Skill training in medical practice
Raouf
Sallam
General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
author
text
article
2018
eng
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
1
1
https://amj.journals.ekb.eg/article_55311_4d0f12b8754661196b1e30cb85e96f5a.pdf
dx.doi.org/10.12816/0052809
EARLY REVASCULARIZATION BENEFITS IN LOW CARDIAC FUNCTION PATIENTS
Medhat
Refaie
Department of Cardiothoracic Surgery, Al-Azhar University
author
Mohamed
Al Shehri
Cardiac Services at Military Prince Khalid Ben Sultan Centre
author
text
article
2018
eng
Background: Management ofpatients with impaired left ventricular functionremains challenging in spite of the progress achieved in medical therapies and surgical techniques.
Objectives: Detecting the impact of revascularization on the left ventricular function in low ejection fraction patient’s ≤ 35% after coronary artery bypass.
Patients and Methods: Twenty three patients with impaired left ventricular function were subjected to coronary artery bypass grafting (CABG) during the period from January 2017 to January 2018 at military prince Khalid Ben Sultan Centre, Saudi Arabia. The only inclusion criterion was preoperative ejection fraction (EF) ≤ 35%. Echocardiography assessments were done preoperatively and early postoperatively (three months after CABG).
Results: Baseline preoperative transthoracic echocardiography assessment (TTE) was done for the twenty three patients and revealed that the mean end diastolic diameter (EDD) was 5.2 ± 0.08 mm, the mean end systolic diameter (ESD) was 4 ± 0.1 mm and the mean ejection fraction was 30 ± 1.1%. The first 3 months after CABG, the mean ejection fraction increased significantly from 30 ±1.1% at baseline TTE to 36 ±1.6 %. Moreover, the mean EDD decreased significantly from 5.2±0.08 mm at baseline TTE to 4.8±0.2 mm at early follow up. However, the reduction in the ESD from 4±0.1 mm at baseline to 3.8±0.2 mm postoperatively was insignificant.
Conclusion: The low EF patients undergoing CABG showed significant improvement in LV function by 20% increase in EF in the early postoperative follow up.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
467
474
https://amj.journals.ekb.eg/article_55564_a95fbd50a14ab903d5003338ac8dc942.pdf
dx.doi.org/10.12816/0052810
ROLE OF THIAZOLIDINEDIONES (TZDs) AND GLUCAGON-LIKE PEPTIDE-1 (GLP-1) AGONISTS AND ANTAGONOSTS IN TYPE-II DIABETES MELLITUS ON ADULT MALE ALBINO RATS
Nageh
Mabrouk Gabr
Department of Medical Physiology, Faculty of Medicine, Al-Azhar University
author
Albayoumi
Fouda
Departments of Medical Physiology, Al-Azhar Faculty of Medicine
author
text
article
2018
eng
Background: The rising incidence of insulin resistance to epidemic proportions has closely paralleled the surge in the prevalence of diabetes and outpaced therapeutic advances in diabetes prevention and treatment. Thiazolidinediones and glucagon-like peptide-1 agonists are insulinotropic peptides and are being evaluated for the regulation of lipid profile in diabetes mellitus (DM). Thiazolidinedione and glucagon-like peptide-1 antagonists have anti- insulinotropic effects.
Objectives: Evaluating the possible effects of thiazolidinediones and glucagon-like peptide-1 agonists, and their antagonists in lipoststic function in diabetic male albino rats.
Materials and Methods: Seventy adult male albino rats were divided into seven equal groups: Group I served as a normal control group, group II was diabetic control, group III was diabetic group treated with thiazolidinedione agonist (pioglitazone), group IV was diabetic group treated with glucagon-like peptide-1 agonists (exendin-4), and group V was diabetic group treated with both pioglitazone and exendin-4, group VI was diabetic group treated with thiazolidinedione antagonist [Bisphenol A diglycidyl Ether (BADGE)], and group VII was diabetic group treated with glucagon-like peptide-1 antagonist (Exendin- 9-39). At the end of the experimental period, blood samples were collected for measuring of fasting blood glucose, insulin level, total cholesterol, triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL), aspartate transaminase (AST), and alanine transaminase (ALT). Body weights at the beginning and at the end of the study were determined.
Results: Alloxan-induced diabetes mellitus was associated with significant higher levels of serum blood glucose, total cholesterol, TG and LDL-C, AST, and ALT, with significant lower levels of insulin, and HDL-C as compared to the control normal group. Pioglitazone, exendin-4 or both showed significant lower levels of blood glucose, total cholesterol, TG, LDL-C, AST, and ALT, and significant higher levels of insulin and HDL-C as compared with the control diabetic rats. BADGE and exendin-9-39 revealed significant higher levels of serum blood glucose, total cholesterol, TG, LDL-C, AST, and ALT, and significant lower levels of insulin and HDL-C as compared with the control normal group. As regards the differences between pioglitazone (group III) with exendine-4 group (group IV), the obtained data showed insignificant changes in all parameters. There were insignificant changes also between groups VI and VII in all parameters.
Conclusion: Thiazolidinediones and glucagon- like peptide-1 agonists therapy has a marked effect on improvement of blood glucose, lipid profile and liver enzymes, while their antagonists blocked insulin secretion and impaired liver enzymes.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
475
492
https://amj.journals.ekb.eg/article_55567_9702603786b087d1551121739669a9c1.pdf
dx.doi.org/10.12816/0052811
EFFECTS OF MUSIC AND STRESS ON HEALING OF INDUCED WOUND IN THE SKIN OF ADULT MALE ALBINO RATS
Mohamed
Zakaria Eletreby
Departments of Medical Physiology, Al-Azhar Faculty of Medicine
author
Mohamed
El-Sayed Abd-El-Fattah
Departments of Medical Physiology, Al-Azhar Faculty of Medicine
author
Hassan
Sabry Ali Al-Dawy
Departments of Medical Physiology, Al-Azhar Faculty of Medicine
author
Mohamed
Abd-El-Hameed Khedr
Departments of Pathology, Al-Azhar Faculty of Medicine
author
Mohamed
Abd-El-Fattah El-Salamoni
Departments of Medical Physiology, Al-Azhar Faculty of Medicine
author
text
article
2018
eng
Background: Wound healing is a complex process involving intrinsic dermal and epidermal cells, and infiltrating macrophages and leukocytes.Noise and music exposure have long been used to investigate their effects on biological and biochemical responses.
Objectives: Studyingthe possible acceleration effect of the process of wound healing after exposure to music, and the stressor effect after exposure to noise.
Materials and Methods: Forty adult male albino rats of local strain were chosen as an animal model for this study. They were divided into four equal groups:Control group, wound group, stress-exposed group andmusic-exposed group. On the day of infection, superficial surgical wounds were produced on the shaved backs of anesthetized rats by making a longitudinal midline incision, 2.3 ± 0.2 cm in length and extending down to the panniculuscarnosus.At the end of the experiment (30 days), blood samples were obtained for estimation of WBC, neutrophils, lymphocytes and platelets count. Immediately after the animals were killed, 5-mm punch biopsy specimens of excised skin were taken, and immediately fixed in phosphate-buffered (pH 7.4) formalin (4%).
Results: Stress- exposed group showed significant increase in both WBCs and neutrophils counts, and significant decrease in both lymphocytes and platelets counts. In music-exposed group, WBCs significantly increased and platelets significantly decreased. Histopathological examination revealed that the exposure to noise resulted in significantly slowed inflammatory process. This effect was demonstrated by increased infiltration of wounds with polymorphnuclear leucocytes (PMNL). The music exhibited significant acceleration of wound healing activity as compared to noise exposed group .The wound closure time was lesser, as well as the percentage of wound contraction was more. The epithelization of wound was found to be earlier as compared tonoise exposed group.
Conclusion: Music has some antistressor effects and may accelerate wound healing.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
493
510
https://amj.journals.ekb.eg/article_55572_b3ed9a99d333fcaf4b51361480a7274d.pdf
dx.doi.org/10.12816/0052812
THE EFFECT OF COMBINATION OF DICLOFENAC SUPPOSITORY AND LIGNOCAINE CREAM ON POSTOPERATIVE PAIN AFTER ANAL SURGERY
Mohammad
Arafat Abdel-Maksoud
General Surgery Department, Faculty of Medicine, Al-Azhar University
author
text
article
2018
eng
Background: Anal surgery is associated with severe postoperative pain which is a source of such anxiety that some patients refuse the operation. Opiates and non-steroidal anti-inflammatory drugs have often been used to control pain.
Objectives: Evaluation of the effect of diclofenac suppository and lignocaine cream on postoperative pain after anal surgery.
Paitents and Methods: This study was a prospective randomized double blinded controlled study carried on 120 patients presenting with anal conditions (hemorrhoid, anal fissure or low perianal fistula), who underwent anal surgery. Patients were divided randomly into two equal groups. Group (A) was a control group, and group (B) received diclofenac suppository (100 mg) and topical lignocaine cream 5% (5 g) at the end of surgery. The mean VAS scores at 2, 4, 8, 12, and 24 hours after surgery were recorded.
Results: The pain reported by group (B) was statistically lower than that in control group (group A) in all intervals. Also, the incidence for administration of postoperative analgesic in group (B) was statistically lower than that in group (A).
Conclusion: Combination of diclofenac suppository and topical lignocaine cream significantly decreased the severity of postoperative pain after anal surgery, and decreased the requirement of post-operative analgesics.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
511
516
https://amj.journals.ekb.eg/article_55574_4ab9655edd36b7a68fadc40193969260.pdf
dx.doi.org/10.12816/0052813
MERCEDES BENZ INCISION: A MODIFICATION OF THE MAGPI PROCEDURE FOR DISTAL HYPOSPADIAS REPAIR
Mohamed
Shahin
Department of surgery, (Pediatric Surgery Unit), Faculty of Medicine - Al-Azhar University
author
Mohamed
Ramadan Rehan
Department of Urology, Faculty of Medicine - Al-Azhar University
author
text
article
2018
eng
Background: Hypospadias is one of the most common congenital abnormalities of the male genito-urinary system. The main goal in surgery is to attain cosmetic and functional correction. Hypospadias repair should be done with minimal complications. Duckett innovated meatal advancement and glanuloplasty (MAGPI) procedure and was applied for correction of this lesion.
Objectives: Evaluation of Mercedes Benz incision as a modification of the MAGPI procedure for repair of distal hypospadias with mobile meatus.
Paitents and Methods: Forty five children with distal hypospadias and mobile meatus were operated on using this technique. Mean age of patients was 2 ± 4.2 year (1-10) years.
Results: Patients were discharged home after 3 days. The operation resulted in a slit-like urethral meatus. Follow-up was done for 6 months. Good cosmetic and functional results were obtained in 44 patients (97.78%). One patient (2.22%) had mild meatal stenosis that corrected by frequent dilation. Complication occurred in one patient (2.22%) who suffered from dehiscence of the wound and retraction of the meatus. The meatal retraction was corrected using circum-meatal urethral advancement technique.
Conclusion: Mercedes Benz incision as a modification of the MAGPI procedure was feasible and suitable for appropriately selected cases with distal hypospadias and mobile meatus. It provides a cosmetically natural vertical slit-like urethral meatus at the tip of the glans.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
517
526
https://amj.journals.ekb.eg/article_55584_a5d835fa57ac507d390524acdb3f4d4e.pdf
dx.doi.org/10.12816/0052814
CARDIOVASCULAR EFFECTS OF ORAL ANTIVIRAL TREATMENT FOR NON-CARDIAC HCV PATIENTS
Sameh
R H Allam
Department of Cardiology,Faculty of Medicine, AL-Azhar University (Cairo)
author
Gamal
M M Soliman
Department of Tropical Medicine, Faculty of Medicine, AL-Azhar University (Cairo)
author
Ashraf
A Sayed
Department of Clinical Pathology, Faculty of Medicine, AL-Azhar University (Cairo)
author
Ahmed
A Mahdy
Department of Cardiology, Faculty of Medicine, AL-Azhar University (Cairo)
author
Mahmoud
M Aboelhagag
Department of Cardiology, Faculty of Medicine, AL-Azhar University (Cairo)
author
text
article
2018
eng
Background: The prevalence of hepatitis C virus (HCV) in Egypt is quite high, and the combined oral direct-acting antiviral agents (DAAs) may have impressive results.
Objectives: To assess the cardiovascular effects of oral antiviral treatment in non-cardiac HCV patients.
Paitents and Methods: The study enrolled 100 patients with positive HCV who were enrolled for the new oral antiviral therapy in the form of Sofosbuvir and dclatsavir with or without ribavirin for 3 or 6 months. All patients on our study were subjected to follow up pre-and post-oral antiviral course, and the end point of the study was the development of a major cardiovascular event, e.g. congestive heart failure, echocardiographic evidence of left ventricular dysfunction, occurrence of significant arrhythmias, or acute coronary syndrome. The following parameters were accomplished: medical history and clinical examination, electrocardiogram, Echo-Doppler study, and laboratory investigations.
Results: No significant differences were found between the patients regarding demographic criteria. None of the patients had developed any major cardiac event. No significant changes were observed regarding ST segment and T wave abnormalities, arrhythmias, or QT interval. None of patients developed echocardiographic regional wall motion abnormalities at baseline or at study end. Systolic function parameters showed minute non-significant changes over study visits. Diastolic function parameters showed non-significant changes between baseline and post oral antiviral course visit.
Conclusion: The DAAs used in combination regimen didn’t significantly affect the cardiovascular system.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
527
538
https://amj.journals.ekb.eg/article_55587_ee96b6b7a5a6fab073e3134a9fc62269.pdf
dx.doi.org/10.12816/0052815
IMPACT OF ORBICULARIS OCULI MUSCLE STRIP EXCISION DURING UPPER LID BLEPHAROPLASTY ON TEAR FILM BREAK UP TIME AND POSTOPERATIVE DRY EYE SYMPTOMS
Mostafa
F Mohammed
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
author
text
article
2018
eng
Background: Dry eye syndrome (DES) is common after upper lid blepharoplasty (ULB), but tends to be self-limiting over the course of days to weeks. This occurs because the blink mechanism and tear film spread over the cornea are disrupted temporarily. More aggressive surgical techniques and over-excision of skin and orbicularis oculi muscle (OOM) appeared to increase the risk of dry eye following ULB.
Objectives: to study the impact of OOM strip excision during ULB on the tear film break up time (TFBUT) and postoperative occurrence and severity of dry eye symptoms.
Paitents and Methods: This interventional comparative study included 40 eyes of 20 patients (14 females and 6 males, the mean (M) age was 57.05 ± 4.80 years old. All patients had bilateral aesthetic ULB. Patients were divided into two groups: Group A: 8 patients (5 females and 3 males, M age was 58.38 ± 5.53 years old) who had bilateral ULB surgeries including OOM strip excision. And Group B: 12 patients (9 females and 3 males, M age was 56.17 ± 4.26 years old) who had bilateral ULB surgeries with preservation of OOM.
Preoperative evaluation: General medical history and full ophthalmologic history were taken. Full ophthalmologic examination was performed including corneal and tear film examination, TFBUT and Schirmer's tests. Lid crease height, palpebral fissure and marginal reflex distance were measured. Patients with uncontrolled chronic systemic diseases were excluded. Patients with exophthalmos, lid retraction, ptosis, brow ptosis, entropion or ectropion were also excluded.
Follow up: TFBUT and dry eye symptoms were assessed for each patient at one week and at one month postoperatively. Patients with continuous symptoms of dry eye postoperatively were followed up until three months. The changes of TFBUT of participants were statistically analyzed using the paired t-test. The M and standard deviation (SD) were used to obtain probability (P) value which was considered statistically significant when it was ≤ 0.05.
Results: As regard changes of TFBUT; there was statistically significant decrease in TFBUT M values in group A from 11 ± 1.37 seconds (s) preoperatively to be 9.69 ± 2.18 s at one week postoperatively. This decrease in TFBUT M value was temporary and reversible as there was statistically significant increase of TFBUT M value from 9.69 ± 2.18 s at one week postoperatively to be 10.56 ± 1.86 s at one month postoperatively which was near to the preoperative value As regard group B, there were non-statistically significant changes in TFBUT M values. Dry eye symptoms had been recorded by four patients from group A (50%) and two patients from group B (16.7%). These symptoms were more severe in patients of group A. All these symptoms were reversible and frequent use of lubricating eye drops and gels for one week was enough to reduce the patients' discomfort in most of cases, but 2 female cases from group A with multiple combined risk factors had needed to use low dose steroid eye drops and night eye anti-inflammatory ointments in addition to relatively longer period of lubricating eye drops using to reduce dry eye symptoms. According to the present study results, the most important risk factor for postoperative dry eye symptoms was excision of OOM strip during ULB. History of lubricating eye drops using was also associated with increased incidence of postoperative dry eye symptoms. Hypothyroidism and diabetes mellitus (DM) were suspected risk factors which have needed to be proven by further specific studies. Changes of TFBUT and reported dry eye symptoms following ULB were temporary and reversible in all cases of the present study.
Conclusion: Excision of OOM strip during ULB was associated with temporary statistically significant decrease in TFBUT and was also associated with more occurrences of reversible dry eye symptoms. Avoiding excision of OOM strip during ULB (if not indicated) was proven to minimize the occurrence of postoperative dry eye symptoms especially for patients with history of DES, for patient with repeated ULB, and those with systemic risk factors such as DM and thyroid dysfunctions.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
539
550
https://amj.journals.ekb.eg/article_55590_e8a8c87d4f2f510a310e7461c5dd6faf.pdf
dx.doi.org/10.12816/0052816
PATTERNS OF CLINICAL MANAGEMENT OF ATOPIC ECZEMA AMONG DERMATOLOGISTS AND OTHER SPECIALTIES
Amal
A Kokandi
Department of Dermatology, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
author
text
article
2018
eng
Background: Eczema is a common chronic skin disease with varying severities. Dermatologists and other specialties share the management of this disease including general physicians, pediatricians, immunologists and others.
Objectives: to explore the eczema management strategy differences between dermatologists and other specialties at Saudi Arabia.
Methods: An anonymous online questionnaire was sent to dermatologists and other specialties. The questionnaire included questions about eczema management strategies and opinions.
Results: All specialties advised the use of moisturizers and the avoidance of irritants. However, there were few differences among specialties. Immunologists were less likely to prescribe topical corticosteroids and more likely to check vitamin D. Immunologists and pediatricians are the highest in ordering IgE and specific IgE for food and aeroallergen tests in their practice.
Conclusion: Eczema management in our area has few discrepancies between specialties of dermatology, immunology, pediatrics, medicine and family medicine.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
551
560
https://amj.journals.ekb.eg/article_55592_13f74b621addb3b4b903f69301e7d5df.pdf
dx.doi.org/10.12816/0052817
LISINOPRIL VERSUS AMLODIPINE IN HYPERTENSIVE PATIENTS SUBJECTED FOR ANESTHESIA
Tawfik
M. Tawfik Noor-Eldin
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo
author
Mohamed
Samey Sharaf
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Damietta
author
Abd
El-Wahab Abd-Esattar Saleh
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo
author
Abd-Allah
Mohamed Abd-Allah
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo
author
Mohamed
Gameel Mohamed Yousef
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Damietta
author
text
article
2018
eng
Background: Hypertension is regarded as an additional risk factor during anesthesia. Antihypertensive usage and its implications during perioperative period have unpredictable effects on hemodynamics.
Objectives: To evaluate the effect of anesthesia (general) on hemodynamics in hypertensive patients chronically treated with amlodipine in comparison to patients on lisinopril.
Patients and Methods: This study included sixty adults, of both sexes, aged between 40 and 60 years old, controlled hypertensive with amlodipine or lisinopril, randomly divided into four equal groups. Group AG: On amlodipine subjected for general anesthesia, Group AS: On amlodipine subjected for spinal anesthesia, Group LG: On lisinopril subjected for general anesthesia, Group LS: On lisinopril subjected for spinal anesthesia, scheduled for elective lower limb or lower abdominal surgeries. Monitoring of arterial blood pressure (SBP, DBP, MAP), HR, oxygen saturation were recorded as pre-operative basal reading , immediately after induction, every 5 minutes for 20 minutes, then every 15 minutes till the end of operation. Hypertension was considered when increase >20% from basal reading, and hypotension when decrease <20% from basal reading.
Results: There were statistically significant differences as regard systolic, diastolic, mean arterial blood pressure between group AS and group LS with significant decrease in SBP, DBP, MAP more in group LS after spinal injection, also there were statistically significant differences as regard systolic, diastolic, mean arterial blood pressure between group AG and group LG with significant decrease in SBP, DBP, MAP more in group AG after induction of anesthesia. Also, there was astatistically significant difference as regard heart rate between AS and LS groups with significant decrease in HR more in group AS after spinal injection than LS group, Statistical significant difference was noticed in heart rate between AG and LG groups with significant decrease in HR more in group LS after induction of anesthesia.
Conclusion: Amlodipine was better than lisinopril in its effect regarding hemodynamics in hypertensive patients subjected for anesthesia.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
561
572
https://amj.journals.ekb.eg/article_55594_2afac79f7b5d1fd52f73a94d7d868755.pdf
dx.doi.org/10.12816/0052818
MIDAZOLAM VERSUS NALBUPHINE ON PREVENTION OF EMERGENCE AGITATION IN PEDIATRIC PATIENTS ON SEVOFLURANE ANESTHESIA
Tawfik
M. Noor EL-Din
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo
author
Mohamed
S. Sharaf
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Damietta
author
Ali
A. Alkumity
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo
author
Mahmoud
E. Elgammal
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Damietta
author
Eman
A Salem
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Girls
author
text
article
2018
eng
Background: Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Nalbuphine and midazolam have been used for prophylactic treatment. It is characterized by mental confusion, irritability, disorientation, crying, and increased recovery time in the post anesthesia recovery room, increasing parents’ concern and anxiety with respect to the clinical condition of their children. It can also lead to possible injury, damage to surgical dressings, lost intravenous catheters, and disconnected cables and monitoring instruments and source of dissatisfaction for parents, nurses, and others taking care of these children.
Objectives: The aim of the present study was to compare the effect of nalbuphine and midazolam before termination of sevoflurane-based anesthesia on the incidence and severity of EA in children as a primary outcome and post-operative pain, comparison of alertness and spontaneous behavior according to 3 step scales, adverse effects in both groups, and intraoperative hemodynamics as a secondary outcome.
Patients and Methods: This prospective double-blind randomized studyon 90 children between 4 and 8 years of age and of American Society of Anesthesiologists I undergoing adenotonsillectomy under sevoflurane-based anesthesia was enrolled in the study. Children were randomly allocated to one of the two equal groups: group (N) received nalbuphine 0.1 mg/kg and group (M) received midazolam 0.03 mg/kg. The study drugs were administered 5 min before the end of surgery. In the postanesthesia care unit, the incidence of EA was assessed with Aonos four-point scale. Severity of EA was assessed with the pediatric anesthesia emergence delirium scale upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), and 30 min (T30).
Results: The incidence and severity of EA were lower in group (N) as compared with group (M) at T0, T5, and T10.
Conclusion: Nalbuphine 0.1 mg/kg was more effective compared with midazolam 0.03 mg/kg in decreasing the incidence and severity of EA, when administered 5 min before the end of surgery in children undergoing adenotonsillectomy under sevoflurane anesthesia.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
573
586
https://amj.journals.ekb.eg/article_55596_6b7931fdb62ffccfda82f7e8560fa0cb.pdf
dx.doi.org/10.12816/0052819
DOPPLER STUDY OF SPLENIC ARTERY AND RENAL ARTERY RESISTIVE INDEX AS A PREDICTIVE OF ESOPHAGEAL VARICES AND ITS BLEEDING RISK IN EGYPTIAN CIRRHOTIC PATIENTS
Shaban
Salah Al-Azhary
Tropical Medicine Department - Al-Azhar Faculty of Medicine
author
Samy
Zaky
Tropical Medicine Department - Al-Azhar Faculty of Medicine
author
Abdullah
Hussein Ahmed
Radiology Department - Al-Azhar Faculty of Medicine (Girls)
author
Mahmoud
Hagag Abd El Fadeel
Tropical Medicine Department - Al-Azhar Faculty of Medicine
author
text
article
2018
eng
Background: Esophageal varices (EV), a major complication of liver cirrhosis, can lead to life threatening through gastrointestinal (GI) bleeding. Early detection of EV and prediction of its bleeding risk is important.
Objectives: Evaluate the resistive index (RI) of the renal artery (RA) and splenic artery by Doppler in various stages of liver cirrhosis, and their values for detection of EV and its bleeding.
Patients and Methods: This study included Sixty six patients with confirmed diagnosis of LC, twenty two patients with esophageal varices and having history of variceal bleeding episodes, twenty four patients with esophageal varices and having no variceal bleeding episodes history, and twenty patients without esophageal varices. All patients were subjected to history taking, clinical examination, laboratory investigations, calculation of some important non-invasive indices (CHILD, FIB 4, and APRI), abdominal ultrasonography, renal and splenic artery Doppler, and Upper GI endoscopy.
Results: RA RI served as predictors of the presence as well as bleeding risk of esophageal varices, and this prediction capability further empowered when both LRA RI and RRA RI were incorporated in a prediction equation, predicting the presence of esophageal varices with 95.7%, sensitivity and 50 % specificity at a cut off value of 0.715. Also, LRA RI revealed a sensitivity of 81.8%, and a specificity of 50% at the cut off value of 0.725 for prediction of esophageal varices bleeding. The splenic artery resistive index revealed a sensitivity of 69.6%, and a specificity of 90.1% for prediction of esophageal varices in a cut off value of 0.715 and a sensitivity of 68.2%, and a specificity of 70.5% for prediction of esophageal varices bleeding in a cut off value of 0.725.
Conclusion: Resistive index of the renal artery may help in predictions of esophageal varices and its bleeding risk, LRA RI was more sensitive for prediction of esophageal varices bleeding. In contrast, the splenic artery was less sensitive for prediction of esophageal varices and its bleeding risk.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
587
602
https://amj.journals.ekb.eg/article_55601_8ef6f3b14351c96263a4272252d9758b.pdf
dx.doi.org/10.12816/0052820
Effect of fluoxetine hydrochloride on the histological structure of the cerebellar cortex of albino rat offspring of treated mothers
Amany
M. Abo-Ouf
Department of Anatomy and Embryology, Faculty of Medicine (Girls), Al-Azhar University
author
text
article
2018
eng
Background: Fluoxetine hydrochloride is one of the most commonly used antidepressants in the selective serotonin reuptake inhibitor (SSRI) class.
Objectives: Demonstrating the effect of fluoxetine hydrochloride on the histological structure of the cerebellar cortex of albino rat offspring of treated mothers by 20 and 40 mgs throughout the first 2 weeks after delivery, and 40mg throughout the last week of pregnancy and the first 2 weeks after delivery.
Materials and Methods: Sixty pregnant rats and 180 of their offspring were used in this work. They were divided equally into two main groups; A-control group (Group C) and B-treated group (Group T). The pregnant rats and their offspring of the control group were divided equally into C1, C2 and C3. Immediately after delivery, each delivered rat of C1 and C2 was given0.18 ml and 0.36 ml of distilled water respectively for two weeks. Each pregnant rat of C3 was given 0.36 ml of distilled water throughout the last week of pregnancy and for 2 weeks after delivery. The pregnant rats and their offspring of the treated group were divided equally into T1, T2 and T3. Immediately after delivery each delivered rat of T1 and T2 was given 0.18 ml (Containing 0.36 mg of fluoxetine hydrochloride) and 0.36 ml (Containing 0.72 mg of fluoxetine hydrochloride) of distilled water respectively for 2 weeks. Each pregnant rat of T3 was given 0.36 ml of distilled water (Contained 0.72 mg of fluoxetine hydrochloride) throughout the last week of pregnancy and for 2 weeks after delivery. The treatments were given once/day orally. The specimens were collected at two ages, i.e. 1-week and 2-weeks old. The cerebella of all studied offspring were used for light microscopic examination. In addition, the cerebella of 2-weeks old offspring of all groups were used for electron microscopic examination and morphometric study.
Results: Light and electron microscopic examination and morphometric studies demonstrated that fluoxetine hydrochloride induced various signs of delayed development of the cerebellar cortex. It also induced degeneration and necrosis of the cerebellar cells and nerve fibers in the form of cytoplasmic vacuoles, dilated rough endoplasmic reticulum, swollen mitochondria with destructed cristae, degenerated mitochondria and nuclear changes in the form of karyolysis, pyknosis and karyorrhexis. Also, there was decrease in the number of Purkinje cells.
Conclusion: Fluoxetine hydrochloride induced various deleterious changes in the histological structure of the cerebellar cortex of albino rat offspring of treated mothers. These changes were directly proportional with increasing the dose and duration of its administration.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
603
634
https://amj.journals.ekb.eg/article_55604_a7cb2d42bad762d4b3b2d3e98352789f.pdf
dx.doi.org/10.12816/0052821
ONE STAGE CORRECTION OF CONGENITAL COMPLEX PENILE CURVATURE BY COMBINED MODIFIED NESBIT'S PROCEDURE WITH DORSAL DARTOS FLAP
Mohamed
Shahin
Department of Surgery (pediatric surgery unit), Faculty of Medicine, Al-Azhar University
author
Mohamed
Ramadan Rehan
Department of Urology, Faculty of Medicine, Al-Azhar University
author
text
article
2018
eng
Background: Congenital complex penile curvature (CCPC) is a rare deformity that arises from asymmetry of the corpora cavernosa. Congenital complex penile curvature has two abnormality components: torsion and curvature of the penis either ventral or dorsal. Objectives: Evaluation of one stage correction of CCPC by combination of modified Nesbit's procedure with dorsal dartos flap. Patients and Methods: This prospective study was conducted at Al-Azhar University Hospital in Damietta. Twenty eight patients with CCPC were evaluated and corrected during the period from October 2014 to September 2017. Their mean age was 5.5±2.1years (range 2–9.5 y). The direction of mal-rotation was anticlockwise in 23 patients and clockwise in 5 patients. Fifteen cases have ventral curvature; 8cases have dorsal curvature, while 5 cases have lateral curvature. All cases were treated firstly by modified Nesbit's procedure for correction of chordee, and then dorsal dartos flap was used for correction of penile mal-rotation in one stage. Results: All patients were corrected with high success rate. There were no more than 10° of residual mal-rotation or binding in all patients. One patient (3.57%) had penile hematoma that treated conservatively. All patients and their parents were satisfied with wonderful cosmetic and functional outcomes with no recurrent mal-rotation or binding. All cases were followed up for a mean follow up period of 9 ± 1.7 months (range 6 - 12 m.). Conclusion: Congenital complex penile curvature can be treated in one-stage surgery with excellent cosmetic and functional outcomes by combination of modified Nesbit's procedure with dorsal dartos flap.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
635
646
https://amj.journals.ekb.eg/article_55605_fd9dfdebce5b4e926b8efaa100ae9276.pdf
dx.doi.org/10.12816/0052822
THE EFFECT OF COENZYME Q10 AND/OR SILYMARIN ON RENALASE GENE EXPRESSION OF CARDIORENAL SYNDROME IN ADULT MALE ALBINO RATS
Gehan
A. Youssef
Physiology Department, Faculty of Medicine (Girls), Al Azhar University, Cairo, Egypt
author
Mona
G. Al Anany
Physiology Department, Faculty of Medicine (Girls), Al Azhar University, Cairo, Egypt
author
Ghada
M. M. Salah El-din
Physiology Department, Faculty of Medicine (Girls), Al Azhar University, Cairo, Egypt
author
Sara
N. M. Mousa
Physiology Department, Faculty of Medicine (Girls), Al Azhar University, Cairo, Egypt
author
text
article
2018
eng
Background: Therapeutic strategies in cardiorenal syndrome (CRS) should be directed to the cardio-renal connectors like renalase. Coenzyme Q10 (CoQ10) and silymarin are natural anti-oxidant and anti-inflammatory agents.
Objectives: Assessing the effect of CoQ10 and/or Silymarin on renalase gene expression in CRS induced by high fructose diet (HFD) in male rats.
Patients and Methods: Fifty adult male albino rats of local strain were divided into 5 equal groups and subjected to the following regimens for 8 weeks: Group I: Supplemented orally with 1 ml of 2% aqueous solution of tween 80. Group II: Received HFD in the form of 30% fructose in drinking water. Group III: Received HFD and CoQ10 orally at a dose of 20 mg/kg/day dissolved in 2% tween-80 aqueous solution. Group IV: Received HFD and Silymarin orally at a dose of 200 mg/kg/day dissolved in 2% tween-80 aqueous solution. Group V: Received HFD and both CoQ10 and silymarin in the same regimen as described before.
Results: CoQ10 and/or Silymarin significantly decreased plasma lipid profile, cardiac troponin-I, creatinine, malondialdehyde (MDA) & tumor necrosis factor alpha (TNF- α) levels when compared to HFD group. On the other hand, CoQ10 and/or silymarin caused significant increase in plasma catalase level & renalase gene expression in kidney tissue when compared to HFD group. They also improved HFD -induced cardiac and renal fibrosis.
Conclusion: CoQ10 and Silymarin induced improvement in HFD-induced CRS as they possessed cardio-protective, reno-protective, hypo-lipidimic, anti-oxidant, anti-inflammatory and anti-fibrotic activities, as well as increased renalase expression.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
647
660
https://amj.journals.ekb.eg/article_55608_a822e64b0a791cdb7ce49eb5c9b85962.pdf
dx.doi.org/10.12816/0052823
COMPARISON BETWEEN CHANGES OF PARAFOVEAL OUTER PLEXIFORM-INNER NUCLEAR LAYERS THICKNESS AND CHANGES OF PARAFOVEAL GANGLION CELL LAYER THICKNESS AFTER INTRAVITREAL RANIBIZUMAB INJECTION FOR DIABETIC AND BRANCH VEIN OCCLUSION RELATED MACULOPATHY
Mostafa
F Mohammed
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
author
text
article
2018
eng
Background: Optical coherence tomography (OCT) has enabled objective measurement of macular thickness in diabetic and branch retinal vein occlusion (BRVO) associated macular edema (ME). Recent advances in OCT with higher resolution enabled segmentation of the individual retinal layers, quantification of the thickness of retinal layers and qualitative evaluation of lesions in individual layers. Objectives: Studying the changes of parafoveal outer plexiform-inner nuclear layers thickness (OPINLT) and changes of parafoveal ganglion cell layer (GCL) thickness at the thickest parafoveal point after single injection of ranibizumab in patients with ME caused by diabetic retinopathy (DR) or BRVO. Patients and Methods: The present study included 36 eyes of 30 patients (21 males and 9 females, mean age was 52.87±7.56 years old). All patients had single intravitreal injection of 0.5 mg (0.05 mL of 10 mg/mL) of ranibizumab (bilaterally in 6 patients and unilaterally in 24 patients) for treatment of ME caused by DR or BRVO. OCT images were taken preoperatively, and one month after intravitreal ranibizumab injection for all participants using spectral OCT SLO combination imaging system. Foveal thickness was measured. Parafoveal measurements were obtained at the thickest parafoveal point (1200 μm from foveal center) in the superior, nasal, inferior and temporal parafoveal sectors. Parafoveal measurements included parafoveal thickness, OPINLT, isolated GCL thickness and GCL-IPL thickness (GCIPLT). Results: The study included 30 eyes with diabetic ME caused by moderate to severe non-proliferative diabetic retinopathy (NPDR) or early proliferative diabetic retinopathy (PDR); 17 eyes with cystoid macular edema (CME) and 13 eyes with diffuse macular edema (DME), in addition to 6 eyes with CME due to BRVO. As regards changes of participants' best corrected visual acuity (BCVA) and foveal thickness, there was a statistically significant improvement in BCVA mean value from 0.36±0.19 preoperatively to be 0.7±0.27 one month after injection, and statistically significant decrease in mean foveal thickness from 342.64±110.04 μm preoperatively to be 249.55±68.90 μm one month after injection. As regards total parafoveal thickness, there was statistically significant decrease in mean parafoveal thickness of the participants in each parafoveal sector after injection and the postoperative parafoveal thickness mean values were higher in the superior and nasal sectors. As regards detailed segmented parafoveal measurements, there were statistically significant decrease in both OPINLT and GCIPLT mean values in all parafoveal sectors after injection. By further analysis of isolated GCL, the present study results have shown that the changes of GCL mean thickness in each parafoveal sector were not statistically significant. In addition, preoperative and postoperative GCL thickness mean values were higher in the superior and nasal sectors. Conclusion: OPINLT and GCIPLT decreased significantly at the thickest point of parafoveal area after single intravitreal ranibizumab injection for treatment of ME caused by DR or BRVO, while isolated GCL thickness did not change significantly after injection. It was proven also that GCL which contains the cell bodies of ganglion cells (GCs) was proven to be the least affected layer by ME.
Al-Azhar Medical Journal
Al-Azhar Scientific Medical Society
1110-0400
47
v.
3
no.
2018
661
672
https://amj.journals.ekb.eg/article_55610_d9e03f54820494fee78705efe6272aaf.pdf
dx.doi.org/10.12816/0052824