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   Table of Contents - Current issue
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September-December 2018
Volume 35 | Issue 3
Page Nos. 265-450

Online since Monday, January 7, 2019

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Oral gabapentin premedication for post-tonsillectomy nausea, vomiting, and recovery p. 265
Ibrahim M. Abdel Moety, Dina H.A El Barbari, Mohammed M.A Esmael
DOI:10.4103/bmfj.bmfj_24_18  
Background Gabapentin is a second-generation anticonvulsant that is successful in the management of chronic neuropathic pain. It was not previously known to be useful in acute perioperative conditions, but recently it has been used for acute perioperative conditions. However, evidence-based medicine suggests that perioperative administration is useful for postoperative analgesia, preoperative anxiolysis, attenuation of the hemodynamic response to laryngoscopy and intubation, and preventing chronic postsurgical pain, postoperative nausea and vomiting (PONV), and delirium. This article reviews the clinical trial data to describe the efficacy and safety of gabapentin for perioperative anesthetic management. Aim The aim of the study was to evaluate and update the effect of preoperative gabapentin on the incidence of postoperative vomiting and on analgesic requirements after adenotonsillectomy in pediatrics. Materials and methods This randomized, double-blind study was designed to explore the possible effects of oral gabapentin as a premedication on the incidence and severity of PONV and on the early recovery profile of pediatric patients undergoing adenotonsillectomy under sevoflurane anesthesia. Results The incidence of PONV in the gabapentin group was significantly lower than in the gabapentin group. However, the numbers of rescue ondansetron doses and the PONV severity score were comparable in the two groups. Conclusion The use of gabapentin as premedication in pediatric patients undergoing adenotonsillectomies under sevoflurane anesthesia reduces the incidence of PONV and emergence agitation in the early postoperative period. However, gabapentin did not reduce pain and analgesic consumption after surgery.
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ORIGINAL ARTICLES Top

Left ventricular untwist in patients with diastolic dysfunction: speckle tracking imaging study p. 270
Mahmoud A Soliman, Mahmoud K Ahmed, Morad B Mena, Mohamed S.S Montaser
DOI:10.4103/bmfj.bmfj_132_18  
Background There is no single noninvasive index that can directly assess diastolic function. Untwist contributes to diastolic suction and early filling. Speckle tracking imaging (STI) can be used to study the relation between diastolic indices and untwist in patients with diastolic dysfunction. Patients and methods A total of 75 patients with diastolic dysfunction and 25 normal volunteers were selected for this study. According to mitral flow pattern, the patients were classified into group I (abnormal relaxation), group II (pseudonormalized), and group III (stiffness pattern). Using STI, the basal and apical short-axis views were imaged. Stored data were processed to get apical and basal rotation, systolic twist, peak systolic twist ratio, diastolic untwist ratio, and time to peak twist and untwist ratio. Results Peak untwisting ratio was significantly higher in Group I Patients that decreased to be normalized and even decreased with progression of diastolic dysfunction from Group II to Group III. There was a highly significant positive and negative correlation with end-diastolic volume and end-systolic volume, respectively. Time to peak untwist ratio nonsignificantly increased from group I to III, with nonsignificant correlation between untwist ratio and peak E, A, and E/A ratio. Conclusion Patients with relaxation abnormality have a higher untwist ratio, which decreases gradually with progression from relaxation to stiffness pattern. It may appear as a compensatory mechanism to ensure early filling with relaxation abnormality.
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The role of dynamic contrast-enhanced MRI analysis of perfusion changes in hepatocellular carcinoma p. 277
Ahmed M Elzeneini, Mohamed I Yousef, Medhat M Refaat
DOI:10.4103/bmfj.bmfj_46_18  
Background Dynamic contrast-enhanced (DCE)-MRI functional imaging is primarily focused on quantitative evaluation of tumoral perfusion and permeability, thus enabling an insight into the pathophysiology of tissue and serving as early noninvasive biologic markers of tumorigenesis. Aim The aim was to evaluate the functional role of DCE-MRI analysis of perfusion changes in hepatocellular carcinoma (HCC). Patients and methods A total of 43 patients with liver cirrhosis having 65 HCCs all underwent 3 T multiphase DCE-MRI assessment. Maximum relative enhancement, area under curve, wash-in ratio, wash-out ratio, time to arrival, and time to peak semiquantitative measurements were analytically compared between the hepatocellular carcinogenic lesions and the adjacent lesion-free liver cirrhosis. Results Comparison of different perfusion metrics across hepatocellular carcinogenic lesions and adjacent lesion-free liver cirrhosis revealed exceling statistical significance. Diagnostic accuracies were highest when using wash-out ratio (86.2%) to detect HCC from background cirrhosis, whereas they were lowest using area under the curve (67.7%). Implementing wash-in ratio (81.9%), as a first-pass perfusion metric, surpassed its counterpart, maximum relative enhancement (73.4%), in diagnostic reliability. Regarding the timing of flow dynamics, time to arrival (84.1%) was more important than time to peak (78.1%) as a diagnostic indicator of hepatocarcinogenesis. Conclusion Multiphase DCE-MRI perfusion analyses provide quantitative hemodynamic metrics that promise potential usefulness as noninvasive biomarkers in the detection of HCC.
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Noninvasive predictors of hepatic fibrosis in patients with chronic hepatitis C virus in comparison with liver biopsy p. 282
Ayman N Menessy, Nancy A Ahmed, Nagwa I Abdallah, Salah S Arif
DOI:10.4103/bmfj.bmfj_132_17  
Background Liver fibrosis is the main predictor of the progression of chronic hepatitis C, and its assessment by liver biopsy can help plan therapy. However, biopsy is an invasive procedure with occasional complications and poor patient acceptance. Aim The aim of this work was to compare noninvasive and invasive methods for evaluation of fibrosis in patients with chronic hepatitis C. Patients and methods This cross-sectional study was carried out at the Liver Unit of Mansoura University Hospital and Mansoura Health Insurance Hospital. The study was conducted on 100 patients with chronic active hepatitis. Biochemical and virological studies were performed in addition to abdominal ultrasonography and liver biopsy in all patients. Moreover, analyses of serum fibronectin (FN), AST-to-platelet ratio index (APRI), and alanine aminotransferase/aspartate aminotransferase (AST/ALT) ratio were performed. Results We found that FN has the highest sensitivity and specificity, and the independent variables related to fibrosis were FN, APRI, and AST/ALT ratio. Conclusion The biochemical tests including APRI, AST/ALT ratio, and particularly FN could be valuable noninvasive predictors for assessment of liver fibrosis in patients with chronic hepatitis C infection.
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Orbitozygomatic approach results of 16 spheno-orbital hyperostotic meningiomas (en plaque) p. 287
Ashraf El Badry, Azza Abdel Azeez, Ahmed Abdel Khalik
DOI:10.4103/bmfj.bmfj_119_17  
Objective This study aimed to evaluate the results of the orbitozygomatic approaches of intraosseous meningiomas that causes hyperostoses involving the greater wing of the sphenoid and orbital bones with a small soft tissue component. Patients and methods We carried out a prospective and retrospective study of 16 patients with meningiomas en plaque who underwent surgical procedures by the orbitozygomatic approach in the period between 1999 and 2014 at the Neurological Surgery Department, Mansoura University Hospital of Egypt. Results The mean age of the patients was 49.6 years, whereas the most common complaint was proptosis accounting for 81.25% of cases. The second most common complaint was visual impairment accounting for 56.25% of cases. The orbitozygomatic approach was used for all the cases and drilling of the greater wing of the sphenoid, lateral orbital wall, orbital, and optic canal roof was performed. The small soft tissue component of the meningiomas was in the anterior and middle cranial fossa involving hyperostoses in all surrounding bones in all cases, whereas four cases showed intraorbital soft tissue meningioma. The results after surgery indicated an improvement of proptosis in 75% of cases, with less improvement in visual impairment observed in 56.25% of cases. Complications included third nerve palsy in 87.25% (14) of cases, and improved only in five cases. The extent of tumor surgical resection was subtotal in 75% (12) of cases. These tumors progressed in eight cases and only two patients underwent a second surgical intervention; others were referred to radiotherapy. Conclusion Despite good surgical exposure in this approach, the radical excision of the tumors may be extremely difficult as the tumor in these areas showed involvement of very delicate structures (because of late medical consultation), which made the dissection impossible, but using this approach we can achieve good results including proptosis and visual impairment.
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Intrathecal nalbuphine as an adjuvant to bupivacaine in spinal anesthesia for lower-limb surgeries: intraoperative and postoperative effects p. 297
Saad I Saad, Ehab E Afifi, El-Sayed M Abd El-Azim, Walid H.I Moftah
DOI:10.4103/bmfj.bmfj_81_17  
Background Many opioids are added to intrathecal local anesthetics to provide longer duration of analgesia; however, we have to choose an additive with the longest analgesic time and least intraoperative and postoperative side effects. In this study, nalbuphine was compared with fentanyl and pethidine as additives to hyperbaric bupivacaine used in spinal anesthesia for lower-limb surgeries. Patients and methods A total of 100 patients of both sexes, American Society of Anesthesiologists I and American Society of Anesthesiologists II, scheduled for lower-limb surgeries under spinal anesthesia were assigned randomly into four groups: group B received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml sterile water; n=25); group N received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml nalbuphine 500 μg; n=25); group F received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml fentanyl 25 μg; n=25); and group P received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml pethidine 10mg; n=25). We recorded the onset of sensory and motor blocks, peak sensory and motor block times, sensory block levels and two-segment regression time using the pin-prick method, motor block level using the modified Bromage scale, and any intraoperative or postoperative complications. Results The mean onset of sensory block significantly decreased in groups N, F, and P compared with group B, whereas the peak sensory time did not significantly change in all the four groups. In contrast, the mean onset of the motor block in all four groups was nonsignificantly different, whereas the mean time for peak motor block was significantly short in both the N group (nalbuphine and bupivacaine) and the P (pethidine and bupivacaine) group compared with the B (bupivacaine alone) and F (fentanyl and bupivacaine) groups. There was significant prolongation in both two-segment regression time and the first analgesic request time in groups N, F, and P (all narcotics and bupivacaine) compared with group B (bupivacaine alone). Conclusion Nalbuphine, fentanyl, and pethidine as adjuvants to spinal anesthesia prolong the duration for first-rescue analgesia with minimal hemodynamic and respiratory complications; however, nalbuphine at a dose of 0.5 mg has the best quality of spinal block when added to intrathecal 0.5% heavy bupivacaine in patients undergoing lower-limb surgeries.
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Effect of Nigella sativa oil on Schistosoma mansoni immature worms in experimentally infected mice p. 307
Azza S Al Hamshary, Ibrahim M Nagati, Maysa A Eraky, Eman A Abou-Ouf, Asmaa A Kholy, Ghada H Omar
DOI:10.4103/bmfj.bmfj_2_18  
Background Nigella sativa oil is one of the promising drugs of a plant origin that have an antischistosomal effect. Aim The aim of the present work was to explore the role of N. sativa oil either alone or in combination with praziquantel on immature worms of Schistosoma mansoni. Materials and methods N. sativa oil capsules dissolved in corn oil were administered to S. mansoni-infected mice aiming to study the therapeutic and prophylactic effects. The study included six groups of mice: (a) noninfected and nontreated, (b) infected and nontreated, (c) prophylactic N. sativa oil group, (d) praziquantel group, (e) therapeutic N. sativa oil group, and (d) combined group. All mice were killed 4 weeks after infection and treatment. The antischistosomal effect of N. sativa oil was assessed by worm burden, histopathology, and scanning electron microscopy. Results Therapeutic N. sativa oil group showed the highest significant decrease in the mean number of immature worm burden (R% was 57%) when given after infection followed by the combined group (R%=55.67%), whereas prophylactic N. sativa oil group showed nonsignificant decrease (R%=37%). The least changes were observed in praziquantel group (R%=0%). Conclusion N. sativa oil has a potent effect on immature S. mansoni which could be helpful for potentiating praziquantel effect and thus reducing development of resistance.
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Diagnostic accuracy of lectin-reactive α-fetoprotein (AFP-L3) in the diagnosis of hepatitis C virus-related hepatocellular carcinoma p. 312
Atef Ahmed Ali Ibrahim, Roshdy Mohamed Khalaf Allah, Amr M El Hammady, Rizk Sayad Rizk Sarhan, Medhat A Khalil, Marwa Mohiy Eldin Abdel Rahman
DOI:10.4103/bmfj.bmfj_33_18  
Background Hepatocellular carcinoma (HCC) is one of the most malignant neoplasms. It has a very poor prognosis because the diagnosis is very late. Therefore, early detection is important in the management of this neoplasm. α-fetoprotein (AFP)-L3 has been recommended as a marker for early-stage HCC in many countries all over the world. Aim The aim was to evaluate the potential clinical value of lens culinaris agglutinin-reactive AFP-L3 against total AFP in the diagnosis of hepatitis C virus-related HCC and to evaluate its role in disease diagnosis. Materials and methods This study included 40 patients who were diagnosed as hepatocellular carcinoma (diagnosis was based on the BCLC staging classification), 20 patients with chronic liver disease, and 20 healthy subjects as a control group. Results Results showed that there was a significant positive correlation between each of serum AFP and AFP-L3 and each of tumor size and tumor number among patients with HCC. The median value of both serum AFP-L3 and AFP-L3/AFP ratio was significantly higher in patients with HCC group when compared with patients with chronic liver disease and normal control individuals. Receiver operator characteristic curves were constructed for serum AFP, AFP-L3, and AFP-L3/AFP ratio as predictors of HCC. Serum AFP-L3 had the largest area under the curve. The best cut-off point for AFP as predictor of HCC was 128 ng/ml [sensitivity 75%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 66.7%, and efficacy 83.3%]. The best cut-off point for AFP-L3 as predictor of HCC was 23 ng/ml (sensitivity 97.5%, specificity 100%, PPV 100%, NPV 95.2%, and efficacy 98.3%). The best cut-off point for AFP-L3/AFP ratio was 16% (sensitivity 97.5%, specificity 100%, PPV 100%, NPV 95.2%, and efficacy 98.3%). Conclusion In conclusion, AFP-L3 is a promising marker for diagnosis of HCC especially when combined with AFP, as the diagnostic sensitivity was optimum, so both markers can be used in the screening of HCC.
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Effect of ambroxol on experimentally induced acute oxidative stress in the heart, kidney, and intestine in rats p. 317
Mahmoud M Elfouli, Mohie E Said, Hanan T Emam, Nashwa H Abu-raia, Manar A Metwally
DOI:10.4103/bmfj.bmfj_163_17  
Background Intestinal ischemia–reperfusion (IR) is a frequently occurring phenomenon during abdominal and thoracic vascular surgery, small bowel transplantation, hemorrhagic shock, and surgery using cardiopulmonary bypass, carrying high morbidity and mortality. Ambroxol hydrochloride is an active N-desmethyl metabolite of bromhexine hydrochloride. Ambroxol is indicated as ‘secretolytic therapy in bronchopulmonary diseases associated with abnormal mucus secretion and impaired mucus transport’. Aim The present study was designed to evaluate the effect of ambroxol on experimentally induced acute organ oxidative stress in the form of remote organ injury including kidney and heart after intestinal IR. Materials and methods Thirty animals were classified into five groups. First group: normal control group, second group: nontreated intestinal IR group (intestinal IR was induced by mesenteric artery ligation), third group: ambroxol pretreated intestinal IR group (35 mg/kg), fourth group: ambroxol pretreated intestinal IR group (70 mg/kg), fifth group: ambroxol pretreated intestinal IR group (140 mg/kg). Results Ambroxol significantly reduced the malondialdehyde level in the heart and the kidney when compared with intestinal IR with no medication group. It also improved cardiac troponin and, kidney functions (urea and creatinine) and histopathological affection when compared with intestinal IR with no medication group. Conclusively, in this study ambroxol could have a protective effect against intestinal IR through its antioxidative and anti-inflammatory effect.
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The potential combined effect of vitamins E and C on fluoride-induced hepatic toxicity in albino rats p. 326
Amany M.S El Din, Rania N Sherif, Salwa M.M El Khyat, Yassmin G Salem
DOI:DOI: 10.4103/bmfj.bmfj_73_17  
Background Fluoride is a well-determined nonbiodegradable and moderate pollutant, which at high levels causes serious health problems. Aim The present study was designed to investigate the histopathological changes in liver as a result of exposure to sodium fluoride in albino rats and the possible therapeutic effect of both vitamins E and C. Materials and methods Eighteen adult albino mice were divided into three groups (six rats per each group). The first group served as control. The second group was treated with 3.6 mg/kg body weight sodium fluoride for 30 days, and the third group received 3.6 mg/kg body weight of sodium fluoride for 30 days followed by vitamins E and C for the next 13 days. At the end of the treatment period, the animals were sacrificed by means of cervical dislocation and the liver was dissected out. Blood samples were taken for the assessment of serum glutamic-pyruvic transaminase and serum glutamic oxaloacetic transaminase. Results Liver tissue was cleared and used for assessing the histopathological changes. Liver tissue homogenate was used for the assessment of malondialdehyde and glutathione peroxidase levels. The histopathological results in the present study indicated that exposure to sodium fluoride for 30 days caused degenerative changes in the liver. Light microscopic examination revealed the degenerative changes in the liver, such as disorganization of the cell plates, dilation of the central vein, pyknotic nucleus, ballooned hepatocytes and hepatocytes with empty nuclei, and disturbed mucopolysaccharide metabolism in liver cells. Biochemical examination revealed elevated serum glutamic-pyruvic transaminase, serum glutamic oxaloacetic transaminase, and malondialdehyde and decreased glutathione peroxidase level. Conclusion Administration of vitamins E and C during the first 13 days of the recovery period of sodium fluoride intoxication revealed minimal improvement, which was detected at the biochemical and metabolic level.
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Intravitreal bevacizumab with prompt laser compared with steroid with prompt laser and prompt laser alone for treatment of diffuse diabetic macular edema p. 336
Ashraf A Alshayeb, Tarek T Soliman, Osama A Shalaby, Amro M Abdel-Galil
DOI:10.4103/bmfj.bmfj_43_16  
Aim The aim of this study was to compare the efficacy of combined intravitreal bevacizumab injection plus prompt laser versus combined intravitreal triamcinolone injection plus prompt laser and laser alone in the management of diffuse diabetic macular edema on both central macular thickness (CMT) and visual acuity. Patients and methods Sixty patients with diabetes mellitus (type 2) with diffuse macular edema (35 males and 25 females) were recruited for this prospective, randomized, interventional study. Complete history taking, full ophthalmological examination, and CMT measurement using optical coherence tomography were done for all patients. They were subdivided randomly into three groups: laser photocoagulation group (laser group), combined laser and intravitreal bevacizumab group (IVB+laser group), and laser and intravitreal triamcinolone acetonide group (IVTA+laser group), and they were followed up every 2 months for 1 year for evaluation of their response to these treatment modalities as well as for detection of any adverse effects. Results After 12-month follow-up, IVB+laser group showed a higher significant decrease in CMT than that occurred with the other two groups (P<0.0001). However, the laser-treated group showed the least significant change in CMT than baseline. In addition, the visual acuity letter score showed a significant improvement in the IVB+laser group (P˂0.008) than the IVTA+laser group (P<0.048). Compared with the laser-treated group, the most commonly recorded adverse effects during the period of follow-up were increased intraocular pressure and accelerated cataract formation with the need for surgery, with the highest incidence of these complications in the IVTA+laser group than the other two groups. Conclusion Combined IVB+laser photocoagulation provided the highest and the longest efficacy in improving visual acuity and reducing CMT in treating diabetic macular edema, compared with laser group or combined IVTA+laser.
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Biochemical relations between copper, selenium, zinc, and magnesium with the glycemic state of diabetic pregnant women p. 344
Raafat R Mohammed, Mostafa M Mehrez, Hussein Abdel-Maksoud
DOI:10.4103/bmfj.bmfj_213_17  
Background Micronutrients, have specific roles in the metabolism, normal growth, and the pathogenesis and progress of diseases with a specific alteration in diabetic patients. Aim The present study aims to follow up the levels of urinary and serum copper, selenium, zinc, and magnesium (Cu, Se, Zn, and Mg) of pregnant diabetic primigravida and multigravida (second and third pregnancy) women compared with their levels in healthy nondiabetic pregnant ones and their possible association with the glycemic status. Patients and methods Three groups of pregnant diabetic, primigravida women, second pregnancy and third pregnancy with their corresponding nondiabetic pregnant controls were followed up in this study. Results The results of this study showed that the urinary levels of Cu, Se, Zn, and Mg were significantly higher in diabetic pregnant women when matched with healthy controls in all durations of sample collection at the first day of the third, sixth, and ninth months of pregnancy. The results are highly significant at multigravida (second and third pregnancy) than the primigravida ones. However, serum (Cu, Se, Zn, and Mg) levels were decreased all over the pregnancy periods. Conclusion The results confirmed that alterations of urinary levels of Cu, Se, and Zn are associated with diabetes mellitus.
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Thyroid dysfunction in patients with metabolic syndrome in medical ICU of Zagazig university hospitals p. 350
Osama A Khalil, Mohamed Awad, Fayrouz O Selim, Ayman M.E.M Sadek, Mohamed S Fawzy
DOI:10.4103/bmfj.bmfj_31_18  
Context Thyroid hormones are responsible for different metabolic processes. Hormonal imbalance is a suggested risk factor for metabolic syndrome (MS) development. Aim We aimed to explore the frequency of undiagnosed thyroid dysfunction (TD) among patients with MS in medical ICU and its relation to each component of MS, morbidity, and mortality. Settings and design We carried out a cross-sectional cohort study on patients who were admitted to medical ICU of Zagazig University Hospitals. Patients and methods Of 941 medical ICU patients admitted over 6 months, 106 patients had MS. We measured thyroid stimulating hormone (TSH), free T3, and free T4 for those patients within 48 h of admission and acute physiology and chronic health evaluation II score calculation within 24 h of admission, and then we followed them up for short-term in-hospital mortality. Results The frequency of TD in patients with MS was seen in 32 of 106 patients (90.6% of them were hypothyroid). We found an increased relative risk (RR) of 1.92-fold owing to the female sex. Logistic regression analysis revealed that obesity, hypertension, and hypercholesterolemia were the factors most associated with TD (P<0.001), with an increased RR by 1.25-, 1.45-, and 1.37-fold, respectively. Acute physiology and chronic health evaluation II score and mortality RR increased by 1.05 and 1.26-fold, respectively. Conclusion MS in women may carry a high risk for TD, especially hypothyroidism, with poor medical ICU prognosis.
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First-trimester prediction of preterm labor using disintegrin and metalloprotease 12, uterine artery Doppler, and maternal characteristics p. 356
Mohamoud El Sayed Abd Razek, Ayman Abd El Hakim Abd El Ghany
DOI:10.4103/bmfj.bmfj_100_18  
Background A disintegrin and metalloprotease 12 (ADAM12) is a complex placenta-derived protein with proteolytic activity that may serve as a marker of placental dysfunction for the identification of preterm birth. This has benefits of an early intervention and increased antenatal surveillance. In addition, uterine artery Doppler studies are noninvasive measurements of placental vascular flow with increased resistance reflecting impaired trophoblastic invasion. Objectives The objective of this study is to estimate the efficiency of first-trimester maternal serum ADAM12, uterine artery Doppler, and maternal characteristics in the early prediction of preterm birth. Patients and methods This cohort study was conducted on 90 pregnant women in their first trimesters with selection criteria. All patients were investigated for ADAM12 protein level, uterine artery Doppler, and maternal characteristics. They were followed up for screening of preterm birth (before 37 weeks). Results Uterine artery Doppler pulsatility index and maternal serum ADAM12 level either individually or combined are not statistically significant predictors of spontaneous preterm birth. The combination of maternal ADAM12 and BMI with cutoff levels of 162 pg/ml and 32 kg/m2, respectively, was a highly significant effective predictor of preterm birth. Advancing maternal age, increasing parity, increased BMI, and hypertension were maternal characteristics that correlated significantly with preterm birth. Conclusion Uterine artery Doppler pulsatility index and maternal serum ADAM12 level are not statistically significant predictors of spontaneous preterm birth, but ‘combined’ ADAM12 and BMI can do it significantly.
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Matrix metalloproteinase-9 gene variants and pregnancy-induced hypertension in Egyptian women: a lack of association p. 363
Neveen A Abdulhafeez, Eman R Abd-Elgawad, Ahmed W.A Morad, Ola S El-Shimi, Rana A Khashaba
DOI:10.4103/bmfj.bmfj_91_18  
Background Gestational hypertension (GH) is a common disorder during pregnancy that can progress to preeclampsia (PE). PE and its complications have become the leading cause of maternal and fetal morbidity and mortality worldwide. The development of PE is unpredictable and thus challenging to prevent and manage clinically. A cluster of enzymes, called matrix metalloproteinases (MMPs), have been reported to be involved in the pathophysiology of hypertensive states of pregnancy. Aim We aimed to investigate the association of two functional polymorphisms [−1562C/T and −90(CA)13–25] in the MMP-9 gene and their haplotypes with PE and/or GH in a group of Egyptian patients. Methods A total of 150 pregnant women; 50 healthy (control), 50 with GH, and 50 with PE were enrolled and genotyped for −1562C/T and −90(CA)13–25 polymorphisms by PCR-RFLP and end-point PCR correspondingly. Results For both studied polymorphisms, no significant differences were found in genotype, allele, and haplotype frequencies when PE or GH groups were compared with control group. Conclusions Although MMP-9 −1562C/T and −90(CA)13-25 polymorphisms and their haplotypes were not associated with either GH or PE Egyptian patients, the role of MMP-9 and its genetic variants cannot be ruled out in the pathophysiology of different hypertensive states of pregnancy.
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Protective effect of obestatin on indomethacin-induced acute gastric ulcer in rats: role of VEGF and TNF-α p. 369
Reham M Ibrahim, Mona M Allam, Ola A El-Gohary, Alaa E.A El-Talees, Mohamed S El-Hamady
DOI:10.4103/bmfj.bmfj_86_18  
Background Gastric ulcer (GU) is one of the most common disorders that affect the gastrointestinal tract. Obestatin, a ghrelin-related peptide, has been shown to exhibit some protective and therapeutic effects in the gut. Aim This study aimed at investigating the protective effect of obestatin on acute indomethacin (IND)-induced GU, clarifying the role of vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α). Materials and methods A total of 32 adult Wistar albino male rats were divided into four main groups: control group, obestatin group, GU group, and obestatin+GU group. Obestatin was given by a single intraperotineal injection (30 µg/kg) 1 h before induction of GU by a single oral dose of IND (40 mg/kg). Pyloric ligation was carried out in all animals before IND or distilled water administration. Four hours later after IND treatment, gastric ulcer index, preventive index, gastric juice volume, and free and total acidity were assessed. Nitric oxide, VEGF mRNA, and TNF-α mRNA were measured in gastric tissue, as well as histopathological study of gastric injury. Results IND caused a significant increase in ulcer index, gastric juice volume, free and total acidity, and TNF-α mRNA, with a significant decrease in nitric oxide and VEGF mRNA. Pretreatment with obestatin reversed these effects. Conclusion Obestatin pretreatment showed a gastroprotective effect against the IND-induced GU that can be explained by the anti-inflammatory and angiogenic effects of obestatin treatment and reduction of gastric juice volume, free acidity, and total acidity.
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Protective effect of captopril on cardiac fibrosis in diabetic albino rats: a histological and immunohistochemical study p. 378
Hamdino M Attia, Medhat Taha
DOI:10.4103/bmfj.bmfj_122_18  
Background Cardiomyopathy is one of the common complications of diabetes mellitus. Aim The aim of the present study was to investigate the effects of Captopril on myocardial fibrosis in streptozotocin-induced diabetic rats (an animal model of type 1 diabetes mellitus). Materials and methods Forty albino rats were divided into five groups. Group I (control group), group II (untreated diabetic rats), group III (insulin-treated diabetic rats), group IV (Captopril-treated diabetic rats), and group V (insulin and Captopril-treated diabetic rats) were killed at 4 and 8 weeks, and the samples were collected for histological evaluation using hematoxylin and eosin, Masson trichrome, and immunohistochemical staining with anti-P53 for apoptosis, alpha smooth muscle actin (α-SMA) for collagen deposition. Results Treatment of streptozotocin-induced diabetic rats with insulin and Captopril (group V) showed marked decrease in myocardial injury and apoptosis, which was confirmed by marked decrease of sarcoplasmic p53 expression. Group V also showed decreased collagen deposition as confirmed by Masson trichrome staining and α-SMA expression. The results were better after 8 weeks compared with those after 4 weeks. Conclusion The administration of Captopril alone with diabetic rats minimally affected cardiac fibrosis, while the combination of Captopril and insulin markedly improved cardiac fibrosis.
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Diagnosis of gray matter lesions in multiple sclerosis using variant sequences of magnetic resonance imaging (T2, fluid-attenuated inversion recovery, and double inversion recovery) p. 386
Ahmed F Youssef, Ahmed E.M Shaalan, Shimaa A El-Sabbagh
DOI:10.4103/bmfj.bmfj_166_18  
Background and aim Gray matter atrophy is significantly correlated with both physical and cognitive disability in patients with multiple sclerosis (MS). Patients and methods The study was conducted on 40 patients with definite relapsing-remitting MS according to McDonald criteria. All patients were subjected to conventional MRI [T2 and fluid-attenuated inversion recovery (FLAIR) sequences] and double inversion recovery (DIR) sequence to assess their sensitivity for detecting gray matter lesions in patients with MS. Results Comparative studies between serial MRI sequences revealed highly significant increase in detected number of white matter lesions in FLAIR and DIR-MRI sequences (P=0.0007). Comparative studies also revealed a nonsignificant difference in detection rate in all 3 MRI sequences (P>0.05). Moreover, there were significant increases in detected number of gray matter lesions in DIR-MRI sequences (P=0.021) and a highly significant increase in detection rate in DIR-MRI sequences compared with T2 and FLAIR-MRI sequences (P<0.001). By using receiver operating characteristic curve analysis, T2-MRI sequences failed to discriminate patients with gray matter lesions from patients without, with failed accuracy, having sensitivity of 17% and specificity of 100% (P=0.051). However, FLAIR-MRI sequences discriminated patients with gray matter lesions from patients without with poor accuracy, having sensitivity of 34% and specificity of 100% (P<0.0001). On the contrary, DIR-MRI sequences discriminated patients with gray matter lesions from patients without, with perfect accuracy, having sensitivity of 100% and specificity of 100% (P<0.0001). Conclusion DIR is a valuable MRI sequence in imaging of MS because of the following: (a) it showed better delineation between the white matter, the gray matter, and the MS lesions owing to its high image contrast measurements; (b) it detected more MS lesions compared with T2WI and FLAIR sequences in all anatomic locations; (c) it revealed more periventricular and juxta-cortical MS lesions, which are characteristic of MS; and (d) it detected more intracortical lesions as well, which should be considered in all patients with MS.
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Can the degree of religiosity affect female sexual behavior in a sample of Muslim married women? p. 394
Ihab Younis, Ala M El-Hady, Lobna S El-Degheady
DOI:10.4103/bmfj.bmfj_130_18  
Background Contemporary literature exhibits conflicting evidence about the link between religiosity and sexual behaviors. However, defining religion and spirituality remains a challenging prospect for scientists. Aim The current study aimed to test if the degree of religiosity of a sample of Muslim women affected their sexuality. Patients and methods A total of 406 married Muslim women responded to a self-report questionnaire that included questions about their sexual activities. Women were divided into three groups according to their assumed degree of religiosity. Results The most common coital frequency was two to three times/week, which was ‘suitable’ for most women. Most participants refused the idea of initiating sexual contact with their husbands. Among our sample, 52.5% denied ever masturbating mainly because it is ‘haram’, and they believe that masturbation harms sexual life. Most women could reach orgasm in greater than 50% of their sexual encounters. More than once pre week was the commonest rate of having spontaneous desire. Although no statistically significant differences (P>0.05) could be found among the three groups, the group labeled as less religious than average tended to be more able to admit having masturbation sessions before marriage and they also faked orgasms more. Again, with no statistically significant differences (P>0.05), women labeled as more religious than average tended to be more able to achieve orgasm, to consider being tired as the reason for no interest to engage in sexual act, and to be more satisfied with their sexual life. Conclusions The degree of religiosity seems to have no effect on sexual behavior in this sample of Muslim Egyptian women.
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Diffusion-weighted magnetic resonance imaging for the characterization of ovarian tumors in the reproductive age group p. 401
Samar El-Ghazaly Taalab, Medhat M Reffat, Islam M Elshazly
DOI:10.4103/bmfj.bmfj_160_18  
Aim/objective This study aims at emphasizing the role of Diffusion-weighted MR imaging in characterization of ovarian tumors at reproductive age group. Background Ovarian tumors are relatively common and represent approximately 6% of female malignancies. Although the final diagnosis of an ovarian tumor is based on the histological examination, the accurate characterization of ovarian masses as benign or malignant could avoid unnecessary surgery and allow young females (in reproductive age group) to go for conservative treatment. Diffusion Weighted Imaging (DWI) depends on Brownian motion phenomenon which describe the random motion of molecules of water and how it is affected by tissue cellularity and microstructures. As a result, malignant ovarian tumors due to its hyper cellular nature show diffusion restriction, unlike most benign tumors. Patients and Methods MRI Unit, Radio diagnosis department, Meet Ghamer oncology center and Banha University hospital. A cross sectional study, included 30 women who presented with suspicious adnexal masses on previous ultrasound examination and referred for further assessment by DW-MRI. Post-menopausal females and females with contraindications to MRI (e.g. cardiac prosthesis, metallic implants and sever claustrophobia) are excluded. Results The study included 30 women ranging in age between 19 and 49 years with mean age 33.03 ± 9.9. Out of 30 cases, 11 had malignant ovarian tumors while 19 had benign tumors. Conclusion Adding DWI to conventional MRI increases the specificity and accuracy of MRI study.
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Short-term outcomes of the component separation technique for the repair of complex ventral hernia p. 407
Amro ElHadidi, Mohammed Samir, Mohamed Abdelhalim, Ahmed Taha, Nashaat Noaman, Ibrahim Dawoud
DOI:10.4103/bmfj.bmfj_156_18  
Backgrounds The component separation technique is a well-known procedure for closure of a large abdominal wall defect. Primary reconstruction either alone or with synthetic mesh reinforcement provides physiological advantages. Our study evaluates this technique in terms of indications, operative outcomes, and postoperative results. Patients and methods Fascial component separation was performed either alone or with mesh reinforcement for patients with large abdominal wall defects between January 2013 and December 2016. Results A total of 40 patients, 15 (37.5%) men and 25 (62.5%) women were included in the study. The mean age of the patients was 53.8 years (range, 27–68 years). The mean body mass index (BMI) was 35.3 kg/m2 (range, 25.5–45.9 kg/m2). The mean defect size was 12.8 cm (range, 10–15 cm). The mean operative time was 152.5 min (range, 81–220.5 min), with the mean duration of hospital stay being 14 days (range, 9–19 days). Forty-five percent of patients needed mesh reinforcement. The mean follow-up period was 24 months. The total recurrence rate was 5% (2/40). No mortality or major intraoperative or postoperative complications were observed. Conclusion The component separation technique provides a reliable, autologous reconstructive modality for treating large abdominal wall defects. Additionally, mesh reinforcement can decrease the recurrence rate without an increase in the rate of major intraoperative or postoperative complications.
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A comparison study of proximal femoral nail and dynamic hip screw devices in unstable trochanteric fractures p. 413
Hassan H Ahmed, Hani A.M Bassiooni, Elsayed M Mohamady, Mohamed A Mostafa
DOI:10.4103/bmfj.bmfj_81_18  
Background Trochanteric fracture of the femur is a common orthopedic injury in the geriatric population, and the use of extramedullary dynamic hip screw (DHS) is still more superior with fewer complication rates in stable trochanteric fractures. On the contrary, proximal femoral nail (PFN) may have some advantages in fractures at the level of lesser trochanter, reversed obliquity fractures and in subtrochanteric fracture, although the evidence is yet insufficient. Aim The aim of this study was to compare the results of treatment of unstable trochanteric fracture of femur in 40 patients treated by either PFN or DHS regarding primary outcomes: early mobilization, pain improvement, radiological assessment for fracture reduction and fixation and secondary outcome. Patients and methods This study was conducted on 40 patients with unstable pertrochanteric fractures treated surgically, where 20 patients were treated by DHS and 20 patients were treated by PFN. All were planned for follow-up examination for a period of 8 months from the date of operation. Full workup including the age, sex, medical history, type of fracture, mechanism of injury, and plain radiographs was carried out on admission. Results In this study, the duration of union in the whole study population ranged from 1.5 to 8 months, whereas in the group of patients with trochanteric fractures, it ranged from 2 to 8 months. Conclusion We recommend to conduct larger studies to further evaluate the DHS and PFN in the management of unstable trochanteric fractures, with a longer follow-up duration.
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Evaluation of modified semisolid Rappaport Vassiliadis medium in comparison with conventional media in the isolation of Salmonella species from different samples p. 419
Soheir Abd El Rahman Abd El Samie, Yasser Mahmoud Ismail, Sahar Mohammed Fayed, Shaimaa Sobhy Hamed
DOI:10.4103/bmfj.bmfj_175_18  
Objectives The goal of this study is to assess the performance of the modified semisolid Rappaport Vassiliadis media (MSRV) for detecting Salmonella spp. in comparison with conventional media especially xylose lysine desoxycholate agar (XLD agar) and Salmonella Shigella (SS) agar. Results The analysis showed that the overall Salmonella prevalence was 10% (18/180). Of the 18 Salmonella-positive samples, 16 (89%) were isolated from patients suffering from gastroenteritis, while one Salmonella strain (5.5%) was detected in the 45 stool samples of food handlers, and one Salmonella strain (5.5%) isolated from the 45 food samples. SS culture results comparable to serotyping resulted in sensitivity, specificity, positive predictive, negative predictive, accuracy values of 83.3, 98.2, 83.3, 98.2, and 96.7%, respectively, while XLD generated 83.3% sensitivity, 97.5% specificity, 79% positive predictive value, 98.1% negative predictive value, 96.1% accuracy. Statistically, the MSRV method resulted in higher values of sensitivity (94.4%), specificity (99.4%), positive predictive value (94.4%), and negative predictive value (99.4%), and accuracy (98.9%) than those obtained by the other two culture methods. Conclusions The current study showed that the overall diagnostic performance of MSRV for the detection of Salmonella spp., including sensitivity, specificity, and accuracy, was significantly (P<0.05) greater than that of SS and XLD culturing methods. The incidence of Salmonella in diarrheal patients was significantly (P<0.05) higher than in food handlers and food samples. The occurrence of Salmonella was not significantly (P<0.05) related to the age and the sex of diarrheal patients. Salmonella typhimurium and Salmonella lamberhurst were the most prevalent serotypes in the tested samples.
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Ultrasound-guided serratus anterior plane block versus thoracic paravertebral block for postmastectomy analgesia p. 429
Samar R.M Amin, Ehab A Abdelrahman, Ehab El Shahat Afify, ELsayed M Elsayed
DOI:10.4103/bmfj.bmfj_162_18  
Background Women undergoing mastectomy surgery often experience severe postoperative pain and may develop into chronic pain. Objective The current study compared the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) with thoracic paravertebral block (TPVB) for controlling acute postmastectomy pain. Patients and methods This prospective study was conducted on 60 female patients undergoing mastectomy surgery. Patients were randomized into two groups: the TPVB) group (n=30) included patients who received paravertebral block at T4 with 20 ml of bupivacaine 0.25% and adrenalin 5 µg/ml and the SAPB group (n=30) patients who received serratus intercostal plane block with 0.4 ml/kg bupivacaine 0.25% plus adrenalin 5 µg/ml. Both performed as single injection at the end of surgery. Postoperative visual analog scale pain scores, time to first analgesic requirement, total dose of rescue analgesic, hemodynamic parameters, and incidence of postoperative nausea and vomiting were all recorded. Results Visual analog scale scores were significantly lower in the SAPB group compared with the TPVB group at 12th and 16th hour postoperatively. The total dose of rescue analgesic was significantly lower in SAPB compared with the TPVB. Time to the first analgesic dose was significantly longer in the SAPB compared with the TPVB. There was no significant difference between the study groups regarding the hemodynamic parameters and incidence of postoperative nausea and vomiting. Conclusion Both SAPB and TPVB provide adequate analgesia for breast surgeries, but the current study found that SAPB superior to TPVB in terms of delayed requirement for the first rescue analgesia and 24 h reduced analgesic consumption, indicating that SAPB is a feasible and effective method for pain treatment after breast surgery.
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Propofol–midazolam versus propofol–dexmedetomidine as a deep sedation for endoscopic retrograde cholangio-pancreaticoduodenoscopy p. 437
Doaa G Diab, Emad El Hefnawy
DOI:10.4103/bmfj.bmfj_147_18  
Background Endoscopic retrograde cholangio-pancreaticoduodenoscopy (ERCP) is a day procedure for diagnostic or therapeutic biliary problems. Many kinds of sedation are used to provide patients comfort and facilitate work. Propofol and midazolam is the preferred cocktail. Dexmedetomidine with sedo-analgesic properties makes it another suitable regimen. The aim of this study was to compare the efficacy of adding either midazolam or dexmedetomidine to propofol for procedural sedation during ERCP. Patients and methods This study was conducted in Mansoura University Hospitals, Gastroenterology Center. A total of 84 patients (40–80 years), American Society of Anesthesiologist II, III, and IV scheduled for ERCP were randomly allocated into two groups: the PM group received propofol–midazolam and the group PD received propofol–dexmedetomidine. Heart rate, mean arterial blood pressure, and SpO2 were recorded at basal, intraoperative, postanesthesia care unit (PACU), till discharge. O2 desaturation, total dose of propofol, intraoperative complications, patients, and surgeon satisfaction were recorded. Results Heart rate and mean arterial blood pressure showed a significant reduction in group D compared with group M. Onset of deep sedation shows a significant reduction in group D versus group M. Recovery time and onset of discharge from the postanesthesia care unit shows statistically significant prolongation in group D versus group M. The total dose of propofol, intraoperative complications and also surgeon and patient satisfaction were comparable. Conclusion Administration of 1-μg/kg loading dose of dexmedetomidine or midazolam 1 mg intravenous, followed by intravenous propofol (1 mg/kg) and then 10 mg increments can produce an effective and smooth sedation without causing hemodynamic or respiratory side effects. So, dexmedetomidine could be an important alternative to midazolam for sedation in ERCP and other short procedures.
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A randomized study comparing conventional surgery versus endovenous laser therapy for the treatment of primary varicose veins of the long saphenous vein p. 442
Ahmed S Ezzat, Atef A.G Salem, Hussein G El-Gohary, Bishoy E Luiz
DOI:10.4103/bmfj.bmfj_126_18  
Introduction Traditionally, long saphenous vein (LSV) varicosis with saphenofemoral junction incompetence was treated with high ligation and stripping. Postoperatively patients have significant discomfort and bruising. Endovenous laser therapy (EVLT) was developed to offer patients who have varicose veins a less painful treatment alternative to stripping, with a faster return to work and normal activities. EVLT of the LSV has been proven to be safe, with long-term results comparable to traditional high ligation and stripping. Aim The aim of this work was to compare between two different modalities for the treatment of primary varicose veins disease of the LSV: standard ligation with stripping, and EVLT, with regard to the effectiveness, complications of each treatment modality, recovery and return to work. Patients and methods This randomized study was conducted upon 40 patients in Benha University Hospital, enrolled from April 2016 to December 2016. Twenty patients underwent high ligation and stripping of LSV, while 20 others underwent EVLT. Results Our study found no significant difference in success of obliterating the vein using either method; however, patients who underwent EVLT showed less early complications and faster recovery and earlier return to work. Conclusions EVLT in varicose veins of the LSV is a safe viable alternative to high ligation and stripping using surgery. It has the advantage over surgery of having no incisions, less initial serious complications and faster ambulation and return to work.
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CASE REPORT Top

Textiloma discovered 22 years after splenectomy: a case report p. 447
Hesham Elgendy
DOI:10.4103/bmfj.bmfj_28_16  
Background Retained foreign body after laparotomy is not uncommon. Surgical sponge is considered the most common retained foreign body and this is called textilomas or gossypibomas. Retained sponge induces a severe foreign body reaction, which usually leads to serious complications. Although the complications induced by retained foreign bodies are known, only a few cases can be found in the literature because of medicolegal aspects. Case presentation This case report focuses on a 50-year-old male farmer with a history of splenectomy, who presented to us with a picture of acute small bowel obstruction and toxemic shock. Laboratory investigations indicated marked leukocytosis, and elevated serum bilirubin and creatinine levels. Computedtomography scan of the abdomen showed a heterogeneous round object in the left upper quadrant of the abdomen. Upon exploratory laparotomy, a textiloma was discovered with intestinal loops coiled round it. Resection of the diseased bowel loops was performed with ileostomy. The patient was admitted to the ICU as his condition continued to deteriorate; he developed hepatorenal syndrome, followed by hepatic encephalopathy and died. Conclusion Gossypiboma is not a straightforward diagnosis; accidentally retained sponges are not usually suspected clinically, but subsequently recognized on computed tomography imaging studies. The delay in the detection of RFO leads to serious complications that may cost the patient his/her life, which is why it must be suspected in any patient with a history of operative intervention.
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