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   Table of Contents - Current issue
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July-December 2017
Volume 34 | Issue 2
Page Nos. 59-151

Online since Monday, November 20, 2017

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ORIGINAL ARTICLES  

Serum interleukin-6 concentration and association with response to hepatitis C virus therapy for chronic hepatitis C patients Highly accessed article p. 59
Fatma M Abd El Salam, Naglaa E El Toukhy, Amal A Mohamed, Hend A Nekola
DOI:10.4103/bmfj.bmfj_1_17  
Background Egypt has the highest prevalence of hepatitis C virus (HCV) in the world. Interleukin 6 (IL-6) is a pleiotropic cytokine that is elevated in chronic hepatitis C patients. IL-6 was suggested by several studies to play a major role in response to HCV therapy. Aim The aim of this work was to assess the possible role of IL-6 in the response status of patients with HCV during treatment. Moreover, we attempted to use IL-6 as a predictive factor for response in patients with chronic HCV. Patients and methods Serum concentrations of IL-6 were measured before and after treatment using a commercially available Quantikine enzyme-linked immunosorbent assay in 57 patients with chronic hepatitis C treated with sofosbuvir and simeprevir for 3 months. Results The mean values of IL-6 level in responders and nonresponders were 272.96 and 230.5 pg/ml, respectively. IL-6 levels decreased significantly after treatment in the sustained virological response group. The best cutoff point for IL-6 was 233 pg/ml with a sensitivity of 70%, a specificity of 75%, a positive predictive value of 97.2%, and a negative predictive value of 16.7%. Conclusion Virological response during HCV therapy was associated with a decrease in IL-6 level.
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The role of anti-mullerian hormone as an indicator of reproductive health in women with obesity and concomitant polycystic ovary syndrome p. 66
Moharram A Abdel Hay, Seham A El-Berri, Tarek E Sleem, Mohammed I Mohammed, Salwa T Nour El-Deen
DOI:10.4103/bmfj.bmfj_10_17  
Background Obesity has harmful effects on the female reproductive system. Anti-Mullerian hormone (AMH) is considered to reflect the extent of follicular growth and the reservoir of ovarian function. The relation between AMH and obesity was not fully investigated in polycystic ovary syndrome (PCOS). Aim The aim of this study was to evaluate the relation between AMH and antral follicular count (AFC) and BMI in patients with PCOS, and the relation between AMH, AFC, and site. Patients and methods The study included 200 patients with the diagnosis of PCOS. The patients included in the study were divided into four equal groups according to BMI: group A included individuals with average body weight; group B included individuals with BMI between 25 and 30 (overweight); group C included individuals with BMI between 30 and 35 (mild obesity); and group D included individuals with BMI greater than 35 (morbid obesity). The female participants were subjected to full history taking, clinical examination, evaluation of serum levels of AMH, and transvaginal ultrasound. Results There was a significant decrease in parity with increased BMI. AMH ranged from 0.30 to 17.22 ng/dl, and there was a significant increase in AMH with increased BMI. There was a positive correlation between BMI, waist–hip ratio, and ovarian volume and AMH, whereas there was a significant inverse correlation between parity and AMH. Moreover, there was a significant positive correlation between AFC and age, BMI, waist–hip ratio, mean ovarian volume, and AMH, whereas there was a significant negative correlation between AFC and parity. There was a significant increase in AMH in female patients with acne when compared with female patients without acne. In addition, female patients with acne showed a significant increase in AFC when compared with cases without acne. Conclusion The level of AMH was positively correlated with both BMI and AFC. These results reflect that body weight can play a role in the pathogenesis of polycystic ovary.
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The role of multislice computed tomography in the differential diagnosis of retroperitoneal masses p. 73
Medhat M Reffat, Islam M Elshazly, Ahmed F Mohammed
DOI:10.4103/bmfj.bmfj_100_17  
Background The great majority of retroperitoneal masses are found incidentally as a result of the use of computed tomography (CT), ultrasonography, and MRI. Therefore, the proper characterization of the masses is essential so that appropriate management is instituted. With modern CT imaging equipment, the diagnosis of most retroperitoneal masses is usually straightforward and accurate. Aim The aim of this study was to know the role of multidetector CT in the diagnosis and detection of retroperitoneal masses. Patients and methods The study was performed at National Cancer Institute, and approved by its ethical committee, and informed consent was given by all patients. The study was conducted on 32 patients (17 male and 15 female) presented to the National Cancer Institute with abdominal or pelvic swelling (on clinical examination or detected by previous imaging study) suspected to be of retroperitoneal origin to perform CT of the abdomen and pelvis for initial assessment or follow-up. Results At present, CT is the most reliable, effective, and efficient instrument in this context, offering sensitivity and specificity values in excess of 87%, with a diagnostic reliability of over 90% in application to retroperitoneal masses of a cystic or complex nature, with nonspecific or specific inflammatory characteristics, or of a primary or secondary neoplastic nature. Conclusion The differential diagnosis of retroperitoneal masses may be based on the predominant cross-sectional CT imaging appearance as either cystic or solid and neoplastic and non-neoplastic. Characteristic imaging findings, such as the composition (fat, calcification, and necrosis), enhancement pattern, vascularity, location, and relationship to adjacent structures, may be combined with clinical information and assisted by diagnostic scheme to help narrow the differential diagnosis.
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Sentinel lymph node assessment by radioactive isotope in early breast cancer patients Highly accessed article p. 77
Sherif M Elhadidy, Inas I Abdulhalim, Hassan M Abdulah, Magda E Allam, Dalia H Morad
DOI:10.4103/bmfj.bmfj_106_17  
Background and aim The objective of this study was to report the role of sentinel lymph node assessment by radioactive isotope in early breast cancer (BC) patients. Patients and methods This is a prospective study conducted at National Cancer Institute (NCI), Cairo, Egypt, between January 2015 and December 2016. Sentinel lymph nodes were assessed after injection of 99mTc sodium pertechnetate in 60 early BC patients without clinically palpable lymph node. The patients underwent sentinel lymph node biopsy (SLNB) with frozen section examination. Data collected included the characteristics of patients, sentinel nodes (SNs), and SLNB results. Results Sixty patients had 62 tumors. SN was identified in 58 patients having 60 tumors (96.7%). No SN was found intraoperatively in two patients. Frozen section results showed that two patients were SN negative, whereas 58 patients were SN-positive and subsequently underwent immediate axillary lymph node dissection. Conclusion The obtainable results from our local study in SLNB in BC concur with those seen in published similar literature.
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Ovarian reserve testing and uterine blood flow assessment using two-dimensional and three-dimensional Doppler in patients with unexplained recurrent miscarriage p. 81
Ahmed M Elewa, Ahmed E.A Mansour, Mahmoud A Gehad, Hosam-Eldin A Afify
DOI:10.4103/bmfj.bmfj_107_17  
Background and aim The aim of this study was to evaluate ovarian reserve, uterine artery blood flow, and endometrial and subendometrial blood flow in women with unexplained recurrent miscarriage compared with normal fertile women. Patients and methods The study design was a case–control one. The study was conducted in the Department of Obstetrics and Gynaecology, Benha University, Benha, Egypt. Women were divided into two groups: those with a history of unexplained recurrent miscarriage (the study group, n=50), and those who had no history of miscarriage and had at least one child born at term (the control group, n=50). At days 3–4 of the cycle, ovarian reserve testing was performed for all women by measuring follicle-stimulating hormone, luteinizing hormone and oestradiol levels. Thereafter, two-dimensional (2D) and 3D transvaginal ultrasonography and power Doppler were performed to detect antral follicle count, ovarian volume, and ovarian stromal Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index (VFI). Between days 18 and 23 of the cycle, transvaginal ultrasonography was performed for all women using 2D, pulsed Doppler and 3D-power Doppler mode to detect endometrial thickness, Uterine Artery Pulsatility Index, endometrial volume and endometrial and subendometrial blood flow presented by the indices VI, FI and VFI. The indices between the two groups were compared. Results Uterine Artery Pulsatility Index was significantly higher in the study group (P=0.001), whereas endometrial VI (P≤0.001), FI (P=0.01) and VFI (P≤0.001) and subendometrial VI, FI and VFI (P≤0.001) were significantly lower in the study group. The ovarian reserve tests, endometrial thickness and endometrial volume, however, were not significantly different between the two groups. Conclusion The presence of good uterine and endometrial blood flow is an important prerequisite for successful implantation and continuation of pregnancy as shown by higher uterine artery blood flow resistance and lower endometrial and subendometrial blood flow in recurrent unexplained miscarriage cases. We could not find any cutoff values that could predict the occurrence of miscarriage, and hence larger prospective studies are needed to confirm such results and reaching values that can accurately predict the occurrence of miscarriage.
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Evaluation of nanogold-beads-based enzyme-linked immunosorbent assay for detection of cryptosporidium antigen in stool samples of diarrheic patients p. 88
Mona E Naser, Mohamed S Younis, Ibrahim R Bayoumi, Maysa A Eraky, Nagwa S Aly, Rabab E.O El Attar
DOI:10.4103/bmfj.bmfj_109_17  
Background Biomedical nanotechnology is providing opportunities for rapid and simple diagnosis of many infectious diseases. Aim The aim of this study was to evaluate nanogold-beads-based enzyme-linked immunosorbent assay (ELISA) for the detection of Cryptosporidium antigen in stool samples of diarrheic patients. Patients and methods Two hundred stool samples were collected from diarrheic patients attending Abo El-Resh Hospital. Parasitological examination of the collected samples was performed by direct smear, concentration method, and staining technique. Immunological examination was performed by sandwich ELISA and nanosandwich ELISA. Results There were five (2.5%) stool samples that were positive for Cryptosporidium spp. detected by merthiolate–iodine–formaldehyde concentration technique. There were 47 (23.5%) stool samples positive for Cryptosporidium spp. detected by modified Ziehl–Neelsen staining. There were 78 (39%) stool samples positive for Cryptosporidium spp. detected by sandwich ELISA and 89 (44%) stool samples positive for Cryptosporidium spp. detected by nanosandwich ELISA. The sensitivity of sandwich ELISA and nano-ELISA for the detection of Cryptosporidium antigen in human stool samples was 68 and 85%, respectively. The specificity of sandwich ELISA was 77.3%, but the specificity of nano-ELISA was 73.4%. Conclusion The nanosandwich ELISA improves the sensitivity and specificity of sandwich ELISA.
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Flank suspended supine position versus standard supine and prone positions in percutaneous nephrolithotomy p. 93
Salah A El Hamshary, Ehab M El Barky, Mostafa M Mostafa, Ashraf M Abd El Al, Mohammed A Hassanine
DOI:10.4103/bmfj.bmfj_12_17  
Background and aim The aim of this article was to compare the outcome of percutaneous nephrolithotomy (PCNL) in flank suspended supine position (FSSP), standard prone position, and standard supine position. Patients and methods This study was conducted on 60 patients with renal stone disease from March 2013 to October 2016 in the Department of Urology, Benha University Hospital, and they were divided randomly into three groups: group A had 20 patients who underwent PCNL in FSSP, group B had 20 patients who underwent PCNL in standard supine position, and group C had 20 patients who underwent PCNL in prone position. Results A total of 60 patients were divided into three groups − A, B, and C − with 20 patients in each group. Mean age in group A was 30.05±14.93 years, in group B was 49.35±14.31 years, whereas in group C was 35.15±15.18 years. The mean BMI by kg/m2 in group A was 25.81±6.16, in group B was 27.68±6.74, and in group C was 30.94±6.65. There were 38 males and 22 females who were divided into three groups: group A had 11 (55%) males and nine (45%) females, group B, had 10 (60%) males and 10 (40%) females, whereas group C had 13 (75%) males and seven (25%) females. There were 33 right renal stones and 27 left renal stones, which were divided into three groups. Group A had 11 (65%) right renal stone cases and nine (35%) left renal stones, group B had 13 (70%) right renal stones and seven (30%) left renal stones, whereas group C had nine (45%) right renal stones and 11 (55%) left renal stones. Conclusion In conclusion, PCNL in the FSSP position is safe, effective, and suitable for patients, especially morbidly obese patients; it has several advantages like less operative time because of less patient handling and needing drape only once.
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Prevalence of sensitization to mould and yeast allergens in Egyptian patients with respiratory allergy p. 98
Nabil E Khatab, Atef A Ibrahim, Maged M Refaat, Mohamed N Farres, Ali E Ali, Medhat M Elamawy
DOI:10.4103/bmfj.bmfj_149_17  
Background Burden of fungal allergic diseases to humans is broad and still needs much clarification on the prevalence of its related disease. Asthma-related deaths, hospital admissions, respiratory symptoms, and pulmonary functions can be adversely affected by high fungal spore concentrations in outdoor air. Aim The aim of this study was to evaluate the prevalence of sensitization to various species of mould and yeast allergens among other common aeroallergens in Egyptian patients with respiratory allergy diseases. Patients and methods Totally, 200 patients with allergic bronchial asthma and/or allergic rhinitis were selected from those followed up at the Allergy and Clinical Immunology Clinic at Ain Shams University Hospitals. For each patient, detailed allergic history and clinical examination were carried out. Asthma control level and severity of allergic rhinitis were classified according to 2015 Global Initiative of Asthma report and Allergic Rhinitis and its Impact on Asthma 2008, respectively. Complete blood count and Spirometry were done. In addition, skin prick test to 10 mould allergens, besides other six common aeroallergens and positive and negative controls, were carried out. Statistical package for the social sciences was used. Results The results revealed that 74% had positive results to at least one allergen extract. Out of skin prick test-positive participants, 41.9% showed positivity toward fungal allergen. Alternaria alternate and Penicillium spp. mixture each represented 32.2% of positive fungal sensitivity patients. Moreover, 38.9% of poorly controlled asthmatic patient’s category was fungal sensitized, whereas the percentage in well-controlled patients was 30.8% and it was a significant finding as P value was 0.02. Conclusion Fungal sensitivity is clearly correlated with respiratory allergic disease and its severity.
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Dyslipidemia in Egyptian children and adolescents with type 1 diabetes mellitus p. 104
Mohamed M El Bakry, Amira I Mansour, Marwa E Ahmed, Hamada E Sptan
DOI:10.4103/bmfj.bmfj_15_17  
Background Increased cardiovascular morbidity in type 1 diabetes mellitus (T1DM) may be due to vascular endothelial dysfunction, accelerated thickening of arterial intima, and changes in the ventricular functions. Aim The study aimed to describe the frequency and the pattern of dyslipidemia in children and adolescents with T1DM, and its relation to the degree of glycemic control, regular activities, and the duration of diabetes. Patients and methods This case–control study included 50 patients with T1DM, aged more than or equal to 9 years, with more than 1-year duration of diabetes, and 39 healthy age-matched and sex-matched children as controls. All participants were subjected to the following: full history taking, full clinical examination, and investigations including glycated hemoglobin, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglycerides. Results There was a high statistically significant increase in the frequency of dyslipidemia in diabetic patients (64.0%). Twenty (50%) patients had elevated LDL-C, with a mean of 102.0±34.4 mg/dl; the most common type of dyslipidemia was high LDL-C and low HDL-C in eight (25.0%) patients followed by isolated high LDL-C in six (18.75%) patients, isolated low HDL-C in five (15.63%) patients, and hypercholesterolemia and high LDL-C in four (12.50%) patients. There was no statistically significant difference between the dyslipidemia group and the normolipidemic group regarding BMI (P=0.070), but waist circumference showed statistically significant increase in the dyslipidemic group compared with the normolipidemic group (P=0.045). As regards the degree of activity affecting the lipid profile, as in the normolipidemic group, 94.4% were practising mild regular activities, whereas in the dyslipidemic group, only 62.5% were practicing mild regular activities (P=0.041). Conclusion Our study support the hypothesis that LDL-C is the ‘cornerstone’ for assessment of lipoprotein-related cardiovascular risk. In addition, activity is important for the prevention of dyslipidemia, and waist circumference is an easily obtainable measure of abdominal adiposity.
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Aspirin versus low-molecular-weight heparin in treating recurrent miscarriages in women without antiphospholipid antibody syndrome p. 108
Ahmed T Abd Elfattah, Samy A Amer, Wael R Hablas, Mohamed I Elmohandes, Osama M Hamoda
DOI:10.4103/bmfj.bmfj_20_17  
Background As hypercoagulability may result in recurrent miscarriages, anticoagulants (clexane) and aspirin (aspocid) could potentially increase live-birth rate in subsequent pregnancies in women with either inherited thrombophilia or unexplained recurrent miscarriages. Patients and methods This randomized trial included 120 pregnant women who were recruited by the closed-envelope method from the outpatient clinics of El-Hussien University Hospital and El-Galaa Maternity Teaching Hospital with history of at least three recurrent miscarriages. The trial was designed to compare the effects of low-dose aspirin (aspocid 75 mg tab) and low-molecular-weight heparin (LMWH) (clexane) on pregnancy outcome and live-birth rate. Pregnant women were divided into two groups: group 1 (60) was administered oral, low-dose aspirin (aspocid 75 mg tab) daily, and group 2 (60) was administered LMWH (clexane) 1 mg/kg subcutaneously daily. Results Regarding primary outcome (live-birth rate), the two groups did not differ significantly. Both drugs increased live-birth rate with an incidence of 81.7% in group 1 and 83.3% in group 2. Conclusion Low-dose aspirin (aspocid 75 mg tab) and LMWH (clexane 1 mg/kg) improve pregnancy outcome and increase live-birth rate, with no significant differences between the two drugs in patients with history of recurrent miscarriages without antiphospholipid antibody syndrome.
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Antenatal screening for hepatitis B virus infection p. 113
Magdy A Gad, Mohamed A Metwally, Hesham A Eissa, Mahmoud A Gehad, Moataz M Rayan
DOI:10.4103/1110-208X.218829  
Background Hepatitis B virus (HBV) infection continues to have a relatively high incidence and prevalence worldwide. In the postvaccination era in developing countries, perinatal vertical transmission remains the most common mode of transmission. Prevention of mother-to-child transmission requires screening of pregnant women for hepatitis B surface antigen (HBsAg) to identify which newborns must be immunized. Aim This study aimed to evaluate the prevalence of HBV infection among pregnant mothers who were attending the outpatient clinic of the Department of Obstetric at Benha University Hospital for routine antenatal care. Patients and methods A cross-sectional study included 448 pregnant women. Enzyme-linked immunosorbent assay technique for HBV was performed for all women and all patients positive for HBsAg were subjected to alanine transaminase, aspartate transaminase, bilirubin (total and direct) evaluation, hepatitis B envelope antigen test, and abdominal ultrasonography. Results Out of 448 pregnant women, seven (1.56%) were positive for HBsAg by enzyme-linked immunosorbent assay test, where alanine transaminase, aspartate transaminase, and bilirubin were normal in six positive cases but high in the seventh positive case, hepatitis B envelope antigen was negative in all seven positive cases, and abdominal ultrasound was normal in six positive cases and showed hepatosplenomegaly in the seventh positive case. There was no significant association between the seroprevalence of HBV infection (HBsAg) in the studied women and their sociodemographic data. No statistically significant difference was seen between HBsAg-positive patients and HBsAg-negative patients in terms of age and duration of marriage, history of blood transfusions, history of hospitalization, history of major operations, history of diabetes mellitus, having a husband who is HBsAg positive, and history of addiction. Conclusion HBV infection is prevalent among pregnant mothers attending our outpatient services. Therefore we recommend screening of all Egyptian pregnant mothers for HBV to prevent neonatal infection by immunoprophylaxis.
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Lactoferrin as an added therapy in the treatment of Helicobacter pylori p. 119
Fawzy A Megahed, Mohammed A El-Assal, Ahmed S Dabour, Ramy A Samy, Mahmoud A Rizk, Soha H Al Adhm
DOI:10.4103/bmfj.bmfj_25_17  
Background Bovine lactoferrin (bLF), an iron-binding glycoprotein, is a nonenzymatic antioxidant found in the whey fraction of fermented milk as well as in colostrum. The possibility that bLF may help improve the Helicobacter pylori eradication rate was first conceived in 1997 when an in-vitro study by Yamazaki and colleagues showed that bLF was bactericidal to H. pylori in Brucella broth. Later in-vitro studies have confirmed the same and yielded evidence of the possible mechanism of the bactericidal action of bLF, relating it to the high iron-binding affinity and prevention of iron utilization by H. pylori. Lactoferrin is used for treating stomach and intestinal ulcers, diarrhea, and hepatitis C. Aim The aim of the study was to verify the value of adding lactoferrin to the treatment of H. pylori infection. Patients and methods This study was conducted on 50 patients selected from Internal Medicine Department, Benha University Hospital. They were divided into group 1, which included 25 patients who were treated with traditional therapy (clarithromycin, omeprazole, amoxicillin, or metronidazole), and group 2, who were treated by traditional therapy plus lactoferrin (pravotin) for 1 week. H. pylori stool antigen testing was performed for both groups before and after therapy to assess the response to therapy. Results were statistically analyzed. Results Our results show that addition of lactoferrin improves the H. pylori infection eradication rate.
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Quality assessment of blood bank performance in Benha University Hospitals p. 123
Mahmoud F Elgendy, Rabaa M Alanwar, Rania H Shaker, Shereen M Abdelwahab, Abdulqader M Taher
DOI:10.4103/bmfj.bmfj_29_16  
Background Blood transfusion is an essential therapeutic intervention, and we may all need blood in emergency situations and some of us need regular transfusions. Therefore, it is important to assess the quality of blood bank performance to assure better provision of healthcare. Aim of the study The aim of this study was to assess the quality of performance of the blood bank at Benha University Hospitals. Materials and methods This was an observational study carried out to identify defects in blood bank processes and assess the knowledge of staff members about performance standards. The present study was carried out for 6 months from November 2012 up to April 2013. This study was performed at the blood bank of Benha University Hospitals in Benha city, Kalyobia governorate, Egypt. Results Regarding venipuncture site, the total score was 20 for 10 checked items. The studied sample had a mean score of 17.14 out of 20 with a SD of 1.88. The highest percentages of the items showed good disinfection patterns and infection control, as 89.3% of the staff washed their hands properly before preparation, 92.9% wore new gloves. All the staff disinfected the venipuncture site with alcohol swabs, with 17.9% doing it in a circular manner and 75.0% doing it from the center outwards. 89.3% of them reported that they do not touch the venipuncture site after disinfection, and 78.6% of the staff changed gloves between donors. Regarding bag procedure performance, we assessed using 12 checklists of items that included assessing expiry date of the bag with relevant donor number, donation date, blood expiry date, and label sample tube, and all previous items proved to be performed properly. Conclusion and recommendation Continuous monitoring through standard quality indicators of a quality management system will improve blood transfusion services. Regular training and continuous monitoring is a must in all processes regarding blood transfusion in blood banks.
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Changes of biomarkers expression between preoperative biopsy and after definitive surgical treatment in patients with invasive breast cancer who receive neoadjuvant chemotherapy p. 130
Ahmed S Ezzat, Hassan K Soueni, Hala A Agena, Ahmed M Nowar, Ahmed M.F Salama
DOI:10.4103/bmfj.bmfj_41_17  
Background Neoadjuvant systemic therapy has become a valuable strategy in the multidisciplinary treatment approach to breast cancer. There are conflicting results regarding the effect of neoadjuvant chemotherapy (NAC) on estrogen receptor, progesterone receptor, and human epidermal growth factor 2 (Her2) status in breast cancer. Aim The aim of this study was to shed some light on the effect of NAC on the biomarkers of breast cancer cells in patients with invasive cancer breast. Patients and methods A total of 22 female patients with breast mass that proved to be malignant by tru-cut biopsy underwent HR, Her2, and Ki67 assessments following administration of NAC and excision of the tumors, which were sent for histopathological assessment and assessment of the aforementioned markers. Changes were analyzed according to the type of the tumor, the grade, the hormone receptor status, and Her2 status of the tumor. These patients were managed in the General Surgery and Pathology Department, Faculty of Medicine, Benha University Hospital, during the period from January 2015 to June 2016. Results This study show that tumor cells that are hormone receptor negative and those that are Her2 positive are more sensitive to NAC with an obvious effect on proliferation index rate and higher rate of achieving complete pathological response. Infiltrating lobular carcinoma of the breast is associated with poorer response to NAC in comparison with duct carcinoma. The higher the grade of the tumor, the poorer the response to NAC. Conclusion The study shows that the breast cancer cells that are hormone receptors negative, Her2 positive, duct carcinoma, and lower grade tumors are more responsive to NAC.
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Serum prolactin level as a biological marker of severity in liver cirrhosis p. 140
Fawzy M Khalil, Mohamed A Elassal, Ahmed M Hussein, Mahmoud Rizk, Mohamed A Awadein, Eman G Behiry, Mahmoud M Abd El-Fadil Kelany
DOI:10.4103/bmfj.bmfj_60_17  
Background Cirrhosis of the liver is a chronic disease that involves the whole organ. In liver cirrhosis, the gonadal axis is affected. Hyperprolactinemia is often present in these patients as well as hyperestrogenemia, both are responsible for the clinical characteristics of feminization. Patients and methods We investigated 50 patients with cirrhosis. The diagnosis of cirrhosis was based on biochemical evidence and clinical diagnosis including ascites or encephalopathy. Moreover, prognostic indices (Child–Pugh) and prolactin (PRL) levels are assessed. Results Mean age was 51.94±5.99. Mean Child–Pugh score was 9.16±3.16. Mean PRL level was 18.76±9.14 ng/ml. Patients with hepatic encephalopathy compared with patients without encephalopathy had significantly higher levels of PRL. PRL levels were also significantly related to ascites degree. Mean PRL levels were 13.67 versus 20.05 versus 21.6 ng/ml in patients with first, second, and third degree of ascites, respectively. In regression analysis, PRL level was significantly dependent on Child–Pugh score. Conclusion PRL level increases significantly with severity of liver disease particularly in patients with ascites and hepatic encephalopathy. High PRL level could therefore be considered as a negative prognostic marker of liver cirrhosis.
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CD4+ CD28null in cases of polycystic ovary syndrome p. 146
Mohamed F.M Al-Shirbiny, Khalid M Salama, Afaf R.A Al-Said
DOI:10.4103/bmfj.bmfj_70_17  
Background The immunopathogenesis of polycystic ovary syndrome (PCOS) is established. However, the role of CD4+ CD28null in such patients is underinvestigated. Aim The aim of this study was to evaluate and compare CD4+ CD28null T cells in patients with polycystic ovary (PCO) (with high androgen level and with normal androgen level) and non-PCO patients. Patients and methods This study was carried out at Benha University Hospital. It included 100 PCO patients and 50 controls selected from the gynecology and obstetrics outpatient clinics. All included female patients were subjected to history taking and clinical examination. Transvaginal ultrasound was performed to confirm the ultrasonic criteria of PCOS. Hormonal profile included the evaluation of thyroid-stimulating hormone, prolactin, dehydroepiandrostendione-S total testosterone, lipid profile, and fasting blood glucose. Finally, total lymphocytic count, CD4 T cell, and CD4+ CD28null frequency were evaluated. Results Ovarian volume was significantly increased in higher and normal androgen subgroups (11.18±1.31 and 10.53±0.84) when compared with the control group (7.15±1.66). Immunological profile revealed that there was a significant increase in total lymphocyte count and CD4+ CD28null in the study group when compared with the control group. In addition, there was a significant increase in total lymphocyte count and CD4+ CD28null in both higher and lower androgen subgroups when compared with the control group. Finally, there was a significant increase in CD4+ CD28null in higher androgen when compared with lower androgen subgroup (3.15 vs. 2.73, respectively). Conclusion There was a higher expression of CD4+ CD28null T cells in PCOS, especially with hyperandrogenic state.
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