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Evaluation of serum ferritin level in patients with fever of unknown origin
Raed Hamed Mansour, Shaban Salah Abd El-moneum, Tarek Aly Hassan, Ahmed Abdelalim Abuo Elhassan, Mohamed Hasan Elnadry, Wlid Mohamed Elbakrawy
July-September 2017, 15(3):135-141
Background Diagnosis of the cause of fever of unknown origin (FUO) is a great challenge. Serum ferritin may be a useful index for differentiating between infectious and noninfectious causes of FUO (malignant disease or collagen disease). In this respect, serum ferritin has the advantage of decreasing the number of unnecessary tests and helping to exclude infectious disease. Objective This study aimed to evaluate serum ferritin levels among patients suffering from FUO. Methods A comparison was made between infectious, noninfectious, and undiagnosed cases of FUO as regards serum ferritin level using an in-vitro enzyme-linked immunosorbent assay. Results The most common causes of FUO were infectious diseases (120/300, 40%), followed by noninfectious diseases such as malignant (61/300, 20.4%) and autoimmune causes (49/300, 16.3%). Undiagnosed cases constituted 70/300 (23.3%). The mean serum ferritin level in the infectious group, noninfectious group, and undiagnosed group was 99.25±49.58, 1098.94±284.54, and 112.40±183.23, respectively, with highly significant difference between infectious and noninfectious causes of FUO (P<0.001). However, there were no significant differences between infectious and undiagnosed causes of FUO. The optimal cutoff point was 559.0; the area under the curve was 0.79, with highly significant difference (P<0.001) at 95% confidence interval of 0.71–0.88. Conclusion High serum ferritin level (>559 ng/ml) helps in differentiation between infectious and noninfectious causes of FUO. In undiagnosed cases of FUO we must direct our thinking to infectious diseases.
  4,056 259 -
Impact of dual hepatitis B and C infection on disease severity and treatment outcome: updated review
Gamal Esmat, Tamer Elbaz
October-December 2016, 14(4):149-152
Hepatitis B, C are commonly present together. They both share same routes of transmission. Dual infection carries a wide, variable range of virological, clinical profiles. Even in terms of management, large debates arose due to related issues such as priority for treatment, fate of the second virus if the primary one is eradicated.
  1,113 2,749 -
Bacterial catheter-associated urinary tract infection in the Intensive Care Unit of Assiut University Hospital
Sherine A Aly, Rania A Tawfeek, Ismail S Mohamed
April-June 2016, 14(2):52-58
Objective The aim of this study was to identify the risk factors and common pathogens associated with catheter-associated urinary tract infection (CAUTI) in the ICUs of Assiut University Hospital, Egypt. Methods Urine samples were collected from patients suffering from CAUTI according to the case definition of Centers for Disease Control and Prevention. The samples were subjected to culture on different culture media, and all positive colonies were identified according to their biochemical profile and antibiograms. Klebsiella isolates were further tested for extended-spectrum β-lactamase production. Results The overall bacterial CAUTI incidence rate was 11% (15/136 patients). Female sex, old age (>60 years old), diabetes mellitus, and prolonged duration of catheterization (>6 days) were found to be risk factors for the development of bacterial CAUTI. Klebsiella was the commonly isolated microorganism (8/16, 50%). All Klebsiella isolates were found to be phenotypically Extended-spectrum β lactamase producers, and five of these isolates contained either blaTEM or blaSHV genes. Conclusion This study revealed the high incidence of bacterial CAUTI (11%) in ICUs of Assiut University Hospital. ESBL-producing Klebsiella spp. is responsible for about 50% of bacterial CAUTI cases. All isolated microorganisms were found to be multidrug resistant. Strict implementation of infection control procedures appears to be necessary to control the spread of multidrug resistant organisms.
  2,500 265 2
Is bronchial asthma a risk factor for chronic kidney disease?
Zeinab R Adawy, Rayyh A Mohamad-Saleh, Taghreed Abdul-Aziz M Ismail
January-March 2017, 15(1):27-34
Introduction Bronchial asthma is a chronic, inflammatory lung disease with exacerbations. Patients with asthma have higher risks of coronary heart disease, diabetes mellitus, and hypertension, although the impact of asthma on other vital organs is not yet verified. Chronic kidney disease (CKD) is a major global problem. In addition to well-known risk factors of CKD, there might be other previously underestimated or unrecognized risk factors that are not yet discovered. Aim The aim of this study was to determine the frequency and factors associated with CKD among asthmatic patients. Patients and methods An analytical, cross-sectional study was conducted on 118 patients known to have bronchial asthma and 118 healthy individuals; all of them were subjected to spirometry. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study group equation. Results Development of CKD was significantly higher among asthmatic patients than in healthy individuals (17.4 vs. 0.8%, respectively). GFR was higher in the well-controlled asthmatic group than in the uncontrolled group (96.3±18.1 vs. 90.1±20.3), but this difference was statistically insignificant. Occurrence of CKD was significantly higher among those with asthma for 20 years or longer than those with asthma for less than 20 years (45.5 vs. 2.4%, respectively). GFR was negatively correlated to age, BMI, and disease duration with high statistical significance, and was positively correlated with all parameters of pulmonary function test (FVC%, FEV1%, FEV1/FVC, and PEFR%) and partial O2 pressure with high statistical significance. Significant predictors for the development of CKD among asthmatic patients were longer disease duration and higher BMI. However, high partial O2 pressure was protective for the development of CKD. Conclusion Bronchial asthma can be associated with CKD. Prolonged disease duration and higher BMI were the most common predictors for the development of CKD.
  2,434 184 -
Inclusion of the fracture level in short-segment fixation of unstable traumatic thoracolumbar spine fractures
Samir A Elshoura, Mostafa A Elsamea
October-December 2016, 14(4):153-157
Introduction The diagnosis, classifications, and treatment of injuries of the thoracolumbar spine continue to attract controversy. Objective The present study evaluated the efficacy of treatment of unstable thoracolumbar burst fractures by transpedicular screw fixation including the fractured vertebra. Patients and methods From January 2013 to March 2015, 40 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in Al-Azhar University Hospital, Damietta. Results Forty (25 male and 15 female) patients with age ranging between 16 and 66 years (mean 41.8%) were operated upon by posterior transpedicular screw fixation. According to the American Spinal Injury Association scoring system, all patients were grade E. The mean of kyphotic deformities measured preoperatively was 18.4±5.5° and after 12 months of follow-up it was 9.0±4.1°. Conclusion By applying the transpedicular screw fixation of the unstable fractures of the thoracolumbar spine, a stable fracture fixation can be achieved; this kind of fixation prevents secondary spine deformities.
  861 1,337 -
Importance of histopathological evaluation of appendectomy specimens
Mohamed Abd Al-Fatah
April-June 2017, 15(2):97-103
Background Appendicitis is by far the commonest major emergency general surgical operation. Pathological evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings. The objective of this study was to analyze the clinical benefit of histopathological analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. Patients and methods The clinicopathological data of 460 patients who underwent appendectomies for presumed acute appendicitis were reviewed prospectively. Results There were 265 men and 195 women [sex ratio (male/female): 1.4] aged between 16 and 62 years (mean: 27.6 years). All patients underwent open appendectomy. Histological examination of the surgical specimen showed normal appendix in 28/460 (6%) cases, gross inflammation in 365 (79.3%) cases, gangrenous appendix in 32 (7%) cases, perforation and localized peritonitis in 30 (6.6%) cases, and generalized peritonitis in five (1.1%) cases. Incidental unexpected pathological diagnoses were noted in 39 (8.5%) appendectomy specimens. They included Enterobius vermicularis (n=19), mucinous neoplasms (n=3), neuroendocrine tumors (n=1), granulomatous inflammation (n=12), tuberculosis (n=1), bilharziasis (n=1), and endometriosis (n=2). Other associated pathological findings were ruptured ovarian cyst (n=9), perforated duodenal ulcer (n=3), Meckel’s diverticulum (n=1), disturbed ectopic pregnancy (n=3), and cecal adenocarcinoma (n=2). Conclusion The diagnosis of acute appendicitis has been improved, with a significant reduction in negative appendectomy rates. Routine pathological examination of appendectomy specimens is of value for identifying unsuspected pathologies requiring further postoperative management. Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic examination. It is highly recommended that in order to avoid misdiagnoses, all appendix specimens should be examined histopathologically.
  1,869 213 1
The role of methylene blue in laparoscopic sleeve gastrectomy
Osama A Abdul Raheem, Mohamed Yousef, Abd-EL-Aal Ali Saleem Mohran, Hassan A Abdallah, Asmaa Gaber
July-September 2016, 14(3):122-125
Introduction Methylene blue (MB) is a molecule that has been playing important roles in microbiology and pharmacology for some time. It has been widely used to stain living organisms and to treat methemoglobinemia, and lately it has been considered as a drug for photodynamic therapy. Nowadays, it is used in the treatments of basal cell carcinoma, Kaposi’s sarcoma, melanoma, and virus and fungal infections. MB has low toxicity and no adverse effects. Patients and methods This study was conducted in Aswan University on female and male patients. Our study was done on 70 patients, who had an average age of 29.8 years, with minimum of 25 years and maximum of 35 years. Patients were studied preoperatively with complete investigations, a multidisciplinary workup including specialist counseling (internal medicine, psychiatry, and anesthesiology), and complete performance status evaluation. Patients were well informed about the surgical procedure, with all potential advantages and possible complications and adverse effects. Then they were proceeded to laparoscopic sleeve gastrectomy and the uses of intraoperative MB to confirm any leaks from the stapler line. Postoperative data regarding fever, tachycardia, vomiting, abdominal pain and distention, abdominal ultrasound for any collection, and complete blood count were recorded. All the above data were collected and analyzed to obtain statistically relevant results. Results Apart from mild abdominal pain and tenderness, and low-grade fever, no collection appeared clinically or by ultrasound examination in all cases. All patients received oral fluids on the third postoperative day, and no vomiting developed. White blood cell count was done for all patients, and they were normal except five patients who developed chest infection with low-grade fever which improved with antibiotic. Before discharging the patients, abdominal ultrasound was done for all, and no collection of fluid appeared. Conclusion Intraoperative MB usage is a safe and effective technique in detecting gastric leak during laparoscopic sleeve gastrectomy.
  1,813 146 -
Peptide tyrosine tyrosine (PYY) as a new strategy for treating obesity
Ahmed Mostafa Mahmoud
July-September 2016, 14(3):101-108
Background Obesity is a risk factor for obesity-related disorders such as type 2 diabetes mellitus, vascular disease, osteoarthritis, sleep apnea, and malignancy. Obesity cohinder the individual work capacity, and the cost for managing obesity complications is high. Objective The objective of this research was to study the role of pancreatic polypeptide family including neuropeptide Y and peptide tyrosine tyrosine (PYY) in obesity development and its metabolic changes. Materials and methods Twenty-seven adult female albino rats of a local strain were randomized into three equal groups for 5 weeks: sham-operated group, ovariectomized nontreated group, and ovariectomized treated group received PYY3–36 at a dose of 50 μg/kg, by intraperitoneal injection twice daily during the fifth week. Results Peripheral PYY3–36 administration reduces food intake, body weight gain, and serum glucose in ovariectomized obese female rats. Conclusion PYY system may offer a new therapeutic strategy for obesity management and its metabolic abnormalities.
  1,443 465 -
Interictal ceramide kinase in migraine
Manal H Maabady, Ghada S Abdelazim, Asmaa El Madbouly
October-December 2017, 15(4):163-167
Introduction Migraine is a common neurologic disorder. It is still controversial whether migraine is a primarily vascular disorder or caused by neuronal dysfunction, but it is likely that both have a significant role to play. Objective The objective of this study was to evaluate serum levels of interictal ceramide kinase in patients with migraine. Patients and methods A total of 35 patients with migraine, including 12 patients with migraine with aura and 23 patients with migraine without aura, and 16 apparently healthy, age-matched and sex-matched individuals were included in this study. Patients underwent full history taking, including type of headache, frequency of headache attacks per month, and assessment of migraine-related disability by the Migraine Disability Assessment Scale. Serum ceramide kinase level was evaluated for both patients (during pain-free period) and control participants using quantitative sandwich enzyme-linked immunosorbent assay. Results The patients with migraine had significantly higher serum levels of ceramide kinase than the control group, and these levels were significantly correlated with the frequency of the attacks and with scores of Migraine Disability Assessment Scale. Conclusion The results suggested that migraine is associated with alteration in sphingolipid metabolism and that might be because of increased levels of ceramide kinase.
  967 881 -
The effect of ginger on experimentally induced atherosclerosis in the aorta of rabbits: a histological and immunohistochemical study
Essam O Kamel, Wail M Gad El-rab
January-March 2017, 15(1):43-51
Background Atherosclerosis is a major disease of arteries, related to age and plasma cholesterol levels. Objective The objective of this study was to investigate the possible effects of ginger on experimentally induced atherosclerosis in the aorta of rabbits. Materials and methods Thirty, male rabbits aged 6 weeks were used in this study and were divided into three groups: group I included 10 male rabbits fed an ordinary diet for an experimental period of 8 weeks; group II included 10 male rabbits fed an ordinary diet mixed with 1% cholesterol powder at a dose of 200 mg/kg body weight for a period of 8 weeks; and group III included 10 rabbits fed an ordinary diet mixed with 1% cholesterol powder and were treated with ginger powder (4 g/kg of the dried rhizome) dissolved in saline solution daily for 8 weeks. The thoracic aorta was dissected and then processed for light microscopic studies. Results Our results showed an apparent decrease in the thickness of both tunica intima and tunica media in the ginger-treated group. There was no intimal invasion of smooth muscle cells. Regular wavy elastic fibers were noticed in the media with apparently normal smooth muscle cells distributed in between. In addition, there was no apparent difference in the CD34 reaction of endothelial cells in the ginger-treated group when compared with the control group. Conclusion Ginger has an attractive role in modulating atherosclerosis in the aorta of rabbits.
  1,597 162 -
Modified PPIs (a search for the better)
Hussein Abdel-Hamid
January-March 2016, 14(1):8-10
'Modified PPIs' is the term given to proton pump inhibitors (PPIs) introduced after the four conventional PPIs – omeprazole, lansoprazole, pantoprazole, and rabeprazole – all of which have similar actions and limitations and are produced by similar technologies. Modified PPIs include isomeric PPIs, dual delayed release PPIs, immediate release PPIs, and long half-life PPIs, which are manufactured by different technologies to overcome certain limitations of conventional PPIs. This modified category includes esomeprazole (Nexium), dexlansoprazol (Dexilent), omeprazole-sodium bicarbonate mixture (Zegred), and S.tenatoprazole. Although some of these new products have better efficacy, longer duration of action, can be taken with disregard to meals, and have better nocturnal effect, we still lack the ideal PPI.
  1,430 212 -
Prevalence and predictors of spontaneous bacterial peritonitis: does low zinc level play any role?
Asmaa N Mohammad, Laila M Yousef, Hamdy S Mohamed
January-March 2016, 14(1):37-42
Introduction Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening complication of cirrhosis. Several large studies have identified additional risk factors for the development of SBP. Zinc deficiency has been found to be frequent in cirrhotic patients. Aim of the work The aim of the present study was to evaluate the frequency, possible risk factors and the role of zinc in the development of first-time and recurrent SBP. Methodology A total of 176 cirrhotic ascetic patients admitted to the Hepatology Department in Sohag University Hospital were enroled in the study. SBP peritonitis was diagnosed through history-taking and through examination and laboratory investigations, including ascetic fluid study and the detection of serum zinc level. Results Of the 176 cirrhotic patients, SBP was diagnosed in 54 (31%); in total, 40 patients (23%) had single and 14 (8%) had recurrent episodes of SBP. Out of the 23 studied clinical and laboratory variables, we found that the prolonged use of proton pump inhibitor (PPI) (P = 0.001), lower prothrombin concentration (P = 0.03), ascetic protein level less than or equal to 1 g/dl (P < 0.0001) and zinc deficiency (P = 0.001) were independent risk factors for the development of SBP in cirrhotic patients; using multivariate analysis, only low protein in ascites less than or equal to 1 and low zinc status were predictors of SBP. Conclusion In our study, the frequency of SBP was 31%; overall, 23% of the patients had first-episode and 8% had recurrent SBP. The use of PPI, low platelet count, ascetic protein content and zinc deficiency were the predictors for the development of SBP; only low protein in ascites less than or equal to 1 and low zinc status were independent predictors of SBP.
  1,392 209 2
The Durazo technique is beneficial in Egyptian liver transplant programs
Abd Elrazek M Ali Hussein
January-March 2016, 14(1):2-5
For nearly four decades, the American people have partnered with the people of Egypt to promote an environment where all groups in Egyptian society – including women and minorities – can lead healthy, productive lives. USAID's program in Egypt, helped scientists and researchers collaborate with American universities aiming to learn about modern American scientific innovations. I was lucky that I have collaborated with one of the most premier USA universities in Hepatology and Liver surgery; UCLA, where I can apply all the liver new techniques I have learned in UCLA in Egypt. Durazo technique is one of very interesting method-post liver transplant, would decrease morbidities and mortalities not only in USA and Egypt, but also Globally.
  1,417 160 -
Vitamin D deficiency and its correlation to hemoglobin A1C in adolescent and young adult type 1 diabetes mellitus patients
Amira M Elsayed, Ghada A Mohamed
April-June 2016, 14(2):76-80
Background Some studies have described the relationship between autoimmune diabetes or type 1 diabetes mellitus (T1DM) and vitamin D deficiency. Few studies correlate between vitamin D deficiency and glycemic control. Purpose This study was conducted to appraise the status of vitamin D in adolescent and young adult T1DM patients and to correlate its deficiency to glycated hemoglobin (HbA1c). Patients and methods Around 63 Kuwaiti patients with T1DM were recruited in a descriptive cross-sectional study in April 2015. Serum level of vitamin D [25(OH)D] was measured using enzyme-linked immunosorbent assay, and glycemic control was measured by HbA1c using autoanalyzer. The relationship between vitamin D levels and HbA1c was analyzed by Spearman’s correlation. Among the participants, 21 (33.3%) were male and 42 (66.7%) were female. The mean age was 18.41±6.19, and the mean diabetes duration was 6.98±4.99. The mean vitamin D concentration was 47.29±2.91 nmol/l, with 38.1% of participants identified to have vitamin D deficiency and 19% identified to have vitamin D insufficiency. There were high levels of HbA1c (10.08±2.28), with a significant inverse correlation between HbA1c and vitamin D (r=−0.374 and P=0.003). Conclusion Low vitamin D in T1DM is extremely highly and closely correlated to HbA1c. We recommend that evaluation of the level of vitamin D in type 1 diabetic patients is very critical, and vitamin D supplementation may improve glycemic control.
  1,386 179 -
Prevalence of Helicobacter pylori infection in patients with portal hypertensive gastropathy owing to liver cirrhosis in Upper Egypt
Khaled Abd-Alazeim Eid, Muhammad Abd El-Gawad Shawky, Amro Metwaly Hassan, Ahmed Qasem Mohammed, Mostafa Ismail Mohammed
July-September 2016, 14(3):109-114
Background Gastrointestinal bleeding and anemia in patients with liver cirrhosis are common problems caused by various etiologies such as bleeding esophageal and gastric varices, bleeding peptic ulcer whether Helicobacter pylori or non-H. pylori related, portal hypertensive gastropathy (PHG), and other causes. Impairment of the gastric protective barriers and production of inflammatory cytokines such as tumor necrosis factor-α and interleukins, which occur because of colonization of gastric mucosa by H. pylori, may make the stomach more susceptible to the effects of portal hypertension. Aim of work The aim of this study was to investigate the prevalence of H. pylori infection and its association with PHG in patients with liver cirrhosis. Patients and methods Overall, 50 patients with liver cirrhosis and PHG (cases) and 50 patients with cirrhosis without PHG (controls) were enrolled in this study. H. pylori stool antigen rapid bedside test and upper endoscopy were done for patients in both groups to diagnose PHG and H. pylori infection. Results The prevalence of H. pylori infection among patients with PHG was higher than those without PHG (34 vs. 10%, respectively; P=0.031), and prevalence of H. pylori infection was 22% among the whole of the studied groups. There was no correlation between H. pylori infection and severity of PHG (P=0.381), Child score, Model for End-Stage Liver Disease score, or serum albumin level. However, our study showed a significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG (P=0.002). Conclusion There is significant association between H. pylori infection and PHG, but there is no significant correlation between H. pylori infection and the severity of PHG or the severity of liver cirrhosis. Also, there is significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG.
  1,328 191 1
Measurement of liver and spleen stiffness by shear wave elastography as a noninvasive evaluation of esophageal varices in hepatitis C virus-related cirrhosis
Alaa E Mahmoud Hashim, Mustafa M Shakweer, Farid F Attia, Hany M Awadallah, Fathya M Elraaey, Abdelhakam M Ibrahem
April-June 2017, 15(2):111-116
Background Several noninvasive methods have been developed to predict esophageal varices (EVs) in patients with cirrhosis aiming to restrict endoscopic screening. Recently, two-dimensional shear wave elastography (2D-SWE) was evaluated for this purpose. The aim of this study was to evaluate the use of 2D-SWE for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) for prediction of EV presence and grading. Patients and methods This study included 100 patients with hepatitis C virus cirrhosis who were subjected to upper endoscopy for detection and grading of EV as well as LS and SS measurements using 2D-SWE. Results There was a significant difference between patients with and without EV regarding LS and SS (P<0.001). The measurement LS at cutoff of 16.2 kPa and SS at cutoff of 42.7 kPa by 2D-SWE predicted the presence of EV with sensitivity of 89.8 and 94.9%, respectively, and specificity of 57.6 and 87.9%, respectively. Moreover, at cutoffs of 19.6 and 51.5 kPa for LS and SS, respectively, the presence of high-risk EV was predicted with sensitivity of 77.5 and 85%, respectively, and specificity of 63.4 and 84.6%, respectively. Conclusion The measurement of LS and SS by 2D-SWE predicted the presence of EV and high-risk EV in patients with cirrhosis, with more sensitivity and specificity for SS than LS.
  1,285 161 2
Effect of new direct-acting antiviral drugs on insulin resistance and glycemic control after treatment of chronic hepatitis C virus infection in type 2 diabetic patients
Alaa E.M Hashim, Hanaa T Kandeel, Olfat M Hendy, Khaled El-Mola, Fathyia M El-Raey, Mohamed S.M Attia
October-December 2017, 15(4):187-195
Background Hepatitis C virus (HCV) infection is associated with diabetes and may worsen glycemic control in patients with diabetes. The benefits of eradicating HCV infection with direct-acting antiviral (DAAs) may go well beyond avoiding the damage caused by chronic liver inflammation, to include declines in glycated hemoglobin percent and other metabolic parameters. The present study was designed to evaluate the effect of new DAAs drugs, used for treatment of HCV, on insulin resistance and glycemic control at the end of treatment and 3 months after end of treatment of HCV infection in patient with type 2 diabetic mellitus (T2DM) in Damietta Governorate. Patients and methods This study included 75 T2DM patients with chronic HCV infection. Patients were divided according to level of glycosylated hemoglobin percent into three groups. All patients received DAAs and were monitored by A1C%, homeostasis model assessment-insulin resistance, and fasting blood sugar before, at the end of treatment, and 12 week after the end of treatment. Patients were allocated into two groups: the first group included 57 (76%) patients with improved glycemic control (IGC) and the second group included 18 (24%) patients with nonimproved glycemic control (NIGC). Results In IGC group, 45 (78.9%) patients needed to decrease the dose of antidiabetic treatment. There were no significant differences between IGC and NIGC groups regarding sex and liver condition. The percentage of patients with old age, those with positive family history of T2DM, and those with long duration of T2DM were significantly higher in NIGC group compared with IGC. Conclusion Diabetic patients receiving DAAs should be closely monitored during reduction of antidiabetic drugs, especially regarding insulin and sulfonylurea, to avoid hypoglycemic events. Improvement of glycemic control with DAAs is seen more in younger patients without family history of T2DM and short duration of diabetes mellitus.
  1,264 171 -
Epidemiological evaluation and outcome of pure abdominal trauma victims who underwent surgical exploratory laparotomy
Abd-El-Aal A Saleem, Osama A Abdul Raheem, Hassan A Abdallah, A Mohamed Yousef
January-March 2016, 14(1):24-28
Objective The aim of this study was to evaluate the epidemiological profile, surgical treatment, and outcome of patients suffering from pure abdominal injuries who underwent exploratory laparotomy in the emergency department of Aswan University Hospital, Egypt. Patients and methods This was an evaluation and assessment of observational and descriptive study with prospective approach through interviews of 80 patients with pure abdominal trauma who were subjected to surgical treatment in the form of exploratory laparotomy and evaluation of their medical records. Results The most affected individuals were male patients younger than 49 years, most of them with low educational level and single. There was a predominance of trauma in the rural areas that mostly occurred at night-time and evening. Blunt trauma was the most common type of abdominal trauma, and road traffic accidents were the most frequent mechanism of trauma. The upper abdomen was the most affected region. Pain was the most common presenting symptom, and the spleen was the most affected organ. The hospital stay ranged from 1 to 11 days. Most patients were discharged with permanent sequelae; there were six deaths. Conclusion Blunt trauma was the most common type of abdominal injury. Road traffic accidents were the most common mechanism of blunt trauma, and stab wounds were the most common type of penetrating injuries. A number of risk factors were identified in this study, which include the type of abdominal trauma, presence of chronic diseases, delay in early transport from the site of trauma to the emergency department, and age of patient. Despite the magnitude of traumas, the outcome was satisfactory.
  1,229 186 1
Rate of development of incisional hernia 1 year after urgent midline laparotomy
Abd-El-Aal A Saleem, Hassan A Abdallah, Osama A Abdul Raheem, Mohamed A Yousef
April-June 2016, 14(2):59-66
Objective The aim of the present study was to determine the rate of development of incisional hernia at 6 months and 1 year in patients suffering from peritonitis (potentially septic wounds) and other patients suffering from intraperitoneal hemorrhage (IPHge) (aseptic wounds) who had undergone urgent midline laparotomy. In addition, we aimed to evaluate different surgical techniques and suture materials used for abdominal closure and the prevalence of postoperative complications among the studied groups in the Emergency Department of Aswan University Hospital, Egypt. Patients and methods This observational and descriptive study included evaluation and assessment of interviews of 160 patients divided into two groups (A and B). Group A included 80 patients suffering from peritonitis and group B included 80 patients suffering from IPHge. All patients submitted to the surgical treatment in the form of emergency exploratory laparotomy and evaluation of their medical records, involving different surgical techniques and suture materials used for abdominal closure. Postoperative follow-up was set at 6 months and 1 year for the development of incisional hernia. Results Analyses of 160 patients in the two groups indicated that the incisional hernia rate increased significantly from 7.5% at 6 months to 17.5% at 1 year after urgent midline laparotomy in all studied patients (P=0.007). There was a significant increase in incisional hernia rate in group A in comparison with group B at 6 months (12.5 vs. 2.5%; P=0.02) and at 1 year (25 vs. 10%; P=0.01) follow-up after urgent midline laparotomy. Regarding the techniques of closure of urgent midline laparotomy and the used suture materials (Vicryl and Prolene), there was an insignificant deference as regards the development of incisional hernia between subgroups A1 and A2 at 6 months (P=0.50) and at 1 year (P=0.30), and also between subgroups B1 and B2 at 6 months (P=0.49) and at 1 year (P=1.0) follow-up after urgent midline laparotomy. Conclusion The incisional hernia remains the most common complication after midline laparotomy, representing 7.5% at 6 months and 17.5% at 1 year follow-up in the present study. Incisional hernia was significantly increased in patients suffering from peritonitis than in those patients suffering from IPHge at 6 months and at 1 year after urgent midline laparotomy. Regarding the surgical techniques and suture materials used for closure of urgent midline laparotomy, there was an insignificant difference as regards the development of incisional hernia between closure of urgent midline incision by continuous suture plus some interrupted sutures in between using slowly absorbable multifilamentous suture material [Vicryl (polyglactin)] and continuous suture only using nonabsorbable monofilamentous suture material [Prolene (polypropylene)] at 6 months and 1 year between subgroups A1 and A2, and between B1 and B2.
  1,231 124 -
Comparative study of midazolam, dexmedetomidine, and ketamine as an adjuvant to lidocaine in intravenous regional anesthesia for forearm and hand surgeries
Alaa E Mahmoud, Abdelwahab A Saleh, Ali A Mahareak, Ali A Alkumity
July-September 2017, 15(3):127-134
Background Intravenous regional anesthesia (IVRA) is an ideal method of providing anesthesia for minor surgical procedures to the extremities performed on an ambulatory basis. This study aimed to study the effects of adding midazolam, dexmedetomidine, or ketamine as an adjuvant to lidocaine in IVRA during forearm and hand surgeries and examine their benefits and complications. Patients and methods A total of 120 patients were included, aged 40–60 years (American Society of Anesthesiologists physical status I–II), undergoing hand and forearm, from April 2015 to August 2016. Patients were randomly divided into four equal groups. Lidocaine-only group (LL group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg). Lidocaine plus midazolam group (LM group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus midazolam 50 µg/kg added as an adjuvant. Lidocaine plus dexmedetomidine group (LD group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus dexmedetomidine 1 µg/kg added as an adjuvant. Lidocaine plus ketamine group (LK group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus ketamine 0.5 mg/kg added as an adjuvant. The time of onset, duration, and quality of analgesia; levels of sensory and motor block; heart rate; mean arterial blood pressure; and visual analog score were recorded. Adverse effects of hematoma, injection pain, skin erythema, sedation, and hallucinations were recorded. Results The onset time of sensory and motor blocks was significantly shorter in the adjuvant groups LM, LD, LK in comparison with the control group LL. The grade of sensory and motor blocks was significantly better in groups LM, LD, and LK in comparison with the LL group. The onset time of tourniquet pain was significantly shorter in the control group LL in comparison with adjuvant groups LM, LD, and LK. There was a significant increase in fentanyl requirements in the control LL group compared with adjuvant LM, LD, and LK groups. The duration of postoperative analgesia was significantly prolonged in adjuvant groups LM, LD, and LK compared with the control LL group. Hematoma, injection pain, cutaneous erythema, and hallucination were reported as postoperative complications. Conclusion The addition of midazolam, dexmedetomidine, or ketamine to lidocaine for IVRA improved the quality of intraoperative and postoperative analgesia with minimal adverse effects and higher patients and surgeon satisfaction.
  1,135 179 -
Diagnostic challenges of tuberculosis peritonitis in upper Egypt
Nahed A Makhlouf, Gamal A Makhlouf, Ahmed Soliman, Mahmoud F Sherif, Hebat-Alla G Rashed
July-September 2016, 14(3):115-121
Background Tuberculosis (TB) is a major global health problem. Peritoneal tuberculosis involves the omentum, intestinal tract, liver, spleen, or female genital tract in addition to the parietal and visceral peritoneum. It accounts for ∼1–2% of all cases of tuberculosis. Aims of the study The aims of this study was to analyze the clinical, laboratory, and imaging findings in patients with TB peritonitis and to evaluate the diagnostic methods. Patients and methods This prospective, observational study was carried out on patients with obscure ascites. All patients were subjected to history taking, clinical examination, and laboratory investigations. Ascitic fluid analysis and calculation of serum-ascites albumin gradient were done. Abdominal ultrasound (US) and computed tomography scans were performed. Laparoscopic-guided biopsies from peritoneal tubercle and unhealthy omentum were taken for histopathology and culture analysis. Results The study included 22 cases. Approximately 77.3% were female. The mean age was 42.6±15.1. More than two-thirds of the cases had fever, pain, and abdominal swelling. No portal hypertensive ascites was found in 86.4% of cases. Ascitic fluid cytology revealed lymphocytes in 91%. In abdominal US, ascites was the only finding in 59% of cases; however, adhesion was found in 22.8% of cases. Lymphadenopathy was observed in 13.6% of cases undergoing abdominal US. During laparoscopy, small tubercles on the peritoneum, omentum, and/or intestine with extensive adhesions were the predominant findings. Regarding the histopathologic findings, TB granuloma was predominant in 80% of cases. Conclusion TB peritonitis was common among middle-aged females. Ascites and adhesions were the commonest findings. Laparoscopy and histopathology were the best diagnostic modalities.
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Evaluation of primary repair of common bile duct in common bile duct stones
Mohamed A Abdel-Raheem, Abdelmonem A Mohamed, Emad A Ibrahim, Mohamed B Gaber
January-March 2016, 14(1):29-32
Background Despite advancements in gallbladder surgery with the introduction of endoscopic and laparoscopic techniques, many surgeons, especially in the developing world, still perform open cholecystectomy with common bile duct (CBD) exploration for choledocholithiasis. Aim of the study The purpose of the study was to report the outcomes of open CBD exploration without the use of T-tubes. Materials and methods A prospective study of open CBD exploration and primary closure was performed without T-tube drainage. Preoperative investigations, the surgical techniques, and perioperative outcomes were recorded. Results Fifty patients had CBD exploration. In 45 patients this was performed by means of a supraduodenal choledochotomy, and in five of these patients free passage into the duodenum could not be achieved using catheters, irrigation, and dilators. These were completed with a choledochoduodenostomy. Conclusion In a limited resource setting, there is still a role for open CBD exploration and primary closure without the necessity of T-tubes and stents as evidenced by a good perioperative patient outcome.
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Effects of adopting preventive measures on malaria parasitemia among pregnant women in Kaduna state, Nigeria
Idris Abdullahi Nasir, Mustapha Jelili, Amos Dangana, Peter Omale Musa, Adamu Babayo, Yahaya Usman, Nkechi B Ugboaja, Maryam Muhammad Zakari
July-September 2016, 14(3):126-129
Background There are several malaria preventive measures. The availability of a particular method does not guarantee its adherence and effective usage. This eventually may not provide the desired results for the fight against malaria. Pregnant women are at higher risk of contracting malaria, and therefore it is necessary that they should be protected against the infection. Objective of the study This cross-sectional study investigated the significant roles of various preventive measures against malaria infection among pregnant women attending four selected secondary health facilities in Kaduna state, Nigeria. Materials and methods Blood samples were collected from 353 pregnant women attending selected hospitals. Malaria parasite microscopy was conducted on the basis of standard protocols. Structured questionnaires were used to obtain data with regard to subject knowledge and practice of preventive measures against malaria. Results Out of the 353 subjects tested, 79 (22.4%) had malaria parasitaemia. One hundred and fifteen (32.6%) subjects used no preventive measure, 45 (12.7%) used sulfadoxine-pyrimethamine prophylaxis, 53 (15.0%) used insecticide treated nets (ITNs), 72 (20.4%) used indoor insecticide house spray, while 68 (19.3%) used > 1 preventive measures. Out of the 79 subjects infected with malaria, 57 (72.2%) do not know how to prevent malaria, while 22 (27.8%) had prior knowledge of malaria prevention. Highest cases (41 [51.9%]) of malaria parasitaemia were recorded in women with no knowledge of preventive measures during pregnancy, while women who used > 1 measures have the least cases (5 [6.3%]) of malaria parasitaemia. There was statistical association between the use of preventive measures and decreased malaria parasitaemia (P < 0.0001). Conclusion Findings from this study revealed that there is need for more sensitization campaigns on available malaria preventive measures. Also, the combination of preventive methods should be considered by pregnant women in order to minimize their chances of acquiring malaria.
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An Indian study of postural variation in peak expiratory flow rates in healthy, adult, male participants
Ajith Pakkala, Amrith Pakkala
April-June 2016, 14(2):49-51
Background Peak expiratory flow rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR showing postural variation that follows a specific pattern in asthmatics and healthy individuals has been identified. Adequate data are not available for postural variation in normal individuals who are students of professional courses with a sedentary lifestyle. Lung volumes in normal individuals were significantly higher in the standing position. Some studies have reported that in healthy participants spirometric indices were higher while standing in comparison with the sitting position, whereas other studies have reported no differences between spirometric values obtained in the lying, sitting and standing positions. Hence, this study was undertaken to study the postural variation in PEFRs in healthy, adult, male participants in south India. Materials and methods PEFR was recorded in 50 adult, healthy, male participants aged 18–23 years who were students of professional courses. Mini Wright’s peak flow meter was used to measure the PEFR. Three readings were taken in the standing and lying positions. The best of the three recordings was considered as the final value. Results PEFR was decreased while lying down compared with standing in the participants studied, and the quantum of difference was noted. Conclusion With postural changes, the PEFR significantly differs on the basis of whether the measurements are taken in the standing or in the lying posture in healthy participants. The effect of posture may be of importance in recording PEFR, and changing to a better posture may be especially useful for those with weak expiration.
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BMI and breast cancer in upper Egypt
Abeer F Amin
January-March 2016, 14(1):33-36
Background and aim BMI may be an important factor affecting breast cancer outcome. Materials and methods The present study included 100 patients who were newly diagnosed with breast cancer at Assiut University Hospital. Their BMI was measured, and the relation of BMI to the stage of breast cancer and age was determined. Results Patients' ages ranged from 27.0 to 72.0 years. Overall, 45% of the patients were between the ages of 50 and 60 years, and their mean age was 50.6 years. Stage I, II, III, and IV breast cancer were diagnosed in 14, 64, 12, and 10% of the patients, respectively. Around 29% of the patients were overweight and 35% of them were obese. There was a significant positive correlation between age and BMI (P = 0.000). In addition, there was a significant positive relation between BMI and the stage of breast cancer at diagnosis, with a statistical significant difference (P < 0.05). Conclusion Overweight and obese breast cancer patients were more often older, and this was significantly associated with later stages at diagnosis.
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