ORIGINAL_ARTICLE
Intercostal Nerve Schwannoma As a Rare Cause of Refractory Mid Back Pain
Background: Schwannoma is the most common neurogenic tumor of the posterior mediastinum. Though commonly become asymptomatic, back pain with intercostal neuralgia mimicking post herpetic neuralgia is rare presentation and infrequently found in the available literature. Case description: Here, we report a 22-year-old female without any history of trauma, surgery or infection presented with midback pain with radiation towards the right 10th intercostal space. Although clinical evaluation simulates the features of post herpetic neuralgia, she was mildly responsive to traditional conservative treatment. Later on, magnetic resonance imaging [MRI] was performed to rule out the neoplastic cause which ultimately revealed Schwannoma of the right 10th intercostal nerve. Patient symptomatically get well after complete removal of tumor. Beside this, we also briefly review the clinical presentation, neuroimaging features, different surgical options and outcome from the pertinent literature.Conclusion: This report emphasizes early radiological evaluation of dull aching resting pain to avoid unnecessary medications to prolong duration.
https://ijma.journals.ekb.eg/article_168508_17fa8c6786653b4fcf560d18f78fa446.pdf
2021-07-01
1494
1499
10.21608/ijma.2021.71247.1294
schwannoma
Mid back pain
Post-herpetic Neuralgia
Peripheral nerves
Shahidul
Khan
sikhan55@yahoo.com
1
Consultant, Department of Orthopedic surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
AUTHOR
Nazmin
Ahmed
nazmin.bsmmu@gmail.com
2
Consultant, Neurosurgery, Ibn Sina Diagnostic and Consultation Center, Lalbag, Dhaka, Bangladesh
AUTHOR
Mahamud
Mannan
eshaanrafan@gmail.com
3
Consultant, Department of Orthopedic surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
AUTHOR
K M Atiqul
Islam
kazidmc@gmail.com
4
Assistant Registrar, Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
AUTHOR
Gianluca
Scalia
gianluca.scalia@outlook.it
5
Neurosurgery Unit, Highly Specialized Hospital and National Importance, Garibaldi, Catania, Italy
AUTHOR
Santino Ottavio
Tomasi
ottavio.tomasi@gmail.com
6
Department of Neurological Surgery, Christian Doppler Medical Centre, Laboratory for Microsurgical Neuroanatomy, Paracelsus Medical University, Salzburg, Austria
AUTHOR
Vishal
Chavda
chavdavishal2@gmail.com
7
Division of Anesthesia, Sardar Women Hospital, Bapunagar, Ahmedabad, India
AUTHOR
Giuseppe E.
Umana
umana.nch@gmail.com
8
Department of Neurosurgery, Trauma and Gamma Knief Centre, Cannizzaro Hospital, Catania, Italy
AUTHOR
Bipin
Chaurasia
trozexa@gmail.com
9
Consultant, Department of Neurosurgery, Bhawani Hospital and Research Centre, Birgunj, Nepal
LEAD_AUTHOR
ORIGINAL_ARTICLE
Comparison between the Effect of Trendelenburg 20 Degree and Straight Leg Raising 45 Degree Positions on The Hemodynamics After Tourniquet Deflation in Knee Arthroscopy
Background: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects [hypotension and tachycardia]. Trendelenburg position or passive leg raising [PLR] are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of post-tourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy.Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group [1] included 49 cases who were exposed to the Trendelenburg position after deflation, and group [2] included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded.Results: No significant difference was noticed between the two groups regarding demographic variables, heart rate before tourniquet deflation, and one-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group [1] showed significantly higher mean arterial pressure [MAP] compared to group [2] after deflation. Hypotension was more significantly encountered in group [2], and thus ephedrine requirements were increased. Conclusion: Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.
https://ijma.journals.ekb.eg/article_170060_7cba3618c4b0d0bd8c6075af141bb214.pdf
2021-07-01
1500
1506
10.21608/ijma.2021.62396.1262
Trendelenburg Position
Straight leg raising test
Tourniquet deflation
Knee surgery
hypotension
Ahmed
Sonbol
dr.sonbol@gmail.com
1
Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
LEAD_AUTHOR
Sameh
Ghareeb
sameh926@yahoo.com
2
Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Potential Effect of Curcumin versus Atorvastatin on Hepatic and Metabolic Changes in Rat Model of Metabolic Syndrome
Background: Metabolic syndrome is defined as a cluster of metabolic disorders, including hypertension, insulin resistance, dyslipidemia, diabetes, cardiovascular disease and abdominal [central] obesity. It is also found under different names, such as syndrome X, “deadly quartet” and insulin resistance syndrome. The aim of the work: to investigate the potential effect of curcumin and compare it with the effect of metformin and atorvastatin on hepatic and metabolic changes in metabolic syndrome.Materials and Methods: Fifty male Sprague–Dawley [8 weeks old] weighting 150-200 g obtained from animal house of the department of pharmacology, Al-Azhar Faculty of Medicine. Rats were kept in regular dark – light cycle with free access to groups [specific diet and water] that were renewed daily and were observed for water intake, food intake, changes in body weight and abdominal circumference during 16-week study period.Results: Histopathological changes after administration of high carbohydrate high fat [HCHF] diet, revealed fatty changes, ballooning degeneration [vacuoles] and fibrosis. Infiltration by large numbers of inflammatory cells was detected in the portal area and there was an inflammatory reaction dividing the hepatic parenchyma into lobules. On the other side, the treated rats with curcumin showed improved inflammation [few inflammatory cells, slight ballooning and fibrosis, but still present moderate steatosis in liver samples. The atorvastatin group revealed comparable results to the curcumin group. However, when combined together, they were able to restore hepatic tissue to nearly its normal structure. Conclusions: Combination therapy by curcumin and atorvastatin was more effective in the management of non-alcoholic fatty liver/non-alcoholic steatohepatitis [NAFL/NASH]. However, further studies are required to evaluate the applicability of the present results in human beings and to judge the safety and efficacy of curcumin, atorvastatin and their combination.
https://ijma.journals.ekb.eg/article_169946_2d2596929ecd9e9b4ba52b689dafa3b0.pdf
2021-07-01
1507
1515
10.21608/ijma.2021.61857.1267
Curcumin
Atorvastatin
combination
Therapy
Metabolic syndrome
Alaaeldin
Eissa
dralaaeissa2016@gmail.com
1
Department of Pharmacology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Abdelateef
Abdelateef
abdelatif.said35@yahoo.com
2
Department of Pharmacology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Hassan
Elkotby
hassan_elkotby@hotmail.com
3
Department of Pharmacology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Role for Video-Assisted Thoracoscopy in Undiagnosed Pleural Effusion: An Audit to Represent our Clinical Experience?
Background: Undiagnosed pleural effusion represents a health challenge. To discover possible causes, there were a number of invasive and non-invasive modalities. Each modality had its own accuracy. The aim of the work: The current work aimed to evaluate the role of video-assisted thoracoscopy (VATS) in the undiagnosed intermediate pleural effusion.Materials and Methods: The current work included forty patients with undiagnosed intermediate pleural effusion. All underwent preoperative assessment [history, physical examination, laboratory and radiological investigation]. Then, all submitted to VATS, pleurocentesis had been completed, and pleural aspirates were sent for culture and sensitivity. Also, the aspirate was subjected to biochemical investigation]. Operative data related to VATS included time of the whole procedure, intraoperative complications, amount of drained pleural fluid, the ability to obtain multiple biopsies, field exposure and degree of lung expansion. The visual analogue scale [VAS] was used to assess postoperative pain. Any postoperative complications were documented.Results: The mean operative time was 54.37±7.63 minutes, and no intraoperative complications had been recorded. The field exposure was adequate among the majority (77.5%). The VATS was able to provide a diagnosis for all studied patients. The mean duration of hospital stay was 5.90±1.53 days; the mean chest tube duration was 5.65±1.27 days. Finally, recurrent effusion was reported in 7 patients (17.5%) (5 males and two females). All patients need postoperative analgesia with great variability and postoperative pain showed significant variance across time (during the first 24 hours). 60% need no further intervention, while 32.5% need pleurodesis, and 7.5% need decortication. Malignant effusion was reported in 9 patients (22.5%). Conclusions: VATS as a diagnostic and therapeutic tool for undiagnosed pleural effusions, is an effective and safe intervention. Thus, it is advocated to be used as the standard and first intervention in such patients.
https://ijma.journals.ekb.eg/article_174079_24a89a902f0d7cc25935e98f77dd1fe3.pdf
2021-07-01
1516
1524
10.21608/ijma.2021.174079
Video Assisted
Effusion
Pleura
Exudate
thoracoscopy
Zakaria Mostafa
Almashtouly
zelmashtouly@gmail.com
1
Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ismail Nasr
El-Sokkary
drismailnasr@gmail.com
2
Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ibrahim
Zaki
iz.cardiothoracic@gmail.com
3
Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Nitric Oxide Donor Administration For improvement of Uterine Blood Flow in Unexplained Recurrent Pregnancy Loss
Background: Recurrent pregnancy loss is still a challenging obstetric condition. It linked to impaired uterine blood, and vasodilators seem to prevent recurrent pregnancy loss. The aim of the work: The current study aimed to compare between investigate the Doppler uterine artery indices in females with recurrent pregnancy loss [unexplained]. It also aimed to study the effect of intravaginal isosorbide mononitrate, on the pattern of uterine blood flow.Materials and Methods: This observational, nested case control study had been completed at Al-Azhar University Hospitals. Two groups of females [each 50 females] were studied. The control group [females with no previous pregnancy loss and have a viable child or more]. The study group [females with history of unexplained recurrent pregnancy loss]. Vaginal color Doppler ultrasound was done to assess pulsation and resistance indices of uterine arteries in the mid-luteal phase of the cycle. Then, 20 mg of isosorbide mononitrate was applied vaginally and measurement of the vascular indices were registered after two hours again. Both groups were compared and the effect of isosorbide mononitrate on the uterine artery vascular indices the study group was documented.Results: Higher uterine artery resistance and pulsation indices are noticed in females with recurrent pregnancy. A significant reduction in these indices was found after vaginal application of Isosorbide mononitrate. Both groups were comparable regarding patient demographics. Doppler indices were significantly lower in control than study group. The endometrial thickness was negatively correlated with right RI and left PI (r = -0.328, -0.342, p = 0.039 and 0.031, respectively). Conclusion: Poor uterine perfusion is associated with spontaneous abortion. The vaginal application of isosorbide mononitrate, nitric oxide donor could be an effective treatment for the correction of uterine vasculature in patients with recurrent pregnancy loss.
https://ijma.journals.ekb.eg/article_182971_d7a4475905fc0caf94ef66debf30a41e.pdf
2021-07-01
1525
1529
10.21608/ijma.2021.182971
Isosorbide mononitrate
Recurrent pregnancy loss
Pulsatility Index
uterine artery
uterine receptivity
Mazen A.
El-Zahry
mazenobgyn@gmail.com
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt.
LEAD_AUTHOR
ORIGINAL_ARTICLE
Five-Years Outcomes of Different Procedures for The Treatment of Female Stress Urinary Incontinence: A Systematic Review and Network Meta-Analysis
Introduction:The current body of evidence is limited regarding the long-term outcomes of different modalities for stress urinary incontinence (SUI). We conducted this systematic review and network meta-analysis to compare the long-term follow-up outcomes of mid-urethral slings (MUS), Burch colpo-suspension, pubo-vaginal sling (PVS), anterior colporrhaphy with Kelly’s plication, and laser therapy in the treatment of SUIMethods: In this systematic review and network meta-analysis, we included prospective and retrospective studies that assessed the long-term outcomes of modalities for the management of SUI. We performed an online, bibliographic, search in four bibliographic databases: Cochrane Central Register of Controlled Trials (CENTRAL), Medline via PubMed, Web of Science, and Scopus.Results: A total of 42 studies were included. For the subjective cure rate, five different interventions were compared; pooling direct and indirect comparisons revealed an advantage of tension-free vaginal tape (TVT) intervention over TVT-obturator (TVT-O), laparoscopic Burch colpo-suspension, trans-obturator tape (TOT), and TVT-sling (TVT-S). Concerning objective cure rate, the pooling direct and indirect comparisons showed an obvious advantage of TOT, followed by TVT, and then TVT-O, Burch lap, and TVT-S. For repeated surgery, four different interventions were compared, and the comparisons revealed an advantage of TVT intervention over TVT-O, PVS, and TOT. The comparisons revealed the advantage of TVT and TVT-O over other procedures for lower urinary symptoms and postoperative complications.Conclusion: In conclusion, MUS appears to be the most effective and safe procedure for SUI at long-term follow-up. However, these findings should be interpreted with caution as there is scarcity in the published reports assessing long-term outcomes of other modalities, especially PVS and laser therapy.
https://ijma.journals.ekb.eg/article_180020_6040c5c9961d324a3083a9de572449ee.pdf
2021-07-01
1530
1549
10.21608/ijma.2021.79651.1323
Stress Urinary Incontinence
Mid-urethral slings
Burch colpo-suspension
Laser Therapy
Meta-Analysis
Doaa
Effat
doaaeffat4560@yahoo.com
1
Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Egypt
LEAD_AUTHOR
Mona
Alkafrawy
elkafrawym64@yahoo.com
2
Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Egypt
AUTHOR
Hanaa
Ahmed
hanaafaruk11@gmail.com
3
Department of Obstetrics and Gynecology, Faculty of Medicine for Ggirls, Al-Azhar University, Egypt
AUTHOR
Amany
Soliman
damanyahmed@gmail.com
4
Department of Urology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Comparative Study between Topical Latanoprost versus Topical 5- Fluorouracil after Dermabrasion for Treatment of Non-Segmental Stable Vitiligo
Background: Latanoprost [LT], a prostaglandin F2-alpha [PGF2α] analogue used in the treatment of glaucoma. It induces skin pigmentation in guinea pigs. The rationale of trying 5-fluorouracil [5‐FU] in vitiligo treatment may come from the first report of hyperpigmentation induced by 5‐FU as a side effect in the skin tumors and psoriasis treatmentThe Aim of the work: Comparison between the efficacy of topical latanoprost versus topical 5-fluorouracil after skin dermabrasion in induction of skin repigmentation in stable non-segmental vitiligo.Patients and Methods: This study included thirty Egyptian patients, 18-60 years old, with stable non-segmental vitiligo. They were divided into: group [A] patients subjected to 5 fluorouracil after dermabrasion and group [B] patients subjected to latanoprost after dermabrasion then followed up every two weeks for three months. Result: There was no statistically significant difference between both groups regarding total response to treatment and degree of repigmentation. However, there was higher response to treatment in group A than group B. In both groups patients were satisfied with the degree of improvement. As regard complication there were minimal complications only one case of koebnerization and two cases of post inflammatory hyperpigmentationConclusion: 5- fluorouracil 5% was associated with better improvement than latanoprost. However, the difference did not reach statistical significance. Patients reported high satisfaction with the two treatment modalities.
https://ijma.journals.ekb.eg/article_169689_c863dc71bb8424a99e672afaa154913e.pdf
2021-07-01
1550
1555
10.21608/ijma.2021.70410.1290
Latanoprost
Five-fluorouracil
Vitiligo
dermabrasion
Rehab
Abd El Razek
m.rehab1188@gmail.com
1
Medical Administration Branch [For Girls], Al-Azhar University, Egypt
LEAD_AUTHOR
Zakaria
Obaid
zakariamahran67@gmail.com
2
Department of Dermatology and Venereology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Osama
Magdy Elshahat
elshabory@yahoo.com
3
Department of Dermatology and Venereology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Adult Spinal Hamartoma Involving Conus Medullaris: Brief Review About Associated Congenital Abnormalities and Surgical Outcome
Background: Spinal hamartoma is an extremely rare lesion for symptomatic spinal cord compression in adult population. Without any association of spinal dysraphism and neurofibromatosis, only 3 cases have been reported in the literature.Case description: A 40-year-old man presented with lumbago femorica for 6 months. Gradually the symptoms worsened and he developed features of Cauda equina syndrome. Magnetic Resonence Imagimg demonstrated a heterogeneously hyperintense intradural extramedullary mass in both T1 and T2WI, involving conus medullaris and cauda equina, opposite to L1. Patient underwent near total resection of lesion through posterior midline approach. Histopathological features were consistent with hamartoma. Patient neurologically improved and follow up MRI at 6 months showed static small nodular tumor residue.Conclusion: To the best of our knowledge, current report is the fourth case of spinal hamartoma in adult male, without any association of spinal dysraphism and neurofibromatosis .This may be the first reported case from Bangladesh.
https://ijma.journals.ekb.eg/article_160652_7a0bbe9d7c5cd1a6ecf9cc5edd7e61b0.pdf
2021-07-01
1556
1561
10.21608/ijma.2021.66305.1279
hamartoma
Neurofibromatosis
Spinal dysraphism
Nazmin
Ahmed
nazmin.bsmmu@gmail.com
1
Department of Neurosurgery, Ibn Sina Diagnostic and Consultation Center, Lalbag, Dhaka, Bangladesh
AUTHOR
Shahidul
Khan
sikhan55@yahoo.com
2
Consultant, Department of Orthopaedic surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
AUTHOR
KM Tarikul
Islam
dr.tarik_2007@yahoo.com
3
Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
AUTHOR
Avijit
Dey
paradiselost1131@gmail.com
4
Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
AUTHOR
Vishal
Chavda
chavdavishal2@gmail.com
5
Division of Anesthesia,Sardar Womens Hospital, Bapunagar, Ahmedabad, India
AUTHOR
Ottavio
Tomasi
ottavio.tomasi@gmail.com
6
Department of Neurological Surgery,Christian Doppler Medical Centre, Laboratory for Microsurgical Neuroanatomy,Paracelsus Medical University,Salzburg, Austria
AUTHOR
Gianluca
Scalia
gianluca.scalia@outlook.it
7
Neurosurgery Unit,Highly specialised Hospital and National importence,Garibaldi,Catania,Italy
AUTHOR
Giuseppe E.
Umana
umana.nch@gmail.com
8
Department of Neurosurgery,Trauma and Gamma Knief Centre,Cannizzaro Hospital,Catania,Italy
AUTHOR
Bipin
Chaurasia
trozexa@gmail.com
9
Department of Neurosurgery, Bhawani Hospital, Birgunj, Nepal
LEAD_AUTHOR
ORIGINAL_ARTICLE
Tyrosine Hydroxylase Expression is Associated with Bone Marrow Infiltration in Neuroblastoma Patients
Background: Neuroblastoma is a complex heterogeneous disease. Bone marrow is the most commonly affected metastatic site. The aim of the work: The current study aimed to assess the role of tyrosine hydroxylase in diagnosing bone marrow infiltration in neuroblastoma.Methods: Tyrosine hydroxylase was assessed in the bone marrow aspirate of 104 pediatric neuroblastoma patients, compared to 25 matched normal controls by real time polymerase chain reaction. The data were correlated to the clinic-pathological features of the patients, response to treatment, bone marrow infiltration, disease free survival and overall survival.Results: Tyrosine hydroxylase was expressed in 78/104 [75%] of the patients. Bone marrow infiltration was significantly higher in patients with high tyrosine hydroxylase expression compared to those with tyrosine hydroxylase low expression [median [range]: 193 [0-277750] versus 4 [0- 7849]; p=0.003]. Use of tyrosine hydroxylase for diagnosis of bone marrow involvement in neuroblastoma had a sensitivity of 55.2%, a specificity of 65.2%, and positive predictive value of 66.7% and negative predictive value of 53.6%.Conclusions: Tyrosine hydroxylase may serve as a useful tool for diagnosis of bone marrow infiltration in neuroblastoma. Bone marrow infiltration is associated with poor disease free survival and overall survival.
https://ijma.journals.ekb.eg/article_172330_77f1ddf07e6a3325cd87a9449d7afa82.pdf
2021-07-01
1562
1569
10.21608/ijma.2021.70994.1292
neuroblastoma
Tyrosine hydroxylase
Bone marrow
Samar
El-Shazly
samarsami.elshazly3@gmail.com
1
Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo 11976, Egypt
AUTHOR
Mona
Abdellateif
mona.sayed@nci.cu.edu.eg
2
Department of Medical Biochemistry, Molecular Biology, and Cancer Biology, National Cancer Institute, Cairo University, Cairo 11976, Egypt.
AUTHOR
Fadwa
Said
f2said@yahoo.com
3
Department of Clinical Pathology, Faculty of Medicine, Cairo University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Ketamine versus Dexmedetomidine in Local Wound Infiltration for Postoperative Pain Relief in Cesarean Section
Background: Cesarean delivery is a frequently obstetric operation in Egypt with a recently reported over all cesarean section rate of 54% and it causes moderate to severe postoperative discomfort. Infiltration of the wound site is a method to improve postoperative analgesia. The aim of the work: To compare the pain relief effects of ketamine versus dexmedetomidine combined to bupivacaine in local wound infiltration in patients underwent cesarean section and to estimate side effects of medications.Patients and Methods: This randomized, controlled study including 90 women were subjected for elective cesarean delivery under general anesthesia and were divided at random into 3 equal groups to receive 40 ml bupivacaine (0.25%) + either 2 mg/kg ketamine in (group A), 2 μg/kg dexmedetomidine in (group B) or 2 ml saline in (group C) via local wound infiltration. The primary outcome was time of the first analgesia requested. The secondary outcomes were total dose of analgesia per 24 hours, Visual analogue scale, time of starting movement, breast-feeding, passing flatus or stool, start of eating and adverse effects of medications.Results: A significant increase in time of the first analgesic request in group A (8.4 ±1.91) h. and group B (7.5±1.81) h. than group C (4.3±1.24) h. A significant decrease in pethidine consumption in group A (59 ± 28.93 mg) than group B (72 ± 23.1 mg) and group C (102 ±16 mg). The visual analogue scale (VAS) was significantly lower (p <0.001) in groups A and B than in group C. The time of start movement, breast-feeding, passing flatus and eating was decreased in groups A and B than in group CConclusions: Addition of ketamine or dexmedetomidine to local anesthetics wound infiltration increased time to the first analgesia request and decreased total analgesic consumption, but ketamine is superior.
https://ijma.journals.ekb.eg/article_185126_eebee0753e09134ce26335f26c3bdc62.pdf
2021-07-01
1570
1575
10.21608/ijma.2021.185126
Ketamine
Dexmedetomidine
local anesthesia
wound infiltration
Nourhan R.
Biomy
nourhan_biomy@gmail.com
1
Department of Obstetrics and Gynecology, El Hawamdyia General Hospital, Ministry of Health, Egypt
AUTHOR
Asmaa
Fathelbab
asmaa_fathelbab@gmail.com
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Amina
Abdel-Fattah
amona_update@yahoo.com
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Abeer E.
Farhat
abeer_farhat@gmail.com
4
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Radiofrequency Denervation of Genicular Nerves for Advanced Knee Osteoarthritis Pain: A retrospective Observational Study
Background: Knee joint osteoarthritis is a degenerative disorder resulting in pain and disability. The treatment of knee osteoarthritis pain includes the use of oral analgesics, oral glucosamine and chondroitin sulfate, intra-articular steroid, and viscous supplementation, but with limited efficacy.Aim of the work: This retrospective observational study aimed to evaluate the efficacy of radiofrequency thermocoagulation of genicular nerves for control of the pain of knee joint osteoarthritis.Material and methods: This study included patients with knee pain of Kellgren Lawrence grade 3 and 4 osteoarthritis who underwent radiofrequency neurotomy of the knee joint from July 2015 to July 2018. The 68 joints of 60 patients were evaluated for knee pain VAS score [0–10 mm], oxford knee score [12–60] and development of any adverse effect at pre and post-procedure at 1, 3, 6 and 12 months.Results: The mean± SD values of Visual analog scale [VAS] [0–10] for knee joint pain were 7.93±1.21, 3.38±1.59, 4.10±2.30, 4.90±1.88, and 5.80±1.71 at pre-procedure and at 1, 3, 6 and 12 months post-procedure. The mean ± SD values for Oxford Knee Score [OKS] [12–60] were 40.87±7.66, 23.90±5.60, 25.93±5.48, 27.93 ± 5.48, and 31.43±5.62 at pre-procedure and at 1, 3, 6 and 12 months post-procedure. One-way repeated measures of ANOVA test showed a significant decrease in VAS and OKS scores between pre and post-procedure at 1, 3, 6 and 12 months [p <0.001].Conclusion: Radiofrequency thermocoagulation of genicular nerves provides significant pain relief and functional improvement in advanced knee joint osteoarthritis patients for a duration of one year.
https://ijma.journals.ekb.eg/article_172331_86689e9eca58186c1a4c5bf82f77fc2d.pdf
2021-07-01
1576
1583
10.21608/ijma.2021.68924.1286
Radiofrequency ablation
Local anaesthetic block
knee pain
Ultrasound Guided
Fluoroscope guided
Sandeep
Khuba
sandeepkhuba@gmail.com
1
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
LEAD_AUTHOR
Sanjay
Kumar
drsanjaygupta9@gmail.com
2
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
AUTHOR
Sujeet
Gautam
docsksg@gmail.com
3
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
AUTHOR
Anil
Agarwal
anil_sgpgi@hotmail.com
4
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
AUTHOR
Chetna
Shamshery
drchetna@rediffmail.com
5
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
AUTHOR
Keshav
Garg
keshavmckdoc@gmail.com
6
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
AUTHOR
Rajput
Kumar
drrajputabhishek@gmail.com
7
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
AUTHOR
ORIGINAL_ARTICLE
Efficacy of Nebulized Hypertonic Saline 3% in comparison to Nebulized Normal Saline 0.9% in Children with Acute Bronchiolitis
Background: Bronchiolitis is the most common lower respiratory tract infection in children. The management guidelines recommend only supportive measures; however, there is an increasing burden for bronchiolitis especially in developing countries. The use of nebulized hypertonic saline may aid in decreasing hospital stay and decrease the global burden of the disease.Objective: To compare between the efficacy of hypertonic saline versus normal saline in reducing duration of hospital admission and improving symptoms of acute bronchiolitis.Patients and methods: A randomized comparative clinical trial included 90 children with acute bronchiolitis, conducted at Al-Azhar University Hospital (New Damietta) during the period from October 2019 till June 2020. Patients were randomly assigned into 2 groups; 45 patients received 3% hypertonic saline nebulization (group 1), and 45 patients received 0.9% normal saline nebulization (group 2). Efficacy of treatment was assessed through duration of hospitalization and oxygen supplementation, and severity of respiratory distress.Results: there was no significant difference between both groups as regard to age, sex, baseline clinical severity score and O2 saturation. After treatment, patients who received nebulized hypertonic saline showed less duration of hospitalization (62.3±20.8 hours vs 76.8± 26.1 hours; p=0.001), less duration of O2 therapy (16.2±6.0 hours vs 25.3±5.4 hours; p=0.01). As regard to severity clinical score, patients received nebulized hypertonic saline showed significant improvement started within 24 hours from admission (P=<0.001).Conclusions: Nebulized hypertonic 3% saline is effective in reducing hospital stay among children with bronchiolitis compared with nebulized normal saline. Further large studies are required to confirm these results.
https://ijma.journals.ekb.eg/article_172360_91935a253834a3fc0d5045efafe7f578.pdf
2021-07-01
1584
1588
10.21608/ijma.2021.42037.1162
Nebulization
bronchiolitis
Normal saline
Hypertonic saline
Hosam
Elesh
hosam11.pediatrics@domazhermedicine.edu.eg
1
Department of Pediatrics, Damietta Faculty of Medicine; AL-Azhar University, Egypt
LEAD_AUTHOR
Hany
El-khaleegy
hanykhaleegy@yahoo.com
2
Department of Pediatrics, Damietta Faculty of Medicine; AL-Azhar University, Egypt
AUTHOR
Mohamed
elsamanoudy
mohamed_elsamanody@yahoo.com
3
Department of Pediatrics, Damietta Faculty of Medicine; AL-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Comparison between Single Mesh and Double Mesh Placement in Huge Inguinal Hernia
Background: Recurrence after surgical treatment of inguinal hernia is still a challenge facing surgeons during their daily practice. Aim of the Work: The current trial aims to compare single and double mesh placement in huge inguinal hernia repair. Patients and Methods: 40 cases were involved in the study. They were classified into two equal groups according to the operative technique [A for single mesh and B for double mesh]. The study's candidates were examined and investigated thoroughly regarding their complaint, the presence of a clinically detectable hernia in the inguinal region, its size, characters, onset, duration, and associated symptoms. Then, all were examined clinically and prepared for surgical intervention after lab investigations. Results: The mean ages were 56 and 56.9 years for groups A and B. Both groups were comparable to body mass index, risk factors, type of hernia, hernia side, and intraoperative blood loss. There was a significant decrease in operative time in group A when compared to group B [54.50 ± 8.256 vs. 61.25 ± 6.664 minutes, respectively]. The overall rate of complications was lower in group B when compared to group A [30.0% vs. 50.0%, respectively]. Complications in group A were seroma [10.0%], wound infection [5.0%], scrotal edema [25.0%], and chronic pain [10.0%]; while in group B, seroma [10.0%], scrotal edema [5.0%], chronic pain [15.0%]. Recurrence was confined to group A, and reported to three patients [15.0%]. However, the difference was statistically nonsignificant. Conclusion: Double mesh technique is a safe and efficacious approach for managing huge inguinal hernia. It is associated with lower rate of recurrence than the single mesh approach with comparable operative time, complications, and outcomes.
https://ijma.journals.ekb.eg/article_172863_94a78d455ce169576c1ae4c048db8f02.pdf
2021-07-01
1589
1597
10.21608/ijma.2021.56574.1239
Inguinal
Huge
double
single
Mesh
Ahmed Talat Ali
Behiery
ahmed.talaat@domazhermedicine.edu.eg
1
Department of Surgery, Ministry of Health, Egypt
LEAD_AUTHOR
Ahmed Salama
Sayouh
asalama2000@domazhermedicine.edu.eg
2
Department of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Nagah Atwa
Salem
nagahsalem@domazhermedicine.edu.eg
3
Department of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Oral Isotretinoin in the Treatment of Recalcitrant Molluscum Contagiosum in Children
Background:Recalcitrant molluscum contagiosum in children has been treated with many destructive procedures with a high recurrence rate, alternative treatments would be desirable in pediatric patients. Oral isotretinoin has been used to treat viral warts successfully in children.Aim of the work: Our aim in this study wasto investigate the influence of oral isotretinoin in MC patients. Methods: Twenty children less than 18 years, with recalcitrant molluscum contagiosum were enrolled in this study, the treatment protocol was oral isotretinoin [0.5 mg/kg] daily until complete clearance [maximum duration 3 months]. Patients were evaluated clinically and photographically every two weeks to assess the response to treatment and to report side effects of therapy. Patients with complete response were followed up monthly for three months to record the recurrence rate. Lipid profile [Triglycerides, cholesterol, LDL and HDL] and liver function tests [SGOT and SGPT] were performed before treatment and every 4 weeks during the treatment period.Results:Mean age of participants was 12.90 ± 2.64 years, 80% of them were more than 10 years old, [65%] were male, and the mean weight of studied cases was 49.10 ± 15.33 kg. The face was most common affected site in most cases [45%]. The mean lesion size was 2.63 ± 1.11 mm, and mean number of molluscum lesions of 23.55 ± 12.85. As regarding to recurrence rate, 93.8% of cases who had complete response were still free at the end of 3 months follow up and only 6.3% had recurrence. Reported side effects were dry lips in all participants, 55% had a dry skin and 30% had a dry nose.Conclusion: Oral isotretinoin therapy improves recalcitrant MC lesions in children, which maycontribute to its therapeutic efficacy.
https://ijma.journals.ekb.eg/article_174076_3e94fb852d82ad04eee3d370267169e3.pdf
2021-07-01
1598
1601
10.21608/ijma.2021.71160.1293
Isotretinoin
molluscum contagiosum
children
Rahma
Ramdan
rahma_ramdan2020@yahoo.com
1
Department of Dermatology, Venereology and Andrology, Dermatology and Leprosy Hospital in Damietta, Ministry of Health, Egypt
LEAD_AUTHOR
Hany
Abou Alwafa
dr_hanyos138@yahoo.com
2
Department of Dermatology, Venereology and Andrology, Al-Azhar Faculty of Medicine, Damietta, Egypt
AUTHOR
Emad Eldin
Elgamal
elgamal55@yahoo.co.uk
3
Department of Dermatology, Venereology and Andrology, Al-Azhar Faculty of Medicine, Damietta, Egypt
AUTHOR
ORIGINAL_ARTICLE
Detection of Biocides Resistance Genes among Clinical Isolates of Both Methicillin-Resistant and Methicillin-Sensitive Strains of Staphylococcus Aureus
BACKGROUND: Biocides compounds are widely used in infection control programs, including hand washing and skin decolonization before invasive procedures. However, its overuse leads to the emergence of Staphylococcus aureus with decreased biocides susceptibility, which became a problem in hospitals in different parts of the world.AIM OF THE WORK: The present work aims to study the susceptibility of methicillin-resistant isolates of staphylococci aureus, obtained from different clinical samples to commonly used biocides, determines the prevalence of the biocide resistance genes, qacA/B, and qacC, among these isolates.METHODS: Biocide’s resistance genes [qacA/B, qacC] in Both Methicillin-Resistant and Methicillin-Sensitive Strains of Staphylococcus aureus were detected by PCR method. The minimum inhibitory concentrations [MICs] of Biocide agents were determined by broth dilution method, whereas antibiotic susceptibility was analyzed by disk diffusion and MICs methods according to Clinical and Laboratory Standards Institute [CLSI] criteria.RESULTS: The frequency of Biocides resistance genes [qacA/B, qacC] was found to be high in our clinical staphylococci isolates. The qacA/B gene was detected in [63.3%] of MRSA isolates compared with only [23.3%] of MSSA isolates. Simultaneously, the qacC gene was detected in [63.3%] of MRSA isolates compared to only [13.3 %] of MSSA isolates., with the significant difference between both groups [p <0.05]. We also found an association between the presence of antiseptic resistance genes qacA/B, and increased MIC values to both savlon, hypochlorite, and Phenol [p <0.05]. We also showed that an association between the presence of antiseptic resistance genes qacC and the MICs to both savlon, hypochlorite, and Phenol [p <0.05].CONCLUSION: Our study detects biocide resistance genes [qacA/B, qacC] in Staphylococcus aureus isolates in Egypt; more studies are needed to correct the biocide uses and to support infection control programs to avoid the development of new resistance mechanisms.
https://ijma.journals.ekb.eg/article_177074_c755a36efed7e5845fec1d35e4d40d78.pdf
2021-07-01
1602
1610
10.21608/ijma.2021.62186.1260
resistance
Biocides
Staphylococcus aureus
Methicillin-resistant
Biocides’ resistance genes
Walid
Sabry
walid.sabry@domazhermedicine.edu.eg
1
Department of Microbiology and Immunology, Damietta faculty of Medicine, Al-Azhar university, Egypt
LEAD_AUTHOR
Mohammed Yosry
Al-Dakhakhni
yosridakhakhni@gmail.com
2
Department Medical Microbiology and Immunology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ibrahim
Al-hoseiny
ibrahim_m70@hotmail.com
3
Department Medical Microbiology and Immunology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Raafat Abd Rabbo
Abdel Tawab
drraafat8@gmail.com
4
Department of Microbiology and Immunology, Damietta faculty of Medicine, Al-Azhar university, Egypt
AUTHOR
ORIGINAL_ARTICLE
Dorsolumbar Spinal infection: Surgery versus Conservative Treatment
Background: The spinal infection is defined as infection accompanied by the destruction of the vertebral bodies, starting at the endplate with secondary involvement of the intervertebral disks. Patients with spinal infection experience back pain with or without fever.Aim of the Work: The aim of the current study was to compare the results for both surgical interference and conservative methods in managing dorsolumbar spinal infections.Patients and Methods: This was a prospective study that included 30 patients with dorsolumbar spinal infection. They were admitted and managed at the Neurosurgery Department, Al-Azhar University hospitals and Health Insurance hospitals through the period of 2015 to 2020.Result: The disease was more common in males. Patient age ranged from 29 to 65 years. Diabetes mellitus was the most common reported comorbidity. The most affected region was the thoracic region followed by the lumbar region. Diagnosis was established bacteriologically for 32%. The average erythrocyte sedimentation rate [ESR] in the first hour was 84.5 mm/hr, elevated in the second hour to 94mm/hr. C-reactive protein [CRP] level was greater than 10mg/L in all cases with an average of 55.8mg/L. All patients received more than 4 weeks of antibiotic therapy. The outcome was excellent to good outcome among 60% and 73.3%. Fair outcome was 13.3% and 20%, poor outcome, was 20% and 6.7%, and patients died was 6.7% and 0%, in conservative and surgical groups, respectively. Relapse developed in 10% of patients.Conclusion: ESR and CRP were very important in both diagnosis and follow-up [with CRP superior to ESR]. Surgery is superior than conservative treatment.
https://ijma.journals.ekb.eg/article_177951_fdd1a33d90e1c70e3d2250ef003a9048.pdf
2021-07-01
1611
1617
10.21608/ijma.2021.66161.1275
Spinal infection
Vertebral osteomyelitis
Disk space infection
Spondylodiscitis
Epidural abscess
Ahmad
Elmezain
ahmad.mofreh@gmail.com
1
Tanta Health Insurance Hospital, Ministry of Health, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Facial Nerve Paralysis as A Complication of Acute Otitis Media
Background:Facial nerve paralysis is not a very frequent association with acute otitis media (AOM). The pathophysiology and treatment of this condition still under debate.Aim of the Work:to review the treatment strategies and extent of recovery in patients with facial nerve paralysis after AOM.Patients and Methods:The study was a retrospective study. Authors reviewed a total of 4710 cases of AOM seen during the period form 2010 to 2020. Fourty cases developed facial nerve paralysis. All were reviewed for epidemiological data and clinical assessment. Facial palsy was graded by House-Brackmann scale. All patients were treated with antibiotics combined with oral or intravenous corticosteroids. Myringotomy with or without application of a ventilation and mastoidectomy without decompression of the facial nerve were performed in selected cases.Result:Normal facial function was resumed to normal in all patients. The paralysis was mainly of acute onset (90.0%) and otorrhea reported among 12.5%. The initial paralysis grade was mainly grade IV (41.3%) followed by grade III (26.3%). The topography was mainly infrageniculate (86.3%). A collected material for bacteriology was reported for 40.0%, and 53.1% of them had negative culture. The most common detected organism was staphylococcus aureus (18.8%). Myringotomy was done for 7.5%, aspiration for 10.0% and Mastoidectomy for 10.0%. The overall outcome was good among 90.0% and bad among 10.0%. The duration for complete cure in cases with good outcome not exceeded 3 months. Only lower initial grade on House-Brackmann scale and infrageniculate topography were associated with favorable outcome.Conclusion: The management of facial nerve paralysis due to acute otitis media could be conservative by antibiotics with corticosteroids.
https://ijma.journals.ekb.eg/article_185449_7fc77f79585dc91104f8e6d9b343c89d.pdf
2021-07-01
1618
1623
10.21608/ijma.2021.185449
facial nerve
Otitis media
Paralysis
House-Brackmann scale
Mastoidectomy
Mohamed Mahmoud
Fatthy Ramadan
mramadanent@domazhermedicine.edu.eg
1
Department of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Mahmoud Helmy
Elsaied
mheh.973@gmail.com
2
Department of Medical Education, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Mohamed Gaber
Hassan
m_gaber56@domazhermedicine.edu.eg
3
Department of Physiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Risk of Vibrio Transmission Linked to Consumption and Contact with Water in Benin
Background:Vibrio infections have increased in Benin, and this phenomenon is expected to increase due to climate change, increased consumption of contaminated water and the number of people who are immunocompromised. The aim of the work: The objective of this study was to evaluate the risk of Vibrio transmission linked to the use of contaminated water in Benin. Methodology: Water samples [n = 220] were analyzed to isolate Vibrio strains using their biochemical and cultural characteristics. The species were identified by the Polymerase Chain Reaction technique by monitoring the search for genes encoding the cholera toxin of Vibrio cholerae [ctxA and ctxB] and the direct thermostable and thermostable hemolysins linked to Vibrio parahaemolyticus [tdh and trh]. Results: Among the 220 collected samples, the biochemical tests revealed 86 strains of Vibrio species; Vibrio cholerae [35%], Vibrio parahaemolyticus [18.60%] and Vibrio alginolyticus [13.95%] were identified using molecular tool. The presence of genes encoding the main virulence factors of the strains studied. Thus 6.67%, 10% and 3.33% of the strains of Vibrio cholerae respectively contain the toxins ctxA, ctxB and the couple ctxA and ctxB. Likewise, the Vibrio parahaemolyticus strains contain 12.5% tdh toxins and 31.25% [tdh and trh]. The search for genes [tdh and trh] in Vibrio alginolyticus was also negative. Conclusion: Epidemics can be triggered by natural or fabricated events that contaminate drinking water or compromise access to safe drinking water and sanitation. The incidence of vibriosis is increasing, perhaps in part because of the spread of Vibrio species promoted by climate change and increasing water temperature.
https://ijma.journals.ekb.eg/article_178168_eec81518aa619fc24ae977c53e3b1d98.pdf
2021-07-01
1624
1635
10.21608/ijma.2021.67136.1289
water
Vibrio Species
polymerase chain reaction
Virulence genes
Bacterial resistance
Bawa
Boya
bawaboya@yahoo.fr
1
Laboratory of Biology and Molecular Typing in Microbiology [LBTMM]. University of Abomey-Calavi, 05 BP 1604 Cotonou, Benin
AUTHOR
Haziz
Sina
sina.haziz@gmail.com
2
Laboratory of Biology and Molecular Typing in Microbiology [LBTMM]. University of Abomey-Calavi, 05 BP 1604 Cotonou, Benin
LEAD_AUTHOR
Théodora A
Ahoyo
taahoyo@gmail.com
3
Engineering of Human Biology / Polytechnic School of Abomey-Calavi [EPAC], University of Abomey-Calavi, Benin
AUTHOR
Victorien T.
Dougnon
victorien88@hotmail.com
4
Research Unit in Microbiology, Application and Pharmacology of Natural Substances [URMAPha], University of Abomey-Calavi, Benin
AUTHOR
Akim
Socohou
akimsocohou@gmail.com
5
Laboratory of Biology and Molecular Typing in Microbiology [LBTMM]. University of Abomey-Calavi, 05 BP 1604 Cotonou, Benin
AUTHOR
Nana Mariama
Maman
chabbertnana@yahoo.fr
6
Research Unit in Microbiology, Application and Pharmacology of Natural Substances [URMAPha], University of Abomey-Calavi, Benin
AUTHOR
Didier
Bompangue
didier.bompangue@gmail.com
7
Department of Microbiology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
AUTHOR
Lamine Saïd
Baba-Moussa
laminesaid@yahoo.fr
8
Laboratory of Biology and Molecular Typing in Microbiology [LBTMM]. University of Abomey-Calavi, 05 BP 1604 Cotonou, Benin
AUTHOR
ORIGINAL_ARTICLE
Role of Vaginal Fluid Aspartate Aminotransferase and Alanine Aminotransferase in the Diagnosis of Pre-Labor Rupture of Membranes
Background: Pre-labor rupture of membrane is a common obstetric complication. Rapid and good diagnosis is needed to prevent bad obstetric complication and unneeded hospitalization.Aim of work: The aim of this study was to evaluate the reliability of aspartate aminotransferase [AST] and alanine aminotransferase [ALT] enzymes measurement in vaginal washing fluid for the diagnosis of pre-labour rupture of membranes.Patient and method: This case-control study was carried out in two departments of Obstetrics and Gynecology [Al-Azhar University Hospital, New Damietta and Senbellawein General Hospital], between March 2019 and December 2020. It included 90 pregnant women at gestational age 30-40 weeks. They were divided into two equal groups. Group І [case group, PROM group]: included women with diagnosis of rupture of membranes confirmed by visualization of amniotic fluid passing from the cervical canal, and Group ІІ [control group] included women without any complaint or complication. All were clinically evaluated and the vaginal fluid was aspirated for laboratory analysis. Results: Results revealed significant differences between the studied groups. The mean AST level in the PROM group was 18.84±5.74 and 3.33±1.29 in the control group [p <0.001]. The optimal cutoff concentration for AST levels in vaginal secretions is >8 IU/L. The mean ALT levels were 5.09±2.1 in the PROM and 1.13±0.94 in the control group, with significant difference between groups [p <0.001]. The cutoff value of >2.5 IU/L is optimal.Conclusion: Vaginal fluid Aspartate aminotransferase [AST] and Alanine aminotransferase [ALT] have high sensitivity and high negative predictive value. So, they are considered a good screening tests for detection of PROM. Also measuring vaginal fluid AST and ALT levels are cheaper, faster, available and reliable method for detection of pre-labor rupture of membranes.
https://ijma.journals.ekb.eg/article_178216_06ec4e105e175819b0290ea7185f59f7.pdf
2021-07-01
1636
1641
10.21608/ijma.2021.76404.1316
rupture of membranes
Alanine
aspartate aminotransferase
vaginal washing fluid
amniotic fluid
Aya
Elnemr
uouo4everafter@gmail.com
1
Department of Obstetrics and Gynecology, El-Senbellawein General Hospital, Ministry of Health, Egypt
LEAD_AUTHOR
Rashed
Rashed
rashid.mrashid@domazhermedicine.edu.eg
2
Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Alaa
Alarshal
arshl123@domazhermedicine.edu.eg
3
Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Role of Magnetic Resonance Imaging and Ultrasonography in Evaluation of Chronic Non osseous Shoulder Pain.
Background: Chronic shoulder pain is a common clinical presentation. It is of osseous or non-osseous origin. In non-osseous shoulder pain, proper diagnosis is critical. Magnetic resonance imaging [MRI] is the standard diagnostic modality. However, it is expensive and not available in many medical centers. Thus, the availability of cheap alternative is crucial.Aim of the work: The current research aimed to assess the diagnostic performance of ultrasonography versus conventional MRI in different causes of chronic non-osseous shoulder pain.Patients and Methods: Fourty patients with chronic shoulder pain due to different causes were participated in the current work. They were selected from Al-Azhar University Hospital [Damietta]. All were assessed on clinical basis [history, physical examination and laboratory investigations]. Then, all were submitted to radiological investigations [Plain X-ray, shoulder ultrasound, and Magnetic resonance imaging]. The diagnostic value of ultrasound was estimated versus that of magnetic resonance imaging.Results: by ultrasound, tendinosis was reported in 55.0%, partial thickness tear in 27.5%, articular surface in 20.0%, full thickness tear in 12.5%, bursal surface [7.5%], neoplastic [2.5%] and infraspinatus tendon full thickness tear [2.5%]. Ultrasound able to diagnose supraspinatus tendinopathy [91.7%], full thickness complete tear [83.3%], supraspinatus impingement [85.3%], subacromial subdeltoid bursitis [92.0%] and long head biceps tenosynovitis [84.2%]. Otherwise, ultrasound specificity is over its sensitivity power for partial thinness tear on articular [80.0%] or bursal surfaces [85.3%], full thickness complete tear [94.1%], shoulder joint effusion [92.3%], LHB tenosynovitis [85.7%] and labral tears [100.0%].Conclusion: Shoulder ultrasound could be considered as a reasonable alternative to magnetic resonance imaging in the diagnosis of different causes of chronic shoulder pain. However, its value widely different from condition to another. Thus, it could be used as a rapid screening tool, and the use of MRI could be ascribed for specific conditions [cases with lower ultrasound sensitivity].
https://ijma.journals.ekb.eg/article_180982_e278a8190759584db0c7d37b954c7e05.pdf
2021-07-01
1642
1650
10.21608/ijma.2021.74120.1307
Chronic shoulder pain
Ultrasound
tendinosis
bursa
Non-Osseous
Abdelrahman
Hassan
ganna_050@hotmail.com
1
Department of Radiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Mostafa
Shakweer
mshakweer1@domazhermedicine.edu.eg
2
Department of Radiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ahmed
Ashour
dr_ahmed.ashour@domazhermedicine.edu.eg
3
Department of Radiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ahmed
Abo Rashid
aama.radiology@gmail.com
4
Department of Radiology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
The Impact of Adenoid Hypertrophy on Pediatric Chronic Maxillary Sinusitis
Background:The hypertrophied adenoids lay a role in rhinosinusitis, which is not fully unknown. The present view proposed that the hypertrophied adenoids perform as a bacterial pool and restricts the nasal mucociliary clearance. Obstructive adenoids may lead to stasis of nasal secretions with subsequent infection.Aim of the Work:The current work aimed to assess the impact of adenoid enlargement on pediatric chronic maxillary sinusitis [PCMS].Patients and Methods:This study included 60 Children. The size of adenoid was graded through endoscopic examination. The Clemens grading system was used. Paranasal sinuses were radiologically investigated by computerized axial tomography scan. The radiological and endoscopic data were correlated. Additionally, all adenoid samples were cultivated for bacteriological growth. Result:The highest incidence of adenoid hypertrophy was seen in the age group 3-6 years old [60%], with similar male to female affection rate [1:1]. The positive computed tomography [CT] scan findings among children with hypertrophied adenoid were [55%]. The highest incidence of positive CT findings was found in grade-III adenoids, which is the highest grade of size [33.3%]. Adenoidectomy was performed for all patients and specimens were examined for bacteriological growth. 20% of adenoid tissue had multiple growth and 80.0% showed single organism. The frequency of isolated organism were H. Influenzae, S. Pneumoniae, S. Pyogenes, S. Aureus and Methicillin Resistant Staphylococcus Aureus.Conclusion: The endoscopically graded adenoid hypertrophy is significantly correlated to positive CT scan signs of rhinosinusitis in children. Isolation of bacteria from adenoid tissue supports the inflammatory mechanism of adenoid in pathogenesis of rhinosinutis in addition to its obstructive action. Early initiation of empirical antibiotic therapy is crucial and adenoidectomy provides a cure for adenoid hypertrophy and rhinosinusitis.
https://ijma.journals.ekb.eg/article_186021_39c83a999b7278c6ebe98496213e62e3.pdf
2021-07-01
1651
1656
10.21608/ijma.2021.186021
Pediatrics
Chronic Maxillary Rhinosinusitis
adenoid hypertrophy
Computerized Axial Tomography
Mohamed Mahmoud Fatthy
Ramadan
mramadanent@domazhermedicine.edu.eg
1
Department of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Walaa Mohamed Omar
Ashry
walaaomar2011@gmail.com
2
Department of Microbiology and Immunology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
A community-Based Epidemiological Study of Epilepsy among Students of Primary and Preparatory School Stages in New Damietta City
Background:Even though Epilepsy is a common neurological disorder globally, developing countries still have insufficient epidemiological data regarding epilepsy.Aim of the Work:We aimed to estimate the prevalence of epilepsy in primary and preparatory school students in New Damietta city, Damietta governorate, Egypt.Patients and Methods:A cross-sectional community-based study that was conducted over a period of six months from February to July 2020. All students from conventional schools were screened using a special validated Arabic translated questionnaire. Students with positive questionnaire findings were subjected to a detailed history, neurological examination, Electroencephalography [EEG], and Magnetic resonance imaging [MRI] whenever possible. Data were coded and analyzed. Result:Lifetime prevalence was 7.5/1000 in conventional schools. Male: Female ratio was 2:1 with statistical significance [95% Confidence Interval= 0.276 to 0.963]. Low socioeconomic class students had a statistically significant higher prevalence of epilepsy. Prenatal and neonatal insults, history of febrile convulsions, and family history of epilepsy were the risk factors with statistical significance. Generalized seizures were more frequent than focal and 62.2% of children were receiving treatment. EEG detected epileptiform discharges in 33.3% of students.Conclusion: The prevalence of overall epilepsy among primary and preparatory school students was similar to that of other Egyptian districts within the same age group. Being male and low socioeconomic status was associated with a high prevalence of epilepsy. The reported prevalence is similar to the prevalence of epilepsy in other Egyptian Governorates and other Arab countries, but lower than the prevalence in Upper Egypt and most developing countries.
https://ijma.journals.ekb.eg/article_185120_9f7f7caf2fbcb511c87100de9de92055.pdf
2021-07-01
1657
1663
10.21608/ijma.2021.64734.1278
Epilepsy
School
children
Cross-sectional study
Egypt
Mohamed
Ali
mohamed.ali@domazhermedicine.edu.eg
1
Department of Neurology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Abdel Monem Mohamed
Hassan
abdelmonemab087@gmail.com
2
Department of Neurology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ayman
Mahmoud
aymanahmed1231@yahoo.com
3
Department of Public Health; Damietta faculty of Medicine, Al-Azhar university, Egypt
AUTHOR
Hossam
Ali
drhossamabdelmonem@domazhermedicine.edu.eg
4
Department of Neurology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Assessment of Iron Profile and Its Effect of Deficiency in Growth and Development in Infants at One-Year-Old Age
Background:Anemia is described as a decreased erythrocyte count and or hemoglobin value below the 5th percentile of the usual hemoglobin value specified for that age in healthy individuals.Aim of the Work:To assess the iron status and evaluate the iron deficiency and their association with the development of motor activity and anthropometric measurement in one-year-old infants.Patients and Methods:This randomized cross-sectional study is performed on 200 infants aged one year in primary care unit at vaccination set in Damietta governorate. 45% Of them were females and 55% were males all of them underwent laboratory tests (complete blood count (CBC), serum ferritin, total iron binding capacity (TIBC), serum iron), growth and developmental assessment. Result:34% of infants were with normal hemoglobin ,serum iron and ferritin ,infants who have deficiency of iron were 25%, infants who have anemia without iron deficiency were 15% and. Infants who have iron deficiency anemia26%, of them 26.9% were underweight, 23.1% were stunted and 26.9% were delayed development, but growth and development unaffected in other cases.Conclusion: The percentage of iron deficiency anemia and iron deficiency is high in infants at one year, so we must start iron therapy at the first year to avoid the effects of iron deficiency on growth and development.
https://ijma.journals.ekb.eg/article_183085_84767f79d83187057981b6c4782862cf.pdf
2021-07-01
1664
1670
10.21608/ijma.2021.70718.1291
Iron Deficiency (ID)
Hemoglobin
Anemia
Growth
Development
Shimaa
Bassiuony
shimaabassiuony788@gmail.com
1
Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Hany
El-khaleegy
hanykhaleegy@yahoo.com
2
Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Saad
Mohamed
saad_dawody@yahoo.com
3
Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Amer
Abd-Elhamid
dr.amermohamed@domazhermedicine.edu.eg
4
Department of Medical Biochemistry, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Perceived Stress and its Contributing Factors among a Group of Egyptian Women during COVID-19 Lock-down
Background: The pandemic of corona virus disease [COVID]-19 had its great impacts on global health due to the increasing both morbidity and mortality. In addition, being quarantined is linked with high stress levels, insomnia, irritability and trauma-related disorders particularly in vulnerable populations. Therefore, there is a need to assess accurately and timely the magnitude of psychological health outcomes in those having exposure to COVID-19 pandemic.The Aim: The current work aimed to assess the perceived stress level among a group of Egyptian women and to explore the potential contributing factors for that during the COVID-19 lockdown.Methods: A cross-sectional survey targeted educated women from different Egyptian governorates, and of different socioeconomic standards. The total sample was 286 women who were recruited by non-probability snowball sampling and through a semi-structured, online questionnaire comprising socio-demographic data, the validated Arabic version of Cohen Perceived Stress Scale 10 [PSS]. Possible contributing factors of the perceived stress due to COVID-19 were also inquired.Results: total females who responded to the questionnaire were 286 with mean age of 46.5± 11.0 years. During the quarantine period, the total score of the perceived stress scale was 17.1±5.37, and both high and moderate levels of stress were recorded among 73.4% of the studied sample. Stress level was significantly influenced by disruptions of social communication with friends and families, "getting basic needs for health and safety are unmet then ", conflicts between mother and her children represented as a load", being younger women [below 50 years], and "feel stressed due to inability for social gatherings".Conclusion: COVID -19 pandemic has its obvious psychological impact on females, and many factors were contributing to such situation, which put the spotlight on the importance of taking these impacts into consideration when designing policies to slow the spread of the pandemic.
https://ijma.journals.ekb.eg/article_183086_f84ada78ceb3ce1f693f1b365cb2b848.pdf
2021-07-01
1671
1680
10.21608/ijma.2021.79373.1322
COVID-19
perceived stress
stress level
contributing factors
Hanaa
Abou elhassan
hanaaabouelyazid@azhar.edu.eg
1
Department of Community Medicine, Faculty of Medicine for Girls, Al-Azhar University, Egypt
LEAD_AUTHOR
Heba
Abd ElGalil
hebamohamed.medg@azhar.edu.eg
2
Department of Community Medicine, Faculty of Medicine for Girls, Al-Azhar University, Egypt
AUTHOR
Omneya
Elsherif
oelsherif@hotmail.com
3
Department of Family Medicine, Cairo University Hospital, Egypt
AUTHOR
Safaa
Hamouda
saf_a2@yahoo.com
4
Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Omaima
Aboushady
omaymaaboshady@gmail.com
5
Department of Parasitology, Faculty of Medicine, Cairo University, Egypt
AUTHOR
Nadia
Kotb
dr_nadiakotb@yahoo.com
6
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Egypt
AUTHOR
Amal
Saad-Hussien
amel_h@hotmail.com
7
Department of Environmental and Occupational Medicine, National Research Centre, Egypt
AUTHOR
ORIGINAL_ARTICLE
Fatigue in A sample of Egyptian Multiple Sclerosis Patients: A Cross Sectional Study
Background: Multiple sclerosis [MS] is an inflammatory demyelinating disease of the central nervous system, which is the second-most common cause of physical handicap in young individuals. Fatigue is the most prevalent [50%–90%] symptom of MS interfering with everyday life with at least one mild symptom of fatigue even in the early stages of the disease [36.5%] when clinical symptoms are still negligible.The Aim of The Work: To evaluate the prevalence and relation of fatigue in MS patients with sleep disorders and other clinical factors in an attempt to understand the underlying mechanisms of this symptom which might be of help in easing its evaluation and optimizing patient care.Patients and Methods: A cross-sectional study was performed on patients recruited from MS unit at Al-Azhar University Hospitals in Cairo. Fifty patients were investigated and submitted to clinical evaluation as well as fatigue severity assessment using fatigue severity scale and sleep scales: Epworth sleepiness scale for assessment of daytime sleepiness, Pittsburgh sleep scale for assessment of sleep quality, and polysomnography.Results: Fatigue was present in 60% of MS patients. Decreased sleep efficiency, pain and progressive types were significantly higher among MS patients with fatigue. Male patients with fatigue were significantly more than those without fatigue. About 84% of patients with MS were complaining from sleep disorder symptoms, 72% had insomnia, pain and nocturia ranged from 54%-60% while leg spasm and narcolepsy were present in 30% and 20% respectively.Conclusion: The present study emphasized the prevalence of fatigue in MS patients and its relation with sleep disorders and disease progression denoting wide variety of pathological mechanisms and the necessity of multimodal management.
https://ijma.journals.ekb.eg/article_183087_1c28c4a9d1af3c8007592cccc4aaaf81.pdf
2021-07-01
1681
1688
10.21608/ijma.2021.76416.1312
sleep disorders
polysomnography
fatigue scales
sleep scales
Mohammad
Hassan
m.elomairy@gmail.com
1
Department of Neurology, Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Endoscopic Management of Lumbar Disc Prolapse
Background: Endoscopic management of lumbar disc herniation as a minimally invasive procedure become more popular around the world. Although accepted surgical outcomes of the endoscopic approach to manage lumbar disc herniation [LDH], this procedure still to be relatively challenging and needs a high learning curve, so operative failures and complications may occur.The Aim of The Work: To assess using the endoscope in the management of lumbar disc prolapse by interlaminar approach using Easy Go and Destandau systems.Patients and Methods: This is study included twenty patients, who had lumbar disc herniation, and operated by using Easy Go and Destandau's endoscopic systems after the failure of conservative treatment. They were included between March 2016 and April 2020. They followed up for at least three months postoperatively. All were selected from the Neurosurgery Department, Al-Azhar University Hospitals, Egypt.Results: Low back pain was the main complaint reported by all patients. The radicular side was mainly the left side [70.0%] and L4/L5 was the most common affected level [65.0%]; the disc protrusion was mainly paracentral [80.0%]. There was a significant pain reduction after surgery when compared to before surgery. The outcome was excellent for 55.0%, good for 25%, fair for 15% and poor for 5%. Complications were in the form of unintended durotomy among 10.0%, nerve injury among 10.0% and infection among 5.0%. Conclusion: Endoscopic lumbar discectomy through interlaminar approach by Destandau's and Easy Go systems become a golden procedure to manage lumbar disc prolapse at any level especially L5-S1 as a minimally invasive technique with some accepted complications that can easily be managed compared to classic traditional open techniques.
https://ijma.journals.ekb.eg/article_183894_1a2522b02482e3afcdcf7642fb7a39e9.pdf
2021-07-01
1689
1693
10.21608/ijma.2021.49297.1206
Lumbar Disc Herniation
Spine Endoscopic Systems
Interlaminar Approaches
Easy Go
Destandue systems
Mahmoud
Mahmoud
mahmoudramadan4291@gmail.com
1
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Adel
Almelesy
adelalmelesy@gmail.com
2
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Mostafa Alsayed
Mohamed
malgrem5@gmail.com
3
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Assessment of Left Ventricular Systolic Function by Speckle Tracking in Diabetic Patients Receiving Direct Acting Antiviral Drugs for Chronic HCV
Background: Diabetes mellitus [DB] is a well-known risk factor for cardiovascular disease. The co-existence of DM and microvascular abnormalities could lead to hypertrophy of left ventricle (LV) with diastolic and/or systolic dysfunction. However, early stages of the disease are asymptomatic due to its chronic nature and the effective control of diabetes. Aim of the work: This clinical cohort aimed to assess left ventricular systolic function in DM patients, receiving direct acting antiviral (DAA) drugs for chronic hepatitis-C virus by speckle tracking.Subjects and methods: This clinical cohort included 90 patients who were divided into three equal groups. Patients were recruited from Hepatology Outpatient Clinic of Kafr El-Shaikh University hospital, who were sent to the cardiovascular department for evaluation. Patients were evaluated just before, one month and three months after starting therapy. Results: No one in control group had diastolic dysfunction compared to 10.0% and 16.7% in DAAs and Non-DAAs groups, respectively. Conventional echocardiography returned statistically non-significant difference except significant increase of LVESD, IVST and LVPWT in study groups than control groups. However, the difference between DAAs and Non-DAAs groups was statistically non-significant. The basic strain parameters returned significant lower values at different windows in control than study groups. The strains were reduced in the follow up visits (first and third months) in DAAs groups, but not significantly reduced in non-DAAs group. Acute myocardial infarction was reported among one patient in non-DAAs group compared to none in DAAs group. Conclusion: The speckle tracking is a useful tool for early detection of subclinical left ventricular dysfunction in HCV diabetic patients and could be used for following up of response DAA treatment. DAAs therapy is associated with improvement, not of HCV disease, but also of cardiac dysfunction
https://ijma.journals.ekb.eg/article_185109_8d0e28af1269beb1be54cd617b282bca.pdf
2021-07-01
1694
1699
10.21608/ijma.2021.80445.1326
Diabetes mellitus
left ventricle
Hepatitis C virus
Echocardiography
Direct anti-viral drugs
Wael
Hassib
wael372002@yahoo.com
1
Department of Cardiology, Faculty of Medicine, Kafrelsheikh University, Egypt
LEAD_AUTHOR
Mohamed
Abd Elraouf
mhmdgamil124@gmail.com
2
Department of Cardiology, Faculty of Medicine, Kafrelsheikh University, Egypt
AUTHOR
Reda
Biomy
redamagy189@gmail.com
3
Department of Cardiology, Faculty of Medicine, Kafrelsheikh University, Egypt
AUTHOR
Mohammed
Hamouda
mohamed.hamouda01@fmed.bu.edu.eg
4
Department of Cardiology, Faculty of Medicine, Benha University, Egypt
AUTHOR
Mohamed
Mohamed
mohamed.afify01@fmed.bu.edu.eg
5
Department of Cardiology, Faculty of Medicine, Benha University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Prevalence of Asymptomatic Bacteriuria among Pregnant Women At Damietta Governorate, Egypt
Background:Asymptomatic bacteriuria during pregnancy is a main health problem, which is related to an increased risk of maternal and fetal morbidity.Aim of the Work:To estimate incidence of asymptomatic bacteriuria among pregnant females at Damietta Governorate, Egypt.Patients and Methods:Five hundred randomly selected pregnant females attending antenatal care units at Damietta Governorate during the period July, first, 2019 – January 31st, 2021. All participants were subjected to full history taking, complete blood count as well as urine culture and bacterial count. Result:A relatively high incidence of asymptomatic bacteriuria [13.8%] was revealed among participants in whom the most causative organism was Escherichia coli. The rate was lower among pregnant women with a high social standard and during the first trimester. Maternal age, parity, education level, or hemoglobin level, on the other hand, had no significant relationship .Conclusion: Screening of asymptomatic bacteriuria in pregnancy must be added to routinely antenatal care investigations and doing another studies on a wider scope are recommended.
https://ijma.journals.ekb.eg/article_186027_b0c2e0713f934f6089c51b00bd9e2a34.pdf
2021-07-01
1700
1707
10.21608/ijma.2021.78877.1321
asymptomatic bacteriuria
Escherichia coli
pregnant females
urine culture
bacterial count
Eman
Abd EL- Aziz
emanabdelhady20@gmail.com
1
Department of Obstetrics and Gynaecology, Mansoura Specialized Hospital, Ministry of Health, Egypt
LEAD_AUTHOR
Walaa
Elbassioune
walaa.abozid@domazhermedicine.edu.eg
2
Department of Obstetrics and Gynaecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Ahmed
Abdeltawab
drelwan850@domazhermedicine.edu.eg
3
Department of Obstetrics and Gynaecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Mohamed
Morshdy
mohammedaldesoky@domazhermedicine.edu.eg
4
Department of Microbiology and Immunology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Magnesium Sulfate versus Tramadol as Adjuvants to Lidocaine in Intravenous Regional Anesthesia for Carpal Tunnel Release Surgery: A Randomized Clinical Study
Background: Intravenous regional anesthesia [IVRA] is a simple and effective anesthetic method for providing regional anesthesia of the upper limbs during carpal tunnel release surgery [CTRS]. However, the procedure is associated with significant postoperative pain and adjuvant analgesic agents are recommended. The Aim of The Work: This study aimed to compare the analgesic effects of magnesium sulfate and tramadol when added to lidocaine for IVRA during CTRS.Methods: In this double-blinded, randomized clinical trial, 60 ASA I-II patients eligible for elective CTRS with IVRA were randomly allocated into one of 3 groups. The first group [lidocaine group] received IVRA with 40 ml lidocaine 0.5%. The second group [lidocaine + tramadol group] received IVRA with40 ml 0.5% lidocaine and tramadol 1mg/kg. The third group [lidocaine + magnesium sulphate group] received IVRA with 40 ml 0.5% lidocaine and magnesium sulfate 10 mg/kg and normal saline. Outcome parameters included time to onset of sensory and motor block, time to onset of tourniquet pain, need of intra-operative analgesia, intraoperative consumption of fentanyl, duration of postoperative analgesia and pain intensity were noted in each patient.Results: Comparison between the studied groups regarding the outcome parameters. The Lidocaine + Tramadol and the Lidocaine + Magnesium groups achieved better performance in all the studied parameters in comparison to the Lidocaine group. In addition, Lidocaine + Tramadol groups had significantly better performance in comparison to the Lidocaine + Magnesium group. No significant differences were reported between the studied groups regarding post-operative complicationsConclusions: Use of tramadol and magnesium sulphate as adjuvants to lidocaine achieved better performance in all the studied parameters in comparison to the lidocaine only. In addition, tramadol had significantly better performance in comparison to magnesium sulphate without significant side effects.
https://ijma.journals.ekb.eg/article_186028_204d6850b72596b96c0548d022466b56.pdf
2021-07-01
1708
1713
10.21608/ijma.2021.72475.1299
magnesium sulfate
tramadol
Intravenous regional anesthesia
Carpal Tunnel Release Surgery
Khaled
Elsheshtawy
khaledshrief2@gmail.com
1
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
LEAD_AUTHOR
Ahmed
Elsawy
drahmedelsawy@azhar.edu.eg
2
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
AUTHOR
Ahmed
Abouelnasr Khalifa
ahmed.maher101@azhar.edu.eg
3
Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University
AUTHOR
ORIGINAL_ARTICLE
Correlation between Iron Status and Simple Febrile Seizures in Children
Background: Febrile seizures are non-epileptic types of seizure that occur frequently during early childhood. Multiple factors are implicated in the pathogenesis of these types of seizures. Iron deficiency might play as an etiological or, at least, augmenting factor in the development of febrile seizures.Objective: To study iron status among children with simple febrile seizures, and to estimate the prevalence of iron deficiency between them.Patients and methods: A case-control study included 100 febrile children aged 6 months to 60 months, and were ascribed to 2 groups; 50 children with simple febrile seizures [case group], and 50 children who had febrile disease without occurrence of seizures [control group]. Venous samples were obtained for the analysis of complete blood count, and iron indices [serum ferritin, serum iron and total iron binding capacity].Results: The peak temperature was significantly elevated among the case group [P=0.03]. Regarding iron profile, compared to controls, the case group had significantly lower iron [54.24±16.04 vs. 62.6±16.02; P=0.011], and lower ferritin [37.612±19.85 vs. 80.624±31.57; P <0.001]. Correlation analysis revealed a significant negative correlation between serum ferritin and frequency of febrile seizures [P=0.025]Conclusions: Iron deficiency and iron deficiency anemia were more common among children with simple febrile seizures, and they were associated with increase in the duration and frequency of seizures. Special attention should be paid for the assessment of iron status among children with febrile seizures.
https://ijma.journals.ekb.eg/article_186029_8a360b69fef9dd38bef8343c39f6a359.pdf
2021-07-01
1714
1718
10.21608/ijma.2021.79064.1320
Fever
Seizures
iron
Anemia
febrile seizures
Marwa
Elkafafy
marwa11.pediatrics@domazhermedicine.edu.eg
1
Department of Pediatrics, EL-Raml Pediatric Hospital, Ministry of Health, Egypt
LEAD_AUTHOR
Magdy
Sakr
sakrmagdy@hotmail.com
2
Department of Pediatrics, Damietta Faculty of Medicine, AL-Azhar University, Egypt
AUTHOR
Mohamed
Elsamanoudy
mohamed_elsamanody@yahoo.com
3
Department of Pediatrics, Damietta Faculty of Medicine, AL-Azhar University, Egypt
AUTHOR
hesham
abd al-samee
dr.hesham012@gmail.com
4
Department of Clinical Pathology, Damietta Faculty of Medicine, AL-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Triceps Sparing Approach for Fixation of Distal Humerus Fractures in Adults
Background: Distal humerus fractures had acquired an attention due to poor outcomes regardless of treatment modality which may be conservative or surgical. These fractures can be addressed with either triceps splitting or triceps sparing approach. The triceps sparing approach was performed by lateral window was developed on the lateral side of the triceps as it is elevated off the posterior border of the intermuscular septa and posterior humerus.Objective: The current work aimed to evaluate the outcome of surgical treatment of fracture distal humerus through triceps sparing approach.Patients and methods: A prospective, descriptive clinical study had been conducted at the Department of Orthopedic Surgery [Al Mataria Teaching Hospital, Egypt]. The study included 33 patients, and the average follow up was 12 months. The study completed from December 2018 to May 2020. Pain, clinical and radiological outcomes had been assessed and documented. Preoperatively, all patients had been clinically and radiologically evaluated. In addition, laboratory investigations had been performed to assess the fitness of the patient.Results: The study participants were 25 males and 8 females. Their age ranged between 30 and 55 years [mean age 43.09±7.93 years]. The mean quick Disabilities of the Arm, Shoulder and Hand [DASH] score was 18.3±3.3 points [ranged between 15 and 25]. The mean range of elbow flexion was 143.3 ± 3.9 degrees [135-145], while the mean range of elbow extension and contracture 8.6 ± 1.7 degrees [6-15]Conclusions: Triceps sparing avoids direct triceps injury with bloodless fields. However, a limited articular surface visualization of the distal humerus is an evitable drawback.
https://ijma.journals.ekb.eg/article_187038_feba477f014ecc64805d8d513fb1be9b.pdf
2021-07-01
1719
1723
10.21608/ijma.2021.80438.1325
Total Elbow Arthroplasty
Distal humerus
fixation
Triceps sparing
Fractures
Mohamed
Safy
mohamedsafyeldeen123@gmail.com
1
Department of Orthopedics, El-Mataria Teaching Hospital, Ministry of Health, Egypt
LEAD_AUTHOR
ORIGINAL_ARTICLE
Outcome of Open Reduction and Internal Fixation of Posterior Acetabular Fractures
Background:Acetabular fractures are a common clinical challenge. The posterior wall fractures represented 35% of all acetabular fractures and usually complexed. The curative treatment is surgical and depends on the fracture anatomy and surgeon preferences.Aim of the Work:The current study aimed to assess the short term results of posterior acetabular fractures management by open reduction and internal fixation.Patients and Methods:Thirty patients with displaced posterior wall acetabular fractures were included. They were treated by open reduction and internal fixation using neutralizing plates and screws. All patients were assessed by a pre-prepared trauma assessment sheet. Post-operative, active assisted and pain free passive range of motion exercises in all planes was advised. Functional outcome was evaluated using the Merle D'Aubinge and Postel score. Patients were followed up initially at 3 weeks intervals for first 2 months and thereafter at 6 weekly intervals for the next 6 months. Result:Patients were classified to two groups: Group [A] “70%” patients with isolated posterior wall fracture, and Group [B] “30%” of patients with posterior column plus posterior wall acetabular fracture. Both groups were comparable regarding age, gender, side and mode of trauma. The double plating fixation method was significantly increased in group B when compared to group A [77.8% vs. 0.0% respectively]. Group B was associated with significant increase of operative time than group A [164.44±13.33 vs. 128.57±27.80 minutes, respectively]. Blood loss significantly increased in group B than group A [1422.22±376.76 vs. 780.95±437.46 ml, respectively]. The excellent outcome was significantly associated with younger age, lower or absent complications, and anatomical [good quality] of direct postoperative radiological outcome.Conclusion: Most of our patients had an excellent and good outcome as a result to application of more strict selection criteria of patients and pattern.
https://ijma.journals.ekb.eg/article_187692_cf419823de01cb934c4a207293a43d4a.pdf
2021-07-01
1724
1734
10.21608/ijma.2021.72017.1296
acetabulum
Posterior Wall
Fractures
Open reduction
internal fixation
Shady Abdou
Goda
shadygoda.sg@gmail.com
1
Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Asharaf
Ezzedeen
ashraftabie@gmail.com
2
Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Osman
Elsherif
docosman@gmail.com
3
Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Speckle Tracking Versus Conventional Echocardiography in Patients with Symptomatic Premature Ventricular Contractions
Background:Frequent premature ventricular complexes [PVCs] are linked to the left ventricular [LV] dysfunction. Early diagnosis is crucial for the proper treatment.Aim of the Work:This study aimed to prove the superiority of modern diagnostic modalities as speckle tracking over the conventional echocardiography in the detection of subtle left ventricular dysfunction in symptomatic PVCs.Patients and Methods:This study included 40 patients with frequent PVCs and 20 healthy subjects, as a comparison group. The myocardium strain in the circumferential [CS], radial [R] and longitudinal [L] directions were evaluated using conventional echocardiography and speckle tracking imaging. Result:The study included 21 male and 39 females with age ranging between 22 and 56 years in the study group and between 22 and 57 years in the control group. In the case group, PVCs were more frequent [18.73 ± 7.15]. The two groups have normal resting conventional echocardiography with no evidence of structural heart or systemic disease. In the study group, 25 patients have PVCs arising from the right ventricle [RV] [62.5%] and 15 patients have PVCs arising from the LV [37.5%]. There was no significant correlation between PVCs origin and LV global longitudinal strain [GLS], radial strain [RS] and circumferential strain [CS] [p value= 0.285, 0.380 and 0.401] respectively. There was a significant inverse correlation between the total number of PVCs [PVC burden] and LV ejection fraction [EF], GLS, RS, and CS [p value <0.001].Conclusion: The study concluded that speckle tracking echocardiography is an important and valuable tool for early identification of impairment in the LV function in patients with frequent PVCs earlier than conventional echocardiogram.
https://ijma.journals.ekb.eg/article_187695_fc79eb5f86a5199b4a7047c0e17ac6af.pdf
2021-07-01
1735
1740
10.21608/ijma.2021.72817.1300
left ventricle
speckle tracking
Echocardiography
Premature
Ventricular Complexes
Mohamed Mohamed
Hal
mohamedhal76@yahoo.com
1
Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Mohamed
Omar
m_omer76@yahoo.com
2
Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Hammuda
Al-Bahnasy
ddr.hamouda@yahoo.com
3
Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Mohammad Ismail
Al-Deftar
mideftar@gmail.com
4
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Mohamed Moanes
Mohamed
drmoanes11@yahoo.com
5
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Mohie AL-Dein Mohamed
Samy
mohie_aldein.cardio@gmail.com
6
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Comparison between Foldable and Hard [PMMA] Iris Claw Phakic Intraocular Lens Implantation for Correction of High Myopia
Background:Iris claw phakic intraocular lens [PIOL] is one of the surgical techniques used for the correction of high myopia. This procedure reduces myopia with stable refractive results and preserves the accommodation.Aim of the Work:The aim of this study is to assess the outcome of foldable and hard [PMMA] iris claw PIOL implantation as one of surgical procedures in the management of high myopic young patients.Patients and Methods:A prospective comparative study having foldable and hard [PMMA] iris claw phakic intraocular lens [PIOL] for correction of high myopia. This study includes forty eyes [40 eyes] of twenty high myopic patients [20 pt.] with refraction range of [-10.0 D to -25.0 D] without or with cylinder not more than [-2.0 D]. The patients were divided to two groups [A] and [B], each group contains twenty [20] eyes, the first 20 eyes [group A] received a concave-convex foldable iris claw PIOL and the remaining 20 eyes [group B] received a biconcave optic hard PMMA iris claw PIOL. Result:The mean postoperative SE at 6 months in group [A] was [-0.30 ± 0.10 D] within ±1.00 D of emmetropia. In group [B] it was [- 0.50 ± 0.50 D] within ±1.0 D of emmetropia. The mean postoperative cylinder at 6 months was [-0.31 ± 0.10] in group [A], and [-0.51 ± 0.51] in group [B]. There was a statistically significant difference between preoperative UCVA and postoperative UCVA at 6 months were [p <0.001] in both groups. Postoperative BCVA [logMar] at 6 months was 0.11 ± 0.14 in group [A] and 0.27 ± 0.17 in group [B].Conclusion: iris-claw phakic IOL implantation is frequently used for highly myopic cases. Compared to corneal refractive surgery, phakic IOLs favorably compete for the correction of high myopia, with increasing predictability, efficacy, safety, and quality of vision.
https://ijma.journals.ekb.eg/article_187696_57b0166bc4b87d85852b608e16d4488c.pdf
2021-07-01
1741
1747
10.21608/ijma.2021.68409.1284
Iris Claw
Foldable
Hard
Phakic
Wael H
Alazab
waelhaggag66@gmail.com
1
Department of Ophthalmology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
LEAD_AUTHOR
Abdallah H.
Hamed
abdallah.hophthalmol@gmail.com
2
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Younes E
Abdel Hafez
younis_abdelhafez@domazhermedicine.edu.eg
3
Department of Ophthalmology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Abdelghany I.
Abdelghany
abdelghany.i@gmail.com
4
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Seroprotection Status of Hepatitis B Vaccine in Children with Type 1 Diabetes Mellitus
Background:"Type 1 diabetes mellitus [T1DM]" is the most common endocrine disease in the Pediatric population. It has been suggested that T1DM had inadequate immunological response to vaccines, including hepatitis B virus [HBV] vaccine.Aim of the Work:To evaluate the immunological status against HBV vaccine among children with T1DM, and assess various possible risk factors for immunity failure.Patients and Methods:A comparative cross-sectional study included 60 children [4-10 years] with T1DM [case group], and 60 healthy age- and sex-matched children [control group]. All included children had completed obligatory HBV vaccine. The evaluation of the immunological response was assessed through analysis of antibodies against HBV surface [HBsAB]. Seroprotection status to HBV vaccine was identified as plasma HBsAB of ≥ 10 mIU/ml. Results:The mean duration of T1DM was 2.03 ± 1.73 years. The frequency of immunity failure to HBV vaccine [non-responders; HBsAB < 10 mIU/ml] was 51.7% among the case group, and 28.3% among the control group [P = 0.009]. Risk factors for immunity failure, as evaluated by regression analysis, were older age [P=0.002], and longer duration of T1DM [P=0.023].Conclusion: Children with T1DM have a reduced level of HBV vaccine seroprotection when compared to the control group. Patients with older age and longer duration of T1DM showed a trend toward non-responding HbsAB titer. Long-term follow-up of responders is recommended to retest the level of immune response.
https://ijma.journals.ekb.eg/article_187697_fc895f4c39c95df2dfdbc56f928fb724.pdf
2021-07-01
1748
1753
10.21608/ijma.2021.81707.1331
seroprotection
hepatitis B
vaccine
Type-1 Diabetes Mellitus
Dina
Elsharkawy
dina.pediatrics@domazhermedicine.edu.eg
1
Department of Pediatrics, Sporting Students' Hospital, Ministry of Health, Egypt
LEAD_AUTHOR
Hany Abd Elhady
El-khaleegy
hanykhaleegy@yahoo.com
2
Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Saad
Mohamed
saad_dawody@yahoo.com
3
Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Gamal
Mohamed
gemy1412@gmail.com
4
Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
ORIGINAL_ARTICLE
Ventricular Function and Pulmonary Artery Pressure in Children with Mild and Moderate Bronchial Asthma
Background: Bronchial asthma is a chronic airway disease. Cardiac affection in children with bronchial asthma was reported mainly in cases with severe asthma and during acute exacerbations.Aim of the Work: To study cardiac affection in children with mild and moderate bronchial asthma using conventional and tissue Doppler imaging [TDI] echocardiography.Patients and Methods: This was a prospective case control study. Study involved 160 children aged 6-14 years old who were following in outpatient pediatric clinic, Al-Hussein hospital, Al-Azhar University, Cairo, Egypt, during the period from January 4, 2016, till February 15, 2017. All children underwent peak expiratory flow rate [PEFR] assessment. Echocardiography was done for all to assess systolic and diastolic functions of right ventricle [RV] and left ventricle [LV] using conventional and tissue Doppler imaging [TDI] echocardiography.Results: TDI parameters showed evidence of RV diastolic dysfunction in patients with moderate asthma in the form of significantly lower tricuspid valve [TV] e’ [12.1 ± 2.7 cm/s], lower TV e’/a’ ratio [1.28 ± 0.18], prolonged RV isovolumetric relaxation time [IVRT] [71.8 ± 2.4 ms], and higher RV myocardial performance index [0.49 ± 0.04] compared to control group. Also, patients with mild asthma had impaired RV diastolic function in the form of significantly lower TV e’/a’ [1.51 ± 0.13] and longer RV IVRT [65 ± 2.9 ms] compared to control group. Pulmonary artery pressure was significantly elevated in moderate asthma group [18.4 ± 9.2 mmHg]. RV IVRT was the only parameter showing a significant negative correlation to PEFRConclusion: Pediatric patients with mild and moderate bronchial asthma may have RV diastolic dysfunction. TDI is a good screening tool to detect early changes in cardiac function in such patients. RV IVRT measured by TDI is a sensitive tool to detect early diastolic impairment.
https://ijma.journals.ekb.eg/article_187835_415b275c985e08c48cdf69377d5d9b98.pdf
2021-07-01
1754
1760
10.21608/ijma.2021.187835
bronchial asthma
children
Ventricular function
Tissue Doppler imaging
Pulmonary Artery Pressure
Tarek Kotb
Alsayad
elsayadtarek@gmail.com
1
Department of Pediatrics, Pediatric Cardiology Division, Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR
Saad Ahmed
Mohamed
saad.am.pedia@gmail.com
2
Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt
AUTHOR