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   Table of Contents - Current issue
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October-December 2022
Volume 20 | Issue 4
Page Nos. 311-374

Online since Wednesday, December 21, 2022

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REVIEW ARTICLE  

Changing epidemiology of monkeypox and risk for wide-scale outbreak p. 311
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/azmj.azmj_33_22  
Monkeypox has spread over Europe, posing a major threat to public health. Monkeypox is a rare pox infection that has returned, with zoonosis suspected as the cause. Human-to-human transmission is now under observation. The medical community has been alerted by an increasing number of reported cases in several countries. SARS-CoV-2 pandemic taught us that in the event of an outbreak, we must act promptly to respond, examine thoroughly, and take appropriate action. Although monkeypox is an old disease, a new genetic mutation may have resulted in a more severe illness and a widespread outbreak.
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ORIGINAL ARTICLES Top

Specular microscopic changes of corneal endothelial cells after phacoemulsification in patients with pseudoexfoliation p. 314
Hassan S Yousef, Ibrahim Amer, Shymaa A.A Thabet
DOI:10.4103/azmj.azmj_128_21  
Background and aim Pseudoexfoliation (PEX) syndrome is an age-related ocular disorder that is known to be linked with early development of cataract. Phacoemulsification, a cataract surgery, is thought to carry higher risk of complication in patients with PEX. This study aimed to evaluate the corneal endothelial cell changes before and after phacoemulsification in pseudoexfoliative patients relative to healthy adults. Patients and methods In total, 100 eyes of 100 patients were enrolled in this prospective nonrandomized study who were divided into two groups (PEX and non-PEX patients). All participants were subjected to ocular examination with specular microscopy before and after phacoemulsification. Data for corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonal cells were recorded before operation and at 1 week, 1 month, and 6 months postoperative. Results No significant difference was detected between the two studied groups regarding ECD, CV, and hexagonality either preoperatively or postoperatively at 1 week, 1 month, and 6 months. However, a significant difference between preoperative and postoperative data of ECD, CV, and hexagonality was detected in each group. Conclusion Despite the previous conviction that phacoemulsification surgery carries more risks in eyes with PEX, the results of this study prove that phacoemulsification is a safe choice in these eyes without a higher rate of postoperative complications.
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COenzyme Q10 ameliorates bisphinol A induced reproductive male toxicity: A transmission electron microscopic and immunohistochemistry study p. 319
Samia S.M Barghash, Islam M Farrag, Fatma El-Zahraa Abd El-Hakam, Somia M.M Ali, Eman M.A Aly
DOI:10.4103/azmj.azmj_24_22  
Background and aim The endocrine disruptor compound bisphenol A (BPA) affects spermatogenesis and exacerbates benign prostate hyperplasia induced by testosterone. Nonetheless, the direct effect of BPA on prostate and testicular cells is not fully investigated. The objective of this study was to evaluate the pathogenic effects of BPA on the structure of the prostate and the ultrastructure of the testis of adult male albino rats via immunohistochemical and transmission electron microscopic study and the potential protective effect of CoQ10 supplementation. Methods A total of 30 male albino Wistar rats were categorized into five equal cohorts: group I, no treatment; group II was administered corn oil; group III received coenzyme Q10 (CoQ10); group IV was administrated BPA; and group V received BPA+CoQ10. Results BPA administration significantly decreased the mean values of the plasma fertility hormones and serum antioxidant enzymes and increased malondialdehyde. BPA administration markedly affected seminal parameters. Coadministered CoQ10 significantly reversed these biochemical changes. BPA induced histopathological alterations in the epithelium and connective tissue of prostate. Immunohistochemistry of the prostate revealed decreased E-cadherin and increased vimentin expressions in BPA-treated group. Ultrastructural analysis of the testis showed impairment of the basal lamina of seminiferous tubules and tight junctions between Sertoli cells after BPA exposure. Conclusion The biochemical and histopathological results of this study revealed direct evidence for BPA-induced male reproductive toxicity in the testes and prostate, causing male infertility. CoQ10 coadministration with BPA partially protects against its damaging effect mediated via its antioxidant capabilities.
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Doxycycline Plus Trimethoprim-Sulfamethoxazole versus Doxycycline plus Rifampicin in Treatment of Brucellosis: A Randomized Controlled Trial p. 333
Waleed A Hassan, Muhammad Abdel-Gawad, Ahmed S Abdelmohsen
DOI:10.4103/AZMJ.AZMJ_61_22  
Background and aim Brucellosis is one of the most common endemic zoonotic diseases that have large animal and human burden. Many regimens of drug combinations are used for a variable period (at least 6 weeks). Rifampicin with doxycycline is one of the most used combinations. In this respect, we aimed to compare between the efficacy of two different combinations: trimethoprim-sulfamethoxazole combined with doxycycline (TMX-Doxy) versus rifampicin combined with doxycycline (Rif-Doxy). Patient and methods Between June 2020 and January 2022, 100 patients with brucellosis were included. Half of them (50 patients) received TMX-Doxy, whereas the other half (50 patients) received Rif-Doxy for 6 weeks. Follow-up was done during the treatment course and 6 months after the end of treatment to detect successfully treated cases, failed-to-treat cases, and relapsed cases. Results The success rates of both used drug regimens were comparable, with the rate of success of TMX-Doxy combination being 90%, whereas it was 94% in the RIF-Doxy group (P=0.23). The failure rate was 4% in the TMX-Doxy group and 2% in the RIF-Doxy group (P=0.31). Relapse of brucellosis was recorded in 6% of patients in the TMX-Doxy group, whereas it was 4% of patients in the RIF-Doxy group (P=0.32). The adverse effects of both drug combinations were mild and self-limited, and none of the enrolled patients needed to stop treatment. Conclusion Combination of TMX-Doxy is effective, safe, and not inferior to the more used RIF-Doxy combination.
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Cognitive impairment after first-ever ischemic stroke p. 338
Mosaab S.L Omran, Nabil H.M Ibrahim, Mohammed A Zaki
DOI:10.4103/azmj.azmj_72_21  
Background and aim Ischemic stroke has a good outcome because these patients usually have a good motor recovery. The aim of this work was to assess the prognostic value of the neurocognitive status to detect early cognitive dysfunction in stroke phases, evaluate outcome after first-ever ischemic stroke, and to choose proper preventive management of stroke cognitive dysfunction. Patients and methods Patients with ischemic stroke were prospectively evaluated using Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) individually and in combination with National Institutes of Health Stroke Scale (NIHSS), either at the subacute stroke phase or within 2 weeks (baseline), and modified Rankin scale (mRS) scores, for functional outcome 3 and 6 months later. Results Cognitive impairment was diagnosed at baseline in 37.5% of patients with median NIHSS=4 and median mRS=2 (P<0.001). Baseline NIHSS, MMSE, and MoCA can individually predict mRS scores at 3 and 6 months, and NIHSS is the strongest predictor. However, patients with more disability at baseline (NIHSS>2), baseline MoCA, and MMSE had a moderately large significant predictive value to the baseline NIHSS for mRS scores at 3 and 6 months. Conclusion Screening of cognitive state at the subacute stroke phase can predict functional outcome independently and improve the predictive value of stroke severity scores. And it is important to evaluate what cognition is, and the brief cognitive test may facilitate assessment in the early phases.
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Role of antisecretory drug in treatment of children with acute watery diarrhea: A Randomized Controlled Trial p. 345
Reham M Sayed, Hosny M.A El-Masry, Ismail Abd El-Razek Kasem
DOI:10.4103/azmj.azmj_126_21  
Background and aim Previous studies have shown that Racecadotril is safer and more effective in treating children with acute diarrhea. This study aimed to evaluate the effect of Racecadotril as a booster to oral rehydration solution in the management of acute watery diarrhea among children aged 5 years or less. Patients and methods This random clinical trial included 50 children with acute watery diarrhea for less than or equal to 5 days with a frequency of more than or equal to three diarrheic stools in the past 24 h before admission to the hospital, with no mild-to-moderate dehydration. Our study is registered to clinicaltrials.gov (NCT05216822). Results The main findings of this study were that Racecadotril reduced the duration of the diarrheal episodes and the duration of hospitalization significantly. This study revealed that Racecadotril showed an improvement in the consistency of stool, which protects the patient from fluid loss and dehydration. Conclusion Racecadotril is an effective booster-rehydration drug that carries out its antidiarrheal effect by inhibiting intestinal enkephalinase. It is efficient in reducing the volume and frequency of stool output.
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Systemic thrombolytic therapy in treatment of acute limb ischemia: a single-center retrospective observational study p. 350
Khaled Attia, Mahmoud Moawad, Walied Khereba
DOI:10.4103/azmj.azmj_61_21  
Background and aim Owing to the increased risk of morbidity and mortality, the treatment of acute limb ischemia (ALI) is challenging. The authors aimed to investigate the outcomes of thrombolysis in the treatment of ALI and limb salvage. Patients and methods A retrospective observational study was conducted to revise the data of 49 patients who underwent catheter-direct thrombolysis for ALI. A total of 33 cases were at lower limb and 16 cases were at upper limb. The assessed outcomes were primary and secondary patency, survival, amputation-free survival, and conversion to surgery. Results The patients were classified according to the Rutherford classification into class I (52%), class IIa (38%), class IIb (8%), and class III (2%). The primary patency was present in 34% of the patients after the first year and 22% after the second year. On the contrary, 28% of the patients were subjected to conversion to open surgery, 8% were subjected to reintervention, and 6% were subjected to amputation within the first month. The mortality rate within 1 month was 6%. The worst primary and secondary patency rates were seen in the prosthetic grafts in addition to vein bypasses, whereas the native artery was the most successful one regarding the primary patency, secondary patency, and amputation-free survival (P<0.05 for each). Conclusion The thrombolysis of vein bypass and prosthetic grafts did not show technical success as that seen with native artery. Additional treatment at the time of thrombolysis was shown to be associated with better outcomes.
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Effect of new oral anticoagulants on microcirculation in ischemic diabetic foot ulcer p. 356
Khaled Attia, Mahmoud Moawad, Walied Khereba
DOI:10.4103/azmj.azmj_60_21  
Background and aim Diabetic patients with foot ulcer and peripheral ischemia were shown to be associated with hypercoagulation and dysfunction in the fibrinolytic system that in turn would affect the healing of the ulcer. The authors aimed to investigate the role of rivaroxaban in improving the microcirculation of the skin and peripheral tissues and how it can improve ischemic diabetic foot ulcers. Patient and methods The authors conducted an observational retrospective case–control study at Al-Azhar University Hospital, New Damietta, from January 2015 till December 2020. Diabetic patients with foot ulcer and peripheral limb ischemia who received rivaroxaban till ulcer healing were considered as the case group, whereas patients who did not receive rivaroxaban were considered as the control group. Clinical assessment and pulse oximeter were used for the assessment of transcutaneous microcirculation. Results Throughout the 5 years of the study, 172 patients were included; the case group included 87 patients and the control group included 85 patients. There was a significant difference between the two groups regarding the improvement of limb ischemia, tissue plasminogen activator antigen, and transcutaneous microcirculation (P<0.05). Before the treatment, there was a significant correlation between both permeability coefficient and plasma fibrinogen and transcutaneous microcirculation. Conclusion The oxygenation of the ulcer and the microcirculation were found to be improved in the case group and accelerate wound healing in the ischemic diabetic foot.
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Colposcopic evaluation of cervix in patients with bacterial vaginosis p. 361
Abdel Aziz Galal El-Deen El-Darwesh, Abdel Halim Mohammed Abdel Halim, Mahmoud Abbas Mahmoud Sayed
DOI:10.4103/azmj.azmj_146_21  
Abstract Background and aim Bacterial vaginosis (BV) is a clinical syndrome emerging from changing of the bacteria Lactobacillus species that produce hydrogen peroxide in the vagina with many population of anaerobic bacteria. A lot of researchers have agreed with the relation between BV and cervical intra-epithelial lesions. However, other researchers have not accepted this relation between cervical neoplasia and BV. The study aim was to evaluate the abnormal colposcopic findings associated with BV and to study the relation between BV and cervical lesions. Patients and methods This study is a cross-sectional observational one that included 246 women diagnosed as having BV using Amsle’s criteria. All participants underwent proper history taking, general and abdominal examination, local vaginal examination, and colposcopic examination. Finally, Swede score was applied to abnormal colposcopic findings. Results By naked-eye examination, there were 163 patients with normal findings and 83 patients had abnormal cervical appearance, colposcopic examination of patients revealed 14 patients with unsatisfactory findings, and 196 patients had normal findings and 36 patients had abnormal cervix. The abnormal colposcopic findings were significantly associated with urban (55.6%) than rural women (44.4%) (P=0.039), educated (72.2%) than noneducated women (27.8%) (P=0.033), nonemployed (72.2%) than employed women (27.8%) (P=0.011), and women using oral contraceptive pills (OCP) (38.9%) than other contraceptive methods (P=0.024). Conclusion Most cervical lesions associated with BV in our study were of low grade and although use of colposcopy allowed early detection and management of cervical precancerous lesions associated with BV.
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Short-term outcome of cataract surgery in tertiary hospitals p. 368
Nermine M Mahmoud, Ibrahim A.S Major, Mona N Mansour, Afaf H Rashwan
DOI:10.4103/azmj.azmj_104_21  
Background and aim In this study we aimed to assess the short-term outcome of phacoemulsification in a tertiary hospital and to analyze which are the factors affecting visual outcomes. Patients and methods This is a prospective cohort study that included 50 eyes (50 patients) with senile cataract, phacoemulsification was done between September 2019 and December 2020. Comprehensive ophthalmic examination: preoperatively, first day, 1 week, and 1 month postoperatively was done. The changes in best-corrected visual acuity, corneal curvature, and intraocular pressure were compared. Double-angle plot of the corneal surgically induced astigmatism (SIA) was calculated, including centroid values (C-SIA) and mean of surgically induced astigmatism (M-SIA). Results The mean age was 64.86±8.48 years, 60% right eyes. No intraoperative complications. Best-corrected visual acuity (log MAR) was 1.079±0.66 with significant improvement postoperatively (P=0.00). Mean intraocular pressure was 16.88±3.193 with significant decrease postoperatively (P=0.04). Corneal astigmatism significantly increased from 0.939±0.57 D preoperatively to 1.146±0.67 D postoperatively (P=0.02). The M-SIA was 0.65±0.32 D (OD), 0.55±0.31 D (OS), the centroid of surgically induced astigmatism C-SIA was 0.28±0.67 D at an axis of 68° (OD), and 0.15±0.72 D at an axis of 76° (OS). Good visual acuity (>20/40) was achieved in 80% and 20/20 in 22%, dense cataract significantly influences the visual outcome (P=0.02). Conclusions This study implicates that in the absence of ocular comorbidity, the visual outcome of phacoemulsification is satisfactory in short-term follow-up, and effort should be exerted during surgery to deal with ocular conditions requiring complex surgery such as dense cataract and to observe every postoperative visual progression for interventions.
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LETTER TO THE EDITOR Top

Monkeypox: typical and atypical clinical presentation p. 373
Pathum Sookaromdee, Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/azmj.azmj_26_22  
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