Background: Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by public hospital. Cataract surgery can be performed by or phacoemulsification or sutureless manual small Incision cataract surgery. Manual small incision cataract surgery is more cost effective Objective: Comparing the morphological (cell density, coefficient of variation and standard deviation) endothelial changes after phacoemulsification versus manual small-incision cataract surgery (MSICS). Patients and Methods: Patients were randomly allocated to undergo phacoemulsification (Group A, n = 40) or MSICS (Group B, n = 40). The patients underwent complete ophthalmic evaluation and specular microscopy preoperatively, and after 1 and 6 months postoperatively. Morphological endothelial evaluation was done using Topcon SP- 2000 specular microscope. Phacoemulsification was performed by stop and chop technique. MSICS was performed by the irrigating vectis technique. Results: On comparing between the phacoemulsification and MSICS groups regarding the endothelial cell density, the P value after 1 month and 6 months postoperatively were not statistically significant. The difference in mean endothelial cell density between groups at 1 week and 6 weeks was statistically significant. The mean coefficient of variation and mean standard deviation between groups were not statistically significant. Conclusion: Both groups showed comparable endothelial cell loss in the post-operative period. As SICS was economical and less dependent on technology than phacoemulsification, it may be the appropriate surgical procedure for treatment of cataract in the developing world.
Background: Women who have had pre-eclampsia (PE) are more prone to recurrent negative pregnancy outcomes and altered utero-placental and umbilical flows in their future pregnancy. In addition, to an increased risk of later cardiovascular diseases, which clearly suggest a shared aetiology. Yet, the mechanisms involved have not been identified. Although, the causes of PE are not well understood, there is a possibility that PE has, at least in part, a genetic basis. The "physiological remodelling" of spiral arteries throughout pregnancy is mediated by the rennin-angiotensin system (RAS). The ACE I/D polymorphism of the ACE gene accounted for 47% of total phenotypic variance of the serum Angiotensin converting enzyme (ACE), contributing much to the variability of the ACE level. Previous studies failed to reproduce a persistent link of ACE I/D genotype and PE in nulliparous women. Objective: In this prospective study, we analysed the association of the ACE genotype and the recurrence of PE and/or fetal growth restriction (FGR) in subsequent pregnancy in women at high risk for a previous PE as primipara, without other known risk conditions. Patients and Methods: Sixty women with history of PE as primipara, with no known risk factors apart from nulliparity, were recruited in their second pregnancy. Their ACE genotyping were detected. Uterine arteries resistance indices (RI) and umbilical artery pulsatility index (PI), were recorded at 16th, 20th, 24th weeks of gestation and clinical pregnancy outcome was analyzed, as well. Results: ACE I/D genotype distribution among our cases of 90 Egyptian pregnant women were compatible to other races in literature. DD genotype was detected in 41.1% of our cases, 34.4% were ID genotype and 24.4% were II genotype. Significant difference in ACE I/D genotype and D-allele frequency were observed in cases with recurrent PE and/or FGR. Mid trimester uterine arteries resistance indices (RI) at 16th, 20th, 24th weeks of gestation, and umbilical artery pulsatility index (PI) at 20th, 24th weeks were significantly higher in DD genotype group compared to ID and II genotype respectively. In addition, DD genotype group had significantly lower gestational age at time of delivery, lower birth weight and placental weight. Conclusion: ACE DD genotype and D- allele frequency adversely affected pregnancy outcome and utero-placental and umbilical flow velocimetry in women with history of preeclampsia as nulliparous without known risk factors apart from nulliparity.
Background: Standard neurological examination was found to be inadequate for diagnosing suspected early peripheral neuropathy in patients with Rheumatoid Arthritis (RA) though electrophysiological testing can be utilized for early diagnosis and defining the extent of peripheral nerve involvement. Objective: To evaluate nerve conduction study and electromyography in patients with rheumatoid arthritis complained of neuropathic symptoms. Patients and Methods: This study was carried out on thirty patients with clinical diagnosis of rheumatoid arthritis who had neuropathic symptoms as tingling or burning sensation in any extremity. Also control group consisted of thirty patients with clinical diagnosis of rheumatoid arthritis without evidence of peripheral neuropathy by history and examination. patient group subdivided into subgroup A (patients had neuropathic affection in nerve conduction study (NCS) and subgroup B (patient had normal findings in NCS). Results: There was a highly statistically significant difference between patient and control groups as regarding neurophysiological evidence of neuropathy. There was a statistically significant difference between sub groups A and B as regarding age of the patients. There was also a highly statistically significant difference between sub groups A and B as regarding abnormal findings in clinical examination. Conclusion:Possibility of presence of peripheral neuropathy in electrophysiological study in patients with rheumatoid arthritis who complained neuropathic symptoms was more than patients who didn’t complain. Electrophysiological studies should be included in the routine examination of rheumatoid arthritis patients for early detection of neurological involvement
Background: Chronic hepatitis C virus (HCV) infection has been linked to numerous co-existing conditions including metabolic abnormalities and cardiovascular disease. Stroke is a major public health crisis world-wide. About 87% of strokes are ischemic. Between 25- 40% of ischemic stroke may be cryptogenic. HCV infection is associated with a wide spectrum of extra-hepatic manifestations, affecting different organ systems. Neurological complications occur in a large number of patients and range from peripheral neuropathy to cognitive impairment and/or cerebral infarctions (CI). Objective: Studying the role of HCV infection in patients having CI. Patients and Methods: After departmental ethics committee approval and patient consents were obtained, 60patients included in this work: 20 patients having CI and chronic hepatitis C (CHC), 20 patients having CI without CHC, and 20 patients having CHC without CI. All patients were subjected to history taking and clinical examination, complete blood count (CBC), evaluation of HCV antibodies, polymerase chain reaction (PCR) for HCV ribonucleic acid (RNA), hepatitis B surface antigen (HBs-Ag), liver function tests, renal function tests, lipid profile, antinuclear antibody (ANA), anticardiolipin antibodies immunoglobulin G (ACL-IgG), antineutrophil cytoplasmic antibodies (ANCA), cryoglobulin, fasting plasma glucose (FPG) and post-prandial plasma glucose (PPPG). In addition, ultrasound (U/S) abdomen, magnetic resonance imaging (MRI) brain, doppler study of the carotid arteries and echocardiography. Results: Group A (CI and CHC) patients were significantly younger and females were predominant in these patients than those of either group B (CI without CHC) or C (CHC without CI) .Group B patients were significantly overweighed compared to group A or C. Total cholesterol (TC), triglyceride (TG), FPG and low density lipoprotein (LDL) significantly decreased in group A and C compared with group B .Patients of group A showed significantly higher positive of HCV viremia, cryoglobulins, ANA, c-ANCA and ACL-IgG, compared with group C, while those of group B were negative for same parameters. Carotid atherosclerosis and ischemic heart disease (IHD) were significantly higher in patients of group A, compared with group (B and C), respectively. Conclusion: Chronic HCV infection is a risk factor in development of CI by multiple mechanisms including atherosclerosis, thromboembolism and vasculitis. Also, it increases stroke risk and might be considered as an important and independent risk factor.
Background:Noise stress is implicated in various illnesses of human, and it is responsible for increased morbidity associated with modern life style. Music induces emotions which are often accompanied by physiological reactions. Objective:Investigating the effect of light music and noise on growth and maturation from weaning to puberty in female rat with studying the histological structuresof pituitary, thyroid and ovaries. Material and Methods:Fifty animals were used in this work and divided into five equal groups: ● Control group. ● Rats exposed to noise for 60 days (over 90db, 1h/day). ● Rats exposed to music for 60 days (1h/day). ● Rats exposed to music then noise for 60days (2h/ day). ● Rats exposed to noise then music for 60days (2h/ day). At the end of experiment, serum was obtained from the rats during the di-estrous phase for determination of: 1. Growth hormone. 2. TSH level. 3. Gonadotrophic hormones (FSH, LH). 4. Prolactin hormone. 5. Leptin hormone. Histopathological study for pituitary, thyroid and ovaries were done. Results: This study revealed that noise caused significant decrease in gonadotrophic hormones (LH, FSH) and TSH, with significant increase in serum leptin without any changes in both growth and prolactin hormones. In addition, it produced significant pathological changes in pituitary, thyroid, ovaries and uterus. These changes included congested dilated blood sinusoids and loss of normal cellular arrangement. On the other hand, music caused insignificant changes in gonadotrophic hormones (LH, FSH) and TSH levels, with significant increase in leptin hormone without any changes in both growth and prolactin hormones levels. In addition, it produced insignificant pathological changes in pituitary, thyroid and ovaries as compared with the control group. Conclusions: Exposure to noise stress could affect the process of reproduction but does not affect the process of growth. In addition, listening to light music does not disturb the process of reproduction or growth. Where there was an equilibrium in biochemical and histological results.
Background: Although the increased fetal morbidity and mortality associated with post-term pregnancy has long been appreciated, most authors have studied gestational age as the alone contributing factor. The influence of other factors such as maternal age, parity, maternal smoking, fetal genders, birth weight and past history of post-term has not been adequately evaluated, Additionally, the accuracy of earlier studies is limited by the fact that they predate the widespread use of both ultrasonography for accurate gestational dating and intensive fetal testing to establish fetal wellbeing. Objective: the present study was conducted to evaluate the effects of prolonged exceeding 287 days of menstrual age on the Doppler flow velocity waveforms in the umbilical, middle cerebral and uterine arteries, and its impact on neonatal outcome to determine the best predictor of adverse outcome in post-term. Patients and Methods: The present study included 50 pregnant ladies All patients were submitted to ultrasound for detection of fetal genders, fetal weight and amniotic fluid index (AFI) Also, they were submitted to color Doppler velocimetery of fetoplacental and fetal vessels including middle cerebral pulsitility index MCA PI), umbilical artery pulsitility index UA PI), middle cerebral resistance index MCA RI), umbilical artery resistance index UA RI), uterine artery pulsitility index UtA PI),and uterine artery pulsitility index UtA RI). Results: In the present study, there was no statistical signification with gestational age, fetal heart rate and parity. The primary gravida had the highest incidence. There was higher rate of CS which was significant with prolongation of pregnancy, but with no statistically significant difference between adverse and normal outcome Also, the incidence of males was more than females in our population with no significant relation between fetal gender and neonatal outcome. Adverse outcome was associated with lower MCA PI, MCA RI, AFI, Apgar score, and higher UA RI compared to normal outcome with statistically significant difference between them, but there was no statistically significant difference as regard UA PI, UtA PI, UtA RI. Conclusion: The perinatal morbidity and mortality may be increase in post-term pregnancies. However, the all screening tests and Doppler indices may be normal due to mode of delivery, time of delivery, and type of anesthesia during labor. So, during labor, rapid interference should be taken to decrease incidence of adverse neonatal outcome. In post-term pregnancies with adverse outcomes, impedance to flow in umbilical arteries may be increased, while impedance to flow in the fetal middle cerebral arteries may be decreased, but impedance to flow in uterine arteries may be normal
Background: Capnography provides insight into the management of many emergencies. It reflects the factors affecting perfusion and metabolism, and it is used for continuous monitoring of mechanically-ventilated patients.Objectives: To investigate the correlation between the partial pressure of end tidal carbon dioxide (PetCO2) and arterial blood carbon dioxide (PaCO2), and to investigate the accuracy of the change of capnographic curve in diagnosis of special pathological situations. Patients and Methods: A total of 100 patients (1 day to 15 years), mechanically-ventilated due to various clinical causes were monitored by PetCO2, and arterial blood gas (ABG) concomitant with assessment of PetCO2. Results: Significant correlation was found between PaCO2 and PetCO2, and abnormal PaCO2-PetCO2 gradient was found to be correlated well with the duration of mechanical ventilation. Various PetCO2 waveforms were recorded. Conclusion: Capnography should be used for monitoring of critically ill patients and for confirmation of endotracheal intubation. It should be applied during cardio pulmonary resuscitation (CPR) and to monitor the quality of CPR. It is used to monitor the integrity of patient ventilator interface, identification of ventilated patients in need for additional sedation or neuromuscular blockage, and readjustment of ventilator parameters.
Background: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition. Emerging evidence suggests that vitamin D (VD) may play a role in the pathogenesis of NAFLD. Objective: Studying VD status in patients with NAFLD. Patients and Methods:Seventy five patients were divided into 5 groups: Group (1) Diabetic patients with NAFLD, Group (2): Dyslipidemic patients with NAFLD, Group (3): Non-diabetic, non-dyslipidemic patients with NAFLD, Group (4): Diabetic patients without NAFLD, and Group (5): Healthy subjects (age and sex matched). All subjects were subjected to full history taking, clinical examination and laboratory investigations including assessment of serum VD, fasting insulin, lipid profile, blood glucose, AST and ALT, and assessment of IR by determination of HOMA-IR. This were in addition to abdominal ultrasonography and using Hamaguchi score to evaluate fatty liver state. Results: VD significantly decreased in all NAFLD patients (groups 1, 2 and 3), in addition to group 4 (diabetic patients without NAFLD), compared with group (5). This association was independent from age, sex, insulin resistance (IR), or liver functions. Also, VD significantly decreased in males of group 2 compared to females of same group. Moreover, there was significant negative correlation between VD and US score of NAFLD patients. Conclusion: VD was deficient in patients with NAFLD and diabetic patients without NAFLD. This association was independent from age, sex, diabetes, IR or liver functions. The greater the degree of NAFLD, the greater was the degree of VD deficiency. Also, there was an inverse correlation between VD and US score.
Background: Retinal detachment is the separation of the neurosensory retina (NSR) from the underlying retinal pigment epithelium (RPE). These two layers are derived from neuroectoderm that lines the optic vesicle during embryogenesis. Objective: We compared spectral-domain optical coherence tomography imaging with postoperative visual acuity to evaluate the relationship between morphological changes in the macula and visual outcome after successful repair of RRD with macula off. Patients and methods: We enrolled 30 patients (30 eyes) 21 eyes were phakic (70%) and 9 eyes were pseudophakic (30%). with successful repair of RRD. the examination had been done 1,2,6-months and one year follow up after surgery in this prospective research. The mean age of the patients was 17 to 73 years with mean age value of 44 ± 13.4 years. The duration of retinal detachment (RD) ranged from 1 to 14 weeks with a mean of 6.8± 4.2 weeks. There was history of trauma in 3 cases (10%). The IS/OS line was evaluated considering its continuity and any disruption in the line was measured by manual caliber. The extent of disruption was evaluated in the 5-lines raster scan. In the scan that showed the largest defect, the extent of the IS/OS disruption was measured along a 1.8 mm-diameter area centered on the fovea. Results: SD-OCT was done to all patients post-operatively according to OCT findings, the 30 eyes were divided into three groups; A, B, and C. Group A included all cases with residual subretinal fluid, Group B included cases with other finding rather residual subretinal fluids. Group C included eyes with no detectable OCT findings. There were 8 (26.7%) eyes with retained subretinal fluids (Group A), 18 eyes (60%) with pathology other than Subretinal fluid (Group B), and 4 eyes (13.33%) with no detectable pathology after the operation (Group C) Conclusion: SD-OCT is an irreplaceable instrument for the postoperative assessment of macula in patients who have undergone surgery for macula-off RRD. It permits detection of the presence of foveal changes that are not visible with ophthalmoscope. Persistent sub-retinal fluid is responsible for the poor prognosis after surgery. Although there was a detectable improvement in vision with decrease of the amount of subretinal fluid, Visual prognosis related to other pathological finding as photoreceptors integrity, and presence or absence of Cystoid macular edema.
Background: Hospital waste is one of the most common health related subject for health care provider. Effective surveillance of hospital waste as regard collection, storage, transportation and incineration in Al-Hussein or crushing and sterilization in Sayed Galal hospitals. The related health education paper is an important tool to increase the awareness of the health care providers and decrease the risk factors of developing blood born hepatitis among them. Objectives: Identifying the occupational health hazards to which the hospital waste workers were exposed in Al-Azhar University Hospitals, and find out the proportion of hospital waste workers who were infected by blood born hepatitis (B and C), and identifying risk factors of developing infection by blood born hepatitis (B and C). Subjects and Methods: Four hundred subjects from workers and nurses at different Departments of Al-Hussein and Sayed Galal University Hospitals as exposed group, and another 400 subjects as non exposed (control group) from security, and different administrative departments. Results: Fifty Six subjects developed hepatitis antibodies at the end of the study period, and 344 subjects were not infected. 52.5% were mainly injured by needle stick, 89.2% were mainly supervised by nurses, 32.5% did periodic medical examination, and 77.5% agreed that safety box easily opened, accessible and evacuated before filling, 90% were using the personal protective equipments and 37.5% were vaccinated against HBV. There were 46.6% attending and following monthly the health education seminars.There were 74.8% attending and following the training courses seminars. 96.25% were knew and fellow the color coding specification and separation. 40% of the studied group worked less than five years, 30% from five to ten years and 30% more than ten years .70% were satisfied with job. There were 22.5% of the studied group had excellent knowledge before health education, 25% of the studied group had good knowledge before health education, 27.5 % had fair knowledge before health education, and 25% had poor knowledge before health education and changed after health education to 40%, 36.2, 18.8 and 5.0 respectively. 23.8 % of exposed were hypertensive, but only 11.5% of none exposed were hypertensive. 24.3 % of exposed were diabetics, but only 10.8% of none exposed were diabetic, 16.5 % hade chronic bronchitis and 11.3 % of exposed were asthmatic. Conclusion: Fourteen of exposed had positive hepatitis Ab. 91.1% had positive PCR for HCV and HBV. 15% were positive hepatitis in Al-Hussein, but only 11% in Sayed Galal. 74.8% were attending and following the training courses seminars. 96.25% knew and fellow the color coding specification and separation. 40% of the studied group worked less than five years, 30% from five to ten years and 30% more than ten years. 70% were satisfied with job.
Background: Erectile dysfunction (ED) has considerable impact on the quality of life of middle-aged men and is a significant global health problem with estimates of 33–52% prevalence. Although the origins of ED were thought to be psychogenic or neuropathic, evidence now clearly suggests that the predominant etiology is vasculogenic. Objective: Evaluation the effect of the level of serum arginase II on erectile function. Patients and methods: The current study was carried out on 80 individuals attending the outpatient clinic of Andrology, Al-Azhar University Hospitals. Selected individuals were divided into 2 equal groups: ● Group I: Individuals with vasculogenic erectile dysfunction. ● Group II: Matched healthy individuals as controls. All patients were subjected to full history taking including personal history, sexual history, past history of medical disorders or operations. Evaluation of erectile function using a bridged five-item version of the International index of erectile function-5 questionnaire (IIEF-5), penile duplex, general and genital examination, and measurement of serum arginase 2 were done. Results: There was a statistically highly significant difference between patients and controls as regard serum arginase 2 (ng/ml). There was marked increase in serum arginase 2 level and prevalence of ED with increased age.There was a significant correlation between serum arginase 2 level and diabetes mellitus with significant difference in serum arginase 2 level between different types of vasculogenic erectile dysfunction. The highest percentage was to corporovenogenic erectile dysfunction (45%), followed by arteriogenic erectile dysfunction (32.5%), and finally mixed type (22.5%). With increase in serum arginase 2, there will be decrease in IIEF-5 score and an increase in erectile dysfunction, and that higher levels of serum arginase 2 level was in patients with severe ED with IIEF-5 score (5-7). There was a statistically negative correlation and significant between serum arginase 2 level and IIEF-5 score. Conclusion: Arginase 2 played an important role of male sexual health as with increase age more endothelial dysfunction.
Background: Dopamine and serotonin transporter genes play an important role in the control of the mechanism of ejaculation. Objectives: Evaluation of the role of serotonin transporter gene promoter and dopamine transporter gene polymorphisms in lifelong premature ejaculation and their role in determining the response to paroxetin and escitalopram. Patients and Methods: Eighty consecutive patients and controls were recruited. Forty of them suffered lifelong premature ejaculation. They were divided into two equal groups: One group received paroxetine (20 mg daily)for 1 month, and the other one received ecistalopram (20 mg daily) for 1 month. Their wives were instructed to measure the intravaginal ejaculation latency time using stopwatch. Five ml blood was withdrawn from patients and controls for PCR. Results: The present study revealed that the majority of the patients were SL and SS genotypes of the serotonin transporter gene promoter polymorphism. Also, this study revealed that the majority of the patients were (10R/10R) genotypes of the dopamine transporter gene polymorphism. Both of paroxitine and escitalopram significantly delayed ejaculation in the responders. Conclusion: The study revealed significant association between such response and dopamine transporter gene polymorphism. The present study augmented the significant effect of both paroxetine and escitalopram in delaying ejaculation in the responders.
REVIEW ARTTICLE: NUTRITIONAL COMPLICATIONS OF DIFFERENT TECHNIQUES OF BARIATRIC SURGERY By Diaa El-Deen Mahmoud Abd El-Kareem, Mohamed Kamel Elmzyen, and Osama Osman Ali Khaliel Department of General Surgery, Faculty of Medicine, Al-Azhar University INTRODUCTION Obesity is an escalating problem in all age groups and it is observed to be more common in females than males. About 25% of women meet the criteria of obesity and one-third of them are in the reproductive age. Because morbid obesity requiring surgical treatment is observed with increasing frequency, surgeons are undergoing new challenges. (Snyder-Marlow et al., 2010 ). Bariatric surgery is widely accepted as first choice treatment of morbid obesity. The number of operations each year is increasing, as well as, consequently, the urgent need for a coordinated nutritional approach, as protein deficiencies, vitamins deficiencies, micronutrient deficiencies occur frequently in these patients. Official guidelines on chronic use of multivitamins and minerals are, yet, unavailable in bariatric medicine. The current review provides an algorithm that supports bariatric teams to guarantee adequate nutrition after the operation. (Snyder- Marlow et al., 2010). Obesity is a multi factorial disease in which the excess of body fat is related to genetic predisposition and mainly environmental factors. Patients with severe obesity often suffer serious illness as well as physical and psychological disabilities that markedly increase mortality and morbidity. Certainly, the first-choice therapy for severe obesity is a non surgical program that integrates behavior modifications, adequate physical activity and psychological support. (Snyder- Marlow et al., 2010 ). However, in many cases of severe obesity, non surgical treatment fails in providing sustained weight loss and surgical treatment can be indicated in some specific cases (body mass index 40 or 35 with co-morbidities). Although bariatric surgery was first introduced in the 1950s, safe and successful surgical management has progressed over the last two decades, Bariatric surgeries are divided into restrictive, restrictive mal-absorptive and mal-absorptive procedures. Several recent reviews about open and laparoscopic procedures have been published (Snyder-Marlow et al., 2010). Purely restrictive procedures, including vertical banded gastro-plasties and silastic ring vertical gastro-plasties, are based on the reduction of gastric capacity, reducing food intake. The weight loss in these techniques is moderate, in general less than that established as the criteria of success (excess-weight loss 45% sustained for at least 5 years after surgery) (Smith et al., 2011). The classical restrictive mal-absorptive surgery is the Roux-en-Y gastric by-pass (RYGB). In this procedure, gastric capacity is reduced by 90–95%. The bilio-pancreatic limb is ana-stomosed generally 50–100 cm above the ileo-cecal valve, creating the common limb. As food and enzymes are only mixed in the small area of the common limb, the digestion and absorption of most nutrients are compromised (Smith et al., 2011). The first mal-absorptive operation was the jejuno-ileal by pass. Due to severe nutritional complications, this procedure is now discredited. Bilio-pancreatic diversion with or without duodenal switch replaced jejuno-ileal by pass. Bilio- pancreatic diversion consists of a modest gastric restriction associated with a long bilio-pancreatic limb with the common limb of 50 cm. In bilio - pancreatic diversion with duodenal switch, there is a smaller gastric pouch with preservation of the pylorus and a small portion of duodenum. As a consequence of these mal-absorptive procedures, an excess-weight loss of 75–80% can be reached. (Snyder-Marlow et al ., 2010). However, it was found a reduction of fetal macrosomia and normalization of the infant’s birth weight in pregnant women previously submitted to bilio-pancreatic diversion. Despite favorable pregnancy outcomes after bariatric surgery, careful studies are required to evaluate nutritional status in both mother and child after bariatric surgery in mothers ( Maggard et al., 2008). Many obese subjects already have clinical or subclinical nutritional deficien-cies before surgery, such as of vitamin D, folate , and vitamin B12. Bariatric surgery can also result in nutritional deficiencies, the most common deficiencies reported are B12 (12-33%), iron (49-52%), and vitamin A (50-70%) with B12 and iron more prevalent in Rou–en-Y -GB and vitamin A more prevalent in BPD-DS. BPD-DS also carries greater risk of developing vitamin K, Zinc, and vitamin D deficiencies (Barnett 2007). The BPD-DS patient had a greater risk of developing folate (37.%), vitamin D (100%), and transferring (83%) deficiency. The Rou–en-Y -GB patients had a greater risk of developing anemia (50%) (Thampi et al ., 2007) The most common nutrient deficien-cies among all surgery types were iron (34%), vitamin D (66%), vitamin A (35%), and albumin (38%), Comparing the rate of nutrient deficiencies among restrictive and mal-absorptive surgeries there were greater risks of developing nutrient deficiencies following mal-absorptive procedures (Brolin and Kowalski 2007). Morbid obesity and associated health problems have increased at un-precedented rates over the past two decades. To date traditional methods of weight loss including diet modification, exercise, behavioral therapy, and pharma-cotherapy remain ineffective at rates of 2.1 - 10 % EBWL over 2 years with continued behavioral intervention (Bavaresco et al., 2012). Recently, it has even been suggested that one-third to two-thirds of dieters regained more weight than originally lost on their diets and that regardless of the amount of weight lost improvements in health were not consistently observed (Bavaresco et al ., 2012). However, the success of bariatric surgery in generating long-term weight loss and reducing co-morbidities is well documented (Skroubis et al., 2006). The following improvements have been noted following RYGB surgery: 64 - 100% resolution of diabetes, 25 - 100% show resolution of hypertension, 60 - 100% show resolution of dys-lipidemia , 74-98% resolution of obstructive sleep apnea, 72-98% resolution of gastro-esophageal reflux disease, and an 89% reduction in 5 year death rate (Agha- Mohammadi and Hurwitz 2008). Weight loss percents have been reported at 61.6% for RYGB, 47.5% for LAGB over a 2-year period and 73 – 80% for BPD-DS over a 9-month to 10-year period. Our weight loss findings were on par with this as we found 59.7% for RNY-GB, 46.3% for VSG (purely restrictive procedure similar to LAGB), and 70.9% for BPD-DS after 1-year.The downside is that bariatric surgery can also result in nutritional deficiencies and complications related to surgery. However, the risk of developing deficiencies and complications following bariatric surgery remain poorly studied, as do specific nutrient recommen-dations to prevent deficiencies. (Aills et al., 2008). The most common deficiencies reported are B12 (12-33%), iron (49-52%), and vitamin A (50-70%) with B12 and iron more prevalent in RNY-GB and vitamin A more prevalent in BPD-DS. BPD-DS also carries greater risk of developing vitamin K, Zinc, and vitamin D deficiencies (Barnett et al., 2007). The BPD-DS patients in our essay had a greater risk of developing folate (37.%), vitamin D (100%), and transferrin (83%) deficiency. However, the small sample size (n=8) of the BPD-DS group must be taken into account when interpreting these results (Decker et al ., 2007). The RNY-GB patients had a greater risk of developing anemia (50%),The most common nutrient deficiencies among all surgery types were iron (34%), vitamin D (66%), vitamin A (35%), and albumin (38%). There were too few vitamin E, vitamin K, and zinc values overall to produce good results or an accurate comparison among surgeries. It was found that B12 deficiency occurred in only 1.2% of patients within the 3-18 month time frame following surgery. Up to 36% of vitamin B12 deficiency has been observed in other studies (Agha- Mohammadi and Hurwitz, 2008). Our low incidence may be related to the multivitamin that was recommended, which at its maximum dose gave 500 mcg of vitamin B12 daily and was to be started one week following surgery and continued long term. It was also found that the vitamin B12 deficiency occurred following the VSG and 4% of VSG patients had an occurrence of folate deficiency, where in previous studies no vitamin B12 or folate deficiencies occurred following restrictive procedures (Koffman et al., 2006). Comparing the rate of nutrient deficiencies among restrictive and mal-absorptive surgeries remains under-evaluated and the traditional rule of thought was that there were greater risks of developing nutrient deficiencies following mal-absorptive procedures. In our research we found that there were surprisingly few differences in deficien-cies between the RYGB and the VSG. The only significant finding was that the RYGB patients had a greater risk of developing anemia following surgery. It was also notable that there was such a high overall rate of fat soluble vitamins, even among of the restrictive VSG (20% vitamin A deficiency and 63% vitamin D), as this has not been documented in previous findings (Shankar P et al., 2010). In addition to this, we found that the average vitamin D level after surgery among all surgery groups was below the normal reference range. The 66% deficiency rate of vitamin D was much higher than the 25.7%seen in previous studies (Barnett, 2007). Our finding also support previous researches about the risk of calcium deficiency in purely restrictive versus mal-absorptive procedures .We also found an absence of documented calcium deficiencies in the VSG group within the 3 - 18 months following surgery while there were documented calcium deficien-cies in both the RNY-GB and the BPD-DS groups (Shankar P et al., 2010). Some studies have suggested that the laparoscopic adjustable gastric banding (LAGB) or sleeve gastr-ectomy are more suitable for young women than Roux-en-Y gastric bypass or Bilio-pancreatic Diversion (Bal et al ., 2012). After mal-absorptive bariatric surgery all pregnant patients should be precisely examined with supplementation and if necessary supplemented (Kjaer and Nilas., 2012). Patients have to be informed about avoiding pregnancy in the first year after bariatric surgery and about the insufficiency of oral contraception (Bebber et al., 2011 ). The period of pregnancy and breast feeding should be correlated with the laboratory tests’ controls in each trimester and later every three months with the adequate supplement modification. Currently there are no recommendations for pregnant women following bariatric surgery, Folate and vitamin B12 deficiencies in the peri conceptional period contribute to neural tube defects, and low serum levels of B12 have been linked to negative cognitive, motor and growth out comes , which commonly involve the central and peripheral nervous system (Thampi et al., 2007). The American College of Obstetrics and Gynecology recommends that women who have undergone bariatric surgery receive nutritional counseling before and after conception. CONCLUSION Most publications about bariatric surgery state that the analysis of excess-weight loss and improvement of metabolic complications are the major goals of this type of surgery. However, the success of surgical treatment of morbid obesity needs to include not only weight loss and the improvement in Nutrition and the gastrointestinal tract obesity-related co-morbidities, but also changes in quality of life experienced by the patients after the operation. In addition, a careful and regular check of nutrients should be also introduced once their deficiencies limit quality of life. As both success of surgery and incidence of nutritional deficiencies are related to the magnitude of weight loss, especial attention should be given to patients undergoing more aggressive mal-absorptive procedures. Adolescents and women in reproductive age are the most vulnerable groups at risk of nutritional deficiencies. To avoid severe nutritional deficiencies as seen in the first years after bariatric surgery it is important to predict, prevent, and promptly treat nutritional abnormalities in vulnerable patients. RECOMMENDATIONS We recommend for bariatric patients: 1. Drawing of vitamin and mineral levels pre-operatively to identify and correct nutritional deficiencies prior to bariatric surgery. Within this study, vitamin D, MCV, hemoglobin or hematocrit, albumin, and vitamin A were the lab values most frequently abnormal prior to surgery. 2. Routine testing following bariatric surgery should be performed even for patients receiving purely restrictive procedures. 3. Long-term data needs to be evaluated to better determine risks and benefits of the VSG. 4. Consideration to draw nutritional labs should be given to any morbidly obese patient. 5. Registered dietitian visits before and after surgery show benefits in both weight loss and nutritional status and should be considered as part of a comprehensive bariatric program. REFERENCES 1. Agha-Mohammadi S, and Hurwitz DJ( 2008): Nutritional deficiency of post bariatric surgery body contouring patients: what every plastic surgeon should know. Plast Reconstr Surg., 122:604–13. 2. Aills L, Blankenship J, and Buffington C (2008): ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis., (4):S73–108. 3. Bal BS, Finelli FC, Shope TR and Koch TR (2012): Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinal., (98) :544–56. 4. Barnett AH (2007): Pharmacotherapy as part of a weight management programme : a UK perspective. Br J Diabetes Vasc Dis., (7):268-77. 5. Bavaresco M, Paganini S and Lima TP (2012): Nutritional course of patients submitted to bariatric surgery. Obes Surg., (20):716-771 . 6. Bebber F. E. Rizzolli r, J. and Casagrande D (2011):“Pregnancy after bariatric surgery: 39 pregnancies follow-up in a multidisciplinary, Team Obes surg ., (10):1540-1551. 7. Brolin RE and Kowalski C (2007): Operations for morbid obesity. In: Yeo CJ, Dempsey DT, Klein AS, et al. editors. Shackleford’s surgery of the alimentary tract, 6th ed. pbl Philadelphia: Saunders/Elsevier, pp 928–939. 8. Decker GA, Swain JM and Crowell M (2007): Gastrointestinal and nutritional complication after bariatric surgery. Am J Gastroenterol., 102 (11):2571-2580 9. Kjaer M. M. and Nilas L (2012): “Pregnancy after bariatric surgery - areview of benefits and risks,” Acta Obstetricia et Gynecologica Scandi ,.(92) : 264-271. 10. Koffman BM, Greenfield LJ and Pirzada NA (2006): Neurologic complications after surgery for obesity. Muscle Nerve (33):166–76. 11. Maggard MA, Yermilov I, Li Z, Maglione M, Newberry S and Suttorp M (2008): Pregnancy and fertility following bariatric surgery: a systematic review. JAMA., 300(19): 2286–96. 12. Skroubis G, Anesidis S and Kehagias I (2006):Roux-en-Y gastric bypass versus a variant of bilio-pancreatic diversion in a non-super obese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies .Obes Surg., (16):488–95 13. Shankar P, Boylan M and Sriram K. (2010): Micronutrient deficiencies after bariatric surgery. Nutrition, 26(11–12):1031–7. 14. Smith BR, Schauer P and Nguyen NT (2011): Surgical approaches to the treatment of obesity: bariatric surgery. Med Clin North Am., (95) :1009-30. 15. Snyder-Marlow G, Taylor D and Lenhard MJ. (2010): Nutrition care for patients undergoing laparoscopic sleeve gastr-ectomy for weight loss. J Am Diet Assoc., 110(4):600–7. 16. Thampi A, Corprew JR and paris WJ (2007): nutritional consequences and manage-ment. Obesity Surgery Principles and Practice., (39):319-326. 17. Woodard. C. B. (2004):Pregnancy following bariatric surgeryJournal of Perinatal and Neonatal Nursing , 18(4): 329–340. دراسة المضاعفات الغذائية الناتجة عن التقنيات المختلفة من جراحات علاج البدانة ضياء الدين محمود عبد الکريم, محمد کامل المزين وأسامة عثمان على خليل قسم الجراحة العامة- کليه طب الأزهر تعد السمنة المفرطة مرض العصر الحديث حيث زادت معدلات السمنة المفرطة المصحوبة بمشاکل صحية عديدة بمعدلات غير مسبوقة خلال العقدين الماضيين. ولا تزال الطرق التقليدية فى فقدان الوزن غير فعالة فکثيرا ما يستعيد المريض الوزن الذى فقده بالطرق التقليدية بل وقد يزداد وزنه عن الماضى بخلاف العلاج الجراحى الذى يؤدى الى فقدان مستمر للوزن مع الحد من الامراض المصاحبة. على سبيل المثال بعد اجراء عملية تحويل للمسار المعدى فقد وجد تحسن فى مرض السکرى بنسبة 100% وارتفاع ضغط الدم بنسبة من 25-100% ومن مرض توقف التنفس بنسبة 72-98% ويساعد هذا النوع من العمليات ايضا على الحد من معدل الوفيات الجانب السلبي هو أن جراحة علاج البدانة يمکن أن يؤدي أيضا إلى نقص التغذية ومضاعفات الجراحة. ومع ذلک، فإن خطر الإصابة بهذه المضاعفات وأوجه القصور والمضاعفات بعد الجراحة لعلاج البدانة لا تزال تدرس على نحو سىء. ويعد نقص الفيتامينات والعناصر الغذائية والأملاح المعدنية بالجسم هى أهم العيوب المصاحبة لعمليات جراحة البدانة, على سبيل المثال نقص فيتامين ب12 بنسبة 12-33%,فيتامين أ بنسبة 50-70% , فيتامين د بنسبة تصل إلى 100% ,وتختلف هذه النسب من عملية الى عملية أخرى . ولابد من ألأخذ بعين الاعتبار النساء اللاتى خضعن لهذا النوع من العمليات بحيث تکون على علم بضرورة تجنب الحمل خلال السنة ألأولى بعد اجراء العملية مع ضرورة إجراء الفحوصات الدوريه أثناء الحمل والرضاعة , حيث يتسبب نقص فيتامين ب12 , حمض الفوليک فى عيوب خطيرة فى ألأنبوب العصبى للجنين التى تؤثر على النمو الحرکى والسلوکى للطفل . وکان الهدف من هذا الاستعراض تلخيص المعرفة الحالية حول أوجه القصور فى التغذية عقب الخضوع لجراحة علاج البدانة، من نقص المغذيات الدقيقة بعد علاج البدانة بالطرق الجراحية فوجود الحد الأدنى من المعلومات بشأن نسبة المغذيات الدقيقة بعد علاج البدانة بالعمليات الجراحية.هام حيث أن المغذيات الدقيقة هي عوامل أساسية مطلوبة للإنسان بنسب ضئيلة تقدر بالميکروجرام أو المليغرام، لتداخلها في مختلف المسارات الأيضية. وتشمل المغذيات الدقيقة العناصر النادرة (مثل الکروم والسيلينيوم، الزنک)، الفيتامينات القابلة للذوبان في الماء (مثل الثيامين فيتامينب1، فيتامين ب6، النياسين، وحامض الفوليک، ، البيوتين، فيتامينب12،فيتامين جيم، الخ)، والفيتامينات القابلة للذوبان في الدهون (فيتامين أ، د، هـ، ک) والمعادن الأساسية بما في ذلک الحديد والکالسيوم واليود. فنقص الفيتامينات والمعادن شائع بعد جراحات علاج البدانة، وکثير من متخصصى علاج البدانة يوصون بأخذ هذه الفيتامينات والمعادن، وکذلک مکملات الکالسيوم يوميا بعد الجراحة .وترتبط هذه العيوب معا بإنخفاض في الإستهلاک الغذائي, ومع التأثير الفسيولوجي الناجم عن التغييرات التشريحية التي أجريت في الجهاز الهضمي من المهم أن نلاحظ أن بعض مرضى نقص العناصر الغذائية موجود بالفعل قبل الجراحة ( کنتيجة ثانوية لمختلف الإضطرابات الهضمية). کما أن نقص فيتامين ب12 قد يؤدي إلى فقر الدم ، قلة الصفائح والکريات البيضاء، والتهاب اللسان، وکل هذه ألأعراض قابلة للعلاج بالمکملات الغذائية ونقص الحديد أيضا هو واحد من أهم أوجه قصور التغذية الأکثر شيوعا بعد جراحة السمنة لأسباب متعددة کسوء الإمتصاص وسوء الهضم.کما تشير الدراسات أيضا الى قصور فى فيتامينات أ ,هـ مما يمکن أن يسبب جفاف الملتحمة وعشى ليلى، مع تدهور بصري وقد لوحظ أيضا نقص حمض الأسکوربيک أو فيتامينسى بعد الجراحة لانخفاض کمية الفواکه والخضروات المتناولة ، وعدم تناول مکملات فيتامين سى . وقد يحدث عجز في الطاقة بسبب الإستهلاک الغذائي المنخفض وسوء الأمتصاص. ويتجلى هذا النقص کما فى نقص البروتين وإنخفاض امتصاص الکربوهيدرات الغذائية نتيجة لسطح الامتصاص المحدود وانخفاض في إفراز إنزيم البنکرياس وتفاعل محدود بين السکريات والأميليز ويظهر ذلک فى صورة إجهاد ، وفقدان قوة العضلات وفقدان الوزن.
Background: Reconstruction of defects in the leg with exposed tendons, bone, and/or other tissues continues to be challenging and they generally need flap coverage. Evolution in flap surgery has enabled fasciocutaneous, adipofascial and superthin flaps to be harvested for the purpose of reconstruction, thereby minimizing morbidity from muscle inclusion into the flap. Objective: A prospective study for patients of 6-54 years old with leg defects and evaluation of perforator (propeller) flaps for reconstruction of defects in the leg. Patients and methods: This study includes twenty patients with leg defects who came to Al Azhar University Hospitals asking for leg reconstruction during the period from Oct 2014 to Sep 2016. All patients were operated under spinal anesthesia. Perforators were identified and traced to major limb vessel, and skin paddle was designed around the perforator. Skin paddle was then rotated into the defect of the leg. Results: All the patients tolerated the procedure well. There was only one case of epidermal loss and one case had partial loss. Two flaps initially underwent distal congestion but, however, improved on day three post-operatively. One case developed bleeding postoperatively and controlled and one case had delayed wound healing. However, the remainder of the flaps survived and wound healed completely. Conclusion: The use of propeller flaps to cover defects of the leg showed satisfactory results as regards flap viability and providing a suitable coverage of various defects.
Background: Chronic and recurrent abdominal pain is a common symptom in children with prevalence ranging between 10% and 20%. Community and school based studies reported that recurrent abdominal pain occurred in 7% to 25% of school-aged children and was severe enough to affect activities in 21 % of them. Chronic abdominal pain includes organic and nonorganic causes. Among organic causes is Giardia Lamblia which is the most important protozoan causing recurrent abdominal pain. Objective: Detection ofthe frequency of giardiasis in school children in Dakahlia Governorate with chronic recurrent abdominal pain using routine stools analysis and stools ELISA test for giardia antigen . Patients and methods: The present study was carried out on 200 school children ( primary, preparatory and secondary schools), aged 7-18 years, from Dakahlia Governorate during the period from February 2016 to October 2016. School children chosen complained from chronic abdominal pain and one or more of the cumulative symptoms that support giardiasis like diarrhea, inefficient defecation ,vomiting, ,weight loss and generalized fatigue. Each child enrolled in the study was submitted thorough clinical examination, blood sample for complete blood count , and stool sample for microscopic stool analysis, and ELISA test for detection of giardia antigen. Anthropometric measurements (Height, weight and determination of nutritional status) were detected. Results : Routine stool analysis showed giardia cysts in 50%of the examined stool samples . ELISA detected the giardia antigen in 90% of the examined stool samples. Regarding validity of stool analysis in relation to Giardia antigen by ELISA ,the sensitivity and specificity was 55.5% and 100% respectively . The stool analysis agreed with ELISA antigen detection for giardiasis by 60%. Conclusion: Giardia Lamblia infection is a causative factor of the recurrent abdominal pain in children. Also, ELISA test for detection of Giardia Lamblia antigen in stool is more sensitive than ordinary stool microscopical examination for diagnosis of giardiasis.
Background: The fixation technique in treating idiopathic scoliosis ranged from either posterior fixation, anterior approach, or combined anterior and posterior approach. Objective: Assessing the short–term outcome of pedicle-screw method in treating adolescent idiopathic scoliosis (AIS). Patients and Methods: Twenty consecutive patients were prospectively included with minimum of 6-months follow-up. The average age of surgery ranged between 11 and 18 years, with a mean age of 15.25 ± 2.24 years. Radiographic and clinical measurements were assessed at preoperative (preop), postoperative (PO), and final follow-up (FFU) period for curve correction rate, correction loss rate, and complications. Results: The average main thoracic curve was corrected from 69.80 ± 21.0° preop to 17.73 ± 7.38° postop. This revealed a rate of 74.56 ± 7.32% correction. The average thoracolumbar curve was corrected from 52.14 ± 20° preop to 15.36 ± 10.53° postop, with a rate of 66.87 ± 24.81 % correction. Conclusion: All-screw method was an efficient and safe method.
Background: Although gray-scale Trans Rectal Ultrasonography (TRUS) was a major achievement in diagnosis of prostate cancer, it has several limitations. Expert users are not able to discriminate among images with more than 32 gray levels out of 256 displayed on a gray-scale image. Objective: The aim of the study was using color and power doppler in targeting prostatic biopsy and detecting prostate cancer. Patients and methods: This prospective study included 100 consecutive patients attended Al-Azhar University Hospitals and National Institute of Urologyand Nephrology with lower urinary tract symptoms (LUTS), and have either Prostatic Specific Antigen (PSA)> 4 ng/ml or abnormal prostate on digital rectal examination (DRE). Patients with coagulopathy, history of prostate cancer diagnosis or evidence of a prostatic intraepithelial neoplasm of any grade were excluded. All patients were subjected to (DRE), International Prostatic Symptoms Score (IPSS), complete laboratory investigation including PSA, pelvi-abdominal ultrasound, gray-scale, color and power doppler TRUS, and TRUS-guided systematic biopsies with other focal lesion-targeted biopsies. Results: Histopathological examination of cores taken from hypo-echoic lesions revealed adenocarcinoma in 24 cases: 6 out of them were of group (A), and 18 were of group (B). So, cancer was detected in 50 % (6/12) of hypo-echoic lesions in group (A), and in 64.3% (18/28) of group (B) which was statistically significant. Correlation between the cores taken from hyper-vascular areas and the results of histopathology revealed that cancer was detected in 38 (74.5%) out of 51 hyper-vascular areas (8 out of them were of group A, and 30 were of group B). So, the incidence of cancer detection in hyper-vascular areas in group B (83.3%) was higher than group A (53.3%) which was statistically significant. Conclusion: The combination of color and power doppler ultrasound and gray-scale TRUS increased the sensitivity of detecting prostate cancer while not decreasing the specificity.
Background: Polycystic ovary syndrome (PCOS) is a very common problem in reproductive age; Obesity and insulin resistance (IR) play critical roles in its etiology. Limited studies have investigated the link between nesfatin-1 levels and PCOS. However, these studies are controversial. Objectives: This study aimed to evaluate possible changes of serum nesfatin-1 Levels in letrozole-induced PCOS in lean and obese rats, and its association with some hormonal and metabolic parameters. Material and methods: Forty two young virgin healthy female albino rats were used. Rats were divided into three equal groups: Group I (control), group II (lean PCOS) rats fed ordinary rodent diet for 9 weeks, and then received a daily single dose of letrozole orally (0.5 mg/kg/BW) for 21 days. Group III (obese PCOS) rats fed high fat diet for 9 weeks, and then received a daily single dose of letrozole (0.5 mg/kg/BW) orally for 21 consecutive days. At the end of experiment, serum levels of Nesfatin-1, free testosterone, LH, FSH, estradiol, progesterone, glucose and insulin were detected. BMI and HOMA-IR were calculated. Ovarian histopathology was done. Results: In obese polycystic ovary group, serum nesfatin-1 level was significantly lower and accompanied by significant hyperinsulinemia, hyperglycemia, insulin resistance, and high BMI when compared to both of lean polycystic and control groups. Moreover, serum nesfatin-1 level significantly negative correlated with serum insulin levels, serum glucose levels, HOMA-IR, and BMI, but correlated positively with LH levels. In lean polycystic group, serum nesfatin-1 level did not significantly change, when compared to control group, In addition, there was an absence of any significant change in serum insulin levels, serum glucose levels, HOMA-IR, or BMI. Conclusion: Serum nesfatin-1 level seemed to be related to several metabolic syndrome parameters rather than to polycystic ovary syndrome. Our findings raised a possibility that nesfatin-1 level played some role in PCOS. Therefore, larger scale and more detailed molecular studies in vivo and vitro on ovarian function are needed.
Background: Colorectal cancer is incredibly common. It represents the 4th leading cause of mortality and the second most common malignancy worldwide. With the advent of technological improvement, computed tomography (CT) became one of the important diagnostic tools in the evaluation of local characteristics, preoperative staging, and prognostic factors of colon cancer. Objective: In this study, we aimed to evaluate the role of contrast enhanced multidetector computed tomography (CEMDCT) in local staging of colorectal carcinoma (CRC). Patients and methods: MDCT was performed for 37 patients with pathologically proved CRC. All patients submitted to MDCT after IV nonionic iodinated intravenous contrast and oral and rectal positive or negative bowel opacification with water enema. The CEMDCT findings for each patient were recorded and correlated with operative and pathological findings as a reference standard. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Results: In the detection of extramural invasion, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DC) of CEMDCT were 89.5%, 77.8%, 81%, 87.5%, and 83.8% respectively. In the detection of lymph node status, the sensitivity, specificity, PPV, NPV, and AD were 88.9%, 78.9%, 80%, 68.2%, and 83.8%, respectively. In the detection of retroperitoneal surgical margin (RSM) involvement, the sensitivity was 75%, no false negative patient. Conclusion: CEMDCT is a sensitive tool in locoregional evaluation of colonic cancer.
Background: The introduction of direct acting anti virals hase increased sustained virological response (SVR) rates in chronic hepatitis C infection. At present, data on long-term durability of viral eradication after successful triple therapy are lacking. Objective: The predicators of durability of Sustained Virological response (S.V.R.) and its impact as pre-treatment markers. Patients and Methods: Sixty patients with chronic hepatitis C virus achieved S.V.R. (sustained virological response). After 12 months of treatment, all patients were subjected to D.M., H.T.N, any special habits like smoking, clinical examination, PCR for HCV, IL28B genotyping, Liver function tests, CBC and other associated diseases e.g. HIV ,HBV, Serum iorn concentration. Results: Several factors (host or viral-related factors or treatment related factors) influenced response to therapy and durability of S.V.R, advanced fibrosis, cirrhosis and steatosis have a negative impact on S.V.R. Also, IL28B genotyping can influence the durability of S.V.R. Patients with CC genotype were more likely to be cured by Peg-IFN and RBV, or recent free INF therapy. Conclusions: Many factors can influence patients response to therapy and durability of SVR and IL28B C/C genotype play a great role in clearance of HCV.
Background: Vitiligo is an acquired pigmentary disorder due to loss or destruction of melanocytes from the epidermis. The question about the presence of residual melanocytes in the depigmented skin remains and accurate methods of their identification are considered. Objective: This study aimed to search about the presence of residual melanocytes in the skin of vitiligo patients and if there is a relation between destruction of melanocytes and presence of inflammatory cells mainly T-lymphocytes. Patients and Methods: This study was conducted on 30 patients with vitiligo (localized and generalized) together with 10 healthy volunteers were investigated for Melan-A (А103 clone) expression by immunohistochemical analysis and for CXCR3 antibody. Results: Melan-A+ cells were detected in depigmented skin as indication that the residual melanocytes are preserved in vitiligo lesions. Decrease of Melan-A+ melanocytes amount was revealed in perilesional normally pigmented skin of vitiligo patients (P < 0.01) compared with the skin of healthy volunteers. Also this study found significantly increased number of CXCR3-expressing cells in the dermis of vitiligo lesions (depimented skin) in comparison to healthy controls and those cells were mainly lymphocytes Conclusion: Melan-A marker is useful not only for identifying melanocytes in vitiligo patients’ skin but also for estimating their content in different zones of the vitiligo lesions. Clinically intact skin involvement in the pathological process should be taken into consideration if local treatment methods are recomended. CXCR3 and its ligands play role in the pathogenesis of vitiligo. So, blocking T-cell recruitment by blocking CXCR3 and its ligand chemotactic mechanism may present a new and effective therapy for vitiligo.
Background: Obesity, a sort of dietary imbalance, is one of the most frequently encountered medical problems associated with many complications as hypertension, hyperlipidemia, and seems to make morphological alterations of kidney too. Pumpkin seeds oil (PSO) is rich in unsaturated fatty acids, antioxidants and fibers. Objective: Evaluation of the efficiency of using PSO on regulation of arterial blood pressure, cardiac and renal health in high fat diet (HFD)-treatedrats. Materials and methods: Thirty adult male albino rats were divided into three equal groups: Group I (control group), Group II (HFD-treated group), Group III (HFD & PSO 100 mg/kg-treated group). At the end of the experiment body weight, mean arterial blood pressure (MABP) and electrocardiogram (ECG) were determined for all groups. These were beside measuring serum levels of lipid profile (TC, TG, LDL and HDL), urea, creatinine, nitric oxide (NO), malondialdehyde (MDA), reduced glutathion (GSH), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) and vascular cell adhesion molecule 1 (VCAM1). The effect of different doses of PSO (75-1200 μg/ml) on norepinephrin-induced contractionsof isolated rabbit aortic spiral strips was recorded also. Kidney samples were taken and processed for light and electron microscopic examination too. Results: PSO significantly decreased body weight, blood pressure, heart rate and kidney function tests in HFD rats. Serum cholesterol, triglycerides and LDL significantly decreased, while HDL significantly increased. Furthermore, PSO suppressed the increase in MDA, IL-6, TNF-α and VCAM1 levels and elevated GSH level significantly. Histological examination revealed that PSO improved the kidney structure as it decreased the extent of renal tissue damage and interstitial fibrosis in HFD rats. Also it decreased the norepinephrin-induced contraction in aortic strip of rabbit. Conclusion: PSO possessed anti-atherogenic action by its ameliorative effect on the lipid profile, kidney functions, inflammatory markers, kidney structures and its effect on aortic strip. Thus, Pumpkin may be a novel strategy for prevention and treatment of atherosclerosis and hypertension.
Background: Upper gastrointestinal (GIT) bleeding remains one of the most important emergencies. It has been widely accepted that the first-line treatment for acute upper GIT bleeding, especially peptic ulcer bleeding, is endoscopic hemostasis. Endotherapy for upper gastrointestinal bleeding can be challenging. Hemospray is a novel hemostatic agent for the treatment of upper gastrointestinal bleeding. Objective: Report initial experience of hemospray use in treatment of upper GIT bleeding. Patients and Methods: The present study included twenty-five patients with acute GIT bleeding originating from variceal or non-variceal sources. Hemospray was endoscopically applied when active bleeding occurs; and outcome was measured. Results: success rate was achieved in 92.0% of cases with no unwanted side effects. Patients showed stable postoperative hemodynamics and needs no further intervention. Conclusion: hemospray appears to allow safe and effective control of upper gastrointestinal bleeding
Background: Safety blood transfusion is based on reliable donor screening for transmissible infections such as the hepatitis C virus (HCV) infection. HCV-RNA by polymerase chain reaction (PCR) test is a gold standard test for HCV infection but with three major limitations: liability of RNA molecules, higher costs, and longer turnaround time as compared with HCV core antigen (HCVcAg) testing. Objective: To evaluate HCV core Ag as an alternative to PCR for HCV RNA to early diagnosis of HCV infection among blood donors. Patients and Methods: 4222 blood donors collected between March 2015 and July 2016 at Blood Bank Center of Najran Hospitals, Southwestern Saudia Arabia. Anti-HCV, HBsAg, syphilis and HIV were screened by third generation ELISA. Those reactive to HbsAg, syphilis and/or HIV were excluded. HCV core Ag and HCV RNA by RT-PCR were performed on 76 positive HCV-Ab sera. Results: Among total 4222 blood donors (3837 males (90.88%) and 385 females (9.12%)), 76 (1.8%) were positive for HCV-Ab (72 males; 94.74% and 4 females; 5.26%). HCV core Ag was ≥ 11 fmol/L in 65 cases (85.53%) of HCV Ab positive patients (61 males; 93.85% and 4 females; 6.15%), 3 cases with HCVcAg levels in grey zone (3-11 fmol/L) and 8 cases with HCVcAg ≤ 3 fmol/L all of both were males. HCV RNA was detected in 71/76 (93.42%) of donors with positive HCV-Ab and in 3 of 8 (37.5%) of those with positive HCV-ab and negative HCVcAg. HCVcAg has sensitivity, specificity, PPV and NPV of 97.14, 100, 100 and 99.76 values respectively at a cutoff 2.82 fmol/L compared to HCV RNA test. Conclusion: Higher sensitivity and specificity of HCVcAg with rapid turn around time of the results, and its lower price suggested that can be used alternatively to HCV RNA test in early diagnosis of HCV infection.
Background: Bladder carcinoma is the most common tumor among the low urinary tract, accounting for 90% of cancer cases. Conventional cystoscopy does not provide information about extravescical extensions of the tumor. Multi-detector computed tomography cystography (MDCTC), combined with virtual cystoscopy, is mandatory for tumor, lymph node and metastases staging, and also is useful when conventional cystoscopy is inconclusive or cannot be performed. Objective: Evaluation of the accuracy of 160-MDCT cystography and virtual cystography versus convention cystoscopy in diagnoses of urinary bladder masses Patients and methods: This study included seventy patients referred from the inpatient and outpatient clinic of Damietta and Al-Zahraa Urology Departments, Al-Azhar University Hospitals for 160-MDCT cystography and virtual cystoscopy examination, over a period from October 2014 to October 2016. Patients were fifty one males and nineteen females, their ages ranged from eighteen to eighty years, and the mean age was fifty eight years. Results: Convention cystoscopy detects eighty seven urinary bladder lesions while eighty three lesions identified in MSCT MPR & virtual cystoscopy when used together, while eight lesions detected with MSCT MPR and eighty two with virtual cystoscopy when used separable from each other. Their diameters ranged from 5-mm to 35-mm. Morphological classification were fifty two polypoid lesions and thirty five sessile. The histopathological examination of fifty eight malignant lesions in fifty one patients: Fifty lesions were transitional cell carcinoma, four lesions of squamous cell carcinoma, two lesions carcinoma in situ and two lesions of small cell carcinoma. In addition, twenty nine benign lesions were detected in nineteen patients: Eighteen lesions were polypoidal cystitis, eight were bilharzial, and three were papilloma. Conclusion: MDCT cystography and virtual cystoscopy were non-invasive technique for primary diagnosis of urinary bladder lesion and extravesical extension, but still convential cystoscopy was the method of choice for biopsy.