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   Table of Contents - Current issue
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January-March 2019
Volume 17 | Issue 1
Page Nos. 1-108

Online since Thursday, September 12, 2019

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ORIGINAL ARTICLES  

Effect of eating and psychopathological traits in psoriatic patients p. 1
Naglaa A Ahmed, Taghreed M El Shafie, Sherihan M Abd Alhalim
DOI:10.4103/AZMJ.AZMJ_59_18  
Background Psoriasis is a chronic inflammatory immune-mediated skin disease. Few studies have investigated the link between psychiatric disorders including eating disorders (EDs) and psoriasis. We hypothesized that EDs and the psychological effect of psoriasis contribute to the development of obesity and metabolic syndrome in psoriatic patients, who are frequently susceptible to psychiatric comorbidity. Objective The objective of this study was to evaluate the presence of EDs and psychological distress in patients affected by psoriasis compared with a control population and correlate these data with different features of the cutaneous disease and BMI. This was done to suggest the importance of a psychological support that could reduce the occurrence of loss of control over food and help psoriasis improvement. Patients and methods From September 2014 till February 2015, we enrolled 100 consecutive psoriatic outpatients and a control group of 100 selected nonpsoriatic outpatients, matched by age, sex, and BMI to the study group. The assessment utilities were composed by the Eating Disorder Inventory (EDI), the Symptom Checklist-90-Revised (SCL-90-R), and the Psoriasis Area Severity Index score. Results Regarding EDI and SCL-90-R subscales, psoriatic patients had higher scores for all EDI and SCL-90-R subscales than nonpsoriatic patients. According to the relation between BMI and SCL-90-R subscales in psoriatic patients, obese and overweight groups showed higher scores in all SCL-90-R subscales than the normal weight group. Conclusion In patients with psoriasis, EDs and severe psychiatric symptoms seem to be associated with overweight/obesity more frequently than in the general population.
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Peripheral blood mononuclear cells hepatitis C virus RNA as a predictor for the response to daclatasvir-containing oral antiviral regimen in chronic hepatitis C patients from the Damietta Governorate p. 9
Alaa E Hashim, Samy Zaky, Naglaa Azab, Fathiya El-Raey, Mahmoud A Halim
DOI:10.4103/AZMJ.AZMJ_78_18  
Background Eradication of hepatitis C virus (HCV) infection is the goal of direct-acting antivirals with a high rate of sustained virological response (SVR). Currently, SVR is determined by negative serum HCV RNA by real-time (RT)-PCR that may not give any information about intracellular HCV replication. Aim To study peripheral blood mononuclear cells (PBMCs) HCV RNA as a predictor for the response to daclatasvir-containing oral antiviral regimen in chronic hepatitis C patients. Patients and methods In all, 150 patients with chronic HCV, classified into 100 easy-to-treat patients (group I) and 50 difficult-to-treat patients (group II), who achieved SVR to sofosbuvir plus daclatasvir with or without ribavirin were enrolled in the study. HCV RNA was evaluated in both sera and isolated PBMCs using the polymerase chain at 3 and 12 months from the end of treatment (EOT). Results As regards HCV RNA in peripheral blood mononuclear cells (PBMCs) we found that no case was positive in the easy to treat (group I). In difficult to treat (group II), six (4%) patients were positive at 3 months and 24 (16%) patients at 12 months after EOT. However, there is no virological, clinical, or biochemical relapse noted during the follow-up period among positive cases. All positive cases were cirrhotic, with significantly lower platelets count and albumen level but higher bilirubin than group I. Conclusion All easy-to-treat groups were HCV RNA in PBMCs negative at EOT and during the follow-up period (1 year). Follow-up of cirrhotic patients with positive HCV RNA in PBMCs showed no clinical, biochemical, or virological relapse.
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Assessment of comorbidities in patients with chronic obstructive pulmonary disease: a cross-section study p. 14
Ammar M Nashwat, Hamada Kawshty, Yasin Abd-ElKareem, Ibrahim M Shalan
DOI:10.4103/AZMJ.AZMJ_100_18  
Background Chronic obstructive pulmonary disease (COPD) is common and usually coexists with other diseases. The aim of this study was to assess comorbidities in patients with COPD. Patients and methods This is a cross-sectional controlled study of comorbidities in patients with COPD that was carried out on 200 patients with COPD and 180 non-COPD patients as control. They were admitted to or investigated in outpatient clinic of Chest Disease Department of Assiut Hospital, Al-Azhar University, during the period from November 2016 to May 2018. A patient with COPD was defined as a smoker with forced expiratory volume in first second/forced vital capacity less than 0.7, and comorbidities were defined based on objective laboratory findings and questionnaires. Results This study included 380 patients, comprising 200 patients with COPD (75% males and 25% females, with mean age of 62±10.1 years) and 180 non-COPD patients (76.7% males and 23.3% females, with mean age of 61.1±5.6 years). The most common comorbidities reported in our COPD population versus non-COPD in decreasing order of frequency were hypertension (40 vs. 30%) followed by dyslipidemia (35 vs. 30%), asthma (30 vs. 13.8%), gastroesophageal reflux disease (30 vs. 16.1%), obesity (22.5 vs. 20%), bronchiectasis (21 vs. 6.1%), diabetes mellitus (19 vs. 12.2%), anemia (19 vs. 12.2%), ischemic heart disease (17 vs. 10%), and pneumonia (15.5 vs. 7.8%). Conclusion COPD is more common in smoker old aged male individuals, and the most common comorbid conditions associated with COPD are hypertension, dyslipidemia, gastroesophageal reflux disease, diabetes mellitus, and ischemic heart disease.
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Harmonic scalpel versus conventional hemorrhoidectomy p. 24
Hazem A Megahed
DOI:10.4103/AZMJ.AZMJ_104_18  
Introduction In this study, harmonic scalpel hemorrhoidectomy was compared with the classical Milligan–Morgan hemorrhoidectomy regarding the outcome and the postoperative complication rates. Patients and methods Between June 2014 and September 2018, 40 patients aged between 30 and 60 years old underwent a hemorrhoidectomy operation in Al-Azhar University Hospital, New Damietta. The patients were randomly subdivided into two groups: group A included 20 patients who underwent the classical Milligan–Morgan hemorrhoidectomy operation, which represented the conventional method, and group B included 20 patients who underwent a hemorrhoidectomy with the use of a harmonic scalpel. The outcome and postoperative complications were compared between the two groups. Results In the harmonic scalpel group (group B), the posthemorroidectomy static pain was significantly lesser on the postoperative days 3, 7, and 14, but it was nonsignificantly lesser on the first postoperative day. Moreover, there was significant decrease in mean hospital stay in group B (1.0±0.2 days) vs. in group A (conventional method group) (1.3±0.4 days). The operative time was significantly decreased in group B (15±1.1 min) versus group A (20±2.1 min). Regarding early complications such as minor bleeding and urinary retention, they were lesser in group B, but without significance. Conclusion Harmonic scalpel hemorrhoidectomy is a less time-consuming bloodless procedure and has lesser postoperative pain and bleeding when compared with conventional hemorrhoidectomy.
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Risk factors for cessation of breastfeeding p. 30
Hussein Koura
DOI:10.4103/AZMJ.AZMJ_111_18  
Introduction The Kingdom of Saudi Arabia is advancing quickly in all parts of life and health care. Nonetheless, breastfeeding is said to be on the deterioration. Patients and methods A case–control study was carried out to evaluate the risk factors that may lead to cessation of breastfeeding among infants and children less than 2 years who live in Al Kharj and Al Riyadh cities, Saudi Arabia. Cases included mothers of infants who stopped breastfeeding during first year after delivery, whereas controls were mothers of infants or children who were breastfed for 1 year or more. In total, 366 mothers were enrolled: 183 for continued breastfeeding group and the same number for stopped breastfeeding group. Each enrolled mother was interviewed by a specially designed questionnaire. Results Risk factors for cessation of breastfeeding were delivery by caesarean section, full- or part-time mother’s employment, usage of oral contraceptives, higher level of education, and absence of support for breastfeeding. Adjusted odds ratios were 2.2, 2, 1.9, 1.8, and 1.6, respectively. Conclusion As a result of the study, it was recommendation to pay attention toward pregnant women with these risk factors to support them to continue breastfeeding for 2 years.
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Comparative study between ranibizumab and aflibercept in the management of macular edema caused by diabetes mellitus in age group more than 40 years p. 35
Abd El-Magid M Tag El-Din
DOI:10.4103/AZMJ.AZMJ_115_18  
Background Diabetic macular edema (DME) is a common cause of blindness and visual impairment in diabetic patients, which can affect the quality of life. Aflibercept and ranibizumab are used as intravitreal anti-vascular endothelial growth factor injections; both of them have a relatively safe effective treatment of DME. Aim of the work To compare the effect of aflibercept and ranibizumab in the management of DME. Patients and methods A prospective invasive and nonrandomized study, including 20 eyes in 20 patients, more than 40 years old, was conducted in Al-Azhar Faculty of Medicine, Cairo, with three times injections 1 month apart. Eyes were divided into two groups: group A included 10 patients who received ranibizumab 0.5 mg (0.05 ml of 10 mg/ml solution) as an intravitreal injection, and group B included 10 patients who received aflibercept 2 mg (0.05 ml of 40 mg/ml solution) as an intravitreal injection. Follow-up period was 4 months. Results A statistically significant improvement of best-corrected visual acuity (BCVA) and central macular thickness with ranibizumab was reported over the follow-up period. There was also a statistically significant improvement of BCVA, central macular thickness, and intraocular pressure over the follow-up visits with aflibercept. Ranibizumab was more effective in BCVA correction and in the reduction of central macular thickness than aflibercept. Conclusion Both ranibizumab and aflibercept are effective in improving the BCVA and in the reduction of central macular thickness. Ranibizumab is more effective for BCVA correction and in the reduction of central macular thickness than aflibercept Recommendations Further studies are needed to confirm the effect of ranibizumab and aflibercept intravitreal injection on the central macular thickness and intraocular pressure.
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Role of central lymphadenectomy in managment of differentiated thyriod cancer p. 48
Mohammed Mamdoh Ahmed Asar, Mohamed Kamel El Awady, Ahmed Seddik Abdelgelil, Mohammed El Sharkawy, Osama Mostfa Mostafa
DOI:10.4103/AZMJ.AZMJ_131_18  
Background Differentiated thyroid cancers may be associated with regional lymph node (LN) metastases in 20–50% of cases. Papillary thyroid cancer is the most common thyroid malignancy, and cervical nodal metastases are frequent at presentation. Objective This study aims to detect the therapeutic and prophylactic results of centeral neck dissection (CND) in an adjunct to total thyroidectomy for the treatment of differentiated thyroid cancer and its effect in reducing local recurrences and the need for postoperative radioiodine ablation. Patients and methods This study was carried out on 30 patients with thyroid cancers. They were managed at Oncological Surgery Departments of Al-Azhar University between January 2017 and August 2018. This study included 30 patients, comprising 10 (33.3%) males and 20 (66.6%) females, and their ages ranged from 26–82 years old, with a mean age of 51 years. They all underwent total thyroidectomy and CND for differentiated thyroid cancer, which was proved preoperatively by fine-needle aspiration from thyroid swelling. Neck ultrasound and high-resolution neck computed tomographic scan with contrast were done to detect size and extension of thyroid cancer and any concerning LNs. Results The analysis of nodal spreading in this study showed an ipsilateral central nodal metastasis on the same side of affected lobe and bilateral central LN metastasis when the tumor arose within each lobe or from isthmus, as the lesions from isthmus had wide diffusion. Moreover, this study showed tumors with size of 20 less than or equal to T2 less than 40 mm associated with the presence of LN metastases were subjected to postoperative 131I ablation, and also a size greater than or equal to 40 mm with vascular invasion or tumor extension beyond the thyroid capsule even not associated with the presence of LN metastases were subjected to postoperative 131I ablation. Conclusion Prophylactic central compartment neck dissection (ipsilateral or bilateral) should be considered in patients with differentiated thyroid cancer (DTC) with clinically noninvolved central neck LNs (cN0) who have locally advanced primary tumors (T3 or T4), and prophylactic ipsilateral CND and lateral neck dissection for DTC less than 2 cm in diameter allowed selection of patients for postoperative 131I ablation and modified the indication for 131I ablation in patients with pT1 tumors.
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Comparison of endoscopic findings in Egyptian and Indian patients: a retrospective cohort p. 54
Essam A Hassan, Tarek I Ahmed, Sanjay Rajput
DOI:10.4103/AZMJ.AZMJ_139_18  
Aims Esophagogastroduodenoscopy is the commonest diagnostic procedure performed to evaluate upper gastrointestinal tract. However, there are limited data on the differences in endoscopic findings in different populations. Therefore, we conducted this study to compare the frequencies of endoscopic findings in two different populations. Patients and methods We used a large endoscopic database to retrieve the data of patients who underwent esophagogastroduodenoscopy at Fayoum University Hospital, Egypt and Ansh Clinic, Ahmadabad, India in the year of 2016. Results A total of 7107 patients were included in the final analysis: 5527 from India and 1580 from Egypt. Indian patients were more likely to present with normal finding (54.6 vs. 22.7%, P<0.001), whereas Egyptian patients were presenting with varices more commonly (49.5 vs. 15.9%, P<0.001). The Egyptian cohort showed a high frequency of grades I and III gastroesophageal reflux disease, whereas the Indian cohort revealed higher grades I and II varices (P<0.001). Gastritis was more common in Indian patients (67.2 vs. 35.2%, P>0.001). Overall, varices are most common in older male patients (>20 years), gastroesophageal reflux in males, and gastritis in females. Conclusion Further research is needed to validate our findings regarding the effect of age and sex on the frequency of endoscopic findings.
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Role of drug-eluting beads versus conventional transarterial chemoembolization in the treatment of hepatocellular carcinoma p. 61
Mahmoud Abu Elfadl, Mohamed S. Abdelaziz Shehata, Mohammed G Mohamed, Ahmed S Elskaan
DOI:10.4103/AZMJ.AZMJ_4_19  
Background Transarterial chemoembolization has become the current standard therapy for the intermediate-stage hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer staging system. Conventional transarterial chemoembolization (cTACE) involves the injection of an embolic agent into the tumor-feeding arteries to block its major nutrient source resulting in tumor ischemic necrosis. Drug-eluting beads transarterial chemoembolization (DEB-TACE) was developed to deliver higher doses of chemotherapeutic agents over longer drug-tumor contact times. Objective The aim of this study was to highlight on the safety and efficacy of DEB-TACE versus cTACE in patients with intermediate-stage HCC. Patients and methods This study was carried out on 55 patients presented with irresectable who HCC underwent either cTACE: group 1, 25 patients or DEB-TACE; group 2, 30 patients from July 2016 to June 2017. All patients were subjected to full history taking, thorough clinical examination, investigations, imaging, adequate follow-up at 1, 3, and 6 months and were categorized according to the modified Response Evaluation Criteria in Solid Tumors. Results According to the modified Response Evaluation Criteria in Solid Tumors responding disease was seen in 28 patients who underwent DEB-TACE and 18 who patients underwent cTACE, while nonresponding disease was found in two patients who underwent DEB-TACE and seven patients underwent cTACE (P=0.033). Complications such as postembolization syndrome and ascites occurs more in patients who underwent cTACE than after DEB-TACE (P=0.04, P=0.61). Conclusion DEB-TACE is more effective than cTACE in intermediate-stage HCC with less side effects.
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Inflammatory biomarkers as prognostic indicators for liver cirrhosis p. 68
Naglaa Abou-Elfattah Tawfik, Naglaa A El-Gendy, Hanaa Abou Elyazid Abou Elhassan, Eman Elshohat Ebrihem, Rayyh Abdelazeem M Saleh
DOI:10.4103/AZMJ.AZMJ_15_19  
Background Severity of liver cirrhosis is commonly assessed by Child–Pugh and model of end-stage liver disease (MELD) scores, which reflect liver dysfunction mainly and do not assess associated systemic events, which influence the failure of other organs. Aim To study the role of serum level of copeptin (CPP) and high-sensitivity C-reactive protein (hsCRP) as indicators of prognosis in liver cirrhosis and compare these results with usual prognostic scores, raising the importance of proper management of systemic infections in cirrhotic patients to prevent cirrhosis progression. Patients and methods A cross-sectional study was carried out on 80 cirrhotic patients, who were classified into four equal groups: Child A, B, C, and Child C with systemic infections. Serum CPP and hsCRP were measured by enzyme-linked immunosorbent assay technique. Results There was a statistically significant increase in CPP serum levels among cirrhotic patients [9.70 (7.70–14.30)] in comparison with its serum level in healthy participants [5.95 (5.40–6.75)]. There were gradually increases of CPP serum levels through Child–Pugh A, B, and C groups [6.40 (5.42–8.05), 10.15 (7.75–14.20), and 13.05 (8.77–17.27), respectively] in comparison with the control group. There were positive correlations of CPP with MELD score, Child–Pugh, and hsCRP (r=0.60, 0.71, and 0.60, respectively, P<0.000). There was a significantly increase in serum level of hsCRP among cirrhotic patients [9.90 (7.12–16.67)] than control group [2.50 (1.67–5.91)]. Its median values and interquartile range concentrations were the lowest among healthy group and increased gradually through Child–Pugh A, B, and C and Child–Pugh C with infection groups [2.50 (1.67–5.91), 7.15 (6.32–9.45), 8.35 (7.12–12.17), 9.20 (6.95–13.15), and 20.35 (14.85–32.22), respectively] (P=0.000). There were significant positive correlations of hsCRP with CPP, MELD score, and Child–Pugh (r=0.51, 0.54, and 0.75, respectively). Conclusion CPP and hsCRP serum levels can be used as prognostic indicators of liver cirrhosis and account for systemic infections involved in deterioration of liver cirrhosis.
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Comparison study between bentall operation and valve-sparing procedures p. 75
Mahmoud M.Z Ghalwash, Mohamed Abdel Hafez Fouly
DOI:10.4103/AZMJ.AZMJ_18_19  
Background The best solution for management of cases presented with aortic aneurysm still presents a lot of debate. Objectives To compare between Bentall operation and valve-sparing procedures in different cases of aortic aneurysm. Patients and methods The study included 45 patients who underwent the aortic root operation either Bentall operation (group A=30 patients) or Tirone David operation (group B=15 patients). Comparison between the two groups was done in several preoperative, intraoperative, and postoperative data. Conclusion Bentall is preferred than Tirone David for patients who undergo aortic root operation.
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Is chronic obstructive pulmonary disease a risk factor for erectile dysfunction? A cross-sectional, comparative study p. 79
Hamada Kawshty, Mahmoud A.S Makki, Walid A Elmorsy, Maher A Shabaan, Ahmad A Ahmad
DOI:10.4103/AZMJ.AZMJ_26_19  
Background Sexual dysfunction is a common problem in chronic obstructive pulmonary disease (COPD). Aim To evaluate the sexual activity in patients with COPD. Patients and methods A total of 100 male patients with COPD (diagnosed and staged according to the American Thoracic Society guidelines) and 96 healthy volunteers (controls) with normal pulmonary function were included. After clinical evaluation, pulmonary function test, arterial blood gas, and hormonal profiles such as follicle-stimulating hormone, leutenizing hormone, and testosterone (total and free) were measured and compared. Participants were asked to answer the International Index of Erectile Function questionnaire as a method to diagnose and classify impotency. Results Varying degrees of erectile dysfunction (ED) was detected in 78 (78%) patients with COPD and 56 (58.3%) of controls. The mean score of ED was found to be significantly (P<0.000) lower in comparison with the controls with significantly correlated with age, smoking index, percentage of forced expiratory volume in the first second, percentage of forced vital capacity, FEV/EVC ratio, PaO2, PaCO2, oxygen saturation (SaO2), total testosterone, and 6-min walk test. The smoking index, PaCO2, follicle-stimulating hormone, and leutenizing hormone were found to be significantly higher in patients with COPD compared with controls whereas percentage of forced expiratory volume in the first second, percentage of forced vital capacity, PaO2, SaO2, and BMI were significantly lower in patients with COPD. The results of 6-min walk test test between the two groups reveal highly significant decrease in physical fitness in patients with COPD than normal controls. Conclusion ED is a frequent problem in patients with COPD. Hypoxemia, smoking, limitation of physical activity, and hormonal imbalance are thought to be responsible mechanisms for ED in patients with COPD.
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Frequency of cow milk protein allergy in children during the first 2 years of life in Damietta Governorate p. 86
Hussein M. Abdel Maksoud, Lotfy Abdel F Al Seheimy, Kamel Abdel G Hassan, Mahmoud F Salem, Eman Abd A.M Elmahdy
DOI:10.4103/AZMJ.AZMJ_29_19  
Background Many research studies have been done to explore the prevalence of cow milk allergy. Aim of the work The aim of this study is to determine the frequency of cow’s milk protein allergy (CMPA) among children of Damietta Governorate during the first 2 years of life. Patients and methods A cross-sectional study with nonsystemic random sampling was conducted on 1000 children in the first 2 years of age, comprising 512 male and 488 female exposed to cow milk or its products either directly or indirectly, attending outpatient clinics of Al Azhar University Hospital in New Damietta. Each included infant was subjected to history taking and clinical examination, and suspected cases from history and examination were subjected to skin prick test, specific immunoglobulin E (IgE) for cow’s milk protein, oral food challenge, and food elimination tests. Results In the present work, there was a male predominance among the suspected group (58.5% males and 41.5% females). We found that infants from urban regions were more affected than those from rural regions (61.76% of the confirmed cases were from urban areas and 38.24% from rural regions). We found that the risk of CMPA declined in exclusively breast-fed infants. The clinical manifestations in infants with suspected CMPA were variable, and the main presenting feature was gastrointestinal tract manifestations (84% of the cases) (P<0.001). Conclusion This study showed that the frequancy of CMPA in infants in the first 2 years of life in Demietta Governrate was 3.4%, as confirmed by positive food elimination and oral food challenge tests, and the IgE-mediated CMPA was more common, as 67.6% of cases had IgE-mediated CMPA.
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Comparative study between onlay and sublay repair of ventral hernia p. 96
Radwa M Mohamed, Omnia M Rabie
DOI:10.4103/AZMJ.AZMJ_60_19  
Background Ventral hernia is one of the most common surgical operations performed all over the world. Surgical repair is done using prolene mesh and can be placed over anterior rectus sheath (onlay) or in preperitoneal space. However, the debate still continues about the superiority of each technique over the other. Aim To study operative time, easy of procedure, early postoperative complications, duration of hospital stays, recurrences, and outcomes of the onlay versus sublay mesh repair. Patients and methods One hundred patients with paraumbilical, epigastric, and supraumbilical incisional hernias were included in this study and were managed at Al Zahra Hospital. Patients were divided into two main groups: group A underwent onlay mesh repair and group B sublay mesh repair. The patients included were evaluated for operating time, postoperative seroma formation wound infection, drain duration, postoperative hospital stay, and recurrence of symptoms. Results A total of 100 patients were operated in our study: 50 patients were in group A and 50 patients in group B. The mean operative time in group B was 70±18.50 min and in group A was 50±12. The duration of hospital stay was on an average 1–3 days in group B, and average hospital stay was 2–4 days in group A. In the group B, the drain was removed after 2–3 days, and in some patients with small defect, there was no need for putting a drain, but in group A, the drain was removed after 2–5 days, except for one patient with large supraumbilical incisional hernia, where drain was removed after 10 days. Postoperative complications like a seroma and wound infection were comparable in both groups. Conclusion Sublay mesh repair is a better technique with less incidence of seroma formation, a lower rate of postoperative compilations like infection and wound edge necrosis, no recurrence rate, and minimal mesh related-compilations.
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Evaluating the role of MRI with diffusion-weighted images in diagnosis of uterine focal lesions p. 103
Hoda A.E Abd Elsamie, Mahmoud I El-Rasheedy, Mohammed A.A Mohammed
DOI:10.4103/AZMJ.AZMJ_61_19  
Objective The aim of this study is to highlight the role of MRI with diffusion-weighted (DW) images in diagnosis of uterine focal lesions, especially in differentiation between benign and malignant masses, and initial staging of known malignancies. Patients and methods A total of 34 patients with uterine focal lesion were included in the study. The patients’ age ranged from 25 to 87 years old, with mean age of 49.6 years. All the patients were referred from the Obstetrics and Gynecology Department to Radiodiagnosis Department at Al Azhar Assiut University Hospital during the period from November 2017 to October 2018. Results In this study, DW MRI could correctly diagnose 33 of 34 lesions. It correctly diagnosed 22 of 22 benign lesions (facilitate diffusion) and 11 of 12 malignant lesions. Overall, 11 malignant lesion showed restricted diffusion, and only one malignant lesion showed facilitated diffusion. Conclusion This study suggests that, in addition to conventional MRI features, DW imaging provided an additional tool for distinguishing uterine benign focal lesions from malignant lesions.
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ERRATUM Top

Erratum: Sensory and motor effects of dexmedetomidine as an adjuvant to bupivacaine for brachial plexus block p. 108
Yousry Kandil, Medhat Noaman
DOI:10.4103/AZMJ.AZMJ_99_19  
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