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   2015| July-December  | Volume 32 | Issue 2  
    Online since April 14, 2016

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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.
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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.
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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.
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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.
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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.
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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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Saussurea lappa root extract accelerates the reversion of liver fibrosis induced by carbon tetrachloride in rats
Hassan Reda Hassan Elsayed, Mostafa Mohammed Abd-Elmonem, Omar Mahmoud Gabr, Farid Abd-Elreheim Badria
July-December 2015, 32(2):116-125
Background and aim of work Liver fibrosis is a major health problem associated with high morbidity and mortality, particularly in Egypt. It is mainly regulated by hepatic stellate cells, which acquire a fibrogenic character in response to oxidant stress and inflammatory cytokines. We tried to test the efficacy of Saussurea lappa (Sl) root extract on the reversion of the already established liver fibrosis as this extract was reported to have anti-inflammatory and antioxidant activities. Materials and methods A total of 24 albino rats were divided into four groups: negative control group, carbon tetrachloride (CCl 4 ) fibrosis model group, spontaneous resolution group, CCl 4 followed by Sl root extract group. In all rats, serum alanine transaminase, aspartate transaminase, liver malonaldehyde and liver reduced glutathione were measured. Histopathological assessment were carried out through haematoxylin and eosin (H&E), sirius red staining and α-smooth muscle actin immunohistochemical staining with evaluation of the fibrosis grade and percentage of the area occupied by collagen fibres. Results Administration of Sl root extract for 4 weeks, after 8 weeks of CCl 4 injection, caused a significant decrease in CCl 4 -induced rise in plasma levels of alanine transaminase and aspartate transaminase, liver malonaldehyde and the percentage of collagen area and an increase in liver glutathione with almost preserved liver architecture, less inflammatory infiltration, less collagen deposition, fewer thinner septa, less bridging fibrosis and less positive reaction for α-smooth muscle actin as compared with the spontaneous resolution group. Conclusion These data indicate that Sl root extract can accelerate matrix degradation and reversion from liver fibrosis induced by CCl 4 in rats. This might be through antioxidant, anti-inflammatory activities and through inhibition of the activated hepatic stellate cells or probably inducing their apoptosis.
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Lateral pharyngoplasty versus uvulopalatopharyngoplasty: A comparative
Allam F Ahmed, Helmy A Adel, Abdelaal M Taha, Abdelaleem A Abdelrahman
July-December 2015, 32(2):131-136
Objectives The aim of this study is to explore the efficiency of lateral pharyngoplasty as a new treatment for obstructive sleep apnea hypopnea syndrome (OSAHS) versus uvulopalatopharyngoplasty (UPPP). Study design Prospective randomized study. Patients and methods This study was submitted on 30 patients diagnosed to have OSAHS with retropalatal obstruction classified randomly into two groups: in one group, we performed the lateral pharyngoplasty (15 cases) with blunt palatal tunneling, and in the other, we did the UPPP (15 cases). We compared the efficiency of surgeries subjectively through the Epworth Sleepiness Scale and objectively through clinical and polysomnographic findings. Results In the lateral pharyngoplasty, the mean apnea-hypopnea index (AHI) improved from 40.95 ± 28.50 to 8.92 ± 7.9 (P < 0.01) and in the UPPP, the mean AHI improved from 33.87 ± 20.92 to 15.66 ± 8.7 (P < 0.01). Comparing the postoperative mean AHI in both groups (8.9 ± 7.9 and 15.66 ± 8.7 correspondingly) there was a statistically significant difference. In contrast with UPPP, the group of lateral pharyngoplasty shows improvement in the average PsO 2 from 91.93 ± 4.67 to 94.27 ± 3.53% (P < 0.05) and in the lowest PsO 2 from 71.8 ± 10.56 to 81.27 ± 8.92 (P < 0.01). In the lateral pharyngoplasty group, the median Epworth Sleepiness Scale changed from 11 to 7 and the persistent nasal regurge was not recorded (0.0%), but in UPPP group the persistent nasal regurge was recorded in four patients out of 15 (26.7%) (P < 0.05). Conclusion The lateral pharyngoplasty may offer benefits over UPPP in treatment of OSAHS patients with retropalatal obstruction. We observed improvements after the two surgeries, but the lateral pharyngoplasty gave better polysomnographic findings with less complications.
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Percutaneous combined common extensor origin release and drilling of lateral humeral epicondyle resistant tennis elbow
Medhat T Maaty, Maged M El-Shennawy, Wail L Abdel-Naby, Mohib S Ahmad
July-December 2015, 32(2):137-140
Despite tennis elbow being a common disease in orthopedic surgery, its causative pathology is poorly understood. A prospective study b etween February 2012 and December 2014 of 16 patients (12 males and four females) of resistant tennis elbows after failure of conservative treatment for more than 6 months, had sustained to a combined percutaneous common extensor origin release and drilling of lateral humeral epicondyle. All patients were followed up for at least a year. Clinical results were evaluated in terms of pain relief, activity improvement and patient satisfaction. The results were excellent in 12 patients (75%) and good in three patients (18.75%) and poor i n one patient (6.25%). Pain relief was achieved on average 12 weeks after surgery. No wound complications were detected. Combining the percutaneous common extensor origin release with drilling of lateral humeral epicondyle in resistant tennis elbow cases improved the results and .increased patient's satisfaction.
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Evaluation of mannose-binding lectin serum level in prediction of neonatal sepsis
El-Sayed A Amer, Ossama S El-Shaer, Ibrahim M Mohamed
July-December 2015, 32(2):126-130
Background Despite improved neonatal care over the past decades, infections remain common and sometimes life threatening in neonates admitted to the neonatal ICU. Neonatal sepsis has the highest morbidity and mortality. Objective The aim of the study was to evaluate mannose-binding lectin (MBL) serum level as a marker for prediction of neonatal sepsis. Patients and methods This prospective case-control study was conducted on 90 neonates admitted to the neonatal ICU. The 90 neonates were divided into two groups: the patient group and the control group. The patient group included 45 cases with neonatal sepsis and the control group included 45 healthy neonates. Serum levels of MBL were measured by immunoassay. The results were tabulated and analyzed with SPSS. Results Serum MBL levels were significantly lower in the neonates with sepsis than in the control group (0.455 ± 0.245 vs. 1.212 ± 0.249 μg/ml; P < 0.001). The lowest MBL levels were detected in those infants with septic shock. MBL had high sensitivity (97.7%) and specificity (86.6%) as well as positive (88%) and negative (97.5%) predictive values to detect sepsis. Conclusion and key messages MBL serum level could be considered a sensitive and specific marker for prediction of neonatal sepsis. Neonates with significant decrease in MBL are at increased risk for developing sepsis and septic shock.
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The effect of topical estrogen on healing of chronic tympanic membrane perforations and hearing threshold
Ahmed M Seliet, Mohsen M Abdel Razik, Naslshah G Kazeem, Ahmed A Ibrahim, Omneya E Bioumy
July-December 2015, 32(2):141-145
Background Tympanic membrane (TM) perforations can arise from a variety of causes. Major causes include trauma and middle ear disease. Surgical treatment involves higher costs, more effort, and surgical risks. Therefore, many investigators have studied topical use of substances to facilitate TM repair. Estrogen can influence the various phases of wound healing in cutaneous repair. Topical estrogen application may influence the repair of TM perforations. Aim of the work The aim of the work was to evaluate a new procedure for repairing TM perforation and improving hearing threshold after 30 days using estrogen paper patch. Patients and methods After obtaining informed consent, patients were randomly allocated into two groups. One group was treated with estrogen paper patch (paper patch impinged with1% estrogen ointment to act as the study group), and the second group was treated with paper patch impinged with local antibiotic ointment to act as the control group (we used 1% tetracycline ointment in our study). Conclusion Perhaps, there is a significant and promising result for estrogen paper patching as a method of repairing TM perforation.
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