Background: Since the early development of functional endoscopic sinus surgery (FESS) in the 1970s, this technique has gained increasing popularity. Objective: To compare the efficacy of combined regional nasal anesthesia and general anesthesia -in a group of patients undergoing FESS versus the efficacy of general anesthesia. Patients and Methods: A double blinded study was carried out, in Al-Azhar University Hospitals on 40 adult patients undergoing endoscopic sinus surgery, Physical status (ASA I&II), after approval of the ethical committee of Al-Azhar University. Written consent was obtained from all patients. Every patient received an explanation to the purpose of the study and given a code number. The SPSS program was used for data handling. Results: After analysis of the data, the results have shown that the regional anesthesia in Group B could achieve better surgical fields, less blood loss, a stable hemodynamic profile with no need for the use of risky multimodal drugs, less anesthesia time, and better postoperative analgesia. Conclusion: Regional anesthesia of the nose after induction of general anesthesia in patients undergoing FESS is an effective method that can provide better surgical field visualization with fewer bleeding, more stable hemodynamic profile without the use of multimodal drugs, less anesthesia time, and better postoperative analgesia when compared to the induced hypotension technique.
Background: Glycemic control is important in diabetes mellitus to minimize the progression of the disease and the risk of potentially devastating complications. Inhibition of the sodium glucose cotransporter (SGLT2-inhibitor) induces glucosuria and has been established as a new anti-hyperglycemic strategy. Canagliflozin is approved as sodium glucose co-transporter 2 inhibitors (SGLT2-inhibitor), plays a distinct and complementing role in glucose homeostasis. Objective: Comparing the effects of Canagliflozin on streptozotocin-induced type-I and type- II- diabetes in adult male albino rat. Materials and Methods: Sixty male albino rats were randomly categorized into 6 equal groups; Group I (Normal control group): Rats received 2 ml/100 g Na citrate buffer by intraperitoneal injection, Group II (Normal-Canagliflozin-treated-group): Rats received Canagliflozin (10 mg/kg/day, orally), Group III (Streptozotocin-induced type-I diabetic group): Rats were subjected to induction of diabetes by a high single intraperitoneal injection of streptozotocin 65 mg/kg body weight in citrate buffer, Group IV (Streptozotocin- nicotinamide- induced type-II diabetic group): The overnight fasted rats were subjected to induction of diabetes by a small single intraperitoneal injection of streptozotocin 40 mg/kg body weight (2 ml/100 gram) in citrate buffer and nicotinamide in a dose of 110 mg/kg boy weight 15 minutes before streptozotocin injection, Group V (Streptozotocin + Canagliflozin): Received a high dose of streptozotocin (65 mg/kg body weight) and Canagliflozin (10 mg/kg/day, orally), and Group VI (Streptozotocin + nicotinamide + Canagliflozin): Received a small dose of streptozotocin (40 mg/kg body weight), nicotinamide (110 mg/kg body weight), and Canagliflozin (10 mg/kg/day, orally). At the end of the experimental period, blood samples were collected for measuring of fasting serum glucose level, insulin level, C-peptide level, total cholesterol, triglycerides (TG), cholesterol- low density lipoproteins (LDL-C), cholesterol-high density lipoproteins (HDL-C), aspartate transaminase (AST), and alanine transaminase (ALT). Histopathological studies of the pancreas were done. Results: Streptozotocin-induced diabetes mellitus was associated with significant higher levels of serum blood glucose, total cholesterol, TG and cholesterol- LDL-C, AST, and ALT, with significant lower levels of insulin, C-peptide, and HDL-C as compared to the control normal group. Canagliflozin showed significant lower levels of blood glucose, total cholesterol, TG, LDL-C, AST, and ALT, and significant higher levels of insulin, C-peptide, and HDL-C as compared with the diabetic rats. There were insignificant changes also between groups V and VI in all parameters. Conclusion: Canagliflozin improved glycemic, lipidemic disturbances, liver enzymes, and have a potent tissue protective and regenerative effects for the pancreas.
Background: Hepatitis C virus (HCV) is one of the hepatitis viruses that transmitted through blood or blood products. HCV has been implicated as a major reason of chronic liver disease and hepatocellular carcinoma worldwide. Objective: This study aimed to determine the seroprevalence of HCV antibodies among community in Luxor governorate, Egypt. Moreover to assess if there is any association with the population group, sex, age and other different risk factors. Patients and methods: We randomly selected 745 blood samples; from males and females of different ages (20-65 years). Samples were collected from Luxor governorate, Egypt. Seras from all subjects were tested for hepatitis C virus antibodies using rapid test method and confirmed by the enzyme linked immunosorbent assay (ELISA third generation). Results: Our results showed that 584 (78.40 %) of the community were males and most of them aged between 31 and 50 years. Thirty two (5.48%) from blood samples of males were anti-HCV seropositive, and the highest prevalence of anti-HCV (7.22%) of age groups from 41-50 years. One hundred and sixty one (21.60%) from the community were female and most of them aged between 41 - 65 years. Six (3.73%) of female subjects tested positive for anti-HCV and the highest prevalence of anti-HCV (4.87%) was with age groups from 31-40 years. Four risk factors reflecting high mechanisms of HCV transmission have been associated with HCV infection including residing in rural areas, no education, blood transfusion, and dental treatment. Exposures to surgery and history of schistosomiasis showed low association with Anti-HCV. Among the community exposures, were blood donation and alcohol consumption but these associations were not important. Conclusion: This study has been conducted to determine the prevalence rate of anti-HCV among community in Luxor governorate, Egypt.
Backgrounds: Clinical use of cisplatin is limited by its nephrotoxicity as cisplatin -induced oxidative stress which leads ultimately to kidney dysfunction. Objective: Evaluation of the nephron-protective effect of metformin against nephrotoxicity induced by cisplatin in adult albino rats. Materials and Methods: Sixty adult male albino rats were divided randomly into 6 equal groups: Group I (control group) was injected with 1 ml isotonic saline solution intraperitoneally (I.P). Group 2 was injected with single dose of cisplatin I.P 3.5mg/kg. Group 3 was injected with single dose of cisplatin I.P 7.5 mg/kg. Group 4 was given an oral dose of metformin (350 mg/kg /day for 10 days). Group 5 was given 100 mg kg/day metformin for 3 days before cisplatin injection I.P at a dose of 7.5 mg/kg on day four, and metformin continued for 7days after. Group 6 was given 350 mg kg/day metformin for 3 days before cisplatin injection I.P at a dose of 7.5 mg/kg on day four, and metformin continued for 7days after. Body weight of each rat was recorded on day 1, 4, 7 and 10 and average weight for each group was calculated. At the end of specified duration (10 days), rats were sacrificed and both kidneys were excised, processed and stained with Hematoxylin and Eosin for histopathological study and with Periodic Acid-Schiff (PAS) and Mallory’s stain stains for histochemical study. Results: Rats injected with high dose of cisplatin (7.5 mg/kg) showed more loss of average body weight and higher blood urea nitrogen (BUN) and serum creatinine (Cr) levels than those rats injected with 3.5 mg/kg cisplatin. Rat group injected with high dose of cisplatin (7.5 mg/kg) and given low dose metformin (100 mg/kg/day) showed less loss of average body weight and improved renal functions than rat group given high dose of cisplatin (7.5 mg/kg) and high dose of metformin (350 mg/kg/ day). Histopathological examination with H&E and histochemical examination with PAS and Mallory stains revealed mild glomerular, tubular and interstitial changes in cisplatin low dose group compared to cisplatin high dose group which showed more renal damages. Group given metformin low dose + cisplatin high dose showed less renal damage than those given high dose of cisplatin+ high dose metformin. Conclusion: Metformin has protective effects against cisplatin -induced nephrotoxicity in adult male albino rats.
Background: Pregnancy misfortune happens in 0.5-1% of ladies. The etiology is frequently vague and might be multifactorial, with much debate in regards to determination and treatment. Objective: Investigating the relationship between serum progesterone and CA-125 distinguishing successful from unsuccessful pregnancy outcome during the first trimestic cases of threatened abortion. Patients and Methods: This clinical trial included 80 cases of confirmed intrauterine pregnancies between 6-12 weeks with demonstrable embryonic pulsation 40 asymptomatic patients and 40 cases complicated with vaginal bleeding. All cases were selected from Obstetrics and Gynecology Department, Al-Hussein and Sayed Galal Hospitals, Al-Azhar University, from December, 2018 to August, 2019. All patients showed an evidence of embryonic cardiac activity. CA-125 serum levels ware measured and compared with progesterone levels. Results: The mean level of CA.125 was 42.3±19.1 in threatened group and was 30.1±21.6 in normal group respectively. There was a statistically difference between the two groups regarding serum CA125. On the other hand, there was no statistically difference between the two groups regarding progesterone. ROC curve analysis showed 80.55% sensitivity and 100% specificity of CA125, and 78.65% sensitivity and 98.04% specificity of progesterone for prediction of the occurrence of miscarriage. Conclusion: Serum CA-125 seemed to be a promising biomarker for the early prediction of miscarriage
Background: Spontaneous bacterial peritonitis (SBP) is a severe and frequent complication of cirrhosis with a high mortality rate. Early diagnosis and treatment of SBP is necessary for survival. Objective: To study the mean platelet volume (MPV) versus leucocyte esterase as a marker in diagnosis of decompensated cirrhotic patients with spontaneous bacterial peritonitis. Patients and methods: A total of 200 patients with decompensated liver cirrhosis and ascites, were admitted to the Department of Gastroenterology and Hepatology in Nasser Institute, and were enrolled in this study between January 2016 and October 2017. Patients were divided into two equal groups; group (I) was diagnosed non SBP and group (II) was diagnosed SBP. All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, leukocyte esterase reagent strip test (LERS) (URIT 10V) and culture. All patients underwent assessment of MPV in CBC. Results: Diagnostic performance of mean platelet volume showed that we can use MPV as a good diagnostic marker for SBP with sensitivity 75 %, specificity 99% and accuracy 93.2 %. The best cut off value for discriminating patients with SBP from patients without SBP was 9.2 fl. The test of ascetic fluid by leukocyte esterase reagent strips showed that specificity = 93% , sensitivity = 80%, positive predictive value (PPV) = 92%, negative predictive value (NPV) =82.3% and accuracy = 86.5%. Conclusion: MPV and LERS can be used as a good marker in diagnosis of SBP in cirrhotic patients with ascites.
Background: Since the introduction of tympanoplasty in the 1950s, variety of surgical techniques has been developed for closure of tympanic membrane perforation. Tympanoplasty and myringoplasty are commonly used procedures for the treatment of chronic otitis media. Objective: The aim of the present work was to compare the success rate between endoscopic and microscopic tympanoplasty through transcanal approach as regard improvement of hearing, closure of tympanic membrane perforation and the time of operation. Patients and Methods: This prospective study was carried out on thirty patients who attended to outpatient clinic of Al-Hussien University Hospital from November 2018 to June 2019. All patients with the complaint of discharging ear and decreased hearing were screened. They were divided randomly into two equal groups; group A was treated by transcanal endoscopic tympanoplasty, and group B was treated by transcanal microscopic tympanoplasty. All operations were done at AL-Azhar University Hospitals (Al-Hussein University Hospital). Results: The graft success rate was 80 % in group A, and 73.3 % in group B. There was significant improvement in hearing in both groups pre- and post – operatively, but the difference between both groups was not statistically significant. Microscopic tympanoplasty was shorter than endoscopic with no significant difference between both groups. Conclusion: Tympanoplasty is an effective technique for recovering hearing thresholds secondary to a tympanic membrane perforation. In transcanal approach, postoperative cares were easy as the technique is minimally invasive in surgical approach, scar, bleeding and pain. The telescopic wide angle magnified view of the endoscope overcame most of the disadvantages of the microscope. Endoscopes provided good exposure of the tympanic membrane, usually without canaloplasty.
Background: Tuberculosis (TB) is considered the most common and highly contagious disease worldwide. Early and accurate diagnosis of TB with detection of multidrug-resistant Mycobacterium tuberculosis (M.TB) is of primary importance for both patient management and infection control. Objectives: To evaluate the performance of Microscopic-Observation Drug-Susceptibility (MODS) assay and GeneXpert MTB/RIF( GeneXpert ) assay in diagnosis of TB and detection of MDR-TB directly from sputum specimens in comparison to the convential diagnostic methods (direct Ziehl-Neelsen "Z-N" stained smear and culture on Lowenstein-Jenson media "LJ"). Patients and Methods: After approval of institutional ethical committee a total of 120 suspected pulmonary TB patients admitted to chest hospitals and dispensaries in Egypt (Giza, Cairo, Alexandria, Dakahlia, Suez, Beheira, Monufia, Qena). Their age was more than 16 years; all of them did not receive any anti tubercular drugs. Sputum samples were collected from each patient and subjected to direct ZN smear, culture and sensitivity of M.TB on LJ and Middlebrook 7H9 medium for MODS assay. Finally Genexpert M.TB/RIF assay was done directly for all sputum samples. Results: Infection rate among males was higher than female (81.7% & 18.7%). Also, it was observed that 56.7% of sputum samples gave positive direct Z-N smear, while 64.2% were positive for both LJ culture &MODS assay. On the other hand, by Genexpert, 68% of cases were positive. The sensitivity and specificity of the various diagnostic methods were studied in relation to LJ culture (gold standard). It was found that MODS assay was rapid that results were obtained in a median of 8 days ranged from (7– 21 days), while median time of LJ was 21dayes ranged from (21– 60). MODS had 100% sensitivity and specificity. Direct smear was less sensitive (88.3%), and GeneXpert was less specific (88.4%), but more rapid results were obtained in 2 hours. Finally, detection of MDR-TB using various methods for 77 isolated M.TB strains ranged from 16.9-19.5% to isoniazid (INH) and 9.8%-18.2% to rifampicin (RMP) by various diagnostic methods with statistically insignificant difference between them. Conclusion: MODS was an optimal alternative rapid diagnostic technique for TB and detection of M.TB and MDR-TB in resource limited settings, results were obtained in a median of 8 days. On the other hand, Gene Xpert was a novel integrated diagnostic PCR analysis in a single hand free step for rapid diagnosis of TB and detection of RMP resistance in clinical specimens in 2 hours but it was expensive.
Background: Active aging can be achieved, when people are free of diseases, have intellectual capabilities, possess high physical fitness and can actively be engaged with others. In developing countries, most of which do not have comprehensive policies on aging, big challenges are faced including double burden of disease, increased risk of disability and feminization of aging. It is important to promote the concept of active aging in the population. Objective: To understand the Egyptians perception and attitudes towards the elderly, the contribution of older people in their workplaces, societies and determine the most important actions required to ensure an actively aged Egyptian population. Subjects and methods: A community based study was conducted in eastern Cairo by applying simple random sample to select between 4 main divisions, a sample of 1000 participants yielded a power of approximately 99%. All age groups above 18 years old were included. Subjects were divided into two groups: below 60 years and those equal to or above 60years. Data was collected using interview questionnaire, which was adopted from the special Active Aging questionnaire EUROBAROMETER 378 questionnaire. Results: The majority of the participants feel that a person is considered old at the age of 66, and 51% of participants less than 60 years assured that elderly play a big role towards their family. Workplace age discrimination was highly reported, being unable to adapt to modern workplaces is found to be the main obstacle stopping people aged 60 years and over from working. Conclusion: Flexibility at work and financial rewards for elderly are recommended. More attention must be given to institutions as older people’s organizations and religious organizations that have a positive role in tackling the challenges of aging in population.
Background: Amblyopia is the commonest childhood vision disorder, most children with amblyopia require refractive correction as well as patching; Evidences for direct retinal changes in amblyopic eyes are still inconclusive and controversial. Objectives: To detect changes in the macula by macular Optical Coherence Tomography (OCT) after part time occlusion in children with amblyopia. Patients and Methods: Arandomised non controlled study included forty child suffering amblyopia in this study. Best corrected visual acuity (BCVA: 0.1- 0.5) were recruited and treated with refractive correction, and part time occlusion (6 hours/day) for one week per year. BCVA and macular thickness were measured by OCT before and after treatment. Factorial repeated-measures analysis of variance was performed to determine the macular thickness in amblyopic eyes changed after amblyopia treatment. Results: The mean age of children was 8.57±2.52 years. There was a statistically significant difference in the central macular thickness pre & post amblyopia treatment. There was no statistically significant difference for the other macular thickness parameters except for superior quadrant of parapovea where the difference was significantly significant. Conclusion: The mean of central macular thickness and superior quadrant of parapovea increased after part time occlusion treatment compared to pretreatment. No significant difference in average macular thickness, (nasal, temporal, inferior) parapovea, perifovea, retinal nerve fiber layer (RNFL) thickness and ganglion cell layer (GCL) before and after treatment.
Background: Cognitive brain functions constitute the ability to work with information in a meaningful way, apply gained information, perform preferential changes, and someone ability to change opinions about that information. Individuals with epilepsy have a higher prevalence of impaired cognitive performance compared to healthy individuals who are matched for age and education. Numerous factors can have a deleterious impact on cognition in patients, including age at onset of epilepsy, seizure frequency, duration of seizures, structural cerebral damage as a consequence of repetitive or prolonged seizures and medications used for treating seizures. Objective: Assessing the cognitive functions in patients with generalized onset epilepsy. Patients and Methods: Our study was conducted, in the neurology department of Sohag general hospital upon 75 individuals divided into 3 equal groups presented with epilepsy selected from the inpatient and outpatient clinics. Patients were divided into three groups: I. Group A: patients diagnosed with generalized onset epilepsy with medication (anti-epileptic drugs). II. Group B: patients diagnosed with generalized onset epilepsy without medication (anti-epileptic drugs). III. Group C: healthy subjects will be included in the study as the control group. All of the participants were be subjected to the following: *Full history (demographic data and personal history, detailed history of general health condition and chronic or current diseases) and general and neurological examination *Special tests including: PEBL Wisconsin (Berg) Card Sort test, PEBL The Conners’ continuous performance test, Montreal cognitive assessment (MoCa) *Brain imaging: MRI brain (to exclude organic cause). *EEG. Results: The mean Correct Responses Wisconison card sorting test of study groups was around 76.7±5.65 in group 1, around 78±2.88 in group 2 and 81.8±2.38 in group 3; with significant difference between group 1 and group 3 and significant difference between group 2 and group 3. The mean Target Acc Rate continuous performance test was around 0.956±0.03 in group 1, around 0.970±0.015 in group 2 and 0.974±0.015 in group 3; with significant difference between group 1 and group 2 and significant difference between group 1 and group 3. The mean MoCa of study groups was around 24.1 in epileptic with medication group, 23.96 in epileptic without medication group and 25 in control group with no significant difference between all groups. With high significant difference between Group 1 versus Group 3, and Group 2 versus Group 3. The normal MoCa was around 3 in epileptic with medication group, 2 in epileptic without medication group and 22 in control group with high significant difference between all groups. Conclusion: All patients with epilepsy reported significant impairment in all cognitive measures such as working memory, inhibitory control, goal maintenance, and mental flexibility. We observed attentional deficits in processes such as alertness and attention span and those requiring sustained and divided attention compared with controls. Attentional and executive impairment was correlated with higher frequency of seizures.
Background: Patients having treated with hydroxychloroquine (HCQ) can have retinal function and morphological changes with no evident retinal abnormalities on ophthalmoscopy this can be detected by various imaging Tanique’s. Objective: We aimed to evaluate the early changes of retinal function by multifocal electroretinogram (MF-ERG) and morphology by spectral domain optical coherence tomography (SD-OCT) that may eventually occur in a population of subjects having Rheumatoid Arthritis treated with hydroxychloroquine with no evident retinal abnormalities on ophthalmoscopy. Patients and methods: A prospective study on 30 eyes of patients treated with HCQ (Patient group) and another 30 healthy eyes (control group). SD-OCT and MF-ERG was done in both groups. All patients underwent full medical and ophthalmic history including onset and duration of disease and HCQ therapy, history of ocular surgeries. All patients underwent complete ophthalmic examination including visual acuity: uncorrected VA (UCVA) and best corrected VA (BCVA), anterior segment examination using slit-lamp biomicroscopy, intraocular pressure (IOP) measurement by applanation tonometry, fundus examination, OCT imaging using SD-OCT, and MF-ERG imaging. Results: In patients treated with HCQ, there was a significant reduction in the pri-foveal macular thickness by SD-OCT in comparison to control group. There were also significant MF-ERG changes in the form on decreased P1-wave amplitude and increased P1-wave latency. Conclusion: MF-ERG and SD-OCT were very sensitive tests for the early detection of HCQ-related retinal toxicity. Using either MF-ERG or SD-OCT, or combination of them may be recommended in order to detect retinal changes earlier and also in follow up.
Background: Diabetes mellitus (DM) is associated with a greater risk of cardiovascular disease and almost one third of patients with acute myocardial infarction (AMI) may have undiagnosed DM on admission. DM is associated with abnormal endothelial function, increased inflammatory response, increased platelets and leukocytes plugging and seems to be an important factor deteriorating microvascular reperfusion in acute phase of MI. Objective: The purpose of this study was to evaluate the impact of diabetes mellitus on: (1) Myocardial microvascular reperfusion after primary PCI in patients with acute myocardial infarction utilizing two well validated measures of myocardial reperfusion, resolution of ST- segment elevation and myocardial blush grade (MBG) and (2) Left ventricular systolic function recovery and incidence of remodeling after primary PCI in patients with acute myocardial infarction. Patients and Methods: The study population consisted of 100 patients with STEMI (50 diabetic and 50 non-diabetic) conducted at coronary care unit of El-Zyton specialized hospital .All patients underwent Primary percutaneous coronary intervention (1ry PCI), ECG (pre and post PPCI) to assess ST segment resolution and Conventional 2D echocardiography to asses left ventricular ejection fraction ( LVEF) (by M-Mode and Simpson rule), end diastolic volume (EDV) and end systolic volume (ESV) and wall motion score index(WMSI) was done within 72hr of admission and after 3 months later and patients with LV remodeling, i.e. an increase >20% in LV end-diastolic volume (LVEDV), were identified. Results: No significant difference was found regarding baseline demographic, clinical and lab data except in dyslipidemic number of patients (92% in diabetic group vs. 36% in non-diabetic group. There was a statistically significant difference between both studied groups as regard ECG post PPCI finding, no significant difference between 2 groups as regard baseline ECHO (EF by M-Mode, EF by Simpsons rule, LVEDV, LVESV, E/A ratio, deceleration time (DT) and wall motion score index). As regard coronary angiography and 1ry PCI data there was a significant difference between diabetic and non-diabetic group as regard number of diseased vessel and myocardial blush grade (MBG): MBG(0) was 1 % in diabetic group and was 1% in non-diabetic group, MBG (1) was 12 % in diabetic group and was 4% in non-diabetic group ,MBG(2) was 48 % in diabetic group and was 14% in non-diabetic group and MBG(3) was 38 % in diabetic group and was 80% in non-diabetic group . Conclusion: The microvascular reperfusion in STEMI patients with diabetes was worse than STEMI patients without diabetes. The incidence of remodeling was more in STEMI patients with diabetes than STEMI patients without diabetes.
Background: Hepatitis C virus (HCV) lifecycle is closely connected to host cell lipid metabolism, from cell entry, through viral RNA replication to viral particle production and formation/assembly. Objective: To determine the serum levels of ox-LDL, total antioxidant capacity and superoxide dismutase, and evaluate their role in HCV hepatitis patients. In addition, the effect of direct-acting antiviral therapy on their levels was evaluated. Patients and Methods: This study included forty chronic hepatitis C (genotype 4) patients. Blood samples were taken from the patients before and after taking sofosbuvir (400 mg) and daclatsvir 60 mg; one time daily orally for 24 weeks. Forty apparently healthy personnel were used as control group. Results: Serum TAC in chronic HCV hepatitis patients were significantly low before treatment as compared to the control group. Serum levels of ox-LDL were significantly high in patients before treatment and after treatment as compared to control group. Antioxidants supplementations and direct antiviral drugs did not affect the levels of ox-LDL significantly. Serum levels of extracellular SOD were significantly higher in control group, than levels in HCV patients before treatment and after treatment. Treatment did not restore the levels of serum SOD in patients. Direct-acting antiviral agents had a sustained virological response in the chosen group of patients. Conclusions: Direct-acting antiviral agents did not normalize serum levels of ox-LDL and extracellular SOD. In addition, the currently used antioxidants did not decrease the oxidative changes in LDL.
Background: Tympanic Membrane (TM) perforation is one of the common reasons of patients’ attending Otolaryngology clinics. Repair of tympanic membrane perforations with most accepted techniques reaches a success rate of over 90%. Platelet-Rich Plasma (PRP) can be defined as an autologous concentration of human platelets in a small volume of plasma. Objective: The aim of this study was to evaluate the effect of PRP-enriched gel foam on the healing of chronic TM perforation in comparison with gel foam alone after myringoplasty. Patients and Methods: In this double-blind randomized clinical trial, 40 patients with chronic tympanic membrane perforations, attending the ENT outpatient clinics of Al-Azhar university hospitals between September, 2017 and May, 2019, they were randomly allocated to two groups; intervention group, underwent myringoplasty with platelet rich plasma (PRP)-enriched gel foams and control group, underwent myringoplasty operation with conventional gel foams alone. Patients were seen 1 month, 3 months and 6 months after surgery. Results: Forty patients, 21 males (52.5%) and 19 females (47.5%) with a mean age of 45.3 ± 11.9 years in intervention, and 43.98 ± 10.8 years in control group underwent analysis. Complete TM healing was seen in 19 (95%) patients in intervention group, and 14 (70%) patients in control group three months after intervention. No complications were seen in intervention group, while three otorrhea cases were recorded for control group in the first follow up after intervention which was resolved by medication. Conclusion: Addition of PRP to conventional gel foams used in TM perforation repair increased the complete healing rate of TM perforation to a significant extent.
Background: Subarachnoid hemorrhage (SAH) refers to bleeding that occurs primarily within the subarachnoid space, in between cases of spontaneous SAH and rupture of an intracranial saccular aneurysm accounts for approximately 85%. Objectives: The aim of this study was to assess clinical presentation, risk factors and the etiology of subarachnoid hemorrhage in a sample of Egyptian patients, and also assess the outcome of endovascular management and complications. Patients and Methods: The study was carried out on patients with SAH who were subjected to endovascular neuro-intervention unit in AL-Hussein University Hospital, including patients with SAH retrospectively from 2006 to 2018, and the newly diagnosed patients during 2019. Results: During the period from May 2006 to May 2019, 560 patients with SAH has been admitted. 136 patients (24.2%) were excluded from the study as they were critically ill. Their Hunt and Hess score were 4 to 5. Also, another 51 has been excluded due to missed files or discharge against medical advice. The remaining 373 patients. 145 patients were angiographically free, Patients with aneurysm were 228 patients, 77 patients died before therapeutic endovascular treatment as they delayed due to financial troubles, The remaining patients were 151, The most common type of aneurysm between those patients was anterior communicating aneurysm (27.8%), then MCA aneurysm (17.8%), posterior communicating artery aneurysm (13.9%), para-ophthalmic artery aneurysm (6.6 %), basilar artery aneurysm (5.9%), posterior inferior cerebellar artery aneurysm (6.4%), supraclinoid carotid artery aneurysm (3.1%), peri callossal artery aneurysm (3.3%), T carotid artery aneurysm (7.2%), superior cerebellar artery aneurysm (1.9%), inferior cerebellar artery aneurysm (2.6%) and multiple aneurysms (6.6%). The complications of endovascular treatment in studied patients occurred in 13 patients (3.4%) in the form of aneurysmal rupture, coil displacement, hydrocephalus and vessel rupture. Conclusion: Cerebral catheter angiography is a safe, feasible and efficacious procedure. The new technique in the endovascular management of the cerebral aneurysm as balloon or stent assisted technique and flow diverter stent is greatly reducing the complication rate and making the outcome is very promising.
Background: Continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods in knee arthroplasties. Objectives: This study aimed at comparing the efficacy and hemodynamic changes of CSA technique versus single interspace CSE technique in knee arthroplasties intra & postoperatively, and the potential adverse effects for both techniques. Patients and Methods: After approval of Institutional ethical committee and obtaining written informed consents, forty patients aged 18 to 55 years of both sexes and American Society of Anesthesiologists (ASA) class I, II, were scheduled for elective knee arthroplasties. All Patients were assigned randomly by using a computerized program to one of the two equal groups: Group CSA: Patients undergoing elective knee arthroplasty received continuous spinal anesthesia. Group CSE: Patients undergoing elective knee arthroplasty received single interspace combined spinal epidural anesthesia. The following parameters were assessed: Hemodynamics: including heart rate and systolic (SBP) and diastolic arterial blood pressures (DBP), and percentage of oxygen saturation (SpO2) were obtained then recorded at 5th, 15th, 30 minutes, and at 1st, 2nd, 4th hours intra-operatively till the end of surgery. Postoperatively, they were obtained at 0, 1 hour and every four hours for first 24 hours. Anesthetic complications: PDPH, urine retention, and Postoperative nausea and vomiting (PONV). Postoperative pain was evaluated at rest using a 10-cm Visual analogue scale (VAS) (0 cm=no pain; 10 cm=worst pain possible) and pain scores were recorded at 30 min and 1st, 2nd, 4th, 6th, 12th and 24th hours post-operatively. This prospective randomized clinical trial study was conducted at Al- Azhar University Hospitals (Al- Hussein and Bab-Al-Shaarya) at the orthopedics operating theatre from March 2019 till September 2019. Results: No significant difference between the two groups regarding the length of surgery, hypoxia, post-operative nausea and vomiting (PONV), post-operative pain score. The application time of the anesthetic technique was significantly shorter in the CSA group than CSE group. The heart rate was significantly higher in the CSE group at 1st minutes while SBP and DBP were significantly lower in the CSE group at 1st minutes than the CSA group. Post dural puncture headache (PDPH), and urine retention was significantly higher in the CSA group than the CSE group. PDPH occurred in 35% of the CSA group compared to 10 %. Urine retention occurred in 25% of the CSA group compared to 5% of the CSE group. The total dose of bupivacaine (0.5%) collectively given intra-operatively and morphine postoperatively were significantly lower in the CSA group than the CSE group. Conclusion: The study revealed that CSA and CSE were both effective and safe techniques for knee arthroplasties with superiority of CSA in hemodynamic stability intraoperative at 1st minutes of surgery. CSA offered many advantages over epidural anesthesia by using smaller anesthetic dose with rapid onset and recovery of motor and sensory blockade with better cardiovascular stability than CSE.
Backround: Ovulation is the central event in the reproduction cycle. Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility. Polycystic ovarian syndrome (PCOS) with abnormalities in the metabolism of androgens and estrogen and in the control of androgen production remains one of its leading causes .Polycystic ovary syndrome (PCOS) is a common multisystem endocrine disorder in women, with long-term health consequences Objectives: Comparing the efficacy of Letrozole and Clomiphene citrate, as a first line treatment for induction of ovulation in cases of polycystic ovary syndrome. Patients and Methods: This study was randomized comparative study involving 100 Egyptian women having polycystic ovary syndrome attending Al-Azhar University Maternity hospital (Sayed Galal/ Infertility outpatient clinic, And 6th October Health Insurance Hospital). During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (50 Patients) or 100 mg Clomiphene citrate (50 Patients) from the third until the eighth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The difference between Letrozole and Clomiphene citrate for ovulation rate was 44 (88%) versus 30 (60%) respectively. Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of 9.2 mm (SD 2.37) versus 8.4 mm (SD 1.61) for patients taking Clomiphene citrate, and these differences were statistically significant. In terms of pregnancy rate, Letrozole facilitated pregnancy induction in 19 patients (38%) versus 8 patients (16%) for Clomiphene citrate, which was statistically significant. More dominant follicles exhibiting a mono-follicular morphology were observed in patients treated with Letrozole compared to patients treated with Clomiphene citrate, with a mono-follicular dominant follicle observed in 23 (46%) versus 14 (28%) patients respectively. Conclusion: Letrozole provided a more efficient stimulation compared to Clomiphene citrate in terms of ovulation induction, thickening of the endometrial lining and achievement of a successful pregnancy.
Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It is a combination of symptoms and signs caused by the compression of the median nerve as it passes in the carpal tunnel at the wrist. It is an important cause of functional disability, and is the commonest cause of referral to the Electro diagnostic laboratory. CTS is studied extensively. However, its pathophysiology still unclear and most of the cases still idiopathic especially in middle aged women. Objective: To correlate between severity of CTS and abnormality of lipid profile, and to establish the relationship between severity of CTS and age, Body mass index (BMI), in Egyptian middle aged women. Patients and Methods: This study included 155 female cases and controls recruited from the Neurology outpatient clinics of Al-Hussein University Hospital and Al Sahel Teaching Hospital during the period from November 2018 to September 2019, 103 cases with the clinical and neurophysiological diagnosis of idiopathic carpal tunnel syndrome. The study demonstrated the relation between age, lipid profile, BMI and severity of carpal tunnel syndrome in this group of females in comparison to the 52 females as a controls. Results: Age, high BMI, higher cholesterol and LDL levels, were correlated with severity of CTS, while Cholesterol and LDL were much higher among the cases compared to controls. HDL was less in the patients. Conclusion: Abnormal lipid profile, higher BMI, obesity and poor living circumstances could influence the incidence and severity of CTS among middle aged Egyptian women.
Background: Infertility is a common gynaecological problem that has a multi factorial aetiology. Conception and pregnancy depend on complex physiological, anatomic and immunological factors. Objective: to evaluate the prevalence of chlamydial infection, especially subclinical cases, in a population of Egyptian tubal infertile women and to relate it to history, symptoms, clinical, and laparoscopy findings. Finally, to find any advantage of detecting antichlamydial antibodies in serum of these patients and evaluate its importance in prediction of tubal factor of infertility. Patients and Methods: This study includes 50 primary or secondary infertile females (patients group) their age between 20-30 years, and 50 random fertile females (control group) and Blood sample for IgG, Chlamydia trachomatis antibodies were drawn from all cases of the study for ELISA test. Results: The prevalence rate of Chlamydia trachomatis IgG antibodies was significantly higher in infertile group than that of control group. There was significant higher rate and ratio of positive results in infertile group than that of control group concerning anti-chlamydial IgG. There was a strong correlation between serum levels of anti-chlamydial IgG in the infertility patients. There was a significant correlation between serum anti-chlamydial IgG levels and the duration of infertility. There was no relation between the serum level of anti-chlamydial IgG and the age of the patients of the type of infertility. The results of this study are matched with most of the previous published studies yet there are some differences in the positive and negative ratios. Conclusion: Chlamydia trachomatis plays a major role in the occurrence of tubal factor of infertility. Subclinical chlamydial salpinigits was an important cause of tubal infertility. Serological test for Chlamydia trachomatis namely anti-chlamydial antibodies IgG are sensitive, simple, and inexpensive tests even if compared by using direct methods for detection and should be done as a routine part of infertility investigations. The serological test could be an accurate non-invasive predictor of tubal status especially if combined with other methods as HSG, good history taking and examination.
Background: Hepatic stellate cells (HSCs) regulate vitamin A metabolism and play a vital role during the activation of the immune response. During liver damage, HSCs transform to myofibroblast-like cells, leading to loss of their lipid content and synthesis of extracellular matrix (ECM) inducing liver fibrosis. Objective: The present study aimed to establish the correlation between HSCs activity within different areas of hepatic tissue and the degree of liver fibrosis in individuals with normal liver, hepatitis C virus infected patients and post-transplanted liver. Patients and methods: The study involved thirty four cases from the international medical center classified into three groups: group 1 included ten healthy individuals as control, group 2 included twelve patients with chronic hepatitis C virus and liver cirrhosis and group 3 included twelve patients with post-transplanted liver due to liver previous hepatitis C virus infection and hepatic cirrhosis subdivided into group 3a five patients who received antihepatitis C treatment, and group 3b seven patients who didn’t receive antihepatitis C treatment. We used H&E and Masson trichrome stains, immunohistochemical detection of á-smooth muscle actin (á-SMA), Glial Fibrillary acidic protein (GFAP) and transmission electron microscopy (TEM). Results: H&E stain revealed hepatic tissue with preserved architecture in group 1, disrupted architecture and areas of feathery degeneration in group 2, normal tissue histology in group 3a and moderate cellular infiltration in group 3b. Masson trichrome stain revealed normal collagen fibers distribution in group1, advanced fibrosis in group 2, no fibrotic changes in group 3a and few foci of bridging fibrosis in group 3b. Immunohistochemical analysis revealed increased expression of α-SMA in group 2 and group 3b in comparison to group 1 and group 3a. Immunohistochemical analysis revealed increased expression of GFAP in group 3b in comparison to group 3a, group 2 and group 1. TEM showed increase in the fibrous tissue and degeneration in the ultrastructure of the hepatocyte with few lipid droplets in HSCs of group 2 compared to group 1. Conclusion: The hepatic stellate cells play an important role in the fibrosis of the liver damaged by hepatitis C virus and in the post-transplanted liver which not treated from HCV.
Background: Hepatitis B virus (HBV) infection is an important health problem and the major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC) in Egypt, and especially in Upper Egypt. Objectives: The aim of this study was to estimate the prevalence of hepatitis B virus among Assiut Governorate patients. Patients and method: Our study focused on screened of all patients by ELISA tests for blood-borne viral infections. Seropositive patients were inquired about the exposure to possible risk associations for acquiring these infections. Biochemical, HBV markers by ELIZA, DNA-PCR, were done to classify patients to groups (Low viremia, High viremia, and occult). Results: We examined 1085 patients for HBsAg at Assiut Governorate, Egypt. Out of the 1085 population tested for HBs-Ag, 623 (57.5%) were males, whereas 462 (42.5%) were females. A total of 165 out 1085 were seropositive for HBsAg (15.2%). The highest seropositive of HBsAg were recorded in 106 males (17.1%) compared to 59 females (12.8%). HBsAg seropositive decreased with grassing age, The highest seroprevalence of HBsAg recorded in age ranged between 21-30 years 62 (37.5%). All patients were divided into four groups according to HBV-DNA. Seroprevalence of HBsAg increased with group 2 (Low titer of HBV-DNA < 2000 IU/ml - 46.1%), where highest prevalence of HBsAg was recorded in males (37.6%) compared to females (8.5%). The lowest seroprevalence of HBsAg were recoded with group 3 (high titer of HBV-DNA > 2000 IU/ml -14.5%). HBV was common in rural versus urban community areas (78.2% versus 21.8 % respectively). We did not find abnormal levels of biochemical indicators of liver and kidney functions in HBV infected patients. Conclusion: Screening of HBV infection to monitor liver disease progression in HBV carriers by using molecular, biochemical and serological markers, stated that effective treatment can be initiated early before the development of advanced liver diseases.
Background: Iron deficiency anemia (IDA) is the condition in which there is decrease in the number of red blood cells or the amount of hemoglobin in the blood. It is caused by insufficient dietary intake and absorption of iron, or iron loss from bleeding. Bleeding can be from a range of sources such as the intestinal, uterine or urinary tract. IDA develops when available iron is insufficient to support normal red cell production and is the most common type of anemia. Objective: Comparing the efficacy and the safety of Lactoferrin versus ferrous sulphate for the treatment of iron deficiency anemia during pregnancy. Patients and Methods: This study was done in outpatient clinic of El-Monera General Hospital, from January 2019 to March 2019, between two groups of pregnant women ranging from 20-40 years and gestational age 24-32 weeks with microcytic hypochromic anemia, mild anemia and moderate anemia for 2 months that were selected in a randomized method by the computer. Results: Oral lactoferrin was better tolerated and more acceptable with higher increase in mean hemoglobin when compared to oral iron therapy over two months treatment. Conclusion: Oral lactoferrin was better tolerated and more acceptable with higher increase in mean hemoglobin when compared to oral iron therapy over two months treatment.
Background: Menopause, a natural step in woman`s life aging process, is associated with increased risk of metabolic diseases. Salt, is an essential micronutrient, commonly added to food. However, studies addressing the metabolic effects of high salt intake are controversial and limited. Objective: The present study was designed to determine the changes imposed by increased salt consumption on glucose and lipid homeostasis in ovariectomized rats that mimics the estrogen-deprived condition in postmenopausal women. Material and Methods: Thirty six adult female albino Wister rats were allocated into 3 equal groups: Control group, ovariectomized group, and high salt ovariectomized group which received high salt (2%NaCl) solution for 2 months. Rats were subjected to estimation of body weight (BW), body mass index (BMI), waist circumference (WC), and visceral fat weight. Glucose uptake by diaphragm and glucose output by kidneys were determined. Also, levels of glucose, lipid profile, malondialdehyde, catalase, insulin, estradiol and tumor necrosis factor-α were measured. Pancreatic and hepatic tissues were examined histopathologically. Also, caspase-3 was assessed in pancreas by immunohistochemistry. Results: High salt ovariectomized group showed significant decrease in final WC, and significant increase in serum insulin, HOMA-IR, serum levels of MDA and TNF-α compared to the ovariectomized group. There were significant increases in plasma levels of glucose, triglycerides, total cholesterol, LDL-C, catalase, and AI, and significant decrease in glucose uptake by diaphragm, and plasma HDL-C in high salt group compared to control group. As compared to ovariectomized group, the pancreas in salt loaded group showed decreased number of islets of Langerhans and fatty degeneration together with increased caspase-3. Liver histology was also worsened, and hepatocytes showed ballooning, steatosis and inflammatory infiltration together with massive amounts of collagen fibers around portal tract. Conclusion: High salt intake exacerbated the hyperglycemia and insulin resistance, intensified pancreatic apoptosis and hepatic fatty, and degenerative changes. These effects could be explained by salt loading-induced exacerbation and exaggeration of oxidative and inflammatory influences of ovariectomy.
Background: Marriage timing is one of the important determinants of birth rates and health profile of both the mothers and infants. Child marriage is recognized as a major development issue that affects girls in many developing countries. The practice has been linked to a number of health risks, higher fertility, and lower education attainment. Objective: To estimate the rate of child marriage in some underdeveloped Egyptian governorates and identify its correlates. Subjects and Methods: The study was part of a large survey, which was conducted in six purposefully selected Egyptian governorates and defined as developing; three from upper Egypt (Sohag, Assuit and Menia) and three from lower Egypt (Sharkia, Behira and Ismalia) aiming to measure the prevalence of child marriage and assess the impact of the different social and economic factors that affect the occurrence of the phenomena. Data were collected from 15279 females using an interview questionnaire targeting households’ members (sampling unit) in the selected governorates. Results: Prevalence of early age of marriage was significantly high among governorates of upper Egypt than in lower Egypt (reaching 39.75 in rural areas in El Menia) especially in rural residency. Lower educational level (less than secondary School) and consanguinity were found to have significant association with early age of marriage. Results revealed that early age of marriage has its effect on birth rate with mean number of children of 3.59 per women who married at age less than 18 years. Conclusion: Early age of marriage is an important public health challenge. Hence, a national multi-sectorial approach must be targeted to reduce this phenomenon.
Background: The initial strength of the repair depends on the material properties and knot security of the sutures as well as on the holding capacity of the suture grip of the tendon. Objective: Detecting the effect of cyclic loading on the strength of flexor tendon repair using 6 strand Tang suture experimentally. Materials and Methods: In the present ex vivo study of 50 sheep flexor tendons, six strand Tang suture technique was used: Twenty five repairs were subjected to cyclic tensile testing, and twenty five repairs were subjected to static tensile testing using 4/0 polypropylene simple suture material + epitendinous continuous running sutures using 5/0 polypropylene suture material. Results: The results of the study showed that 44 % survival at 41.7 N cyclic testing, without evidence of significant gap formation or rupture and the breaking force on continuous loading mean 55.95 N. The Tang suture method provided much more sufficient gap resistance and tensile strength able to withstand early active mobilization after primary flexor tendon repair. Conclusion: The Tang suture method provided sufficient gap resistance and tensile strength able to withstand early active mobilization after primary flexor tendon repair. There were some disadvantages regarding to time consuming during surgery and difficult to use in pediatrics and small tendons.
Background: Active range of motion were analyzed as the outcomes of tendon transfer around the shoulder in children who had internal rotation contracture deformities secondary to obstetric brachial plexus palsy (OBPP) to improve the shoulder external rotation. Regarding to importance of external rotation there was some limitation of internal rotation which can affect patient’s daily activities. Methods: 50 patients with brachial plexus injury who underwent tendon transfer (teres major or latissimus dorsi) with or without anterior shoulder release in two separate incisions. Coracohumeral ligament release and Subscapularis release were done for all patients through anterior incision. A separate second incision in the posterior axillary fold was carried out to perform rerouting of the teres major or latissimus dorsi tendon. Results: The average active external rotation in abduction increased from 23.5º preoperatively to 76.4º postoperatively. The average active external rotation in adduction increased from 9.6º to 77.5º. The average shoulder abduction increased from 74.5º to 142.6º. Active internal rotation was analyzed just after operation, 6 month after and one year after. There was limited active IR in adduction from 10º to 50º with mean average 28.21º and improvement gradually with physiotherapy. Conclusions: Anterior shoulder release combined with latissimus dorsi or teres major rerouting significantly improved global shoulder function, but with limitations of active internal rotation which improving significally with physiotherapy.
Background: Primary open angle glaucoma (POAG) is an optic neuropathy characterized by progressive degeneration of retinal ganglion cells (RGC) and their axons, which results in characteristic excavation of the neuroretinal rim with corresponding visual field (VF) deficits. Optical coherence tomography angiography (OCTA) is a novel imaging modality that can detect vascular flow of the retina and choroid in great detail. The ability to segment OCT angiograms into the different vascular layers may improve understanding of disease pathogenesis. Objective: To evaluate the correlation between Ganglion Cell and Inner Plexiform Layers thickness using optical coherence tomography (OCT) and the macular microvasculature density in different stages of primary open angle glaucoma using optical coherence tomography angiography (OCTA). Subjects and Methods: The study was performed on 80 eyes of 48 subjects including 20 eyes of 11 controls, and 60 eyes of 37 POAG cases which were divided into 3 groups according to Hodapp,Parish,Anderson (H-P-A) classification; Group1: mild glaucoma (20 eyes), Group 2: moderate glaucoma (20 eyes),Group 3: severe glaucoma (20 eyes). Results: In our study, we found that there was a significant reduction in Ganglion Cell - Inner Plexiform Layer (GCIPL) thickness and macular VD in patients with POAG which increased with increasing glaucoma severity, also we found that OCT and OCTA parametrs were significantly differentiate between normal and POAG cases and also between different stages of POAG. Also we found that an OCTA was an important diagnostic tool in diagnosing mild cases of POAG and to differentiate between mild and moderate cases of POAG,in contrast to OCT in which there was no significant differance between mild and moderate cases of POAG. OCTA seems to be a good candidate for diagnosis and follow-up of glaucoma, complementing the results provided by OCT and visual field testing. Conclusion: Significant differences between eyes with POAG and normal eyes in terms of the macular GCIPL thickness and microvasculature density (VD) suggest that the macular GCIPL thickness and the retinal capillary vessel area density may be reliable indicators of glaucoma severity.