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  Most popular articles (Since July 30, 2015)

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Iron-deficiency anemia as a risk factor for pneumonia in children
Mohamed M Rashad, Sahar M Fayed, Aly Mona K El-Hag
July-December 2015, 32(2):96-100
Background Pneumonia is the most common single cause of death among children under 5 years of age in the developing countries. Anemia is the most common ailment affecting health, socioeconomic development, and overall betterment of mankind. Objective The aim of this study was to determine the relationship between iron-deficiency anemia (IDA) and pneumonia in Egyptian children. Patients and methods This case-control study included 100 children aged 9-72 months, selected from Benha University Hospital and Shebin El-Kom Educational Hospital from January to December 2014. A total of 50 children with pneumonia and 50 age-matched and sex-matched controls were included in the study. After taking an informed verbal consent from the parents, our children were subjected to medical history taking, clinical examination, and complete blood count. For children with hemoglobin less than 11 g/dl, serum iron, serum ferritin, and total iron binding capacity were detected. C-reactive protein and chest radiography were performed for the patients. Results Anemia, particularly IDA, was significantly more frequent among patients (54 and 22%, respectively) than among controls (24 and 22%, respectively) (P = 0.001 and 0.002, respectively). Hemoglobin level was significantly lower in the IDA patients than in the IDA controls (P = 0.03). Anemia was a risk factor for childhood pneumonia (P = 0.001, odds ratio 4.03, and confidence interval 1.71-9.49) and recurrent chest infection (P < 0.001, odds ratio 15.55, and confidence interval 4.88-49.53). Conclusion Anemia, particularly IDA, is a community problem in Egypt. Anemic children are about four times more susceptible to develop pneumonia compared with the nonanemic ones, and IDA is predominating. Prevention, accurate diagnosis, and prompt treatment of anemia are necessary.
  5,104 569 1
Genetic variations in the growth arrest-specific 6 protein gene in patients with acute coronary syndrome
Mohamed M Elshafey, Jehan H Sabry, Omnia E Abdalla, Rania F Abdel Ghany
July-December 2016, 33(2):65-71
Growth arrest-specific gene 6 (GAS6) encodes a vitamin K-dependent protein that regulates inflammation, angiogenesis, and atherosclerotic plaque formation. The level of GAS6 expression is associated with plaque stability and stroke. The role of GAS6 in cardiovascular disease, particularly in acute coronary syndrome (ACS), was explored. The study investigated the role of the single nucleotide polymorphism (c.834 + 7G >A) of GAS6 in ACS. The genotype frequencies for GG, AG, and AA, respectively, in patients with ACS were 57.1% (16/28), 28.6% (8/28), and 14.3% (4/28) and were 20% (4/20), 40% (8/20), and 40% (8/20) in the control group. The AA genotype and A allele were less frequent in patients with ACS than in controls (P < 0.05). Our study indicates that the AA genotype and A allele of the GAS6 gene relate to ACS and may have a protective role against ACS.
  1,266 3,401 -
Serum prolactin level as a biological marker of severity in liver cirrhosis
Fawzy M Khalil, Mohamed A Elassal, Ahmed M Hussein, Mahmoud Rizk, Mohamed A Awadein, Eman G Behiry, Mahmoud M Abd El-Fadil Kelany
July-December 2017, 34(2):140-145
Background Cirrhosis of the liver is a chronic disease that involves the whole organ. In liver cirrhosis, the gonadal axis is affected. Hyperprolactinemia is often present in these patients as well as hyperestrogenemia, both are responsible for the clinical characteristics of feminization. Patients and methods We investigated 50 patients with cirrhosis. The diagnosis of cirrhosis was based on biochemical evidence and clinical diagnosis including ascites or encephalopathy. Moreover, prognostic indices (Child–Pugh) and prolactin (PRL) levels are assessed. Results Mean age was 51.94±5.99. Mean Child–Pugh score was 9.16±3.16. Mean PRL level was 18.76±9.14 ng/ml. Patients with hepatic encephalopathy compared with patients without encephalopathy had significantly higher levels of PRL. PRL levels were also significantly related to ascites degree. Mean PRL levels were 13.67 versus 20.05 versus 21.6 ng/ml in patients with first, second, and third degree of ascites, respectively. In regression analysis, PRL level was significantly dependent on Child–Pugh score. Conclusion PRL level increases significantly with severity of liver disease particularly in patients with ascites and hepatic encephalopathy. High PRL level could therefore be considered as a negative prognostic marker of liver cirrhosis.
  3,372 207 1
Evidence-based medicine in high tibial osteotomy for knee osteoarthritis
Ahmed Mohamed Hassanin, El-Husseiny Mustafa El-Husseiny, Mohamed Gouda Montaser, Sayed Mahmoud Baioumy
July-December 2015, 32(2):87-91
Knee osteoarthritis is the most common joint disorder, and symptomatic disease occurs in 10% of men and 13% of women older than 60 years. Patients with osteoarthritis of the medial compartment often have varus alignment, and the mechanical axis and load-bearing axis pass through the medial compartment. The medial compartment is almost 10 times more frequently involved than that of the lateral compartment. Moreover, varus but not valgus alignment increases the risk for incident tibiofemoral osteoarthritis. An osteotomy is a surgical procedure, which implies that the bone is cut. A correction osteotomy at the knee is used to realign the leg and to transfer the weight-bearing axis from the pathological compartment to the healthy compartment. Patients with osteoarthritis of the medial compartment and varus alignment can be treated with a valgus osteotomy. Several correction osteotomy techniques are available for unicompartmental knee osteoarthritis, such as the closing wedge technique with removal of a wedge of bone, the opening-wedge technique with creation of a wedge, a combined (opening and closing wedge) technique, and techniques that are performed without creating a wedge in the bone, including dome osteotomy and hemicallotasis osteotomy with an external fixator. Unloading will result in slowing down of the osteoarthritis process. In retrospective studies, this procedure resulted in pain relief, improved function, and postponement of knee arthroplasty for 7-20 years, depending on participant selection, stage of osteoarthritis, and achievement and maintenance of adequate operative correction.
  1,919 1,313 -
Left ventricular untwist in patients with diastolic dysfunction: speckle tracking imaging study
Mahmoud A Soliman, Mahmoud K Ahmed, Morad B Mena, Mohamed S.S Montaser
September-December 2018, 35(3):270-276
Background There is no single noninvasive index that can directly assess diastolic function. Untwist contributes to diastolic suction and early filling. Speckle tracking imaging (STI) can be used to study the relation between diastolic indices and untwist in patients with diastolic dysfunction. Patients and methods A total of 75 patients with diastolic dysfunction and 25 normal volunteers were selected for this study. According to mitral flow pattern, the patients were classified into group I (abnormal relaxation), group II (pseudonormalized), and group III (stiffness pattern). Using STI, the basal and apical short-axis views were imaged. Stored data were processed to get apical and basal rotation, systolic twist, peak systolic twist ratio, diastolic untwist ratio, and time to peak twist and untwist ratio. Results Peak untwisting ratio was significantly higher in Group I Patients that decreased to be normalized and even decreased with progression of diastolic dysfunction from Group II to Group III. There was a highly significant positive and negative correlation with end-diastolic volume and end-systolic volume, respectively. Time to peak untwist ratio nonsignificantly increased from group I to III, with nonsignificant correlation between untwist ratio and peak E, A, and E/A ratio. Conclusion Patients with relaxation abnormality have a higher untwist ratio, which decreases gradually with progression from relaxation to stiffness pattern. It may appear as a compensatory mechanism to ensure early filling with relaxation abnormality.
  2,878 327 -
Update in facial nerve paralysis: tissue engineering and new technologies
Mohamed A Elsayed, Ahmed M.M. Elrefai, Ahmed A Abd Elfattah
July-December 2016, 33(2):72-76
The facial nerve is one of the most commonly injured cranial nerves. Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Here, we review recent developments in the management of facial nerve paralysis and in facial reanimation restoring both form and function. We also discuss tissue engineering and new technologies and their role in the treatment of facial nerve paralysis.
  1,735 1,280 -
Morphometric (MRI and sonography) study of the human spinal cord in prenatal and postnatal life (from birth to 20 years)
Saadia A Shalaby, Essam M Eid, Naglaa A Saber, Ali M Ali, Samar F Gad
July-December 2015, 32(2):146-151
Introduction The assessment of the position of the conus medullaris is very important to perform lumbar puncture and surgical procedures. There are some reports about the relationships between the clinical manifestations and the spine morphology or spinal cord morphology in patients with myelopathy. It has also been reported that there are variations in the cross-sectional area of the cervical segments of the spinal cord. Aim The aim of the present study was to compare the levels of conus to measure the diameters of the cervical spinal cord segments. Participants and methods In the prenatal group, sonographic evaluation of the conus medullaris and the conus distance were carried out. In the postnatal group, the T2-weighted MRI was used to record the level of conus medullaris. In addition, the transverse and anteroposterior diameter of the cervical spinal cord and cross-sectional area from C2 to T1 at the level of each intervertebral disk were investigated. Results In the prenatal group, the mean of conus distance was 32.38 ΁ 12.13 mm. The level of the tip of the conus medullaris in the postnatal group showed almost distribution from the T12 to L2-L3 disk. The peak of the distribution of the conus height was at the level of disk between T12 and L1. The anteroposterior diameter decreased linearly from C2 to T1.The transverse diameter and the cross-sectional area were largest at the level of C4-C5, and decreased progressively to segment T1. There was no statistically significant difference in relation to sex. Conclusion Linear regression analysis showed a significant correlation between the conus distance and gestational age and femur length. The ascent of conus medullaris seems to occur early in postnatal life. The transverse diameter and the cross-sectional area were largest at the level of C4-C5, whereas the anteroposterior diameter decreased from C2 to T1.There was no significant correlation between cervical diameters and sex.
  2,751 204 1
Prediction of cesarean section scar dehiscence before delivery using three-dimensional transabdominal ultrasonography
Mahmoud Abosrie, Mohamed A Elhadi Mohamed Farag
July-December 2015, 32(2):101-106
Objective This study aimed to evaluate the efficacy of three-dimensional (3D) ultrasonography in the prediction of cesarean scar dehiscence in pregnant patients at term and to compare the outcome of measurement with the intraoperative visual assessment of the scar. Design This was a prospective study. Patients and methods Seventy pregnant women with a history of a previous cesarean section attending Benha University Hospital were included in this study. All participants underwent a 3D transabdominal scan at third trimester and the data were recorded. We measured the lower segment thickness from the muscularis and mucosa of the bladder on the outer side to the chorioamniotic membrane on the inner side, with the myometrium in between, and hence, depending on a three-layered pattern. This was compared with the pregnancy outcome and the intraoperative scar condition. The data were then statistically analyzed. Results The mean scar thickness as measured by 3D transabdominal sonography in the third trimester was 4.63 ± 0.85 mm. The best cut-off level for predicting uterine scar defects was less than or equal to 2.75 mm (highest diagnostic accuracy) with sensitivity 25%, specificity 100%, positive predictive value 100%, and negative predictive value 95%. Conclusion The current study suggests that prenatal 3D US examination determining the degree of lower uterine segment thinning in patients with previous cesarean delivery provides an additional element for assessing the risk of uterine rupture and may increase safe management of trial of labor.
  2,596 337 1
Serum interleukin-6 concentration and association with response to hepatitis C virus therapy for chronic hepatitis C patients
Fatma M Abd El Salam, Naglaa E El Toukhy, Amal A Mohamed, Hend A Nekola
July-December 2017, 34(2):59-65
Background Egypt has the highest prevalence of hepatitis C virus (HCV) in the world. Interleukin 6 (IL-6) is a pleiotropic cytokine that is elevated in chronic hepatitis C patients. IL-6 was suggested by several studies to play a major role in response to HCV therapy. Aim The aim of this work was to assess the possible role of IL-6 in the response status of patients with HCV during treatment. Moreover, we attempted to use IL-6 as a predictive factor for response in patients with chronic HCV. Patients and methods Serum concentrations of IL-6 were measured before and after treatment using a commercially available Quantikine enzyme-linked immunosorbent assay in 57 patients with chronic hepatitis C treated with sofosbuvir and simeprevir for 3 months. Results The mean values of IL-6 level in responders and nonresponders were 272.96 and 230.5 pg/ml, respectively. IL-6 levels decreased significantly after treatment in the sustained virological response group. The best cutoff point for IL-6 was 233 pg/ml with a sensitivity of 70%, a specificity of 75%, a positive predictive value of 97.2%, and a negative predictive value of 16.7%. Conclusion Virological response during HCV therapy was associated with a decrease in IL-6 level.
  1,680 1,217 1
Oral gabapentin premedication for post-tonsillectomy nausea, vomiting, and recovery
Ibrahim M. Abdel Moety, Dina H.A El Barbari, Mohammed M.A Esmael
September-December 2018, 35(3):265-269
Background Gabapentin is a second-generation anticonvulsant that is successful in the management of chronic neuropathic pain. It was not previously known to be useful in acute perioperative conditions, but recently it has been used for acute perioperative conditions. However, evidence-based medicine suggests that perioperative administration is useful for postoperative analgesia, preoperative anxiolysis, attenuation of the hemodynamic response to laryngoscopy and intubation, and preventing chronic postsurgical pain, postoperative nausea and vomiting (PONV), and delirium. This article reviews the clinical trial data to describe the efficacy and safety of gabapentin for perioperative anesthetic management. Aim The aim of the study was to evaluate and update the effect of preoperative gabapentin on the incidence of postoperative vomiting and on analgesic requirements after adenotonsillectomy in pediatrics. Materials and methods This randomized, double-blind study was designed to explore the possible effects of oral gabapentin as a premedication on the incidence and severity of PONV and on the early recovery profile of pediatric patients undergoing adenotonsillectomy under sevoflurane anesthesia. Results The incidence of PONV in the gabapentin group was significantly lower than in the gabapentin group. However, the numbers of rescue ondansetron doses and the PONV severity score were comparable in the two groups. Conclusion The use of gabapentin as premedication in pediatric patients undergoing adenotonsillectomies under sevoflurane anesthesia reduces the incidence of PONV and emergence agitation in the early postoperative period. However, gabapentin did not reduce pain and analgesic consumption after surgery.
  2,383 466 -
Morphometric analysis of hard palate in Egyptian skulls
Saadia A Shalaby, Esam M Eid, Naglaa A. S. Sarg, Amany M. A. Sewilam
January-June 2015, 32(1):59-72
Background As the hard palate is an essential region of the skull its gross anatomy and morphological variations have been of interest in many studies. Aim The aim of the present study was to describe the gross anatomy of the hard palate in Egyptian skulls, and determine sex from the morphometric study of the hard palate and location of the position of the greater palatine foramen (GPF) in relation to certain fixed intraoral anatomical reference points, all of which are visible or palpable in a living patient. Materials and methods In this study, 100 skulls (64 male and 36 female skulls) were subjected to the following measurements: palatal length, breadth, and height, the diameters of the GPF and its shape, the direction of opening of the GPF onto the palate, the relation of GPF to the maxillary molar teeth; the distance from the GPF to the midline maxillary suture, to the incisive foramen, to the posterior border of the hard palate, and to the tip of the hamular process of the pterygoid; the angle between the axis of the greater palatine canal (GPC) and the hard palate; the length of GPC plus the length of the pterygopalatine fossa; and the height of the maxilla. Twenty cadaveric heads were also dissected to measure the thickness of the palatal mucosa over the GPF. Results The mean palatal length was 51.65 ± 4.7 mm and palatal breadth was 38.68 ± 2.9 mm, with a highly significant difference between male and female skulls. Palatal height was 11.8 ± 2.7 mm with no significant difference between the two sexes. Of the total skulls 64% had narrow palates, 24% had intermediate ones, and 12% had wide palates with no significant difference between the two sexes; 36% had low palates, 56% had intermediate, and 8% of the sample had high-arched palates with a significant difference between the two sexes. The mean anteroposterior and transverse diameters of GPF were 4.86 ± 0.9 and 3.02 ± 0.7 mm, respectively. It was frequently an oval opening in 71%, a rounded opening in 22%, and lancet and slit in the remaining. Its direction in 69% was anteromedial, that in 28% was anterior, and that in 3% was anterolateral. The majority (84%) of the total foramina were opposite the maxillary third molar tooth. The mean distance from the GPF to the midline maxillary suture was 14.25 ± 1.7 mm, that from the GPF to the incisive foramen was 35.93 ± 3.5 mm, and that from the GPF to the posterior border of the hard palate was 3.89 ± 0.9 mm. The mean length of GPC and the pterygopalatine fossa was 29.39 ± 3.1 mm, the height of the maxilla was 30.44 ± 3.4 mm, and the difference between the two sexes was significant. The angle between the GPC and the horizontal plane of the hard palate was 40.48 ± 9.1°. The mean thickness of the palatal mucosa over the GPF was 4.92 ± 1.93 mm. Conclusion As the measurement studies of the hard palate show considerable variations among races, the data in this study will help clinicians to localize the GPF more precisely in Egyptian patients and to predict the depth of a needle to anesthetize the maxillary nerve with a low rate of complications.
  2,424 383 -
Role of ultrasonography in the evaluation of Achilles tendon disorders
Mohamed A Borg, Saleh El-Essawy, Roshdy M El Sallab, Amany Ezzat, Ahmed M Abd El-Khalek
January-June 2016, 33(1):54-59
Background This study was conducted to highlight the role of ultrasonography as an initial imaging modality for evaluation of symptomatic Achilles tendon disorders. Patient and Methods 60 patients (33 men and 27 women) had symptomatic Achilles tendons disorders and confirmed clinically as all patients were referred from orthopedic surgery department. 20 patients had history of blunt trauma followed by pain which may be associated with lost plantar flexion. 40 patients had chronic pain either associated or not associated with swelling at the site of Achilles tendon. US examination (13 MHz probe, GE logic P5 machine) using real time with color and power Doppler examination was performed while the patient in prone position. Results US depicted full-thickness tears in 11 (18.5%) tendons where tendon gaps were not significant (less than 5 mm) in 6 tendons and significant (more than 5 mm) in 5 tendons. De novo partial tears were detected in 15 (25%) tendons. Tendinopathy were seen in 18 (30%) tendons. US depicted paratenonopathy in 3 tendons (5%). 13 (21.7%) tendons appeared normal by ultrasonography. Conclusion Ultrasonography is an initial imaging of choice for evaluation of symptomatic Achilles tendon disorders. Diagnostic accuracy reaches 85%. However, Tendons that appeared normal by US should be followed by MRI for more diagnostic accuracy, detailed regional evaluation and subsequently can exclude other etiologies giving similar clinical manifestations.
  2,499 287 -
Effect of cataract surgery on diabetic retinopathy
Khalid G Ali, Tarek T Soliman, Asmaa A Mohammed
July-December 2015, 32(2):92-95
Objectives The aim of this study was to review articles on the effect of cataract surgery on diabetic retinopathy (DR). Of the reviewed publications, it was found that diabetic patients with mild-to-moderate DR are less likely to show progression of DR after phacoemulsification. Patients with severe nonproliferative diabetic retinopathy and proliferative diabetic retinopathy have high risk of progression. Elevated hemoglobin A1c (HbA1c) at the time of cataract surgery increases the risk for DR progression after surgery. Conclusion Currently, early surgery is favored before the development of significant DR rather than waiting for the cataract to become denser. All efforts should be made to stabilize DR before cataract surgery.
  2,399 287 -
Aspirin versus low-molecular-weight heparin in treating recurrent miscarriages in women without antiphospholipid antibody syndrome
Ahmed T Abd Elfattah, Samy A Amer, Wael R Hablas, Mohamed I Elmohandes, Osama M Hamoda
July-December 2017, 34(2):108-112
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.
  2,538 147 -
Noninvasive predictors of hepatic fibrosis in patients with chronic hepatitis C virus in comparison with liver biopsy
Ayman N Menessy, Nancy A Ahmed, Nagwa I Abdallah, Salah S Arif
September-December 2018, 35(3):282-286
Background Liver fibrosis is the main predictor of the progression of chronic hepatitis C, and its assessment by liver biopsy can help plan therapy. However, biopsy is an invasive procedure with occasional complications and poor patient acceptance. Aim The aim of this work was to compare noninvasive and invasive methods for evaluation of fibrosis in patients with chronic hepatitis C. Patients and methods This cross-sectional study was carried out at the Liver Unit of Mansoura University Hospital and Mansoura Health Insurance Hospital. The study was conducted on 100 patients with chronic active hepatitis. Biochemical and virological studies were performed in addition to abdominal ultrasonography and liver biopsy in all patients. Moreover, analyses of serum fibronectin (FN), AST-to-platelet ratio index (APRI), and alanine aminotransferase/aspartate aminotransferase (AST/ALT) ratio were performed. Results We found that FN has the highest sensitivity and specificity, and the independent variables related to fibrosis were FN, APRI, and AST/ALT ratio. Conclusion The biochemical tests including APRI, AST/ALT ratio, and particularly FN could be valuable noninvasive predictors for assessment of liver fibrosis in patients with chronic hepatitis C infection.
  2,234 304 -
The role of dynamic contrast-enhanced MRI analysis of perfusion changes in hepatocellular carcinoma
Ahmed M Elzeneini, Mohamed I Yousef, Medhat M Refaat
September-December 2018, 35(3):277-281
Background Dynamic contrast-enhanced (DCE)-MRI functional imaging is primarily focused on quantitative evaluation of tumoral perfusion and permeability, thus enabling an insight into the pathophysiology of tissue and serving as early noninvasive biologic markers of tumorigenesis. Aim The aim was to evaluate the functional role of DCE-MRI analysis of perfusion changes in hepatocellular carcinoma (HCC). Patients and methods A total of 43 patients with liver cirrhosis having 65 HCCs all underwent 3 T multiphase DCE-MRI assessment. Maximum relative enhancement, area under curve, wash-in ratio, wash-out ratio, time to arrival, and time to peak semiquantitative measurements were analytically compared between the hepatocellular carcinogenic lesions and the adjacent lesion-free liver cirrhosis. Results Comparison of different perfusion metrics across hepatocellular carcinogenic lesions and adjacent lesion-free liver cirrhosis revealed exceling statistical significance. Diagnostic accuracies were highest when using wash-out ratio (86.2%) to detect HCC from background cirrhosis, whereas they were lowest using area under the curve (67.7%). Implementing wash-in ratio (81.9%), as a first-pass perfusion metric, surpassed its counterpart, maximum relative enhancement (73.4%), in diagnostic reliability. Regarding the timing of flow dynamics, time to arrival (84.1%) was more important than time to peak (78.1%) as a diagnostic indicator of hepatocarcinogenesis. Conclusion Multiphase DCE-MRI perfusion analyses provide quantitative hemodynamic metrics that promise potential usefulness as noninvasive biomarkers in the detection of HCC.
  2,185 322 -
Sublingual misoprostol before insertion of an intrauterine device
Mohamed A Mohammed, Khaled S Seleem, Ahmed M Sadek, Ahmed I Zaky Nada
January-April 2018, 35(1):104-110
Objective The aim of the work was to investigate whether sublingual misoprostol before intrauterine contraceptive device (IUCD) insertion facilitates the insertion and reduces the number of failed insertions, insertion-related complications, and pain during insertion. Background The intrauterine device (IUD) is a highly effective and safe contraceptive method. However, insertion through a narrow cervix may be technically difficult and painful. Misoprostol has been shown to be effective for cervical priming in nonpregnant women. Patients and methods Two hundred and sixty women were randomly allocated to receive 400 mg misoprostol sublingually or placebo 2 h before IUD insertion. Primary outcome measure was the proportion of failed insertions. Pain during insertion and difficulty in IUCD insertion were evaluated. Complications and side effects were recorded together with bleeding and expulsion of the loop after 6 weeks. Results Misoprostol significantly reduced the number of failed insertions from six failed insertion in the placebo group (4.6%) to only one (0.8%) case in the misoprostol group (P=0.023). Pain during insertion was significantly lower (P<0.001). Difficulty in insertion was significantly lower (P<0.001). As regards side effects, no significant differences were found between the two groups except for abdominal cramps and nausea. Cramps occurred in 22.3% of participants using misoprostol and in 5.4% of participants using placebo (P<0.001). Nausea occurred in 6.9% of participants using misoprostol and in 1.5% of participants using placebo (P=0.046). There were no significant differences as regards the rate of expulsion and the amount of vaginal bleeding. Conclusion 400 micrograms of sublingual misoprostol 2 h before IUCD insertion reduces the number of failed insertions and pain during insertion. A facilitating effect of misoprostol on IUD insertion was also found.
  2,311 132 -
Contrast-enhanced spectral mammography versus magnetic resonance imaging in the assessment of breast masses
Ahmed F Yousef, Hamada M Khater, Lara M Jameel
January-April 2018, 35(1):5-12
Background Contrast-enhanced spectral mammography (CESM) has high diagnostic accuracy. It involves the same principles as MRI in terms of the enhancement pattern because of the similar uptake of contrast medium or enhancement. Therefore, the indication should be the same. Aim The aim of the study was to compare CESM and MRI in the assessment of breast masses. Patients and methods This study included 20 patients, and was carried out from December 2016 to May 2017. The age of the patients ranged from 30 to 60 years. Our study was carried out using CESM and breast MRI. Results This study included 20 patients with breast lesions. The age of the patients ranged from 30 to 60 years. All multiple histologically proven lesions were detected by CESM (100%) and MRI (100%), with no significant difference in their site and number in both modalities. Conclusion CESM is useful for the differentiation of local recurrence of post-treatment scarring after breast-conserving therapy and evaluation of residual tumor after treatment, with unknown primary site of malignancy. Recommendations CESM is recommended as the imaging modality of choice in the detection and extension of breast cancer, particularly in problematic cases, or when conservative breast therapy is attempted, but the best correlations with lesion pathology were found in MRI more than CESM, as in MRI, there are the same overlapping patterns of benign and malignant enhancements.
  2,144 274 -
Management of chest trauma
Al Ashry T Ghoneim, Gamal E Saleh, Refaat S Salama, Mohammed K Zghloul
January-April 2018, 35(1):1-4
Thoracic trauma is a major medical problem with high mortality. It is a life-threatening situation and frequently involves other anatomical areas that require simultaneous management. The typical management is supposed to be multidisciplinary and preferably started at the accident location and maintained during patient transport, through the arrival to the emergency department, through transport to surgical theatre, in the operation room and then in the ICU. Early management is the key to decrease morbidity and mortality. The aim of this study was to throw some light on the types of chest trauma with special reference to its recent management.
  2,134 273 -
Role of gamma knife radiosurgery in the management of functioning pituitary adenomas
Mohammad F Elshirbiny, Raef F. A. Hafez, Nabil Ali, Ashraf A Ezzeldien, Mohammad A Kassem
January-June 2015, 32(1):6-12
Historically, the treatment armamentarium for secretory pituitary adenomas included neurosurgery, medical management, fractionated radiotherapy, and, recently, gamma knife surgery (GKS). The objective of this study was to evaluate the efficacy, safety, and role of GKS in the treatment of secretory pituitary adenomas as regards hormonal and adenoma size control. Between January 2010 and January 2014, a prospective analysis of 40 consecutive patients who underwent GKS for secretory pituitary adenomas at the International Medical Center, Cairo, Egypt, was carried out. Eight patients had adrenocorticotropic hormone-secreting adenoma, 16 patients had prolactin-secreting adenoma, and 16 had growth hormone-secreting adenoma. In 19 patients, GKS was the secondary treatment to a prior surgery with failure of hormonal control along with medical treatment. In the remaining 21 patients, the secretory pituitary adenomas were not controlled with medical treatment alone. The follow-up period ranged between 12 and 60 months. Hormonal control was achieved with either normalization or a marked decline in abnormal hormone level of more 50%. Radiological tumor size control was carried out with either tumor size stabilization or reduction. Among the 40 patients, 21 had microadenoma of 1 cm 3 volume or less. Overall, 24 patients (60%) had hormonal control and 38 patients (95%) had tumor size control after GKS. There was a direct correlation between tumor size, prescription radiation dose, and hormonal and size control after GKS. Twenty out of the treated 21 microadenoma cases showed both hormonal and size control. In conclusion, GKS is a safe and effective treatment method for secretory pituitary adenomas that have failed to respond to medical treatment alone or have postsurgical residual tumor, or recurrence, especially microadenomas.
  2,170 223 2
Evaluation of the results of arthroscopic meniscal repair
Magdi M ElSayed, Alhusseiny M Alhusseiny, Mohamed G Montaser, Mahmoud M El-Sherbiny
January-June 2015, 32(1):49-58
Introduction Menisci have a role in optimal knee function. Meniscal preservation in younger active individuals presenting with symptomatic meniscal disease is important. The success of meniscal repair depends on appropriate meniscal bed preparation and the surgical technique. Patients and methods A prospective study of 20 cases of post-traumatic meniscal tear was conducted during the period between March 2012 and December 2013. All cases were subjected to arthroscopic evaluation to confirm the diagnosis and ensure they fulfilled the criteria for repair on the basis of site, size, description, and associated injury of the tear. The inclusion criteria were vertical longitudinal tear from 1 to 3 cm in length in the red-red or red-white zone. The exclusion criteria were patient age older than 45 years, white-white zone tear, radial tear, and complex degenerative meniscal tear. The Lysholm score and International Knee Documentation Committee (IKDC) subjective and objective knee scores were used preoperatively and postoperatively for presentation of overall results. All cases were treated by means of the all-inside arthroscopic repair technique using a FasT-Fix meniscal repair device. Results Twenty patients were followed up for an average of 60 weeks. The mean age of the patients was 20.95 ± 1.60 years; the average suture used was 2.85; 70% had isolated meniscal injury, and 30% had associated anterior cruciate ligament (ACL) tear; the average tear length was 1.91 cm. The mean preoperative and postoperative Lysholm scores were 38.25 and 91.20, respectively. The mean preoperative and postoperative IKDC subjective evaluation results were 31.28 and 91.44, respectively. The preoperative IKDC objective evaluation results revealed 16 (80%) patients with severely abnormal knees (grade D) and four (20%) patients with abnormal knees (grade C). The postoperative IKDC objective evaluation results revealed two (10%) patients with abnormal knees (grade C), three (15%) patients with nearly normal knees (grade B), and 15 (75%) patients with normal knees (grade A). There is better improvement in scores if ACL reconstruction is performed simultaneously with meniscal repair, the procedure is performed for vertical longitudinal tears, the tear is in the 'red-red' zone, and the tear length is less than 21 mm. There were no differences in functional results on the basis of repair of medial meniscus or lateral meniscus, acute or chronic injuries, or age. Conclusion Better outcome of meniscal repair was seen in patients with vertical longitudinal tear in the red-red zone with a tear length of less than 21 mm and associated with ACL reconstruction.
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Vitrectomy for idiopathic macular hole: outcomes and complications
Amr Mohammed Elsayed Abdelkader, Mohamed Nader Roshdy El-Metwaly, Mohamed Ahmed Khalaf, Amal Moustafa El Bendary, Amr Mohamed Hassan El-Kannishy
July-December 2015, 32(2):107-115
Purpose The aim of this study was to determine the anatomical closure rate together with the rate of functional success of idiopathic macular holes following vitreous surgery in different optical coherence tomography (OCT) stages. Patients and methods This was a prospective, case series, interventional study. Twenty-two eyes were enrolled in this study conducted at Mansoura University Ophthalmic Center during the period between June 2012 and December 2014 with at least 3 months of follow-up. Eyes with stage 2, 3, and 4 idiopathic macular hole according to the Gass classification were included. All eyes were subjected to 23-G pars plana vitrectomy, inner limiting membrane peeling, fluid-gas exchange, and postoperative positioning. Results Idiopathic macular hole closure was achievable in 18 of 22 cases, with overall 81.4% anatomical success. Type 1 closure (U-shaped closure) was achieved in 13 cases (59.1%), type 2 closure (V-shaped closure) in three cases (13.6%), type 3 closure (irregular closure) in one case (4.5%), and type 4 closure was reported in one case (4.5%). The median postoperative log MAR visual acuity at 3 months was 1.0 (0.9445-1.2073). The overall postoperative visual acuity improvement was strongly statistically significant (P = 0.000). The visual acuity improvement at 3 months compared with the preoperative visual acuity was statistically significant (P = 0.000). The delta change in log MAR visual acuity at 3 months was 0.5 (−0.7782 to −0.4331), with greater improvement in log MAR visual acuity in group I (stage 2 OCT) compared with group III (stage 3 and 4 OCT at 3 months; P = 0.05). Retinal breaks were observed intraoperatively in three cases. Retinal detachment was reported in one case 4 months postoperatively. Conclusion Macular hole closure rate and visual acuity markedly improved following vitreous surgery for idiopathic macular holes.
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Associated comorbidities of specific language impairment
Hassan Ghandour, Sally Kheir Eldin, Yossra Sallam, Shaimaa Mahmoud
May-August 2018, 35(2):115-121
The primary linguistic difficulties of individuals with specific language impairment (SLI) have been addressed in detail in previous research. Recently, several studies have also reported the presence of associated comorbidities in children with SLI such as memory disorders, motoric deficits, dyslexia, ADHD, auditory processing disorders, and psychosocial disorders. The aim of this paper is to highlight the issues in SLI associated with memory disorders, motoric deficits, and dyslexia. This is a literature review. Short-term memory and working memory are commonly affected in children with SLI. In addition, those children exhibit deficits in fine and gross motor skills both simple and complex. The risk of dyslexia is associated with language delays and speech difficulties in the preschool years. SLI is a multifaceted disorder with both linguistic and nonlinguistic features including memory disorders, motoric deficits, and dyslexia.
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Orbitozygomatic approach results of 16 spheno-orbital hyperostotic meningiomas (en plaque)
Ashraf El Badry, Azza Abdel Azeez, Ahmed Abdel Khalik
September-December 2018, 35(3):287-296
Objective This study aimed to evaluate the results of the orbitozygomatic approaches of intraosseous meningiomas that causes hyperostoses involving the greater wing of the sphenoid and orbital bones with a small soft tissue component. Patients and methods We carried out a prospective and retrospective study of 16 patients with meningiomas en plaque who underwent surgical procedures by the orbitozygomatic approach in the period between 1999 and 2014 at the Neurological Surgery Department, Mansoura University Hospital of Egypt. Results The mean age of the patients was 49.6 years, whereas the most common complaint was proptosis accounting for 81.25% of cases. The second most common complaint was visual impairment accounting for 56.25% of cases. The orbitozygomatic approach was used for all the cases and drilling of the greater wing of the sphenoid, lateral orbital wall, orbital, and optic canal roof was performed. The small soft tissue component of the meningiomas was in the anterior and middle cranial fossa involving hyperostoses in all surrounding bones in all cases, whereas four cases showed intraorbital soft tissue meningioma. The results after surgery indicated an improvement of proptosis in 75% of cases, with less improvement in visual impairment observed in 56.25% of cases. Complications included third nerve palsy in 87.25% (14) of cases, and improved only in five cases. The extent of tumor surgical resection was subtotal in 75% (12) of cases. These tumors progressed in eight cases and only two patients underwent a second surgical intervention; others were referred to radiotherapy. Conclusion Despite good surgical exposure in this approach, the radical excision of the tumors may be extremely difficult as the tumor in these areas showed involvement of very delicate structures (because of late medical consultation), which made the dissection impossible, but using this approach we can achieve good results including proptosis and visual impairment.
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The role of MRI in the evaluation of vascular malformations
Ahmed G Sadek, Mohamed A Borg, Hisham S El-Din, Adel G El-Badrawy, Ahmed I Tawfik
January-June 2015, 32(1):1-5
Objective The aim of this study was to evaluate the role of MRI and MR angiography in the assessment of vascular malformations as compared with the usefulness of duplex sonography and digital subtraction arteriography. Participants and methods A total of 40 patients (age range, 1-35 years; 21 male and 19 female) with diagnosed vascular malformations on the basis of color duplex imaging were examined on a 1.5 T whole-body MR scanner. Using parameters based on a fast localizer sequence, we acquired axial or coronal T1-, T2-, short-time inversion recovery (STIR) and contrast-enhanced T1-weighted images. Dynamic postcontrast three-dimensional (3D) gradient-echo MRIs were used for patients with high-flow arteriovenous malformation. MR data sets were evaluated for the detection of the lesion, determination of the malformation extent, involvement of surrounding structures, and vascular details with regard to the nidus, feeding arteries, and draining veins. Results were compared with findings from the digital subtraction angiography (DSA). Results All MRIs revealed 14 low-flow venous vascular malformations, 12 high-flow arteriovenous malformations, and 14 hemangiomas. The STIR sequence was helpful for determining the extent of vascular malformation, whereas dynamic postcontrast 3D MR angiography helped in the classification of the type of the vascular malformation. MR angiography was inferior to DSA in revealing the vascular details and for interventional procedure planning. Conclusion MRI and MR angiography appear to play a significant role in the assessment of vascular malformations. The protocol for imaging such vascular malformations should include dynamic postcontrast 3D gradient-echo MRI with STIR sequences. However, DSA is still required for more vascular detail delineation and definitive treatment decisions.
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