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Iron-deficiency anemia as a risk factor for pneumonia in children
Mohamed M Rashad, Sahar M Fayed, Aly Mona K El-Hag
July-December 2015, 32(2):96-100
Background Pneumonia is the most common single cause of death among children under 5 years of age in the developing countries. Anemia is the most common ailment affecting health, socioeconomic development, and overall betterment of mankind. Objective The aim of this study was to determine the relationship between iron-deficiency anemia (IDA) and pneumonia in Egyptian children. Patients and methods This case-control study included 100 children aged 9-72 months, selected from Benha University Hospital and Shebin El-Kom Educational Hospital from January to December 2014. A total of 50 children with pneumonia and 50 age-matched and sex-matched controls were included in the study. After taking an informed verbal consent from the parents, our children were subjected to medical history taking, clinical examination, and complete blood count. For children with hemoglobin less than 11 g/dl, serum iron, serum ferritin, and total iron binding capacity were detected. C-reactive protein and chest radiography were performed for the patients. Results Anemia, particularly IDA, was significantly more frequent among patients (54 and 22%, respectively) than among controls (24 and 22%, respectively) (P = 0.001 and 0.002, respectively). Hemoglobin level was significantly lower in the IDA patients than in the IDA controls (P = 0.03). Anemia was a risk factor for childhood pneumonia (P = 0.001, odds ratio 4.03, and confidence interval 1.71-9.49) and recurrent chest infection (P < 0.001, odds ratio 15.55, and confidence interval 4.88-49.53). Conclusion Anemia, particularly IDA, is a community problem in Egypt. Anemic children are about four times more susceptible to develop pneumonia compared with the nonanemic ones, and IDA is predominating. Prevention, accurate diagnosis, and prompt treatment of anemia are necessary.
  1,130 162 -
Morphometric analysis of hard palate in Egyptian skulls
Saadia A Shalaby, Esam M Eid, Naglaa A. S. Sarg, Amany M. A. Sewilam
January-June 2015, 32(1):59-72
Background As the hard palate is an essential region of the skull its gross anatomy and morphological variations have been of interest in many studies. Aim The aim of the present study was to describe the gross anatomy of the hard palate in Egyptian skulls, and determine sex from the morphometric study of the hard palate and location of the position of the greater palatine foramen (GPF) in relation to certain fixed intraoral anatomical reference points, all of which are visible or palpable in a living patient. Materials and methods In this study, 100 skulls (64 male and 36 female skulls) were subjected to the following measurements: palatal length, breadth, and height, the diameters of the GPF and its shape, the direction of opening of the GPF onto the palate, the relation of GPF to the maxillary molar teeth; the distance from the GPF to the midline maxillary suture, to the incisive foramen, to the posterior border of the hard palate, and to the tip of the hamular process of the pterygoid; the angle between the axis of the greater palatine canal (GPC) and the hard palate; the length of GPC plus the length of the pterygopalatine fossa; and the height of the maxilla. Twenty cadaveric heads were also dissected to measure the thickness of the palatal mucosa over the GPF. Results The mean palatal length was 51.65 ± 4.7 mm and palatal breadth was 38.68 ± 2.9 mm, with a highly significant difference between male and female skulls. Palatal height was 11.8 ± 2.7 mm with no significant difference between the two sexes. Of the total skulls 64% had narrow palates, 24% had intermediate ones, and 12% had wide palates with no significant difference between the two sexes; 36% had low palates, 56% had intermediate, and 8% of the sample had high-arched palates with a significant difference between the two sexes. The mean anteroposterior and transverse diameters of GPF were 4.86 ± 0.9 and 3.02 ± 0.7 mm, respectively. It was frequently an oval opening in 71%, a rounded opening in 22%, and lancet and slit in the remaining. Its direction in 69% was anteromedial, that in 28% was anterior, and that in 3% was anterolateral. The majority (84%) of the total foramina were opposite the maxillary third molar tooth. The mean distance from the GPF to the midline maxillary suture was 14.25 ± 1.7 mm, that from the GPF to the incisive foramen was 35.93 ± 3.5 mm, and that from the GPF to the posterior border of the hard palate was 3.89 ± 0.9 mm. The mean length of GPC and the pterygopalatine fossa was 29.39 ± 3.1 mm, the height of the maxilla was 30.44 ± 3.4 mm, and the difference between the two sexes was significant. The angle between the GPC and the horizontal plane of the hard palate was 40.48 ± 9.1°. The mean thickness of the palatal mucosa over the GPF was 4.92 ± 1.93 mm. Conclusion As the measurement studies of the hard palate show considerable variations among races, the data in this study will help clinicians to localize the GPF more precisely in Egyptian patients and to predict the depth of a needle to anesthetize the maxillary nerve with a low rate of complications.
  713 92 -
Genetic variations in the growth arrest-specific 6 protein gene in patients with acute coronary syndrome
Mohamed M Elshafey, Jehan H Sabry, Omnia E Abdalla, Rania F Abdel Ghany
July-December 2016, 33(2):65-71
Growth arrest-specific gene 6 (GAS6) encodes a vitamin K-dependent protein that regulates inflammation, angiogenesis, and atherosclerotic plaque formation. The level of GAS6 expression is associated with plaque stability and stroke. The role of GAS6 in cardiovascular disease, particularly in acute coronary syndrome (ACS), was explored. The study investigated the role of the single nucleotide polymorphism (c.834 + 7G >A) of GAS6 in ACS. The genotype frequencies for GG, AG, and AA, respectively, in patients with ACS were 57.1% (16/28), 28.6% (8/28), and 14.3% (4/28) and were 20% (4/20), 40% (8/20), and 40% (8/20) in the control group. The AA genotype and A allele were less frequent in patients with ACS than in controls (P < 0.05). Our study indicates that the AA genotype and A allele of the GAS6 gene relate to ACS and may have a protective role against ACS.
  205 510 -
Evaluation of the results of arthroscopic meniscal repair
Magdi M ElSayed, Alhusseiny M Alhusseiny, Mohamed G Montaser, Mahmoud M El-Sherbiny
January-June 2015, 32(1):49-58
Introduction Menisci have a role in optimal knee function. Meniscal preservation in younger active individuals presenting with symptomatic meniscal disease is important. The success of meniscal repair depends on appropriate meniscal bed preparation and the surgical technique. Patients and methods A prospective study of 20 cases of post-traumatic meniscal tear was conducted during the period between March 2012 and December 2013. All cases were subjected to arthroscopic evaluation to confirm the diagnosis and ensure they fulfilled the criteria for repair on the basis of site, size, description, and associated injury of the tear. The inclusion criteria were vertical longitudinal tear from 1 to 3 cm in length in the red-red or red-white zone. The exclusion criteria were patient age older than 45 years, white-white zone tear, radial tear, and complex degenerative meniscal tear. The Lysholm score and International Knee Documentation Committee (IKDC) subjective and objective knee scores were used preoperatively and postoperatively for presentation of overall results. All cases were treated by means of the all-inside arthroscopic repair technique using a FasT-Fix meniscal repair device. Results Twenty patients were followed up for an average of 60 weeks. The mean age of the patients was 20.95 ± 1.60 years; the average suture used was 2.85; 70% had isolated meniscal injury, and 30% had associated anterior cruciate ligament (ACL) tear; the average tear length was 1.91 cm. The mean preoperative and postoperative Lysholm scores were 38.25 and 91.20, respectively. The mean preoperative and postoperative IKDC subjective evaluation results were 31.28 and 91.44, respectively. The preoperative IKDC objective evaluation results revealed 16 (80%) patients with severely abnormal knees (grade D) and four (20%) patients with abnormal knees (grade C). The postoperative IKDC objective evaluation results revealed two (10%) patients with abnormal knees (grade C), three (15%) patients with nearly normal knees (grade B), and 15 (75%) patients with normal knees (grade A). There is better improvement in scores if ACL reconstruction is performed simultaneously with meniscal repair, the procedure is performed for vertical longitudinal tears, the tear is in the 'red-red' zone, and the tear length is less than 21 mm. There were no differences in functional results on the basis of repair of medial meniscus or lateral meniscus, acute or chronic injuries, or age. Conclusion Better outcome of meniscal repair was seen in patients with vertical longitudinal tear in the red-red zone with a tear length of less than 21 mm and associated with ACL reconstruction.
  644 69 -
Diabetes mellitus link with hypogonadism in male patients with type 2 diabetes mellitus aged 40-50 years
Nagla F Almihy, Eman A Eissa, Eman R Amer, Mohamed El-Assal
January-June 2015, 32(1):29-35
Objective Testosterone levels are frequently low in men with type 2 diabetes mellitus (DM), and the majority of these men have symptoms of hypogonadism. Obesity is associated with low testosterone levels in diabetic men. The aim of our work was to study the link between type 2 DM in men aged 40-50 years and the increased incidence of hypogonadism. Patients and methods Our study included two groups of patients: group A, which included 40 male diabetic patients (type 2) aged 40-50 years, and group B, which included 40 healthy age-matched control individuals. All patients and controls were subjected to a medical questionnaire and examination of BMI, waist-hip ratio (WHR), and laboratory investigations for evaluation of total testosterone, free testosterone, sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and glycosylated Hb (HbA1c). Results The patient group showed a significant decrease in serum total testosterone (3.83 ± 2.18 ng/ml), free testosterone (4.15 ± 2.08 pg/ml), and SHBG (27.48 ± 10.07 nmol/l) in comparison with the control group (6.14 ± 1.37 ng/ml, 13.82 ± 5.14 pg/ml, and 62.85 ± 9.17 nmol/l, respectively), a highly significant decrease in LH and FSH (2.35 ± 1.98 mIU/ml and 4.79 ± 2.72 IU/ml, respectively, vs. 4.56 ± 1.22 mIU/ml and 6.88 ± 1.69 IU/ml in the control group), and significant increase in prolactin and HbA1c (19.014 ± 8.65 ng/ml and 6.85 ± 2.12%, respectively, vs. 6.51 ± 2.2 and 4.3 ± 1.16 in the control group). In addition, there was a significant increase in BMI (35.2 ± 3.56 kg/m 2 ) and WHR (1.02 ± 0.12) in comparison with the control group (22.22 ± 1.76 kg/m 2 and 0.8 ± 0.04, respectively). Total testosterone concentration showed a positive nonsignificant correlation with SHBG (r = 0.076) but significant positive correlation with FSH and LH (r = 0.672 and 0.696, respectively) and significant negative correlation with serum HbA1c, BMI, and WHR (r = −0.324, −0.442, and −0.306, respectively) and highly significant negative correlation with prolactin (r = −0.783) in male patients with type 2 DM. Free testosterone showed a nonsignificant negative correlation with SHBG (r = −0.0229) and significant negative correlation with HbA1c, BMI, and WHR (r = −0.311, −0.373, and −0.374, respectively) but a highly significant negative correlation with prolactin (r = −0.740) and a highly significant positive correlation with FSH and LH (r = 0.798 and 0.762) in male patients with type 2 DM. Conclusion This study demonstrates that significant number of men with type 2 DM aged between 40 and 50 years have testosterone insufficiency and symptoms of hypogonadism.
  616 90 -
Role of gamma knife radiosurgery in the management of functioning pituitary adenomas
Mohammad F Elshirbiny, Raef F. A. Hafez, Nabil Ali, Ashraf A Ezzeldien, Mohammad A Kassem
January-June 2015, 32(1):6-12
Historically, the treatment armamentarium for secretory pituitary adenomas included neurosurgery, medical management, fractionated radiotherapy, and, recently, gamma knife surgery (GKS). The objective of this study was to evaluate the efficacy, safety, and role of GKS in the treatment of secretory pituitary adenomas as regards hormonal and adenoma size control. Between January 2010 and January 2014, a prospective analysis of 40 consecutive patients who underwent GKS for secretory pituitary adenomas at the International Medical Center, Cairo, Egypt, was carried out. Eight patients had adrenocorticotropic hormone-secreting adenoma, 16 patients had prolactin-secreting adenoma, and 16 had growth hormone-secreting adenoma. In 19 patients, GKS was the secondary treatment to a prior surgery with failure of hormonal control along with medical treatment. In the remaining 21 patients, the secretory pituitary adenomas were not controlled with medical treatment alone. The follow-up period ranged between 12 and 60 months. Hormonal control was achieved with either normalization or a marked decline in abnormal hormone level of more 50%. Radiological tumor size control was carried out with either tumor size stabilization or reduction. Among the 40 patients, 21 had microadenoma of 1 cm 3 volume or less. Overall, 24 patients (60%) had hormonal control and 38 patients (95%) had tumor size control after GKS. There was a direct correlation between tumor size, prescription radiation dose, and hormonal and size control after GKS. Twenty out of the treated 21 microadenoma cases showed both hormonal and size control. In conclusion, GKS is a safe and effective treatment method for secretory pituitary adenomas that have failed to respond to medical treatment alone or have postsurgical residual tumor, or recurrence, especially microadenomas.
  608 76 1
Prevalence of obesity and overweight in primary school children living in Menoufia governorate, Menouf district
Mohamed H Bahbah, EL-Sayed I Slama, Abd-El Hafiz M Ramadan, Mohamed A Abo Zeed
January-June 2015, 32(1):73-77
Background Obesity is an excessive accumulation of fat that adversely affects well-being and health. It is a major public health problem that affects nearly 18% of teenagers. Aim This study was conducted on primary school children in Menouf district to study the prevalence of obesity and overweight and some associated risk factors. Results Obesity was more prevalent in children between 6 and 9 years of age, and it is more prevalent in girls than in boys. The incidence of obesity was higher among urban than among rural children, and children attending private schools and of high socioeconomic levels were more obese. Conclusion and recommendation Childhood obesity has tripled in the past 30 years. The prevalence in 11 years has increased from 6.5% in 1980 to 19.6% in 2008. There is an urgent need to spread awareness about obesity, its consequences, and ways and means of prevention, especially among children and their families.
  559 106 1
The role of MRI in the evaluation of vascular malformations
Ahmed G Sadek, Mohamed A Borg, Hisham S El-Din, Adel G El-Badrawy, Ahmed I Tawfik
January-June 2015, 32(1):1-5
Objective The aim of this study was to evaluate the role of MRI and MR angiography in the assessment of vascular malformations as compared with the usefulness of duplex sonography and digital subtraction arteriography. Participants and methods A total of 40 patients (age range, 1-35 years; 21 male and 19 female) with diagnosed vascular malformations on the basis of color duplex imaging were examined on a 1.5 T whole-body MR scanner. Using parameters based on a fast localizer sequence, we acquired axial or coronal T1-, T2-, short-time inversion recovery (STIR) and contrast-enhanced T1-weighted images. Dynamic postcontrast three-dimensional (3D) gradient-echo MRIs were used for patients with high-flow arteriovenous malformation. MR data sets were evaluated for the detection of the lesion, determination of the malformation extent, involvement of surrounding structures, and vascular details with regard to the nidus, feeding arteries, and draining veins. Results were compared with findings from the digital subtraction angiography (DSA). Results All MRIs revealed 14 low-flow venous vascular malformations, 12 high-flow arteriovenous malformations, and 14 hemangiomas. The STIR sequence was helpful for determining the extent of vascular malformation, whereas dynamic postcontrast 3D MR angiography helped in the classification of the type of the vascular malformation. MR angiography was inferior to DSA in revealing the vascular details and for interventional procedure planning. Conclusion MRI and MR angiography appear to play a significant role in the assessment of vascular malformations. The protocol for imaging such vascular malformations should include dynamic postcontrast 3D gradient-echo MRI with STIR sequences. However, DSA is still required for more vascular detail delineation and definitive treatment decisions.
  539 124 -
Prediction of cesarean section scar dehiscence before delivery using three-dimensional transabdominal ultrasonography
Mahmoud Abosrie, Mohamed A Elhadi Mohamed Farag
July-December 2015, 32(2):101-106
Objective This study aimed to evaluate the efficacy of three-dimensional (3D) ultrasonography in the prediction of cesarean scar dehiscence in pregnant patients at term and to compare the outcome of measurement with the intraoperative visual assessment of the scar. Design This was a prospective study. Patients and methods Seventy pregnant women with a history of a previous cesarean section attending Benha University Hospital were included in this study. All participants underwent a 3D transabdominal scan at third trimester and the data were recorded. We measured the lower segment thickness from the muscularis and mucosa of the bladder on the outer side to the chorioamniotic membrane on the inner side, with the myometrium in between, and hence, depending on a three-layered pattern. This was compared with the pregnancy outcome and the intraoperative scar condition. The data were then statistically analyzed. Results The mean scar thickness as measured by 3D transabdominal sonography in the third trimester was 4.63 ± 0.85 mm. The best cut-off level for predicting uterine scar defects was less than or equal to 2.75 mm (highest diagnostic accuracy) with sensitivity 25%, specificity 100%, positive predictive value 100%, and negative predictive value 95%. Conclusion The current study suggests that prenatal 3D US examination determining the degree of lower uterine segment thinning in patients with previous cesarean delivery provides an additional element for assessing the risk of uterine rupture and may increase safe management of trial of labor.
  521 102 -
Effect of cataract surgery on diabetic retinopathy
Khalid G Ali, Tarek T Soliman, Asmaa A Mohammed
July-December 2015, 32(2):92-95
Objectives The aim of this study was to review articles on the effect of cataract surgery on diabetic retinopathy (DR). Of the reviewed publications, it was found that diabetic patients with mild-to-moderate DR are less likely to show progression of DR after phacoemulsification. Patients with severe nonproliferative diabetic retinopathy and proliferative diabetic retinopathy have high risk of progression. Elevated hemoglobin A1c (HbA1c) at the time of cataract surgery increases the risk for DR progression after surgery. Conclusion Currently, early surgery is favored before the development of significant DR rather than waiting for the cataract to become denser. All efforts should be made to stabilize DR before cataract surgery.
  509 103 -
Protective effect of Nigella sativa against cerebral ischemia and sodium valproate-induced hepatotoxicity
Elsayed A Abd El Latif, Rezk A Sanad, Omaima M Abdallah, Yasmin M Ismail
January-June 2015, 32(1):41-48
Background Nigella Sativa (NS) is one of the traditionally used herb well known for its healing properties. The most of the therapeutic properties of this plant is due to the presence of Thymoquinone (TQ), the major bioactive component of the essential oil. TQ is also a promising dietary chemopreventive agent for the treatment of number of diseases. Very low level of toxicity has been reported through acute and chronic toxicity studies. Aim The present study aimed to investigate the anti-ischemic effect of NS using carotid artery occlusion model in rats.This study also aimed to investigate the effect of NS on SVP induced hepatotoxicity. Method 0Animals given NS and TMZ for 21 days then subjected to 45 min for brain ischemia then reperfusion.Animals administered NS, SVP for 21 days then subjected to serum measurement of serum ALT & AST and liver histopathological examination. Results NS significantly reduced the percent of necrosis and reduced the size of cerebral infarction compared to control and enhanced the effect of TMZ on cerebral ischemia.NS produced significant decrease in serum ALT and AST and improvement of histopathlogical picture compared to SVP group. Conclusion These results indicate that the NS could have a therapeutic effect against cerebral ischemia.NS has protective effect against SVP induced hepatotoxicity.
  510 71 -
Neurodevelopmental and neurobehavioral aspects of childhood epilepsy
Amir A Sarhan, Mostafa M Ayouty, Ashraf A Elsharkawy, Dina S Abd Elmagid
January-June 2015, 32(1):13-19
Objective The aim of this study was to declare the frequency of neurodevelopmental, behavioral, and psychiatric comorbidities associated with epilepsy and the relation of these disorders with several variables, including age at onset of epilepsy, duration of epilepsy, type of epilepsy, antiepileptic medications (monotherapy or polytherapy), and seizure frequency. Patients and methods This cross-sectional study included 50 epileptic children selected from those regularly attending the Neurology Outpatient Clinic in Mansoura University Children Hospital and already diagnosed with primary epilepsy and maintained on antiepileptic medications. They were subjected to full general and neurological assessment, Wechsler Intelligence Scale (IQ), Child Behavior Checklist, and Developmental Profile-3. Data were analyzed using SPSS program, version 16. Results Children with prolonged duration and earlier onset of epilepsy performed worse on Developmental Profile-3 assessment as they showed significantly delayed cognition, in addition to more attention problems and low IQ. Increased frequency associated with delayed cognitive, social, and communication development, low IQ, and attention problems were observed. Moreover, those with polytherapy were more significantly affected as regards cognition, communication, IQ, attention, social problems, thought problems, and anxiety depression. No significant differences were found between effects of sodium valproate and carbamazepine, but a high dose of valproate was associated with higher incidence of low IQ and cognitive and attention problems. Cognition, communication, and attention were more affected in patients with generalized epilepsy in comparison with those with partial epilepsy. Conclusion Childhood epilepsy is associated with cognitive deficits, intellectual decline, and behavioral problems, which are multifactorial, such as age of onset, frequency, type of seizure, prolonged seizures, antiepileptic drugs, and duration of epilepsy.
  471 109 1
Evidence-based medicine in high tibial osteotomy for knee osteoarthritis
Ahmed Mohamed Hassanin, El-Husseiny Mustafa El-Husseiny, Mohamed Gouda Montaser, Sayed Mahmoud Baioumy
July-December 2015, 32(2):87-91
Knee osteoarthritis is the most common joint disorder, and symptomatic disease occurs in 10% of men and 13% of women older than 60 years. Patients with osteoarthritis of the medial compartment often have varus alignment, and the mechanical axis and load-bearing axis pass through the medial compartment. The medial compartment is almost 10 times more frequently involved than that of the lateral compartment. Moreover, varus but not valgus alignment increases the risk for incident tibiofemoral osteoarthritis. An osteotomy is a surgical procedure, which implies that the bone is cut. A correction osteotomy at the knee is used to realign the leg and to transfer the weight-bearing axis from the pathological compartment to the healthy compartment. Patients with osteoarthritis of the medial compartment and varus alignment can be treated with a valgus osteotomy. Several correction osteotomy techniques are available for unicompartmental knee osteoarthritis, such as the closing wedge technique with removal of a wedge of bone, the opening-wedge technique with creation of a wedge, a combined (opening and closing wedge) technique, and techniques that are performed without creating a wedge in the bone, including dome osteotomy and hemicallotasis osteotomy with an external fixator. Unloading will result in slowing down of the osteoarthritis process. In retrospective studies, this procedure resulted in pain relief, improved function, and postponement of knee arthroplasty for 7-20 years, depending on participant selection, stage of osteoarthritis, and achievement and maintenance of adequate operative correction.
  460 94 -
The protective role of vitamin E and angiotensin II receptor blocker in diabetic cardiomyopathy in male albino rats
Noha I Hussien, Abeer A Shoman
January-June 2015, 32(1):20-28
Background Diabetic cardiomyopathy is a common complication of diabetes mellitus. There are many pathophysiological mechanisms of diabetic cardiomyopathy, such as apoptosis and oxidative stress. Aim This study was designed to assess the issue of cardiomyocyte apoptosis as a possible cause of diabetic cardiomyopathy and the use of vitamin E as an antioxidant and losartan as an angiotensin II receptor blocker in suppressing this apoptosis. Materials and methods Rats were randomly divided into five groups of 10 animals each: group 1 included healthy control rats; group 2, the diabetic group, included rats that were made diabetic with a single injection of streptozotocin; group 3 included diabetic rats treated with losartan; group 4 included diabetic rats treated with vitamin E; and group 5 included diabetic rats treated with losartan and vitamin E. At the end of the experimental period, plasma glucose and serum lipid profile were evaluated. The heart rate and mean systemic arterial blood pressure were measured in all groups. Oxidative stress as assessed with malondialdehyde and reduced glutathione (GSH-PX) concentrations, as well as caspase-3 activity as an index of apoptosis, was determined in cardiac tissue. In addition, cardiac apoptosis was measured with the BCL-X immunohistochemistry technique. Results Administration of vitamin E and losartan caused significant decrease in apoptosis. In addition, there was significant decrease in malondialdehyde and caspase-3 and significant increase in GSH in cardiac tissue homogenate, with significant decrease in the serum lipid level. The mean systemic arterial blood pressure was significantly decreased, whereas heart rate increased to normal level. Conclusion Vitamin E and losartan have a protective effect on diabetes-induced cardiomyopathy in rats.
  457 83 -
Morphometric (MRI and sonography) study of the human spinal cord in prenatal and postnatal life (from birth to 20 years)
Saadia A Shalaby, Essam M Eid, Naglaa A Saber, Ali M Ali, Samar F Gad
July-December 2015, 32(2):146-151
Introduction The assessment of the position of the conus medullaris is very important to perform lumbar puncture and surgical procedures. There are some reports about the relationships between the clinical manifestations and the spine morphology or spinal cord morphology in patients with myelopathy. It has also been reported that there are variations in the cross-sectional area of the cervical segments of the spinal cord. Aim The aim of the present study was to compare the levels of conus to measure the diameters of the cervical spinal cord segments. Participants and methods In the prenatal group, sonographic evaluation of the conus medullaris and the conus distance were carried out. In the postnatal group, the T2-weighted MRI was used to record the level of conus medullaris. In addition, the transverse and anteroposterior diameter of the cervical spinal cord and cross-sectional area from C2 to T1 at the level of each intervertebral disk were investigated. Results In the prenatal group, the mean of conus distance was 32.38 ΁ 12.13 mm. The level of the tip of the conus medullaris in the postnatal group showed almost distribution from the T12 to L2-L3 disk. The peak of the distribution of the conus height was at the level of disk between T12 and L1. The anteroposterior diameter decreased linearly from C2 to T1.The transverse diameter and the cross-sectional area were largest at the level of C4-C5, and decreased progressively to segment T1. There was no statistically significant difference in relation to sex. Conclusion Linear regression analysis showed a significant correlation between the conus distance and gestational age and femur length. The ascent of conus medullaris seems to occur early in postnatal life. The transverse diameter and the cross-sectional area were largest at the level of C4-C5, whereas the anteroposterior diameter decreased from C2 to T1.There was no significant correlation between cervical diameters and sex.
  488 44 -
Saussurea lappa root extract accelerates the reversion of liver fibrosis induced by carbon tetrachloride in rats
Hassan Reda Hassan Elsayed, Mostafa Mohammed Abd-Elmonem, Omar Mahmoud Gabr, Farid Abd-Elreheim Badria
July-December 2015, 32(2):116-125
Background and aim of work Liver fibrosis is a major health problem associated with high morbidity and mortality, particularly in Egypt. It is mainly regulated by hepatic stellate cells, which acquire a fibrogenic character in response to oxidant stress and inflammatory cytokines. We tried to test the efficacy of Saussurea lappa (Sl) root extract on the reversion of the already established liver fibrosis as this extract was reported to have anti-inflammatory and antioxidant activities. Materials and methods A total of 24 albino rats were divided into four groups: negative control group, carbon tetrachloride (CCl 4 ) fibrosis model group, spontaneous resolution group, CCl 4 followed by Sl root extract group. In all rats, serum alanine transaminase, aspartate transaminase, liver malonaldehyde and liver reduced glutathione were measured. Histopathological assessment were carried out through haematoxylin and eosin (H&E), sirius red staining and α-smooth muscle actin immunohistochemical staining with evaluation of the fibrosis grade and percentage of the area occupied by collagen fibres. Results Administration of Sl root extract for 4 weeks, after 8 weeks of CCl 4 injection, caused a significant decrease in CCl 4 -induced rise in plasma levels of alanine transaminase and aspartate transaminase, liver malonaldehyde and the percentage of collagen area and an increase in liver glutathione with almost preserved liver architecture, less inflammatory infiltration, less collagen deposition, fewer thinner septa, less bridging fibrosis and less positive reaction for α-smooth muscle actin as compared with the spontaneous resolution group. Conclusion These data indicate that Sl root extract can accelerate matrix degradation and reversion from liver fibrosis induced by CCl 4 in rats. This might be through antioxidant, anti-inflammatory activities and through inhibition of the activated hepatic stellate cells or probably inducing their apoptosis.
  405 89 -
Vitrectomy for idiopathic macular hole: outcomes and complications
Amr Mohammed Elsayed Abdelkader, Mohamed Nader Roshdy El-Metwaly, Mohamed Ahmed Khalaf, Amal Moustafa El Bendary, Amr Mohamed Hassan El-Kannishy
July-December 2015, 32(2):107-115
Purpose The aim of this study was to determine the anatomical closure rate together with the rate of functional success of idiopathic macular holes following vitreous surgery in different optical coherence tomography (OCT) stages. Patients and methods This was a prospective, case series, interventional study. Twenty-two eyes were enrolled in this study conducted at Mansoura University Ophthalmic Center during the period between June 2012 and December 2014 with at least 3 months of follow-up. Eyes with stage 2, 3, and 4 idiopathic macular hole according to the Gass classification were included. All eyes were subjected to 23-G pars plana vitrectomy, inner limiting membrane peeling, fluid-gas exchange, and postoperative positioning. Results Idiopathic macular hole closure was achievable in 18 of 22 cases, with overall 81.4% anatomical success. Type 1 closure (U-shaped closure) was achieved in 13 cases (59.1%), type 2 closure (V-shaped closure) in three cases (13.6%), type 3 closure (irregular closure) in one case (4.5%), and type 4 closure was reported in one case (4.5%). The median postoperative log MAR visual acuity at 3 months was 1.0 (0.9445-1.2073). The overall postoperative visual acuity improvement was strongly statistically significant (P = 0.000). The visual acuity improvement at 3 months compared with the preoperative visual acuity was statistically significant (P = 0.000). The delta change in log MAR visual acuity at 3 months was 0.5 (−0.7782 to −0.4331), with greater improvement in log MAR visual acuity in group I (stage 2 OCT) compared with group III (stage 3 and 4 OCT at 3 months; P = 0.05). Retinal breaks were observed intraoperatively in three cases. Retinal detachment was reported in one case 4 months postoperatively. Conclusion Macular hole closure rate and visual acuity markedly improved following vitreous surgery for idiopathic macular holes.
  422 65 -
Assessment of serum insulin-like growth factor 1 and serum insulin in children with congenital heart disease
Somaia A Elwan, Effat H Assar, Eman A Essa, Doaa A Elsaid
January-June 2015, 32(1):36-40
Introduction Children with congenital heart disease (CHD) have been reported to show significant growth retardation both prenatally and postnatally. Different types of cardiac malformation can affect nutrition and growth to varying degrees. Objectives The aim of this study was to assess the relationship between insulin-like growth factor 1 (IGF-1) and age, height, weight, head circumference, and BMI of infants. Materials and methods This was a case-control study conducted on 45 infants and children. The study included 30 children with CHD attending the Pediatric Cardiology Unit in Benha University Hospital from December 2012 to May 2013 who constituted the diseased group (groups 1 and 2). Their ages exceeded the neonatal period. Fifteen healthy sex-matched and age-matched children served as the control group (group 3). The infants were subjected to history taking, complete clinical examination, and assessment of serum IGF-1, serum insulin, and random blood sugar. All data were recorded and analyzed in detail. Growth retardation in children with CHD was assessed. Results There was significant difference between cases of CHD and the healthy control group as regards weight and BMI. There was significant difference between infants with cyanotic and those with acyanotic CHD as regards the weight. The cyanotic group was underweight. A significant difference was found in the length between the cyanotic and the acyanotic group. Infants in the cyanotic group were of short stature. There was significant difference between the cyanotic group and the acyanotic group as regards IGF-1 concentration, with the cyanotic group having lower concentration compared with the acyanotic group. Conclusion In light of this study we found that infants with CHD had lower IGF-1 levels compared with controls. Cyanotic CHD in children caused more pronounced growth retardation in comparison with acyanotic CHD.
  331 66 -
A review study on recent advance of headache and facial pain disorders
Kassem M Kassem, Naslshah G Kazem, Ahmed Mohammed M El Refai, Mohammed H El Sayed, Nermine Awad Allah Ramzy
January-June 2016, 33(1):3-9
Headache and facial pain disorders are prevalent, disabling, and largely treatable, but are under-recognized, underdiagnosed, and undertreated, and a burden, both to the individual and to the society. Headache and facial pain cuts across a diverse group of physicians, including neurologists, neurosurgeons, headache specialists, otolaryngologists, dental specialists, anesthesiologists, and pain specialists. This review discusses the relevant neuroanatomy, the updates in pathophysiology, and classification of headache and facial pain disorders. We will also introduce the art of history-taking in headache patients, as well as physical examination, investigation, and treatment of the most common disorders.
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Evaluation of mannose-binding lectin serum level in prediction of neonatal sepsis
El-Sayed A Amer, Ossama S El-Shaer, Ibrahim M Mohamed
July-December 2015, 32(2):126-130
Background Despite improved neonatal care over the past decades, infections remain common and sometimes life threatening in neonates admitted to the neonatal ICU. Neonatal sepsis has the highest morbidity and mortality. Objective The aim of the study was to evaluate mannose-binding lectin (MBL) serum level as a marker for prediction of neonatal sepsis. Patients and methods This prospective case-control study was conducted on 90 neonates admitted to the neonatal ICU. The 90 neonates were divided into two groups: the patient group and the control group. The patient group included 45 cases with neonatal sepsis and the control group included 45 healthy neonates. Serum levels of MBL were measured by immunoassay. The results were tabulated and analyzed with SPSS. Results Serum MBL levels were significantly lower in the neonates with sepsis than in the control group (0.455 ± 0.245 vs. 1.212 ± 0.249 μg/ml; P < 0.001). The lowest MBL levels were detected in those infants with septic shock. MBL had high sensitivity (97.7%) and specificity (86.6%) as well as positive (88%) and negative (97.5%) predictive values to detect sepsis. Conclusion and key messages MBL serum level could be considered a sensitive and specific marker for prediction of neonatal sepsis. Neonates with significant decrease in MBL are at increased risk for developing sepsis and septic shock.
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Lateral pharyngoplasty versus uvulopalatopharyngoplasty: A comparative
Allam F Ahmed, Helmy A Adel, Abdelaal M Taha, Abdelaleem A Abdelrahman
July-December 2015, 32(2):131-136
Objectives The aim of this study is to explore the efficiency of lateral pharyngoplasty as a new treatment for obstructive sleep apnea hypopnea syndrome (OSAHS) versus uvulopalatopharyngoplasty (UPPP). Study design Prospective randomized study. Patients and methods This study was submitted on 30 patients diagnosed to have OSAHS with retropalatal obstruction classified randomly into two groups: in one group, we performed the lateral pharyngoplasty (15 cases) with blunt palatal tunneling, and in the other, we did the UPPP (15 cases). We compared the efficiency of surgeries subjectively through the Epworth Sleepiness Scale and objectively through clinical and polysomnographic findings. Results In the lateral pharyngoplasty, the mean apnea-hypopnea index (AHI) improved from 40.95 ± 28.50 to 8.92 ± 7.9 (P < 0.01) and in the UPPP, the mean AHI improved from 33.87 ± 20.92 to 15.66 ± 8.7 (P < 0.01). Comparing the postoperative mean AHI in both groups (8.9 ± 7.9 and 15.66 ± 8.7 correspondingly) there was a statistically significant difference. In contrast with UPPP, the group of lateral pharyngoplasty shows improvement in the average PsO 2 from 91.93 ± 4.67 to 94.27 ± 3.53% (P < 0.05) and in the lowest PsO 2 from 71.8 ± 10.56 to 81.27 ± 8.92 (P < 0.01). In the lateral pharyngoplasty group, the median Epworth Sleepiness Scale changed from 11 to 7 and the persistent nasal regurge was not recorded (0.0%), but in UPPP group the persistent nasal regurge was recorded in four patients out of 15 (26.7%) (P < 0.05). Conclusion The lateral pharyngoplasty may offer benefits over UPPP in treatment of OSAHS patients with retropalatal obstruction. We observed improvements after the two surgeries, but the lateral pharyngoplasty gave better polysomnographic findings with less complications.
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Protective effect of exenatide (glucagon-like peptide-1 receptor agonist) on renal ischemia–reperfusion injury in diabetic rats
Ola A El-Gohary, Mona A Said
January-June 2016, 33(1):24-30
Aim Diabetes mellitus (DM), especially type 2, is a major health problem, and diabetic nephropathy is the main cause of end-stage renal disease. Renal ischemia–reperfusion (I/R) injury is common in diabetic patients. Recent studies reported increased vulnerability of kidneys to I/R injury in diabetic rats. In view of the reported efficacy of glucagon-like peptide-1 (GLP-1) on I/R injury, this study was designed to assess the effect of exenatide (GLP-1) on renal I/R in type 2 DM. Materials and methods Type 2 DM in rats was induced by administration of nicotinamide (110 mg/kg, intraperitoneal), 15 min before a single dose of streptozotocin (45 mg/kg, intraperitoneal). Renal I/R was performed in both diabetic and normal rats. The protocol comprised ischemia for 30 min followed by reperfusion for 24 h aynd a treatment period with exenatide 2 weeks before induction of ischemia. Results Renal I/R in diabetic rats induced marked renal dysfunction associated with a significant increase in malondialdehyde, nitric oxide, and tumor necrosis factor α levels. Antioxidant enzymes such as reduced glutathione and superoxide dismutase were significantly reduced. Exenatide treatment significantly normalized these biochemical parameters compared with diabetic I/R rats. Conclusion In conclusion, exenatide protects renal I/R injury in type 2 DM. These findings have major implication in the treatment of ischemic injury that is prone to develop in DM.
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Quality of life in some Mansoura University students
Youssef G Youssef, Nancy A Ahmed
January-June 2016, 33(1):60-64
Background/aim The progress of any nation depends on the academic achievement and professional development of its young, and for this reason every nation emphasizes on the achievements and development of its students. Thus, the aim of the present study was to assess the quality of life of some Mansoura University students in the Faculty of Education and the Faculty of Medicine. Methods This cross-sectional study was carried out at Mansoura University on 150 students by using a questionnaire designed during lectures. Results We found a significant difference in the quality of life between Malaysian and Egyptian students, as the mean score for Malaysian students was 160.42 (high) and for Egyptians it was 131.94 (good). There was no significant difference in the quality of life between male and female students, as the mean score for males was 134.22 (good) and for females 144.43 (good). There was no significant difference as regards the reaction between nationality and sex on the quality of life between the four groups (Egyptian males, Egyptian females, Malaysian males, and Malaysian females) and their mean scores were 129.32, 133.47, 158, and 160.88 (good, good, high, and high), respectively. There was no significant difference between the students of the Faculty of Education (132.36) and Egyptian students of the Faculty of Medicine (131.52). Conclusion The quality of life of Malaysian students living in Egypt was better than that of Egyptian students; it did not differ much between male and female students. Moreover, the quality of life was not affected by nationality if sex was taken into consideration. Comparing Egyptian students in both faculties (Medicine and Education) showed no significant difference as regards the quality of life.
  166 52 -
Update in facial nerve paralysis: tissue engineering and new technologies
Mohamed A Elsayed, Ahmed M.M. Elrefai, Ahmed A Abd Elfattah
July-December 2016, 33(2):72-76
The facial nerve is one of the most commonly injured cranial nerves. Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Here, we review recent developments in the management of facial nerve paralysis and in facial reanimation restoring both form and function. We also discuss tissue engineering and new technologies and their role in the treatment of facial nerve paralysis.
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Undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma of the larynx with giant cells and myogenic differentiation: a case report
Laila Seada, Fawaz Al Rashid, Hanan Oreiby
January-June 2016, 33(1):19-23
Undifferentiated pleomorphic sarcoma (UPS)/malignant fibrous histiocytoma (MFH) is quite rare in the larynx, with few cases reported. In the present study, we report an UPS/MFH of the larynx arising as a second primary neoplasm. It showed giant cells, spindle areas with vague storiform appearance, and myxoid areas. CD68 was positive in the giant cells and focally in the tumor cells. S100 showed scattered positivity in stellate cells. Desmin and specific muscle actin were negative, whereas h-caldesmon was positive in tumor cells and medium-sized blood vessels, denoting a possible myogenic differentiation. To the best of our knowledge this is one of the rare case reports of UPS/MFH with giant cells in the larynx arising as a second primary neoplasm.
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