (0.021), history of injury (0.001) and infection (0.001) to the ipsilateral arm, positive lymphadenopathy (0.020), advanced stage of cancer (0.009), positive human epidermal growth factor receptor-2/neu receptor (0.001), level III axillary dissection (0.001), and lack of information about BCRL and/or not following prophylactic advice (0.001). Meanwhile, multiple logistic regression analysis showed only old age (0.005), history of injury (0.016), cellulitis (0.033), level III axillary dissection (0.011), lack of information about BCRL, and not following prophylactic advice (0.012) to have a significant relation to lymphedema. Conclusion Healthcare personnel and patients must be aware of the prevention and early treatment of lymphedema.
  1,691 212 -
Magnitude and pattern of maternal near-miss cases admitted to Women's Health Hospital, Assiut University
Shaimaa S Abdel-Raheem, Dalia G Mahran, Ghada S. T. Al-Attar, Mohammad H Qayed, Zein E. A. Zareh, Essam El-Din R. A. Othman
September-December 2016, 1(3):92-99
Introduction Maternal near-miss (MNM) is one of the related concepts to maternal mortality. MNM is a special category of survivors, whose stories provide unique insights and valuable information on maternal mortality. Measuring MNM beside maternal mortality and identifying its causes is essential, and should be calculated regularly for the purpose of planning, monitoring, and evaluation of provided maternal healthcare. Objectives The objectives of the study were to determine the magnitude and to identify the patterns of MNM among cases admitted to Women's Health Hospital, Assiut University, Egypt. Methodology This paper is a part of a larger case–control prospective study; however, for this analysis, we are presenting only the findings of the MNM cases. (The full profile of the cases and controls was presented in another paper.) The study was conducted at Women's Health Hospital, Assiut University and included 342 MNM cases by total coverage of all eligible cases who met the criteria of MNM identification published in WHO bulletin (2011) throughout the 12 months' period of the study. A checklist was used to collect data from the hospital records of eligible respondents. Results During the 12 months' period of the study, there were 17 503 deliveries and 16 972 live births. The maternal mortality ratio was 276 per 100 000 live births and the MNM incidence ratio was 20 per 1000 live births. This means that there was one maternal death for every seven cases of MNM. The mean age of MNM cases was 28.4 ± 8.5, whereas the mean gestational age of MNM was 35.66 ± 8.6 weeks. The main direct obstetric causes of MNM were hypertensive disorders of pregnancy (49.8%), obstetric hemorrhage (38.3%) and dystocia (32.5%). On the other hand, cardiovascular disorder was the most prevalent nonobstetric cause among MNM cases (48.8%). The peak frequency of the cases occurred during the summer season. Conclusions and recommendations MNM and maternal mortality are alarmingly high. Hypertensive disorders of pregnancy and obstetric hemorrhage were the two main direct obstetric causes of near misses that require strict and quick management protocols.
  1,683 213 1
Levator recession with adjustable sutures in management of upper eyelid retraction
Omar Mohammed Ali, Abd El-Nasser A. Mohammed, Hazem Abdel EL-Motaal Hazem, Shymaa Kamel Ibrahim
September-December 2017, 2(3):167-172
Purpose To assess the efficacy of levator recession with adjustable sutures in treatment of upper eyelid retraction. Patients and Methods Patients with upper eyelid retraction were included in this prospective, non-randomized, interventional case series study. All patients underwent correction of upper eyelid retraction with levator recession using adjustable sutures ,and were followed up every week for a month, then monthly for three months. In each visit, the margin reflex distance (MRD1) and palpebral fissure (PF) were measured. Results The included patients of the present work were classified into 3 groups: Group A: lid retraction secondary to over correction of ptosis, group B: thyroid related lid retraction, and group C congenital lid retraction. Among the 17 patients that participated in the follow-up examination, mean age ± SD was 21.12 ± 13.73 years (range 7–52 years). Eight were males and nine were females. Mean ± SD (range) of central height of the palpebral fissure was 13.79 ± 1.37 mm (10–16 mm) preoperatively, and 11.04 mm (9–12 mm) at follow up. Mean ± SD (range) of MRD1 was 6.77 ± 0.86 mm (5–8 mm) preoperatively, and 4.78 mm (4.5–5 mm) at follow-up. Conclusion Levator recession with adjustable sutures is effective technique in treatment of upper eyelid retraction of all degrees with different causes. However,increase the number of cases with long term follow up are recommended.
  1,646 218 -
Role of dynamic multidetector computed tomography using 'eee' phonation in the diagnosis of various laryngeal lesions
Shimaa Farghaly, Sami Abd El Aziz, Ezzat Saleh, Eman Sayed, Hazem Abu Zeid
May-August 2016, 1(2):17-23
Objective The aim of the study was to determine the effectiveness of dynamic multidetector computed tomography (MDCT) using 'eee' phonation in the detection and delineation of extension of various laryngeal lesions in comparison with conventional nonfunctional MDCT. Patients and methods The study included 60 patients with suspected laryngeal pathology who underwent precontrast and both prephonation and during-phonation contrast-enhanced MDCT. Each imaging study was evaluated for pyriform sinus and ventricle involvement, vocal cord mobility, and local tumor staging of malignant laryngeal lesions. All patients subsequently underwent direct laryngoscopy. Detailed endoscopic findings were reported and compared with MDCT findings. Results Dynamic MDCT using 'eee' phonation is effective in the assessment of pyriform sinus and ventricle involvement with high sensitivity (100% for both), high specificity (97.83 and 97.44%, respectively), and high accuracy (98.3% for both), compared with lower accuracy of conventional nonfunctional MDCT, which is 78.3% and 93.3%, respectively. It is also highly accurate in the assessment of vocal cord mobility (94.6%) and it increases the accuracy of MDCT in local tumor staging of malignant laryngeal lesions to 80.4% compared with 76.1% accuracy of conventional nonfunctional MDCT. Conclusion Dynamic MDCT using 'eee' phonation is effective in the detection and delineation of extension of various laryngeal lesions and is more accurate than conventional nonfunctional MDCT.
  1,635 166 -
Association between albuminuria and abnormal cardiac findings in patients with type 2 diabetic nephropathy: role of urine albumin excretion
Ghada A Mohamed, Marwa A Gaber
May-August 2016, 1(2):1-5
Background Diabetic patients have higher morbidity and mortality from cardiovascular diseases compared with nondiabetic patients, particularly in the case of patients with high urinary albumin excretion (UAE). The main aims of our study were to detect abnormal cardiac findings in patients with type 2 diabetic nephropathy (DN) and its relation to increased levels of UAE. Patients and methods Our descriptive cross-sectional study consisted of 105 diabetic patients with documented DN who attended the diabetic outpatient clinic of the Internal Medicine Department, Assiut University Hospital, and underwent routine investigation, glycated hemoglobin (HbA1c), 24 h UAE, and transthoracic echocardiography. Results We evaluated 105 patients with type 2 DN (56 men and 49 women) who were divided into two groups: group I included those with microalbuminuria (39%) (age: 54.3 ± 14.4 years) and group II included those with macroalbuminuria (61%) (age: 59.7 ± 7.9 years). There was a significant relationship between the degree of albuminuria and occurrence of left ventricular hypertrophy and segmental wall motion abnormality in both groups (P < 0.001 and P = 0.032, respectively). Conclusion Our data indicate a possible link between abnormal cardiac findings and progression of DN. We suggest that assessment of cardiac morbidity by means of echocardiography in patients with DN be mandatory for early preventive strategies.
  1,604 188 -
Differential expression of MOC-31, Hep Par 1, and N-cadherin in primary carcinoma and metastatic adenocarcinoma in the liver
Mohammed A Ahmed, Fatma A Badary, Etemad H Yassin, Said A Mohammed, Madiha M El-Attar
September-December 2016, 1(3):54-60
Background Immunohistochemistry plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) and in its distinction from other primary and metastatic neoplasms. In this study, we examined the expression of MOC-31 (Anti-epithelial cell adhesion molecule monoclonal antibody, clone number-31), hepatocyte paraffin 1 (Hep Par 1), and N-cadherin in primary carcinoma and metastatic adenocarcinoma (AC) in the liver. Aim The aim of this study was to evaluate the usefulness of MOC-31, Hep Par 1, and N-cadherin in the differential diagnosis of primary carcinoma and metastatic AC in the liver. Materials and methods The present study included 56 specimens from cases of primary and metastatic liver tumors, including 20 primary HCCs in the liver, five intrahepatic cholangiocarcinomas, and 31 metastatic ACs in the liver. They were studied to evaluate MOC-31, Hep Par 1, and N-cadherin expression using immunohistochemistry. Results The sensitivity of MOC-31 for AC in the studied group was 97.2%, whereas its specificity was 90%. The sensitivity of Hep Par 1 for HCC was 75%, whereas its specificity was 100%. The sensitivity of N-cadherin for primary liver carcinoma was 72%, whereas its specificity was 83.9%. Using the combination of the three antibodies, a final diagnosis could be established in 52 of 56 (92.9%) cases of studied group. In conclusion, a panel of these three antibodies can be helpful in the distinction between primary carcinoma and metastatic AC in the liver.
  1,598 164 1
The effect of maternal hypothyroidism on the postnatal development of the pituitary–thyroid axis in albino rats: a histological, morphometric, and immunohistochemical study
Mohamed R Shehata, Dorreia A Mohamed, Manal M. Samy El-Meligy, Ashraf E Bastwrous
January-April 2017, 2(1):79-97
Background The adequate functioning of the maternal thyroid gland plays an important role in ensuring that the offspring develop normally. Therefore, maternal hypothyroidism and hyperthyroidism are associated with offspring abnormalities. Aim of the work This study was carried out to examine the effect of maternal hypothyroidism on the postnatal development of the pituitary–thyroid axis in the albino rat. Materials and methods Thirty pregnant female albino rats were divided into two groups. Group I was the control group and group II was the hypothyroid group whose rats were given carbimazole in a dose of 5 mg/rat/day through the intragastric intubation from the gestational day 10 until the postnatal day 20. The offspring of both groups were killed at the ages of newborn, 10, 30, and 60 days. The pituitary and thyroid glands were extracted from the pups of control and treated animals and processed for light and electron microscopy and morphometric analysis. In addition, an immunohistochemical study was carried out on the pituitary specimens for the detection of thyrotrophs. Results The present study revealed that the maternal hypothyroidism caused morphological changes in the pituitary–thyroid axis of the offspring. The changes started to appear in the newborn age and persisted throughout the postnatal life. The light microscopic examination revealed shrunken thyroid follicles. The follicular epithelial height increased and was composed of tall columnar cells with a vacuolated cytoplasm. The colloid decreased or was completely absent. Regarding the pituitary gland, there were many large pale vacuolated cells with dark nuclei and sometimes the vacuolation affected most of the cells. The electron microscopic examination of the thyroid follicular cells and thyrotrophs showed ultrastructural signs of an increased activity, which included dilated endoplasmic reticula, well-developed Golgi, enlarged mitochondria, and a decreased number of the secretory granules. Large cytoplasmic vacuoles were also observed. The immunohistochemical study of the pituitary gland revealed an increased number of thyroid-stimulating hormone immunopositive cells. The morphometric analysis of the pituitary and thyroid sections showed a significant decrease in the thyroid follicular diameter and a significant increase in the thyroid follicular epithelial height and in the number of the thyrotrophs per reference area. Conclusion From this study, it could be concluded that the experimentally induced maternal hypothyroidism disturbed the pituitary–thyroid axis of the offspring.
  1,568 192 -
Role of medical management in otitis media with effusion Journal of Current Medical Research and Practice
Mohammed A Mohammed, Wafaa T Elsherief, Mohammed M Osman, Aida A Abdelmaksoud
May-August 2016, 1(2):24-27
Introduction Otitis media with effusion (OME) is a common disease characterized by the retention of fluid and inflammatory byproducts in the middle ear without any clinical symptoms of acute infection. Objective The aim of the study was to evaluate the benefits of medical management and watchful waiting before surgical intervention in patients with OME. Patients and methods A total of 130 patients with OME, aged newborn to 35 years, were selected for this study. All patients received medical treatment in the form of amoxicillin for 10 days as first trial therapy; if no improvement was seen with amoxicillin, clavulanic acid was given for another 10 days as second trial therapy. Patients with persistent effusion after medical treatment were followed up for 3 months for spontaneous regression (watchful waiting, third trial therapy). Patients with persistent effusion after 3 months were subjected to surgical management according to the predisposing factor. Results A total of 86 (66.2%) patients showed complete recovery with medical management. Of them, 29.2% (38 patients) responded after the first trial of medical therapy, 26.1% responded after the second course, and 35.3% showed spontaneous recovery on watchful waiting. Conclusion An initial trial of medical therapy with watchful waiting for 3 months should be practiced before surgical intervention.
  1,576 180 -
Delays associated with maternal near-miss cases admitted in Women's Health Hospital, Assiut University
Shaimaa S Abdel-Raheem, Ghada S. T Al-Attar, Dalia G Mahran, Mohammad H Qayed, Zainel-Abidin Z. H Alib, Essam El-Din R. A Othman
January-April 2017, 2(1):1-9
Introduction Maternal near-miss (MNM) is recognized as a new concept and has emerged as an adjunct to investigation of maternal deaths as the two represent similar pathways. A conceptual model that had helped us to explain the underlying preventable causes of MNM by examining three phases of delay on maternal healthcare utilization was developed by Thaddeus and Maine. By identifying and reducing the three delays, we will have the greatest impact in reducing MNM and hence maternal deaths. Aim The aim of this study was to describe the extent, main types, and contributed factors for three delays in care associated with MNM among women admitted in Women's Health Hospital, Assiut University, Egypt. Methods A prospective case–control study was conducted over a period of 1 year from 1 May 2014 to 30 April 2015 at Women's Health Hospital, Assiut University; 342 MNM women and 684 age-matched control women were included in the study. The criteria we used for the identification of MNM were generally based on the presence of different levels of organ dysfunction, which have been identified as recommended by WHO. Data were collected through two approaches: record review and direct interview before discharge. Delays experienced by the study population were collected according to the three-delay model of Thaddeus and Maine. Results A high proportion of the MNM group had experienced delay irrespective of the type, with statically significant differences from their controls. Nearly 50% of near-miss cases were more likely to have experienced two or more types of delays compared with 7.7% of controls. Financial problems, fear of being maltreated in hospitals, lack of awareness about signs of obstetric complications, lack of participation in decision making, lack of antenatal care, negative attitude of healthcare worker, and lack of blood availability were associated with delays among MNM cases compared with controls. Having experienced third delay within the intermediate facilities (referral status) was the highest significant predictor that contributed to MNM by delay types. Conclusion and recommendations Third delay experienced by the women within the intermediate facilities (referral status) was the most prevalent delay among studied women. Reformation of healthcare system on multiple levels and improvement of the socioeconomic status of women are necessary in Upper Egypt to overcome causes of delay among MNM cases.
  1,501 253 -
Doxorubicin-eluting beads versus combined conventional transarterial chemoembolization and percutaneous alcohol injection in the treatment of large hepatocellular carcinoma
Ahlam M. A. Farghaly, EhabFawzy A Moustafa, Hany M. A. Seif, Moustafa H. M. Othman, Reda H. M. Tabashy, Mohammed O. A. Abdelglil, Essam Eldeen M. O. Mahran
May-August 2017, 2(2):105-110
Introduction Hepatocellular carcinoma (HCC) is a primary tumor of the liver, which usually develops in the setting of chronic liver disease, particularly in patients with chronic hepatitis B and hepatitis C. Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment of Barcelona Clinic Liver Cancer-B patients. The aim of this work is to compare the efficacy, safety, feasibility, and cost-effectiveness of drug-eluting bead (DEB)-TACE versus combined conventional transarterial chemoembolization (c-TACE)+percutaneous ethanol injection (PEI) for improving the outcome of large HCC. Patients and methods In all, 75 patients with large HCC were included in this study: 30 patients were treated by combined c-TACE + PEI and 45 patients were treated by DEB-TACE. Results By comparison of the results of the combined c-TACE + PEI group with the DEB-TACE group, there was no significant difference in tumor response, with better results in the combined c-TACE + PEI group and significant decrease in the median value of the serum level of α-fetoprotein after treatment among patients treated with combined c-TACE + PEI (P = 0.004), and a statistically significant difference in the median value after treatment between the two groups (P = 0.036). Conclusion Results of combined c-TACE + PEI and DEB-TACE are comparable, but the cost of a DEB-TACE session is three times that of c-TACE + PEI, and thus cost-effectiveness analyses recommend the use of combined c-TACE + PEI (less cost) in the treatment of large HCC; in addition, there was a significant reduction in the level of α-fetoprotein after combined c-TACE+PEI treatment.
  1,529 215 -
Prevalence of ovarian hyperstimulation in normal responders receiving letrozole in assisted reproductive technology: A randomized controlled trial
E Ihab, M Alaa Eldeen, A Elwany, Amr Sh
September-December 2017, 2(3):157-161
Introduction The use of letrozole, a selective aromatase inhibitor, induces follicular maturation. Randomized controlled trials addressing the utility of letrozole in normal responders are few. We evaluated whether incorporation of letrozole could be effective in decreasing ovarian hyperstimulation syndrome (OHSS) in normal responders undergoing intracytoplasmic sperm injection cycles. Objective The objective of this study was to compare the aromatase inhibitor (letrozole) with low-dose gonadotropins versus the standard long protocol for controlled OHSS in normal responder women undergoing intracytoplasmic sperm injection in terms of OHSS. Patients and methods This was a randomized noninferiority clinical trial registered in clinicaltrials.gov (NCT02429999). This study was conducted in Assiut University Fertility Center, from January 2015 to April 2016, and included 61 normal responder women randomized in a 1: 2 ratio. Twenty-one women (study group) received letrozole at a 10 mg daily dose from days 3 to 7 together with follicle-stimulating hormone (FSH) 75 IU/day from day 5. Gonadotropin-releasing hormone antagonist (orgalutran 0.25) is given when the follicle size is equal to 14 mm until human chorionic gonadotropin injection. Forty women (control group) received 0.1 mg decapeptyl from day 21 in the preceding cycle and continuously stimulated by FSH (150–225 IU/day) from day 2. The total dose of FSH received, number of mature oocytes, good-quality embryos, and OHSS were evaluated in both groups. Statistical analysis was done using Student's t-test and χ2-test when appropriate. Results Comparable rates for maturation index, fertilization, and good-quality embryos were yielded by both groups. The incidence of OHSS was significantly lower in the letrozole group compared with the long protocol group (P = 0.03). Conclusion Minimal stimulation protocol using letrozole with gonadotropins may form an effective tool to decrease the incidence of OHSS in in-vitro fertilization cycles in normal responding women.
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Anti-C1q antibodies as a marker for disease activity in systemic lupus erythematosus and lupus nephritis
Eman A.H. Omran, Nadia M Ismail, Eman Mosad, Yasmine S Hussein
September-December 2016, 1(3):47-53
Background Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory autoimmune disease that is characterized by a number of immunological abnormalities. Disease onset is triggered by ill-defined environmental factors in genetically susceptible individuals. C1q plays a key role in apoptotic cell and immune complex removal, and hence it is a very important functional molecule in SLE pathogenesis. Investigation of the relationship between peripheral lymphocyte apoptosis and serum levels of anti-C1q autoantibodies in SLE patients suggests that increased serum levels of anti-C1q autoantibodies are responsible for apoptosis and may play a pathogenic role in SLE patients, especially in active disease. Objectives The aim of this study was to measure the serum level of anti-C1q in SLE patients, and to evaluate the correlation between anti-C1q and SLE disease activity, especially renal activity. Patients and methods Fifty SLE patients diagnosed according to the Systemic Lupus International Collaborating Clinics classification criteria 2012 and 33 healthy volunteers who were age and sex matched were included in the study. SLE activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and renal activity was assessed using the renal SLEDAI. Anti-C1q was estimated using enzyme-linked immunosorbent assay kit. Results Serum anti-C1q was significantly higher in SLE patients (64.86 ± 27.88 U/ml) compared with healthy controls (30.15 ± 13.93 U/ml) (P < 0.000). There was a significantly positive correlation between anti-C1q and the SLEDAI (P = 0.035, r = 0.299) and the renal SLEDAI (P = 0.025, r = 0.316). Anti-C1q has a sensitivity and specificity of 92.7 and 66.7%, respectively, a positive predictive value of 92.7%, negative predictive value of 66.7%, and 88.0% accuracy for detecting SLE disease activity, whereas for lupus nephritis diagnosis anti-C1q has a sensitivity and specificity of 94.12 and 50.0%, respectively, a positive predictive value of 80.0%, negative predictive value of 80.0%, and 80.0% accuracy. Conclusion Our results support the finding that anti-C1q level might be used as a marker for SLE activity and not lupus nephritis in adult SLE patients.
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Serum level of interleukin-22 in patients with psoriasis and its correlation with disease severity
Eman R. M. Hofny, Hanan Morsy, Ashraf Hasaball, Howida Twisy
May-August 2017, 2(2):133-135
Introduction Psoriasis is a T-cell-mediated inflammatory disease where T-helper (Th) lymphocytes (Th1, Th17, and Th22) play an important role in its pathogenesis. The aim of the present study was to assess the serum levels of interleukin (IL)-22 and its correlation with disease severity. Materials and methods The present study included 25 psoriatic patients and 25 healthy controls. Using serum samples collected from psoriatic patients and healthy controls, the concentrations of IL-22 were examined using ELISA kits. The severity of psoriatic skin lesions was assessed using psoriasis area and severity index scores. Results IL-22 concentrations were significantly higher in psoriatic patients in comparison with the control group. A significant, positive correlation between the concentrations of IL-22 and the severity of psoriasis was found. Conclusion The results of our study suggest that Th22 along with its cytokine responses may contribute to the skin and systemic inflammatory conditions characteristic of psoriasis. It seems that early identification of soluble biomarkers and initiation of well-matched treatment may prevent exacerbation and progression of psoriasis.
  1,487 197 -
Real-time quantitative polymerase chain reaction detection of minimal residual disease in acute lymphoblastic leukemia: a single-center experience
Shabaan Redwaan, Hesham Abdelraheem, Taghreed K Eldin, Hosny Badrawy, Eman M Nagiub Abdelsalam
September-December 2016, 1(3):31-37
Background Monitoring of minimal residual disease (MRD) has become a frontline clinical practice in the treatment of virtually all childhood acute lymphoblastic leukemia (ALL) cases and in many cases of adult patients with ALL. The MRD diagnostics has proven to be the strongest prognostic factor allowing for risk group assignment into different treatment arms. The MRD techniques need to be sensitive (≤10–4), which means, the ability to detect one malignant cell among 10 000 normal cells; broadly applicable; accurate; reliable; fast; and affordable. Aim The objective of this study is to evaluate the analysis of immunoglobulin heavy chain (IGH) or T-cell receptor (TCR) gene rearrangements as targets for MRD assessment in ALL, allowing early detection of relapsed cases, compare with the results of morphological evaluation of the same cases and to risk stratify patients with ALL according to the MRD assessment as a prognostic marker independent and superior to other conventional risk factors. Patients and methods Overall, 30 patients (15 males and 15 females) with age ranged from 1 to 25 years old were included in this study. Patients were subjected to full medical history, clinical examination, laboratory examinations such as complete blood count, bone marrow aspirate smear examination, cytochemistry, and immunophenotyping. The molecular studies done by real-time PCR were performed using consensus primers and allele-specific primers for (IGH) or (TCR) gene rearrangements as targets to detect MRD. The ALL cases were assessed by real-time quantitative PCR at the time of diagnosis and at the end of induction chemotherapy, and comparative cycle threshold (Ct) relative quantification method was used for quantitative gene expression. Results The results showed discrepancy between the morphologic examination for ALL assessment depending on the 5% blast index as an indicator of remission or nonremission; morphological nonremissions (>5% blast) were detected in eight (26.7%) cases whereas 22 (73.3%) cases showed morphological remissions (<5% blast). Real-time quantitative PCR for IGH/TCR gene rearrangements was done for 30 patients. Of the 22 cases that showed morphological remission, there were 18 (81.8%) cases which were MRD positive (i.e. not in molecular remission) and four (18.2%) cases which were MRD negative (i.e., in molecular remission). Patients who showed nonremission morphologically (right cases) were confirmed to be MRD positive. None of the patient's clinical variables such as age, sex, total leukocyte count, and ALL immunophenotype have been identified as predictors of MRD risk. Conclusion Approximately 81% of ALL cases previously diagnosed as being in the remission state depending on the morphologic assessment only tend to harbor MRD as evident by positive MRD assessment using real-time PCR. The molecular assessment of MRD allows early detection of relapse with chance of intervention and tailoring of treatment according to the patients' need. It was found that there was no relation between MRD results and risk stratification in ALL according to age and white blood cell at diagnosis; this confirms that detection of MRD of leukemic cells can be considered a superior prognostic marker of relapse, independent from conventional prognostic factors. The risk classification in ALL based on MRD results could be used to guide the final treatment strategy and predict early relapse; this should allow prediction of response and relapse while patients are still in the state of clinical remission and morphological remission too.
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Evaluation of visual and refractive outcomes of wavefront optimized versus wavefront guided laser-assisted in situ keratomileusis in patients with myopia and myopic astigmatism
Gamal N Mahmoud, Tamer H Massoud, Ahmed M Fathlla, Asmaa K Ahmed
May-August 2017, 2(2):111-118
Purpose The aim of this study was to compare the visual and refractive outcomes of wavefront optimized (WFO) ablations with wavefront guided (WFG) ablations in patients with myopia and myopic astigmatism. Patients and methods Two consecutive groups of eyes were treated for myopia and myopic astigmatism with laser insitu keratomileusis. One group was treated with WFO ablation, and the other group was treated with WFG ablation. Refractive evaluation (efficacy, safety, predictability, accuracy, stability, and refractive astigmatism), higher-order aberrations (HOAs), and contrast sensitivity were analyzed preoperatively and at 1, 3, and 6 months postoperatively. Results The WFO ablation group comprised 20 eyes of 11 patients who showed a change in the mean spherical equivalent refraction from − 3.34 ± 1.64 D preoperatively to − 0.21 ± 0.30 D at 6 months postoperatively, and the WFG ablation group comprised 34 eyes of 17 patients who showed a change in the mean spherical equivalent refraction from − 3.54 ± 1.50 D preoperatively to − 0.23 ± 0.57 D at 6 months postoperatively. A statistically significant difference was found when comparing within the group preoperatively versus 6 months postoperatively as regards contrast sensitivity, HOAs, trefoil root mean square (RMS), and spherical aberration. However, there was no significant difference in induced coma and spherical aberration RMS within each group preoperatively and at 6 months postoperatively. A statistically significant difference was found when comparing the two groups at 6 months postoperatively with respect to contrast sensitivity, induced HOA RMS, induced trefoil RMS, and spherical aberration. There was no significant difference between the two groups, except for induced coma and spherical aberration RMS. Conclusion Both the WFG group and the WFO showed comparable accuracy, efficacy, and safety with nearly equal induction of all HOAs.
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Liquid nitrogen cryotherapy in the treatment of alopecia areata: An Egyptian study
Ensaf M Abdel-Majid, Doaa S. S. Abdel-Kader, Aliaa A Allam
September-December 2018, 3(3):187-190
Introduction Alopecia areata (AA) is a common cause of nonscarring alopecia that occurs in a patchy, confluent or diffuse pattern. It may involve loss of hair from some or all areas of the body, usually from the scalp. The aim of this study was to evaluate the effect of cryotherapy in the treatment of AA. Patients and methods Through a nonrandomized and nonblinded study, 17 patients with 20 recalcitrant patchy AA lesions were recruited at the outpatient dermatology clinic, Assiut University Hospital, between August 2014 and September 2016. The lesions were treated with liquid nitrogen cryotherapy spray once weekly for 6 weeks. The lesions were sprayed for 2–3 s, until it became slightly frozen. After the frozen area was thawed (∼3–5 s), a second spray was done in the same manner. The lesions were assessed by direct scalp observation for the size and hair regrowth and by taking photographs. The therapeutic response of the lesions to cryotherapy was evaluated in relation to the age of the patients, the size of the lesions, and the duration of the disease. Results A positive therapeutic response was noted in 13 (65%) lesions. By studying the clinical response to cryotherapy in relation to the age of the patients, we found that 53.8% of the lesions which responded to cryotherapy were in patients aged more than 30 years compared with 46.2% in patients aged less than 30 years. Lesions less than or equal to 3 cm have shown a better clinical response than those of more than 3 cm (76.9%). The clinical response of AA lesions was better (84.6%) when the disease duration was less than 6 months. Conclusion Superficial cryotherapy with liquid nitrogen is a therapeutic option with a good treatment outcome. It has the privilege of being simple, convenient, short-term and office-based technique, especially in mild to moderate recalcitrant AA.
  1,558 87 -
No chest tube protocol in video-assisted thoracic surgery procedures
Moustafa M El-Badry, Hussein Elkhayat, Gamal A Makhlouf, Ahmed Ghoneim
September-December 2017, 2(3):151-152
The urge for less pain, earlier mobility, low financial cost, and better cosmetic outcome has driven the everlasting pursuit of thoracic surgeons for smaller incisions, low port number, and shorter hospital stay. Management of chest tubes is pivotal in the postoperative care of patients submitted to thoracic surgeries. However, thoracic surgeons have traditionally managed chest tubes based more on their experience and personal preference rather than guided by an evidenced-based approach. Chest tubes increase the rate of postoperative pain and hospital stay, and the removal of a chest tube improves ventilator function and reduces chest pain after pulmonary resection. Removing a chest tube sooner not only has financial benefits but also has beneficial functional effects for the patient. Upon witnessing the benefits of early removal of chest tubes after video-assisted thoracic surgery procedures, some surgeons are starting to adopt a no chest tube protocol especially in thoracic procedures, in which the lung is left untouched. Upon reviewing the papers published on avoiding chest tubes in video-assisted thoracic surgery procedures, it showed that such a technique can be safely used without affecting the quality of the procedures. Moreover, it can lead to a more favorable postoperative course.
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Construction of an Arabic computerized cognitive skill battery for the diagnosis of children with specific learning disabilities
Wafaa M. A. Farghaly, Mohammed A Ahmed, Taha A. H. Elmestikawy, Reda B Abdel-Rasool, Mohammed S. H. Farghaly, Montser S Omar, Amr S Ramadan, Mohammed Salamah, Mohammed A Abdel-Hameed, Adel T Mohammed
September-December 2016, 1(3):38-46
Objective Most of the previously designed Arabic tests for the assessment of specific learning disabilities (SLDs) are noncomputerized and do not pay attention to many of the cognitive skills that are believed to have an important role in the early stages of literacy development and its relations with learning disabilities. Computer usage supports and enhances children's creativity, self-esteem, and cooperative learning. Therefore, we aimed to design an Arabic computerized cognitive skill battery for the detailed assessment of children with SLD, through the assessment of their auditory as well as visual processing skills, to identify their points of weakness that might contribute to their learning disability. Participants and methods This study was carried out in Assiut city, Egypt. All fourth grade students from six chosen public primary schools (n = 858 students) were interviewed except those who were absent during their school visits (n = 142 students), or those who did not complete the test battery (n = 56 students). The rest of the sample (660 students) completed the test battery. The study included four stages. The first stage included identification of students with SLD with previous standardized tests [the Arabic reading test, the writing test (it is the sum of the script part of visuomotor test, which was specifically designed for this study, plus spelling part of Arabic reading test), the Math test, and the Wechsler Intelligence Scale for Children-Revised to assess their IQ level]. The second stage included battery construction by seven expert staff members (this took 1 year from 1 October 2012 to 30 September 2013). The third stage included application of the newly constructed battery in a pilot study to 10 normal students (9–10-year-old) to ascertain clarity of the tests of the battery. The fourth stage included test standardization. Results The reliability of the battery was proven using Cronbach's α correlation coefficient (α≥0.7), interitem correlations (all values are positive and highly significant), and corrected item-total correlation coefficient (all values >0.3). Validity was proven with judgment validity, construct validity (factorial analysis) (all loadings ≥0.5), contrasted group validity, and predictive validity (sensitivity and specificity). Conclusion The constructed battery was thus proven to be highly reliable and valid for the assessment of SLDs among Arabic reading children, and thus remediation programs can be directed properly and early.
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