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   Table of Contents - Current issue
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May-August 2018
Volume 35 | Issue 2
Page Nos. 115-263

Online since Friday, August 17, 2018

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REVIEW ARTICLE  

Associated comorbidities of specific language impairment Highly accessed article p. 115
Hassan Ghandour, Sally Kheir Eldin, Yossra Sallam, Shaimaa Mahmoud
DOI:10.4103/bmfj.bmfj_155_17  
The primary linguistic difficulties of individuals with specific language impairment (SLI) have been addressed in detail in previous research. Recently, several studies have also reported the presence of associated comorbidities in children with SLI such as memory disorders, motoric deficits, dyslexia, ADHD, auditory processing disorders, and psychosocial disorders. The aim of this paper is to highlight the issues in SLI associated with memory disorders, motoric deficits, and dyslexia. This is a literature review. Short-term memory and working memory are commonly affected in children with SLI. In addition, those children exhibit deficits in fine and gross motor skills both simple and complex. The risk of dyslexia is associated with language delays and speech difficulties in the preschool years. SLI is a multifaceted disorder with both linguistic and nonlinguistic features including memory disorders, motoric deficits, and dyslexia.
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ORIGINAL ARTICLES Top

Chest wall reconstruction for traumatic chest wall lesions p. 122
Mohammed K Abdelnaby, Hany M Elrakhawy, Mohammed M Saffan, Ataa E.A. Abdallah
DOI:10.4103/1110-208X.239201  
Background The study was conducted to project the different available surgical modalities of chest wall reconstruction for different traumatic chest wall lesions. Patients and methods Sixty patients were divided into two equal groups of 30 patients each. In the first group, skeletal tissue reconstruction was performed using plates and screws in 15 patients. In the second group, soft tissue reconstruction was performed using latissimus dorsi flap in 15 patients and using pectoralis major flap in the other 15 patients. The mandibular plate was the type used in fixation with three interlocking screws on each side of fracture. The prolene mesh was sutured to margins of skeletal defects with interrupted prolene sutures and then covered with muscle flap. The latissimus dorsi flap was used to cover lateral and anterior soft tissue defects. In addition, pectoralis major flap was used to cover superioanterior and upper lateral soft tissue defects. Each patient was assessed for primary outcomes such as ICU admission, mechanical ventilation, and hospital stay and secondary outcomes such as deformity, redo surgery, and death. Results The need for mechanical ventilation, ICU admission, seroma formation, redo surgery, hospital stay, and deformity are more decreased in the plates and screws subgroup than in prolene mesh reconstruction, but no difference was found in chest infection, wound infection, and death between the two subgroups. However, flap hematoma, seroma formation, and residual deformity are more decreased in pectoralis major flap than in latissimus dorsi flap. Conclusion Fixation of fractures with metal plates and screws decrease morbidity. Most skeletal chest wall defects can be reconstructed with prolene mesh. The latissimus dorsi and pectoralis major flaps are the most versatile and reliable flaps used in reconstruction today.
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Role of laparoscopic sleeve as an initial operation for super obese patients Highly accessed article p. 128
Mohamed M Mohamed, Ahmed M Zidan, Refaat S Salama, Khalid A.O. Japr
DOI:10.4103/bmfj.bmfj_20_18  
Background Obesity is recognized widely as an epidemic disorder, and morbid obesity is the most dangerous among all types of obesity. In past years, sleeve gastrectomy has evolved as a single-stage procedure for the treatment of morbid obesity, but still super obese patients (BMI >50–60) have high risks of being operated on (anesthesia and postoperative risks). Objective The aim was to investigate the initial weight loss (6 months postoperatively) in super obese patients after laparoscopic sleeve gastrectomy (LSG). Patients and methods A prospective study included 20 patients. All patients underwent LSG as an initial and solitary bariatric procedure over a 12-month period in Kasr Alaini, Benha University, and Ahmed Maher teaching hospitals during the period from October 2016 till September 2017. Results We identified 20 patients who underwent LSG as a primary weight loss procedure and met the inclusion criteria during the study period. Mean age at the time of LSG was 36.68±12.17 years (range: 18–58 years), and most patients were female [N=15 (75.0%)]. At the time of LSG, mean weight was 142.4±15.02 (range: 115–173), mean height was 162.4±8.58 (range: 148–185), and so mean BMI was 53.26±2.93 (range: 50–59). After a median follow-up of 6 months, overall percentage total weight loss was 41.61±11.31% (24–59.39), with a decrease in mean BMI from 53.26±2.93 preoperatively to 31.44±5.99 at the end of the study. Conclusion According to the benefits shown through weight loss and the minimum complications, our data along with previous studies strongly support the use of LSG among super obese patients as a first and standalone operation, as it is a safe and feasible option.
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Evaluation of nanogold particles-based enzyme-linked immunosorbent assay for detection of hydatidosis p. 134
Samia M Rashed, Mona E Naser, Ibrahim R Bayoumi, Nagwa S.M. Aly, Waleed E Mohamed, Amira S ElGhannm
DOI:10.4103/bmfj.bmfj_13_18  
Background Use of nanotechnology in clinical diagnosis meets the demands for increased sensitivity and early detection in less time. Purpose The aim of this study was to evaluate the nanogold particles-based dot-enzyme-linked immunosorbent assay (ELISA) as a test for detection of protoscolices antigen in serum samples of infected animals in comparison with traditional dot-ELISA. Methods A total of 76 blood samples were collected and included in the study: 36 sample of hydatidosis confirmed cases, 20 samples infected with other parasitic infection except hydatidosis as positive controls, and 20 samples as negative controls. Dot-ELISA was applied using two polyclonal antibodies against protoscolices antigen, the purified immunoglobulin G (IgG) polyclonal antibodies, and peroxidase-conjugated IgG, whereas in the nanogold dot-ELISA, the purified IgG polyclonal antibodies were conjugated with nanogold particles. Results On detection of protoscolices antigen by dot-ELISA, 31 (86.1%) of 36 serum samples were found to be positive, whereas nanogold dot-ELISA gave 34 (94.4%) positive serum samples. Dot-ELISA with nanogold particles had higher values than dot-ELISA regarding sensitivity (94.4 vs. 86.1%), positive predictive value (94.4 vs. 93.9%), negative predictive value (78.3 vs. 90%), and accuracy (92.9 vs. 87.5%), but specificity (90%) was the same for both tests. Conclusion Nanoparticles-based dot-ELISA is superior over traditional dot-ELISA for the detection of protoscolices antigen in hydatidosis. Dot-ELISA is rapid and easy to perform and the results can be read with the naked eye, so it does not require expensive equipment.
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Vaginal fluid prolactin in cases of suspected premature rupture of fetal membranes p. 139
Mahmoud E.A. Donia, Gamal M Hashish
DOI:10.4103/bmfj.bmfj_157_17  
Objectives The aim of this study was to evaluate vaginal fluid prolactin (PRL) as a diagnostic tool in cases of suspected premature rupture of fetal membranes and to get a cutoff value of PRL level for the definitive/diagnosis of premature rupture of membranes (PROM). Backgrounds Preterm PROM refers to a patient who is before 37 weeks’ gestation and has presented with rupture of membranes (ROM) before the onset of labor. Spontaneous PROM is ROM after or with the onset of labor. Prolonged PROM is any ROM that persists for more than 24 h and before the onset of labor. Patients and methods This case–control study was performed on 150 pregnant women attending casualties and outpatient clinics at Shebin El-Kom Teaching Hospital. The study included three groups: group 1 included 50 women with suspected PROM; group 2 included 50 women with definitive PROM; and group 3 included 50 healthy pregnant women as a control group. All study participants were subjected to full history, examination, ultrasonography, collection of 3 ml of vaginal fluid, and measurement of PRL concentration. Results There were high statistically significant differences between women of the three groups concerning amniotic fluid index and cervicovaginal PRL concentration (P=0.001). Receiver operating characteristic curve was constructed for vaginal PRL concentration as a predictor of PROM. Vaginal PRL concentration is a good predictor of PROM (P=0.001). Conclusion Vaginal fluid PRL can be used in suspected cases of ROM; the cutoff value was 4.38 ng/ml and vaginal fluid PRL is a simple, cheap, rapid, and reliable test.
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Lipids and uric acid in mid-second trimester and prediction of adverse pregnancy outcome p. 145
Ahmed M El-Ewa, Seham Abd-El-Halim El-Berry, Khalid M Salama, Naglaa Y.I. El-Maghraby
DOI:10.4103/bmfj.bmfj_18_18  
Background Studies have shown that abnormal metabolism may be a potential contributor to endothelial cell dysfunction and adversely affect the pregnancy outcome. Aim To measure the concentrations of serum lipids and uric acid (UA) in the healthy nulliparous women in mid-second trimester and to assess the predictive values of these metabolic markers for adverse pregnancy outcome. Patients and methods The study was conducted on 500 healthy nulliparous women in second trimester who attended the outpatient clinic of Banha University to predict any pregnancy outcomes. Lipids and UA concentrations were measured in mid-second trimester of pregnancy, and the odd ratios and 95% confidence interval were estimated with unconditional logistics regression adjusting for maternal age and BMI. Results The mean serum UA was statistically significantly higher in preeclampsia and gestation diabetes mellitus (GDM). We found differences in patients with preeclampsia and normotensive patients (4.77±0.99 vs. 3.15±1.07 mg/dl) and patients with GDM and non-GDM (5.94±0.77 vs. 3.29±1.09 mg/dl) but not in preterm birth. A positive correlation of serum UA with adverse pregnancy outcome was found (r=0.57, P=0.00). Serum lipids were statistically significant in prediction of adverse pregnancy outcomes. The odd ratios and 95% confidence interval of triglycerides, low-density lipoproteins, high-density lipoproteins, and total cholesterol were r=0.35, P=0.00; r=0.29, P=0.00; r=0.39, P=0.00; and r=0.63, P=0.00, respectively. Total cholesterol and triglyceride were positively correlated. Conclusion The combination of serum lipid profile and serum UA in mid-second trimester can be used to predict adverse pregnancy outcomes.
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Effects of moderate exercise training and detraining on diabetic peripheral neuropathy in streptozotocin-induced diabetic rats p. 150
Mona M Allam, Marwa H Muhammad
DOI:10.4103/bmfj.bmfj_48_18  
Context Exercise training programs have been shown to have prophylactic effects on diabetes-associated complications in murine models. Objective The present study aimed to elucidate the effect of moderate exercise training for 4 weeks and detraining for 2 weeks on diabetic peripheral neuropathy in type 1 diabetic rat model. Materials and methods Type 1 diabetes was induced by a single intraperitoneal injection of streptzotocin (45 mg/kg). Exercise training lasted for 4 weeks in trained group, whereas the detrained group stopped training for 2 weeks after training for 4 weeks. After 4 weeks, tail flick test latency, body weight, serum glucose, inflammatory markers, and nerve growth factor levels were measured, and the same was done in detrained diabetic rats after 2 weeks of detraining. Results Moderate exercise training for 4 weeks increased significantly tail flick latency and nerve growth factor levels, whereas the inflammatory markers were significantly improved compared with diabetic sedentary rats. Interestingly, the prophylactic effects of exercise training were maintained in the detrained rats after 2 weeks of detraining. Conclusion Our results explore the prophylactic mechanisms underlying the exercise training in diabetic peripheral neuropathy rat model and give further insights into the maintained prophylactic effects that lasted after 2 weeks of detraining.
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The role of magnetic resonance imaging in the assessment of acromial morphology in association with rotator cuff tear p. 157
Ahmed A Hassan, Medhat M Refaat, Islam M El-Shazly
DOI:10.4103/1110-208X.239198  
Background The pathogenesis of rotator cuff tear (RCT) remains controversial. The acromion portion of the scapula and its morphology may be attributable for a variety of shoulder disorders such as RCT. Aim The purpose of this article is to throw light on the role of MRI in the assessment of morphological characteristics of different acromial shapes in association with RCTs. Patients and methods This study was carried out from January to August 2016 at the Ahmed Maher Teaching Hospital Radiodiagnosis Department. We used MRI prospectively to image the shoulders of patients who presented to the radiology department with suspected RCT. Their ages ranged between 20 and 60 years with a mean age 40 years. Data were tabulated and manipulated using SPSS (vi 16), and the level of significance was less than 0.05. Results The study revealed that type III acromion was encountered in male and female patients (42.9 and 42.1%) and type IV acromion was noticed less frequently among male and female patients, respectively (4.8 and 15.8%). In patients younger than 45 years of age (n=25), type I and type III acromion was the most commonly seen (64%) in both sexes. In patients more than 45 years of age, type III acromion was commonly seen (60%). All age and sex differences were not significant (P>0.2). It also revealed that type III was mostly encountered in full-thickness tear (82.4%) and partial tear (52.9%), whereas type I was less frequently associated with partial tear or full-thickness tear (25%). Type III was associated with tendinopathy, acromioclavicular osteoarthritis, and joint effusion. Conclusion The acromial shapes were classified into four types. On MRI, acromial shapes were better recognized using the mathematical classification scheme for MRI obtained just lateral to the acromioclavicular joint. This should shed light on the morphological characteristics of different acromial shapes that may be of value in diagnosing and treating subacromial pathologies. Such morphological characteristics include measurements of the acromiohumeral distance, the acromial index, and the lateral acromial angle using T2-weighted MRI coronal oblique images.
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Potential effects of aliskiren on myocardial infarction on top of hypertension and heart failure in rats p. 163
Al-Zahraa Z Elsayed Mohamed
DOI:10.4103/1110-208X.239199  
Background Myocardial infarction (MI) is defined as an irreversible injury or subsequent necrosis of myocardial cells due to interruption of blood supply to a part of the heart. Heart failure (HF) occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs. Hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated; it is said to be present when blood pressure values are at or above 140/90 mmHg. Aliskiren is a direct renin inhibitor indicated for the treatment of hypertension. Aim The present study was designed to evaluate the effects of aliskiren (50 mg/kg, intraperitoneally) on experimentally induced MI in hypertensive rats with HF. Materials and methods Model of MI: animals were classified into the following groups: normal control group, MI with no medication group (MI was induced by coronary artery ligation), MI l-nitro arginine methyl ester hydrochloride (l-NAME) group (hypertensive infarcted group), and aliskiren-treated MI l-NAME group. Model of HF: animals were classified into the following groups: normal control group, HF group (isoprenaline-induced HF), and aliskiren-treated HF group. Results Model of MI: aliskiren reduced blood pressure significantly when compared with the MI l-NAME group. It also improved cardiac enzymes (troponin and creatine phosphokinase-MB), ECG changes (heart rate and T-wave voltage), and infarction size when compared with the MI with no medication group and the MI l-NAME group (infarcted groups). Model of HF: it was found that aliskiren significantly reduced blood pressure when compared with the control group. It also significantly reduced heart rate and improved ejection fraction and histopathological changes of the heart compared with the HF group. Conclusion In this study, aliskiren had antihypertensive effects. It also could have a protective effect against MI and improve HF.
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Comparison between thoracic epidural and systemic opioid analgesia on lung mechanics in obese patients in major gynecological procedures p. 173
Hamdy H Eliwa, Ehab El-Shahat Afify, Ahmed H Abd-El-Rahman, Yahya S.A. Dabour
DOI:10.4103/bmfj.bmfj_87_16  
Background The study was conducted to compare the effects of thoracic epidural analgesia versus systemic opioid analgesia on lung mechanics in obese patients undergoing major gynecological procedures (abdominal hysterectomy, ovarian cyst, ovarian mass, and abdominal explorations). We evaluated their analgesic efficacy over the first 12 postoperative hours after gynecological surgeries, in a randomized, single-blind, clinical trial in 60 patients divided into two equal groups, with 30 patients in each group. Patients and methods Sixty patients were randomized into two equal groups, with 30 patients in each group: group I received general anesthesia in combination with intravenous opioids, and group II received general anesthesia in combination with thoracic epidural anesthesia. General anesthesia was induced with fentanyl 1–2 μg/kg and propofol 1–3 mg/kg followed by rocuronium 0.6 mg/kg. Each patient was assessed for pulmonary function tests, pethidine consumption, visual analog pain scale at rest and on movement, vital signs and the presence of complications (nausea, vomiting, sedation, and pruritus) postoperatively by a blinded investigator in the postanesthesia care unit and at 1, 3, 6, and 12 h postoperatively. Results Group II patients showed significantly increased postoperative pulmonary function test values compared with group I patients at 1, 3, and 6 h; the postoperative analgesia is more effective with group II than with group I (epidural>systemic opioid), and the postoperative consumption of pethidine in the epidural group is lower than in the opioid group. As regards complications during the study in all groups, complications such as nausea, vomiting, pruritus, and sedation were recorded, which were more in the systemic opioid group than in the epidural group. Conclusion Particularly for obese patients, epidural anesthesia and postoperative epidural analgesia improve the postoperative respiratory functions, compared with general anesthesia and systemic analgesia, and reduce postoperative pain in obese patients undergoing major gynecological procedures.
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Role of cardiac MRI in diagnosis of congenital heart diseases p. 180
Mohamed A Nasr, Medhat M Eldosoky, Hany H Lotfy, Noha H Behery, Shaheen A Dabour
DOI:10.4103/1110-208X.239195  
Background Patients with congenital heart disease (CHD) are a challenge for imagers, since CHD requires a profound knowledge of the morphologic and functional characteristics of a broad range of congenital heart defects. Patients and methods 39 patients with CHD underwent MRI. In all patients, the abnormalities were demonstrated previously by echocardiography and 12 of them underwent CTA before MRI. The true diagnosis was considered to be the findings shown by 2D echocardiography except for extracardiac anomalies. Results ToF was the commonest CHD evaluated by MRI. The other cases in this study are variety of intra- and extra-cardiac anomalies with some post-operative cases. Cardiac MRI is considered as a valuable modality for evaluation of CHD as compared to other modalities it has much to offer by (a) generating high-resolution morphological images (b) offering quantitative information of the severity of regurgitant or stenotic lesions and (c) quantification of shunt. Conclusion Cardiac MRI provides a powerful tool, giving anatomic and haemodynamic information that echocardiography and catheterization alone do not provide. Finally, cardiovascular MR surpasses both catheterization and echo in its ability to create high resolution, three-dimentional reconstructions of complex CHD.
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Assessment of plasma level of cyclophilin A in type 2 diabetic patients suffering from vascular diseases p. 188
Anas A Yossef, Hesham A Issa, Enas S Ahmad, Shereen E Farag, Noha A Abd El Bar
DOI:10.4103/bmfj.bmfj_138_17  
Background Peptidyl-prolyl isomerase cyclophilin A (CypA) plays important roles in inflammation. However, little is known about the mechanisms by which CypA exerts its effects. It is secreted in human by monocytes activated by high glucose level. It has a role as an inflammatory mediator in vascular tissue damage. Aim This study aims to compare plasma levels of CypA in type 2 diabetic patients with or without coronary artery disease (CAD) with those in healthy participants to determine the potential role of CypA in promoting vascular disease in diabetic patient and to study the association of high-sensitivity C-reactive protein with CypA levels. Patients and methods The present study was conducted on 80 participants who were divided into four groups: group 1, which included apparently healthy individuals; group 2, which included patients with type 2 diabetes mellitus (DM) without CAD; group 3, which included patients with type 2 DM with CAD; and group 4, which included patients with CAD without DM. The plasma level of CypA was measured using a CypA enzyme-linked immunosorbent assay kit. Results The results showed an increase in the median CypA concentration in all patient groups in comparison with the controls (P<0.001). Also, there was a statistically highly significant increase in the median CypA concentration in diabetic patients with CAD group when compared with only diabetic patients group (P<0.001) and in patient with only CAD when compared with diabetic patients with or without CAD (P<0.001). Conclusion This study demonstrated that CypA has a potential role in promoting vascular disease in diabetic patients and revealed that CypA is a good biomarker for CAD with or without DM better than high-sensitivity C-reactive protein.
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Imaging of Müllerian duct anomalies p. 194
Ahmed F Yousef, Hamada M Khater, Ibrahim A Hussein
DOI:10.4103/bmfj.bmfj_178_17  
Background Müllerian duct anomalies (MDAs) are relatively common disorders, although the actual incidence and prevalence of these disorders are difficult to assess. Aim This work aimed to survey the role of imaging in determining the location and order of peculiarities of Müllerian conduits by various picture modalities. Patients and methods The study included 37 patients with primary amenorrhea with suspected MDAs on the basis of a preliminary ultrasound study. Patients with primary infertility, secondary infertility, or recurrent abortions were investigated for possible MDA or patients with cyclic abdominal pain referred from the Gynecology Department to the private Radiology Department in Benha and Cairo City. Results The study included 37 patients. All patients underwent pelvic ultrasound, hysterosalpingography, and pelvic MRI. Patients were further divided according to their final diagnosis by hystrosalpingography pelvic ultrasonography and pelvic MRI, which was correlated with clinical characteristics. Conclusion MRI in our study showed excellent diagnosis performance compared with hysterosalpingography and ultrasound. Recommendations Clinicians should be suspicious for Müllerian anomalies in cases of primary amenorrhea, pelvic pain, and certain adverse obstetrical outcomes.
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Influence of the shape of Nd:YAG capsulotomy on visual acuity and refraction p. 202
Hazem M El-Feky, Waheed M Orouk, Rana H Ahmed
DOI:10.4103/bmfj.bmfj_208_17  
Background Posterior capsule opacification (PCO) is a common complication after cataract surgery. The need for PCO prevention becomes increasingly important. During the past decades, various forms of prevention have been examined, including general measures during surgery, pharmacological prevention, and by interfering with the biological processes of epithelial mesenchymal transformation (EMT) in lining epithelial cells (LECs). The first-line treatment option is posterior capsulotomy performed with a neodymium:yttrium–aluminum–garnet (Nd:YAG) laser. To evaluate the influence of the size and shape of Nd:YAG laser capsulotomy on visual acuity and refraction. Patients and methods We evaluated 20 eyes of 20 patients treated with Nd:YAG laser posterior capsulotomy for PCO. Patients were divided into two groups according to the shape of capsulotomy: patients with cruciate shape capsulotomies with openings of more than 3 mm (group 1) and patients with circular shape capsulotomies of more than 3 mm. Results The mean number and energy of laser firings were significantly higher in group 2 and significantly lower in group 1 (P=0.011). In the preprocedural spherical equivalent, there was no statistical significance between the two groups (P=0.971). In the postprocedural spherical equivalent also there was no statistical significance between the two groups (P=0.643). Significant change in intraocular pressure following capsulotomy was observed in group 2 (P=0.011), but there was no significant change in group 1. A higher number of patients in group 2 and a lower number of patients in group 1 report floating bodies after YAG laser capsulotomy (P≤0.050 significant). Regarding floating bodies there was statistical significance between the two groups (P=0.025). Best-corrected visual acuity highly significantly improved following capsulotomy in both the groups (P≤0.001). Conclusion Cruciate shape capsulotomy provides improvement in visual function with minimal complications.
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Microsurgical management results of occipital encephalocele p. 207
Ashraf El Badry, Azza Abdel Azeez, Ahmed Abdel Khalek
DOI:10.4103/bmfj.bmfj_120_17  
Background Encephalocele is a central nervous system birth anomaly with a herniation of the brain and the covering meninges through a bony skull defect to the exterior. Objective The aim of this research was to describe the prognostic factors and current possible hypotheses explaining associated anomalies observed in a series of 17 patients with encephalocele and show the effectiveness of setting up a microsurgical technique in the treatment of these cases. Materials and methods Seventeen patients who were identified with occipital encephaloceles and referred to our Neurosurgery Clinic at the Mansoura University Hospital, Mansoura Insurance Hospital, between October 2004 and July 2013 were enrolled in this study. Patients’ sex, age at the time of the procedure, features of the lesion including site, size, associated cerebrospinal fluid leak, radiological evaluation and intraoperative findings (sac contents), and intracranial and extra cranial-associated anomalies were determined in the study. Results In our study, 17 patients (12 female and five male) were included. Their ages varied between newborn and 1 month. The encephalocele sac was situated in the occipital region in 15 (88.2%) patients and in the occipitocervical region in two (11.8%) patients. We used a microsurgical technique on all patients. Five (29.4%) of the 17 patients died: three in the postoperative early period (0–7 days) and two in the late postoperative period (2 weeks to 3 months). The mortality rate in our study was 29.4%. Conclusion The evidence in our series showed the importance of some factors that can alter the survival of patients with occipital encephalocele such as the sac size, the neural tissue existence in the content, hydrocephalus, infections, and other associated malformations. In this study, we report improvements in the surgical results by introducing the microsurgical technique as an alternative to traditional management despite the high morbidity and mortality linked to this congenital anomaly.
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Corneal epithelial thickness changes as imaged by Fourier-domain optical coherence tomography in eyes with keratoconus p. 214
Ahmed Y Fekry, Aysar A Fayed, Ashraf A El Shayeb, Abdel Monem M Hamed
DOI:10.4103/bmfj.bmfj_46_17  
Purpose The purpose of this study was to document changes in the corneal epithelium as imaged by Fourier-domain optical coherence tomography (OCT) in cases of keratoconus. Patients and methods This is a comparative cross-sectional study including 20 eyes of 14 patients with keratoconus (n=20, study group) and 16 eyes of eight normal individuals (n=16, control group). Both groups were imaged using Scheimpflug imaging corneal topography and Fourier-domain AS-OCT system. Corneal epithelial thickness maps obtained by the AS-OCT system were studied and compared between the two groups. Results There was no statistically significant difference in mean corneal epithelial thickness between study and control groups (unpaired Student’s t-test, P<0.05). Minimum corneal epithelial thickness was statistically significantly less and maximum corneal epithelial thickness was statistically significantly more in the study group compared with the control group (unpaired Student’s t-test, P<0.05). Corneal epithelial thickness was least in the central, temporal, and inferotemporal sectors of the study group. A distinct pattern of epithelial thinning over the thinnest pachymetry and highest back elevation with varying degrees of surrounding epithelial thickening located in the inferotemporal quadrant was observed in 71.43% of the study group. Conclusion Recognizable corneal epithelial thickness changes are seen in keratoconic eyes. The diagnostic potential of such changes need to be further investigated.
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Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in locally advanced rectal carcinoma p. 218
Nawal M El-Kholy, Eman A Abdallah, Eman A Tosson, Ola M El-Nady
DOI:10.4103/bmfj.bmfj_170_17  
Background Evaluation of the safety and efficacy of neoadjuvant chemoradiation containing oxaliplatin in locally advanced cancer rectum. Patients and methods A prospective, single-arm, phase-II study, carried out on 40 patients with locally advanced (T3, T4, N+) rectum cancer from June 2013 to June 2015. Patients received 2 months induction FOLFOX4 chemotherapy, followed by concomitant chemoradiotherapy (CRT) consisted of oxaliplatin 100 mg/m2 D1, 29 of radiotherapy (RT), folinic acid 20 mg/m2 D1: 29, and 5-FU 300 mg/m2 D1: 5, 29: 33 continuous infusion (during the first and fifth week of RT), with three-dimensional conformal pelvic RT 45 Gy by conventional fractionation. Surgery was done 4–6 weeks after end of the CRT course. Adjuvant treatment consisted of 2 months FOLFOX4 chemotherapy. A booster dose of RT 9 Gy/5 fractions was added in cases with positive margin or persistent T4 tumors after surgery. Results In all, 95% of the patients ended neoadjuvant CRT course with 75% receiving full treatment doses. Overall response occurred in 86% of patients; 16% of them showed pathological complete response; initial failure occurred in only 5% of patients; sphincter sparing surgery was done in 43% of patients. CRT course passed with tolerable and reversible toxicity; grade III toxicity occurred in only 10% of patients, and no grade IV toxicity was reported. Conclusion Adding oxaliplatin to neoadjuvant CRT in locally advanced cancer rectum cases was feasible, tolerable, with satisfactory response rates, thus encouraging more studies with larger number of patients and longer follow-up periods.
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Biochemical changes in adiponectin and myeloperoxidase in acute myocardial infarction p. 225
Raafat R Mohammed, Hussein Abdel-Maksoud, Yasser M Abdel-Nabi
DOI:10.4103/bmfj.bmfj_16_18  
Background Nitric oxide is a common mediator for the action of adiponectin and myeloperoxidase (MPO). Its importance is as a predictor of acute myocardial infarction (AMI) severity. Aim The aim of the present study was to find a relationship between plasma adiponectin level, MPO activity, lipid profile, serum nitrite/nitrate, and severity of AMI disease. Patients and methods To achieve this aim, 30 patients with AMI with age ranged from 35 to older than 70 years and 10 clinically healthy participants as control were subjected to this study. Results The result of this study showed a significant association between the occurrence of AMI and low adiponectin level, high MPO activity, low nitrite level, high total cholesterol level, high triacylglycerol level, high low-density lipoprotein-cholesterol level, low high-density lipoprotein-cholesterol level, and high low-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol ratio. These parameters may all be regarded as predictors or risk factors for AMI. Conclusion The findings of the present study suggest that hyperlipidemia, vascular inflammation, and oxidative stress are primary interacting mediators in the pathogenesis of AMI.
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Adiponectin levels in serum of women with pre-eclampsia p. 229
Mohamed K Aloush, Mohamed F Elsherbiny, Tamer M Asar, Hisham A Essa, Alshaimaa H Mohamed
DOI:10.4103/bmfj.bmfj_15_18  
Background and aim The aim of this study was to investigate the association between serum adiponectin levels and some clinical and hormonal parameters in cases of pre-eclampsia. Patients and methods This cross-sectional controlled observational study was carried out on 75 pregnant women recruited from antenatal outpatient clinic and obstetric departments of Benha University Hospital. The women were subdivided into three subgroups: 25 normal pregnant women, 25 pregnant women with mild pre-eclampsia, and 25 pregnant women with severe pre-eclampsia. All studied groups were subjected to complete history taking, clinical examination, and routine laboratory investigations, for example, complete blood count, Rh, random blood sugar, serum uric acid and proteinuria, serum adiponectin, progesterone, and estradiol levels. Results Serum adiponectin levels in women with pre-eclampsia were significantly higher than in normal pregnant women, and the increase was more marked in cases of severe pre-eclampsia. There was a significant positive correlation between adiponectin levels and arterial blood pressure in all groups. However, there was no correlation between serum adiponectin and estradiol and progesterone levels. The results support the theory that adiponectin might be part of a feedback mechanism for improving insulin sensitivity and cardiovascular health in patients with pre-eclampsia. Conclusion It has been concluded from the study that plasma adiponectin level is increased in pre-eclampsia. It can be taken independently or along with other parameters as a marker for severity of pre-eclampsia, hence, avoiding risk effects of pre-eclampsia to mother and fetus. Serum adiponectin assay increases sensitivity for prediction of pre-eclampsia.
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Chromogranin a as a serum marker for hepatocellular carcinoma p. 235
Samir M Kabil, Hala M El-Feky, Mona M El-Behisy, Samir H Mosallam
DOI:10.4103/bmfj.bmfj_29_18  
Background Hepatocellular carcinoma (HCC) has an increasing incidence worldwide. The observation of neuroendocrine activity during the clinical course of HCC suggested the use of neuroendocrine serum markers to detect it and elevated serum chromogranin A (CgA) has been reported in patients with HCC. Aim To investigate the clinical utility of serum CgA, as a diagnostic marker of HCC. Patients and methods This study was conducted on 80 patients who were classified into two groups. Group 1: the liver cirrhosis group which included 40 patients diagnosed by clinical settings, laboratory criteria, and radiological methods. Group II: the HCC group which included 40 patients who were diagnosed by two appropriate imaging studies and serum α-fetoprotein (AFP). They were recruited from Hepatology, Gastroenterology, and Infectious Diseases Department, Benha University Hospital. Liver function tests (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and serum albumin) by colorimetric assay, CgA (by enzyme-linked immunosorbent assay), and AFP (by immunometric assay) were estimated. Results CgA levels were significantly higher in group II (HCC patients) when compared with group I (cirrhotic patients) (P<0.0001). A statistically significant positive correlation was detected in the HCC group between CgA versus aspartate aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin, AFP, Child score, Barcelona-Clinic Liver Cancer Classification, number and size of focal lesions and negative significant correlation versus platelets count and serum albumin (P<0.0001). CgA level shows a best cutoff of 99.95 nmol/l and it showed 90% sensitivity, 90% specificity, 90% positive predictive value, 90% negative predictive value with 95.8% accuracy for the diagnosis of HCC, while when combined with AFP, it had 90% sensitivity, 67.5 specificity, 73.5% positive predictive value, 87.1% negative predictive value with 78.8% accuracy for the diagnosis of HCC. Conclusion CgA represents a useful diagnostic biomarker for HCC.
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Thyroid-stimulating hormone in pregnancy: are we in need of a lower cutoff value? p. 241
Mahmoud F Midan, Khaled N Elfayoumy, Walaa M El-Bassiony, Ahmad A Al-Metwally
DOI:10.4103/bmfj.bmfj_85_18  
Background No consensus has been reached regarding the normal range of thyroid-stimulating hormone (TSH) in the first trimester of pregnancy. Aim To determine the effect of TSH levels and thyroid peroxidase antibody (TPOAb) positivity on miscarriage outcome among Egyptian euthyroid women. Materials and methods The study was a prospective case–control study conducted at Al-Azhar University Hospital in New Damietta. It included 80 newly-diagnosed pregnant euthyroid women: 40 women with unexplained recurrent miscarriage, assigned as group 1 (subdivided into two subgroups according to the presence of TPOAb), and a control; group of 40 randomly selected fertile pregnant women who had no history of miscarriage, assigned as group 2. Free T4, TSH, and TPOAb assays were performed at 8-week gestational age. We followed all cases periodically every 4 weeks and when necessary. Results The study revealed significant higher frequency of positive TPOAb in group 1 than group 2 (P=0.045). During the study observation, miscarriage occurred more than two-fold higher in group 1 than group 2 (17.5 vs. 7.5%, respectively, P=0.176) but was significantly higher among TPOAb positive than TPOAb negative women within group 1 (54.5 vs. 3.4% respectively, P<0.001). Interestingly, 75% of cases who were positive for TPOAb and at the same time had a family history of autoimmune thyroid disease were aborted. In group 1, there was a positive correlation between TSH and TPOAb titer (P=025), and abortion occurred more frequently with TSH more than 2.5 mU/l (P=0.021). Conclusion TPOAb is a useful marker for identifying the risk for miscarriage among Egyptian euthyroid women. The risk was augmented when TSH exceeded 2.5 mU/l in the first trimester of pregnancy, and in the presence of family history of autoimmune thyroid disease.
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Human round window: morphometry and topographical anatomy and their effect on cochlear implantation p. 246
Ahmed M Seliet, Ashraf S El Hamshary, Ahmed M El Refai, Ali M Ali, Sara R Gabal
DOI:10.4103/1110-208X.239200  
Background Renewal interest of round window (RW) approaches necessitates further acquaintance of its complex anatomy and its variations. Aim of work The aim of this work is to study the anatomical characteristics of human RW and the importance of variations in this anatomy to the process of cochlear implantation (CI). Materials and Methods Twenty human temporal bones were obtained from cadavers and preserved in formalin. Microdissection was done in two phases, phase 1 through facial recess approach and phase 2 external auditory canal approach after the tympanic membrane and ear ossicles were removed, the RW and OW areas were exposed, shape, height and width of the RW were noted. Its distances from OW was measured. Results Oval (60%), round (25%) and triangular (15%) shapes of RW were observed. The average height and width of the RW were 1.91 ± 0.78 mm and 1.37 ± 0.43 mm, respectively. There was a statistically significant correlation (r = 0.95, P < 0.001) between the height and width of RW. The distances between the RW and the OW was in the range of 1–3.5 mm. There were no statistically significant differences as regard to gender, or side. Electrode insertion could be challenging in cases where the height and width of the RW are <1 mm. Conclusion This information could be useful for selecting cochlear implant electrodes in order to avoid potential risks to vital neurovascular structures during implant surgery.
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Pattern and mode of delivery among women attending Benha and October 6 University hospitals p. 253
Osama Mohamed Wassef, Mahmoud Fawzy Elgendy, Eman Abd El Fattah AlBitar, Rasha Shaker Eldesouky, Yasmine Hamdy Mohamad Eisa
DOI:10.4103/bmfj.bmfj_21_18  
Background Cesarean section (CS) rates have been increasing worldwide, raising the question of the appropriateness of the selection of cases for the procedure. Aim The aim of this study was to assess the patterns of CSs and identify the incidence of CSs among Benha and October 6 University hospitals and to identify the determinants of mode of delivery and study factors attributed to the increased CS rate among the studied women. Participants and methods A cross-sectional study targeted physicians delivering women attending Benha and October 6 University hospitals; 300 deliveries performed by the studied physicians were investigated. Fetal distress was the alarming sign to perform CS in 100% and 98.5% of cases in October 6 and Benha University hospitals. Conclusion The sex of the physicians participating in this study, male physicians were 71% and female physicians were 29%, with 100% of the physicians performing CS having an urban residence. Only 5% of physicians performing CS were specialists and 60% were residents, male physicians performing CSs were 58% and female physicians were 42%. Fetal distress was one of the main indications for performing a CS in 99% of cesarean deliveries, and the frequency of antenatal care visits was less than four visits in 81% of cases delivered by CS; 97% of CSs had a favorable outcome; 99% of CSs did not need further interventions; and 63% of CSs had no complications on admission; and the incidence rate of CS was found to be 24.7% in both the studied hospitals.
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Relationship between serum sialic acid concentration and diabetic retinopathy in Egyptian patients with type 2 diabetes mellitus p. 257
Mohamed S El-Sayed, Ayman El Badawy, Rasha O Abdelmoneim, Ahmed E Mansour, Medhat El-Moneim Khalil, Karim Darwish
DOI:10.4103/bmfj.bmfj_17_18  
Background Degree of diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM) and one of the most common causes of blindness worldwide. Plasma sialic acid (SA) is one of the markers that has been utilized as an acute-phase response. In DR, there is a great increase in SA. Aim We aimed in this study to shed light on the relationship between serum SA and DR in Egyptian patients with type 2 DM. Patients and methods The patients of this study included 40 patients with type 2 DM (25 with DR and 15 without DR) as well as 10 healthy volunteers as control. A questionnaire was done to every patient including baseline characteristics, examination, laboratory investigations, and dilated fundus examination. Results Serum SA level was found to be significantly increased in patients with type 2 DM compared with control and in diabetic patients with retinopathy compared with diabetic patients without retinopathy. Conclusion This study showed that DR has a significant impact on serum SA level.
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