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   Table of Contents - Current issue
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January-April 2018
Volume 35 | Issue 1
Page Nos. 1-114

Online since Wednesday, February 28, 2018

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REVIEW ARTICLE  

Management of chest trauma Highly accessed article p. 1
Al Ashry T Ghoneim, Gamal E Saleh, Refaat S Salama, Mohammed K Zghloul
DOI:10.4103/bmfj.bmfj_82_16  
Thoracic trauma is a major medical problem with high mortality. It is a life-threatening situation and frequently involves other anatomical areas that require simultaneous management. The typical management is supposed to be multidisciplinary and preferably started at the accident location and maintained during patient transport, through the arrival to the emergency department, through transport to surgical theatre, in the operation room and then in the ICU. Early management is the key to decrease morbidity and mortality. The aim of this study was to throw some light on the types of chest trauma with special reference to its recent management.
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ORIGINAL ARTICLES Top

Contrast-enhanced spectral mammography versus magnetic resonance imaging in the assessment of breast masses Highly accessed article p. 5
Ahmed F Yousef, Hamada M Khater, Lara M Jameel
DOI:10.4103/bmfj.bmfj_177_17  
Background Contrast-enhanced spectral mammography (CESM) has high diagnostic accuracy. It involves the same principles as MRI in terms of the enhancement pattern because of the similar uptake of contrast medium or enhancement. Therefore, the indication should be the same. Aim The aim of the study was to compare CESM and MRI in the assessment of breast masses. Patients and methods This study included 20 patients, and was carried out from December 2016 to May 2017. The age of the patients ranged from 30 to 60 years. Our study was carried out using CESM and breast MRI. Results This study included 20 patients with breast lesions. The age of the patients ranged from 30 to 60 years. All multiple histologically proven lesions were detected by CESM (100%) and MRI (100%), with no significant difference in their site and number in both modalities. Conclusion CESM is useful for the differentiation of local recurrence of post-treatment scarring after breast-conserving therapy and evaluation of residual tumor after treatment, with unknown primary site of malignancy. Recommendations CESM is recommended as the imaging modality of choice in the detection and extension of breast cancer, particularly in problematic cases, or when conservative breast therapy is attempted, but the best correlations with lesion pathology were found in MRI more than CESM, as in MRI, there are the same overlapping patterns of benign and malignant enhancements.
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Comparison between the effects of intravitreal and posterior subtenon injection of triamcinolone acetonide for treatment of diabetic macular edema p. 13
Mohamed A Soliman, Ayman A Hamed, Tarek Nehad, Islam M. Abdelhakim Ali Metawee
DOI:10.4103/1110-208X.226424  
Aims Comparing the effect of intravitreal versus posterior subtenon injection of triamcinolone acetonide in treatment of diabetic macular edema. Settings and Design The study was conducted at Ophthalmology Department, Benha University Hospital in the period from march 2016 till september 2016. Material and methods This is prospective randomized longitudinal interventional comparative study including 30 eyes of patients with DME. Patients were divided into two groups. Group I included 15 eyes that received 4 mg of intravitreal triamcinolone acetonide injection. Group II comprised 15 eyes that received 40 mg of subtenon triamcinolone acetonide injection. Patients will be examined in the first post-injection day, then at 1st, 4th, 12th week interval after injection. At each visit full ophthalmological examination will be done . Central Macular Thickness (CMT) measurement with optical coherence tomography (at the 4th and 12th week). Statistical analysis Statistical Package of Social Sciences version 20 was used. P value of less than or equal (0.05) was considered statistically significant. Results There was no significant difference at 1 and 3 months (P > 0.05) as regards their post-treatment outcome for visual acuity and macular thickness. There was statistically significant difference in IOP change after 1 and 3 months after injection between the two groups, the change of IOP in the intravitreal injection group was greater than that of the posterior subtenon injection group. Conclusions Subtenon triamcinolone acetonide achieves results comparable to intravitreal injection as regards the reduction in CMT and the improvement in VA . However, Subtenon triamcinolone acetonide is safer.
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Nebulized fentanyl: is it effective in pediatric postoperative analgesia? p. 20
Hani I Taman, Hisham M Sheere, Hosam I Elsaid Saber
DOI:10.4103/1110-208X.226408  
Background Postoperative pain management in pediatric patients is challenging. Intravenous (IV) fentanyl appears to be an appropriate solution; however, nebulized fentanyl could be a new, promising, noninvasive method for systemic fentanyl administration with less side effects in pediatric patients. Patients and methods A total of 40 pediatric patients who underwent lower abdominal surgery under general anesthesia were classified into two groups − group IV received 1 µg/kg IV fentanyl and group N received 2 µg/kg nebulized fentanyl. Observations were made with regard to pain relief by the FLACC score and sedation by the Ramsay score. Hemodynamics and other side-effects such as vomiting, bradychardia, hypotension, and pruritus were also recorded. Results Although FLACC changes were observed in lesser than 10 min after initiation of drug administration in group IV when compared with group N, incidence of side-effects in group IV was higher when compared with group N. The rapidity of onset of fentanyl’s analgesic effect was faster in group IV followed by group N. No differences were found between the two groups with regard to the Ramsay score. Conclusion We found that 2 µg/kg nebulized fentanyl has equal analgesic effects with less side-effects compared with 1 µg/kg IV fentanyl but with slower onset of action.
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Sleep patterns in Egyptian children with nocturnal enuresis p. 24
Adel S El Said, Elham Abdel Ghafar Mohammady, Mohamed M El Hamady, Ashraf M Abdel Aal, Hanaa R Omar
DOI:10.4103/bmfj.bmfj_2_17  
Background Enuresis is widely regarded as parasomnia because it occurs only during the nonrapid eye movement sleep cycle. Polysomnography can be used to monitor appropriate physiological variables associated with children’s sleep-related problems. Aim The aim of this study was to determine sleep patterns in Egyptian children who were suffering from primary nocturnal enuresis. Patients and methods Twenty children with primary nocturnal enuresis and ten healthy children were included in our study. Patients were recruited from outpatient clinics of the Pediatric Department of Benha University Hospital, during the period between March 2015 and March 2016. The following investigations were carried out on all patients: urine analysis and culture, random blood sugar, Ca, Na+, creatinine, pelvic-abdominal ultrasound, lumbosacral radiograph, uroflowmetry, voiding cystometry, and polysomnography. Results Uroflowmetric tests were normal in all cases excluding local urological causes of enuresis. Cystometric measurement of bladder capacity revealed that three out of 20 (15%) patients had reduced bladder capacity, and 17 (85%) patients had normal bladder capacity. A statistically significant difference (P=0.001) was observed in the number of awakenings, where the patients showed a significantly higher number of awakenings. A statistically significant difference (P=0.002) was observed in delta-wave sleep, where the patients showed significantly less delta sleep activity and lower sleep efficiency compared with controls. Rapid eye movement sleep percentage was low in enuretic children, although the difference was not statistically significant (P=0.142). Conclusion Monosymptomatic nocturnal enuresis can be explained by a multifactorial etiology. Sleep disturbances with consequent urodynamic findings seem to be the cornerstone of this problem.
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Role of vascular adhesion protein-1 in patients with alopecia areata p. 28
Abd El-Aziz I El-Taweel, Amany I Mustafa, Ola S El-Shimi, Fatma Y Abd El-Aziz Anwer
DOI:10.4103/1110-208X.226420  
Objective The aim of this study was to detect the role of vascular adhesion protein-1 (VAP-1) in patients with alopecia areata (AA). Background AA affects about 2–3% of new patients attending dermatology clinics. The etiology of AA is still largely unknown. Clinically, AA presents as an area of well-circumscribed patch of sudden hair loss. The severity of disease is graded using Severity of Alopecia Tool score. Treatment depends on disease involvement. In 1996, Arvilommi and colleagues reported that about 75–100% of dermal vessels in skin lesions demonstrated positive VAP-1 expression. Patients and methods This study included 50 patients with AA (group A), and 30 apparently healthy individuals of matched age and sex were chosen as a control group (group B). All patients were selected from the Outpatient Clinic of Dermatology and Andrology Department of Benha University Hospitals. Results The mean±SD age of the patients was 27.3±14.05, whereas the mean±SD age of the control group was 32.8±11.27 years. Serum level of VAP-1 was higher in AA patients with progressive course compared with patients with constant course. Serum VAP-1 level was variable according to the pattern of hair loss in the patient group. The VAP-1 level according to the presence or absence of exclamation mark was not statistically significant. There was a highly significant variation in serum VAP-1 level according to psychological stress. VAP-1 level was not statistically significant according to the presence or absence of nail pitting. There was a highly statistically significant correlation between VAP-1 level and the Severity of Alopecia Tool score. There was a statistically significant correlation between VAP-1 level and the number of lesions. There was no statistically significant correlation between VAP-1 level and the size of the lesion. There was no statistically significant correlation between VAP-1 level and the age of the patients and the duration of the disease. Conclusion Serum VAP-1 level is an important marker for the early diagnosis (prediction) of suspicious cases of AA, prognosis of the disease, the course of the disease, and whether the case will progress to alopecia totalis or universalis or it will remain stationary. It can be a target for new therapeutic lines for the disease.
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Serum level of Golgi protein-73 as a diagnostic marker for hepatocellular carcinoma p. 36
Fawzy M Khalil, Sherif I Negm, Mohamed A El Assal, Anas A Yousif, Raafat S Salem
DOI:10.4103/bmfj.bmfj_173_17  
Background Golgi protein-73 (GP73) as a potential serum marker for hepatocellular carcinoma (HCC) has not been validated in studies. The aim of this study was to determine the value of serum Golgi protein-73 (SGP73) in the diagnosis of HCC. Patients and methods SGP73 and α-fetoprotein (AFP) were compared in a total of 80 human participants in this study; 35 patients with HCC, 35 patients with cirrhosis, and 10 healthy controls were included. Results Using 10.3 relative units as a cut-off value, the sensitivity and specificity of SGP73 for HCC were 97.1 and 85.7% compared with 57 and 55.6% for AFP (P<0.001) using 100 ng/ml as a cut-off value. The GP73 level was significantly increased in patients with HCC compared with the healthy controls (35.55 vs. 4.13%, P<0.001). Conclusion GP73 is an accurate serum marker for the detection of HCC with higher sensitivity and specificity than AFP.
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Gene expression of excision repair cross-complementation group 1 enzyme as a novel predictive marker in patients receiving platinum-based chemotherapy in advanced bladder cancer p. 42
Wesal M Eldehna, Mona M Fouda, Soumaya M Eteba, Mona Abdelrahim, Mohamed S Elashry
DOI:10.4103/bmfj.bmfj_184_17  
Background Excision repair cross-complementation group 1 enzyme (ERCC1) expression is most probably associated with cisplatin resistance in different tumors, including bladder tumors. Predictive role of ERCC1 expression in the neoadjuvant setting in bladder cancer had been studied as this genetic testing could personalize the chemotherapy by selecting the patients who would benefit from platinum-based chemotherapy. Participants and methods This is a descriptive study that was conducted on 80 patients with muscle invasive bladder cancer who received platinum-based chemotherapy. Clinical and histopathologic parameters along with immunohistochemical ERCC1 staining were examined and correlated with response rates and survival. Results The study showed a significant relationship between treatment response and ERCC1 expression of tumor tissue samples (P=0.013), indicating an association between negative immunoexpression and more favorable outcome. analysis of variance test revealed no significant difference neither between mean progression-free survival in different immunoexpression levels (P=0.794) nor mean overall survival in different immunoexpression levels (P=0.499). Conclusion Our study showed that there was a significant relationship between treatment response and ERCC1 expression of tumor tissue samples, although it did not show a significant difference between ERCC1 expression and mean overall survival or progression-free survival in different immunoexpression levels in patients with bladder cancer who received neoadjuvant platinum-based chemotherapy. ERCC1 may represent a potential predictive, but not prognostic, marker for platinum-based treatment in bladder cancer.
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Distribution of the chemokine receptor-5 gene in Egyptian breast cancer patients p. 49
Amal I.A Youssef, Amal A Hassan, Shuzan A Mohammed, Hebat Allah E.M Ahmed
DOI:10.4103/bmfj.bmfj_191_17  
Background Chemokine receptor type-5 (CCR5)-Δ32, a 32-base pair deletion of the C–C CCR5 gene, is associated with slowed human immunodeficiency virus disease progression in heterozygotes and protection against infection in homozygotes between carriers and noncarriers of each genetic variant. Aim The present study aimed to investigate the frequency of the CCR5-Δ32 mutation in Egyptian breast cancer (BC) patients. Materials and methods We determined the genotypic frequency of wild and mutant variants of CCR5 in 40 BC patients and 20 healthy individuals using restriction fragment length polymorphism and reverse hybridization. Results We found the absence of heterozygous and homozygous mutant gene variants in both BC patients and controls. Conclusion No significant difference in the frequency of CCR5 genotypes and alleles between patients and controls and no association between that gene and BC.
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Evaluation of serum interleukin-33 in nonsegmental vitiligo p. 54
Adel A Ebrahim, Ahmed M Hamed, Enas S Ahmed, Alaa S Khudhair
DOI:10.4103/bmfj.bmfj_59_17  
Background Vitiligo is a common, acquired pigmentary disorder of unknown etiology, affecting up to 0.1–2% of the population worldwide. It is characterized by white macules and patches. Loss of melanocytes in vitiligo appears to occur through a combination of several mechanisms that act in concert. Interleukin (IL)-33 is a recently discovered cytokine and one of the newest members that belongs to the IL-1 superfamily of inflammatory cytokines, and is mainly expressed by different types of structural cells. IL-33 is considered an alarmin because of its release after necrosis or tissue damage. Objective The aims of the present study were to evaluate serum levels of IL-33 in nonsegmental vitiligo patients and to examine its relationship with disease severity and vitiligo type. Patients and methods This was a case–control study that included 40 vitiligo patients (group A) and 40 apparently healthy individuals as controls (group B), who were matched for age and sex, at the Dermatology and Andrology Clinic, Benha University Hospital. All participants were subjected to the following: detailed history taking, assessment of the rule of nine score and the Vitiligo Disease Activity score measuring the activity of vitiligo, tests to determine the distribution and morphology of the lesions, complete dermatological examination, and laboratory investigations including assessment of IL-33 using commercial enzyme-linked immunosorbent assay kits. Results The majority of our sample included females. Serum IL-33 levels were significantly higher in patients affected by vitiligo as compared with controls. There was no statistically significant difference in serum levels of IL-33 among different types of vitiligo. There was no significant correlation between serum IL-33 levels and severity of vitiligo. A statistically significant negative correlation was found between serum levels of IL-33 and duration of vitiligo, and a statistically significant difference was found in serum levels of IL-33 between stable (negative) type and progressive vitiligo. Conclusion Serum IL-33 levels in patients with vitiligo were significantly increased compared with controls. There was a positive correlation between serum IL-33 levels and disease activity, but there was no correlation with the clinical type of vitiligo. This explains a possible systemic role of IL-33 in the pathogenesis of vitiligo, and IL-33 serves as an alarmin in inducing melanocyte death in vitiligo skin. Inhibiting IL-33 activity might be a novel therapeutic strategy in the treatment of autoimmune inflammatory diseases such as vitiligo.
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Clinical outcome of patients with diabetes mellitus and acute myocardial infarction treated with primary angioplasty p. 60
Saad M Ammar, Reda B Bayoumi, Mohamed Abd El-Kader Elian, Kerolus K Gad
DOI:10.4103/1110-208X.226419  
Purpose The purpose of the present study was to examine the influence of diabetes mellitus (DM) on the clinical outcome in patients with acute myocardial infarction (MI) treated with primary coronary stenting within 24 h of the onset of symptoms. Methods We enrolled 100 patients (50 diabetics and 50 nondiabetics) admitted to the coronary care units of Benha University hospitals and National Heart Institute from January 2015 to December 2015 with acute MI treated with primary coronary stenting within 24 h of the onset of symptoms. Clinical outcome was observed in every patient for major adverse cardiac events and hospital stay. Echocardiography was also performed before the patient’s discharge from the hospital. Patients were followed up at 3 months for the occurrence of major adverse cardiac events. Results The diabetic patients showed higher incidence of hypertension (P=0.003), renal impairment (P=0.045) and dyslipidemia (P=0.05) and also higher incidence of heart failure (P=0.013) during admission and higher mean serum creatinine kinase MB mass assay levels (P=0.005). There were no statistically significant differences in other variables. Procedural success was similar in the two groups. With regard to in-hospital clinical course, diabetic patients were more likely to have early post-MI heart failure (P=0.013), target vessel revascularization (P=0.037) and longer hospital stay (P=0.019). At 3 months, diabetic patients were significantly more likely to experience revascularization (P=0.045) and were more likely to be rehospitalized for acute coronary syndrome and decompensated heart failure (P=0.037); however, there was no significant difference in mortality (P=0.307). Conclusion Compared with nondiabetics, diabetic patients are more likely to have early post-MI heart failure, target vessel revascularization, and longer hospital stay. Moreover, diabetic patients are significantly more likely to experience revascularization and are more likely to be rehospitalized for acute coronary syndrome or decompensated heart failure.
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The potential effect of vitamin D on rats with fatty liver induced by a choline-deficient diet p. 67
Alaa El Den A El Talees, Noha I Hussien, Mona M Allam, Dania A Mohammed
DOI:10.4103/bmfj.bmfj_3_17  
Background Nonalcoholic fatty liver disease (NAFLD) is present worldwide and is considered the most common cause for abnormal liver function tests and chronic liver disease in both developed and developing countries. Aim This study aimed to investigate the effect of pretreatment with vitamin D on NAFLD and the role of transforming growth factor-β1 (TGF-β1) in vitamin D-mediated hepatoprotective effect. Materials and methods NAFLD was induced in albino rats by administration of a choline-deficient diet. Serum activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), serum levels of albumin, bilirubin, and 25 hydroxyvitamin D [25(OH)D], body weight, liver weight, and liver index were measured in different experimental groups to assess liver affection. In addition, TGFβ1 was immunohistochemically determined. Results NAFLD caused significant increases (P<0.005) in serum levels of AST and ALT, liver weight, and liver index, with a significant decrease (P<0.005) in serum levels of 25(OH)D. Administration of vitamin D (1, 5, and 10 μg/kg) caused a significant reduction (P<0.005) in serum levels of AST and ALT, liver weight, and liver index with a significant increase (P<0.005) in serum levels of 25(OH)D. TGFβ1 expression showed improvement in a dose-dependent manner. Conclusion Vitamin D has a hepatoprotective effect in NAFLD induced by a choline-deficient diet, and TGFβ1 contributes to this protection.
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The possible therapeutic effect of mesenchymal stem cells on experimentally induced brain hypoxic-ischemic encephalopathy in neonatal rats p. 74
Nesrine Ebrahim, Mohamed Y Salem, Dina Sabry, Ashraf Shamaa
DOI:10.4103/bmfj.bmfj_6_17  
Background Hypoxic-ischemic encephalopathy (HIE) in neonates is a serious disorder, and till now, no curable treatment is available. Aim The present study was conducted to evaluate the therapeutic effect of bone marrow-derived mesenchymal stem cells (BM-MSCs) in attenuating the experimentally induced brain HIE in neonatal rats. Materials and methods Totally, 45 healthy neonatal rats (7 days old) were divided into three groups: group I was the control group. In group II (encephalopathy group), rats were exposed to surgical induction of hypoxic-ischemic (HI) brain injury and subdivided into two subgroups: group IIa rats were killed 3 days later to evaluate the histopathological changes and group IIb rats were killed after 28 days for recovery. In group III (encephalopathy+stem cell group), rats were exposed to surgical induction of HI brain injury and then underwent infusion with BMSCs through tail vein. Two behavior tests (the righting reflex and the geotaxis reflex) were performed 3, 7, 14, and 28 days after induction of HI brain injury. Cerebral cortex tissue was processed for histological and immunohistochemical (nestin, glial fibrillar acid protein, and neurofilaments) studies and for real-time PCR quantitative expression of vascular endothelial growth factor-receptor 2 and endothelial nitric oxide synthase genes. Results Group IIb (recovery) showed nearly the same picture as group IIa. Group III showed improvement in all parameters (neural function tests, histopathological studies, and genes expression) compared with group II. Conclusion BM-MSCs attenuated the HIE in rats, but compared with the normal control, this effect was still away.
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Comparison between the effect of praziquantel and essential oil of Lamiaceace family on hymenolepis nana egg viability in experimentally infected mice p. 85
Samia Mostafa Rashed, Azza Mohammed Salah Eldin Elhamshary, Rabab Fawzy Mohamed seleem, Ahlam Farag Elsadek Moharram, Fayza Ali
DOI:10.4103/bmfj.bmfj_185_17  
Background Hymenolepis nana (H. nana) is the most common tapeworm infection worldwide. It is more prevalent in warm climates where sanitation is poor, particularly among children. Objectives In this work, we investigated the effect of praziquantel (PZQ), given at a dose of 25 mg/kg body weight (single dose), and essential oil of Lamiaceace family given at a dose of 400 μl/kg body weight (for 5 days and a second course given after 1 week) on the egg viability of experimental H. nana-infected mice (80 laboratorybred male Swiss albino mice). Methods Two groups of mice were used in the study: one group received PZQ and the other received essential oil of Lamiaceace family. The mice that received treatments were killed after the development of the adult stage, confirmed by egg detection in stool. Results PZQ resulted in significant reduction in the number of viable eggs from the first day of treatment, whereas essential oil of Lamiaceace family resulted in significant reduction in the number of viable eggs from the third day of treatment and was remarkable after the second course of treatment. Conclusions It was concluded that essential oils of Lamiaceace family have significant anticestodal properties that enable them to be a very effective alternative to PZQ against H. nana.
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Erythropoietin versus allopurinol on ischemia/reperfusion-induced acute kidney injury in rats p. 89
Rehab H Ashour, Mohamed A Abd-Allah, Fatma E Mostafa, Basma H Osman, Yomna T Kahter, Azza A El-Biomy, Abdel-Hady AEl-Gilany, Mohamed-Ahdy A Saad, Mohamed A Sobh
DOI:10.4103/bmfj.bmfj_165_17  
Objective Renal ischemia/reperfusion (I/R) injury involves multiple mechanisms including oxidative stress. Erythropoietin (EPO) and allopurinol have an antioxidant effect and are protective against I/R-induced kidney injury. This study compares the ability of EPO to compete oxidative stress and kidney injury induced by I/R with that of allopurinol. Materials and methods A total of 72 male Sprague–Dawley rats were randomized into the following groups: sham group, I/R group, EPO-treated I/R group, and allopurinol-treated I/R group (n=18 in each group). I/R was persuaded by 45 min clamping of the left renal pedicle followed by right nephrectomy. The therapeutic intervention started before the operative procedure. In each group, animals were killed at 1, 3, and 7 days after the operation. Serum creatinine, serum aspartate aminotransferase, tissue malondialdehyde, and pathological score for injury and regeneration were determined. Results We found that both EPO and allopurinol were able to attenuate the elevation of serum creatinine. EPO was more effective than allopurinol in reducing aspartate aminotransferase and malondialdehyde levels. Both drugs were equally effective regarding their effect on the active injury and regeneration scores. Conclusion These results indicate that although EPO or allopurinol can effectively reduce kidney damage, EPO is a better choice as an antioxidant and for reducing the overall damage of I/R-induced kidney injury.
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Assisted liposuction with abdominoplasty versatility and results p. 97
Ahmed Y Farid, Gamal I Elhabbaa, Ayman M Abdelmofeed, Ahmed M Kamel Tohamy
DOI:10.4103/bmfj.bmfj_28_17  
Background Abdominoplasty is an important and common procedure in plastic surgery; the final results may not always be esthetically pleasing. To overcome these problems, abdominoplasty has been paired with liposuction, which amazingly led to a lower complication rate. The procedure has been updated to prove, in its current form, to be trouble-free. Aim The aim of this study was to evaluate the safety and surgical outcome of assisted abdominoplasty with liposuction for abdominal contouring. Patients and methods A total of 30 female patients underwent assisted liposuction with abdominoplasty in the Banha University Hospital. All patients indicated for traditional abdominoplasty were selected from the plastic surgery outpatient clinic for this procedure; all had generalized abdominal lipodystrophy, skin laxity, and musculoaponeurotic flaccidity. Results In 11 (36.7%) cases, we observed the presence of seroma, and it was solved with aspiration with a syringe. There were five (6.7%) cases of umbilical complications and two cases of wound dehiscence, and secondary suturing was done. The superior and inferior borders were effectively accommodated, because of the uniform thickness of the fatty tissue as a result of liposuction. Consequently, we observed that there was a low incidence of ‘dog-ear’ deformity, which was managed by liposuction and the final scar was shorter. We also observed an improvement in the body shape and in the body contour with marked improvement in subcostal, umbilical, and suprapubic girths, resulting in a more youthful abdomen. Conclusion Combining abdominoplasty and abdominal liposuction is a safe procedure that achieves gratifying results. It promotes a more youthful abdominal silhouette, better matching between the abdominal flap and the pubis, and a shorter scar. We believe that it is a safer way to treat the abdominal region than classical abdominoplasty and has a fewer complications.
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Sublingual misoprostol before insertion of an intrauterine device p. 104
Mohamed A Mohammed, Khaled S Seleem, Ahmed M Sadek, Ahmed I Zaky Nada
DOI:10.4103/bmfj.bmfj_72_17  
Objective The aim of the work was to investigate whether sublingual misoprostol before intrauterine contraceptive device (IUCD) insertion facilitates the insertion and reduces the number of failed insertions, insertion-related complications, and pain during insertion. Background The intrauterine device (IUD) is a highly effective and safe contraceptive method. However, insertion through a narrow cervix may be technically difficult and painful. Misoprostol has been shown to be effective for cervical priming in nonpregnant women. Patients and methods Two hundred and sixty women were randomly allocated to receive 400 mg misoprostol sublingually or placebo 2 h before IUD insertion. Primary outcome measure was the proportion of failed insertions. Pain during insertion and difficulty in IUCD insertion were evaluated. Complications and side effects were recorded together with bleeding and expulsion of the loop after 6 weeks. Results Misoprostol significantly reduced the number of failed insertions from six failed insertion in the placebo group (4.6%) to only one (0.8%) case in the misoprostol group (P=0.023). Pain during insertion was significantly lower (P<0.001). Difficulty in insertion was significantly lower (P<0.001). As regards side effects, no significant differences were found between the two groups except for abdominal cramps and nausea. Cramps occurred in 22.3% of participants using misoprostol and in 5.4% of participants using placebo (P<0.001). Nausea occurred in 6.9% of participants using misoprostol and in 1.5% of participants using placebo (P=0.046). There were no significant differences as regards the rate of expulsion and the amount of vaginal bleeding. Conclusion 400 micrograms of sublingual misoprostol 2 h before IUCD insertion reduces the number of failed insertions and pain during insertion. A facilitating effect of misoprostol on IUD insertion was also found.
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Influence of the number of previous cesarean sections on lower uterine segment state p. 111
Mohamed K Alosh, Mohamed A Farag, Samah B Omar
DOI:10.4103/bmfj.bmfj_147_17  
Background The present study aims to determine the influence of the number of previous cesarean section (CS) on the lower uterine segment (LUS). Patients and methods The study included 200 pregnant women divided equally into four groups: group I included 50 women with one previous CS, group II included 50 women with two previous CS, group III included 50 women with three previous CS, and group IV included 50 women with no previous uterine operation as a control group. The women studied were subjected to the following: a careful assessment of history, a thorough clinical and obstetrical examination, and ultrasonographic assessment of the LUS below, at, and above the CS scar to evaluate thickness. Results The results showed that women with previous CSs have significantly thinner LUS compared with the group of pregnant women without scars. With increasing numbers of previous CSs, the LUS thickness decreases, but the difference is not statistically significant. Conclusion Women with more CR had thinner LUS scars and more scar defects.
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