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   Table of Contents - Current issue
Coverpage
January-June 2017
Volume 34 | Issue 1
Page Nos. 1-58

Online since Wednesday, May 24, 2017

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REVIEW ARTICLE  

Microinvasive glaucoma surgeries p. 1
Tarek T Aboulnasr, Hazem M Elfiky, Yasser A Mohamed
DOI:10.4103/1110-208X.206898  
Because of the complications of current penetrating glaucoma surgeries as in trabeculectomy or glaucoma drainage devices, there is now an increased interest in newly introduced microinvasive glaucoma surgeries, which provide a safer and not a less-efficient alternative for such procedures, along with a decrease in dependence of glaucoma medications postoperatively. The microscopic implants can be implanted by following either an ab-interno approach (e.g. iStent, CyPass, Trabectome, and Xen Gel microshunt) or an ab-externo approach (e.g. Ex-Press minishunt and canaloplasty). The procedures aim to utilize the trabecular pathway, suprachoroidal space, or the subconjunctival space to increase aqueous drainage. These procedures can be performed in conjunction with phacoemulsification to augment the intraocular pressure-lowering effect, and the devices can be implanted during the same session without or with minimal additional risk.
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ORIGINAL ARTICLES Top

Tumor necrosis factor-α promoter gene polymorphism (308 G/A) in the Egyptian patients with systemic lupus erythematosus p. 5
Ibrahim M Rageh, Ahmed A Sharaawy, Ali I Fouda, Eman R Abdelgawad, Walid A Abdel Halim
DOI:10.4103/1110-208X.206895  
Background Tumor necrosis factor-α (TNF-α) is a very important cytokine having different physiological and pathogenic effects that lead to tissue destruction. The polymorphism of the TNF-α promoter gene at position –308 has been thought as a genetic risk factor for systemic lupus erythematosus (SLE). Thus, we aimed in this study to evaluate the association between TNF-α gene polymorphism (308 G/A) and SLE in the Egyptian population and its relation to the activity and the clinical manifestations of SLE. Participants and methods A case–control study was performed on 50 female patients with SLE (mean age, 32.4 ± 8.6 years) and 50 female healthy volunteers (mean age, 31.9 ± 8.3 years) served as controls. Genotyping was carried out by PCR. The PCR products were digested by NcoI restriction enzyme. Results TNF-α promoter gene polymorphism (rs1800629) GA and AA genotypes and A allele were significantly increased in the studied SLE patients when compared with healthy controls (P = 0.023 and 0.007, respectively). TNF-α genotypes showed significant differences between the various Systemic Lupus Erythematosus Disease Activity Index activity grades (P = 0.012). Moreover, GG genotype had a significantly lower incidence of renal disorders and persistent proteinuria when compared with AG or AA genotypes (P = 0.006 and 0.001, respectively). However, AA genotype showed a significantly higher incidence of neurologic disorders when compared with GG and AG genotypes (P < 0.001 and P = 0.026, respectively). Conclusion Our results indicate that TNF-α (–308 G/A) polymorphism may have a role in the susceptibility and pathogenesis of SLE in the Egyptian population.
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Management of moderate ischemic mitral regurgitation: revascularization alone versus revasularization and mitral valve repair p. 10
Mohamed K Abd El Naby, Youssry Al-Saeed, Ali H Taher, Hany M El-Rakhawy, Medhat N Riad Moussa
DOI:10.4103/1110-208X.206901  
Background Ischemic mitral regurgitation (IMR) is a frequent condition post-myocardial infarction. Management of moderate myocardial infarction is still debatable, with adding mitral valve repair (MVR) to coronary artery bypass grafting (CABG) being questionable. Aim To compare echocardiographic and clinical outcome of moderate IMR treated by revascularization alone versus another group of patients treated by revascularization and MVR. Patients and methods Forty consecutive patients with ischemic heart disease with moderate IMR undergoing on-pump CABG are randomly selected. They were divided into two groups: group I (20) had CABG+MVR, group II (20) had only CABG; echocardiography was done postoperatively and after 6 months for both groups. Results Our study revealed improvement in the grade of mitral regurgitation (MR) in both groups which was more evident and significant in group I than II with 11 (61%) of group I showing complete resolution of MR versus 0 patients in group II which was highly statistically significant (P=0.0001). Follow-up after 6 months, there were significant reduction in the New York Heart Association functional class as well as the mean grade of MR in group I versus group II, (P=0.004), with nine (50%) patients in group I against two (11%) patients in group II had complete resolution (P=0.004). We found also significant reduction in left ventricular dimensions and function. Conclusion MVR can be performed safely, concomitantly with coronary artery bypass grafting in patients who have moderate IMR.
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Renoprotective effect of saxagliptin and Hibiscus sabdariffa Linn extract in Nω-nitro-L-arginine methyl ester-induced hypertensive nephropathy in male albino rats: the role of proinflammatory and fibrogenic cytokines p. 17
Omaima M Abd Allah, Abeer A Shoman
DOI:10.4103/1110-208X.206902  
Objective The purpose of this paper is to evaluate the possible prophylactic effects of saxagliptin (SAX), a dipeptidyl peptidase 4 inhibitor, and Hibiscus sabdariffa Linn extract (HSE) and their combination against Nω-nitro-l-arginine methyl ester (l-NAME)-induced hypertensive nephropathy in rats; in addition, their effects on proinflammatory and fibrogenic cytokines involved in renal injury induced by hypertension were investigated. Materials and methods Rats were randomly divided into five groups (eight each) as follows: control group; l-NAME-treated group (50 mg/kg/day in drinking water); SAX+l-NAME-treated group (10 mg/kg/day postoperatively); HSE+l-NAME-treated group (100 mg/kg/day post operatively); SAX+HSE+l-NAME-treated group that received the same doses. Systolic blood pressure was measured. Kidney function tests (blood urea nitrogen, serum creatinine, total protein contents in 24-h urine, and creatinine clearance rate) and renal tissue oxidative biomarkers (malondialdehyde, glutathione, and glutathione peroxidase activity) were assessed. Proinflammatory cytokines (tumor necrosis factor-α and interleukin-6) levels were assessed in renal tissue homogenate; in addition, renal tissue transforming growth factor-β1 mRNA expression level was assayed. Histopathological analysis of the kidney and scoring were also performed. Results Administration of either SAX or HSE for 8 weeks attenuated l-NAME-induced increased oxidative stress, inflammation, and fibrosis in the kidney of rats, associated with improvement of the impaired renal function and histopathological changes, but their combination was found to be more effective in the protection against l-NAME-induced hypertensive renal damage than each drug alone. Conclusion A combination of SAX and HSE protected the kidney tissue against l-NAME-induced hypertensive nephropathy through their antioxidant, anti-inflammatory, and antifibrotic activities.
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Antipsychotics-induced diabetes mellitus in rats: it is time to change p. 28
Shimaa M Motawei
DOI:10.4103/1110-208X.206897  
Introduction The use of antipsychotics has progressively increased in the last 50 years. Despite the fact that second-generation antipsychotics have shown marked therapeutic benefits in treatment of psychosis than earlier typical ones, they produce many metabolic side-effects. Aim This study aimed to measure the metabolic effects of three classes of atypical antipsychotics on albino rats. Materials and methods A total of 40 albino rats including 16 males and 24 females were grouped into four groups: group I (control group) received the control diet and tap water ad libitum; group II received olanzapine 10 mg/kg intraperitoneally, group III received respiridone 0.2 mg/kg intraperitoneally; and group IV received aripiprazole 20 mg/day intraperitoneally. Blood glucose and insulin as well as serum cholesterol, triglycerides, malondialdehyde, high-density lipoprotein, and low-density lipoprotein were measured before treatment and 60 days after continuation of treatment. Results Significant elevation in blood glucose levels, disturbance in insulin levels, and elevation in malondialdehyde, low-density lipoprotein, and total serum cholesterol levels in atypical antipsychotics-treated animals, as compared with vehicle-treated rats, were found. These effects were more prominent with olanzapine, which is a very commonly used antipsychotic, followed by respiridone. Aripiprazole produced the least disturbance in these parameters. Conclusion Individual second-generation antipsychotics disturb blood glucose and insulin levels and produce different degrees of other metabolic derangements. There is a need to introduce safer agents for clinical use.
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Efficacy of adding cisatracurium or rocuronium to the local anesthetic used for peribulbar anesthesia in patient undergoing cataract surgery p. 33
Reem A Sharkawy, Tamer E Farahat, Ehab H Nematallah
DOI:10.4103/1110-208X.206899  
Objectives The peribulbar block (PBA) has been considered the sole of anesthetic of choice for cataract surgery. But it has a delayed onset of akinesia, which requires large volume of anesthetic solution and higher rate of supplementation when compared with retrobulbar anesthesia. We designed this study to evaluate the benefits of adding rocuronium and cisatracurium to PBA. Patients and methods In total, 60 patients were enrolled in this prospective randomized double-blind study and were subjected to cataract surgery. Patients were randomly divided into three groups equally: the first group (S) received PBA with 4-ml lignocaine 2%, 4-ml bupivacaine 0.5%, and hyaluronidase 30 IU/ml plus 0.5-ml normal saline. The second group (C) patients received 2.5-mg (0.5 ml) cisatracurium added to the standard local anesthetic mixture. The third group (R) patients received 5-mg (0.5 ml) rocuronium added to the standard local anesthetic mixture. The onset and duration of lid and globe akinesia were assessed. Results The onset of lid and globe akinesia was significantly shorter in the cisatracurium group compared with the other two groups (P<0.001). The duration of both lid and globe akinesia was significantly longer in the rocuronium group than in the other groups (P<0.05). Regarding the need for supplementary block, it was lesser in the rocuronium group (5%) than in the cisatracurium group (10%) and the standard group (25%). Conclusion Adding muscle relaxant to the local anesthetic mixture (lidocaine, bupivacaine, and hyaluronidase) for PBA provides optimal globe akinesia, shortens the block onset time, and improves the postoperative analgesia.
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Hematoma expansion in spontaneous intracerebral hemorrhage p. 37
Amir A Elsaeed Egila, Rizk M Khodair, Maged K Faheem, Shaimaa M Kasem
DOI:10.4103/1110-208X.206904  
Background Intracerebral hemorrhage is the most devastating form of stroke. Location and baseline hematoma volume are strong predictors of mortality. Expansion of the initial hematoma is a further marker of poor prognosis. Several risk factors for hematoma expansion (HE) have to be identified. Objectives The objectives of this study were to detect the incidence of HE and to study its predictors. Patients and methods 145 patients underwent this study by analyzing demographic factors and vascular risk factors such as hypertension, diabetes mellitus, and oral anticoagulant intake, as well as clinical factors using National Institutes of Health Stroke Scale (NIHSS) and radiological factors using computed tomography brain imaging. Results In this study, HE occurred in 55 (37.93%) patients. Expansion occurred in 45.45% of hypertensive patients, 55.56% of oral anticoagulant intake patients, 45.83% of low cholesterol level patients, 3.64% of diabetic patients, 85.71% of patients with high NIHSS, 35.71% of patients older than 60 years, 20% of patients with atrial fibrillation, and 22.2% of renal patients. Conclusion Warfarin intake, hypertension, low cholesterol, normal blood glucose, lack of blood disease, and high NIHSS are the main predictors of HE.
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Comparison of visual, clinical, and microbiological diagnosis of symptomatic vaginal discharge in the reproductive age group p. 43
Abdelsattar M Farhan, Elsayed A Eldesouky, Essam A Gaballah, Mohammed E Soltan
DOI:10.4103/1110-208X.206900  
Background Symptomatic vaginal discharge is the most frequent symptom in women of reproductive age group. Discharge may be physiological or pathological, for which bacterial vaginosis is the most common cause, followed by candidiasis and trichomonas. Multiple infections can also coexist. Aim This study aimed to determine the microbiological and clinical profile of symptomatic vaginal discharge and its utility in the management of genital tract infection. Participants and methods This was a prospective study of 200 women with vaginal discharge referred for clinical examination and pelvic examination through a speculum examination according to the criteria of vaginal discharge. To determine the cause, high vaginal swab by Ayre’s spatula was obtained for the Microbiology Department through transport media. The collected data were tabulated and analyzed. Results Bacterial vaginosis is the most common cause of vaginal discharge, followed by candidiasis and trichomonas in our setup. For the etiological diagnosis of symptomatic vaginal discharge, the microbiological diagnostic approach is the best. A specific diagnosis was made in 83.5% of cases, whereas an etiology was not found in 16.5% of cases. Conclusion Treatment on the basis of a clinical diagnosis is not accurate. Thus, the most ideal approach in this study is the microbiological diagnostic approach for the etiological diagnosis of symptomatic vaginal discharge.
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Determinants of behavior of health care workers at Mansoura National Hospital toward needlestick injuries and hepatitis B virus infection p. 49
AM Abdel Hamied
DOI:10.4103/1110-208X.206903  
Background Needlestick injuries (NSIs) are among the hazards and problems that can expose health care workers (HCWs) to infections. WHO estimates that 40% of cases of hepatitis B virus (HBV) infections among HCWs are a result of NSIs. Aim Aim of this was to illustrate the behavior of HCWs at Mansoura National Hospital toward NSIs and HBV infection. Materials and methods A cross-sectional study was conducted on 203 total hospital staff (99 males and 104 females) who fulfilled the inclusion criteria to participate in the study. Results It was found that 37.9% of HCWs at Mansoura National Hospital were previously exposed to NSIs (included 64.9% of paramedicals and 44.1% of physicians); and 67.5% knew about the risk of NSIs. HCWs who were in routine close contacts with patients knew that diseases transmitted by NSIs included HBV (81.3%); 57.1% knew that HBV is more infectious than HIV; 63.4% knew about the existence of a vaccine to prevent HBV; 62.5, 49.1, and 55.4%, respectively, knew that wearing gloves, wearing eye protection, and hospital disinfection were protective measures against hepatitis B (HB) infection; 35.7% agreed that HB vaccine should be taken before working in the hospital. Regarding hospital staff, 76.8% of HCWs knew that HBV may be transmitted (included all physicians and 71.9% of paramedicals), 32% did not know the degree of vaccine protection, and 47.3% suggested that the vaccine gives relative protection. Also, 23.6% of HCWs were vaccinated against HB (included 48.5% of physicians), 53.7% washed their hands after patient contact, 18.7% used gloves, and 4.9% used eye protection. Conclusion There was a gap in knowledge, attitude, and behavior among HCWs regarding NSIs and risk of contracting HBV, and this gap can be reduced by provision of health education sessions at preplacement medical examination and then periodically.
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LETTER TO THE EDITOR Top

Plagiarism: a global dilemma p. 58
Hamza H Khan, Zarak H Khan, Bilal Zafar, Muhammad B Malik
DOI:10.4103/1110-208X.206896  
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