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Category: Vol. 83, June 2015

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Nifedipine Versus Nitroglycerin in the Inhibition of Preterm Labour, SARAH M. HASSAN and DOAA S. BELAL

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Category: Vol. 86, March 2018

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Effect of Cupping Therapy on Glycemic Control in Type II Diabetic Patients, SAMAR K. ALNOUMANY, AZZA A. ABD EL-HADY, BASANT H. EL-REFAY and MOHSEN M. HELMY

Abstract
Background: Diabetes mellitus is a group of metabolic disorders in which there are high blood glucose levels over a prolonged period. If left untreated, diabetes can cause many complications [13]. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death [2]. Serious long-term complications include cardiovascular dis-ease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes [12].
Purpose: To study the effect of cupping therapy on glyc-emic control in diabetic patients.
Methods: Thirty type 2 diabetic patients were selected from Internal Medicine Department of Central Berket El-Sabaa Hospital to determine the effect of cupping therapy on glycemic control in diabetic patients. The practical work was done in the duration between July 2014 till September 2014.
They were diagnosed with specialized physician as T2DM patients, their age ranged from (45-55 years) and they were randomly divided into two groups equal in number. Patients were randomly assigned into two groups (A&B); each group consisted of fifteen patients. Parameters measured from both groups were HbA1c, fasting plasma glucose, postprandial plasma glucose level. Group (A) performed aerobic training for three sessions every week for 3 months and cupping therapy one time a month for 3 months while group (B) performed aerobic exercise only. Both groups were under medical treatment.
Results: There was a significance decrease in HbA1c, fasting blood glucose, and post prandial blood glucose in group A compared with group B post treatment. The percent of improvement of HbA1 c, fasting blood glucose, post prandial plasma glucose for group (A) was 30.13%, 14.08%, and 23.62% and for group (B) was 18.97%, 13.03%, and 16.26% respectively. The significance decrease in the mean values post treatment (p=0.02), (0.04), (0.3).
Conclusion: Using cupping therapy combined with aerobic exercise is superior to aerobic exercises only regarding glyc-emic control in type 2 diabetic patients.

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Category: Vol. 84, June 2016

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Reliability of the Arabic Egyptian Version of Short Form 36 Health Survey Questionnaire to Measure Quality of Life in Burned Patient, REHAM A. EL-KALLA, MOHAMED M. ABD ELKHALEK KHALAF, MAMMDOOH A.A. SAAD and EMAN M. OTHMAN

Abstract
Background: Burns are one of the most significant health problems throughout the world. Burn patients often have physical, psychological and social problems affecting their quality of life. In Egypt there is no Arabic assessment tool of quality of life of burned patients. SF-36 is one of the most widely-used QOL evaluation tool in the world.
Objectives: The aim of the study was to examine the reliability of the Arabic version of short form 36 health survey questionnaire to measure the recovery of quality of life of burn survivors. After translating and culturally adapting SF-36 from English to Arabic language.
Methods: Arabic translation and adaptation of the SF-36 scale were obtained by the "forward/backward translation" method. Then forty patients of both sex (22 males and 18
females) had been selected randomly from Outpatient Physical Therapy Clinic (Burn and Surgery Unit) Cairo University, Om El-Masreen Hospital and Ahmed Maher Hospital from May 2015 to March 2016. All of them were suffered from burn injury ranged from 20-30 TBSA% affecting upper and lower limbs. Their age were ranged from 20 to 40 years. They were asked to fill the Arabic version of SF-36 questionnaire twice with one week interval between them with the same investigator.
Results: The 40 patients completed the reliability test for Arabic version of the SF-36. The internal consistency of Arabic version of the SF-36 was assessed by Cronbach alpha coefficient. The Cronbach alpha was good (a=0.8). Test-retest reliability was assessed using Pearson Correlation Coefficient (PCC). There was a strong direct relationship between pre-score and post-score (PCC=0.873).
Conclusion: This study demonstrated that the Arabic SF-36 is a reliable measure of quality of life for Egyptian burned patients to document the efficacy of physical as well surgical intervention after burn.

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Category: Vol. 83, September 2015

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Role of Transcendental Meditation for Controlling Pre-Eclampsia, RADWA M. YEHIA, SOHEIR M.A. El-KOSERY, HALA M. EMARA and AMRO ABOUL-ELA

Abstract
Background: Pre-eclampsia (PE) is one of three common causes of maternal mortality in the world. Critical cases, suffering from multiple organ failures and that may lead to maternal death.
Objectives: To estimate the effect of Transcendental Meditation (TM) for controlling PE.
Methodology: The thirty pre-eclamptic women were randomly assigned into two groups equal in number as follow: Group (A) (Control group): (13 primigravidae and 7 multi-gravidae, they were subjected to the regular antihypertensive treatment (Methyledopa) and Group (B): (Study group): (11 primigravidae and 9 multigravidae), they were subjected to TM aiming for relaxation about (3 sessions per week for 6 weeks) plus the same regular antihypertensive treatment (Methyledopa) as in Group (A).
Results: Comparison between both Groups (A & B) showed statistically non significant difference at (SBP) as well as (DBP), (PR) and proteinuria levels after 6 weeks of treatment (3 sessions/week) which in favor Group (B).
Conclusion: TM has a no added effect on SBP as well as DBP, PR & proteinuria levels in PE.

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Category: Vol. 80, March 2012

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Beneficial Health Effects of Fennel Seeds (Shamar) on Male Rats Feeding High Fat-Diet,AMR A. REZQ

Abstract
Fennel has been known since antiquity as a medicinal and aromatic herb, it commonly used in household remedy for various medicinal purposes. The present study was con-ducted to investigate the effect of beneficial health effects of fennel seeds on feeding rats with high fat-diet. Histopatho-logical changes of aorta, heart and liver were examined. Thirty five male albino rats of Sprague-Dawley strain weighing 200±5g were used. Animals were divided into five groups of seven rats each: group (1) fed on the basal diet and kept as a negative control group; group (2) fed on high fat–diet and kept as positive control group; groups (3), (4) and (5) fed on high fat diets supplemented with three different levels of fennel seeds (5, 10 and 15%, respectively. The present results revealed that rats fed on high fat-diet only (positive control group) had significant (at p<0.05) increase in serum TL, TG, TC, LDL-C, VLDL-C, AST, ALT, ALP and MDA concentra-tions, and significant decrease in serum HDL-C level as well as significant decrease in HDL-C/LDL-C ratio value and serum activity of CAT, GPX and SOD enzymes as compared to rats fed on basal diet only (negative control group). High fat-diet supplemented with the three different levels of fennel seeds significantly improved serum levels of TL, TG, TC, LDL-C, VLDL-C, AST, ALT, ALP and MDA, and significant raise in serum HDL-C level, values of HDL-C/LDL-C ratio and improve activities of CAT, GPX and SOD enzymes compared to the positive control group. Histopathological investigation showed vaculations of tunica media and narrow-ing in the lumen of aorta sections and congestion of cardiac blood vessel as well as fatty change of hepatocytes in positive control rats. Vaculations of tunica media in aorta sections and fatty changes of hepatocytes were showed in rats fed high fat-diet supplemented with 5% of fennel seeds. Slight thick-ening in the wall of aorta sections was showed in rats treated with 10% fennel seeds, whereas, other sections showed ap-parent normal histological structure. Its liver sections had small vacuoles in the cytoplasm hepatocytes. Liver sections of treated rats with 15% fennel seeds showed small vacuoles in the cytoplasm of some hepatocytes and other sections revealed apparent normal hepatocytes. There were no histo-logical changes in heart sections of all treated rats with fennel seeds and in aorta of rats treated with 15% fennel seeds. In conclusion, the present study revealed that fennel seeds improve dyslipidaemia by improving lipid profile, cholesterol and low density lipoprotein cholesterol, and decrease the risk of chronic heart diseases by increasing level of HDL-C as well as enhancing activities of antioxidant enzymes.

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Category: Vol. 83, June 2015

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TIMI Risk Score as A Predictor for No-Reflow Phenomenon in Patients Undergoing Primary Angioplasty for Acute STEMI, MOHAMED FAKHER, MAHMOUD KHALED, MOHAMED DESSOUKI, MAHMOUD EL-BADRY and MOHAMED ASHRAF

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Category: Vol. 79, March 2011

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Cause-Specific Neonatal Mortality at the Armed Forces Hospital, Southern Region Khamis Mushayt, Kingdom of Saudi Arabia,ABDURRAHMAN M. AL-NEMRI and SULIMAN H. AL-FIFI

Abstract
Objective: To document the perinatal and neonatal char-acteristics in a single hospital setting, to identify the main causes of neonatal deaths and to review the trends in neonatal mortality over a 6-year period.
Methodology: This is a 6-year retrospective analysis of perinatal and neonatal data at the Armed Force Hospital, Sou-thern Region, Saudi Arabia.
Results: During the study period, there were 3 7,3 84 births resulting in 4,352 (11%) admissions to the neonatal intensive care unit (NICU). The average stillbirths rate was 54/1000 of the total births, and perinatal mortality rate was 9.6/1000 live births. Of the total NICU admissions, 2,698 (62%) were preterm, low-birth-weight (LBW) babies and 234 (5.4%) were extreme low birth-weight neonates (ELBW<1000gm). Overall neonatal mortality was 5.3% of the total admissions. Mortality rate was highest among ELBW babies (n=85; 36%). Prema-turity-related conditions and multiple congenital anomalies accounted for the majority of deaths in the unit (61% and 44%, respectively), followed by birth asphyxia (10%). In ELBW infants, respiratory failure (45%) and grade IV intra-ventricular hemorrhage (40%) were the leading causes of early deaths, while sepsis accounted for 50% of late neonatal deaths. The mortality rate was significantly lower for larger neonates (10% for 1000-1500gm birth weight infants and only 3.3% of near-term neonates above 1500gm). The major cause of death was respiratory failure in smaller babies (52%) and multiple congenital anomalies in near-term infants. The presence of multiple congenital anomalies and extreme pre-maturity were the major contributing factors to neonatal mortality.
Conclusions: There is a pressing need to study neonatal mortality to ascertain the cause of neonatal deaths in the Kingdom of Saudi Arabia.

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Category: Vol. 84, March 2016

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A Complimentary Index to Classical Caries Indices, SAIMA Y. KHAN and MAHENDRA K. JINDAL

Abstract
Objectives: To validate the PUFA/pufa index and to assess the prevalence and severity of oral conditions related to untreated dental caries.
Methods: Pufa index records the presence of pulpal exposure (P/p), ulceration caused by sharp edges of dislodged tooth fragments (U/u), fistula (F/f) and abscess (A/a) formation in grossly decayed teeth.
Results: Good Kappa values shows reliability of the index. The prevalence of PUFA/pufa was 0.01% and 86.8% for 6- year old and 50% and 32.9% for 12-year old respectively. In 6 and 12-year old, 74.9% and 74.5% of decayed teeth had progressed to odontogenic infections.
Conclusions: PUFA/pufa index provides a true picture to the prevailing and often ignored oral condition.

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Category: Vol. 82, September 2014

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Relationship between Stress and Eating Habits among Nursing Students in Assiut, AZZA M. ABD EL-AZIZ, SOAD A. SHARKAWY and YOUSSERIA E. YOUSEF

Abstract
Background: Nursing students experience many stressors in their academic lives and they often eat as a way of dealing with stress.
Aim of the Study: The purpose of this study was to deter-mine if there was a correlation between stress among nursing students and their patterns of eating habits in Assiut City, Egypt.
Subjects and Methods: The study included 1078 female nursing students between the ages 15-22 years who were conveniently sampled. A cross-sectional survey was conducted including students of the first and the last years of graduation. The study was conducted in the period from December 2012 to May 2013. The study applied. The Compulsive Eating Scale (CES) and the Stressful Situations Questionnaire (SSQ) were used to measure each variable.
Results: There was a highly significant relation between CES, stress (SSQ) and students’ age (p=0.001). The high mean score was present in age group (20-22 year) at early adulthood of development. According to class rank, there was a highly significant relation between stress (SSQ) and class rank of students (p=0.001), the higher percentage of students (86%) had high level of stress while 94.5% had poor eating scale. A highly positive correlation between uncontrollable eating habits and stress was present.
Conclusions and Recommendations: This study showed consistent associations between unhealthy eating habits and exposure to stressful situations among female nursing students. Students living at parental home during university years displayed healthier nutritional habits than residing outside family home. It is necessary for students to be aware of the possible correlation between stress and uncontrollable eating habits, and alternative strategies for coping to stress should be presented to them. This suggests that during stress students need counseling services to choose course of action that involves a constructive way to deal with stress and starting to gain control in stressful situations. Also we must promote activities that keep them calm and centered, such as exercise, journaling or meditation.

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Category: Vol. 80, March 2012

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DuraSeal Xact Adhesion Barrier and Sealant System: An Advanced Hydrogel Technology for Watertight Dural Repair in Spinal Cases,SALEM FAISAL

Abstract
Introduction: Cerebrospinal fluid leakage is a major problem in neurosurgical operations. A large variety of biologic and artificial materials have been suggested as sealant for achieving a watertight dural closure. We prospectively eval-uated the safety and efficacy of a duraSeal Xact adhesion barrier and sealant system in patients with predicted CSF leaks after sutured spinal dural closure.
Material and Methods: This study is a prospective clinical trial in 25 patients who need spinal dural augmentations. DuraSeal Xact system was used in 19 patients underwent intentional spinal durotomy and 6 patients who had unintended incidental durotomy. Patients were followed up for 3 months postoperatively with clinical examinations and diagnostic imaging.
Results: DuraSeal Xact system was effective in preventing CSF leaks in all patients. We have observed only 2 complica-tions with uncertain relationship with the used system.
Conclusion: DuraSeal Xact system meets the clinical challenge to reliably seal the dura to prevent CSF leak. It may also facilitate subsequent reoperations by acting as a mechan-ical barrier to adhesion formation.

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Category: Vol. 80, March 2012

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Body Mass Index (BMI), Nutritional Status, Dietary and Physical Activity Pattern of Preparatory School Age Children (11-14 Years) of Selected UNISCO Affiliated Schools,SAFAA E. TAWFIK, NEBAL A. ABOUL ELLA and WAFAA A. FAHMY

Abstract
Background: The lifestyle of children is susceptible to rapid changes and these my affect the nutritional status of children.
Objectives: To provide information on body mass index (BMI), nutritional status, dietary and physical activity pattern of 11-14 years old, preparatory school age children in 4 selected UNISCO affiliated schools in the urban areas of Cairo and Giza Governorates.
Material and Methods: This study was a part of Nutrition Education for school age adolescents in associated school UNISCO’s project network (ASPNET). It was carried out by team of the National Nutrition Institute in the year 2008. Cross-sectional descriptive study, where purposive non-probability sample was selected from four ASPNET Urban schools from four Educational directorates, two from Giza Governorate and two from Cairo Governorate. Total sample was 330 students equally distributed between selected schools, they were 148 male and 183 female and covered the age from 11-14 years. Pre designed questionnaire was used to collect information on gender, date of birth, dietary pattern and physical activity levels. The studied students were subjected to anthropometric and dietary assessments.
Results: Overweight and obese males accounted for 21.0% of the total sample while the percentage is mostly doubled among females to reach 40%. About half of the males consumed vegetables and half of females consumed fruits on daily basis. Nearly half of students consumed milk, yogurt and cheese daily. About one fourth of the students consumed effervescent drinks and about one third of them consumed tea daily. The median of caloric intake of overweight and obese children of the current study (3139.9 and 2941.9 calories respectively) is considered very high compared to recommend-ed daily estimated requirements. Almost one half of females and one third of males did not meet their requirements from Vitamin A, more than half of females (63.9%) consumed more than 100% of their adequacy of folic acid daily versus (45.6%) of males. Nearly half of males (49.7%) and females (59.0%) consumed less than 50% of their adequacy of vitamin C and about 30.6% of males versus 26.2% of females got <50% of vitamin E daily. About half of females versus one third of males got <50% of RDA of iron daily, in contrast more than two third of the sample meet the recommended daily require-ments for calcium and zink intake had exceeded the require-ments for age and sex in 75.5% of males and 79.8% of females. Of clinical importance is that Na consumption was >!120% RDA in 89.1% of females and in 82.3% of males. The current study reported that females spent more time in front of TV screen compared to males. With respect to physical activity, boys reported higher levels compared to girls. Females practice more safely regarding wrapping of sandwiches and almost all the students whether males and females practiced washing hands before food consumption.
Conclusion: A large percentage preparatory school children have a diet of low quality and inadequate physical activity. Poor nutrition and sedentary lifestyle are important risk factors in the emerging problems of obesity. Public health policy makers should urgently focus their attention to school children and design school health education programs that target the areas that need attention in order to reduce the burden of obesity and is related diseases.

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Category: Vol. 84, March 2016

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Comparing the Effects of Aquatic and Land-Based Exercises on Balance and Walking in Spastic Diplegic Cerebral Palsy Children, WANEES M. BADAWY and MOHAMED B. IBRAHEM

Abstract
Background: Children with spastic diplegic Cerebral Palsy (CP) often show motor impairment due to a number of deficits; including poor muscle control, weakness, spasticity and reduced range of motion in the extremities. All these factors affect the ability of children with CP to maintain balance and walk which are the primary rehabilitation concerns of parents and clinicians.
Aim of the Study: The present study was designed to compare between aquatic and land-based exercises on balance control and gait kinematics in children with spastic diplegia.
Material and Methods: Thirty children with spastic diple-gic (CP) of both sexes (19 boys and 11 girls) with gross motor function classification system level (II-III) and age ranged between 6-9 years were included in this study. Children were randomly assigned into two equal groups; Aquatic intervention (AQ) group and land-based exercise (LB) group. Balance parameters (overall, mediolateral and anteroposterior stability indices) were evaluated using biodex balance systemTM. Also gait kinematics parameters (step length, walking speed and time spent on each foot) were measured using biodex gait trainer IITM. Evaluation for each child in both groups was done before and after 12 successive weeks of treatment.
Results: There was a statistically significant improvement in the measured parameters in both groups when comparing their pre and post treatment mean values. However, significant difference was recorded between the two groups after treatment in favor of the aquatic intervention group.
Conclusion: The obtained results suggest that the aquatic therapy is beneficial to improve balance control and walking performance in spastic diplegic (CP) children.

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Category: Vol. 77, March 2009

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3D-CRT Techniques for Simultaneously Integrated Boost in Breast Conserving Radiation Therapy,

YASIR BAHADUR, CAMELIA CONSTANTINESCU, EHAB E. FAWZY and NOOR GHASAL

Abstract
Aim: To evaluate the dosimetric outcomes of two different three dimensional conformal radiation therapy (3D-CRT) of concomitant boost delivery to the intact breast.
Methods: Ten patients were evaluated using two standard opposed tangents conformal to the whole breast PTV, plus a pair of wedged fields conformal to the boost PTV; all fields have the same isocenter, placed in the whole breast planning target volume (PTV) (WBI) or located in the boost (BI) PTV. Dose Volume Histograms were calculated and analysed for the difference in maximum and minimum doses; also mean doses and volumes receiving 90% and 107% of the prescribed dose. Lung irradiation was analysed in terms of maximum and mean doses.

Results: For breast PTV coverage, significant differences were observed only in the maximum doses (62.3Gy Vs. 61Gy, p=0.003) and higher Dose Homogeneity Index DHI (0.66 Vs. 0.64, p=0.003) in favour WBI. For boost PTV coverage, a significant difference between the two techniques with max-imum dose (62.6 versus 60.87, p=0.003) as well the DHI (0.97 Vs. 0.94, p=0.002) in favour of WBI. The Conformity Index CI was significantly better in WBI (0.87 Vs. 0.64, p=0.001). Dose to lung or healthy tissue was not statistically significant difference between the two methods.
Conclusion: This study shows a dosimetrical superiority of using the whole breast isocenter technique over boost isocenter technique in whole breast PTV coverage, dose homogeneity index and boost PTV coverage. The clinical significance of this difference needs further clinical studies.

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Category: Vol. 77, March 2009

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Osteoporosis in -Thalassemia Major Patients: Role of COLIA1 Gene G-T Polymorphism,HALA F. SHEBA, IBTESSAM M.R. HUSSEIN, MONA F. ABD EL-GAWAD, AMAL EL-BESHLAWY, MOSHERA E. ZAKI, MONA HAMDY, AMAL RIZK and SOMAIA M. MOUSA

Abstract
Background: Growth impairment and osteoporosis are serious causes of morbidity in patients with b-thalassemia major (b-TM). Desferoxamine (DFO) toxicity and iron over-load have been proposed as the main underlying reasons. G-T polymorphism in regulatory region of COLIA1 gene has recently been associated with reduced bone mass and os-teoporotic fractures in postmenopausal women.
Objectives: To detect the possible implication of COLIA1 gene polymorphism in pathogenesis of osteoporosis in b-TM.
Study Design: Twenty five patients with b-TM and 20 healthy controls were investigated for the G-T polymorphism of COLIA1 gene using restriction enzyme analysis. Bone mineral density (BMD), growth parameters, serum ferritin level and duration of chelation therapy were also assessed.
Results: We detected a heterozygous polymorphism of COLIA1 gene in 12% of b-TM patients and 25% of the control group. Thalassemic patients had significant lower BMD than normal controls (p<0.01). Significant correlation was observed between low BMD and both duration of DFO intake and high ferritin level. Within the control group: Subjects with G/T genotype had significantly lower femoral and lumber BMD than those with G/G genotype. In thalassemic patients: No significant difference was found in BMD between the two COLIA1 genotypes.
Conclusion: We cannot detect evident role for COLIA1 gene polymorphism in the pathogenesis of osteoporosis in this group of b-TM patients although this role has been detected in the control group. Further studies that include higher number of patients and more than one genetic poly-morphism are needed in order to evaluate the role of genetic factors in the pathogenesis of osteoporosis in thalassemic patients.

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Category: Vol. 82, September 2014

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Sustained Hepatitis C Virus Clearance was Achieved by Honey Based Conservative Management in 35% of Chronic Hepatitis C Virus Patients: A Prospective Cohort Study, MAGD A. KOTB and AHMED K. ABDALLA

Abstract
Background: Hepatitis RNA viruses include A, B, C and D. They are typically self-limiting by conservative measures, except hepatitis C virus (HCV) that is self-limiting in only 2-5%. HCV causes chronic infection affecting 170 million people worldwide, its prevalence peak in Egypt is 12.1%. About 5%-7% of patients may ultimately die of consequences of HCV infection, e.g. cirrhosis, and hepato-cellular carcinoma.
Objective: To assess effectiveness of conservative man-agement in chronic HCV patients.
Methods: In a prospective cohort trial 82 patients with chronic HCV (49 children and 33 adults) were advised honey-based healthy diet, regular exercise and abstinence of un-indicated medications. None received concomitant antiviral or interferon therapy. HCV infection diagnosis relies on qualitative HCV RNA diagnosis by nested RT-PCR. Work was conducted in Hepatology Clinic, New Children Hospital, Cairo University, National Egyptian Center for Clinical and Environmental Toxicologic Research, Cairo University & National Cancer Institute, Cairo University during 2008 – 2011.
Results: At enrollment mean age±standard deviation (±SD) of children was 9.08 years ±3.5 years (range=3.17- 16.75 years, median=9.83 years) and 43 year ±11.25 years (range=18.5-61 years, median=46 years) for adults. Conserv-ative management was effective in sustaining HCV clearance in 29 (35%). None suffered progression of liver condition. Breakthrough viremia was observed in 8 (9.8%). For those with final lack of virus clearance, HCV load dropped signif-icantly (p=0.007). Sustained HCV clearance correlated positively with younger age (p=0.024), female sex (p=0.037), height attainment in children who were shorter for age at initiation of trial (p=0.002), and negatively with history of anesthesia (p=0.004), previous operative intervention (p=0.000), and did not correlate with initial HCV load (p=0.468). Predictors of response to conservative manage-ment await exploration. The HCV sustained clearance was irrespective of initial HCV load.

Conclusion: Conservative management achieved 35% cure of HCV in our studied cohort. It is safe and cost effective. Conservative management in HCV, warrants its trial as a first line of management in chronic HCV patients.

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Category: Vol. 77, March 2009

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Apoptosis of Cardiomyocytes Assessed by a Novel Apoptotic Marker (Annexin V) and the Role of Vitamin E in Cardioprotection in Diabetic Rats,

OLA M. TORK and ABDELKARIM KAMEL

Abstract
Background: Recently it has been shown that annexin V is an apoptotic marker in the heart. The aim of the present study was to explore whether annexin V content in the heart changes during diabetes in order to use it as a prognostic factor in diabetic cardiac affection. In addition, the study attempted to show the effect of treatment of insulin and vitamin E (300mg and 600mg/Kg) used separately or in combination.
Methods: The study included 70 male albino rats weighing 170-200gm. They were divided into the following groups of 10 rats each: Group I (cont): Control group, Group II (DM): Diabetic, untreated group. Diabetes was induced by intraperi-toneal injection of streptozotocin (stz) at a dose of 40mg/kg body weight, Group III (Ins): Diabetic group, treated with 1 unit insulin injected subcutaneously, Group IV (E-300): Diabetic group, receiving 300mg/kg vitamin E injected intra-muscularly, 3 times/week for one month, Group V (E-600): Diabetic group, receiving vitamin E i.m injection at a dose of 600mg/kg, 3 times/week for one month, Group VI (I+E-300): Diabetic group treated with insulin and vitamin E (300mg/kg/dose) and Group VII (I+E-600): Diabetic group treated with insulin and vitamin E (600mg/kg/dose). Annexin V and inducible nitric oxide synthase (iNOS) were examined in the hearts of animals by RT-PCR. Also, cGMP, malondial-dehyde (MDA), glutathione peroxidase (GPX) and cardiac enzymes were measured.
Results: There were three major new findings in the present study. First; annexin V levels were significantly elevated in the heart of diabetic rats compared to controls. This elevation in annexin V content indicates that apoptosis is the basis of cardiac injury as shown by the elevated cardiac enzymes AST, ALT & CPK. Second, levels of iNOS protein of the heart were elevated in diabetic rats. On the basis of theses findings, we can suggest that inflammation could play a role in the pathogenesis of diabetic cardiomyopathy in type 1 diabetes. Third, the effect of various types of treatment of diabetes which were used here showed the beneficial effects of the use of the antioxidant, vitamin E.

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Category: Vol. 83, September 2015

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Ultra-Fast Track Cardiac Anesthesia: Risks, Benefits, and Predictors of Outcome, HODA SAAD, MAGED SALAH, HISHAM HOSNY and MOATAZ SALAH

Abstract
Background: Ultra-fast track anesthesia (UFTA) aims at immediate extubation of cardiac surgical patients at the end of the operation. It has not been found to increase postoperative cardiorespiratory morbidity, sympathoadrenal stress, or mor-tality. On the other hand, it significantly reduces costs and improves resource utilization.
Methods: Fifty two consecutive patients underwent open heart surgeries and were managed by the same anesthesiologist. All adult patients undergoing elective cardiac operations were included in the study. They were divided into 2 groups, 26 patients each, UFTA group and conventional group. Patients were given intravenous midazolam, before surgery as a pre-medication. Induction was achieved using midazolam, fentanyl, and propofol. Tracheal intubation was facilitated by atracurium. Maintenance of anesthesia was achieved using sevoflurane, and a continuous intravenous infusion of morphine. Postop-eratively, patients received intravenous morphine infusion, intravenous morphine on demand, and intravenous paracetamol every 6 hours. Pain was assessed with Visual Analogue Scale (VAS), every 6 hours for the first 24 hours of their ICU stay.
Results: There was a significant reduction in mean length of ICU stay between the UFTA and the conventional groups, 57.42 hours and 95.04 hours respectively. There was no significant difference in postoperative pain perception between the 2 groups. But there was a significant difference in ICU morphine usage between the 2 groups.
Conclusion: The implementation of UFTA protocol led to a significant reduction in the length of ICU stay of adult patients undergoing elective cardiac surgical operations, without increasing postoperative complications.

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Category: Vol. 83, September 2015

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Pulmonary Problems among Stone Cutting Workers in West Bank-Palestine, HATIM M. JABER, MONA S. MOHAMED, AMAL M. EL-SAFTY, OMAIMA K. EL-SALAMONI, HANAN M. IBRAHIM and WALEED S. EL-DIN

Abstract
Introduction: Respiratory problem is one of the major health hazards in dust-exposed workers; it is a major cause of morbidity and mortality all over the world.
Objectives: To determine the prevalence of respiratory problems and lung function impairment (PFI) among Pales-tinian stone cutting workers, and to investigate its association with work conditions and other risk factors.
Method: During April-June 2012, a cross-sectional study was conducted among 259 male workers, who were available at all stone-saw workshops (n=42) located around the valley between Nablus and Tulkarm in the northern part of West Bank, Palestine. Respiratory problems and lung function were studied through interviews questionnaire, detailed history, clinical examination and spirometry.
Results: The respondents were all males, with mean age of 36.8 years and with 13.4 years mean duration of current work. Complaints of chronic cough, chest pain and wheezes were present among 28.2%, 17.8% and 3.8% of workers respectively. The prevalence of abnormal pulmonary function test among workers was 21.6%, with 20. 1 % of workers had restrictive lung disease and 1.5% showing obstructive lung disease. Multivariate regression, showed that smokers, longer duration of work, and PPE non users have higher risk for developing abnormal pulmonary function test (OR 4.5; CI: 1.01-20.2; p=0.049), (OR 2. 1; CI: 1.03-4.5; p=0.04) and (OR 2. 1; CI; 1.04-4.5; p=0.03) respectively.
Conclusion: Chronic exposure to dust in stone cutting Industry may increase the risk of respiratory problems and impaired lung function; cigarette smokers, long duration of work and non usage of Personal Protective Equipments (PPE) are at higher risk.

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Category: Vol. 80, June 2012

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Cord Blood Bilirubin as a Predictor of Neonatal Hyperbilirubinemia,NAGWA HAMDI, ALI ELGAYAR and MOHAMMED HOSSAM SALAH

Abstract
Hospital readmission for neonatal hyperbilirubinemia is a cause of concern among clinicians in neonatal departments. While early Hospital discharge of neonates is currently rec-ommended by the neonatologists, it carries the risk of delayed recognition of hyperbilirubinemia and the possibility of brain damage due to kernicterus. In our study we aimed to study whether umbilical cord serum (UCS) bilirubin values could predict the risk of significant hyperbilirubinemia requiring treatment in newborns.
Patients and Methods: In a prospective study carried out at the Neonatal Department of Al-Galaa Teaching Hospital, umbilical cord serum (UCS) bilirubin was collected from 234 newborns who were categorized into three groups according to UCS bilirubin levels, <2mg/dl, 2-4mg/dl & >4mg/dl re-spectively. All demographic data was collected from all included newborns and compared among the three groups. Maternal and neonatal blood groups were checked as well cord hemoglobin and hematocrit concentration. The neonates were then followed by TcB at 24hrs, 48hrs & 72hrs of postnatal age and those who showed significant high TcB values ac-cording to the hour-specific nomogram, were then sampled by venous blood for total & indirect bilirubin levels. Significant hyperbilirubinemia was interpreted as the need for medical intervention in the form of phototherapy and/or exchange transfusion.
Results: A cut-off value of neonatal hyperbilirubinemia in cord blood was 2mg/dl and the end point of the study was the need for treatment. The mean value for total bilirubin in cord blood was significantly higher among newborns whose bilirubin values required phototherapy. The specificity reached 94.2% with a negative predictive value (NPV) of 96.32%. At cut-off cord serum bilirubin level >4mg/dl, the specificity was 98.92% and the NPV was 99.1%.
Conclusion: Cord blood serum bilirubin can be used as a useful screening test for predicting neonatal hyperbilirubine-mia and allowing safe postnatal Hospital discharge.

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Category: Vol. 79, December 2011

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Blood and Renal Affection Among Egyptian Car Painters,ABEER M. ARAFA, SAWSAN F. HELAL and MAY M. AFIFI

Abstract
Background: Car painter workers usually suffer from long-term exposure to relatively high levels of mixture of solvents.
Objective: The aim of this work was to evaluate occupa-tional exposure to organic solvents that entails a risk of haematological changes and renal dysfunction.
Subjects and Methodology: This study was conducted in two car repair shops in Maadi & El Manial in Cairo. The exposed group was 30 male workers, aged 17 to 35ys (26.8±  4.2), working 12 hours/day with one day off. None of the workers used any protective equipment.
A matched referent group of 30 male subjects aged 20 to 38 years (30.8±4.9) and of the same socioeconomic status was also included in our work.
The following were performed after taking individual consent: (A) An occupational history; and full clinical exam-ination (B) Serum creatinine and B2 microglobulin in urine, Nacetylglucosaminidase, hippuric and methylhippuric acid and CBC.
Results: Showed a statistically high significant difference between the exposed and the control groups as regards serum creatinine, urinary B2 microglobulin, N-acetylglucosaminidase, methylhippuric acid erythrocyte count. A statistically signif-icant higher levels of urinary hippuric acid in the exposed group compared to the control groups. No statistically signif-icant difference between the workers and the control group as regards leucocyte and platelet count.
Recommendations: Pre-employment, periodic medical examinations. Personal protective equipment. Health education programs. Following recommended allowable concentrations Further investigations are needed to ascertain the correlation between solvent exposure and kidney and blood affection obtained in this study.

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Category: Vol. 82, September 2014

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Evaluation of the Role of High Resolution Computerized Tomography (HRCT) and Computerized Tomography Pulmonary Angiography (CTPA) in the Diagnosis, Differentiation and Detection of Possible Complications of Pulmonary Hypertension, YOUSSRIAH Y. SABRI, IMAN M. HAMDY, IRENE M. SABRY and ASSAD A. ALHADI

Abstract
Introduction: Multi-detector pulmonary CT angiography and high resolution CT are now play an important role in the diagnosis of pulmonary hypertension (PH) and are considered the first line of investigation in the diagnosis of most of the pulmonary vascular and interstitial disorders that’s cause PH.
Purpose: The aim of this study is to evaluate the role of Multi-detector pulmonary CT angiography (CTPA) and high resolution CT (HRCT) in the diagnosis of PH and its causes.
Patients and Methods: 100 patients (diagnosed either clinically or by echocardiography to have PH) were examined using a 4-MCT scanner in the Radiology Department in Cairo University. The study population was assisted for different MDCT signs of PH, lung parenchyma, vascular and cardiac findings that help in the diagnosis of different causes of PH.
Results: In all cases the main pulmonary artery (MPA) was larger than 29mm and further divided according to the size into three groups (<35mm=54%, >!35!940mm=28%, >40mm=18%). The more than 1:1 relation between segmental pulmonary artery and the bronchus in different pulmonary lobes was seen in 88% of cases. The more than 1:1 relation between the main pulmonary artery and the aorta was seen in 76% of cases. According to the other CT findings, the causes were divided into four groups. Group A (pulmonary) 36%, Group B (cardiac) 27%, Group C (vascular) 17% and Group D (idiopathic) 20%.
Conclusion: CTPA and HRCT are a relatively available, minimally invasive investigation that can now be considered as an important modality that show signs of PH and the first line of investigation in diagnosis of possible causes of PH.

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Category: Vol. 79, September 2011

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Case Report: Treatment of Type 1C Endoleak after Endovascular Abdominal Aortic Aneurysm Repair Using Covered Stent from the between the External Iliac and the Internal Iliac Arteries MUSAAD AL-GHAMDI, M.D.; MAT ROBESON, M.D.; SHUN MACDONALD, M.D. and JASON CLEMENT, M.D.

Abstract
Purpose: To report a case with successful endovascular repairs of type 1c endoleak (EL) by excluding the source of the common iliac artery using endo-graft.
Method and Result: 84-year old male patient underwent an endovascular repair of 5.7cm abdominal aorta aneurysm (AAA) by endografting with aorto-uni endogrft and femoral-femoral crossover and Amblatzer occlusion device was used in the right common iliac artery. The patient developed Type 1C EL around the amblatzer with sac expansion in the follow-up CT scan. After a failed trial of coil embolization, we were successfully able to exclude the source of EL by using endograft between the external and the ipsilateral internal iliac artery.
Conclusions: This case demonstrates the importance of follow-up and close monitoring of the type 1 EL and the successful management with endovascular approach avoiding major complications.

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Category: Vol. 81, June 2013

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Diffusion-Weighted Whole-Body Imaging with Background Body Signal Suppression (DWIBS): MRI Sequence for Metastatic Workup,MOHAMED ZIDAN, MOHAMMAD K. MAHMOUD and HAZEM A. YOUSEF

Abstract
Objectives: To assess the feasibility of DWIBS in screening patients for metastasis either in bone, solid organs or lymph nodes.
Patients and Methods: A total of 50 patients (27 men and 23 women) with their ages ranged from 27-69 years, mean age, 48 years. Forty five patients (25 men and 20 women) had distant metastases from a known primary malignancy, and five patients (2 men and 3 women) had no known primary malignancy. All of them underwent DWIBS, whole body T1WI and STIR reconstructed in the coronal plane and also whole body T2WI for only ten patients.
Results: Distant metastases were well depicted in lymph nodes, solid organs or bone marrow in T1WI, T2WI & STIR images and DWIBS but the later detected more bone marrow lesions than those detected in the former MRI sequences in only two patients. In the patients not known to have primary malignancy; abnormal bone marrow infiltration was depicted in DWIBS and was proved to be lymphoma. In another patient; a right breast mass was detected in DWIBS and was histo-pathologically proved as ductal adenocarcinoma. DWIBS and other conventional pulse sequences depicted recurrent tumors as well as distant metastases; however the conventional pulse sequences localized the lesions better. A high degree of agreement also existed between DWIBS and STIR more than other pulse sequences.
Conclusion: DWIBS satisfactorily shows the presence and the extent of bone as well soft tissue (solid organs and lymph nodes) metastases but not specific for the characteriza-tion of lesions. It needs no ionizing radiation or contrast media and also has better spatial resolution. The relative availability of this technique and local experience should first be taken into account.

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Category: Vol. 78, June 2010

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S100 Expression in Oncocytoma and Chromophobe Renal Cell Carcinoma: An Immunohistochemical Study,WAEL S. IBRAHIM

Abstract
Oncocytoma and chromophobe renal cell carcinoma may show a certain degree of histological overlap. The problem of differentiating both types is expected to increase because of the more frequent use of needle biopsies to diagnose small renal masses. In this study. The expression and the possible diagnostic utility of S 100 was evaluated in both oncocytoma and chromophobe renal cell carcinoma, using immunohis-tochemistry. Ten cases of oncocytoma and 10 cases of chro-mophobe renal cell carcinoma were used for the immunohis-tochemical study. Nine cases of chromophobe renal cell carcinomas (90%) showed no reaction with antibody to S 100. Only one chromophobe renal cell carcinoma (10%) was positive. Eight cases of renal oncocytomas (80%) gave positive reactions with antibody to S100, while two cases (20%) showed no reaction with antibody to S 100.
In conclusion: A significant difference in S 100 immu-noexpression between chromophobe renal cell carcinomas and oncocytomas has been detected (p<0.001) and it can be used as a differentiating point between both subtypes.

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Category: Vol. 84, September 2016

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Effect of Foot Massage on Pain Responses to Heel Stick in Preterm Infants, EBTSAM M. IBRAHIM, SHADIA R. EL-GIUNDY, HANAN M. RASHAD and MOHAMED H. MEBED

Abstract
Background: Foot massage could inhibit the transmission of pain by 'closing the gate' or by activating the endogenous opioid pathway to decrease nociceptive transmission of pain associated with heel stick.
Aim of the Study: To evaluate effect of foot massage on pain responses to heel stick in preterm infants.
Material and Method: A quasi-experimental (time-series) design was utilized on a convenient sample of sixty preterm infants less than thirty seven weeks of gestation at two NICUs of Beni-Suif University Hospital and Beni-Suif Health Insur-ance Hospital in Beni-Suif City. A neonatal assessment sheet about characteristics of both neonates and heel stick sampling, and Premature Infant Pain Profile (PIPP) scale were used to collect data from October 2014 to May 2015. After written consent from parents, infants received no massage on the first sampling, and a 15-minuts. Massage of the foot prior to heel stick on the next sampling (1-3 days) later. One of the re-searchers applied the foot massage, measured PIPP, heart rate, and oxygen saturation 5min prior to heel stick, during and after heel stick immediately.
Results: The current study revealed that preterm infants birth weight ranged from (900-2800gm), massage increased heart rate significantly before heel stick in study group while it decreased significantly after heel stick. Preterm infants who received foot massage prior to heel stick had statistically significant stabled behavioral state than who did not receive. Mean PIPP score had lowered significantly for preterm infants who received foot massage during and after heel stick than who did not received. Duration of sampling was decreased significantly for study than control group.
Conclusion: Foot massage improved physiological and behavioral stability and lowered the severity of pain responses to heel stick in preterm infants, as well as decreasing the sampling duration.
Recommendations: Foot massage must be involved in the routine care for preterm infants prior heel stick.

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Category: Vol. 79, March 2011

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Conventional Lung Protective Strategy Versus Airway Pressure Release Ventilation in Acute Lung Injury: Effects on Cardiac Performance and Lung Mechanics,GAMAL HAMED, TAREK EL-GOHARY, HASSAN EFFAT and KHALED ZEIN EL-DIN

Abstract
Introduction: Since its initial description lung protective strategy using tidal volumes of less than or equal to 6ml/kg predicted body weight, with high respiratory rates and main-taining plateau pressures less than or equal to 30cmH2O has been the standard ventilator management for ALI/ARDS patients, where a large number of randomized controlled clinical trials have proven it to reduce the mortality rates [1].
Airway pressure release ventilation (APRV) has been successfully used in neonatal, pediatric, and adult forms of respiratory failure. Experimental and clinical use of APRV has been shown to facilitate spontaneous breathing and is associated with decreased peak airway pressure and improved oxygenation.
Methods: Our study was conducted on twenty patients admitted in the Critical Care Department, Cairo University Hospital with proven diagnosis of ALI/ARDS, who were ventilated sequentially for twelve hours using Volume Control-Assisted Controlled mechanical ventilation with lung protective strategy settings and Airway pressure release ventilation. Every three hours haemodynamic variables, arterial blood gases, lung mechanics and need for sedation were assessed. Aiming to compare and evaluate the two modes as regards haemodynamic effects, impact on arterial blood gases, need for sedation and the effects on respiratory mechanics.
Results: We did not demonstrate any significant change in the haemodynamic variables (heart rate, mean blood pres-sure, central venous pressure, and pulmonary capillary wedge pressure) between both modes of ventilation. (p-value >0.05).
Partial pressure of carbon dioxide, acid-base status, and serum bicarbonate level did not change significantly between the two modes of mechanical ventilation (p-value >0.05), there was a significant decrease in partial pressure of oxygen with APRV compared to twelve hours of controlled mechanical ventilation with lung protective strategy with a 21.3% reduction (CMV 166.1±46.3, APRV 130.8±47.9) p-value 0.046, there was a highly significant 20.1% reduction in Hypoxic Index after twelve hours of APRV following twelve hours of CMV (CMV 275±80.7, APRV 219.9±86.8) p-value 0.001, there was a significant increase in respiratory rate and minute ventilation by 29.3% and 26.7% respectively during the twelve hours of APRV compared to twelve hours of CMV with respiratory rate increase from 21.5±6.9 with CMV to 27.8±6.2 APRV, p-value 0.007. There was no significant changes in dynamic compliance between both modes of ventilation (53±25.8 CMV, 52.9±26.9 APRV) p-value >0.718. Highly significant decrease of 38.9% in peak airway pressure was noted during ventilation with APRV compared to CMV, (APRV 19.8±4, 32.4±6.7 CMV), p-value 0.0001, associated with that there was also a highly significant 19% decrease in mean airway pressure during ventilation with APRV compared to CMV with lung protective strategy (CMV 18.9±3.7, APRV 15.3±3.3), p-value 0.0001. The need for sedation by propofol during the twelve hour period of APRV significantly decreased by 56.2% com-pared to the twelve hours of application of lung protective ventilation using CMV, where the dosage of propofol decreased from 1.6±0.5mg/kg/hr with CMV to 0.7±0.8mg/kg/hr with APRV, p-value 0.0001.
Conclusion: APRV can be used safely as one of the optimum ventilatory strategies in patients with ALI/ARDS as it decreases airway pressures significantly and decreases the need for sedation while maintaining adequate oxygenation without altering haemodynamics.

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Category: Vol. 78, March 2010

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Concepts of Health and Illness in Egyptian Children, MAI M. YOUSSEF, EBTISSAM M. SALAH, SAMAR M.E. SALEM and HALA S. MEGAHED

Abstract
Background: Concepts of health and illness give additional important information to the biomedical models. According to the literature of lay beliefs, these concepts significantly affect population's health and illness behaviors and their health consciousness. Detecting children's lay concepts of health means a special professional challenge since they are not able to think in an abstract and systematic way yet, particularly to express this verbally. The draw-and-write method, which is based on projective technique, enables us to map children's lay concepts of health in 9-11 years of age.
Objective: The main goal of the present study is to detect 9-11 year-old children's lay concepts of health, illness and risks, by using a technique, which has already been accepted and applied, at international level to inform future health promotion work.
Subjects and Methods: The study was conducted among 4th, 5th grade schoolchildren 9-11 years in two primary schools in Gizza. The sample consisted of 472 students (53% males and 47% female). We used the "draw and write" technique to detect children's lay beliefs and knowledge of health and illness asking them about sources of information.
Results: Most children apply a mixture of the biomedical and holistic health definitions. Many of them also emphasize the role of healthy lifestyle. Television and the media were the most important sources of information of health and illness followed by their parents and physicians.
Conclusion: These findings support earlier findings from international literature that 9-11 year-old children have a significant base of knowledge about health, illness and disease-inducing risks.

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Category: Vol. 77, March 2009

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Evaluation of General ICU Outcome Prediction Using Different Scoring Systems,ABDULLAH HAMZA, LAMIAA HAMMED, MAGED ABULMAGD and AYMAN ELNAJAR

Abstract
Objective: The aim of this study was to evaluate the performance of three general severity-of-illness scores (Acute Physiology and Chronic Health Evaluation [APACHE] IV, Simplified Acute Physiology Score [SAPS] II, Mortality Probability Model [MPM] II0 systems) in Critical Care De-partment at Cairo University, Cairo, Egypt.
Methods: A prospective observational cohort study was performed in an Egyptian intensive care unit. Data were collected over the first 24 hours of ICU stay. The following data were collected prospectively on all consecutive patients admitted to the Intensive Care Unit between 20 January and 20 March 2008: Demographics, APACHE IV and SAPS II scores, MPM II0 variables, ICU outcome.
Measurements: Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was calculated with 95% confidence intervals (CI). Calibration was assessed by calculating Lemeshow-Hosmer goodness-of-fit C statistics. Discrimination was evaluated by calculating the Area Under the Receiver Operating Character-istic Curves (ROC AUC).
Results: A total of 265 consecutive patients were included over 3-month period. The observed ICU mortality was 17%. Predicted mortality by APACHE IV and SAPS II systems was different from actual mortality, whereas MPM II has the most accurate prediction one [SMR for APACHE IV: 1.49, SAPS II: 0.58, MPM II 0: 1.01]. All the models showed reasonable discrimination using the area under the receiver operating characteristic curve (APACHE IV, 0.845; SAPS II, 0.845; MPMII0, 0.81). For same data sets, APACHE IV demonstrated superior calibration to all the models using the chi-squared value from the Hosmer-Lemeshow test (APACHE IV 5.123 [p=0.744]; SAPS II 12.140 [p=0.145] and MPMII 8.825 [p=0.357].
Conclusions: In our ICU population: 1) Overall mortality prediction, estimated by standardized mortality ratio, was excellent for MPM, overestimated by SAPII and underesti-mated by APACHE IV. 2) APACHE IV and SAPS II demon-strated the best discrimination, but the superior calibration of
Correspondence to: Dr. Abdullah Hamza, Department of Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt.
APACHE IV makes it the most appropriate model for com-parisons of mortality rates in different ICUs.

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Category: Vol. 86, June 2018

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Case Report: An Unusual Clinical Presentation of Acute Lymphoblastic Leukemia in a Child, ZEINH H. FARDAN, HESSA M. GILBAN, ALI H. ASIRI, ASHWAG A. ASIRI and ABDULLAH A. ALAMOUDI

Abstract
Background: Acute lymphoblastic leukemia (ALL) is an aggressive disease, which cause accumulation of immature early bone marrow hematopoietic cells known as blast cells.
Objective: To report an unusual presentation of a case of acute lymphoblastic leukemia in a Saudi female child.
Case Report: A four-Year old Saudi girl presented to Abha Maternal and Children's Hospital, Saudi Arabia, with repeated hematemesis. She had a history of fever reaching 39°C, which started 5 days earlier and responded to antipyretics, with no chills or rigor. On physical examination, the patient was conscious, alert, pale, lethargic, with mild dehydration. Res-piratory rate was 30 breaths/minutes, and the heart rate was 135 beats/minutes. Her growth parameters were normal. Bone marrow aspirations revealed being markedly infiltrated by blast cells, with marked reductions of all normal cells. There-fore, the case was diagnosed as acute leukemia, most probably acute lymphoblastic leukemia. She was referred to the Com-prehensive Cancer Center at King Fahad Medical City in Riyadh, to start her chemotherapy course for management of her condition.
Conclusions: Uncommon clinical presentations include hematemesis and diarrhea may lead to delay in diagnosis. Awareness of the uncommon signs and symptoms of childhood acute lymphatic leukemia helps in early diagnosis and proper management of patients.

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Category: Vol. 77, June 2009

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Complications and Outcome of Exchange Blood Transfusion in Neonatal Unconjugated Hyperbillirubinemia,MOHAMAD HASHEM, AMANY E. EL-WAN, NOURAN F. HASSAN and MOHAMAD ABDOU

Abstract
Introduction: Neonatal jaundice is a common neonatal problem, usually have a benign course however in certain unmonitored and untreated conditions, unconjugated hyper-billirubinemia can progress to acute bilirubin encephalopathy, exchange blood transfusion although rarely used now in developed countries still commonly used in developing coun-tries.
Aim of the Work: To assess complications of exchange blood transfusion (EBT) for hyperbillirubinemia, also to study its incidence with exploration of cases with Kernicterus in neonatal intensive care unit (NICU), new children hospital Cairo University.
Patient and Method: A retrospective study in the NICU, new children hospital Cairo University, where data of all cases with neonatal hyperbillirubinemia who were underwent (EBT) over one year starting the first of January – end of December 2007 were collected from patients files and analyzed.
Result: EBT accounted for (30.9%) of NICU cases with neonatal jaundice, 43.8% were females and 56.2% were males, 72.6% delivered by NVD with mean gestational age 37.36±1.67 weeks, the mean age at presentation was 5.4 days ±2.9 (1-20) and the mean body weight was 2.73±0.54kg. ABO incompatibility accounted for 51.9% of causes of jaundice and no cause can be determined in 27.4% of cases, Kernicterus was recorded in 18 cases 8.6%, pre-exchange bilirubin level was the most important determinant factor with (p value 0.000). Complications of EBT included hypoglycaemia (10.09%), hypocalcaemia (25.5%), hyponatremia (6.3%), hypernatremia (3.84%), Hypokalemia (5.3%) and hyperkalemia (5.3%). Thrombocytopenia was recorded in (28.36%), cholesta-sis in ( 9.6%). NEC (0.5%), sepsis (18.3%). Mortality was recorded in 14 cases (6.7%) and it was correlated with GA and age at presentation with (p value 0.03) for both, mortality was more common among kernicteric group with (p value 0.02).
Conclusion: Incidence of neonatal jaundice among NICU is high, exchange blood transfusion was done more frequently which could be explained by relative late presentation with high mean bilirubin level causes of severe neonatal hyperbil-lirubinemia were undetermined in 27.4% complication of EBT included, electrolytes disturbances, thrombocytopenia
and cholestasis, major complications included NEC, sepsis and death. Kernicterus still recorded in NICU with bad outcome and the most important determinant factor for it is a pre-exchange bilirubin level.

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Category: Vol. 80, December 2012

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Low Level LASER Therapy Versus Shock Wave Therapy in Shoulder Impingement Syndrome,SHIMAA N. ABO ELAZM and OLFAT A. KANDIL

Abstract
The Purpose: Of this study was to investigate the effects of Low Level LASER Therapy (LLLT) versus Shock Wave in treatment of shoulder impingement syndrome.
Subjects: Forty patients of both gender (21 females and 19 males) diagnosed as shoulder impingement syndrome with mean age (41.35±3.25) years represented the sample of the study. They were recruited from the Hospital of Misr University for Science and Technology.
Design: Forty patients were evaluated pretreatment and post treatment for shoulder pain severity, shoulder functional disability, shoulder flexion, abduction and internal rotation motions.
Material: Radial Extracorpreal shockwave device and Gallium arsenide low level LASER therapy apparatus were used for treatment. Guymon Goniometer, visual analogue scale (VAS) and quick disability questionnaire were used for evaluation.
Methods: Forty patients were randomly distributed into two equal groups; each group consisted of 20 patients. Group I with a mean age of (49.39±3.91) years received 12 sessions of LASER therapy (total dose of 14.4 J/session, 3 sessions per week) and therapeutic exercises (strengthening exercises, and stretching exercises for shoulder joint) 3 times per week, for 4 consecutive weeks. Group II with a mean age of (50.33±3.22) years received 12 sessions of shock wave (6000 shock, 2000 shocks per session, 3 sessions, 1 weeks a part, 022mJ/mm2) and the same therapeutic exercises as group I (3 times per week, every other day, for 4 consecutive weeks).
Results: The results revealed significant difference in all measured variables regarding group I and II when comparing pre and post treatment mean values (p<0.0001). Significant improvement was observed in favor of group I in all measured variables (pain severity, shoulder disability index and range of motion).
Conclusion: Both LLLT and the shock wave therapy had a significant effect on decreasing shoulder pain severity, shoulder functional disability, increasing in shoulder flexion, abduction and internal rotation motions. However, LLLT was more effective in treatment of patients with shoulder impinge-ment syndrome.

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Category: Vol. 82, March 2014

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Comparative Study between Fibroscan and Liver Biopsy Results in Chronic HBV Egyptian Patients: A Single Center Pilot Study, SAHAR Z. MAKLAD and EHSAN HASSAN

Abstract
Objective: Recent reports have shown that liver stiffness measurement using Fibroscan allowed accurate prediction of hepatic fibrosis in patient with chronic hepatitis C but few reports are published for chronic hepatitis B especially in Egypt. The study aimed to compare and validate the results of fibroscan versus liver biopsy among chronic HBV patients who are not candidates for treatment according to Egyptian Guidelines.
Methods: Thirty one chronic HBV patients not candidates for treatment were included in our study. Patients who were histologically confirmed with liver biopsy within recent 6 months were enrolled. Inclusion criteria were males and females above 18 years, HBeAg positive or negative cases with HBV DNA by 2000IU/ml with normal or fluctuating liver enzymes. Exclusion criteria included concomitant HCV infection, evidence of liver disease induced by other causes, and age less than 18 years. Patients were subjected to liver biopsy and fibroscan study. Both liver biopsy and fibroscan were performed and interpreted in Hepatology And Pathology Departments at National Hepatology and Tropical Medicine Research Institute, Cairo (NHTMRI).
Results: The mean age of our patients was 35.4. Study population showed male predominance as the number of males was 25 cases (80.6%) while the number of females was 6 (19.4%). The mean ALT was 35.01U/L and the mean AST level was 30.89U/L.HBV DNA levels were quite variable with a minimum of 188IU/ML and a maximum of 80,162,000 IU/ML with a mean of 2,613,52 1. Liver biopsy results showed that 4 cases had a fibrosis score of (F0), 19 cases (F 1), 5 cases (F2), and only 3 cases (F3). Fibroscan results coincided with liver biopsy cases in all 4 cases with F0. Eleven cases with an F1 biopsy result had a less fibroscan result of F0, 5 cases had an increased fibroscan score of F2 and only three cases coincided with liver biopsy. Fibroscan results coincided with liver biopsy in 4 cases out of 5 in F2 liver biopsy group. The 3 cases that showed a liver biopsy result of F3 had a less fibroscan result of F2.
Conclusion: Liver stiffness assessment was found to be correlated with liver fibrosis however the results of liver biopsy were not similar to fibroscan results. Most of the cases had a fibroscan result less than liver biopsy results by Metavir score. Only cases with Metavir score of F0 and most of F2 coincided with fibroscan results.

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Category: Vol. 82, December 2014

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Resistance Training Versus Aerobic Training on Obese Non Alcoholic Fatty Liver, MANAL K. YOUSSEF and MARIANA V. PHILIP

Abstract
The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing dramatically affecting up to 30% of the population worldwide and obesity is the most common risk factor. At present, diet and life style modification (physical training) are the best treatment options as pharmacological management of NAFLD has had disappointing results. The current study was conducted to detect the effect of diet accompanied with aerobic exercise versus diet with resistance exercise on liver enzymes and lipid profile and fasting glucose in obese patients suffering from NAFLD. Thirty patients with NAFLD were included into this study from Department of Internal Medicine, Cairo University Hospitals. Their ages ranged from 20-45 years, subjects were divided randomly into two equal groups (A&B). Group A received diet and resistance exercises. Group B received diet and aerobic exercises for 3 months with a total of 36 sessions. All partic-ipants were evaluated before the first session of treatment and at the end of treatment through: Anthropometric measure-ments, which include (weight, height, body mass index, waist circumference, hip circumference), lipid profile, liver enzymes. On comparing the pre and post treatment values of both groups, results revealed decrease in Weight 1.17% in resisted training (RT) compaired to 4% in aerobic training (AT) respectively, BMI decreased 3.3%, 4.5% respectively, waist circumference decreased 4% and 6% respectively, hip circum-ference decreased 0.32% and 31 % respectively, fasting glucose 4.7% and 10.7% respectively, Triglycerides decreased 12.3% and 18% respectively, Total cholesterol decreased 7% and 9.7% respectively, LDL decreased 17% and 24.5% respectively, HDL increased 3.5% and 10% respectively, AST decreased 16.9% and 22.4% respectively, ALT decreased 12.4% and 23.9% respectively.
Conclusion: In sedentary, overweight, and obese adults, aerobic training was consistently more effective than resistance training at improving lipid profile and liver enzymes.

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Category: Vol. 83, September 2015

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Nurse's Perception of Barriers Toward Discussing Female Sexual Issues in Nursing Practice, ZAINAB M. MAHMOUD and MAGDA A. FAWAZ

Abstract
Background: Nursing as a holistic practice, address all dimensions of human health and functioning including sexu-ality to identify any alterations of health.
Aim: This study aims to assess nurse's perception of barriers toward discussing female sexual issues in nursing practice.
Subjects and Methods: A descriptive exploratory research design was adopted for this study.
Sample: A total of 200 convenience samples of nurses working in different setting at teaching hospital affiliated to Cairo University were participated in this study.
Tool: Data was collected through six months during 2013 utilizing (I) interviewing questionnaire sheet was developed by the research investigator which includes three parts: A) Socio demographic profile of the subjects, B) Subject's previous education, experience and training related to sexuality, C) Nurse's knowledge regarding issues affecting female sexual function; (II) Scale for perceived barriers using Likert scale scoring ranged from 1-5.
Result: Findings of this study revealed that barriers includes three parts: A) Nurses perceived barriers such as: Lack of knowledge (67%), feeling embarrassed (65.5%) lack of experience (64%) and afraid of violating woman privacy (59%); B) Women barriers as perceived by nurses such as: Woman concerned with other problems (58%), woman em-barrassed (57%) and woman feel that nurses are too young or not married to understand them (55.5%); and C) Work and community barriers: Lack of a private setting (68%), sexuality representing a low healthy priority (61%) and lack of a role model (58.%) were the common barriers as perceived by the study sample
Conclusion: Finding of this study indicate that there are a numerous barriers which hinder nurses to discuss sexuality with woman.
Recommendation: Sexual education in nursing curriculum, developing an evaluation tool to integrate sexuality history as a routine screening issue in clinical settings, as well as, increase the awareness of nurses about their role in sexuality care.

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Category: Vol. 84, June 2016

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The Effect of Assertiveness Training Program on Psychiatric Nurses' Communication Skills and Self-Esteem, NAGLAA A. MOHAMED, NADIA A. ABD EL-HAMMED and REDAA A. THABET

Abstract
Background: Assertiveness is one of the essential skills in the modern working environment, there are many benefits of being assertive such as; better time management, increased self-esteem and the ability to negotiate more effectively. Psychiatric mental health nurses are confronted with the daily responsibility of assessing, intervening and evaluating client responses to stress and client interactions. They need to identify the meaning of their own stress and develop strategies that increase personal and professional growth. Some nurses may have learned to express their needs honestly, to use anger constructively, to improve personal and work relationships and to build self-confidence through assertive behavior. But others still struggle with being assertive, perhaps because they don't believe they have the right to be assertive, they are anxious about asserting themselves or they don't know how to be assertive. Learning assertive techniques are considered as tools for coping skills with a variety of life stressors. Increasing assertive behavior becomes an expression of person's feelings. So the aim of this study was to assess the effect of assertiveness training program on psychiatric nurses' communication skills and self-esteem.
Subjects and Methods: Setting: The study was conducted at the Psychiatric Mental Health Hospital in Assiut, Egypt. subject the study sample comprised 30 nurses (14 males and 16 females), three tools were used for data collection, namely: Sociodemographic data structured interview schedules, self-esteem inventory, assertive communication skills checklist (ACs-list).
Results: The study proved that, the highest percentage among nurses aged from or more than 30 years, females than males, and single, more than 2/3 (73.3%) of the studied group was lived in rural area. Highly statistical significant difference was noticed between before and after training program regard-ing practice about communication skills, and assertiveness the effect of training program on self-esteem a significant change was found after the training program.
Conclusion: Implementation of assertiveness training program with psychiatric nurses has a positive effect on improving their self-esteem.
Recommendation: The study recommended continuous education provided for all nursing personal working and make nurses updated of new knowledge and technology. Implemen-tation of assertiveness training program for nurses and under-graduate nursing students.

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Category: Vol. 77, March 2009

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Apoptosis of Peripheral Blood Cytotoxic T Lymphocytes in Chronic Hepatitis C Virus Infection: Relation to Disease Severity and Response to Therapy,

ERVAT ABO GABAL, DAHLIA ABD EL-MOHSEN, KHALID GAMIL, OLA I. AHMED and SOHA A. EL-HADY

Abstract
Background: More than 80% of HCV-infected individuals develop chronic disease, which can progress to liver cirrhosis and hepatocellular carcinoma. T cell-mediated protection against HCV depends on constantly activated effector CD8+ T cells that control emergence, spread and expansion of the virus. Why these cells fail to contain HCV replication in 70- 80% of the individuals who develop persistent viremia is not clear. Fas receptors (APO-1 or CD95) and the Fas ligand system (Fas/FasL) have been implicated in the induction of apoptosis which is related with the pathogenesis of hepatitis C.
Aim of the Study: Was to assess the expression of CD95 (Fas/ APO-1) (as an apoptotic marker) on peripheral blood cytotoxic T lymphocytes from patients with chronic HCV infection and to correlate this with disease severity in the liver, response to antiviral therapy and extrahepatic autoim-mune manifestations.
Subjects and Methods: Thirty patients with evidence of chronic HCV infection and 10 healthy age and sex matched volunteers with negative HCV antibodies sera serving as controls were enrolled into the present study. Our patients were classified into two main groups according to antiviral therapy, Group A: They were 17 patients not receiving treat-ment and Group B: They were 13 patients who received antiviral therapy for 24 weeks. Group A patients were further subdivided according to the presence or absence of extrahepatic manifestations into two groups: Group I: They were 11 patients not receiving therapy and had no extrahepatic manifestations. Group II: They were 6 patients not receiving therapy and had extrahepatic manifestations. Group I patients were also sub-divided according to the necroinflammatory score in liver biopsy into three groups with: Mild, moderate and severe disease activity. They were also subdivided as regard fibrosis stage in liver biopsy into groups with: Moderate and severe fibrosis. Group B patients were further subdivided according to their response to antiviral therapy into: Group III: 6 patients received therapy and were non responders and Group IV: 7 patients received therapy and showed good response. After detailed history taking and thorough clinical examination, the following investigations were done: CBC, AST and ALT, serum cryoglobulins (for patients with extrahepatic disease)
and flowcytometric estimation of the percentage of apoptotic peripheral blood cytotoxic T lymphocytes (CD8+CD95+) and non apoptotic cytotoxic T lymphocytes (CD8+ CD95-). Current liver biopsy was performed in patients of Group I and examined histopathologically.
Results: There was highly statistically significant differ-ence between HCV patients and controls as regard ALT, percentage of apoptotic cytotoxic T lymphocytes (CD8+ CD95+) and non apoptotic cytotoxic T lymphocytes (CD8+ CD95-) (p<0.001). There was statistically significant difference between patients of Group I, II, III, IV and controls in per-centage of CD8+CD95+ and CD8+CD95- cells. Comparison between Group I and II revealed non significant difference in percentage of CD8+CD95+ and CD8+CD95- cells or in percentage of CD8-CD95+ cells (apoptotic non cytotoxic T) (p>0.05). Comparison between Group III and IV revealed statistically significant difference in percentage of CD8+CD95+ and CD8+CD95- cells (p<0.05). In Group I the percentage of CD8+CD95+ tended to correlate with activity index of liver biopsy but significantly correlated with serum ALT in Group III. In Group II significant positive correlation between percentage of CD8+CD95+ and AST with tendency toward correlation with ALT was found. Also percentage of CD8+CD95+ correlated with purpura and arthritis but not with cryoglobulinemia. Percentage of CD8+CD95+ showed non statistically significant correlation except with serum prothrombin time in group IV. There was increase in the percentage of CD8+CD95+ cells in higher grade of necroin-flamatory activity and in higher stage of fibrosis in liver biopsy in group I.
Conclusion: Our findings support the suggestion of major role of peripheral blood CD8+ T cells in elimination of HCV and suggest that cellular immune response plays a key role not only in viral elimination, but also in liver pathology associated with HCV-infection. Monitoring apoptosis of CD8+ T cells by measuring FAS expression is useful in follow-up of antiviral response in these patients. Finally, Fas/FasL pathway is critical in persistent HCV infection in humans and represents a potential target for restoring function of exhausted HCV-specific CTLs.

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Category: Vol. 80, September 2012

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Tonsillar Calcification, Computed Tomography and Clinical Findings, A Case Study,HOSAMA.YOUSEF, HAZEM A. YOUSEF, MOHAMED K.M. OMAR, MOHAMED K. AHMAD and TALAAT M.FARGHALY

Abstract
Introduction: Tonsillar calcification or tonsil stones (ton-silloliths) are foul smelling lumps of whitish or yellowish color. They are usually asymptomatic but can be associated with halitosis and bad taste, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. They are a common incidental imaging finding in adults, especially in computed tomography (CT).
Aim of the Work: This is a case study about palatine tonsillar and nasopharyngeal calcifications which require awareness from radiologists, especially in patients with clinical symptoms and signs which may suggest their presence.
Material and Methods: The routine CT studies done for paranasal sinuses or the neck were carefully inspected for presence of tonsillar and/or adenoids calcification. Positive cases with incidentally found calcifications were referred for evaluation by the ear, nose and throat specialists.
Results: Incidental calcifications were found in 31 patients; 30 of them had tonsilloliths and only one patient had calcifi-cation within the adenoids remnants without concomitant palatine tonsillar calcification.
Conclusion: Tonsilloliths are tiny stones lodged in the pharyngeal tonsils, incidentally discovered during CT exam-inations. The awareness of the presence of these calcifications is important for the radiologists to avoid overlooking of these pathological entities which could be of clinical value.

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Category: Vol. 86, December 2018

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Role of Anorectal Manometry in Anal Fissure and Outcome of Tailored Lateral Sphincterotomy in Hypertensive Internal Anal Sphincter: A Modified Minimal Invasive Technique, BESHOY N. NAEEM, ABDALLAH B. ABDALLAH, ALMOATAZ A. EL-TAYEB and RAMY A. HASSAN

Abstract
Background: CAF is a common benign anorectal problem that substantialy impairs the patient's life. Consequently, a rapid and effective solution is required.1
Aim of Study: To do lateral internal sphincterotomy extending up to the upper end of the fissure (but not to the dentate line) in patients have CAF with hypertonic IAS to keep continence. In case of low RAP, V-Y plasty will be done.
Patients and Methods: Our study was done on 34 patients with CAF divided into 2 groups, group 1 included 28 patients with hypertonic IAS underwent tailored LIS and group 2 included 6 patients with normotonic/ hypotonic IAS underwent V-Y plasty to keep continence from June 2017 till December 2017 in general surgery department ,Assiut university hospital.
Results: In group 1 there is no incontinence or recurrence, complete healing of fissures occurred in 96.4%. Only one patient had unhealing fissures, postoperative complications include bruising occurred in 3.5% and minor sepsis of sphinc-terotomy wound in 3.5%, in group 2 there is minor sepsis of the flap in 16.6%.
Conclusion: Our study was done on 34 patients with CAF. These patients were divided according to anomanometric study into 2 groups: - Group 1 included 28 patients with high RAP in whom tailored LIS was done by modified technique which is taiored equal to the length of the fissure which is minimally invasive with good healing rate and no recurrence or incontince postoperative and minor bruising and sepsis of the wound and significant reduction in postoperative RAP. - Group 2 included 6 patients with normotonic /hypotonic IAS in whom excison of fissures were done and the defect is closed by V-Y plasty with good healing rate and low postoperative sepsis.
So tailored lateral internal sphincterotomy is the effective treatment of CAF with anal hypertonia, safe and not affect continence.

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Category: Vol. 77, June 2009

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Early diagnosis of Neonatal Sepsis: The Role of 16S rRNA Gene Sequence Analysis,ISMAIL M. EL-HAWARY, NADA N. NAWAR, MERVAT G. EL-ANANY, MARIAM A. YONAN and MANAL ELSEWEIFY

Abstract
Background: Early diagnosis and treatment of newborn infants with suspected sepsis are required to reduce sepsis associated mortality and to prevent severe life- threatening complications. Clinical diagnosis is difficult and, blood culture, is often negative in the face of strong clinical indicators of septicemia, on the other hand, molecular diagnostics have proved to be a valuable adjunct for detection of neonatal bacteremia. The purpose of this study was to evaluate the role of 16S rRNA gene sequencing for rapid and sensitive diagnosis of clinically septic neonates with pathogen identification to allow for early and specific treatment of neonatal infections.
Subjects and Methods: A prospective study conducted in both NICUs of Kasr Al Aini hospital and Children’s hospital, Cairo University over a period of 3 months from April 2008 to June 2008. Fifty neonates undergoing sepsis evaluation were included in this study. Risk factors, clinical manifestations and hematological findings suggestive of sepsis were recorded. Bloodculture and broad range 16S rRNA polymerase chain reaction (PCR) were collected from clinically septic neonates to confirm diagnosis of sepsis. Genotypic identification of bacteria by sequence analysis of the 16S rRNA gene was performed on all samples positive in PCR.
Results: Fifty neonates suspected clinically of having sepsis were included in the study. 61 samples were collected as a part of evaluation of infection, 50 samples upon admission and 11 samples as follow-up due to persistence of clinical manifestations. The rate of culture proven sepsis was 19.7% (12/61). With the molecular method of broad range 16S rRNA PCR, the detection of bacteria improved to 29.5% (18/61). PCR revealed sensitivity, specificity, positive predictive value and negative predictive value of 91.7%, 85.4%. 61% and 97.6% respectively, while the accuracy of this test was 86.7%. So, compared to culture, the 16S rRNA PCR demonstrated a high negative predictive value for ruling out neonatal sepsis. According to the PCR results, hyperthermia, feeding intoler-ance and abdominal distension were found to be significant among neonates with positive PCR. As for hematological manifestations, we found a significant association between increasing number of abnormal hematological findings and PCR positivity (p=0.006, p for ordinal correlation =0.01). Odds ratio for having 2 or more abnormal hematological findings and PCR positivity was 3.77 (95% CI=1.2-12.3).
Sequence analysis was done for further identification of organism on all samples positive in PCR. The sequenced PCR was in accordance with blood culture results in 10 samples while one sample showed conflicting results (91 % agreement), Seven samples showed no growth by culture but were identified by sequence analysis. The sequencing-based identification of these isolates included: Enterobacter cloacae, Staphylococcus carnosus, Proteus mirabilis, Haemophilus influenzae, Strep-tococcus pyogenes and Klebsiella sp. One sample yielded insufficient DNA to be analyzed.
Conclusion: Broad range 16S rRNA PCR can be used to rule out sepsis. Both PCR and sequence analysis can provide additional diagnostic data that cannot be obtained with the use of broad-range PCR or routine laboratory tests alone. In neonates with clinically suspected sepsis, a primary decision could be made when the PCR results are completed, and within few hours, genotypic identification from the sequencing could be available to allow for early treatment.

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Category: Vol. 80, March 2012

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Behavioral Assessment of Mice Treated with Zinc and Paroxetine,HASAN S. AL AMRY

Abstract
Background: Less than half of older patients with major depression disorder (MDD) achieve remission with antidepres-sant medications and rates of remission are even poorer for those with comorbid condition. The addition of another medi-cation to the antidepressant regimen of patients not responding adequately to their treatment has become a common intervention.
Aim of Study: To examine the behavioral changes of acute and subacute intraperitoneal administration of zinc in the forced swimming test (FST) in mice; to investigate if addition of zinc to selective serotonin reuptake inhibitor “parexotine” would enhance the antidepressant effect of paroxetine; and to study the effects of combined administration of zinc and paroxetine on spontaneous locomotor activity in mice.
Material and Methods: It has been hypothesized that addition of zinc with its multiple pharmacological effects to the antidepressants may modulate and enhance their efficacy. We investigated the behavioral changes of acute and sub-acute interaction of zinc with paroxtine in the FST in mice. Mice were injected with either paroxtine (20mg/kg); zinc sulfate (40mg/kg) or paroxtine in combination with zinc for one day and one week (once daily).
Results: Significant antidepressant effect of paroxtine alone or zinc alone has been shown in a decrease of immobility and increase of swimming behavior. Also, results showed a significant decrease in the immobility time and increase in the swimming behavior time of the animals treated with zinc in combination with paroxtine as compared with animals treated with either paroxtine or zinc alone. There was no significant difference in the animals’ behavior between acute and sub-acute treatment with zinc or even upon its addition to paroxetine. None of the treatment regimens have shown any significant changes in the animals’ motor activities.
Conclusion: The present study supports the notion that administration of zinc may offer additional antidepressant activity. This combination may have a significant clinical application in psychiatric patients particularly in geriatric patients or other population where zinc level has shown dramatic decrease.

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Category: Vol. 77, December 2009

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Validity of Magnetic Resonance Imaging in Early Rheumatoid Arthritis,KHALED FAWZY Z. HASSAN and INASSE IBRAHIM GABALLAH

Abstract
Aim of Study: To assess the diagnostic value of magnetic resonance (MR) imaging in patients with possible early-stage RA in whom the clinical diagnosis is equivocal and who present with polyarthralgia without radiographic evidence of RA.
Patients and Methods: This study comprised 81 patients (20 men and 61 women; mean age, 44±12.7 years), who attended or were referred to the Rheumatology Clinic of Abha Private Hospital. Patients presented with persistent polyarthral-gia with possible early-stage rheumatoid arthritis (RA) and without radiographic evidence of RA. Postero-anterior and oblique hand radiographs in all patients were obtained and interpreted. Participant patients underwent contrast-enhanced MR imaging as part of their diagnostic work-up. To confirm the final diagnosis, patients were instructed to do follow-up visits to the Rheumatology Clinic for at least one year after the MR imaging. A total of 11 patients were excluded from our study as they did not continue their one-year follow-up visits to the Rheumatology Clinic after having the MR imaging.
Results: The confirmed diagnoses of 70 patients were that 38 patients had RA, while 32 had non-RA diseases. By applying the MR imaging criterion, 38 patients were classified as having RA and 32 were classified as having a non-RA condition. The sensitivity of the MR imaging proved to be 97.4%, while its specificity was 90.6%. Positive predictive value was 92.5% while the negative predictive value was 96.7%. Its diagnostic accuracy was 94.3%.
Conclusions: The MR imaging criterion shows excellent validity with high sensitivity, specificity, predictive values and accuracy for the diagnosis of early-stage RA.
Recommendation: MR imaging be added as a useful tool for the evaluation of patients suspected of having early-stage RA.

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Category: Vol. 80, March 2012

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Acoustic and Aerodynamic Analysis of Tracheoesophageal Speech after Total Laryngectomy, MOHAMED M. EL-SAWY and RANA A. KHALIFA

Abstract
Objectives/Hypothesis: The purposes of the study were to determine the acoustic and aerodynamic measurements of voice of the patients underwent primary tracheoesophageal voice prosthesis (TEP) after total laryngectomy (TL).
Patients and Methods: From May 2007 to July 2011, 16 male patients presented with advanced laryngeal tumor at Al Hussein University Hospital underwent TL and primary TEP participate in this study, no secondary TEP was done. All patients who underwent acoustic and aerodynamics study were at least 6 months of the postoperative period. Voice recording was carried out by using the Mutli-Dimentional Voice Program, Kay Elemetrics corp. using the software option for Muti-Speech. The following acoustic measurement param-eters were used in this study: Fundamental frequency, intensity, the Jitter and Shimmer. In addition, aerodynamics measures in the form of maximum phonation time (MPT). Computer analysis compared fundamental frequency, intensity, Jitter, and Shimmer with a male control group that had normal larynxes, and no complaints about voice. Statistics were done by computer using Instat-ANOVA.
Results: Among the TL/TEP speaker, average fundamental frequency was statistically significantly lower than normal. The mean of the average fundamental frequency 107.05±  49.968 SD with range between 71.448Hz and 226.24Hz. Intensity was lower than normal, but not statistically significant. The mean was 59.156±5.209 SD with range between 47.59dB and 69.16dB. Jitter was high and statistically significant comparing to the normal. The mean of the jitter was 6.338±  5.481 SD with range between 0.5800 and 22.129. Shimmer was high and statistically significant comparing to the normal. The mean of the shimmer was 1.889±0.9537 SD with range between 0.1770 and 3.484. MPT was lower and statistically significant when compared to the normal. The mean was 10.494±3.887 SD with range between 5.130 seconds and 17.020 seconds.
Conclusion: In conclusion, TEP has improved speech quality after TL and it is now, the method of choice for many patients and physicians. Compared with other methods of communications, a higher number of patients achieve an acceptable voice, enabling them to communicate under virtually all social circumstances. Finally, this study will encourage the authors for future researches on acoustic analysis of different method of voice rehabilitations after treatment of laryngeal tumors and with other researches in different insti-tutions.

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Category: Vol. 78, June 2010

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Duane Retraction Syndrome,KARIMA L. SHALABY and MOSTAFA BAHGAT

Abstract
Purpose of Study: To evaluate and to manage if manage-ment indicated for cases of Duane retraction syndrome.
Patients and Methods: 15 Duane retraction syndrome (DRS) patients seen in Pediatric clinic in Tripoli Eye Hospital in period from January 2006-December 2006. Complete ophthalmic examination including ortho-optic assessment for all cases.
Results: Patients age ranged 1 year to 20 years in this group of study, females were affected more than males with 2 to 1 ratio. Type 1 (esotropic) is the most common 80% of cases. Left eye was affected more than right eye. Bilateral in 13.3% of cases. DRS clinical picture varies widely, surgical intervention will not eliminate the abnormality but will lessen it. Two cases were operated upon to improve alignment in primary position. Medial rectus muscle was found too tight on forced-duction test surgery included bilateral medial rectus muscle recession.
Conclusion: DRS picture varies widely, no treatment is available to eliminate the abnormalities but only to lessen them. The limitations in treatment are due to poor correction of ductions and versions. Also, up shoot, down shoot and enophthalmos correction is not complete.

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Category: Vol. 77, March 2009

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Ferritin and Insulin Resistance in Patients with Type 2 Diabetes Mellitus,SOAD SULTAN, AMR AL-MELIGI, NAGWA ALTAWEEL and HALA ABD ELAZEM

Abstract
Diabetes mellitus is a syndrome characterized by chronic hyperglycemia and disturbance of carbohydrate, fat and protein metabolism associated with relative or absolute deficiency of insulin secretion and/or insulin action. Ferritin is the major iron storage protein and plays a key role in iron metabolism. In general population, body iron stores are positively associated with the development of glucose intolerance, type 2 diabetes. The aim of the present study was to measure serum ferritin in patients with type 2 diabetes and to study the relationship between serum ferritin, fasting blood glucose, glycated hemo-globin, insulin level and insulin resistance in patients with type 2 diabetes mellitus. This study involved 40 female patients in child bearing period with type 2 diabetes mellitus selected from diabetes and endocrine clinic in Kasr El-Aini Hospital. Twenty healthy, age matched, females were taken as a control group. All subjects were subjected to: History taking, clinical examination and laboratory Investigation including fasting plasma glucose, glycated hemoglobin (HbA1c), fasting insulin and serum ferritin. We found that serum ferritin was signifi-cantly higher in patients with type 2 DM compared with the control group (p<0.001) and in patients with type 2 DM ferritin level was positively correlated with fasting blood glucose (p<0.001), glycated hemoglobin (p<0.001), fasting insulin level (p<0.05) and insulin resistance (p<0.001).

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Category: Vol. 77, September 2009

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Appendiceal Abscess Imaging-Guided Drainage in Children: Can it Replace Laparotomy?,

ABDELHADY T. EMAM and FATMA M. AWAD

Abstract
Introduction: Acute appendicitis is the most common condition requiring emergency abdominal surgery in the pediatric population. Abscess formation is a serious conse-quence to the delayed diagnosis. Percutaneous imaging-guided drainage is the first-line of treatment for infected or symp-tomatic fluid collections in the abdomen and pelvis. The aim of this study is to determine the role of imaging-guided drainage in treating pediatric patients with appendiceal abscess.
Materials and Methods: The diagnosis of appendicitis was based on clinical data, ultrasound (US) and CT scan. Abscess was diagnosed by the presence of fluid collection, +/- air fluid level, having an enhanced wall on CT scan. Abscess drainage was performed guided by CT scan using Seldinger technique. Follow up was done by focused CT scan.
Results: The study consists of 33 pediatric patients, 18 males and 15 females, with age range of 6 to 15 years. Twenty-four cases (72.8%) had solitary abscesses. For four of them, needle aspiration was done and for the rest, catheter insertion was performed. Only in two cases, imaging-guided drainage failed, which warranted surgical interference. Nine cases (27.2%) had multiple collections. Six collections were treated by needle aspiration, while 16 had catheter insertion. Unfor-tunately, two of these cases, eventually, needed surgery. The drainage procedure for all cases was done guided by CT scan. Non-surgical complications occurred in two cases (6%). The mean dwell time of the inserted catheters was 6.2 days. The mean inpatient stay in the hospital was 10.3 days.
Conclusion: Imaging-guided percutaneous drainage is a safe and effective treatment for appendiceal abscesses in children. It can replace invasive surgery.

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Category: Vol. 83, September 2015

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Computed Tomography Versus Fluoroscopy Guidance in Antecrural Celiac Plexus Block, KHALED ABD EL-HAMEED, IKRAM H. MAHMOUD, AZZA F. OMRAN, AHMED SHAKER and SUZAN ADLAN

Abstract
Background: Celiac plexus block has been performed by an anterior or posterior approach. The posterior approach can be either for antecrural or retrocrural space. Antecrural site refers to the injection of neurolytic agent into the space anterior to the diaphragmatic crura and aorta. The antecrural space is the most common site of neurolytic agent injection and is highly effective in achieving pain control because injection into this space directly destroys the celiac plexus where it is most concentrated, and minimizes the risk of somatic nerve roots block, which is associated with retrocrural approach. The purpose of this study is to highlight differences between two techniques as regard Time of doing each technique from its beginning to the end and any complications occurred.
Methods: 60 patients with pancreatic cancer pain for which pharmacological treatment (NSAIDs and opioids) proved either ineffective or limited by side effects were randomly allocated into two groups. Study was done over eighteen months from January 2013 to June 2014. Each patient is assessed by Time of doing each technique from its beginning (needle insertion) to the end and any complications have been recorded.
Results: The parameters were comparable with significant difference between both techniques (p-value !90.05) regarding time consumed and there were no statistical significance regarding complications which occurred in both procedures.
Conclusion: We concluded CT scanning is useful to define the retroperitoneal anatomy especially when anatomic relations of the retroperitoneal organs are distorted by tumor or previous operations limiting time consumed during the procedure. However the technique does not seem important in results or complications.

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Category: Vol. 77, March 2009

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Study of CCR5 Gene Polymorphism in Rheumatoid Arthritis,NOHA SHAHEEN, LOBNA O. ELMESSERY, MAI SHERIF, AYA NASSEF, DINA R. BAHGAT and RASHA GHEITH

Abstract
Chemokines are critical for the inflammatory process in autoimmune diseases such as rheumatoid arthritis (RA). The chemokine receptor-5 (CCR5) mediates chemotaxis by CC chemokines and is expressed by lymphocytes with Th1 phe-notype and monocyte/macrophages. A 32bp deletion in the CCR5 (CCR5-delta 32 allele) abolishes receptor expression in homozygotes, while CCR5-delta 32 carriers express less receptor level than wild type homozygotes. This polymorphism is related to resistance to HIV-1 infection and progression to AIDS. It is hypothesized that CCR5-delta 32 allele may modulate the inflammatory response involved in rheumatoid arthritis and therefore may affect disease severity, susceptibility or both. In the present study 70 rheumatoid arthritis patients and 40 healthy individuals were genotyped. The frequency of CCR5-delta 32 allele was significantly higher in healthy individuals compared to rheumatoid arthritis patients (45% Vs 17%) respectively (p.value 0.033). Homozygous delta 32 mutation was not detected in patients or controls No significant difference was found between CCR5-delta 32 carriers and wild type homozygotes regarding clinical or laboratory findings except for the tender joint count and rheumatoid factor posi-tivity which was higher in wild type homozygotes (p.value 0.046 and 0.007 respectively). Our data suggest that CCR5- dlta 32 carriers may partially protected against rheumatoid arthritis, and suggest CCR5 receptor as a candidate for targeted therapy in rheumatoid arthritis.

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Category: Vol. 77, March 2009

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Do Survivin and HER-2/neu Play a Role in Rheumatoid Arthritis?

MARIANNE S. MAKBOUL, HALA MAHMOUD, GEHAN HAMDY and MOHAMAD R. ALMASRY

Abstract
Rheumatoid arthritis (RA) is an inflammatory joint disease characterized by hyperplasia of synovial tissue and pannus formation growing invasively into the cartilage, followed by cartilage and bone destruction. In RA, the proliferation of synovial fibroblasts and their invasive growth are due to impairment in the regulation of the cell cycle. Survivin belongs to the apoptosis-inhibiting proteins (IAP) family and regulates the inflammatory and destructive process inside the joints of patients with RA. RA Synovial Fibroblasts (SFs) over express the ErbB2/HER2 member of the epidermal growth factor (EGF) receptor family relative to normal fibroblasts. The aim was to study the role of survivin and HER-2/neu in the pathogenesis of RA and the association between their level and the presence of erosion in RA patients and evaluation of the possible influence of the ongoing treatment on their serum level. In this study, serum survivin and serum HER-2/neu levels were measured in 35 erosive and non-erosive RA patients and compared with age and sex matched healthy population. There was a statistically significant difference in serum HER-2/neu between RA patients and controls and also between RA patients treated with methotrexate and those treated with methotrexate and others. There was a statistically significant difference in the serum level of survivin between erosive and non-erosive RA patients.

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Category: Vol. 79, June 2011

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Assessment of Adherence to Iron and Folic Acid Supplementation and Prevalence of Anemia in Pregnant Women,ZAKIA M. IBRAHIM, SEHAM ABD EL-HAMID, HEND MIKHAIL and MAGED S. KHATTAB

Abstract
Anemia during pregnancy is a worldwide problem, Iron deficiency and folate deficiency are considered as the first two causes of nutritional anemia.
Many antenatal care program distributed iron and folic acid supplementation to pregnant women's the effectiveness of theses intervention in reducing maternal anemia's still has been in adequate. Some suggest that poor compliance is the probable reason for the ineffectiveness of such program.
Aim of the Work: The aim of this study is to improve the adherence of pregnant women to Iron and Folic acid supple-mentation.
Study Objectives: To measure the adherence (compliance) of pregnant women to iron and folic acid supplementation and prevalence of anemia in pregnant women and to study the different factors affecting the adherence to Iron and Folic acid supplementation.
Material and Methods: This descriptive cross sectional study was conducted on 270 pregnant women in the second or third trimester attending El-Salam Primary Health Care center in Ismailia governorate were included in the study. study done on January, February, March 2008. Women were excluded from the study if have any of the following disorders including (Hemolytic anemia, hemoglobinopathies, mental disorders, chronic diseases, or chronic inflammatory disorders). All women were assessed for adherence to iron and folic acid supplement through self reported and pill count adherence. Hemoglobin concentration from follow-up charts was recorded.
Results: According to self reported adherence; 58.9% showed no adherence and 41.1% shows adherence while concerning pill count adherence 63.3% showed no adherence and 36.7% showed adherence. Statistically significant differ-ence was found between results of self reported adherence and pill count adherence. 62.2% of the study group were anemic. Hemoglobin level ranged between 6.9-13.0g/dl, and mean ±  SD were 10.5±0.7g/dl. 126/168 (75%) mild anemia, 39/168 (23,2%) moderate anemia, 3/168 (1.8%) severe anemia.
Most prevalent cause of non-adherence was frustration from many tablets (75/270 pregnant women; 54.3%). When studying the best fitting multiple linear regression model for pill count adherence among pregnant women of study sample, it was found that age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors of pill count adherence. Conversely, crowding index, gravidity, and side effects occurrence were statistically significant indepen-dent negative predictors of pill count adherence. The model explains 24% of the variation of pill count adherence, as indicated by the value of r-square.
Conclusion: Pill count is more accurate method for esti-mation of adherence to iron and folic acid supplement than self reported adherence. Age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors. Conversely, crowding index, gravidity, and side effects occur-rence were statistically significant independent negative predictors.

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Category: Vol. 81, June 2013

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Colostomy: Developing Nursing Care Standards for Patient with Colostomy,NABEEL M. BHZEH, SAMIA M. TELEB, MADIHA A. MAHMOUD and AHMED M. SOLIMAN

Abstract
Nursing care standards of colostomy are significant action to ensure quality of care. The examination of nurses' knowledge and practices regarding the nursing care standards of colostomy has not been conducted before at Assiut University Hospital. This descriptive study aimed atestablishing the level of nurses' knowledge and practice and to examine the relationship between nurses' knowledge and practice for developing the nursing care standards of colostomy. The subjects were nurses working in the surgical wards of hospital. The Nurses' Knowl-edge Questionnaire and Practice checklist were administered. Data were analyzed by descriptive statistics and Pearson product-moment correlation. The findings revealed that all of nurses (100%) had knowledge about the standards regarding-colostomy at an unsatisfactory level (M±SD=29.8654± 8.34085) with the maximum mean scores (M=0.8269) and minimum mean scores (M=2.2308). All of nurses (100%) scored the actual nurses' practice of the standards at an unsatisfactory level (M±SD=111.51±25.706) with the max-imum mean scores (M=19.42) and minimum mean scores (M=2.4615). It was found that there was a positive weak relationship between knowledge and practice regarding nursing care standards of colostomy(r=0.15, p=.3). It was concluded that nurses' knowledge and practice in the nursing care standard of colostomy were unsatisfactory. It was needed to be improved through implementation of proposed nursing care standards of colostomy.

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Category: Vol. 78, March 2010

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Determinants of Disabled Elderly Caregivers Burden in Ismailia, Egypt,MOHAMAD MOHAMEDY AWAD, HANAN A. EL GAMMAL, MAGDA T. FAHMY and EMAN IMAM

Abstract
Background: Caring for a physically disabled relative can be physically and emotionally stressful, placing the caregiver at heightened risk of illness and chronic disease onset. Although an abundance of research has focused on the adverse emotional and social effects of care giving, there have been few studies of the physical health consequences for this group.
This study aims to assess relationship between care giving process and disability of the elderly.
Subjects and Method: A cross sectional household study was conducted to assess the burden facing the caregivers of elderly with functional and cognitive disabilities living in Ismailia governorate.
Comprehensive sample was conducted, all disabled elderly were included after assessment of functional disability and cognitive disability among them. Level of functional disabilities of elderly was assessed by using the Katz ADL. (Activity Of Daily Living) scale, and assessment of caregiver burden through The Zarit Burden Interview.
Results: The mean age of the studied elderly was 76.5±  9.2 (65-87), 48.9% were females, 38.6% are having chronic diseases. The mean age of elderly caregiver 37.6±11.5 (15- 76), 78.5% were females, mean care giving hours were 15.6±  6.9 (4-24).
According to Katz index of independence in ADL, the elderly had mild dysfunction in 50.4%, by using the mini-mental score about 28.6% of disabled elderly suffer from cognitive disability with mean mental score was 21.8±3.9.
Prevalence of burden among caregivers was 37% with mean burden score was 22. The study showed that statistically significant positive correlation between burden score and age of the elderly, number of chronic diseases, and caregiver age, and statistically significant negative correlation between burden score and ADL score, MMSE score, but no statistically significance between burden score care-giving hours/d, and income.

Conclusion: Home care of chronically disabled persons has received considerable attention in recent years, Caregivers often spend a disproportionate amount of their emotional, physical, or financial resources on the person requiring care. As time and illness progress, the responsibility may be met with decreasing enthusiasm, regardless of emotional relation-ships, and thus leads to burnout and increased caregiver burden.

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Category: Vol. 80, December 2012

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Oral Levofloxacin Versus Intravenous Cefotaxime in the Treatment of Patients with Spontaneous Bacterial Peritonitis: A Randomized Controlled Trial,HAMDY M. MOUSTAFA, MOHAMED B. BASTTAWEY, KHALED A. EID and MONA M. ABDEL MEGUID

Abstract
Objectives: Spontaneous bacterial peritonitis is a frequent complication in patients with liver cirrhosis and ascites. Intravenous Cefotaxime is a reasonable choice for suspected SBP but certain oral agents as oral oftoxacin, 400mg twice daily may be as effective as parenteral therapy.
Aim of the Work: To compare the therapeutic and cost effectiveness of oral levofloxacin 750mg once daily versus intravenous cefotaxime 2gm/8h in the treatment of cirrhotic patients with SBP.
Patients and Methods: 80 patients with decompensated chronic liver diseases and ascites confirmed to have SBP were enrolled in this study. Patients were randomized into two groups; each group consists of 40 patients. Group 1 treated with cefotaxime 2gm i.v/8h for 5 days and Group 2 treated with levofloxacin 750mg orally once daily also for 5 days. All patients were subjected to: Liver profile, serological tests for viral markers, abdominal ultrasound, modified Child's Pugh score, and ascitic fluid analysis (chemical, microscopical & microbiological) at baseline, after 48 hours and at the end from the start of treatment.
Results: The baseline ascitic PML of group I was 640 cells/ml3 and of group II was 655 cells/ml3. The PML count was markedly decreased after 48 hours and after 5 days of treatment compared to the baseline count in both groups (p<0.001). Negative growth was found in 67.5% of the total patients, 70% of group I, and 65% of group II whereas positive growth was found in 32.5% of the total patients, 30% of group
I,and 35% of group II. In group I, the number of negative growth increased from 28 before to 35 after treatment with no significant difference (p>0.05) and the positive ascitic fluid cultures were decreased from 12 to 5 after treatment also with no significant difference (p>0.05) while in group
II,the number of negative growth were significantly increased from 26 before to 36 after treatment (p<0.05) and the positive ascitic fluid cultures were significantly decreased from 14 before to 4 after treatment (p<0.05). 7 cases in group I and 6 cases in group II failed to respond to treatment. Infection resolution occurred in 33 (82.5%) patients in group I and in 34 (85%) patients in group II.
Conclusion: Oral levofloxacin is comparable to i.v. cefo-taxime in the treatment of SBP. Oral levofloxacin is also cheeper than i.v. cefotaxime, and the oral route and single daily dose is more convenient to the patient than intravenous route.

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Category: Vol. 82, December 2014

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Case Report: Idiopathic Bilateral Sequential Brown Syndrome, SAEED ALQAHTANI

Abstract
Objective: To report a rare case of idiopathic Brown syndrome in the left eye first, then followed by Brown syn-drome in the right eye after free tenotomy and inferior oblique anteriorization of the left eye.
Case Report: A 5-year old girl presented with ocular misalignment. The prism cover test at distant fixation showed hypotropia of the left eye, and chin up position which was 25 prism diopters (PD) in forced primary gaze, while in near fixation 35 prism diopters (PD). Eye movement of the left eye was markedly limited on elevation in adduction with normal elevation in abduction and markedly depression in adduction. Forced duction test of the left eye showed restricted elevation in adduction. Six months after surgical correction by free superior oblique tenotomy and inferior oblique ante-riorization of the left eye, the girl showed hypotropia of the right eye, which was 35 prism diopters (PD) in primary gaze and markedly limited on elevation in adduction and limitation in elevation. Computerized tomography scan of the orbits ruled out any evolving local pathology. The right eye was managed conservatively for 6 months. Then, 10mm right superior oblique spacer was done combined with posterior fibers tenotomy and removal of the spacer in the left eye. Postoperatively, the patient was able to fix both eyes centrally with no misalignment, reasonable extra-ocular muscle move-ments and excellent vision.
Conclusion: Cases of BS can be identified by positive forced duction test. Management of BS is a real challenge to ophthalmologists. Nevertheless, conservative management for several months may prove effective in some cases of BS among children.

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Category: Vol. 83, March 2015

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Laparoscopic Uretero-Neocystostomy, Initial Experience, AMR MOSTAFA, AMR ABD EL-HAKIM, OMAR ABD EL-RAZZAK, HAZEM ABOU EL-FETTOUH and MAHMOUD ABD EL-HAKIM

Abstract
Objective: To assess the feasibility and outcome of lap-aroscopic ureteral reimplantation.
Material and Methods: Five laparoscopic ureteral reim-plantations were performed between June 2011 and December 2012 for ureteral strictures. The mean age was 45 years three patients had unilateral lower ureteric stricture, 2 patients had bilateral lower ureteric strictures. The etiology of stricture formation was bilharziasis in 2 patients, previous ureteroscopy in 2 patients, and unknown in 1 patient. 3 patients underwent laparoscopic ureteral reimplantation, 2 patients underwent modified Lich-Gregoir on the right side and simple anastomosis on the left side.
Results: Mean operative time for all patients was 157 minutes (range 45-350).
Post-operative stay was 2-3 days.
Postoperative radiological imaging showed hydronephrosis in 1 patient at a follow-up interval of 6 months.
Conclusions: Laparoscopic ureteral reimplantation is a feasible procedure with good medium-term results. We believe that this procedure will become an established treatment option.

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Category: Vol. 79, December 2011

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Awareness and Knowledge of Poor Vision Among Students in Taif University,ABDULHAMID ALGHAMDI

Abstract
Objective: To assess the level of awareness and knowledge of problem of poor vision in Taif city among the Taif University students.
Methods: A total of 1132 students were randomly chosen from all colleges of the university to participate in the study. They were 686 males and 446 females, 41.2% of them are students in colleges for medical and none medical sciences and the rest were students in the rest of colleges of Taif University. The participants were good representatives of the whole university students. They responded to a structured questionnaire on poor vision to trained field investigators (fifth year medical students). Having heard of the eye disease in question was defined as “awareness’ and having some understanding of the eye disease was defined as “knowledge”.
Results: Awareness of poor vision (~90%) was good. Knowledge of all the eye diseases assessed was ~70%. Students in colleges of sciences were significantly more aware of the poor vision problem than students from the other colleges. ~35% of female students and 30% of male students answered don’t know when they asked about knowing about poor vision. There is a little difference in knowledge about poor vision among students in different academic years, being more in the last years than in the early years of academic years. The major source of awareness of poor vision was a family member, of the eye diseases was a family member/friend/relative suffering from that eye disease.
Conclusion: These data indicate that knowledge of poor vision and its cause and possible prevention is unsatisfactory, and the available data suggest that there is a need for health education in this population to increase their level of awareness and knowledge of common eye diseases. Such awareness and knowledge could lead to better understanding and acceptance of the importance of routine eye examinations for the early detection and treatment of eye diseases, thereby reducing visual impairment in this population.

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Category: Vol. 81, June 2013

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Burr-Hole Craniostomy Versus Open Craniotomy for Treatment of Combined Chronic and Subacute Subdural Haemorrhage in Patients Above 90 Years Old,AHMED ELSAWAF

Abstract
Objective: To compare the results of either craniotomy or burr hole surgery in highly old patients with subdural haemorrhage.
Methods: 48 patients with chronic subdural haemorrhage (34 patients showed combined subacute blood in CT scan) were collected and followed preoperatively, immediate post-operative and 6 months after surgery. Patients were classified into two groups; (Group 1): 26 patients were operated by two Purr-hole craniostomies about 2cm width for each with sub-dural drain for subsequent few days. (Group II): 22 patients were operated by open craniotomy with subdural drain. They were assessed clinically (GCS, motor, sensory or speech deficits) and radiologically by CT scan preoperatively and in postoperative follow-up periods.
Results: Statistically non-significant better clinical out-come for group I compared to Group II regarding GCS, improvement of neurological deficits, hospital stay (p<0.001) and postoperative morbidity. In spite of that, follow-up CT scan showed higher incidence of postoperative radiological complications in group I which were clinically insignificant.
Conclusion: In spite of the high incidence of combined acute and subacute incidence of subdural haemorrhage, burr hole craniostomy still offers better outcome for those patients with higher safe margin.

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Category: Vol. 77, December 2009

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A Phase II Study of the Role of Selective Cyclooxygenase-2 (COX-2) Inhibitor and Concurrent Chemoradiation as Adjuvant Postoperative Treatment in Patients with Locally Advanced Cancer Larynx,NIVINE M.A. GADO, NASHWA NAZMY ABD ELAZIZ ABD ELKERIM, MANAL M. EL-MAHDY, KHALED NAGIB, WALEED BAYOMI, MOHAMAD SABRY and IMAN ELSHARAWY

Abstract
Objectives: The primary study objective is to determine the tolerability, acute toxicity profile and loco-regional recur-rence (LRR) rate, 2 year relapse free survival (RFS) and overall survival (OS) with the use of selective COX-2 inhibitor, Celecoxib, concurrently with chemoradiotherapy (CRT) as adjuvant treatment for locally advanced squamous cell carci-noma (LASCC) of the larynx. Secondary end point is to study COX-2 expression and assess its prognostic significance with the pathological features and treatment outcomes.
Patients and Methods: This study included 36 patients with histologically confirmed diagnosis of LASCC of the larynx after curative surgery stage III-IVA. All patients received Cisplatin 100mg/m2 days 1,22 and 43 concurrently with external beam radiotherapy and celecoxib in a dose of 300mg twice daily during the whole course of radiotherapy. EBRT was delivered with conventional fractionation in a dose of 1.8-2 Gy/f to 50-54 + boost to high risk areas to 60-66 Gy in 30-33 fractions over 6-7 weeks using (6MV) with isocentric techniques. Tissue samples or paraffin blocks were obtained from eligible patients for detection of COX-2 expression by immunohistochemical method.
Results: More than 75% of the patient had > T2 tumors, 78% had positive lymph nodes and 80% had GI & II tumors. Concurrent CRT and celecoxib were tolerable thus, 32 (89%) patients could proceed to receive a full course of Celecoxib, chemotherapy and radiotherapy. Overall, G3,4 acute toxicities were observed in 18/36 patients (50%) mainly chemotherapy related, but were well tolerated. Most G3 & 4 neuropenia which reported in 22% were transient and not complicated with toxic death on the protocol therapy. The worst nonhe-matalogic toxicities were mucositis (44%), GIT (36) and dysphagia (30%). With a median follow-up period of 27.6 months locoregional recurrence was observed in 17% of the patients. Kaplan-Meier method revealed two-year RFS of 67% and the two-year overall survival of 72%. COX- 2 was expressed in 61% of the patients and was significantly asso-ciated with grade I & II, supraglottic site and positive lymph nodes. Correlation between COX-2 expression in the tumors and treatment outcomes revealed that overall recurrence was
significantly increased in Cox-2 positive patients (73% Vs 27%) which was statistically significant (p<0.05). Additionally COX-2 positivity was associated with decreased 2 years RFS and 2-year overall survival but was not statistically significant (p>0.05).
Conclusion: Cox-2 may have prognostic value in predict-ing disease recurrence. Addition of Cox-2 inhibitors concur-rently with (CRT) was safe and tolerable, however its advantage over the standard CRT regimen couldn't be proved. Confir-matory randomized phase III trial on larger number of patients and longer follow-up is encouraged.

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Category: Vol. 81, June 2013

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Knowledge and Attitude of Students Living in Assiut University Dorms About Consanguinity,FATMA R. SHELKAMY, SAWSAN M. ALAAEL-DIN, SAFAA A. KOTB and SOAD A. SHARKAWY

Abstract
Consanguineous refers to union of individuals having a common ancestor or marriage between a man and woman related by blood. The most common form of consanguineous union contracted is between first cousins.
The Aim of the Study: To assess university students' knowledge and attitude regarding consanguineous, because consanguineous are widely practiced among Arabs.
Subjects and Methods: Descriptive cross sectional study was conducted at Assiut University dorms. The sample included 650 females and 350 males according to proportional distri-bution of both sex in Assiut University dorms in academic year 2011. Data were collected by using personal interview structured questionnaire include socio-demographic charac-teristics (age, sex education, family size and income), knowl-edge of students about the consanguinity, and attitude about it.
Results: 52.8% of studied students their age ranged from 17 to less than 20 years with the mean age of students 19.4±1.4. More than one third (35.0%) of University students were males. As regarding students' religion the majority (93.1%) of studied sample were Moslems. 71.9% of the students had poor knowledge about consanguinity. While more than three quarter (75.8%) of the students had positive attitude toward consanguinity marriage.
Conclusion and Recommendations: There was a significant difference between student's sex and their knowledge and attitudes toward consanguinity marriage. The adolescent and youth should educate about the problems and consequences of the consanguineous through educational program in different grads focus on premarital care.

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Category: Vol. 82, December 2014

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Trends in Breastfeeding and Weaning Practices in Upper Egypt, GIHAN F. AHMAD, MAY MATTER, WAFAA FAHMY and LOBNA AL HADEDY

Abstract
Introduction: Breastfeeding is one of the most important determinants of child survival, birth spacing, and the prevention of childhood infections. The beneficial effects of breastfeeding depend on its initiation, duration, and the age at which the breastfed child is weaned. Breastfeeding practices vary among different regions and communities. Egypt DHS survey 2008 postulate that Exclusive breastfeeding is common but not universal in very early infancy. Continuous vigilance over infant feeding practices in the community is necessary for timely interventions, to ensure optimal growth and develop-ment. We Expect This information will be useful to policy makers for the formulation of interventional programs in the future. The present work indicates more effort is needed to address compliance with immediate initiation of breastfeeding within hour, prelacteal feeding and early weaning, type of weaning foods and feeding practices during illness.
Aims of work:
•To estimate some of the breastfeeding indicators.
•To examine some demographic and socio-economic deter-minants of breastfeeding.
•To identify reasons that led mothers to stop breastfeeding before two years.
Sampling: 1347 children (667 boys and 620 girls) aged 2 years or younger were selected by stratified random sample from four governorates (Menia, Assiut, Sohag, Qena) in Upper Egypt.
Methods: A structured questionnaire was used to collect socioeconomic and breastfeeding and weaning practicesDe-scriptive as well as inferential statistics techniques were utilized. The statistical Package for Social Science (SPSS version 13) was used to analyze the data.
Results: As regard breast feeding practices:
- Most children (96%) were ever breastfed, (20%) started breast feeding immediately after birth while nearly half of them started within days after labor.
- 64.5% got prelacteal feed that was mostly herbal fluids.
- Duration of breast feeding ranged between 12-24 months among 40% of the children.

- Surprisingly, only 17% of children were formula fed beside breast milk.
- During child illness the number of breast feeding was reduced among 40% of the children.
- Mother’s mostly following relatives’ advice specifically grandmothers among low and middle social class.
- On the other hand, physicians were the main source of knowledge among high class mothers.
As regard weaning practices:
The most common reason of starting weaning was the infants’ age which was mostly the age between 4-6 months, however around (20%) of children started weaning at an age less than 2 months.
Conclusion:
•The present work indicates more effort is needed to address compliance with immediate initiation of breastfeeding within hour, prelacteal feeding and early weaning, type of weaning foods and feeding practices during illness.
•Health education programs to promote sound breastfeeding practices and targeting grandmothers and physicians are needed.

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Category: Vol. 83, September 2015

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Serum Vitamin D as a Predictor to the Response of Interferon Therapy in HCV Genotype 4, OLFAT G. SHAKER, ESAM A. MOHAMED, GAMAL ESMAT, SAMAR A. MARZOUK and AMR A. ZAHRA

Abstract
Background and Aim: Chronic infection with Hepatitis
C Virus (HCV) is a huge problem both globally and at the level of the individual patient. We aimed to determine the incidence of vitamin D deficiency in patients with chronic hepatitis C. In addition, we evaluated associations of vitamin
D (Vit D) serum levels with the virologic response of inter-feron-Alfa based treatment in patients chronically infected with HCV in Egypt.
Subject and Methods: Blood samples were taken from 206 patients who are suffering from chronic hepatitis C disease divided into responders (n=126) and non-responders (n=80) according to their initial response to treatment with normal-ization of aminotransferases (ALT and AST) levels and clear-ance of the virus denoted by negative HCV-RNA by PCR after 6 months of receiving treatment. Also 100 blood samples from controls were taken. The following were done: History taking, general examination, liver function tests, hepatitis markers, HCV quantitation by real time PCR and quantitation of Vit.D level by ELISA.
Results: There was significant differences between re-sponders and non responders to interferon therapy of chronic hepatitis C patients before treatment as regards the mean values of Vit D (p=0.001). Stepwise multivariate logistic regression showed that Vit D (p=0.002) was found to be significant predictor for response to interferon therapy of hepatitis C patients.
Conclusion: Serum levels of Vitamin D is a significant predictor for response to interferon therapy of hepatitis C patients genotype 4.

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Category: Vol. 86, June 2018

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Causes and Consequences of Street Life on Homeless Children: Choice or Compulsion?, MAGDA A. MOHAMED, MANAL F. MOHAMED, MONA A. HASSAN and SOHIER G.E. ABD EL-RAHMAN

Abstract
Background: Homelessness influences every facet of a child's life. The experience of homelessness inhibits the physical, emotional, cognitive, social, and behavioral devel-opment of children.
Aim: This study aimed to assess the causes and conse-quences of street life on homeless children. Overall situation of street children living in Port Said City.
Material and Methods: Descriptive design was used. A sample of 200 homeless children was collected from Port Said City during the period from January to December 2015; non-random sampling technique which includes both snowball and purposive sampling was used.
Tool: An interview questionnaire was the main instrument of data collection developed and it completed by researchers.
Results: The study has revealed that the great majority of street children (94.5%) were males, never been attended school and different causal factors have contributed for their street life but, poverty was found to be one of major causes followed by child abuse to push children to move to the street. They were exposed to different types of exploitation and health problems.
Conclusion/Recommendation: The majority of street children faced physical abuse followed by sexual abuses. Drug and substance abuse is very common among street children like cigarette, sniffing glue. So, the study recom-mended that; awareness raising program should be given for the general public to bring about effective and sustainable change in the lives of these innocent children because street life is viewed as a negative phenomenon by the majority of the societies. Child welfare centers should be supplemented with good infrastructures to accommodate street children.

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Category: Vol. 84, September 2016

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Desarda Technique Versus Lichtenstein Mesh Repair for the Treatment of Inguinal Hernia A Short-Term Randomized Controlled Trial, MOHAMMED B.M. KOTB, ABD EL-RADY A. FARGHALY, MOSTAFA T. AHMED and AHMED T.Z. HASSAN

Abstract
Background: Several techniques of tissue and mesh repair for inguinal hernia have been developed over the last decades but still drawbacks are present. Desarda, who has used a new technique since 1990, seeks to get over the challenges faced with the use of the tissue repair and mesh repair techniques. It is based on the concept of providing a strong, mobile and physiologically dynamic posterior inguinal wall. This study is attempt to establish the influence of this new technique on early clinical outcomes of inguinal hernia repair, and if proved to be effective it will be a basis for the promotion of its use in Egypt.
Aim: To compare the short-term outcome of the Desarda's repair with the Lichtenstein technique for the treatment of primary inguinal hernias among adult patients at Assiut University Hospital.
Patients and Methods: The study was a single-center, randomized controlled trial. It was carried out at general surgical outpatient clinic in Assiut University Hospital. Which is the main teaching hospital for Assiut University Faculty of Medicine from March 2013 and February 2015.
Results: Males constituted 100% of the subjects, the majority (61%) had inguinal hernias on the right side. (73%) indirect hernias, direct hernia in Lichtenstein arm (35%) more than in Desarda arm (8%).
Conclusion: The Desarda repair was shown to take a significantly shorter operative time than the Lichtenstein repair and it can safely be employed as one day case surgery and in district hospitals.
Recommendations: Further larger clinical trials are needed for comparing the Lichtenstein and Desarda methods to generalize the results through at regional and district hospitals in Egypt in addition to encourage continuing medical education and to acquire skills to do the desarda method of inguinal hernia repair.

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Category: Vol. 83, March 2015

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Role of Interferon-Inducible Protein P56 in Lichen Planus, NAHLA HUNTAR, MOHAMED ELKOMY, DINA KADRY, RAGIA WESHAHY, WAFAA RASHEED and LAILA RASHED

Abstract
Background: Lichen planus (LP) is an inflammatory disease of skin, nails, hair follicles and mucous membranes. Lichen planus is a disease of unknown etiology. Although, infections and stress has been suggested as a triggering factors. Virus infection or virus triggering the cytotoxic immune response in LP has been discussed. The Interferon (IFN) system is the first line of defense against virus infection. P56 is considered one of the significant IFN inducible proteins. It belongs to a family of structurally related proteins that are induced by viral stresses. Hepatitis C virus infection is asso-ciated with a statistically significant risk for development of LP. Lichen Planus appears to be related to the pattern of immune dysregulation induced by HCV rather than the type of virus itself. Thus, it is probable that other viral associations than HCV may exist in LP.
Objectives: The aim of this work is to detect the presence of interferon-induced protein (P56) in LP lesions, of non-hepatitic patients, and using it as a marker of viral infection, in order to detect a possible role of viral infection other than hepatitis c virus in the pathogenesis of LP.
Methods: The study included 34 patients with LP and 34 apparently healthy subjects as controls. From each patient and control one 4mm punch skin biopsy was be obtained and prepared for real time polymerase chain reaction (PCR) detection of P56 expression.
Results: Our results revealed that mean P56 levels were significantly higher in patients than controls.
Conclusion: This may implicate that a viral infection might play a role in the etiology of LP.

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Category: Vol. 83, March 2015

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Work-Related Stress among Petroleum Company Employees at their Workplace in Egypt, GIHAN B. GHOBRIAL, SOHEIR A. EL-DIN and MONA S. SHENOUDA

Abstract
Work related stress (WRS) has become an important topic to be studied. Several studies have shown that many factors can lead to WRS, this research is conducted to give a holistic view on the WRS causing factors.
Aim: Identify the WRS causing factors among employees at their workplace.
Design: A cross-sectional study was carried out in this study.
Sample: A convenient sample of 200 employees working in a multinational Oil and Gas company in Egypt.
Methodology: An adopted work related stress assessment questionnaire (WRSAQ) developed by Alan Bradshaw (2005), that has demonstrated acceptable reliability and validity, was filled in and submitted by the study sample to assess and identify the WRS causing factors.
Results: Work control was identified as a major component of WRS factor for employees particularly who were females, and those who were working in Human Resource Department. Work life balance was noticed as a key WRS factor for employees who had less than 6 years in the same position. Qualitative work demands were remarked as a main WRS factor for employees who worked in Production Department. Workload was remarked as a significant WRS factor for most of the employees. Organizational factors and role function have an important role to play in determining work stress; however data results did not reveal any ambiguous dominance. Employees between 41 and 50 years old were relevantly exposed to the higher level of WRS than others. Employees worked in Production were relevantly exposed to a higher level of WRS than other departments. Females employees were relevantly more exposed to WRS than males. There was a strong relation between increasing the number of years in the same position and increasing the level of the WRS. Employees with permanent employment contracts were rele-vantly more exposed to higher level of WRS than employees with temporary contracts. Conclusion: The result of the study indicates that, there is strong relationship between certain work factors and the occurrence of WRS.
Recommendation: This research finding supports the Occupational Health Nurse, using the evidence based approach, in developing a program that aimed at managing the WRS causing factors.

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Category: Vol. 77, March 2009

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Effect of Biofeedback Training on Fecal Incontinence in Children with Myelomeningocele,REDA S.M. SARHAN and ENAS EL-SAYED

Abstract
Purpose: This study aimed at evaluating the effects of biofeedback training on children with fecal incontinence.
Subjects: Twenty children (12 males and 8 females), diagnosed as spina-pifida (myelomeningocele), were recruited from pediatrics outpatient clinic, King Abdul-Aziz university hospital, Jeddah, Saudi Arabia. Their age ranged from ten to fifteen years.
Methods: Anorectal manometric functions were assessed for all children before and after treatment. The children were randomly divided into two groups of equal number (control and study). Both groups received physical therapy program (daily rectal evacuation program, diet control and pelvic floor muscle exercises). In addition, the study group received biofeedback training program. Treatment for all patients continued for three months (one hour/session, three times/ week).
Results: The results revealed statistically significant improvement in the outcome measures in the study group. Biofeedback training improved anal squeeze as well as rectal sensation.
Conclusion: Biofeedback training in conjunction with conventional therapy program was effective in improving fecal incontinence in children with myelomeningocele.
.

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Category: Vol. 77, March 2009

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Compliance of Diabetic Patients. Pros and Cons

EMAN TAHER, GEHAN HAMDY, SOAD SULTAN and HEBAT. MOUSTAFA

Abstract
Diabetes is a major public health problem allover the world. Compliance refers to a patient both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other health care workers.
Aim: This study was conducted to demonstrate the pattern of compliance among diabetic patients, its determinants and reasons beyond noncompliance.
Methodology: This cross section descriptive study was conducted at the outpatient Clinic of Diabetes, Kasr Al-Aini. Their compliance pattern were assessed using special scoring.
Results: Improper compliance to diet was more prevalent [104 (34.7%)]. The significant determinants of improper compliance to diet were younger age, type 1 diabetes, long duration of illness, absence of complication, positive family history, receiving 3 or more drugs per day and improper compliance to drugs. Financial constraints and depression were beyond improper diet and drugs compliance.
Conclusion: Compliance to appointment and drugs were better than compliance to diet. Cost and psychological depres-sion were among the main reasons of improper compliance.

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Category: Vol. 82, December 2014

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Effectiveness of Apple Cider Vinegar in Management of Obesity: A Randomized Controlled Trial, HASSAN M. AL-MUSA and OSSAMA A. MOSTAFA

Abstract
Aim of Study: To explore the effectiveness of daily intake of apple cider vinegar (300mg, tablets 3 times daily) on lowering body mass index (BMI) among obese subjects.
Methodology: A total of 100 obese subjects were random-ized into either an intervention group (who received 300mg apple cider vinegar tablets three times daily in addition to their prescribed routine management protocol) or a control group (who received their prescribed routine management protocol only). The researchers met all participants in both groups once monthly to measure their body weight, inquire about any health complaints related to their followed protocol, and to provide health education. In addition, each participant in the intervention group was given his/her monthly doses of apple cider vinegar tables (90 tablets).
Results: By the start of the study, there was no significant difference between participants in the invention group and those in the control group regarding their BMI (33.72±6.24 kg/m2 and 33.60±5.00kg/m2, respectively, p=0.916). However, by the end of the study observation period (5 months), there was a significantly lower mean BMI among the intervention group than the control group (29.38±5.70kg/m2 and 31.59±4.68 kg/m2, respectively, p=0.037), which was not sex- or age-dependent. Reported side effects were in the form of mild heart burn (12%) or transient diarrhea (10%).
Conclusions: Apple cider vinegar can be safely prescribed for a short-term body weight reduction.
Recommendations: Further studies are needed to explore the mechanism by which its intake is associated with weight loss and to identify its long-term side effects.

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Category: Vol. 83, June 2015

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Primary School Teachers' Knowledge about First-Aid, AWAD S. AL-SAMGHAN, FAISAL M. ALSHAHRANI and FATIMAH H. AL-SHAHRANI

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Category: Vol. 81, June 2013

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An Evaluation of an Early Warning Alert and Response Network (EWARN) in Darfur, Sudan,DIANE F. MOROF, ALAA ABOU-ZEID and MUIREANN BRENNAN

Abstract
Objective: To conduct a field-based evaluation of an Early Warning Alert and Response Network (EWARN) in Darfur, Sudan.
Methods: Using adapted surveillance evaluation guide-lines, evaluators reviewed EWARN documents and conducted semi-structured in-depth interviews and group discussions with key informantsat national, state, and local levels. Eval-uators conducted visits at 18 purposively sampled clinics in all Darfur states. Observers examined morbidity reporting, laboratory functions, and disease controland nutrition data. Qualitative and quantitative analysis identified common themes and examinedkey variable frequencies.
Results: All clinicians described EWARN as useful; most indicated that its primary usefulness was early outbreak detection. Between January and October 2009, there were a total of 30 alerts with 10 confirmed outbreaks, 16 negative results, and four results with pending laboratory tests. Of the 26 alerts with investigation results, 10 were confirmed (positive predictive value [PPV] = 38%). The sensitivity of the outbreak detection system could not be determined on the basis of available data. Lack of clarity and variations in the application of case definitions and laboratory testing led to differences in reporting of specific conditions and rendered trend data less reliable. Collecting data on non-epidemicprone diseases at every site was burdensome. Few deaths were reported at the clinic level.
Conclusions: EWARN is a useful system for outbreak detection. Refining, standardizing, and increasing training frequency on case definitions, expanding laboratory capacity, and focusing data collection on epidemic-prone diseases would greatly improve the system's outbreak and surveillance ca-pacity. Mortality reporting from outpatient clinic data should be eliminated.

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Category: Vol. 82, September 2014

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Nuetrophil Elastase Mediated Damage in Infants with Extrahepatic Biliary Atresia: A Prospective Cohort Study, MAGD A. KOTB

Abstract
Background: Neutrophils are part of our innate immune system. They are capable of accumulation in tissues, chemo-taxis, phagocytosis and digests bacteria and fungi by their lysosymes. Yet, paradoxically neutrophils are mediators in acute liver injury. Extrahepatic biliary atresia (EHBA) is a progressive chronic cholangiopathy of infancy, even in those who undergo timely portoenterostomy.
Objective: Assessment of neutrophil involvement in EHBA.
Subjects and Methods: 32 Infants known to have EHBA attendants of Hepatology Clinic, New Children Hospital, Cairo University, were enrolled in this study. It commenced by October, 1999 and ended by October, 2002. Percutaneous biopsied liver tissue (using Menghini needles) required for confirmation of diagnosis of extra-hepatic biliary atresia was assessed for fibrosis, neutrophil infiltration, neutrophil elastase and CD14+.
Results: All biopsies (100%) demonstrated fibrosis of them 2 (6.3%) demonstrated cirrhosis. Neutrophil counts ranged from 2 to 12 cell per high power field (mean ±  SD= 5.8±2.5). Anti-neutrophil elastase stained strong positive in all (100%) biopsies. All biopsies stained positive for CD 14+ where 24 (75%) demonstrated moderate and 8 (25%) strong staining. Strength of CD14+ staining correlated positively with neutrophil counts per high power field (p=0.0000), but not to fibrosis score (p=0.252). CD14+ staining negatively correlated with cirrhosis (p=0.0000). Fibrosis score had a trend for positive correlation with neutrophil counts that did not mount to statistical significance (p=0.065). Both did not predict favorable outcome (CD14+ p=0.356, fibrosis score p=0. 812) or deterioration (CD 14+ p=0. 13 1, fibrosis score p=0.584). Neutrophil elastase stain was strongly positive in all cases. Only predictors of good outcome in a multiregression model with 95% confidence interval was younger age at Kasai portoenterostomy (p=0.012) and less fibrosis (p=0.000).
Conclusion: Neutrophil elastase is integral in liver histo-pathology in EHBA yet neutrophil exact role in tissue injury await exploration.

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Category: Vol. 81, March 2013

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Accuracy of MR Imaging in Diagnosis of Bone Invasion by Soft Tissue Sarcomas: Experience at NCI, Cairo, Egypt,OMAR EISSA, REDA TABASHY, SAMIA SHOMAN and MEHRDAD NADJI

Abstract
Purpose: To evaluate the Magnetic Resonance (MR) imaging signs and overall accuracy of MR imaging for detec-tion of osseous invasion by soft-tissue sarcomas.
Material and Methods: Preoperative MR images of 41 osseous sites in patients diagnosed and treated at the National Cancer Institute (NCI), Cairo University, (2005-2011) for soft tissue sarcomas who underwent surgical bone resection or amputation were assessed retrospectively for signs of osseous invasion, MRI signs assessed included osseous abutment by tumor, cortical destruction, and cortical and medullary signal intensity change on T1- and T2-weighted images. Imaging findings were correlated with histopathological findings.
Resuks: Fifteen sites (36.5%) showed osseous invasion histologically. Tumor abutted bone at 26 lesion sites (63.5%). Maximal diameter of osseous abutment and extent of circum-ferential abutment did not significantly affect osseous invasion. On T1- and T2-weighted images, 13 lesion sites showed cortical signal intensity change (sensitivity, 100%; specificity, 86.7%) and 11 lesion sites showed cortical destruction (sen-sitivity, 73.3%; specificity, 96.2%). Eleven lesion sites showed decreased medullary T1 signal intensity (sensitivity, 100%; specificity, 96.7%), and 11 lesion sites showed increased medullary T2 signal intensity (sensitivity, 100%; specificity, 96.7%). MR imaging had an overall sensitivity of 86.7%, specificity of 100%, PPV of 100%, and NPV of 93%. Total accuracy was 95% for detection of osseous invasion.
Conclusion: Cortical and medullary signal intensity change and cortical destruction on T1- and T2-weighted MR images were sensitive and specific for osseous invasion by soft tissue sarcomas and can be used reliably for preoperative assessment.

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Category: Vol. 84, June 2016

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Differential Diagnosis of ACS by Copeptin in Emergency Department, HOSSAM A. SHAHIN, SABAH F. EL-ABD, EMAD F. ABD EL-MAKSOUD and WAEL S. ABD EL-MAGEED

Abstract
Background: ACS patients presented to ED require rapid differential diagnosis. Although troponin is the gold marker for ACS, there is still cases that can't be diagnosed in the early stages.
Aim of Work: The aim of this study was to investigate copeptin levels in ACS patients and compare them for a cut off level for each ACS case. Also, to compare copeptin to cTnI, CRP to differentiate between ACS type on admission.
Subjects and Methods: Sixty two consecutive patients with ACS presenting to the Emergency Department of the National Heart Institute, Giza (Egypt) between March and June 2014, were recruited for the study, grouped into two groups according to the final diagnosis as AMI (including thirty two patients) and UA (including thirty patients) groups. Their cardiac markers and copeptin levels were assayed and compared to a control healthy group on admission and after 6 hours.
Results: Results revealed significant difference between cardiac levels on admission compared to that obtained after six hours. Only copeptin levels were diagnosing on admission (higher with clear cut off levels) compared to that of six hours (decreased and get non significant differences).
Conclusion: Early measurement of the combination of troponin I and copeptin may revolutionize the diagnostic accuracy and therapeutic decision-making in patients with symptoms suggestive of ACS, differentiate between UA or AMI patients on admission.

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Category: Vol. 83, March 2015

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Is Color Doppler a Useful Complementary Technique to Gray-Scale in Early Detection of Placenta Accreta?, HANY HASSAN, SHERIF NEGM, AHMED TAHER and DALIA FAROUK

Abstract
Objective: To assess the role of color Doppler as a com-plementary technique to grayscale in the early detection of placenta accreta.
Material and Methods: One hundred and ten pregnant women with confirmed placenta previa complete centralize (after 28 weeks' gestation) were included prospectively into this study. Gray-scale trans abdominal ultrasound examination was performed to detect loss of the retroplacental echo lucent zone and other abnormalities suggestive of placenta accreta. Color flow mapping was used to scan the whole placenta to detect any newly formed vessels at the serosa-bladder border or the presence of abnormal lacunae. The ultrasound findings were analyzed with reference to the diagnosis made during Cesarean delivery.
Results: Placenta accrete and its variants were confirmed in 33 patients at the time of cesarean delivery, if we considered the presence of at least one criterion to be diagnostic when using each ultrasound, then gray-scale would have a positive predictive value of (59.6%), followed by color Doppler (55.6%). The majority of patients with placenta accreta showed multiple characteristic features on ultrasound imaging. In contrast, those patients with a false-positive diagnosis (i.e. the final diagnosis was placenta Previa alone) tended to show isolated ultrasound markers of the condition.
Conclusion: Color Doppler is not useful as a complemen-tary technique to gray-scale in the early detection of placenta accrete.

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Category: Vol. 83, March 2015

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The Effect of Addition of Rocuronium to Local Anesthetic in Peribulbar Block for Cataract Surgery, HOSSAM M. ATEF, ALAA EL-DIN M. EL-KASSABY, MAGDY A. OMERA and AMR K. ABDEL GAWAD

Abstract
Introduction: There are a limited number of studies that compared Rocuronium as additive to local anesthetic mixture in cataract surgery using peribulbar technique; but none of these studies evaluated the duration of block.
Purpose: To evaluate the effects of adding Rocuronium (5mg) to local anesthetic mixture on akinesia of globe and eyelid regarding onset and duration in cataract surgery using peribulbar technique.
Methods: This study was carried out as a single blind randomized clinical trial. Sixty patients were randomly as-signed to one of study groups; the first group (control group) received local anesthetic 3.5ml 2% Lidocaine+3.5ml 0.5% plain Bupivacaine+0.5ml saline 0.9%, the second group (Rocuronium group) received local anesthetic 3.5ml 2% lidocaine+3.5ml 0.5% plain Bupivacaine+0.5ml Rocuronium (5mg).
Results: Regarding the onset of lid movement measured at 3 minutes in Rocuronium group only 2 patients (6.67%) of the group showed complete lid akinesia and 16 patients (53.33%) showed flickering, representing statistically signif-icant difference between Rocuronium and control groups. Rocuronium group demonstrated significantly better lid aki-nesia scores than control group at 5 and 10 minutes post injection.
There was statistically significant difference in onset of globe movement at 1 minute with Rocuronium group versus control group, as 8 patients in Rocuronium group (26.67%) show partial akinesia. At 3 minutes, 5 patients of Rocuronium group (16.67%) showed complete akinesia which statistically significant difference and 20 patients of Rocuronium group (66.67%) versus 5 patients of control group (16.67%) had partial akinesia. Also Rocuronium group demonstrated signif-icantly better globe akinesia scores than control group at 5 and 10 minutes post injection. Four patients in Rocuronium group (13.33%) and versus 12 patients (40%) required a supplementary injection 10 min after block because of inad-equate motor block (akinesia score >4) and the difference was statistically relevant (p=0.03).
Duration of globe akinesia was (122.5±9.72) in Rocuro-nium group versus control group (91.5±9.11) showed highly statistical significant difference (p=0.001). No difference in pain scores noted intraoperative or postoperative follow-up for two hours. No systemic or ocular adverse effects were recorded in any group.
Conclusion: The addition of low dose rocuronium 5mg to local anesthetic solution shortens the onset time, prolongs the duration of akinesia and reduces the need for supplementary injections without known complications.

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Category: Vol. 77, December 2009

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Cesarean Section in Althawra Teaching Hospital,FAIZA M. YOUNIS and MOHAMAD M. FAHMY

Abstract
Rising rates of cesarean section have stimulated much debate in the international medical literature. Despite its growing acceptance as an alternative to vaginal birth, cesarean section is not a safe surgery.
Objectives: To obtain an estimate of cesarean section rate and examine the indications and different complications.
Methods: A retrospective study during 24 months (January 2005 to December 2006), from maternal records at Althawra teaching hospital, Albeida, Libya.
Results: During the study period 1388 cesarean sections were performed out of a total 9605 deliveries, with an incidence of 14.45%. Indications for cesarean section were variable, the commonest were repeated cesareans. Different maternal complications were recorded including one maternal death due to uncontrolled intraoperative bleeding.
Conclusion: The tendency to large families, changes in obstetric practice and increase safety of cesarean section were the major influences in the rate of cesarean section by increas-ing the rate of primary cesarean section, which create a large group of women at risk of repeat cesarean section.

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Category: Vol. 79, September 2011

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Comparative Study of the Effect of Allopurinol and Nabumetone either Alone or Combined on Freund’s Adjuvant-Induced Arthritis in Rats,SOHA S. ESSAWY

Abstract
Background: Non steroidal anti-inflammatory drugs (NSAIDs) partially alleviate symptomatic manifestation of rheumatoid arthritis (RA) but do not provide long term pro-tection from articular damage. Nabumetone possesses a pow-erful anti-inflammatory profile as convential NSAIDs, with little gastric and renal side effects due to selective blocking of Cyclooxygenase-2 (COX-2), thus prevent formation of prostaglandins (PGs) responsible for the cardinal signs of inflammation. Over expression of XO enzyme, overproduction of free radicals plus release of inflammatory cytokines has been shown to be involved in the inflammation-induced tissue damage.
Xanthine oxidase (XO) inhibitors as allopurinol may retard disease progression most probably due to an anti-oxidant effect. Hence, XO inhibitors/NSAIDs combinations may help to achieve both long term prevention of disease progression as well as rapid onset of symptomatic control.
Aim of the Work: This study was designed to compare the biochemical and pharmacological effects of allopurinol, nabumetone and their combination in RA.
Material and Methods: Forty male rats were used, divided into five groups (8 rats each): Control group, Complete Freund's Adjuvant (CFA) induced RA group-not treated-, arthritic group treated with allopurinol, arthritic group treated with nabumetone and arthritic group treated with allopurinol plus nabumetone. After 6 weeks of treatment, the anti-infla-mmatory and antioxidant effects of the tested drugs on the severity of arthritis was evaluated by ELISA assay of serum TNF-a, a critical inflammatory mediator in this condition, calorimetric assay of serum uric acid due the evidence of increased XO activity in serum and tissue in patients with RA and by calorimetric assay of the oxidative stress parameters, lipid peroxides (LPO) and superoxide dismutase (SOD), due to overproduction of reactive oxygen species (ROS) during inflammatory process.
Results: In the arthritic non-treated group, the serum levels of TNF-a, uric acid and LPO were significantly higher while the activity of SOD was significantly lower than the control group; also there was a significant difference in right hind paws thickness between the two groups. In the allopurinol treated group, the activity of SOD was significantly increased while the serum levels of TNF-a, LPO, uric acid and right hind paws thickness were significantly decreased in comparison with the arthritic non-treated group. Nabumetone induced a significant decrease in the levels of TNF-a  and LPO and a significant increase in SOD activity accompanied by a signif-icant decrease in right hind paws thickness in comparison with the arthritic non-treated group. Combination of allopurinol and nabumetone induced also a significant improvement of all serum bio-indices and right hind paws thickness compared to other treated group, this improvement was still significantly different from the non-arthritic control group.
Conclusion: Both allopurinol and nabumetone showed anti-inflammatory and antioxidant effects in CFA-induced arthritis in rats. Addition of allopurinol to nabumetone induced a synergistic effect evidenced by reducing paw edema, free radical generation and improves antioxidant status.

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Category: Vol. 77, March 2009

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Diagnostic and Prognostic Value of CRP in Post-ERCP Pancreatitis,AHMAD T. SAYED, EMAD M. EL-MOATASEM and HATEM A. DARWISH

Abstract
Background and Aim: Acute pancreatitis (AP) is an in-flammation of the pancreas secondary to a variety of causes. It is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). As most ERCP is performed on an outpatient base, early evaluation can allow safe discharge of the majority of patients. The aim of this study was to identify the value of C-reactive protein (CRP) in the diagnosis and prognosis of post-ERCP pancreatitis (PEP).
Methods: One hundred patients who were candidate for ERCP examination either diagnostic or therapeutic included in the present study. All patients has been followed-up daily for at least 48 hours after ERCP for symptoms and signs suggestive of post-ERCP pancreatitis and follow-up of post ERCP pancreatitis patients has been done until pancreatic enzymes and CRP became normal. Serum amylase, lipase and CRP were done immediately after ERCP and on 2nd and 7th day after ERCP. CT` abdomen was performed for patients who develop post-ERCP pancreatitis.
Results: Patients were divided into group A (GA) which developed post-ERCP pancreatitis [25 patients (25%)] and group B (GB) which had no pancreatitis [75 patients (75%)]. Serum amylase and lipase were significantly higher in GA relative to GB at T0, T2, T7. Additionally, at T2 both serum amylase and lipase was more than 3 fold the upper limit of normal in GA. Also data concerned with CRP level at T0, T2, T7 revealed a significant increase in GA relative to GB. Data were highly significant at T2 and T7. Out of the 25 cases of Post-ERCP pancreatitis, 17 cases showed CT findings consis-tent with acute pancreatitis, 13 of them had mild and moderate disease. The remaining 4 cases had severe acute pancreatitis.
Conclusion: Since the mean value of CRP at T7 in GA is still high above upper limit of normal, while serum amylase and lipase were not, and the significant rise in CRP level at T0, T2, T7 in GA was directly correlated to the CT findings. Therefore, these data might suggest the importance of the CRP level as a diagnostic test and also in the assessment of the prognosis of Post-ERCP Pancreatitis, it is cheap, readily available but it is not an early marker.

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Category: Vol. 80, September 2012

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Coblation Versus Bipolar Diathermy for Adult Tonsillectomy,AHMED H. FAWZY, AYMAN HUSSIEN, AHMED HUSSEIN and BAHER ASHOUR

Abstract
Objective: To compare coblation and bipolar diathermy tonsillectomy in adults in terms of operative time, operative blood loss, post operative pain and post operative complica-tions.
Patients and Methods: Thirty patients (aged 18-40 years) scheduled for tonsillectomy were enrolled in this study, the patients were randomized using sealed envelopes to have one tonsil removed by coblation and the other tonsil removed with bipolar diathermy. Operative time and operative blood loss were recorded for each side separately and compared. The patients were given a pain diary to record the level of pain on each side using a visual analog score for 7 days. They were asked also to report any complications.
Results: Operative time and operative blood loss were significantly less in the coblation sides (p<0.001). The mean pain score on the coblation sides was significantly lower compared to the diathermy sides on the 1st and 2nd post operative days.
Conclusion: This study can be added to the studies rec-ommending the use of coblation for tonsillectomy in adults based on the minimal post-operative pain and similar morbidity compared to bipolar diathermy.

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Category: Vol. 83, June 2015

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Screening for Hepatocellular Carcinoma by Egyptian Physicians, SAHAR M. HASSANY, EHAB F. MOUSTAFA and MOHAMED EL-TAHER

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Category: Vol. 77, March 2009

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Immune-Changes in Sepsis,HASSAN S. EFFAT, SANAA S. ABDELSHAFY and ENAS A. LATIF

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Category: Vol. 77, March 2009

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Association of Type 2 Diabetes Mellitus and Glutathione S Transferase (GSTM1 and GSTT1) Genetic Polymorphism,

HOIYDA A. ABDEL RASOOL, NADIA K. KASHMIRY, SHAHIRA R. NOWIER, HEBA MORAD and SOMAIA ISMAIL

Abstract
Background: Oxidative stress, arising as a result of an imbalance between free radicals and anti-oxidant defenses, is associated with damage to lipids, proteins and nucleic acids, which could contribute to cellular dysfunctions leading to the pathophysiology of various diseases including atherosclerosis, cancer and diabetes mellitus. Glutathione S-transferases (GSTs) belong to a group of multigene and multifunctional detoxification enzymes, which defend cells against a wide variety of toxic insults. An important condition affecting GST expression is oxidative stress, usually observed in diabetes.
Aim: To assess whether the glutathione S-transferase T1 (GSTT1) and M1 (GSTM1) genotypes are associated with type 2 diabetes mellitus and to ascertain whether the levels of blood lipids given exposure to diabetes are modified by the specific genetic polymorphisms of GSTT1 and GSTM1.
Subjects and Methods: Using a multiplex polymerase chain reaction, GSTT1 and GSTM1 gene polymorphisms were analyzed in 29 patients with type 2 diabetes mellitus compared to 16 healthy age and sex matched control group. The association between genotypes and blood lipids were assessed separately for all the study subjects (type 2 diabetes mellitus group and the control group) with GSTT1 null and also for GSTM1 null compared to GSTT1 present and GSTM1 present genotypes respectively.
Results: The proportion of GSTT1 null genotypes was higher in diabetic patients as compared to controls (17.24% versus 6.25%). No significant difference of the frequency of GSTM1 null was observed between cases and controls (58.6% versus 62.5%). The GSTT1 present genotype conferred a statistically significant 0.39 fold reduction in risk of type 2 diabetes mellitus relative to the null genotype of the GSTT1 genotype but the GSTM1 genotype did not differ with respect to their association with risk of type 2 diabetes mellitus. Among individuals with GSTT1 null and GSTM1 null, the serum cholesterol, triglycerides and high density lipoprotein were not significantly different from GSTT1 present or GSTM1 present genotypes.
Correspondence to: Dr. Hoiyda A. Abdel Rasool, the Department of Clinical & Chemical Pathology, Fayoum University.
Conclusion: GSTT1 gene polymorphisms may play an important role in type 2 diabetes mellitus pathogenesis. The potential role of GSTM1 polymorphism as a marker of sus-ceptibility to type 2 diabetes mellitus needs further studies in a larger number of patients. GSTT1 and GSTM1 null genotype do not have an effect on blood lipids.

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Category: Vol. 78, June 2010

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Case Series: Lobular Capillary Hemangioma of the Nasal Cavity in Pregnancy,AHMAD M.M. AL BASSIOUNY

Abstract
Background: Nasal Lobular capillary hemangioma (LCH) is a benign vascular lesion of unknown etiology but commonly associated with pregnancy, oral contraceptives and trauma that must be included in the differential diagnosis of vascular lesions.
Design: Following Institutional Review Board approval, seven patients who were referred to our institution between February 2006 - December 2009 complaining of recurrent attacks of epistaxis and Nasal obstruction during pregnancy were included in this study.
Material and Methods: 7 pregnant women were surgically treated for removal of vascular lesions arising from the nasal septum and the inferior turbinate. All specimens send to histopathology. Postoperative follow-up carried out for 6 months.
Results: Seven pregnant women with Lobular capillary hemangioma (LCH), which arises from the anterior part of the nasal septum and the inferior turbinate, were presented in this study. All patients operated upon with satisfactory results. Follow-up postoperative period was uneventful.
Conclusion: It is known that the nasal cavity is a rare location for lobular capillary hemangioma and when it is seen in the nasal cavity, LCH mostly locates on the anterior portion of nasal septum (Little’s area), less frequently on anterior part of inferior turbinate.
LCH should be considered in pregnant patients, if they have a complaint of nasal obstruction and recurrent Epistaxis.

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Category: Vol. 80, December 2012

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Anesthesia and Immune Response in Cancer Patients,NEEMAT I. ABD EL-RAHMAN, HASSAN M. AHMED, EMAN A. FOUAD, HEBA M. GOUDA and AMANY H. SALEH

Abstract
Background: This study was designed to evaluate the immunity condition of cancer patients and to assess the efficiency of combined bilateral superficial and deep cervical plexus blocks with general anesthesia in patients undergoing total laryngectomy with respect to the immune response.
Method: The patients (40) were allocated randomly to one of two groups: General Anesthesia Group (GA) (n=20) and Combined Group (regional and general anesthesia) (n=20). After assessment of the airway, propofol was titrated slowly until loss of verbal contact is achieved, after assessment of adequacy of ventilation, vecuronium 0.1mg/Kg was given for muscle relaxation, fentanyl was given in a dose 1ug/kg and then a cuffed endotracheal tube was inserted. The maintenance of anesthesia in both groups was achieved by sevoflurane with fresh gas flow 5 L/min. In combined group, after achieving satisfactory level of anesthesia, the patients received combined bilateral superficial and deep cervical plexus block. The hemodynamic goals were to maintain the mean arterial pressure (MAP) at 60-65mmHg by adjusting the sevoflurane concen-tration and the use of esmolol. The consumption of sevoflurane and the Frequency of use of esmolol were evaluated in both groups. Intraoperative blood loss was assessed. Venous blood samples for measurement of serum SIL-2R and IL-2 levels were obtained before induction of anesthesia, at the end of surgery, and in the mornings of 1st and 5th postoperative days. In addition, serum samples also were collected from 40 healthy volunteers (mean age 39 yr, 30 male and 10 female) for comparison.
Results: The number of patients requiring supplemental fentanyl, and the mean end tidal sevoflurane concentration were significantly increased in GA group. All patients in GA group required supplemental esmolol to achieve the target MAP, in contrast only 5 patients in the combined group required supplemental esmolol (p<0.001). A reduction in blood loss was observed in the combined group during the surgical procedure (p<0.05). As regards, the immune response, Serum SIL-2R were significantly elevated (p<0.005), whereas the serum IL-2 levels were significantly reduced (p<0.005) in both groups compared to those of the healthy persons. Also there was no significant difference in the 2 values between the two groups preoperatively. The mean serum SIL-2R andIL-2 levels at the end of operation (T2), 1st day (T3) and 5th day postoperative values (T4), were comparable to preoperative values (T1) between the two groups. On the morning of the 1st postoperative day (T3), and 5th postoperative day (T4) there were significant differences in the 2 parameters in both groups as compared with the preoperative values; the mean serum levels of SIL-2R had increased (p<0.05), whereas IL-2 levels had declined (p<0.01) but there was less significant increase in the mean serum SIL-2R levels and less significant decrease in the mean serum IL-2 levels in the combined group than in the GA alone group (p-value 0.001).
Conclusion: Cancer larynx is associated with a state of immuno-suppression. surgical procedure performed with GA combined with regional anesthesia had less depressant effects on the immune response in the immediate postoperative period.

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Category: Vol. 78, March 2010

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Colorectal Cancer in Upper Egypt, Does Age Make A Difference in Survival ?, HODA H. EISA

HODA H. EISA, M.D.

Abstract
Background: The incidence of colorectal cancer (CRC) in patients under 40 years in Egypt is rising. However, the prognosis in this subset of patients is controversial. Young age is not yet a poor prognostic marker in CRC.
The Aim of this Study: Was to determine the correlation between age, clinicopathologic features and outcomes of patients with CRC.
Patients and Methods: 102 patients with histologically confirmed CRC were treated between 2004 and 2008 at the Oncology Department of Assiut University Hospital but only (89) patients were eligible for the study. The clinicopathologic features of 36 patients under 40 years (group I) were compared with 53 older patients (group II). Patient gender, Karnofsky performance status (KPS), duration of symptoms, symptoms, stage at presentation, lymph node involvement, site, histologic grade and survival rates were compared.
Results: Patients under 40 years constituted 40.4% of all CRC patients. The male to female ratio was 1.3:1 for group I and 1.5:1 for group II. Most tumours in both groups were located in the rectum (47.2% for group I and 39.6% for group II). Most patients in group I presented with an advanced stage (Dukes’ C and D), constituting 58.3% while most of those patients in group II presented with early stages (Dukes’ A and B) constituting 58.5%. Most patients in group I had worse pathologic features where mucinous/ signet ring and poorly differentiated tumours constituted 41.7% and 25% respectively. Most patients in group II presented with well and moderately differentiated tumours (69.8%). There was no significant difference n survival between the two groups where 2- year survival rate was 83.3% and 71.7% and 5- year survival rate was 38.9% and 30.2% for group I and II respectively. On univariate analysis, tumour stage at presentation. Lymph node involvement and KPS were significantly predictive for overall survival. On multivariate analysis, stage at presentation and KPS were the main independent prognostic factors affecting overall survival of young CRC patients.
Conclusions: The incidence of CRC in young patients in upper Egypt is increasing. Most of the tumours were located in the rectum. Young patients had more advanced stage and worse pathologic features. However, the survival in this young group was not significantly different from the older group. Stage of the tumour, L.N. involvement and KPS were the main prognostic factors for survival.

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Category: Vol. 78, March 2010

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Anemia in Saudi Pregnant Still a Health Problem, SHARIFA A. ALSIBIANI

Abstract
Objectives: To determine prevalence of anemia and degree of severity among pregnant women attending booking prenatal clinic.
Setting: King Abdul-Aziz University hospital, Jeddah, Saudi Arabia.
Methods: A retrospective analysis of booking hemoglobin (Hgb) over period of 4 years (between 1 January 2004 and 31 December 2007). Hemoglobin (Hgb) level results were reviewed and analyzed with respect to age, nationality, gra-vidity, and the number of previous abortion.
Results: Of the 8981 of hemoglobin (Hgb) tests were done, 3869 (43.1%, 95% CI: 42.06 - 44.1%) were anemic, of which 3383 (37.7%, 95% CI: 36.64 - 38.65%) having mild anemia, 462 (5.1%, 95% CI: 4.69 - 5.6%) having moderate anemia, and only 24 (0.3%, 95% CI: 0.18 - 0.4) having severe anemia. Severe anemia was more prevalent among primigravi-da (0.5%) and teenager (0.4%) groups.
Conclusion: Anemia is common (43.1%) among our pregnant women and the majority (37.6%) is mild. Severe anemia is rare (0.3%) and it is more prevalent among primi-gravida and teenager groups.

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Category: Vol. 77, March 2009

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Quality Indicators in Our ICU, a Tool for Improvement!,LAMIA HAMMED, WALIED KAMIL, MAGED ABULMAGD, HESHAM ELAASAR, ALIA ABDUL FATTAH and SHERIF MOKHTAR

Abstract
Study Objective: Patients included in the study were 96 consecutive eligible patients admitted to mixed medical/ surgical ICUs between January, 2008 and March, 2008. Our objective was to use a consensus process to develop a prelim-inary set of quality measures to assess care in our ICU. We built on earlier efforts of the Spanish Society of Intensive Critical Care and Coronary Units (SEMICYUC), in May 2005 to propose specific measures of the structure and process of ICU care. We used an informal iterative consensus process to identify and refine a set of candidate quality measures.
Design: Retrospective cohort study.
Setting: Department of critical care medicine, Cairo university hospitals.
Patients: A total of 96 patients admitted to our ICU from January 2008 to March 2008.
Intervention: None.
Measurements and Main Results: This study was conduct-ed to detect the implementation of a set of indicators that measure the quality of care in intensive care units (ICU) in Cairo university hospitals. The study was done for 3 months in 2 ICUs. All patients were studied for the implementation of the fundamental quality indicators (QI) that was previously published by the Spanish Society of Intensive and Critical Care and Coronary Units (SEMICYUC).
Our results showed that standards (6,14 and 17) were not applicable our ICU. Implementation of indicators 7, 15 and 18 were poorly applied in our ICU. Poor performance was defined as a score of less than 50% of the standard. On the other hand, all other indicators were implemented with different scores in our ICU.
Conclusion: As quality assurance become an important issue in modern ICU practice, ICU quality indicators has become a useful tool to measure ICU quality performance. Our ICU is still lacking implementing quality practice, we need intensive efforts to spread the culture of continuous quality improvement in our ICUs.
Abbreviations:
QI : Quality indicator. ICU: Intensive care unit.

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Category: Vol. 83, June 2015

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Evaluation of Perfusion Index (PI) Efficiency in Pediatric Caudal Block: Is it the Time to Depend on PI?, MOHAMED I.A. EL-SONBATY and AHMED I.A. EL-SONBATY

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Category: Vol. 84, June 2016

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Effect of Mulligan Technique on Sacroiliac Dysfunction during Pregnancy, ADLY A.H. SABOUR, MOHAMED A. AWAD, AMR A. MANSY and MAI I. TOLBA

Abstract
This study was conducted on forty pregnant women who were selected randomly from El Shatbe University Hospital in Alexandria, Alexandria University, having sacroiliac joint dysfunction and shared in this study. Their ages ranged from 20-35 years old and their BMI didn’t exceed 40kg/m2. They were divided into two equal groups: Group A was treated by postural correction exercises, 30 minutes three times per week for two weeks, and Group B was treated by postural correction exercises and mobilization with movement 10 repetitions each session day after day for two weeks. The study was conducted from March 2015 to December 2015. Pain intensity was assessed using pressure algometer and modified Oswestry disability questionnaire. Lumbosacral flexion range of motion (L5, S1) was assessed using universal inclinometer. Results showed that there was highly significant decrease in pain intensity in both groups (A and B) post treatment in pressure algometer and modified Oswestry disability questionnaire. When compared both groups (A and B) post treatment together, there was a significant difference between both groups (more decrease in group B).
There was highly significant increase in lumbosacral flexion ROM in both groups (A and B) post treatment using universal inclinometer. When compared both groups (A and B) post treatment together, there was highly significant dif-ference between both groups (more increase in group B).
It could be concluded that mobilization with movement is valuable and an effective method in decreasing pain, im-proving lumbosacral flexion ROM and disability for pregnant women suffering from SIJD.

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Category: Vol. 79, September 2011

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Effect of Nursing Interventions Using Foot Reflexology on Blood Pressure and Quality of Life of Hypertensive Patients at Mansoura University Hospitals: Preliminary Results KARIMA ELSHAMY, D.N.Sc. and EMAN ELSAFETY, M.D.

Abstract
The aim of this study was to investigate the effect of foot reflexology on blood pressure and quality of life among hypertensive patients. A quasi-experimental study was con-ducted for patients with hypertension attended the outpatient clinic of the Specialized Medical Hospital at Mansoura Uni-versity, Egypt, enrolled in this study during six months, between 15 May and 14 October 2010 were randomly allocated into two equal groups (40 in the foot reflexology group (intervention), and 40 in the control group.
Two tools were used for data collection:
I : Demographic and medical interview schedule. II: Quality of Life Questionnaire.
Systolic blood pressure decreased significantly in inter-vention group from 160.2mmHg to 136.5mmHg compared to (162.5mmHg to 155.2mmHg) in controls. There was a statis-tically significant decrease in means of diastolic blood pressure between pre and post intervention (102.0mmHg –87.5mmHg) within the intervention group (p<0.05), Change in control group was not proved to be statistically significant (100.1mmHg –96.4mmHg pre and post readings respectively, p>0.05). There was no evidence for improvement in Quality of Life in either group (pre levels was 42.2, 47.1 and post levels was 45.9, 47.4 in the 2 groups respectively). This study supported that foot reflexology can reduce blood pressure levels in patients with hypertension, it did not support that foot reflexology could improve quality of life in these patients. Future research is needed to support these findings specially the negative ones. It is recommended that qualitative research might be used in combination with quantitative research to determine details of patients' feelings, interactions, attitudes, cultural influences and satisfaction after intervention.

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Category: Vol. 84, March 2016

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Frequency of Dermoscopic Nevus Subtypes by Age, Skin Phototype and Body Site, HESHAM ZAHER, DALIA BASSIOUNY, RANIA ABD EL-HAY, NESREEN SAMIR and NANEES RAGAB

Abstract
Background: The dermoscopic patterns of nevi were found to be related to a variety of factors such as age, the patient's pigmentary phototype and the location on the body.
Aim of Study: To detect frequency of dermoscopic nevus subtypes stratified by patient age and skin phototype and location of the nevi.
Patients and Methods: 3 0 patients were enrolled in the study in which the age and skin phototype were determined. 59 acquired melanocytic nevi were studied. The location was determined. Each nevus was examined dermoscopically in which the diagnosis was confirmed and the global dermoscopic pattern was detected. Nevi were dermoscopically subclassified as globular, reticular and mixed (reticular-globular) pattern.
Results: The commonest dermoscopic subtype in the studied group was the reticular type. A statistically significant association was found between the skin phototype and der-moscoic pattern (p=0.026). Individuals with skin phototype IV were more likely to have a reticular pattern. No statistically significant association was found between age and dermoscopic nevus pattern. No statistically significant association was found between location of nevus and dermoscopic nevus pattern.
Conclusion: The reticular pattern is the commonest der-moscopic nevus pattern in adults. The dermoscopic pattern of nevi is influenced by the skin phototype. The reticular pattern is more common among the darker skin phototypes (phototype IV).

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Category: Vol. 83, September 2015

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Comparative Study between Multimodal Analgesia Versus Caudal Analgesia for Postoperative Analgesia in Pediatric Cancer Patients Undergoing Abdominal Surgeries, WALAA Y. ELSABEENY, AYMAN A. GHONEIM, DINA N. ABASS, HALA M.R. HASSANEIN and ABDELFATTAH A. HUSSEIN

Abstract
Background: Caudal analgesia is commonly used for perioperative pain control in pediatric abdominal surgeries. The aim of this study was to compare preemptive intravenous multimodal analgesia supplemented with local anesthetic infiltration (LAI) versus preemptive caudal analgesia with bupivacaine and morphine, regarding postoperative pain and adverse effects in pediatric patients undergoing abdominal surgery for excision of suprarenal neuroblastoma.
Methods: Forty patients were randomly enrolled in the study; patients were divided into 2 groups; multimodal group (group M, n=20) received ketorolac, paracetamol, ketamine supplemented with LAI before surgical incision and caudal group (group C, n=20) received caudal block done before surgical incision.
Results: The mean time to the first rescue analgesic requirement was significantly longer in group M (7.3±2.8) hours than in group C (4.6±2.7) hours (p<0.005). The mean morphine consumption in the first 24 hours postoperatively was higher in group C (3.3±1.2) mg than in group M (2.1±0.6) mg (p<0.01). The median pain score was lower in group M in PACU but both groups were comparable at 2 to 24 hours.
Conclusion: Intravenous multimodal analgesia supple-mented with LAI improves analgesia in PACU and reduces morphine consumption within the first 24h postoperatively more than single dose caudal analgesia in pediatric abdominal surgeries.

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Category: Vol. 78, June 2010

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Adjuvant Dendritic Cell-Based Tumor Vaccination for Patient with Malignant Glioma. MOHAMAD EL-BELTAGY, AHMAD ALY, HALA GABR, RANIA ZAYED, EHSAN EL GONEIMY, NEVINE FOUAD and AHMAD ISSA

Abstract
Objective: Glioblastoma multiforme (GBM) is the most aggressive and common primary brain tumor, with a median survival of 12-18 month without the possibility of spontaneous remission. Current treatment has not substantially changed the prognosis for GBM patients. One of the most recent treatment options is the trial of immune therapy.
Methods: The present study included 30 patients; liquid culture was established for generation of dendritic cells from peripheral blood mononuclear cells, using GM-CSF and IL-4, followed by pulsing of the generated dendritic cells by tumor lysate to produce tumor-specific dendritic cells to be used as vaccine. Patients were vaccinated five times, four weeks apart. Follow-up of the patients was done using MRI and DMSA scan.
Results: Dendritic cell generation was proven by CD1a expression & specific morphology. The median disease free survival was significantly improved in the studied patients.
Conclusion: We demonstrated that tumor pulsed dendritic cells can be used as a potential vaccine in the immunotherapy of brain tumors which represents an important approach for improvement of treatment outcome.

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Category: Vol. 82, December 2014

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Assessment of Laryngeal Ultrasound Feasibility in Evaluating Subglottic Stenosis, MOHAMMAD W. EL-ANWAR, HAZEM S. AMER, ISLAM R. HERZALLAH and KHALED M. EL-GERBY

Abstract
Objective: The study was conducted to assess the feasi-bility laryngeal ultrasound in evaluation of subglottic stenosis as regard diameter, length and nature of the stenotic segment.
Subjects and Methods: This study included 26 patients with age ranging from 17 to 58 years, who had subglottic stenosis diagnosed by endoscopy and computed tomography (CT). The relationship between superficial laryngeal ultra-sonography (US) and endoscopic grading of subglottic stenosis (as regard diameter) and CT grading (as regard length) were assessed. In 13 cases that required surgical intervention, the tissue nature of the stenotic segment was assessed both by US and direct endoscopy. US, CT and fibreoptic endoscopic evaluations were also performed for ten controls.
Results: The same grade score was interpreted in US and endoscopy in 23/26 patients (88.5%). The grading score by US as regard length was the same that has been interpreted by CT in 21/26 (80.7%). The nature of the stenotic segment was found to be the same in 12 out of those 13 operated patient (92.3%).
Conclusion: Superficial laryngeal US is a reliable, safe, non invasive diagnostic imaging tool to evaluate diameter, length, and nature of subglottic stenosis.

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Category: Vol. 77, June 2009

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A Predictor of Collateral Formation in Congenital Heart Diseases,YASSER H. KAMEL, YASSER M. BAGHDADY and MOHAMAD SHEHATA

Abstract
Objective: Vascular endothelial growth factor is potent stimulators of angiogenesis. Children with cyanotic congenital heart disease often experience the development of widespread formation of collateral blood vessels, which may represent a form of abnormal angiogenesis resulting in increased morbidity and mortality.
The Aim of this Study: To determine whether children with cyanotic congenital heart disease have elevated serum levels of vascular endothelial growth factor compared to children with acyanotic heart disease.
Methods: Serum was obtained from 44 children with cyanotic congenital heart disease and 36 children with acyan-otic heart disease. Vascular endothelial growth factor levels were measured in the serum of these patients by sandwich enzyme immunoassay.
Results: Vascular endothelial growth factor was signifi-cantly elevated in children with cyanotic congenital heart disease compared to children with acyanotic heart disease (159.3±48.1pg/ml Vs. 85.4±18.7pg/ml, respectively, p<0.00 1). In the cyanotic group, oxygen saturation (SaO2) was negatively correlated with VEGF (r=–0.531, p<0.001) while hemoglobin was positively correlated (r=0.781, p=0.007). No significant correlations were found in the acyanotic group.
Conclusion: Children with cyanotic congenital heart disease have elevated systemic levels of vascular endothelial growth factor directly related to the degree of cyanosis (SaO2 and hemoglobin levels). These findings suggest that the widespread formation of collateral vessels in these children may be mediated by vascular endothelial growth factor.

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Category: Vol. 83, September 2015

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Effect of Designed Nursing Protocol on Nurse's Knowledge and Practice Regarding Chemotherapy, NAGWA M.A. MOHAMED

Abstract
Background: According to the World Health Organization, each year, more than 11 million patients worldwide receive a new diagnosis of cancer. This number is expected to rise to 16 million by 2020. Chemotherapy is still the main treatment regimen, and approximately 50% of patients with cancer receive chemotherapy. Currently, approximately 100 different anti-cancer drugs are in use and many more are under devel-opment. The characteristics of cancer drugs have given rise to many issues. One issue is whether nurses are competent to administer such drugs.
Aimof the Study: To evaluate the effect of implementing the designed nursing protocol on nurse's knowledge and practice regarding chemotherapy.
Subjects and Methods: Aquasi-experimental research design was utilized in this study on a convenient sample of 35 nurses agree to participate in the study. This study was conducted in the South Egypt Cancer Institute at Assiut University. Tools that utilized for data collection were (A) Nurse's knowledge questionnaire sheet, (B) Chemotherapy practice observation checklist sheet. (C) Construction of designed nursing protocol about chemotherapy.
Results: The first and the second hypotheses were sup-ported as a good improvement in the mean knowledge and practice scores were found after implementing of the designed nursing protocol. The third hypothesis was supported as a positive relationship was found between nurse's knowledge and practice scores immediately after application of the designed nursing protocol.
Conclusion: The evidence-based results suggested that nurses have insufficient knowledge about chemotherapy. More fundamentally, however, nurses need more education about chemotherapy in nursing school and through in-hospital continuing education.

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Category: Vol. 77, September 2009

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Spirometry and Cardiopulmonary Exercise Performance in Patients with Thalassemia Major, MONA EL-TAGUI, KHALED SALAMA, HASSAN M. SALAMA, MONA M. MAHMOUD, HOSSAM H. MASSOUD, MOHAMAD EL-BATANONY and AZZA ABDEL MEGIUD

Abstract
Background: Lung function abnormalities in patients with thalassemia major are various, complex and of different etiological backgrounds.
Methods: To evaluate the pulmonary function changes during both rest and integrated cardiopulmonary exercise in patients with thalassemia major, we studied 30 thalassemia major cases with mean age of 18±13.34 years. Nineteen healthy subjects were enrolled as a control group. Routine laboratory tests as well as assessment of pulmonary function test during both rest and integrated cardiopulmonary exercise were performed for cases and controls.
Results: Both forced vital capacity (FVC) and forced expiratory flow in the first second (FEV 1) were significantly reduced in cases than in controls (p<0.01 for both), pointing to a restrictive pulmonary dysfunction. Seventy percent of cases had FVC below the normal predicted value. Functional capacity, anaerobic threshold and O2 pulse were significantly reduced in cases than controls (p<0.05). There is a statistically significant inverse correlation between serum ferritin levels and functional capacity.
Conclusions: In the studied thalassemics, restrictive pattern of pulmonary dysfunction is the predominant abnor-mality. Poor cardiopulmonary exercise performance occurs and is multifactorial.

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Category: Vol. 80, December 2012

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Early Experience with Morton’s Neuroma,SAMEH BADRAN, TAMER M. EWADI and AMR ABDALKADER

Abstract
Background: When conservative treatment of a Morton neuroma is unsuccessful, surgical resection or a less invasive steroid injection is indicated. The purpose of the study was to evaluate the functional outcomes and patient satisfaction and, complications, after surgical resection via dorsal approach or local steroid injection of an interdigital neuroma.
Methods: Thirty two consecutive patients who underwent surgical excision or local steroid injection of a Morton neuroma that had been unresponsive to conservative treatment were included in our study. Patients were selected based on The clinical diagnosis was confirmed by means of magnetic resonance imaging and histological analysis. Sixteen patients underwent excision of the neuroma through a dorsal approach; and sixteen patients were treated by local steroid injection, evaluation forms were handled to each patient and patient satisfaction scale was recorded to assess the results of both procedures.
Conclusions: Surgical resection in of interdigital neuro-mata, in properly selected cases demonstrating a positive Mulder sign, or with a neuroma delineated on MRI scans; provides a reasonably safe treatment option with minimal complications.

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Category: Vol. 77, March 2009

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A Comparison Study of Radiation Dose Received During Cone Beam Computerized Tomography and Portal Imaging Techniques,

YASIR A. BAHADUR, CAMELIA CONSTANTINESCU, HUSSAIN M. NASEEM and EHAB E. FAWZY

Abstract
Background: Although widely varied in modality and method, all radiographic guidance techniques have one thing in common; they can give a significant radiation dose to the patient; which may have a late radiation stochastic effect on normal body tissues.
Aim: To quantify and compare radiation doses to the tumour and the surrounding critical organs resulting from the orthogonal pair portal and megavoltage cone beam computa-rized tomography (MV CBCT) imaging techniques.
Material and Methods: The dose to the patient resulting from the orthogonal pair and the MV CBCT imaging tech-niques, has been calculated based on a 6 MV Oncor linear accelerator equipped with an amorphous silicon flat panel. All calculations were done on Eclipse 3D treatment planning system. 18 patients representing three different treatment sites (head and neck, thorax, and pelvis) were analysed. Data from 6 patients for each treatment site were used to calculate the mean doses. Calculations were done for: The integral dose, maximum dose to the patient, dose at the isocenter, and mean dose to the tumour and each critical organ.
Results: The absolute dose measured as integral dose, maximum dose to the patient, dose at the isocenter, and mean dose to the tumour and each critical organ was higher for MV CBCT as compared to orthogonal pair technique for all treatment sites.
For both techniques, the absolute dose was higher for head and neck and thorax as compared to pelvis. The difference of maximum dose to the patient showed greater variation for head and neck, but not for thorax and pelvis.
Conclusion: There are relatively high dose regions gen-erated by MV CBCT that occur inside critical organs as well treatment area and tend to be larger than those generated by the orthogonal pair technique.

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Category: Vol. 83, June 2015

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Effect of Hypernatremia on the Outcome of Patients with Severe Traumatic Brain Injury, TAMER HELMY, SHERIF ABD EL-MONEM and MAHMOUD OMRAN

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Category: Vol. 83, March 2015

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Cervical Hooks for Atlanto-Axial Posterior Cervical Fusion, IBRAHIUM M. IBRAHIUM, SAMEH SAKR, MOHAMED ADEL ELMALLAWANY

Abstract
Introduction: Treatment of atlantoaxial instability is predominantly surgical aiming at stabilization, bony union, improvement of pain and neurological status and restoration of normal anatomy of atlantoaxial joint.
Purpose: The present study was designed to determine the surgical yield of cervical C1-C2 fixation by implantation of C1-C2 laminar hook systems via posterior approach for the treatment of patients with C1-C2 instability.
Patients and Methods: The present study included 20 patients; assigned for C1-C2 fusion for non-neoplastic disease; diagnosis and inclusion was confirmed by magnetic resonance imaging (MRI). The applied technique for C1-C2 hook fixation was conducted, using either iliac crest or artificial bone graft. Postoperative bracing (firm collar) was applied for 8-12 weeks. Outcome Measures included radiological evaluation of suc-cessful bone fusion, neurological evaluation using the American Spinal Injury Association (ASIA) motor score, neck and arm pain scoring, neck disability index (NDI) and the functional independence measure (FIM) presented as total motor score. Evaluations were conducted preoperatively and at end of follow-up period of at least 6 months.
Results: The study included 11 patients with odontoid fracture, 3 transverse atlantal ligament injuries, 4 as odonto-ideum and 2 had rheumatoid C1-C2 instability. Preoperative neurological evaluation detected 8 patients were ASIA grade B, 7 were ASIA grade C and 5 patients were ASIA grade D. All surgeries were conducted smoothly without intraoperative complications and an autogenous iliac crest graft was applied in 18 patients, while artificial bone grafts were used in 2 patients. Radiological examinations conducted at end of follow-up period at least 6 months showed evidence of fusion in 65%. Postoperative clinical evaluation revealed significant improvement of neurological ASIA grading and 35% showed complete recovery without motor or sensory deficit. Both pain and neck disability scores was decreased postoperatively compared to preoperative scores. Postoperative total FMI motor power scoring was higher compared to preoperative measures.
Conclusion: Posterior C1-C2 fixation using hooks system is technically simple to apply and can be done safely without 

concomitant intra-or postoperative complications. High success rates in obtaining fusion and significant improvement at the end of follow-up with high quality-of-life scores make this method of posterior fixation and fusion an optimal surgical modality for higher cervical spine instability which can be executed without any risk of vertebral injury.

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Category: Vol. 83, June 2015

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Case Report: Traumatic Intracorneal Epithelial Ingrowth, SAMIR HASSAN KHAIRALLAH

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Category: Vol. 77, March 2009

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Vaginal Colonization by Ureaplasma Species in Early Pregnancy: Role in Preterm Birth,MANAL A. AL-MARASHLY, HANAN F. MOHAMAD, MOHAMAD MATAR and WAHEED ABD EL-ALL TOLBA

Abstract
Preterm birth and low birth weight are the leading causes of neonatal mortality and morbidity. Ascending genital tract infections contribute to up to 50% of premature deliveries particularly those occurring before 34 weeks of gestation. Genital mycoplasmas including ureaplasmas species have been implicated in infertility, spontaneous abortion, still birth, premature birth, low birth weight and perinatal morbidity and mortality.
The Aim of this Study: Was to examine the association between colonization by two newly classified species of genital ureaplasmas (ureaplasma parvum and ureaplasma urealyticum) in early pregnancy and subsequent late abortion or preterm birth at less than 34 weeks of gestation using PCR technique.
A total of 160 women with singleton pregnancies at less than eleven weeks were subjected to full history and clinical examination, sterile cotton swabs were used to obtain vaginal material from the posterior fornix and these swab specimens were examined by PCR method, all pregnant women were followed up till delivery.
Results: Ureaplasma parvum was detected in a significantly larger number of women in the preterm birth group 10/15 (66.67%) versus 68/145 (46.89%) in the control group p=(0.037). A significantly larger number of women had a past history of preterm birth at <37 weeks of gestation in the preterm birth group p=(0.009). In addition, a significant larger number of women were treated with antibiotics before 22 weeks of gestation in preterm birth group than in control group p=(0.005). Thus detection of Ureaplama parvum in the vagina, use of antibiotics for incidental inflammatory condi-tions before 22 weeks of gestation, and past history of preterm birth were independently associated with late abortion or early preterm birth. In conclusion, vaginal colonization with urea-plasma parvum but not ureaplasma urealyticum is associated with early preterm birth.

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Category: Vol. 77, March 2009

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Role of MRI in Improving Diagnosis of Breast Tumors,KHALED F.Z. HASSAN and INASSE I. GABALLAH

Abstract
Aim of Study: To assess the role that can be played by MRI to minimize the number of false positive cases of breast tumors that commonly occur with mammography.
Patients and Methods: This study included 200 consecutive patients aged 40 years or more, who were referred to the Department of Radiology for suspicion of a breast lump. Mammography then magnetic resonance imaging (MRI) was performed for each patient. A patient with a positive finding in any of these two modalities underwent histopathological diagnosis. Sensitivity and specificity were calculated for each imaging modality and that for MRI of mammography positive patients.
Results: Most common benign lesion were fibroadenoma (11%) and radial scars (5.9%), while the most common ma-lignant tumors were invasive ductal carcinoma (37.3%) and ductal carcinoma in situ (21.2%). Prevalence of breast tumors among participants increased with their age. Prevalence of breast tumors among nulliparous participants was significantly higher than that among parous participants (88.6% Vs. 72.5%, respectively, p=0.01). The prevalence of breast tumors was significantly higher among those with positive family history of breast cancer (93.2%) than those with negative family history (70.6%), p=0.003. Mammography provided a higher sensitivity than that provided by MRI (97.5% Vs. 90.7%, respectively), but a lower specificity (48.6% Vs. 94.3%, respectively), which has been fully improved by the application of MRI on cases who were positive by mammography (100%).
Conclusion: The application of MRI for cases with positive mammographic findings can be a cost-effective procedure that greatly limits false positives, increases specificity and spares unnecessary invasive interventions.
Recommendation: To conduct a community-based study to assess the role and cost-effectiveness of MRI in screening for breast cancer among females aged over 40 years, applying MRI on all those with mammographic findings.

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Category: Vol. 80, September 2012

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Effect of Estrogen on Basal, Charbacol Stimulated Acid Secretion and Indomethacin Induced Ulcer in Female Albino Rats, NASHWA M.S. EL-TABLAWY, MOHAMED M. OMRAN, AKEF A. KHOWAILED and EMAD EL-DIN M.A. TANTAWY

Abstract
Introduction: Peptic ulcer occurs more frequently in men than in women, sex differences are less marked after 45 years of age probably because the incidence of ulcer increases in post menopausal women. The general assumption is that the ulcer differences between sexes are related in some way to sex hormones and that the female sex hormones protect against ulceration.
The aim of the this study was to investigate in rats the effect of ovariectomy on gastric acid secretion and gastric ulcer and to demonstrate the effect of estrogen, a selective alpha estrogen receptor agonist 1, 3, 5-tris (4-hydroxyphenyl)- 4-propyl-1H-pyrazol (PPT) and a selective beta estrogen receptor agonist 2, 3-bis (4-Hydroxyphenyl) Propionitrile (DPN) on gastric acid secretion on basal, charbacol stimulated acid secretion and also its effect on indomethacin induced ulcer in ovariectomized rats.
Material and Methods: A total of 90 female albino rats weighing 150-200gm were included in the study. The animals were divided into five groups 18 rats each.
•Group I: The control group.
•Group II: Was subjected to ovariectomy.
•Group III: Was subjected to ovariectomy and estrogen replacement therapy at a dose of 10μg/rat/day for ten days.
•Group IV: Was subjected to ovariectomy and a selective alpha estrogen receptor agonist 1, 3, 5-tris (4- hydroxyphenyl)-4-propyl-1H-pyrazol (PPT) replacement therapy at a dose of 10μg/rat/day for ten days.
•Group V: Was subjected to ovariectomy and a selective beta estrogen receptor agonist 2, 3-bis (4-Hydroxyphenyl) Propionitrile (DPN) replacement therapy at a dose of 10μg/rat/day for ten days. Each group is subdivided into three sub groups formed of 6 rats each.
Subgroup A: In which basal gastric acid secretion was measured and number of ulcers was counted.

Subgroup B: In which gastric acid was induced by Car-bamylcholine chloride (carbachol) 30μg/kg S.C. after three hours the stomach was removed, acid secretion was measured and number of ulcers was counted.
Subgroup C: Was subjected to indomethacin induced ulcer by oral administration of indomethacin 48mg/kg after three hours the stomach was removed, acid secretion was measured and number of ulcers were counted.
Results: Results showed that gastric acid secretion and number of ulcers were significantly higher among ovariecto-mized group than in control group when estimated within the basal acid secretion, carbachol induced acid secretion and indomethacin induced ulcer sub groups (p<0.05).
There was statistical significant increase in gastric acid secretion in the ovariectomized with estrogen replacement group as compared to the control group in basal acid secretion sub-group only (p<0.05). Also there was statistical significant increase in the number of ulcers in the ovariectomized with estrogen replacement sub-groups as compared to the control group (p<0.05), except for indomethacin induced ulcer sub group.
No significant difference had been observed between ovariectomized with alpha estrogen receptor agonist (PPT) sub-groups and the control group as regard acid secretion and number of ulcers (p 0.05).
Gastric acid secretion and number of ulcers were signif-icantly higher among ovariectomized with beta estrogen receptor agonist (DPN) group than in control group in basal acid secretion and carbachol induced acid secretion sub groups (p<0.05). While in indomethacine induced ulcer sub group the difference was not significant.
Also the results showed that gastric acid secretion and the number of ulcers were significantly lower among ovariec-tomized with estrogen replacement group and ovariectomized with alpha estrogen receptor agonist group compared with ovariectomized group in all studied sub groups (p<0.05).
The number of ulcers was significantly lower among ovariectomized with beta estrogen receptor agonist group than ovariectomized group in all studied sub groups (p<0.05). While Gastric acid secretion was significantly lower among ovariectomized with beta estrogen receptor agonist group compared with ovariectomized group in indomethacine induced ulcer sub group only (p<0.05).
There was no statistical significant difference between ovariectomized with estrogen replacement group compared with ovariectomized with alpha estrogen receptor agonist group and ovariectomized with beta estrogen receptor agonist group as regard acid secretion and number of ulcers. Except there was a significant lower number of ulcers in ovariecto-mized with alpha estrogen receptor agonist group as compared to ovariectomized with estrogen replacement group in the basal acid secretion and carbachol induced acid secretion sub-groups (p<0.05).
Conclusion: Our data indicate that estrogen decreases gastric acid secretion and number of peptic ulcers and this effect occur through stimulation of alpha and beta estrogen receptors.
This may provide an initial rationale for a potential hormone (estrogen) therapy to protect the GIT in postmeno-pausal women. Hence it is recommended to use estrogen replacement therapy in postmenopausal women to protect against gastric and duodenal ulcers.

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Category: Vol. 77, December 2009

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Brucellosis in Saudi Arabia: Review of Literature and an Alarming Case Report in a Hospital in Jeddah, HANI ABD EL-AZIZ JOKHDAR

Abstract
Brucellosis remains one of the world’s principal zoonostic infections that constitute a major public health problem and economic burden in many parts of the world, in particular, Saudi Arabia. Many factors have been implicated in the transmission of Brucellosis and its prevalence in Saudi Arabia, such as the social customs, dietary habits of its people, uncontrolled importation of poorly screened animals, lack of legislation for proper control of the marketing and movement of animals, husbandry practices, poor animal quarantine procedures and poor cooperation and exchange of information between veterinary and health services. The growing population of Saudi Arabia with its increased demand for dairy products accompanied with changing and intensified farming practices raises the concern for further spread and perpetuation of this disease. The eradication of human brucellosis in Saudi Arabia will ultimately depend on the eradication of animal brucellosis. An effective national brucellosis control programme is there-fore required.
This paper describes the history of brucellosis and the current public health picture in Saudi Arabia. It aims to highlight the current epidemiological situation, identify trends and possible risk factors for Brucellosis and barriers to its control and prevention in Saudi Arabia. A current case report of brucellosis was given.

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Category: Vol. 83, June 2015

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Aortic Coarctation: Evaluation with Computed Tomography Angiography in Pediatric Patients, MOHAMED ZAKI and MOHAMED HASSAN

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Category: Vol. 79, September 2011

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Comparison between Body Image and Self-Esteem Among Female Nursing Students in Three Different Arab Countries,NABILA TAHA, ESSMAT MANSOUR, AMAL SOBHY and ENTISAR M. YOUNESS

Abstract
Current western culture promotes standards of beauty and success which focus on physical attractiveness. These standards can create feeling of inadequacy and body dissatisfaction. Traditionally, women have responded most strongly to cultural messages of bodily attractiveness, there by experiencing greater body dissatisfaction than men. Failure to achieve the ideal has been shown to lead to decreased self-esteem which compounds body dissatisfaction and body image disturbance. Therefore; this study aimed at assessing and comparing the level of body image and self-esteem among three communities based sample from Riyadh- Kindom of Saudia Arabia (KSA), Hadhramout-Yemen, and Assiut-Egypt, 300 female students were recruited, 100 female students from each country. The study was carried out in three different settings; Riyadh Female Health Science Collage-KSA, and Faculty of Nursing, Hadhramout University of Science and Technology-Yamen, Faculty of Nursing, Assiut University-Egypt. Tools for data collection included; body image scale, which developed by El-Desouki. This scale consisted of 20 statements about positive and negative sensation of body image, Rosenberg self-esteem scale, this scale consisted of 10 statements about the positive and negative sensation of self-esteem and interview Questionnaire which developed by the investigators, it includes information about student's age, residence, marital condition, economic condition, parent's educational level, number of brothers and sisters and their orders among them. Results of this study revealed that positive body image constitutes 86% in KSA, 84% from Egypt while 73% from Yemen. The majority of the students in the three countries had high self esteem (78% in KSA, 96% in Egypt and 84% in Yemen). The study also found that positive perception of body image is associated with high self esteem (85.9%, 84.8% and 69.0%) among the studied students’ in KSA, Egypt and Yemen respectively), fortunately; negative perception of body image is associated with low self esteem in (13.6%, 15.2% and 6.2%) among students’ of KSA, Egypt and Yemen respectively. In conclusion high level of self esteem positively correlated with body image. Age, parent’s education, marital status, numbers of brothers and sisters are significantly correlated to body image and self esteem. This study recommended another informative study to investigate other dimensions of body image and self esteem in multi dimensional settings and studying the healthy lifestyle choices which are also a key to improve body image.

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Category: Vol. 77, March 2009

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Peribulbar Block in Pediatric Posterior Segment Ocular Surgery,ASHRAF DARWISH

Abstract
Objectives: Vitreous and retinal (VR) surgery with or without scleral buckling is associated with significant post-operative pain in adults, and recent studies have addressed the effect of retro or peribulbar block on these parameters. VR surgery in children has received little attention regarding the incidence of pain and the role of regional anesthesia in modifying these parameters. In this study, we compared peribulbar block with conventional opioid analgesia in children undergoing VR surgery.
Methods: In a prospective, randomized, single-blind study, 85 children (age 8 to 14 years) were allocated to receive peribulbar block (n=42) or intravenous fentanyl 2μg/kg (n=43) after induction of general anesthesia. Parameters compared were: Intraoperative incidence of oculocardiac reflex and requirement for additional analgesic; postoperative pain intensity; time to first analgesic, total number of postoperative analgesic supplements; and parental assessment of the child's postoperative comfort at 24 hours.
Results: The incidence of intraoperative oculocardiac reflex was significantly less in the peribulbar group (p=.0001). Significantly more children receiving peribulbar block were pain free on awakening (p=.0004) and throughout the postop-erative period. The number of children requiring opioid was significantly lower with peribulbar block (p=.008).
Conclusions: Peribulbar block appears to be a safe and clinically superior alternative to intravenous fentanyl for pediatric VR surgery.

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Category: Vol. 83, March 2015

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Glutathione S Transferase M1 Polymorphism in Extrahepatic Biliary Atresia, MAGD A. KOTB

Abstract
Background: Extrahepatic biliary atresia (EHBA) is a chronic progressive obstructive cholangiopathy of infancy of unknown aetiology. Pathology of bile duct damage involves unanimously neutrophil elastase, variable degrees of fibrosis, and variable CD14+ monocytes intensity staining in the presence of defective p53 and glutathione S transferases Pi class (GST Pi). GST is a super family responsible for detox-ification of an array of substances that affect cellular replication and DNA fidelity, of them cytosolic GST Mu is a member.
Aim of Work: Is to study GSTM1 gene polymorphism in EHBA.
Material and Methods: Genotyping of GSTM1 from peripheral blood of 41 infants with EHBA, and from peripheral blood of their mothers was performed. Study commenced by July, 2001 and ended by July, 2004, in New Children Hospital, Cairo University.
Results: All 41 enrolled infants had a null GSTM1 mutation concordant with homozygous deficiency, and all mothers expressed a pattern concordant with affection of only one allele.
Conclusion: All infants suffering from EHBA had null GSTM1 genotype. Phenotypic loss of function of GSTM1 renders subjects with EHBA susceptible to a wide array of substances that affect cellular replication and DNA fidelity. Susceptibility to EHBA is genetic and transmitted in an autosomal recessive fashion from mothers with single gene allele. This work supports that EHBA is a developmental defect.

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Category: Vol. 77, March 2009

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Influence of Embryo Transfer Distance on Pregnancy Rate in ICSI Cycles,HAMSA RASHWAN, SHERIF EL-SHARKAWY, MEDHAT AMER, MAHA EL-SHAHED, MONA FAROUK, NADIA ABOUZEID, FOUAD ABOU-HAMILA, ESSAD ABDELGAWAD and MOHAMED TOLBA

Abstract
Purpose: To investigate the influence of transfer distance to the fundus on pregnancy rate.
Method: Retrospective single center study, including 674 consecutive cycles of ICSI done at Adam International Clinic between January 2005 and December 2005.
All patients were included and data examined regarding; their age, endometrial thickness at day of HCG, endometrial pattern at day of HCG, number and quality of embryos trans-ferred, difficulty of embryo transfer as reported by the trans-feror, transfer distance to the fundus as measured by trans-abdominal ultrasound and if the ejection of the media inside the inner sheath of the transfer catheter was seen or not.
Results: Our data indicate that the actual distance to the fundus did not affect the pregnancy rate.
Conclusion: Our data proves that the exact position of embryo deposition from the fundus does not influence preg-nancy rate, however the use of trans-abdominal ultrasound can be of help in visualizing the catheter in the more difficult transfer and air bubbles can be documented, also ultrasound guidance adds to the confidence in the procedure by both the physician and the patient.

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Category: Vol. 77, June 2009

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Audit of Diabetes Care at Al Wakra Health Center, Qatar,NAZAR RAWHYA, AL ANSARI YOUSSEF, MOHAMAD SALEM and ABDULMAJEED AHMAD

Abstract
Introduction: Diabetes is a chronic illness that requires continuing medical care. Patient health education and self management aim to, prevent acute complications and to reduce the risk of long term complications. Diabetic care is a complex proces and requires many issues beyond glycemic control. This study was conducted to assess quality of diabetic care in the diabetic clinic at Al Wakra Health Center and to deter-mine some factors that may affect quality of this care.
Methodology: It is a descriptive cross-sectional study. The target population was all diabetic patients (Type 2) meet the inclusion criteria and registered in the center. The structure of diabetic care was assessed by two checklists, the first checklist is for the essential items of care (thirteen items) and the second one is for the less essential items (ten items). The indicators of the process of diabetic care was assessed by a scoring system depends on ten items for standard diabetic care by the primary care physicians in the past year. Assessment of outcome was undertaken according to an international quality assurance protocol and includes: The degree of diabetic control, obesity, smoking among the diabetic patients and control of blood pressure. We added HbA1c to this list. Another questionnaire was designed to determine factors that may affect quality of care and related to patients knowledge and attitudes and divided into 4 sections, personal data, patient knowledge about diabetes and patient attitude toward care and clinical and biochemical assessments. A pilot study was carried out to test the questionnaires. Epi-info. 6 statistical Package was used for data entry and statistical analysis. Chi square or Fisher exact tests were used to test the significance and p value <0.05 was considered significant.
Results: The study showed that diabetic care in PHC represented by Al Wakra PHC center is better than that care in other studies in different countries. 86.7% of physicians show that most of the structure items are good to fair except absence of chiropodist and identification cards for diabetic patients. Assessment of the process of care showed that there is good to fair recording in 91.75% of cases, foot examination is not recorded in most of cases, funds examination is not recorded in 31.7%. The outcome indicators showed that patient knowledge about diabetes is poor in 35% of cases, uncontrolled FBS in 75.6% of cases, uncontrolled HbA1c in 57.8%, obesity in 63.5% and control of blood pressure is not achieved in 49% of cases.
Conclusion: Diabetic clinic in Al Wakra PHC center provides good care for diabetic patient in term of structure, process and outcome; however, we need more to do for refining these services.

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Category: Vol. 84, March 2016

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Carbapenem Resistance among Clinical Isolates of Enterobacteriaceae, MAHA M. KOTB, NAGWA SEDKY, EMAN A. EL-SEIDI, ALAA R. AWAD and SAHAR S. AL-WAKEEL

Abstract
Aim: This study aimed to determine the presence of carbapenem resistance among Enterobacteriaceae by disk diffusion method and Epsilometer test (E-test).
Methodology: In the present study, 100 Enterobacteriaceae were isolated from different clinical samples and identified by Analytical Profile Index (API) 20 E. Antimicrobial suscep-tibility testing was done by modified kirby bauer disk diffusion method; using carbapenems; Ertapenem (ETP) and Meropenem (MEM) and third generation cephalosporins; Cefoprazone (CFP) and Cefotaxime (CTX) and followed by Minimum Inhibitory Concentration (MIC) determination by E-test for ETP and MEM.
Results: The disk diffusion method showed that 8 1 % of the isolates were resistant to CTX, 79% were non-susceptible (i.e. resistant and intermediate isolates) to CFP, and the carbapenem non-susceptibility was 68 isolates (68%) to ETP and 57 isolates (57%) to MEM. MIC determination results by E-test method differed from disk diffusion results and showed that the carbapenem non-susceptibility to ETP and MEM was 19% and 9% respectively.
Conclusions: The presence of carbapenem resistance among Enterobacteriaceae isolates causing healthcare-associated infections in the current study emphasizes the necessity for early detection of these isolates and reporting to infection prevention staff to overcome their spread.

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Category: Vol. 78, December 2010

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A Comparative Study of Endothelial Cell Loss after the Implantation of Posterior Chamber Phakic IOL (ICL) Versus Foldable Anterior Chamber Iris-Fixated Phakic IOL (Veriflex),HAZEM M. YASSIN, AHMED E.M. HABIB, AHMED A. ABD EL-KADER and NAHLA B. ABU HUSSEIN

Abstract
Purpose: To evaluate the endothelial cell loss after im-plantation of posterior chamber phakic intraocular lenses as compared to anterior chamber iris fixated phakic intraocular lenses.
Setting: Al-Oyoun Al Dawli Hospital, Cairo, Egypt.
Methods: A comparative prospective non randomized study involved 30 eyes divided into 2 groups. Group A included 15 eyes of 9 patients that have implanted posterior chamber phakic intraocular lens (ICL, Staar Surgical). Group B included 15 eyes of 8 patients that have implanted foldable anterior chamber iris fixated phakic intraocular lens (Veriflex, AMO). Non contact specular microscopy was done preoperatively and at the 3rd, 6th and 12th months postoperatively.
Results: In both groups, there was a statistically significant loss of endothelial cells over time at 3 months, 6 months and 12 months postoperatively (p<0.001). In the ICL group, the mean percentage loss of endothelial cells at 3 months, 6 months and 12 months postoperatively was 1.34%±0.51, 2.53%±0.9 and 4.74%±1.24 respectively. In the Veriflex group, the mean % loss of endothelial cells at 3 months, 6 months and 12 months postoperatively was 2.42%±2.4, 4.0%±2.86 and 5.47±3.23 respectively. However, the difference between both groups was statistically insignificant (p=0.749).
Conclusion: Continuous endothelial cell loss was observed after the implantation of posterior chamber phakic IOLs (ICL) (Implantable collamer lens) as well as in anterior chamber iris fixated foldable phakic IOLs (Verifelx) during the first year of postoperative follow-up. However the differences in cell loss observed between the two groups of patients were statisticaslly insignificant. Further analysis of the relation between endothelial cell loss and the distance between the corneal endothelium and the implanted lens may be required in further studies. Long term follow-up of those patients could help demonstrate the long term pattern of cell loss.

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Category: Vol. 84, June 2016

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Validity of Kinovea Computer Program in Measuring Cervical Range of Motion in Frontal Plane, SHEREEN H. ELWARDANY, WADIDA H. EL-SAYED and MOHAMMAD F. ALI

Abstract
Purpose: This study was conducted to investigate criterion validity of Kinovea computer program in measuring cervical range of motion in frontal plane compared with the CROM, as a gold standard valid and reliable tool in healthy subjects.
Subjects: Sixty-four normal physical therapy intern stu-dents (54 male and 10 female) participated in this study. Their age ranged from 20-24 years with mean (22.42±0.84) and BMI mean (28.60±1.40).
Methods: Digital camera and labtop with installed Kinovea software were used. The cervical ROM of Rt. and Lt.side bending for each participant were measured using Kinovea computer program three times by examiner (B) to detect the intrarater reliability. The gained measurements by the highest intrarater reliability examiner were compared with the gained measurements by the CROM to detect the validity of Kinovea computer program.
Results: The correlation analysis between the cervical Rt. side bending and Lt. side bending measured angles using KCP and the CROM revealed that there was strong positive corre-lation between the two measurements where the r-value equals (+0.97, +0.95) respectively at p<0.05.
Conclusion: The Kinovea software program was valid method in measuring active cervical range of motion in frontal plane.

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Category: Vol. 78, June 2010

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Cardiac Troponin and Brain Natriuretic Peptide: Prediction of Mortality Among Septic Pts,KHALED HUSSEIN, AMR EL HADIDY, MOHAMAD ASHRAF, HOSAM MOWAFY and NORA ISMAIL

Abstract
Background: Severe sepsis and septic shock are life-threatening illness that results in catastrophic morbidity or mortality in case of delayed or incorrect treatment. The commonest presentation among them is cardiovascular insta-bility.
Brain Natriuretic peptide (BNP) and cardiac troponin (cTn-I) are promising markers for predicting myocardial affection in septic patients (pts).
Objective: This study was intended to analyze the eleva-tions of BNP and cTn-I in septic pts and their ability to predict mortality.
Methods: A total number of 43 patients (pts) diagnosed to have various degrees of sepsis admitted to Critical Care Department at Cairo University Hospital from October 2007 to February 2009 were recruited in the study. They were classified into group I 23 pts with severe sepsis & group II 20 pts with septic shock. All pts were subjected to APACHE II, MODS, SOFA, O/A and day 2, echocardiography O/A, together with BNP and cTn-I sampling O/A, and day 2.
Results: There was a statistically significant higher BNP level at day 2 than O/A in group II (p=0.012). BNP at day 2 was significantly higher in group II than group I (p=0.004). cTn-I in day 2 was higher in group II than group I. (p=<0.001). The overall mortality among our pts (both groups) was 66.7% (28 out of 43 patients). Eighteen of 20 (90%) in group II Vs. 10 of 23 (43.5%) in group I with significant p value (0.001).
Surgical patients have a significantly higher mortality than medical patients (p=0.037). Non-survivors have signifi-cantly higher number of affected organs with APACHE, SOFA & MODS compared to survivors; p<0.001 O/A & day 2. BNP O/A >75pg/ml (cut off value) by Receiver Operating Curve (ROC) had a sensitivity of 64% and specificity of 60% to predict mortality, cTn I O/A >0.4mcg/L (cut of value) had a sensitivity of 18% and 100 % specificity in predicting mortality and combining both BNP and cTn-I 0/A we can obtain 82% sensitivity and 100% specificity to predict mortality.
Whereas at day 2, BNP >210pg/ml had a sensitivity 38% and specificity 93% to predict mortality, cTn-I >0.4mcg/L had a sensitivity of 17% and specificity 93% to predict mortality and combining both measurements will be sensitivity 55% and specificity 93%, will be less valuable than the combination O/A.
Conclusion: Combining BNP and Cardiac troponin has higher sensitivity and specificity than each of them in predicting mortality among pts with severe sepsis and septic shock especially O/A.

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Category: Vol. 83, September 2015

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Effect of Cigarette Smoke Exposure on Kisspeptin Levels in Pubertal Female Rats: Role of Vitamin D Supplementation, MAHA M. ATTIA

Abstract
Background: Animal and human studies have shown associations between active smoking and altered female fertility. However, the reproductive effects of passive smoking is relatively new compared to the effects of active smoking. Pubertal exposure to cigarette smoke may be associated with reproductive effects in adulthood. There are some evidence that in addition to sex steroid hormones, the classic regulators of human reproduction; Vitamin D (Vit D) also modulates reproductive processes in women and men. Recently, the neuropeptide kisspeptin has been identified as a potential regulator of developmental changes in reproduction.
Aim: The present study was designed to evaluate the effect of cigarette smoke exposure on kisspeptin levels, Hypotha-lamic-Pituitary-Gonadal (HPG) axis in pubertal female rats. The effect of Vit D supplementation was also studied.
Material and Methods: Thirty female pubertal albino rats aged (35-40 days) were divided into three groups: Group (I) 10 rats served as control, Group (II) 10 rats exposed to cigarette smoke (1 hour/day) (CSE) and Group (III) 10 rats supplemented with Vit D in a dose of (650 IU/Rat/Day) along with Cigarette Smoke Exposure (CSE +Vit D). In adult female rats (85-90 days), serum levels of Vit D, kisspeptin, Gonado-tropin Releasing Hormone (GnRH), Follicle Stimulating Hormone (FSH), Luteinizing Hormone(LH), estrogen and progesterone were detected. Ovarian levels of estrogen, progesterone, total antioxidant capacity and apoptotic marker (active caspase-3) were also determined.
Results: Cigarette smoke exposure caused a significant reduction in both serum levels of Vit D, Kisspeptin and hypothalamic-pituitary-ovarian hormones (GnRH, FSH, LH, estrogen and progesterone) and ovarian levels of estrogen, progesterone and total antioxidant capacity. Significant ele-vation in active caspase-3 was observed. On the contrary, Vit D supplementation caused a significant elevation in serum levels of kisspeptin, hypothalamic-pituitary-ovarian hormones and ovarian levels of estrogen, progesterone and total antioxi-dant capacity. However, significant reduction in apoptotic marker (caspase-3) was detected. Kisspeptin was positively correlated with Vit D in (CSE) and (CSE +Vit D) groups and with ovarian estrogen in (CSE) group p<0.00 1. On the other hand its inversely correlated with active caspase-3 in both (CSE) and (CSE + Vit D) groups.

Conclusion: According to the findings of the present study, it can be concluded that exposure to cigarette smoke during pubertal period may lead to reduction in Vit D. This could impair kisspeptin level, inducing hypothalamic dysfunc-tion, and affect pituitary and ovarian function. On the other hand, vitamin D supplementation modulates kisspeptin function which preserves hypothalamic-pituitary-gonadal axis, prevents oxidative damage, loss of ovarian function and reduces ovarian apoptosis. Therefore, we could suggest that Vit D may have an important protective role against deleterious effects of cigarette smoke exposure. It could be considered as a key regulator of neuroendocrine and ovarian function.

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Category: Vol. 78, March 2010

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Epidural Vs Combined Spinal-Epidural Labour Analgesia: Is it Associated with Adverse Uterine and Umbilical Flow Indices? HOSSAM M. AL-KADY, KHALED G. AHMAD, EMAD M. ABD-ELLATIF, MAHMOUD F. MIDAN, SHERIF A. HASSAN and MOHSEN M. EISA

Abstract
Objective: To assess and compare the consequences of different approaches of epidural and combined spinal, epidural analgesia on the umbilical and uterine artery flow velocity waveform indices, maternal haemodynamics and neonatal outcome in normal term labour.
Design: A prospective, observational, randomised study.
Settings: El-Hussien Hospital and Kuwait Maternity Hospital.
Subjects and Methods: Sixty normal, term, singleton nulliparous parturients during active labour were randomly assigned to one of four regional blockade regimens: group-l (15-women) received epidural blockade with a 10ml -0.25% bupivacaine solution, group-II (15-women) received epidural blockade with a 10ml -0.25% bupivacaine solution plus 0.5ug/kg fentanyl, group-Ill (15 women) received combined spinal and epidural blockade with 0.25% bupivacaine solution and group-1V (15 women) received combined spinal and epidural blockade with 0.25% bupivacaine solution plus 0.5ug/kg fentanly. Each Doppler velocimetric study, conducted over 90 minutes after intravenous volume preload with 7-10 ml/kg of lactated Ringer's solution, was divided into three.
Phases: 30 minutes of preanaesthetic, 30 minutes during epidural catheter placement "and dosing, and 30 minutes after establishing effective regional blockade. During each phase, maternal blood pressure and pulse were monitored every 10 minutes and Doppler recordings of the umbilical and uterine arteries were made at three separate intervals. Fetal heart rate and uterine activity monitoring were continued after each Doppler study session.
Main Outcome Measures: Maternal haemodynamics (mean systolic and diastolic blood pressures and pulse rate), Doppler indices of the umbilical and uterine arteries (S/D ratio and PI), fetal heart rate, visual analogue scale (VAS) for pain assessment, and neonatal outcome (1- and 5-minute Apgar scores, mean umbilical artery pH, mean birth weight and admissions to neonatal intensive care unit).
Results: The mean systolic and diastolic blood pressures as well as pulse rate declined significantly with the dosing and establishment of regional blockades in the study groups (p*<0.05), but no women experienced hypotension. The difference among the study groups was not significant (p+> 0.05). The mean fetal heart rate did not change significantly throughout the study periods (p*>0.05). The difference was not significant between the study groups (p+0.05). In addition, mean systolic/diastolic (S/D) ratios and pulsatility indices (PI) of the umbilical and uterine arteries did not change significantly during the study (p*>0.05). The neonatal outcome among the groups was similar (p+>0.05) with no adverse effects as the mean 1- and 5-minute Apgar scores were >7, mean umbilical artery pH was >7.25 and no admissions to neonatal nursery for ventilation. It was found that the visual analogue scale (VAS) for labour pain assessment decreased significantly in all parturients during intra-and post-anaesthetic periods (p*<0.05).
Conclusion: Effective epidural and combined epidural - subarachnoid analgesia do not have a significant impact on the Doppler blood flow characteristics of utero-and fetopla-cental circulation despite lowered maternal blood pressure and pulse rate. Adding fentanyl to bupivacaine for regional blockade during normal labour is an effective technique for pain relief as well as safe for mother and fetus. Larger long-term studies are needed to confirm the clinical impact of our findings particularly in long-term assessment of perinatal outcome.

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Category: Vol. 79, March 2011

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Caregivers' Expressed Emotion in Response to Patient Psychiatric Symptoms,YOSR M. EL-MASRI

Abstract
The aim of this study was to assess the caregivers' ex-pressed emotion in response to patient psychiatric symptoms. A descriptive correlational analytical design was utilized in this study. This study was conducted at out-patient clinics in Abbasia and Banha Hospitals for Mental Health. Convenient samples of 83 of family caregivers of psychotic patients who accompany their patients to the out patient clinics, were selected. Three tools were used for data collection, Socio-demographic data sheets, Family Interview questionnaire, and Brief Psychiatric Rating Scale. Results of this study revealed that there were highly significant positive correlations between caregivers' expressed emotion and Patient psychiatric symptoms. It is concluded that patients' symptoms had an effect on the family caregivers expressed emotion. Therefore, the study recommended that, there is a need for frequent psycho-educational programs and counseling services for family care-givers in order to help them to cope with the burden of caring.

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Category: Vol. 77, March 2009

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Comparative Study of the Laryngeal Tube Versus Endotracheal Tube in Mechanically Ventilated Anesthetized Patients,MOHAMAD H. EL-SHARKASY, MAGDY A. OMERA, AMR HELMY and IBRAHIM S. IBRAHIM

Abstract
Randomized double-blind clinical trial designed for com-paring the tracheal tube (TT) versus the laryngeal tube (LT) in mechanically ventilated anesthetized adult patients under-going different non-emergency surgical procedure. The com-parison included evaluating the ease and success of insertion, adequacy of ventilation, airway sealing, hemodynamic re-sponses and local complications. Ninety two adult patients (ASA I/II) were included in the study and randomly allocated into two equal groups. The two groups of patients were found to be matched as regards age, sex, height, weight and baseline hemodynamic status.
As regards ease, and success of insertion, LT was success-fully inserted in all attempted cases (100%), with success rate of 91.3% after the first attempt with a mean duration of insertion 18.13±3.4 seconds (range 12-24 seconds) with no statistically significant difference with those of TT (p>0.05). Adequacy of oxygenation and ventilation of LT was found similar to that of TT (p>0.05). Oxygen saturation has never fallen below 95% and ETCO2 tension has never exceeded 40 mmHg in any case of both groups. The peak airway pressure in the LT group were within an acceptable range (12-25cmH2O) and when compared to TT no statistically significant difference was found at any of the measurement times (p>0.05). Air leak or gastric insulffation didn’t occur at any case of LT group at any given time during controlled ventilation by adequate tidal volume and appropriate respiratory rate. The LT was found to provide an airtight seal as the highest airway pressure without leak (leak pressure) was found to be ranging between 25-40cmH2O with a mean value of 34.84±3.97cmH2O. Con-cerning hemodynamic responses to both airway devices, our study revealed that TT induced more rapid (starting at intu-bation), more intense and prolonged (lasting for at least 10 minutes) increase in heart rate, arterial blood pressure, while the response to LT insertion was significantly in magnitude less and shorter in duration. Local complications at the time of extubation were significantly less in LT group occurring only in 3 patients (6.52%) (cough was the most frequent), while in TT group, these complications occurred in 5 patients out of 46 (10.86%) (cough and blood staining were the most frequent). Occurrence of local complications during the first 24 postoperative hours, were found to be significantly lower in LT group.

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Category: Vol. 84, June 2016

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Optimum Sylvian Fissure Dissection Needed for Anterior Circulation Aneurysms, MOHAMED A. GABR, NASSER F. EL-GHANDOR, KHALED S. ANBAR, AMR EL-TAYEB and AHMED ZAATER

Abstract
Background: Pterional transsylvian approach was opti-mized when the dissection of the sylvian fissure extended to the anterior ascending ramus and that further splitting yielded no additional gain. The point where the ascendant ramus arises anatomically corresponds to the sylvian point. This study was applied in cases with rupture aneurysm where the brain is more friable, the blood obscures the fissure and its contents.
Objective: In this study, the optimum exposure was achieved by dissection of sylvian fissure till anterior ascending ramus whatever dissection started distally in sylvian fissure or by reaching optic carotid cistern earlier.
Patients and Methods: This study carried on 20 patients admitted in Cairo University Hospitals with rupture anterior circulation aneurysms requiring surgical clipping through pterional transsylvian approach providing some brain relaxation and early proximal control of the aneurysm by opening the opticocarotid cistern first, then distal fissure is dissected.
Results: Optimum exposure and clipping by reaching the anterior ascending ramus in 12 patients (60%). However, the number of the patient needed dissection distal to Anterior Ascending Ramus (AAR) was 8 patients (40%).
Conclusion: Optimum exposure in sylvian fissure dissec-tion for rupture anterior circulation aneurysm is achieved by reaching anterior ascending ramus ,further dissection distal to anterior ascending ramus provided no additional gain in exposure.

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Category: Vol. 79, June 2011

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Cytogenetic Damage in Operating Room Nurses Exposed to Anesthetic Gases,DALIA A. SHAKER, AISHA M. SAMIR, HEBA A. HAGAG, ASMAA A. ABD EL-AAL and REHAM A. AFIFY

Abstract
Background: Although eliminated rapidly from the body due to low solubility in blood and tissues, anesthetic gases have been reported to be neurotoxic, teratogenic and carcino-genic. Genetic material has been shown to be a sensitive target of numerous harmful agents.
Aim of the Work: To evaluate genotoxic risk of occupa-tional exposure to anesthetic gases in a group of operating room nurses.
Subjects and Methods: A group of 27 operating room nurses exposed to waste anesthetic gases and 18 control nurses were examined for chromosome aberrations and sister chro-matid exchanges in peripheral blood lymphocytes. The exposed group was compared with the control group which was matched by age, socioeconomic level and duration of employment.
Results: The prevalence of all neurological manifestations were higher in exposed nurses compared to control group. A significant increase in chromosome damage in exposed nurses as detected by total chromosomal aberrations, gaps, deletion and endomitosis while the increase in centromere separation and chromatid breaks was not significant. There was an increase in sister chromatid exchange frequency in exposed nurses compared to control even it was not significant. Most of these parameters of genetic damage in exposed nurses were positively correlated with age and duration of exposure to inhaled anesthetics.
Conclusion: The results of our study suggest that exposure to waste anesthetic gases has the potential to cause changes in human genome which may lead to increased morbidity.

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Category: Vol. 79, March 2011

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Evaluation of Visual System in Microphthalmic Eyes,AHMED A. RADWAN, SAFAA S. MAHMOUD, AHMED T. ISMAIL and TAMER F. EL-MEKAWY

Abstract
Background: Microphthalmia is defined as a globe with a total length that is at least two standard deviations below the mean for age. It can be isolated or occur with other ano-malies or as part of a syndrome.
Objective: The aim of our work was to evaluate any functional or structural abnormality along the whole visual system in microphthalmic eyes.
Patient and Methods: The study included 70 eyes of 42 individuals having microphthalmos. The mean age was 12.47 years (ranged from 9 months to 15 years). All cases were subjected to full ophthalmological history, and examination. Some investigative tools were used as A scan ultrasound, ultrasound biomicroscopy (USB), optical coherence tomog-raphy (OCT), visually evoked potential (VEP), and impression cytology.
All data were recorded and analysed.
Results: Positive family history was present in 29 cases (69%) while positive consanguinity was present in 24 cases (58%). Axial length ranged from 12.8 to 19.9mm (mean 16.1±  2.3). Simple microphthalmos (without any ocular dysgenesis) was recorded in 9 cases (21.4%). Nystagmus was present in 19 cases (45.2%), convergent squint in 9 cases (21.4%), Congenital contract was present in all eyes included in this study. Other ocular dysgenesis found were microcornea 28 eyes (40%), iris coloboma in 3 cases (7.2%), sclerocornea in 1 patient bilaterally (2.4%), posterior synechiae with pin-pointed pupil in 11 eyes (15.7%), patches of iris atrophy in 3 cases (7.2%). Increased intraocular pressure with pallor optic nerve was present in 32 eyes (45.7%). Retinal examina-tion showed picture like retinitis pigmentosa in 3 cases bilaterally (7.2%). Venous congestion and arterial attenuation with decrease vascular reflex were evident in 12 eyes (17.2%). VEP showed marked decreased in signals in all the cases which denotes functional defect of optic nerve.
UBM confirmed the presence of congenital cataract in all the cases (100%). Persistent hyperplastic primary vitreous (PHPV) was encountered in 3 cases (7.2%), corneal hyperre-flectivety with wrinkling at Descement's membrane in 1 case (2.4%), and peripheral anterior synichea was present in 2 eyes (2.9%), while abnormal shaped angle was found in 3 eyes (4.3%).
Impression cytology showed marked squamous metaplasia (Grade IV) in almost all cases with completely absent goblet cells.

OCT showed no abnormalities except in 9 cases (21.4%) with alternating retinal nerve fiber reflectivity being thin in one area and thick in another.
Conclusion: Microphthalmic eyes comprise large entity ranging between simple microphthalmos to complex type. Thus ophthalmological evaluations using examinations and different investigative tools help in suitable management together with control of the necessity of any surgical inter-vention and perform an accurate follow-up.

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Category: Vol. 78, December 2010

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Effect of Regular Consumption of Tiger Nut (Cyperus Esculentus) on Insulin Resistance and Tumor Necrosis Factor-Alpha in Obese Type 2 Diabetic Egyptian Women,SALWA M. ELSHEBINI, MAHA I.A. MOATY, SALWA T. TAPOZADA, LAILA M. HANNA, HAMED I. MOHAMED and HALA M. RASLAN

Abstract
Objective: In this study we tried to focus on an approach that creates a new insight into the regulation of insulin resis-tance and chronic inflammation through diet therapy in Egyp-tian obese diabetic women.
Subjects and Methods: Twenty eight volunteers partici-pated in a short term study, aging 53.29±1.06 years old, with body mass index (BMI) of 32.76±0.65kg/m2, complied to a balanced hypocaloric diet (800-900kcal/day) for eight weeks. In the first four weeks, a supplement of 30g tiger nut flour cooked with water into a two portions pudding was eaten twice daily, before lunch and dinner. Anthropometric mea-surements and biochemical screening including haemoglobin, serum lipid profile, lipid peroxide [malodialdehydes], fasting and 2 hour postprandial blood glucose, insulin, C-peptide and tumor necrosis factor-a  (TNF-a) were performed at the start of the study (basal visit), after the first four weeks at the completion of the supplemented diet period (mid visit), and at the end of the second dietary period (last visit).
Results: A drop of about 2% in weight accompanied by significant reductions of the anthropometric measurements were more pronounced after the first period. There was a significant beneficial rise in high density lipoprotein-cholesterol (HDL-C) after the first period, which was reversed in response to the diet alone. All the other biochemical parameters were significantly decreased after the first period, except TNF-a  which showed only a numerical reduction (–15.01%). Stopping of the supplement was followed by increase in the means of the biochemical parameters that ranged from 2.77 to 48.32%, while TNF-a  continued to decrease by –8.17%. This outcome was demonstrated by the correlations between the key param-eters involved in the pathology such as waist to hip ratio (WHR), triglycerides (TG) and TNF-a, and the rest of the parameters, in which all the unfavorable correlations were at the onset of the study. TG concentration also showed significant positive correlations with most of the insulin resistance parameters at all the time of study. TNF-a  strongly positively correlated with total cholesterol, low density lipoprotein-cholesterol (LDL-C) and the calculated risk factor (p<0.01) at the basal examination.
Conclusion: In Egyptian obese diabetic patients there was a strong association between WHR, serum TG and insulin resistance. TNF-a  at high concentration was more associated with lipid metabolic disorders and may be responsible with other factors in type 2 diabetes mellitus (T2DM) initiation. Hypocaloric diets alone are not adequate to bring about an improvement in the biochemical parameters, and they should be supplemented with appropriate functional foods for the efficiency of such diets.

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Category: Vol. 81, March 2013

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Androgen Ablation Following Radiotherapy in Patients with Localized Prostatic Carcinoma,EL SAYED M. EL HINDAWY, IBRAHIM A. AWAD and EL-HOUSSEINY EL ZALLOUEY

Abstract
Background: Approximately 25% of patients treated with adjuvant radiotherapy (RT) will develop a biochemical failure within 5 yr after RT when doses of 60-64 Gray (GY) are used.
Androgen deprivation therapy (ADT) is increasingly used for the treatment of prostate cancer (PCa), even in clinical settings in which there's no evidence-based proof of prolonged overall survival (OS). ADT, however, may be associated with numerous side effects, including an increased therapy-related cardiovascular mortality.
Abstract: This study was performed on forty cases of and locally advanced prostate cancer, with mean follow-up period of 19 months, range (6-42 months). All patients were referred Clinical Oncology and Nuclear Medicine Department Outpa-tient Clinic, from Urology and Nephrology centre, Mansoura University Hospital, during the period from September 2001 to July 2005. And patients were blindly randomized into two groups.
Group 1: Included twenty patients, who received combined external beam irradiation and androgen ablation therapy.
Group II: Included twenty patients, who received external beam irradiation alone.
Radiation therapy was delivered as a conventional frac-tionation schedule with a dose of 5000cGy over 5.5 weeks in 27 fractions to the whole pelvis followed by 2000cGy boost to the prostate over 2 weeks in 10 fractions.
Concurrent and adjuvant hormonal therapy was given in the form of cyproterone acetate (androcur) which is steroidal antiandrogen in a dose of 200-300mg daily.
Results: The overall response rate was 90% in group I versus 60% in group II, this difference was statistically significant (p=0.048).
Complete remission occurs in 35% of group I versus 10% in group II. Partial remission occur in 55% of group I versus 50% in group II. No response occurred in 5% in both groups.
The mean overall survival & progression free survival was 20.25 & 18.20 for group I versus 18.60 & 11.40 for group II. This difference was statistically significant as regard PFs (p=0.013).

Two year overall survival was 84.6% for group I versus 71.4% for group II.
As regard the complication there is significant increased rate of complication in group I than group II including Gil complication (proctatits & bleeding per rectum), hormonal related complication (easy fatigue) elevated liver enzymes and decreased lipido.
Conclusion: The wide spread use of serum (PSA) as a case finding tool has patently increased the proportion of asymptomatic patients who present with non-palpable, clini-cally localized tumors. With the diagnosis of prostate cancer being made earlier, the emphasis of treatment has shifted from palliation of symptoms to altering disease related morbidity & morality & thus improving overall survival.
It is highly apparent that a substantial proportion of men with clinically localized (Intermediate & high risk) or locally advanced prostate cancer not cured by radical radiotherapy for curative intent, and we have therefore explored the benefit of hormone therapy as adjuvant to radical radiotherapy which was feasible, tolerable & resulted in increase in overall survival, which did not reach statistical significance. Never-theless, resulted in statistically significant improvement in both overall response rate & progression-free survival.

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Category: Vol. 83, June 2015

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Kinesio Tape Versus Compression Garment on Post Mastectomy Lymphedema, MAHA A. HASSAN and SAMAH M. ISMAIL

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Category: Vol. 79, March 2011

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Comparison of Nasal Resistance and Flow in Laryngopharyngeal Reflux Patients and Controls,SAMEH M. AMIN and KHALED H. ABD EL-MAGID

 Abstract
Background: The pathophysiology of laryngopharyngeal reflux (LPR) is not well understood. Respiration affects the status of upper and lower esophageal sphincters.
Objective: We compared nasal airway resistance and flow during respiration in LPR patients and controls to detect a possible correlation.
Methods: Total nasal resistance (TNR) and sum of flow (SF) of 25 LRP patients and 25 controls without LPR was measured with active anterior rhinomanometry. Gastrointestinal and otolaryngological symptoms, severity and duration were assessed according to visual analog scale. Patients were subjected to upper gastrointestinal endoscopy, nasendoscopy and flexible pharyngolaryngoscopy.
Results: LPR patients had before decongestion statistically significant lower TNR (0. 15; p-value: 0.008) and higher SF (547; p-value: 0.004) and after decongestion TNR (0.10; p-value: 0.002) and SF (762; p-value: 0.003) at 75 Pascal compared to controls. Decongestion decreased non significantly (p-value: 0.66) TNR in controls (27.2%) less than in LPR group (28%). Stepwise logistic regression analysis revealed SF >450 increases likelihood of LPR 5 times (95% confidence interval: 1.6-19.2) compared to those having SF <450.
Conclusion: Our results supports that relatively lower TNR and higher SF are associated with LPR. If this is con-firmed in larger group of LPR patients, it will contribute to better understanding of LPR pathophysiology. This may allow also partial explanation of CPAP anti reflux effect. Controlled reduction of TNR by nasal surgery might be needed to avoid disruption of this newly discovered anti reflux barrier.

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Category: Vol. 83, June 2015

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Nurses Performance at Operating Room at El-Miniya University Hospitals, NEHAD E. FEKRY and RASHA M. ALI

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Category: Vol. 81, June 2013

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Developing Nursing Care Standards for Patients Post Discectomy,ABDO M. AHMED, AML M. AHMED and HASSAN M. HASSAN

Abstract
Postoperative nursing care standards of discectomy are the baseline for quality nursing care and the guide of knowl-edge, and skills that are needed to practice nursing care safely. This descriptive study aimed at establishing the level of nurses' knowledge and practice and to examine the relationship between nurses' knowledge and practice for developing the nursing care standards for patients post discectomy. This study was conducted in the Neurosurgery Department at Assiut University Hospital. A convenient sample of 30 nurses was included in this study. Data collected by utilizing the designed questionnaire sheet and observation checklist sheet. The results can be concluded that all of nurses (100%) had an unsatisfac-tory level knowledge regarding standards for patients post discectomy with Mean±SD (9.6±5). All of nurses (100%) had an inadequate level practice regarding standards for patients post discectomy with Mean±SD (89.7±17.4). It was found that there was a strong relationship (7—.815, p=.0001) between total knowledge score and total practice score regarding standards for patients post discectomy.
Conclusion: It can be concluded that, Nurses' knowledge and practice regarding standards for patient post discectomy are at an unsatisfactory and inadequate level and it was needed to be improved through implementation of proposed nursing care standards.

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Category: Vol. 83, March 2015

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Postoperative Complications of Endoscopic Upper Airway Laser Surgery in Kasr Al-Ainy Hospital: A Prospective Study, NEAAMAT I. ABD EL-RAHMAN, MOHAMED S. RIFAI, HASSAN M. AHMED, ABEER A. MOHAMED and SHYMAA F. ABD EL-FATTAH

Abstract
Background: Laser surgery of the upper airway is per-formed endoscopically under the microscope. One of the advantages of this type of surgery over an open partial tech-nique is that it only removes the lesion, preserving larger adjacent free areas and maintaining the laryngeal skeleton closed. However, because of the increase in the use of this technique for laryngeal and hypopharyngeal lesions, a greater number of complications may be expected. The aim of this study was to evaluate the incidence, type, and clinical signif-icance of postoperative complications of upper airway lesions treated with laser surgery.
Patients and Methods: Following approval of departmental ethics and research committee and obtaining written informed consent, sixty-six patients undergoing endoscopic airway laser surgery starting from January 2012 to December 2012 were included in the study. These patients were examined by the ENT consultant, diagnosed as having any airway pathology indicated for endoscopic airway laser surgery, and scheduled for surgical management. Routine investigations were per-formed preoperatively in addition to specific investigations related to the pathology including chest X-ray, indirect laryn-goscopy and arterial blood gases in addition to meticulous assessment of the airway. Patients with severe stridor, tracheo-stomised patients and patients with history of any previous anesthetic complications were excluded. Intraoperative stan-dard monitoring was performed, followed by induction in the presence of all equipments for difficult airway managment. Safety features for laser surgery were taken regarding the patient and medical personnel. Anesthesia was maintained and the patients were monitored for HR, BP, SaO2, EtCO2 and the postoperative complications related to airway man-agement, anesthetic management and surgical management.
Results: Postoperative complications were as follows; respiratory distress (e.g. tachypnea, working accessory respi-ratory muscles) (18%-twelve patients), ICU admission (6%- four patients), one patient had pneumothorax, another one had surgical emphysema and two were tracheostomised due to unrelieved airway oedema, all four patients were admitted in ICU under observation, and vomiting (9%-six patients).
Conclusion: Post-operative complications of endoscopic laser surgery of the upper airway are relatively low. Every anesthetist who is involved in this should have a clear concept of management for these complications, and strategies to avoid these complications should be performed.

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Category: Vol. 78, December 2010

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Clinical Characteristics and Outcomes of Obstetric Patients Requiring ICU Admission, AHMAD H. MOWAFY and KARIM S. MASHHOUR

Abstract
Introduction & Objectives: Critically ill obstetric patients represent unique characteristics, whose management is chal-lenged by the presence of a fetus, an altered maternal physi-ology, and diseases specific to pregnancy. Despite therapeutic advances during this century, maternal mortality remains an important public health problem. So it was logic to study these patients who were referred from the Gynecology and Obstetric Department to our ICU aiming to review a series of these patients in order to assess the spectrum of diseases, required interventions, complications which occurred and maternal mortality and to identify conditions associated with maternal death.
Study Design: A retrospective cohort study in the Critical Care Medicine Department, Cairo University. The medical records of all obstetric ICU admissions over the period from January 2002 to December 2006 were reviewed.
Results: Over these 5 years, 169 women required ICU admission (1.6% of all ICU admissions). The mean age was 29.29±6.06 years; mean gestational age was 34.56±3.01 weeks, and the mean length of ICU stay was 3.32±3.6 days. Most of patients (77%) were admitted with obstetric cause, the most common cause of maternal morbidity was pregnancy-induced hypertension (56.21%), followed by obstetric hemorrhage (17.75%). Heart failure (13.6%) was the principal non-obstetric cause. Maternal mortality rate was 4.14%, with hypovolemic shock and MODS (71.4%) as main causes. Although the incidence of death was higher among patients with obstetric vs non obstetric cause (4.6% & 2.6%, respectively), this was not statistically significant (p=0.91). Twenty-five percent of patients had prior medical diseases, 76.74% of them had
Abbreviations:
ARF = Acute renal failure.
ARDS = Adult respiratory distress syndrome. ETT = Endotracheal tube.
ICU = Intensive care unite.
Mg = Magnesium.
MODS = Multiple organ dysfunction syndrome. NTG = Nitroglycerine.
RBCs = Red blood cells.

cardiac problem. The most common interventions were central venous catheterization (91.1%), ET intubation (16.6%), and mechanical ventilation (12.4%). Disturbed conscious level, MODS, shock, ARF, bleeding, and ARDS were present in 17.8%, 12.4%, 10.7%, 10.7%, 8.9% and 7.1% of patients, respectively. Anemia, leucocytosis, and thrombocytopenia were more present in the obstetric group. The most common ICU therapy was NTG (56.21%), Mg sulphate (25.44%), packed RBCs (21.9%), and vasoactive drugs (12.4%).
Conclusions: The admission rate to the ICU may be reduced by improving the management of the hypertensive disease during pregnancy and by reducing the incidence of hemorrhagic complications. Early admission to the ICU decreases the maternal mortality and morbidity. Physicians in the ICU should be familiar with the complications of pregnancy and should work closely with obstetricians. Despite several complications which occurred with obstetric patients, the prognosis is still good.

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Category: Vol. 84, June 2016

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Case Report: A Case of Accidental Inverted Phakic Intraocular Lens Implantation, NASSER A. AL-SABAANI

Abstract
A patient with high myopia and astigmatism inadvertently received an inversely implanted Implantable Collamer Lens (ICL) in her left eye. The Best-Corrected Visual Acuity (BCVA) decreased in the left eye, and the patient developed high Intraocular Pressure (IOP) secondary to angle closure glaucoma. The anterior chamber was deep centrally and shallow with iridocorneal touch peripherally. After re-inversion of the ICL, the IOP returned to normal, the anterior chamber deepened and visual acuity improved. Inverse ICL implantation is a rare complication that can be mitigated by preventive measures, intraoperative recognition or early postoperative management. To our knowledge, this is the first reported case of inadvertent placement of an inverted ICL that remained within the eye for 5 days.

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Category: Vol. 79, March 2011

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Effect of Some Fruits and Vegetables Peels Extract on CCl4 Induced Hepatic Injury in Rats,MOHAMED S. ABD EL-BAKY and FATMA L. AHMED

Abstract
Free radicals generated by hepatotoxins like CCl4 may overpower the mechanism of the liver and cause hepatic damage. Though the modern medicinal system has grown phenomenally, the drug for treating hepatic disease is still a dream. Hence, people are looking at traditional systems of medicines for remedies to hepatic disorders. Phenolic com-pounds can act as antioxidants by many potential pathways such as free radical-scavenging, oxygen radical absorbance, and chelating of metal ions.
Aim: The present study was performed to evaluate anti-oxidants compounds of some fruit and vegetable peels extract (red apple, banana, red beet roots, and potatoes) and its effects on CCl4 induced hepatic injury in rats.
Methods: Extraction yield of phenolic compounds by different solvents (methanol, ethanol and diethyl ether), esti-mation of total phenolics, total flavonoids and total flavonols of red apple peels, banana peels, red beet peels and potato peels were estimated. A total of thirty six male healthy rats, weighing between (200-220gm) were divided into six groups. To induction cirrhosis all rats except control negative were subcutaneous injected by carbon tetrachloride CCl4 which diluted by paraffin oil (1:1) [in a dose of 2ml/kg of body weight of rat], twice in the week during the experimental feeding period, each group containing 6 rats. Control groups (1,2) negative and positive were fed on basal diet without supplementation. All treated cirrhotic groups (3-6) were fed on basal diet and administrated by gastric tube 2g/kg/day methanol extract of (apple peels methanol extract (APME), banana peels methanol extract (BPME), red beet peels methanol extract (RBPME) and potato peels methanol extract (PPME) respectively.
Results: The results found that Methanol extracts of tested sample proved that the best solvent for yield extracts of all tested solvents, also there was found a strong positive corre-lation between yield extracts of tested samples and polyphenols content. The results observed that cirrhotic rats (control positive group) had significant increase in serum liver function and kidney function parameters AST, ALT, uric acid, urea and creatinine) comparing with control negative group. Also, it could be observed that all cirrhotic groups administrated with different methanol extract of some fruits and vegetables peels (apple APME, banana BPME, red beet RBPME and potato PPME) had significant decrease in serum liver and kidney function parameters and protective effect against histopatho-logical hepatotoxicity induced by CCl4 comparing with control positive. The best treatment was apple peels methanol extract APME which had lowest value of liver and kidney function parameters followed by red beet peels methanol extract RBME.
Conclusion: It can be concluded that extract of some fruits and vegetables peels (apple APME, banana BPME, red beet RBPME and potato PPME) especially methanol extract has a significant protective effect against acute hepatotoxicity induced by CCl4 in rats, which may be due to its free radical scavenging effect and its ability to increase antioxidant activity.

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Category: Vol. 82, December 2014

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Medicinal Attributes of Rumex Vesicarius (Polygonaceae) Growing in Sakaka, Al-Jouf, Saudi Arabia, SAHAR B. GOMAA and NEEVEN M. SALEH

Abstract
Objective: The present research aimed to study the anti-oxidant, antiproliferative and anti-microbial effects of aqueous extracts of Rumex vesicarius (AERV) leaf, flower and leaf plus flower.
Material and Methods: Extracted samples in vitro assays i.e total phenolic content, total flavonoids, antioxidant capacity and cytotoxic activity were evaluated against MCF-7, NCI-H460 and SF-268 human cancer cell lines, in comparison with normal WI 38, Also the antibacterial activity of AERV was determined.
Results: The results show that the aqueous extract (AE) has total phenolic and total flavonoid contents. The high potential of antioxidant activity and its antitumor activity is a dose-response manner. Flower extract of rumex treatment was found to be the most as effective antioxidant and antipro-liferative. The evaluation of antimicrobial activity of AERV, demonstrated that ethanolic flower extract, showed higher antimicrobial activity than water extract and Salmonella Typhimurium was the most sensitive isolates as compared with other sensitive and resistant isolates. Minimum inhibitory concentration of the ethanolic flower extract was 235mg/ml.
Conclusion: The study revealed a considerable antioxidant, antiproliferative and anti-microbial potential in two parts of Rumex vesicarius. The obtained data in this work might be used for further study of extracts of Rumex vesicarius in various applications such as health supplementation and pharmaceutical benefits.

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Category: Vol. 78, March 2010

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Atrial Naturitic Peptide, Heat Shock Protein 70 and c-FOS Modulate Estrogen Protective Effect on Cardiac Performance in Female Rats Subjected to Immobilization Stress, HEMMAT M. KHLOUSSY, MOSHIRA A. RATEB, AHMAD D. BADAWY and ABDULLAH R. EL-SWERKY

Abstract
Several international clinical trials have reported contro-versial effects of estrogen replacement therapy on the cardio-vascular system. The aim of this study was to investigate the effects of estrogen on myocardial performance under conditions of simulated emotional stress in female rats and to elucidate some of its intracellular mediators in the myocardium.
Material and Methods: 64 female albino rats were included in this study and classified into four main groups; each group included 16 rats.
Group 1 (Control group), group 2 immobilization stress group (IMO), group 3 (IMO + ovariectomy), group 4 (IMO+ Ovariectomy + estrogen supplementation 10mg/100gm, once daily by intramuscular injection for 2 weeks). At the end of the experimental protocol, evaluation of cardiac performance in isolated hearts and measurement of cardiac tissue gene expression of c-FOS, HSP 70 and ANP m-RNAs was conducted.
Results: Immobilization stress (IMO) group showed significant increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The animals also showed a significant increase in gene expression of c-FOS (functional marker of cellular activation) and heat shock protein (cardio-protective substance, HSP70) and significant decrease in contractility index in comparison to control group.
Ovariectomized immobilized group (OVE + IMO group 3) showed significant increase in SBP, DBP, c-FOS expression and significant decrease in atrial naturetic peptide (ANP) and HSP70 expression in comparison to IMO group.
Administration of estrogen to OVE rats followed by immobilization stress caused a significant decrease in SBP, DBP, c-FOS expression and a significant increase in ANP and HSP70 expression in comparison to IMO + OVE group.
Conclusion: Estrogen up-regulation of expression of ANP and HSP 70 and down-regulation of c-FOS in the myo-cardium can confer a protective effect on myocardial perfor-mance in states of immobilization stress.

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Category: Vol. 83, June 2015

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Leucorrhea Symptoms and Care Seeking Behavior among Women in Port-Said City, INAAM H. ABD EL-ATI and NAGLAA I. GHIDA

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Category: Vol. 84, June 2016

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Effects of Age and Gender on Facial Movements: Utilizing Moiré Topography, RANIA R. MOHAMMED, RAGIA M. KAMEL, MOHSEN M. EL-SAYYAD and NEVEEN ABD EL-LATIF

Abstract
Objective: The purpose of this study was to investigate the effect of different age groups and gender on facial move-ments by using Moiré Topography.
Design: Observational study.
Setting: The Faculty of Physical Therapy, Cairo University.
Material and Methods: One hundred and fifty healthy subjects, both genders (75 males, 75 females), age range from 20-50 years. It was classified into three groups (20-30), (30- 40) and (40-50 years old) five facial angles were measured at both sides of the face for each subject three times during static position and during contraction ,this angles were raising, closing, smiling, kissing and blowing angles and the Auto-CAD program used to calculate and analyze this angles.
Results: There were a significant effect of age groups on the five facial movements including right and left raising, closing, smiling, kissing and blowing, as F=270, p=0.0001 also there was a significant effect of sex on the five facial an-gles as F=135, p=0.0001 and finally there was a significant interaction effect of age groups and sex difference on the same five facial movements by two way ANOVA as F=270, p=0.0001. The regression analysis indicated that the correla-tions between age groups and facial movement were moderate negative significant correlation for all the five angles at right and left side ranging from (r=–0.52 to –0.61) and also there was a moderate negative significant correlation between sex and five facial angles.
Conclusions: There were a significant effect of age and sex different on the facial movements including the five angles of the face at right and left side and that with increasing the age, the decreased angles of the female are more than the decreased angles of the male in the range of the five facial angles.

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Category: Vol. 83, September 2015

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Effects of Dexamethasone on Fetal Doppler Indices, SHAMEL M. HEFNY, AHMED M.T. HASHEM and AMIRA E. YEHIA

Abstract
Objective: To assess the impacts of dexamethasone given to the mother on fetal Doppler flow velocity waveforms of both umbilical and fetal middle cerebral arteries in pregnancies with normal fetoplacental vascular resistance.
Study Design: Prospective Study.
Patients and Methods: Pregnant women between 28 weeks and 34 weeks gestation at risk of preterm labour, Preterm birth was anticipated on the basis of: History of previous preterm birth, dilating cervix, antepartum hemorrhage, Preterm premature rupture of the membranes, increased amniotic fluid volume, Patients with possible need for early termination of pregnancy including those with history of previous uterine rupture and hysterotomy.
Intramuscular dexamethasone was given as 4 doses dex-amethasone (6mg/12 hours for 48 hrs), Doppler ultrasound assessment of umbilical artery (UA), middle cerebral artery (MCA) both resistive index (RI) and pulsatility index (PI) were done as baseline, day 2 and day 4.
Results: There was no significant variation noted in UA or MCA PI or RI throughout dexamethasone therapy.
Conclusion: Dexamethasone treatment was not associated with significant changes in the mean values of the pulsatility, resistive indices in umbilical artery and fetal middle cerebral artery, Awareness of this drug-induced effect might prevent unnecessary iatrogenic delivery of preterm fetuses.

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Category: Vol. 77, March 2009

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Does Vitamin C and E Supplementation Have a Protective Role in Mild Preeclampsia?

ELHAM S. MAREI, HEBA MANSOUR and AZZA ABDALLAH

Abstract
Objectives: Oxidative stress has been proposed as a key factor involved in the development of pre-eclampsia. Supple-mentation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain.
Aim of the Study: Was to assess if supplementing women with mild pre-eclampsia with antioxidants in the form of (Vitamin C 1000mg + Vitamin E 400IU) during the third trimester of pregnancy might help to counteract oxidative stress and thereby prevent or delay the incidence of severe pre-eclampsia?.
Research Design and Methods: This research includes of 30 mild pre-eclamptic women, all were primigravidae with singletone gestation in the third trimester (28-32 weeks of gestation). Fifteen of them were supplemented with (Vitamin C 1000mg + Vitamin E 400IU) tablets) daily until delivery and were considered as the study group (PE-CE). The control group (n=15) were not supplemented with vitamin C and E tablets (PE). Measurement of serum nitric oxide level (NO) was assessed initially on the first visit and re-evaluated at the end of the study using ELISA. Follow-up of all pregnant women was done until delivery.
Results: Significant increase in serum NO levels were realized among PE-CE group compared to the controls. Also, significant decrease in serum NO levels among PE group were obtained at the end of the study; reflecting the significant decrease in oxidative stress among the pre-eclamptic group who received anti-oxidants. Significant negative correlation between serum NO level and mean arterial blood pressure was evident in PE-CE group.
Conclusion: Patients with pre-eclampsia are exposed to oxidative stress, which may have a role in the pathogenesis of the disease. Supplementation with the antioxidants vitamin C and E could be considered in the management of mild pre-eclampsia and to be routinely administered in mid trimester pregnancy.

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Category: Vol. 83, December 2015

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Breastfeeding Practices among Employed Saudi Mothers, MOSLEH JABARI, KHALID AL-HUSSEIN, MOHAMMED AL-SAYED, ABDULLAH AL-FARIS, ABDULLAH AL-SHAYA and HASSAN AL-SHEHRI

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Category: Vol. 83, June 2015

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Intracutaneous Sterile Water Injections for Relief of Back Pain during Labor, AMR H. FARAG, KHALED S. MOHAMMED and MOHAMMED M. MORSY

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Category: Vol. 77, June 2009

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C-Reactive Protein Level, Could Be a Useful Predictor of LV Systolic Dysfunction Post Myocardial Infarction,AHMAD ABD ELRAZIK OTHMAN

Abstract
Background: C-reactive protein is an acute phase protein that is produced predominantly by hepatocytes under the influence of cytokines such as interleukin (IL)-6 and tumor necrosis factor-alpha, which increased in response to infection, ischemia, trauma, burns, and inflammatory conditions. Ligand-bound or aggregated C-reactive protein binds C1q and in so doing activates the classical complement pathway.
A growing number of studies suggest that C-reactive protein is an independent risk factor for vascular disease, the baseline plasma concentration of C-reactive protein predicts the risk of future myocardial infarction and stroke and is associated with a poor prognosis in unstable angina.
C-reactive protein estimation can help in predicting short-and long-term prognosis after acute myocardial infarction. High plasma C-reactive protein level in the acute phase strongly indicates a poor clinical outcome of the patients with myocardial infarction.
Aim of the Study: To assess the relationship between the admission C-reactive protein levels and left ventricular function in patients with acute myocardial infarction.
Patients and Methods: Thirty patients 26 males (86.6%) and 4 females (13.4%) with a mean age of 52±9.82 years, with recent ST elevation myocardial infarction were included in the study over the period from August 2004 to July 2005. All patients included in the study were presenting with symp-toms of recent myocardial infarction.
Following admission all patients were subjected to full medical history, clinical examination, standard 12-lead ECG, and routine laboratory investigations including cardiac enzymes (CK, CK-MB and LDH) and venous blood samples for C-reactive protein were obtained at time of admission.
Assessment of left ventricular function by echocardio-graphy was done to all patients on day 2 or 3 of hospitalization.
Result: Based on C-reactive protein level we classified the patients into two groups. Group A: Including patients with CRP level £2.5mg/dl, (mean 1.36±0.81mg/dl), (n=16). Group B: Including patients with CRP level >2.5mg/dl, (mean 6.42±3.87mg/dl), (n=14).
The mean C-reactive protein level was significantly higher in group B than group A (6.42±3.87 Vs 1.36±0.81), p value
0.05 and the mean CK and CK-MB level was higher in Group B (528±691.5 & 46.3±2.7U/L) than in Group A (342.3±589.3 & 30.1±2.1U/L) respectively, but the p value was not signif-icant.
LVEDV was significantly higher in group B than group A (79.17±17.2 Vs 62.3±18.6) p value 0. 04, LVESV also was significantly higher in group B than group A (39.4±12.2 Vs 26.9±10.6) p value 0.035.
And LV EF was significantly lower in group B Compared to group A (46.7±11.9% Vs 56.9±7.7%) p value 0.02. And the Severity of diastolic dysfunction was significantly greater in Group B (diastolic dysfunction grade II-III; E/A ratio 1.8±0.3) than in Group A (diastolic dysfunction grade I-II; E/A ratio 1.1±0.2).
In Conclusion: C-reactive protein could be used as an index of the severity of myocardial necrosis and prediction of LV systolic dysfunction.

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Category: Vol. 83, March 2015

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MSCT Pulmonary Manifestations and Complications of Long Standing Sarcoidosis, YOUSSRIAH Y. SABRI, IMAN M. HAMDY, IRENE SABRY and AHMED A. BAZ

Abstract
Background: Sarcoidosis is a multisystem chronic inflam-matory condition of unknown etiology. It is known to have mediastinal lymphadenopathy and parenchymal perilymphatic distribution of its granulomas. In long standing cases, however, fibrosis and honey combing described as fibrocystic changes with classic broncho-centric and upper zonal predilection are recognized. Mycetoma is a reported complication of fibrocystic sarcoidosis. Multi-slice computed tomography (MSCT) espe-cially high-resolution technique (high resolution computed tomography, HRCT) play a very important role in diagnosing pulmonary manifestations and detect the possible complications of long standing sarcoidosis.
Aim of the Work: The purpose of this study is to depict the pulmonary parenchymal changes and the possible compli-cations in long standing sarcoidosis and to explore the role of MSCT/HRCT in its diagnosis.
Patients and Methods: This study included 23 cases 20 females and 3 males, age range 45 to 62 years old (average 51.66 years). Cases were referred to the Radiology Department Kasr Al-Aini for MSCT/HRCT assessment of the chest. All patients were known cases of sarcoidosis with duration of illness ranging from five to seventeen years (5-17 years), all were subjected to thorough clinical evaluation, laboratory assessment. CT chest (with high resolution technique) done to all patients using MDCT (Toshiba- Aquillion, 64 detectors).
Results: In this study multi-slice and high resolution computed tomography (MSCT with high resolution technique; HRCT) detected various CT chest signs in long standing sarcoidosis patients.

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Category: Vol. 82, June 2014

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Case Report: Coronary Artery Anomalies: Abnormal Origin of LAD, Circumflix from Separate Ostea from Right Coronary Cusp, GHADA SOLTAN

Abstract
Coronary artery anomalies (CCA) are a diverse group of congenital disorders whose manifestations & pathophysiolog-ical mechanisms are highly variable.
Anomalous origin of the left main coronary artery is a rare clinical entity that can present with symptoms across the clinical gamut, from asymptomatic to chest pain and possibly even sudden death. The clinical syndrome varies depending on the course of the aberrant left main. The anterior course where the artery runs between the aorta and the pulmonary artery can lead to compression of the left main, resulting in ischemia and possibly sudden death.
In this case female patient complaint of chest pain was underwent multislice CT. She has Absent left main (LM), left anterior descending (LAD), and circumflex artery (CX) ab-normally originate from two separate ostea from right coronary cusp.

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Category: Vol. 82, June 2014

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The role of vitek-2 automated system in identification and susceptibility testing of Gram negative rods in an Intensive Care Unit patients in Egypt, Dina M. Atef and Rania A. Ghonaim

Abstract
The performance of automated Vitek-2 system was evalu-ated for the identification and antimicrobial susceptibility testing (AST) of most common Gram-negative bacilli in in-tensive care unit patients directly from BacT/ALERT positive blood cultures bottles. Direct inoculation of the positive blood cultures with the Vitek cards ID-GNB and AST-GN71 was compared with the standard inoculation method based on the sub-culture of the positive blood culture to agar. We aimed to give the clinician with early information about the results of blood culture allowing a better prognosis and a reduced mortal-ity rate of the ICU patients. A total of 170 blood cultures from ICU patients’ clinical samples were investigated; of these, 165 (97.06%) strains were correctly identified to the species level, 1 (0.59%) strain was not identified. Results were compared with those of the reference method of API identification systems using a pure culture. It was found that 4 (2.35%) strains had been misidentified. The direct-identification reporting time of Vitek-2 was about 3hrs. Direct testing of susceptibility to 19 antibiotics, i.e., amikacin, ampicillin, ampicillin/sulbactam, az-treonam, cefazolin, ceftriaxone, ciprofloxacin, Extended-Spec-trum Beta-Lactamase (ESBL) (include: Cefepime, cefotaxime, ceftazidime, clavulanic acid), gentamicin, imipenem, mero-penem, moxifloxacin, nitrofurantoin, tigecycline, tobramycin and trimethoprim-sulfamethoxazole. AST was also performed by the broth microdilution (MB) method as a reference method. It was determined that the 3,135 organism-antibiotic combina-tions had an overall correct rate of 95.6%. The error rate was 4.4% overall, Only 22 (0.7%) gave severe errors (i.e., reported as sensitive by the Vitek-2 system but shown to be resistant by the MB method), 10 (0.3%) major errors (i.e., reported as resistant by the VITEK 2 system but shown to be sensitive by the MB method) and 106 (3.4%) minor errors (i.e., reported as sensitive or resistant with the Vitek-2 system and intermediate by the MB method or intermedicate with the Vitek-2 system and sensitive or resistant by the MB method).
Conclusion: Direct identification and antimicrobial sus-ceptibility testing with Vitek-2 system gave rapid and reliable results with shortening the turnaround time of microbiological laboratory by 24hrs which leads to a significant reduction of patient’s morbidity, mortality and medical care cost.

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Category: Vol. 83, March 2015

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Satisfaction of Keloids and Hypertrophic Scar Patients Following Fractional CO2 Laser, OMAR AZZAM, DALIA A. BASSIOUNY, MARWA S. EL-HAWARY, REHAB M. SOBHI and MARWA S. ELMESIDY

Abstract
Background: Different modes of therapy for scars are currently being used and are limited by their efficacy and side effects. Newer modes of therapy including laser, are thus being studied for their efficacy.
Aim: Assessment of patients' satisfaction following frac-tional CO2 laser sessions on their scars.
Methods: Scars were treated by fractional CO2 laser in thirty patients for a total of 4 sessions 6 weeks apart. Vancouver scar score (VSS) was done before, one, three and 6 months after the last laser session by a blinded observer. Patients' satisfaction at the end of the study was graded as excellent (more than 75% improvement), good (50-75% improvement), moderate (25-50% improvement) and poor (less than 25% improvement).
Results: Nineteen patients completed the six month follow-up period (12K, 7HTS). VSS score was significantly lower in the treated compared to untreated areas after 3 and 6 months in both K and HTS. Patients were poorly satisfied, 50% of keloid patients, 28.6% of hypertrophic scar patients.

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Category: Vol. 78, September 2010

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Effect of Septicaemia on Renal Performance in the Neonate,MOHAMMAD H. SALAH, NAGWA HAMDI, ALI ALGAYAR, AMR EL KHASHAB, MANAL MARASHLI, and WAFAA AMIN

Abstract
Acute Renal Failure (ARF) and renal impairment may result from insults to the otherwise normal neonatal kidneys in the postnatal period. Neonatal septicaemia is associated with multiorgan dysfunction and is a leading cause for the occurrence of acute renal failure in such infants.
Aim of the Study: Is to assess the occurrence of ARF complicating neonatal sepsis and effect of associated contrib-uting factors.
Patients and Methods: Over a period of 12 months at the neonatal department of Al Galaa teaching hospital, out of 250 studied cases with neonatal sepsis, ARF complicated 79 (31.6%) of neonates. All cases were assessed for gestational age, birth-weight, sex, AS, and other co-morbidities: nephro-toxic drugs, DIC, shock, maternal drug intake and mechanical ventilation. A full sepsis screen and evaluation of renal functions by estimating the urine output, BUN and Pcr was carried out for all studied babies. ARF was diagnosed if Pcr >1.5mg/dl adjusted for gestational and postnatal age, with or without oliguria, with or without increased BUN >20mg/dl., on two separate occasions 24 hours apart.
Results: Majority of cases of ARF complicating neonatal sepsis were preterm babies between 32-36 weeks gestation, 35 cases (44.3%). Oliguric ARF was found in 16.5% of cases. The mortality rate was 72.2% (57 cases) in ARF compared to 26.3% (45 cases) in sepsis without ARF (p<0.001). Acute renal failure was significantly higher in low-birth-weight (LBW) and extremely low-birth-weight (ELBW) neonates of same gestational age group without ARF (87.4% & 30.3% Vs 65.5% & 17%, p<0.01 & p<0.001 respectively). DIC and shock were significantly higher in ARF complicating neonatal sepsis (p<0.05, p<0.001). Perinatal asphyxia, mechanical ventilation and nephrotoxic drugs did not significantly increase the occurrence of ARF in septic neonates. Recovery from ARF occurred in 43 (54.4%) cases.
Conclusion: ARF complicating neonatal sepsis occurred in 31.6% of our study cases. It was significantly increased in, the lower birth-weight and gestational age neonates, DIC and shock.

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Category: Vol. 77, March 2009

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Fatal Prognosis of Methanol Toxicity: Identification of Predictive Factors,NABIL N. REZK and MOHAMAD F. ALLAM

Abstract
Human methanol poisoning is characterized by serious visual impairment, hepatic toxicity, formic acidosis, central nervous system toxicity, and death. This study was conducted on all patients admitted to Ain Shams Toxicology Centre because of methanol toxicity over one year, form January 1, 2004 to December 31, 2004. The patients were divided into two main groups; Group I included patients who survived after methanol poisoning meanwhile group II included patients who died after methanol poisoning. All patients were clinically examined for cardiovascular system manifestations, neurolog-ical, ophthalmic ad effects of acidosis. All patients were subjected to routine investigation including renal profiles and liver profiles, as well as specific investigations mainly arterial blood gases and serum electrolytes. Also, data about if the patient was in need for and had haemodialysis was registered. Patients in group I presented with tachycardia, hypertension, pallor, sweating, blurring of vision, and some of them were agitated. On the other hand patients in group II showed hypertension, arrhythmias, convulsion and coma (grade III, IV), elevated renal profiles (serum creatinine mainly), together with hyperkalaemia and sever acidosis. Comparisons between group I and group II were done using student’s t-test for continuous variables and Person’s Chi-square test for categor-ical variables. The adjusted predicted factors for fatal prognosis were obtained using the logistic regression analysis. The results of the study revealed that mortality was much more prevalent among those who suffered from significant cardio-vascular, CNS, ophthalmic, and renal signs of toxicity together with metabolic acidosis and hyperkalaemia.
The multivariable analysis has identified one independent predictive factor significantly associated with fatal prognosis. This factor was convulsion (p<0.001). It can be concluded that early diagnosis and management of methanol poisoning may improve survival. Also, cardiovascular, CNS toxic man-ifestations and metabolic acidosis were strong predictors of methanol poisoning out come. Our results call for further investigation of predictive risk factors for the fatal prognosis of methanol toxicity; future studies preferably should include measuring of serum and tissue formic acid, and performed on large prospective cohorts over several years, to increase their internal validity.

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Category: Vol. 77, December 2009

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Congenital Anomalies in Giza, Egypt: A Cross-Sectional Study,GHADA M.H. ABDEL-SALAM, HANAN H. AFIFI, MAHA S. ZAKI, MONA S. AGLAN, IBRAHIM HEGAZY, AHMED TORKY, KHALED H. ABDULLA, SALLY TANTAWY, MAHMOUD Y. ISSA, MANAL MICHEAL, RANDA M. KAMAL, IBRAHIM EL-NEKHELY and SAMIA A. TEMTAMY

Abstract
Background: Enlarged vestibular aqueduct (EVA), the commonest radiological finding in children with sensorineural hearing loss is associated with variable auditory and vestibular symptoms.
Aim of the Work: Is to determine vestibular findings in patients with EVA.
Patients and Methods: 20 patients diagnosed as having sensorineural hearing loss and EVA as the study group, 20 healthy subjects matched for age and sex participated as the control group. Both groups underwent: Full history taking, General and neurological examination, Full ENT examination pure tone audiometry, tymanometry, high resolution computed tomography (HRCT), vestibular evoked myogenic potentials (VEMP), caloric test and computerized dynamic posturography.
Results: EVA was bilateral in 14 patients and unilateral in 6 patients. The VEMP amplitude of wave p13-n23 was higher in ears with EVA and it correlated positively with its size, p13-n23 latencies did not differ significantly from the control group, caloric test showed absent response in 4 patients, unilateral weakness in 6 patients and normal results in 10 patients, there was no statistical significant difference regarding computerized dynamic posturography results.
Conclusion: Results showed larger VEMP amplitude, which is indicative of third window lesion. Some patients showed Caloric test abnormalities which indicates a peripheral vestibular lesion. VEMP, caloric test and computerized dynamic posturography testing are effective in evaluating patients with EVA.

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Category: Vol. 80, December 2012

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Audit of Hypertension Care in a Primary Health Care Center in Abha City, Saudi Arabia,MOHAMMAD M. MOGBEL and ABDULLAH A. KHAWAJI

Abstract
Objectives: To evaluate structure, process and outcome of hypertension care in a primary health care center (PHCC).
Methodology: This study was based on the information provided in the files of all hypertensive patients (n=218), who attended Al-Manhal PHCC during the period from 1/1/2011 to 31/12/2011. The structure of hypertension care was assessed by two checklists. The process of hypertension care was assessed by two checklists. The outcome indicators were undertaken according to the Quality Assurance in Primary Health Care Manual. The last blood pressure reading during the year 2011 was taken. The patient was labeled as “controlled” if his blood pressure was <140/90mmHg or “uncontrolled” if it was equal to or more than 140/90mmHg.
Results: The main risk factors for hypertension were diabetes (42.7%) and obesity (78.5%). Check-list of the structure resources score was 32 (out of 47), while the mean score for process evaluation for hypertensive patients was 34 (out of 50). The annual general physical examination was almost completely ignored by physicians, referral to specialists was done for 11.5%, while health education was offered for almost all patients. Most routine investigations were requested to be performed at the secondary health care level, with high proportion of no feedback. Control of systolic blood pressure reached 37.2% while that for diastolic blood pressure was 47.2%. Incidence of systemic complications was generally low.
Conclusions: Main risk factors for hypertension include diabetes and obesity. Primary health care physicians are not trained on proper registration and documentation of medical records. The primary health care centre lacks a standardized protocol for management of hypertension. The health care team does not include a dietitian, social workers or a physician qualified to carry out fundoscopy. The primary health care process needs improvement. The general physical examination of hypertensive patients is rarely done. The design of medical records for follow-up of patients contains several problems. The success rates for control of blood pressure of hypertensive patients are low. All these negative findings should be dealt with accordingly. Moreover, audit studies should be performed at several primary health care centers caring for other chronic diseases.

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Category: Vol. 77, September 2009

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Evaluation of the Application of DOTS Strategy in Gharbia Governorate,EL SAYED SALEM, HODA BAHR, AYMAN SALEM, IBRAHEIM KHALIL, MOSTAFA EL ASEEL and AMAL A. WAFI

Abstract
Background: Egypt has succeeded in implementing the directly observed treatment, short course (DOTS) strategy nationwide. This strategy involves the direct observation of tuberculous patients during drug intake to ensure that the full treatment course is followed. It has been shown world-wide that patients treated without direct observation have a sub-stantially higher risk of adverse outcome than those treated under direct observation.
Objective: Estimate the risk of Mycobacterium Tubercu-losis disease in a trial to reduce its prevalence and evaluating DOTS strategy implementation in Gharbia Governorate to prevent the spread of tuberculosis in the community by early detection of patients with infectious tuberculosis and providing them with effective treatment to ensure a rapid and lasting cure. Diminished development of treatment failure and resistant cases would thus follow as an achievement.
Subjects and Methods: This study included 276 tuberculous patients who attented in the last two year 2006, 2007 in Mehalla El Kobra & Tanta chest centers. They were categorized according to their locality and study year. Their age, sex, site of tuberculosis, the regimen of drug used, were recorded. The treatment outcome of the patient and notification of number of cured, completed treatment, relapsed, treatment failure, transferred and died patients were also thus known.
Results: The 276 tuberculous patient, included 101 patients belonging to Mehalla (41 patients in 2006 & 60 patients in 2007) and 175 patients belonging to Tanta (88 patients in 2006 & 87 patients in 2007). The pulmonary form of the disease represented 77.23% in Mehalla and 76% in Tanta. The remaining were extrapulmonary. In relation to gender there were male predominance 64.36% in Mehalla & 69.71 in Tanta. The difference was statistically insignificant. The percent of treatment success in the form of cured and completed treatment patients were 88.12 in Mehalla & 77.14 in Tanta. The percent of treatment failure were 1.98 in Mehalla & 4.57 in Tanta. The percent of died patient were in 2.97 Mehalla & 5.72 in Tanta. The difference were statistically significant (p<0.05).
Conclusion: According to the international standard of Annual Risk of Infection (ARI), early detection of tuberculosis
cases needs to be improved, so that treatment would be initiated early enough to minimize pre-treatment transmission of infection in the community. The need for interventions aiming at, earlier identification of sources of infection and reducing tuberculosis transmission in the studied communities and in other similar communities, is urgent. However the outcome of successful manangement of the detected cases in the study fulfills the desired international standard in Mehalla and is promising in Tanta, which would satisfy the desired effect of avoiding resistence of the bacillus with its economic, medical and social burden.

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Category: Vol. 82, December 2014

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Assessment of Nutritional Learning Need of the Mother during Postpartum Period, BASMA S. MAHMOUD, GEHAN I. GHONEMY and MAGDA A. FAWAZ

Abstract
Healthy nutrition is one aspect of health promotion to the women through a different phase of life. The reproductive health approach places emphasis on the life cycle perspective, from infancy through adolescence, as well as, during and after pregnancy to ensure a good health for both mothers and their newborn.
Design: A descriptive exploratory research design was adopted for this study.
Aim of the Study: To assess the nutritional learning needs of postpartum women.
Setting: The study conducted at the postpartum unit at Maternity University Hospital, Cairo Governorate.
Sample: A convenient sample of 500 postpartum mothers were selected after admission to the postpartum unit according to certain criteria. A structured interviewing tool was used to collect the data.
Results: Of the current research reveal that more than one half (60%) of sample their age ranges between 20-30 years, 41 % of them had received secondary school education, 54.4% of the sample residence in urban area. Ninety six point four of sample were housewives and 52.8% of the sample had income/month less than 800 pound. Regarding obstetric profile of the sample, 41.6% of the sample delivered by vaginal delivery compared to 58.4% of them by CS,75% were multi-paras and 25% were primiparous. Eighty three point six percent of the sample report their need to know what type of food that not allowed during postpartum, (76.4%) of the sample mentioned that types of food allowed during postpartum period compared to 56.1 % of the sample reported their need to know what types of food that can’t increase their weight as well as, not affect the quantity of milk production.
Conclusion and Recommendations: Maternal concern related to nutritional needs should be discussed with the mothers before they discharged from the hospital to promote their wellbeing as well as for newborn. Nutritional education for postpartum mothers should be propagated by mass media with the widest possible coverage. Raise awareness of post partum women related to proper and needed nutrition through counseling.

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Category: Vol. 81, March 2013

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Renal Artery Embolization in Post Traumatic Vascular Lesions,IHAB I. ALI, HESHAM BADAWY, AMR A. NASSEF and AHMED S. AWAD

Abstract
Background: Renal vascular injuries mostly result from interventional urologic procedures such as percutaneous biopsy and nephrostomy. Serious hemorrhagic complications associ-ated with percutaneous urologic procedures occur in 2.3-15% of the patients endangering patients' life. Conventional surgical treatment including partial and total nephrectomy carries great morbidity and results in remarkable renal parenchymal loss.
With the development of transcatheter endovascular interventional procedures, microcatheters and embolizing materials precise localization and superselective catheterization of the arterial bleeder followed by embolization gives a minimally invasive treatment option which is able to control bleeding with minimal parenchymal loss and complication compared to surgery.
Purpose: To evaluate the effectiveness of endovascular embolization as a therapeutic technique in post traumatic (iatrogenic and non iatrogenic) renal vascular injuries.
Patients and Methods: This is a single center prospective study from July 2004 to November 2009. Thirty two patients (25 males and 7 females) between the ages of 3 and 60 years (mean age 37 years) with suspected renal vascular injury after percutaneous renal intervention or stab injury underwent angiography and percutaneous transcatheter arterial emboliza-tion using coils, glue, poly vinyl alcohol (PVA) particles and absolute alcohol.
Results: The source of bleeding was identified and embo-lized in 87.5% of patients (pseudoaneurysm=17, pseudoaneu-rysm with arteriovenous fistula=7, arteriovenous fistula (AVF) alone=2 and extravasation=2).
Bleeding stopped in 26 of the 28 patients (92.8 %). In two patients (7%), recurrent bleeding occurred. Re-angiography and assessment was done and insertion of another coil was needed in one patient, while in the second one, glue was administrated.
None of the patients underwent embolization required further surgical intervention. No significant immediate or delayed complications related to angiography or embolization was recorded.

Conclusion: Transcatherter endovascular renal emboliza-tion is effective minimally invasive treatment option in iatro-genic and penetrating vascular renal injuries that allow control of bleeding with minimal renal parenchymal tissue loss and rapid recovery.

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Category: Vol. 84, March 2016

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Role of Interluekin-12, 13, 18 and IgE in Asthmatic Yemeni Children, ALI AL-ERYANI, NAJLA AL-SONBOLI, AHMED AL-KHORASANI, NASHER AL-AGHBARI and SALEEM M. AL-HAMADN

Abstract
Background: Asthma is the most common chronic respi-ratory disease among children causing considerable morbidity and mortality. The exact cause of asthma has not yet been identified but it is believed that multiple factors are involved with interplay between host factors (particularly genetics) and environmental factors that occur at a crucial time in the development of the immune.
Airway inflammation in asthma may represent a loss of normal balance between two opposing populations of T-helper lymphocytes; Th1 and Th2 either as overexpression of Th2 or under expression of Th1. Th1/Th2 imbalance plays an important role in the development of asthma and allergic diseases with an imbalance between Th1 and Th2 cytokine profiles and evidence that allergic diseases, and possibly asthma, are characterized by a shift toward a Th2 cytokine-like disease, either as over expression of Th2 or under expres-sion of Th1. Cytokines play an important role in the coordi-nation and persistence of inflammation in asthma, although the precise role of each cytokine remains to be determined.
Objective: To compare the serum levels of Interlukin-12 (IL-12), IL-13, IL-18 and total IgE (TIgE) in asthmatic children with age-matched healthy control group in Sana'a City.
Methods: The study was a hospital based prospective case control study of children 5-15 years old attending two referral Pediatric Hospitals in Sana'a, Yemen; Al-Sabeen Hospital for Maternity and Childhood and Al-Thawra General Modern Hospital. The data collection was for 12 months, from October 2013 up to November 2014. Seventy children were enrolled, 35 asthmatic children and 35 age matched (5-15y) healthy controls. Serum IL- 12, IL- 13, IL- 18 and TIgE concentrations were measured by enzyme-linked immunosorbent assay at the National Blood Transfusion and Researches Center (NB-TRC), Sana'a. Serum IgE levels were measured using: DRG Human IgE ELISA Kit (catalogue number (EIA- 1788), DRG International Inc., USA). Serum IL-12, IL-13 and IL-18: Using Glory Science Human IL- 12, IL- 13 and IL- 18 ELISA Kits (Glory Science Co., Ltd, USA) according to the manu-facturer's instructions. Data were stored and analysed by Epi-info 2011 version 3.5.3.
Results: Serum IL-12 and IL-18 levels in the asthmatic children were significantly lower than controls. On the other hand, serum IL-13 and serum TIgE levels in the asthmatic children were significantly higher than controls. The percentage as well as the absolute count of peripheral blood eosinophils was significantly elevated in the asthmatic children compared with the control group.
Conclusion: Th1-Th2 imbalance is an important charac-teristic of asthma with a predominance of Th2 cytokines such as IL-13 with a relative deficiency of Th1 cytokines, such as IL- 12 and IL- 18. Cytokines are critical in the pathophysiology of asthma raising the possibility that inhibition of Th-2 cytokines or promotion of Th1-skewing cytokines could be a logical approach to asthma therapy.

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Category: Vol. 83, September 2015

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Oncoplastic Breast Surgery Using Latissimus Dorsi Miniflap, HESHAM M. HAMZA, HUSSEIN FAKHRY, SAMIR E. SHEHATA, GAMAL AMIRA, MAHMOUD M. MOSTAFA, ASHRAF EL-YAMANY, BADAWY AHMED and KASSIM ABD EL-AZEEM

Abstract
Background: Breast-conserving surgery plus radiotherapy is firmly established as a good and safe option for most women with early breast cancer. Cosmoses after Breast-conserving surgery depend on two main factors; the site of the lesion and the breast volume excised in relation to total breast volume. Latissimus dorsi miniflap is one of the various autologous tissue reconstructions that can replenishe loss of more than 25% of breast volume. The aim of our study is to evaluate the aesthetic outcome and complications of breast reconstruc-tion using latissimus dorsi miniflap augmentation after wide local excision of the tumor combined with axillary lymph node dissection.
Patients and Methods: The study involved twenty eight patients with breast cancer underwent conservative breast surgery in the form of wide local excision with safety margin with immediate reconstruction using Latissimus dorsi miniflap either by muscle only or musculocutaneous flap. Neoadjuvant chemotherapy was given in some cases to reduce the tumor size and after surgery; all cases received eligible adjuvant therapy.
Results: Most of the patients (71.4%) were having T2 tumor, while (14.3%) of the patients had T1 tumor and (14.3%) had T3 tumor. Neoadjuvant chemotherapy was given for 14 patients with overall response rate about 76.7%. Wide local excision with safety margin with immediate reconstruction using latissimus dorsi mini-flap was done. Seventeen patients had reconstruction with muscle only, while 11 patients had reconstruction by musculocutaneous flap. A deeply satisfied cosmetic result was achieved in (82.1%) and none of them subsequently required mastectomy. After median follow-up of 28 month, the progression free survival was 92.9% and the over all survival was 96.4%. No local recurrence was recorded.
Conclusion: Breast augmentation with autologous tissue comes into play by reducing the resultant deformity when the breast volume excised is significant. The Latissimus dorsi flap is the mainstay of oncoplastic breast surgery after partial mastectomy and it has low donor site morbidity, deep patient satisfaction and low and temporary radiation effects.

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Category: Vol. 83, June 2015

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Ultrasonographic Evaluation of Hand and Wrist Tendons in Patients with Rheumatoid Arthritis, HALA I. ELGENDY, HATEM M. ELAZIZI and RASMIA M. ELGOHARY

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Category: Vol. 82, December 2014

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Suicidal Ideation among Patients with Major Depressive Disorder Living at High Altitude, SAEED A. ASIRI

Abstract
Objective: To compare the prevalence of suicidal ideation among Saudi major depressive disorder (MDD) patients living at sea level with those living at high altitude.
Patients and Methods: All newly diagnosed adult Saudi MDD patients at Abha Psychiatric Hospital (n=69 patients) and Jizan Psychiatric Hospital (n=47 patients) during the period from January till December 2013 were included in this study. The diagnosis of depression for our cases was based on “Structured Clinical Interview for DSM-IV” (SCID), while suicidal ideation was assessed by the “Columbia-Suicide Severity Rating Scale” (C-SSRS). A venous blood sample was taken from each patient for the assessment of FT3, FT4 and TSH blood levels.
Results: The majority of MDD patients in both Jizan Psychiatric Hospital (JPH) and Abha Psychiatric Hospital (APH) were females (80.9% and 84.5%, respectively). Most cases belonged to the age group 25-50 years (64.7%). Mean blood levels of thyroid hormone (T3 and T4) were slightly lower in MDD patients living at high altitude than those at sea level, while the mean blood level of TSH in patients living at high altitude was slightly higher than that in patients living at sea level. Nine MDD patients (8%) had suicidal ideation. All 9 patients with suicidal ideation were females. The prev-alence of suicidal ideation was highest among older MDD patients (15.8%) and was higher among patients living at high altitude than those living at sea level (11.6% and 2.1%, respectively). FT3 blood level was significantly higher in patients with no suicidal ideation than those with suicidal ideation (4.81±0.93pmol/L and 4.01±1.36pmol/L, respectively, p=0.019). FT4 blood level was significantly higher in patients with no suicidal ideation than those with suicidal ideation (15.49±2.75pmol/L and 12.13±5.32pmol/L, respectively, p=0.007). TSH blood level was significantly lower in patients with no suicidal ideation than those with suicidal ideation (2.69±1.82mU/L and 5.51±2.86mU/L, respectively, p=0.001).
Conclusions: MDD among Saudi adults affects mainly females. Lower blood levels of FT3 and FT4 and higher blood level of TSH among MDD patients are significantly associated with suicidal ideation. Living at high altitude may be associated with a higher prevalence of suicidal ideation among MDD patients.

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Category: Vol. 81, March 2013

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Diabetic Patients’ Knowledge and Practice Regarding Prevention of Diabetic Foot,ALI S. ALASMARY, OSSAMA A. MOSTAFA and YAHIA M. AL-KHALDI

Abstract
Aim of Study: To assess knowledge and practice of diabetic patients as regard their feet care.
Patients and Methods: This study was conducted at three primary health care centers (PHCCs) in Abha City, Kingdom of Saudi Arabia. A total of 432 diabetic patients were included in the present study sample which represented 25% of all registered diabetics in these three PHCCs. An interview questionnaire and a feet examination sheet were used.
Results: More than half of patients suffered from hotness sensation in their feet (54.2%). Feet numbness was complained by 47.7% of patients, while feet tingling was complained by 37.7%. Good fasting blood sugar control was achieved only in 14.1% of diabetic patients. Only 41.4% of patients underwent feet examination by primary health care (PHC) physicians. One third of patients received educational brochures about foot care, while health education sessions on importance of and how to conduct foot care have been held only for 43.1% of patients. Some patients had abnormal color of feet skin (14.4%), nails abnormalities (12.7%), swelling (6.9%), defor-mity (7.4%), muscle atrophy (6%), foot skin cracks (10.2%), callus (6.9%) and amputation (1.4%). Palpation revealed temperature fluctuation occurred in 1.4% of cases, absent dorsalis pedis pulse (7.2%) or posterior tibial pulse (17.6%) and absent capillary refill (15.3%). There were diminished/lost vibration sense (12.3%), impaired sense of pressure (18.8%) and impaired Achilles tendon reflex (17.6%).
Conclusions: Most diabetics do not receive the necessary educational materials about foot self-care and health education sessions on importance of and how to conduct foot care. PHC physicians do not provide the required routine foot examination to diabetic patients. Diabetic patients' knowledge and practices regarding diabetic foot care are generally unsatisfactory. Diabetics who have the least knowledge scores are those who are within the age group <40 years, females, non-married, illiterates, unemployed, type 2 diabetic patients, duration of diabetes less than 10 years, and those with bad fasting blood sugar control.
Recommendations: Diabetic patients should receive health education covering all items related to prevention of diabetic foot and diabetic foot self-care. They should be encouraged to practice steps of self-care. A Special emphasis should be directed to: Females, illiterate, with recent diagnosis of diabetes. Diabetic patients with intact protective sensation and peripheral pulse should receive routine foot examination at least once/year. Patients with lost protective sensation and/or foot deformity are to be managed by a family physician and a diabetologist every 3-6 months. Diabetics with lost protective sensation or peripheral arterial disease or with a history of ulcer or amputation should be referred to a podiatrist or a specialty clinic and to be seen every 1-3 months. PHC physicians should receive training to provide ideal and proper routine foot examination and health education sessions to diabetic patients.

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Category: Vol. 77, June 2009

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Etiology and Outcome of Non-Traumatic Coma in the Pediatric Emergency Department,HALA FOUAD, MERVAT HARON, EMAN HALAWA and MANAL TANTAWY

Abstract
Non-traumatic coma in childhood is an important pediatric emergency. It can result from a wide range of primary etiologies.
Objective: To study the etiology and clinical profile of pediatric non-traumatic coma and to determine the clinical signs predictive of outcome.
Setting: Pediatric emergency department (PED) at a tertiary care university teaching pediatric hospital from Sep-tember 2007 to January 2008.
Patients and Methods: A prospective descriptive study of 100 consecutive pediatric non-traumatic coma cases was done. Clinical signs studied were vital signs, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupils, corneal reflex, motor patterns and seizures. These were re-corded at admission and after 48 hours of hospital stay. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability.
Results: The total number of patients with non traumatic neurological emergencies during the study period was 100 patients representing 14.4% of all pediatric emergency cases. The most frequent etiologies were metabolic causes (33%), CNS infections (28%) and intracranial hemorrhage (13%). Fifty percent of those patients died in the PED. On bivariate analysis, hypothermia, hypotension, flaccidity and poor Glas-gow coma scale at admission correlated significantly with mortality. However, after 48 hours of admission, poor pulse volume, poor Glasgow coma scale, abnormal respiratory pattern/apnea and presence of seizures correlated significantly with mortality. On logistic regression, poor Glasgow coma scale at admission while abnormal respiratory pattern and seizures after 48 hours of admission were independent signif-icant predictors of mortality.
Conclusion: Metabolic causes are the most common cause of non-traumatic coma in pediatrics. Simple clinical signs were good predictors of outcome. Emergency room guidelines developed for non traumatic coma should target the most common presenting problem categories.

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Category: Vol. 83, March 2015

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The Potential Efficacy of Endothelial Progenitor Cells With and Without Nitric Oxide Inducer as Cell Therapy for Right Ventricular Impairments Caused by Pulmonary Hypertension in Rats, MOHAMMED T. ABDELAZIZ, LAILA A. RASHED, SOHIER MAHFOUZ, DOAA M. GHARIB, RANIA EL-SAYED and RADWA M. GABER

Abstract
Background: A number of studies now suggest that en-dothelial progenitor cells (EPCs) may induce neovascularisa-tion and could be a promising approach for cell based therapy for pulmonary artery hypertension (PAH).
Purpose: We investigated whether or not intravenous injection of bone marrow-derived endothelial progenitor cells (EPCs), alone or combined with NO inducer restore pulmonary hemodynamics and increase microvascular perfusion in the rat monocrotaline (MCT) model of pulmonary artery hyper-tension so improve right ventricle performance.
Material and Methods: Rats were divided into control, rats with PAH, PAH rats receiving EPCs, PAH rats receiving NO inducer (L-Arginine) and PAH rats receiving EPCs plus NO inducer, after 1 month, serum creatine phosphokinase enzyme, VEGF level in heart and lung were assessed. His-topathological analysis of both heart and lung tissues was performed.
Results: The level of VEGF was increased in all treated groups. Immunohistochemical staining showed perivascular, intravascular and peribronchial CD34 positive cell aggregates in the groups received EPCs whether alone or combined with NO inducer.
Conclusion: The present study proved that, administration of BM-EPCs alone, NO alone or EPCs plus NO, produce therapeutic effect in restoring pulmonary hemodynamics and so improving right ventricle performance in PAH. This effect may be through angiogenic action of EPCs and NO.

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Category: Vol. 82, June 2014

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Conservative Management of Supratentorial Extradural Hematomas in Children, MOHAMED A. EL-GAIDI

Abstract
Background: Acute Extradural Hematoma (EDH) is less common in children compared to adults, which can be ex-plained by the relative flexibility of skull bones at this age which make fractures less frequent than in adults. Furthermore, EDH at this age is characterized by non-specific clinical presentation and inability of very young children to commu-nicate. However, the management guidelines of EDH in children are ill-defined.
Objective: The aim of this study is to assess the safety and efficiency of Bullock et al guidelines for conservative management of EDH in Children.
Patients and Methods: This was a prospective study conducted in Al-Manial university hospital, Kasr Al-Aini Medical School, Cairo University, over a period of one year duration. The study included children (<15 years old) with Glasgow Coma Scale (9-15) suffering from supratentorial EDH (thickness <15mm, volume <30cc and midline shift <5mm) without any focal neurological deficits according to Bullock et al., guidelines.
Results: 18 children (13 boys and 5 girls) matched these criteria and underwent conservative treatment. The most common mode of trauma was fall from height (usually 1.5 meters) (72%), while the most common sites of hematoma were frontal and parietal (33.3% and 27.8% respectively). Early follow-up computed tomography (CT) scan revealed enlargement of seven cases (38.8%), six of them continued the conservative management. While one case exceeded the required parameters for continued conservative treatment and was evacuated successfully. Thus the success rate of conser-vative management of EDH was (94.4%). There was no mortality and all patients had good outcome.
Conclusion: Conservative management of EDH in children is safe and effective if the guidelines of Bullock et al., were followed. However, if conservative treatment of EDH is considered, it is mandatory to secure adequate neurological monitoring and the possibility of urgent evacuation at any time especially in borderline cases.

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Category: Vol. 81, December 2013

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Case Report: Vaginal Neurofibroma, WAEL S. NOSSAIR and MOHAMMED S. FARAG

Abstract
Background: The causes of masses protruding at vulva are many, but vaginal neurofibroma is very rare cause. The manifestations of solitary primary neurofibroma differ as a mass or pain or acute urine retention up to obstructed labour. Pain is one of manifestation that cannot be ignored especially if severe pain that interrupts patient life like physical activity, sexual intercourse, and may lead to psychological disorder. In addition to the repeated attacks of urine retention that may need hospital transfer and repeated catherization.
Case(s): The case presented with mass protruding at vulva, with attacks of acute urine retention relieved by repeated difficult catheterization, in addition to severe pain that partially relieved by analgesia and hypnotics with disturbed sexual relation and 2ry infertility, and at same period with psycho-logical upsets. By Cusco speculum examination using reverse technique i.e. insertion of Cusco speculum in form of blade latterly instead of one bale up and another down, the mass discovered to be pedunculated arising from anterior vaginal wall, the pedicle was long allowing this mass to be entered inside the urethra which was dilated to degree as if vagina is divided transversely in equal manner. Surgical excision was done, neurofibroma detected. Patient became pregnant and delivered safely.
Conclusion: Neurofibroma is rare but should be considered in any painful mass at vulva. By using Cusco speculum in reverse manner we can examine anterior and posterior vaginal wall.

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Category: Vol. 83, March 2015

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Review Article: Extrahepatic Biliary Atresia is an Aflatoxin Induced Cholangiopathy in Infants with Null GSTM1 Genotype with Disrupted P53 and GSTPi to Mothers Heterozygous for GSTM1 Polymorphism: Damage Control is Mediated through Neutrophil Elastase and CD14+ Activated Monocytes: Kotb Disease, MAGD A. KOTB and AHMED KOTB

Abstract
Extrahepatic biliary atresia (EHBA) has long been defined as a progressive cholangiopathy of infancy of obscure aetiol-ogy. It is a grave disease with serious morbidity, mortality and economic burden. EHBA is currently treated surgically by Kasai portoenterostomy. In 10 years post-portoenterostomy the survival does not exceed 30%, and 60-80% of children with EHBA eventually develop liver cirrhosis. EHBA is the leading indication for liver transplantation in children. Evidence supports that immune mediated destruction of extrahepatic portal tracts that extends to intrahepatic bile ductules is an integral part of pathogenesis of EHBA. Yet initiator of immune mediated pathogenesis was still unknown. Evidence supports that the aetiology of EHBA is an aflatoxin induced cholangi-opathy in glutathione S transferase (GST) M1 deficient infants having disrupted p53 and GSTPi, whose mothers are heterozy-gous for GSTM1. Neutrophil elastase and CD14+ mediated damage control and integral in EHBA. These factors combined result in hepatotoxicity and bile duct damage followed by defective regeneration, and disruption of ontogeny respected development. EHBA is a multiple hit disease. Aflatoxins B 1 and B2 are transmitted through foods, they are highly substi-tuted coumarins with short half life that need timely cyto-chrome P450 family and GST detoxification. Bacterial li-popolysaccharide increase aflatoxins induced hepatocyte and bile duct damage up to 20 folds. Evidence supports that placental intrauterine transfer of aflatoxins is recognized, and that maternal detoxification of aflatoxins protects foetus during pregnancy, which will be lost post-partum. Postpartum infantile incompetent detoxification of the aflatoxin hepatic stores would result in hepatic toxicity, in proliferated bile ducts and fibrosis hence EHBA. Maternal detoxification products of aflatoxins delivered in breast-milk punctuate the course of infants with EHBA by attacks of cholangitis. EHBA is poten-tially preventable. We recommend prompt diagnosis by as-sessment of aflatoxins and GSTM1 phentoype in any neonatal hepatitis. Stringent monitoring of upper limits of mycotoxins in our food, and in food of poultry and cattle is a must.

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Category: Vol. 83, June 2015

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PET/CT Assessment of Treatment Response for Patients Known to Have Metastatic Breast Cancer, MOHAMMED ZAKI, MOHAMMED SHAHIN, MOHAMMED THARWAT and HISHAM ABDELGHANY

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Category: Vol. 83, June 2015

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Workplace Bullying and Absenteeism Rate among Staff Nurses at Mansoura University Hospital, AMINA H. AHMED, AHLAM EL-SHAER and NEHAD FEKRY

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Category: Vol. 83, September 2015

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Efficacy of Constrained Induced Movement Therapy Versus Bilateral Arm Training on Upper Extremity Functional Outcomes in Stroke Patients, ABDULALIM ATTEYA, WALEED T. MANSOUR, EBTESAM M. FAHMY and YOUSSEF M. EL BALAWY

Abstract
Background and Purpose: Recovery of motor function after stroke may depend on balance of activity of neural network involvingthe affected and the unaffected motor cortices. Modified constrained induced movement therapy and bilateral arm training share similar key therapeutic elements (mass and repetitive practice with specific techniques), and both target to improvement of the affected upper limb. The aim of the study was to compare the effect of these two techniques on improving upper extremity function in stroke patients.
Patients and Methods: Thirty male ischemic stroke patients with age ranged between 45-55 years. Patients were divided randomly into three equal groups. Group I received modified constrained induced movement therapy in addition to a selected physical therapy program. Group II received bilateral arm training in addition to a selected physical therapy program. Group III received the selected physical therapy program. Motor function of the upper extremity and gross manual dexterity were recorded using action research arm test and box and blocks test respectively.
Results: The results showed statistically very highly significant increase of the mean value of the action research arm test score of the affected upper limb post treatment within each group. (p=<0.0001 in GI, p=0.0001 in GII and p=0.007 in GIII) and Comparing between each pair of the three groups post treatment revealed that there was a statistically non-significant difference between GI and GII (p=0.143) while a very highly significant difference between GI and GIII (p=0.0001) and a highly significant difference between GII and GIII (p=0.008) post treatment. Also, there was a statistically very highly significant increase in BBT scorepost treatment within each group. (p=<0.0001in GI, p=0.0001 and p=0.0018 in GIII)and comparingbetween each pair of the three groups post treatment revealed that there was a statistically very highly significant difference in the mean value of BBT score between GI and GII (p=0.001) and between GI and GIII (p=0.0001) while there was a statistically highly significant difference between GII and GIII (p=0.006) post treatment.Conclusion: Bothmodified constrained induced movement therapy and bilateral arm training improves upper extremity function in hemipareticpatients with more superiority of modified constrained induced movement therapy on improving hand dexterity.

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Category: Vol. 77, March 2009

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The Changing Patterns of Bilharzial Bladder Cancer and its Treatment Outcome, NCI, Cairo University Experience,YASSER A. SALLAM, HOSSAM HUSSIEN, MOHAMAD EZZAT EL SAYED and HISHAM EL HUSIENY

Abstract
Bilharzial bladder cancer (B.B.C) is a major health problem in Egypt, as well as some African & Asian countries it repre-sents a distinct clinicopathologic disease. Tumors are usually advanced at presentation, they can be either of squamous or transitional cell carcinoma type, on the background of bilharzial cystitis. Bilharzial bladder cancer is a preventable malignancy, through eradication of the schistosomal infestation. Manage-ment is mainly surgical, with median 5 years survival about 48%. This article will try to explore clinicopathologic aspects as well as treatment options of such cases.

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Category: Vol. 82, June 2014

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Closed Reduction and Percutaneous Pinning in Fracture Proximal Humerus in Children, Abo-Bakr Z. Said and Haytham A. Abdel-Moneim

Abstract
Background: The majority of proximal humeral fractures can be treated nonoperatively in children with good clinical outcomes. However, severely displaced fractures may be treat-ed operatively to restore anatomic alignment and maximize shoulder motion especially in older children.
Objective: The purpose of this study is to assess clinical outcome and radiographic results of closed reduction and per-cutaneous pinning of proximal humeral fractures in children.
Patients and Methods: Fifteen patients with fracture prox-imal humerus treated by closed reduction and percutaneous pinning. The mean age was 12 years (range 8-15) and mean follow-up duration was 7.7 months (range 3-10). According to Neer-Horowitz classification, there were one patients with type I, five with type II, four with type III and five with type IV. All patients were evaluated by radiographs and CT preoperatively and postoperatively. The mean duration from injury to surgery was 12.75 hours (range 3-72). All cases achieved union at a mean period of 6.2 weeks (range 5-8). We assessed the out-come using a clinical score and the scoring system of Constant and Murley. A final review, the clinical results were graded as excellent in 10 patients, good in four and poor in one.
One case showed slippage of K-wires and two developed pin tract infection.
Conclusion: Closed reduction and percutaneous pinning is effective in stabilizing severely displaced proximal humerus fractures in older children with achievement of satisfactory re-sults. Full clinical and radiological union was achieved at 5 to 8 weeks regardless type of fracture or age of the child.

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Category: Vol. 83, September 2015

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Factors Predisposing to Malta Fever among Families at Rural Community in El-Minia Governorate: Guidelines for Human Protection, SHIMAA A. YONIS, MONA S. SHENOUDA and ENAS H. EL-SHAIR

Abstract
Malta fever is a serious re-emerging zoonosis which vastly afflicts human health. Egypt has high prevalence rates of B. melitensis infections in cattle, buffaloes, camels, sheep, and goats yet it may account for 10% in high risk human population.
Aim of the Work: To assess the predisposing factors to Malta fever among families at rural community in El-Minia Governorate in addition to providing guidelines to these families to protect themselves from the disease.
Research Design: A descriptive correlational design was used to achieve the aims of the current study.
Material and Methods: The study was conducted at El-Hatahta village at Samalout district affiliated to El-Minia governorate. Sample of 260 families were selected by system-atic random sampling method. A semi structured interview questionnaire and an observational checklist were designed to assess demographic data, knowledge about the disease, consumption practices of milk, milk products and meat and practices during contact with animals or its wastes.
Results: The current study revealed that 67.8% of the studied subjects' total level of knowledge about Malta fever was unsatisfactory with statistical significance differences with educational level, duration of work in animal breeding and previous infection with Malta fever where p-value were 0.002, 0.000, 0.000 respectively. Eighty two point four percent of the studied subjects' total level of practices related to Malta fever was poor with statistical significant differences with educational level and duration of work in animal breeding where p-value were 0.007, 0.006 respectively.
Conclusion: Unsatisfactory level of knowledge and poor practices related to Malta fever among the majority of the studied subjects were factors which can predispose them to the disease. Although the investigator provided the subjects with relevant disease information at the end of the study to protect them selves from Malta fever, a coordinated, efficient and effective strategy for primary prevention of Malta fever is needed to mitigate the risk of infection.

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Category: Vol. 83, September 2015

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Dosimetry for Small, Irregular and Rectangular Field Size for Electron Beam Therapy, NASHAAT A. DEIAB, SHAYMAA Z. ABDEL KADER, AIDA R. TOLBA, MOHAMED EL-NAGDY and MONA MOSTAFA

Abstract
Purpose: This study was to investigate the effect of irregularity in shape of field size of electron beam on the percentage depth dose and the output factor. Study the variety of the Percentage Depth Dose (PDD) and the output factors for rectangular and small field sizes when one of field dimen-sions less than the Practical Range (Rp) of the electron energy used. Compare the measured output factors for every rectan-gular and small electron lead cutout with its equivalent square field size.
Material and Method: Measure the percentage depth dose PDD for small, irregular and rectangular lead cutout against reference field size (10 X 10) cm using 3D water phantom and parallel plate ion chamber on linear accelerator (Elekta precise) with electron beam energies 6, 9, 12, 15 and 18 MeV. Measure and calculate the output factor for rectangular lead cutout and its equivalent square field size.
Results: The PDD parameters for irregular lead cutout varied from that for the reference field size depend on the shape of lead cutout and energy, for 6 MeV the variation ranged from 0.5 to 2%, for 9 MeV from 0.2 to 1.8%, for 12 MeV from 1.6 to 6.4%, for 15 MeV from 2.25 to 9.9% and for 18 MeV from 0.7 to 3.2%. The PDD for the small lead cutout varied from the reference field size when one of the field dimension is smaller than the practical range of the electron energy used. The variation in output for the rectangular field sizes and its equivalent square field size are ranged from 5 to 5.5% for (2 X 9) and (3 X 3), ranged from 2.3 to 4.5% for (3 X 9) and (4.5 X 4.5) and for (6 X 9) and (7 X 7) ranged from 0.1 to 0.7% at all electron energies.
Conclusion: The PDD parameters and output factors for irregular, small and rectangular varied from the reference field size (10 X 10) cm2 depended on the field shape and the electron energy used.

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Category: Vol. 78, December 2010

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Mechanism of Nickel and Chromium-Induced Immunotoxicity and Oxidative Stress: A Comparative Study,MANAL H. AHMED, NASHWA M. EL-MAHDY, NEVEIN A. EL-DESSOUKY and LAILA A. RASHED

Abstract
Introduction: Chromium (Cr) and Nickel (Ni) are examples of commonly used industrial substances with negative long time exposure on human health. One mechanism whereby metals can alter health is through modulation of immune homeostasis. They are capable of producing oxidative stress and it is possible that this oxidative stress contributes to the carcinogenic response of these metals.
Aim of the Work: The aim of this study is to highlight the possible immunotoxic potential of both Cr and Ni in occupa-tionally exposed workers, to investigate the oxidative stress and their potential effects on glutathione peroxidase (GPx) among workers exposed to both metals during electroplating process.
Material and methods: The study was carried out in a hot oven factory in electroplating sector in 6th October city. The studied population included randomly selected 28 workers exposed to chromium, 12 workers exposed tonickel and 20 workers not exposed to any metal as controls. Thorough present and past history were taken. Full clinical examination was performed. Both groups were matched as regards the age and smoking habits.
Results: All workers were males with age ranging from 19 to 44 years with a mean value of 29.95±7.25. The duration of exposure of workers ranged from 1 to 15 years with a mean of 6.05±4.06 years. Both Ni and Cr-exposed workers had statistically significant high levels of tumor necrosis factor (TNF-a) and IL-6 and in terleukin-6 (IL-6). Statistically significant differences were found in CD3 and CD4 levels but with higher CD8 level. As regards the oxidative stress markers, serum malondialdehyde (MDA) was significantly higher in exposed groups when compared to the control group; while the serum glutathione peroxidase (GPx) was significantly lower in exposed groups.
Conclusion and Recommendations: Our study shows that chromium and nickel cause significant deviations in various immune parameters with evidence of oxidative stress in occupationally exposed workers. Medical surveillance in combination with biological monitoring can help to protect the workers' health.

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Category: Vol. 83, September 2015

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Efficacy of Modified Lamaze Technique on Gestational Hypertension, RADWA M. YEHIA, SOHEIR M.A. EL-KOSERY, HALA M. EMARA and AMRO ABOUL ELA

Abstract
Background: Gestational Hypertension (GH) is the most frequent cause of hypertension during pregnancy. The rate ranges between 6% and 17% in healthy nulliparous women and between 2% and 4% in multiparous women.
Objectives: To estimate the effect of modified Lamaze technique on Gestational Hypertension (GH).
Methodology: Fourty GH women participated in this study, their ages ranged from 25 to 35 years and body mass index not more than 35kg/m2. They were randomly assigned into two groups equal in number as following: Group (A) (control group): (12 primigravidae and 8 multigravidae), they were subjected to regular antihypertensive treatment (meth-yledopa) and Group (B): (study group): (13 primigravidae and 7 multigravidae). They were watched videos for lamaze training classes but without their other parteners then subjected to "modified Lamaze technique" in the form of deep breathing exercises (3 sessions per week for 6 weeks) aiming for relax-ation plus the same regular antihypertensive treatment as in Group (A).
Results: Comparison between both Groups (A,B) showed statistically non significant difference at (SBP) as well as (DBP) and (PR) levels after 6 weeks of treatment (3 sessions/ week) which in favor Group (B).
Conclusion: Modified Lamaze technique in the form of slow deep breathing exercises, relaxation and massage has a good effect on SBP as well as DBP and PR levels as a method which can control GH.

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Category: Vol. 83, March 2015

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Studying the Effect of Cell Therapy by Endothelial Progenitor Cells With and Without Heme Oxygenase Inducers in Induced Pulmonary Hypertension Rat Model, MOHAMMED T. ABDELAZIZ, LAILA A. RASHED, DOAA M. GHARIB, RANIA EL-SAYED and RADWA M. GABER

Abstract
Purpose: We investigated whether or not intravenous injection of bone marrow-derived endothelial progenitor cells (EPCs), alone or combined with Heme-oxygenase (HO) inducer can restore pulmonary hemodynamics and increase microvascular perfusion in the rat monocrotaline (MCT) model of pulmonary artery hypertension (PAH) so improve right ventricle performance.
Material and Methods: Rats were divided into control, rats with PAH, PAH rats receiving EPCs, PAH rats receiving HO-1 inducer (cobalt protoporphyrin) and PAH rats receiving EPCs plus HO-1 inducer. After 1 month, right ventricular function, was assessed. Gene expression of pro ANP, SDF-1, Bax/Bcl-2, MMP-9 were studied.
Results: Heart functions showed improvement in all the treated groups compared to PAH group. Gene expression demonstrated that proANP, MMP-9 and Bax were downregu-lated while Bcl-2 and SDF-1 were upregulated.
Conclusion: The present study proved that, administration of BM-EPCs alone, HO-1 alone or EPCs plus HO-1 produce therapeutic effect in restoring pulmonary hemodynamics and so improving right ventricle performance in PAH. This effect may be through antiapoptotic action of EPCs and HO-1.

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Category: Vol. 77, September 2009

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Clinical Features and Surgical Outcome of Pediatric Rhegmatogenous Retinal Detachment,

ASSER A.E. ABD EL-MEGUID, AHMAD S. EL-ANTABLY, REHAB R. KASSEM and AHMAD M. KAMAL

Abstract
Purpose: To report the etiology, clinical characteristics and surgical outcome in a series of children presenting with rhegmatogenous retinal detachment (RRD) to a tertiary referral center in Egypt.
Methods: A retrospective analysis of, a non comparative interventional case series of patients aged between 2 and 18 years who were operated upon over the period interval between June 2005 to January 2008 for primary RRD and completed a follow-up period of 3 months.
Result: The study included 30 eyes of 27 patients 18 males and 9 females with an average age at presentation of 10.37±3.89 years with a range of 4 to 18 years. They were followed up for a time interval of 7 to 26 months with an average of 11.3±5.6 months. Retinal lesions as the primary cause of the retinal detachment has been diagnosed in 53%, postsurgical retinal detachment in 27% while post traumatic in 10%. Late presentation was a common feature and bilateral retinal detachment at presentation was present in 9 cases only 3 of them were operable. Standard three port vitrectomy with silicon oil endotamponade was performed in 29 eyes. There was a rate of retinal reattachment of 94% with an average procedures of 2.4. All successfully operated patients with a reattached retina regained hand movement or better visual acuity.
Conclusion: The retinal reattachment rate in pediatric RRD is encouraging, however it is adversely affected by the presence of PVR making the average no of surgeries per eye higher than in adult cases. Visual improvement is limited by the delayed presentation, but in the majority of cases visual acuity greater than or equal to counting fingers was achieved allowing for ambulatory vision postoperatively. Better health care system may allow for earlier detection of RD with the result of better visual outcome.

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