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  Most popular articles (Since July 30, 2015)

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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.
  3,754 464 1
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.
  884 2,880 -
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.
  1,497 984 -
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.
  1,225 1,038 -
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.
  1,974 262 1
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.
  2,068 166 -
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.
  1,867 324 -
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.
  1,882 248 -
Serum interleukin-6 concentration and association with response to hepatitis C virus therapy for chronic hepatitis C patients
Fatma M Abd El Salam, Naglaa E El Toukhy, Amal A Mohamed, Hend A Nekola
July-December 2017, 34(2):59-65
Background Egypt has the highest prevalence of hepatitis C virus (HCV) in the world. Interleukin 6 (IL-6) is a pleiotropic cytokine that is elevated in chronic hepatitis C patients. IL-6 was suggested by several studies to play a major role in response to HCV therapy. Aim The aim of this work was to assess the possible role of IL-6 in the response status of patients with HCV during treatment. Moreover, we attempted to use IL-6 as a predictive factor for response in patients with chronic HCV. Patients and methods Serum concentrations of IL-6 were measured before and after treatment using a commercially available Quantikine enzyme-linked immunosorbent assay in 57 patients with chronic hepatitis C treated with sofosbuvir and simeprevir for 3 months. Results The mean values of IL-6 level in responders and nonresponders were 272.96 and 230.5 pg/ml, respectively. IL-6 levels decreased significantly after treatment in the sustained virological response group. The best cutoff point for IL-6 was 233 pg/ml with a sensitivity of 70%, a specificity of 75%, a positive predictive value of 97.2%, and a negative predictive value of 16.7%. Conclusion Virological response during HCV therapy was associated with a decrease in IL-6 level.
  1,214 902 -
Serum prolactin level as a biological marker of severity in liver cirrhosis
Fawzy M Khalil, Mohamed A Elassal, Ahmed M Hussein, Mahmoud Rizk, Mohamed A Awadein, Eman G Behiry, Mahmoud M Abd El-Fadil Kelany
July-December 2017, 34(2):140-145
Background Cirrhosis of the liver is a chronic disease that involves the whole organ. In liver cirrhosis, the gonadal axis is affected. Hyperprolactinemia is often present in these patients as well as hyperestrogenemia, both are responsible for the clinical characteristics of feminization. Patients and methods We investigated 50 patients with cirrhosis. The diagnosis of cirrhosis was based on biochemical evidence and clinical diagnosis including ascites or encephalopathy. Moreover, prognostic indices (Child–Pugh) and prolactin (PRL) levels are assessed. Results Mean age was 51.94±5.99. Mean Child–Pugh score was 9.16±3.16. Mean PRL level was 18.76±9.14 ng/ml. Patients with hepatic encephalopathy compared with patients without encephalopathy had significantly higher levels of PRL. PRL levels were also significantly related to ascites degree. Mean PRL levels were 13.67 versus 20.05 versus 21.6 ng/ml in patients with first, second, and third degree of ascites, respectively. In regression analysis, PRL level was significantly dependent on Child–Pugh score. Conclusion PRL level increases significantly with severity of liver disease particularly in patients with ascites and hepatic encephalopathy. High PRL level could therefore be considered as a negative prognostic marker of liver cirrhosis.
  1,921 141 -
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.
  1,670 187 2
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.
  1,550 270 -
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.
  1,593 171 -
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.
  1,471 273 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.
  1,442 212 1
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.
  1,461 192 -
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.
  1,432 206 -
Contrast-enhanced spectral mammography versus magnetic resonance imaging in the assessment of breast masses
Ahmed F Yousef, Hamada M Khater, Lara M Jameel
January-April 2018, 35(1):5-12
Background Contrast-enhanced spectral mammography (CESM) has high diagnostic accuracy. It involves the same principles as MRI in terms of the enhancement pattern because of the similar uptake of contrast medium or enhancement. Therefore, the indication should be the same. Aim The aim of the study was to compare CESM and MRI in the assessment of breast masses. Patients and methods This study included 20 patients, and was carried out from December 2016 to May 2017. The age of the patients ranged from 30 to 60 years. Our study was carried out using CESM and breast MRI. Results This study included 20 patients with breast lesions. The age of the patients ranged from 30 to 60 years. All multiple histologically proven lesions were detected by CESM (100%) and MRI (100%), with no significant difference in their site and number in both modalities. Conclusion CESM is useful for the differentiation of local recurrence of post-treatment scarring after breast-conserving therapy and evaluation of residual tumor after treatment, with unknown primary site of malignancy. Recommendations CESM is recommended as the imaging modality of choice in the detection and extension of breast cancer, particularly in problematic cases, or when conservative breast therapy is attempted, but the best correlations with lesion pathology were found in MRI more than CESM, as in MRI, there are the same overlapping patterns of benign and malignant enhancements.
  1,436 200 -
Role of ultrasonography in the evaluation of Achilles tendon disorders
Mohamed A Borg, Saleh El-Essawy, Roshdy M El Sallab, Amany Ezzat, Ahmed M Abd El-Khalek
January-June 2016, 33(1):54-59
Background This study was conducted to highlight the role of ultrasonography as an initial imaging modality for evaluation of symptomatic Achilles tendon disorders. Patient and Methods 60 patients (33 men and 27 women) had symptomatic Achilles tendons disorders and confirmed clinically as all patients were referred from orthopedic surgery department. 20 patients had history of blunt trauma followed by pain which may be associated with lost plantar flexion. 40 patients had chronic pain either associated or not associated with swelling at the site of Achilles tendon. US examination (13 MHz probe, GE logic P5 machine) using real time with color and power Doppler examination was performed while the patient in prone position. Results US depicted full-thickness tears in 11 (18.5%) tendons where tendon gaps were not significant (less than 5 mm) in 6 tendons and significant (more than 5 mm) in 5 tendons. De novo partial tears were detected in 15 (25%) tendons. Tendinopathy were seen in 18 (30%) tendons. US depicted paratenonopathy in 3 tendons (5%). 13 (21.7%) tendons appeared normal by ultrasonography. Conclusion Ultrasonography is an initial imaging of choice for evaluation of symptomatic Achilles tendon disorders. Diagnostic accuracy reaches 85%. However, Tendons that appeared normal by US should be followed by MRI for more diagnostic accuracy, detailed regional evaluation and subsequently can exclude other etiologies giving similar clinical manifestations.
  1,425 176 -
Management of chest trauma
Al Ashry T Ghoneim, Gamal E Saleh, Refaat S Salama, Mohammed K Zghloul
January-April 2018, 35(1):1-4
Thoracic trauma is a major medical problem with high mortality. It is a life-threatening situation and frequently involves other anatomical areas that require simultaneous management. The typical management is supposed to be multidisciplinary and preferably started at the accident location and maintained during patient transport, through the arrival to the emergency department, through transport to surgical theatre, in the operation room and then in the ICU. Early management is the key to decrease morbidity and mortality. The aim of this study was to throw some light on the types of chest trauma with special reference to its recent management.
  1,327 207 -
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.
  1,295 217 3
Role of MRI diffusion in the diagnosis of uterine cervical carcinoma
Eman Samy, Hamada Khater, Medhat M Refaat
January-June 2016, 33(1):10-13
Diffusion-weighted imaging is a potentially useful adjunct to conventional MRI in the evaluation of gynecologic tumors, thus improving the overall diagnostic accuracy, tumor staging, prediction of response to therapy, and treatment follow-up.
  1,332 156 -
Sublingual misoprostol before insertion of an intrauterine device
Mohamed A Mohammed, Khaled S Seleem, Ahmed M Sadek, Ahmed I Zaky Nada
January-April 2018, 35(1):104-110
Objective The aim of the work was to investigate whether sublingual misoprostol before intrauterine contraceptive device (IUCD) insertion facilitates the insertion and reduces the number of failed insertions, insertion-related complications, and pain during insertion. Background The intrauterine device (IUD) is a highly effective and safe contraceptive method. However, insertion through a narrow cervix may be technically difficult and painful. Misoprostol has been shown to be effective for cervical priming in nonpregnant women. Patients and methods Two hundred and sixty women were randomly allocated to receive 400 mg misoprostol sublingually or placebo 2 h before IUD insertion. Primary outcome measure was the proportion of failed insertions. Pain during insertion and difficulty in IUCD insertion were evaluated. Complications and side effects were recorded together with bleeding and expulsion of the loop after 6 weeks. Results Misoprostol significantly reduced the number of failed insertions from six failed insertion in the placebo group (4.6%) to only one (0.8%) case in the misoprostol group (P=0.023). Pain during insertion was significantly lower (P<0.001). Difficulty in insertion was significantly lower (P<0.001). As regards side effects, no significant differences were found between the two groups except for abdominal cramps and nausea. Cramps occurred in 22.3% of participants using misoprostol and in 5.4% of participants using placebo (P<0.001). Nausea occurred in 6.9% of participants using misoprostol and in 1.5% of participants using placebo (P=0.046). There were no significant differences as regards the rate of expulsion and the amount of vaginal bleeding. Conclusion 400 micrograms of sublingual misoprostol 2 h before IUCD insertion reduces the number of failed insertions and pain during insertion. A facilitating effect of misoprostol on IUD insertion was also found.
  1,406 77 -
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.
  1,255 173 1
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.
  1,265 152 1