# IP 2018

Authors:
Farhan MA1,2, Moharram AM2,3, Salah T4, Shaaban OM5.

Title:
Types of yeasts that cause vulvovaginal candidiasis in chronic users of corticosteroids

Abstract:
The current study aims to compare between the types of yeasts that cause vulvovaginal candidiasis (VVC) in women using corticosteroid medication compared to nonusers and estimate their sensitivity to available commercial antifungal agents. In a descriptive analytical cross-sectional study, we recruited 41 chronic corticosteroid users diagnosed clinically to have VVC from Women's Health Hospital, Assiut University, Egypt. Forty-seven age-matched women with VVC were recruited as a control group. Full history and clinical examination were performed. Vaginal sterile swab obtained from the vagina of each participant was subjected to direct Gram-stained smear examination as well as a culture on Sabouraud's glucose agar and HiCrome Candida agar. Further identification of the isolates was done using traditional methods. Fifty out of 88 samples (56.8%) were positive in culture including 25 samples (61%) from corticosteroid users group and 25 (53.2%) from noncorticosteroid users with no statistically significant difference (P = .302). The chronic corticosteroid users had more incidence of recurrent VVC as compared to nonusers (65.9% vs 40.4%, respectively) (P = .015). There was a significantly higher rate of non-Candida albicans (NCA) infections in corticosteroid users compared with nonusers (48% vs 20%, respectively) (P = .036). A higher significant difference in resistance of the isolates against clotrimazole (P = .003) and ketoconazole (P = .017) was demonstrated in corticosteroid users compared to nonusers. Thus, chronic corticosteroid use causes frequent attacks of VVC and increases the frequency of infection by NCA strains. Also, it increases resistance to common antifungal agents especially azole group.

Author Info:
1
Department of Medical Microbiology, Faculty of Science, Ibb University, Ibb, Yemen.
2
Assiut University Mycological Centre (AUMC), Assiut University, Assiut, Egypt.
3
Department of Botany and Microbiology, Faculty of Science, Assiut University, Assiut, Egypt.
4
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Serum Zinc Measurement, Total Antioxidant Capacity, and Lipid Peroxide Among Acute Coronary Syndrome Patients With and Without ST Elevation.

Abstract:
Despite advances in the management of cardiovascular diseases, acute coronary syndrome (ACS) remains the leading cause of death worldwide. ACS is associated with an imbalance between coronary blood supply and metabolic requirements. Lipid peroxidation and production of reactive oxygen species (ROS) damage the cardiac cell membrane. A total of 130 subjects, 65 ACS patients (45 with ST segment elevation (STE-ACS), 20 non-STE-ACS), and 65 healthy controls were recruited. Measurement of serum zinc, total antioxidant capacity (TAC) and malondialdehyde (MDA) by spectrophotometric methods 24 h after onset of ACS, and relations between the studied biochemical parameters and risk factors were performed. MDA levels were significantly increased; TAC and zinc levels were significantly decreased in ACS patients compared to the controls (P < 0.001 for each). No significant difference was detected between the different types of ACS and each of the oxidative stress parameters, cardiac biomarkers, lipogram, and risk factors. Only serum zinc in STE-ACS patients was significantly lower compared with NSTE-ACS patients (P < 0.001). Serum zinc showed the greatest AUC (area under the ROC curve) of 0.926 with 76.92% sensitivity and 95.38% specificity. Negative and positive correlations between MDA and zinc and between TAC and zinc levels respectively (P < 0.01) were found in ACS. Week negative correlation was observed between serum zinc and SYNTAX score (r = - 0.434, P = 0.049). Our results indicate that deficient serum zinc concentration strongly associated with the etiopathogenesis of ACS.

Author Info:
1
Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt. reham.elmahdy@aun.edu.eg.
2
Cardiothoracic Surgery Department, Assiut University Hospital, Assiut University, Assiut, Egypt.
3
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Journal:
Multimedia manual of cardiothoracic surgery : MMCTS

Title:
Uniportal VATS approach for treatment of empyema: Challenges and recommendations

Abstract:
The uniportal VATS approach is now taking the lead in the practice of thoracic surgery and is transforming the way we operate. We describe here how to perform a uniportal VATS debridement and decortication, with a special focus on tips and tricks for getting inside an empyema pouch and identifying the optimal plane of cleavage for decortication. © The Author 2018. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Author Info:
Cardiothoracic Surgery Department Assiut University Heart Hospital Assiut University, Faculty of Medicine Assiut, Egypt


Authors:
Farghaly WM1, Abd Elhamed MA1, Hassan EM2, Soliman WT2, Yhia MA2, Hamdy NA2.

Title:
Prevalence of childhood and adolescence epilepsy in Upper Egypt (desert areas).

Abstract:
BACKGROUND:
A high prevalence of epilepsy in children is frequently found in developing countries.

OBJECTIVE:
This study aimed to determine the prevalence and clinical pattern of childhood and adolescence epilepsy in Upper Egypt.

METHODS:
This is a door-to-door study conducted on all inhabitants < 18 years in Al Kharga district and Al Qusier city (36,195 subjects). The study was conducted through two stages; every stage consisted of two phases (screening and diagnostic).

RESULTS:
Lifetime prevalence of childhood and adolescence epilepsy (children < 18 years) in Upper Egypt was 9.7/1000, with higher prevalence among children < 12 years (10.8/1000) than adolescents (7.2/1000). The age-specific prevalence was highest in early childhood (12.01/1000) and least at adolescence (7.2/1000). More than half of the patients (59.4%) had idiopathic epilepsy. The most frequent etiology for structural/metabolic epilepsy was perinatal complications, particularly in infancy, followed by central nervous system (CNS) infections, in childhood, and post-traumatic epilepsy in adolescence. Partial seizures were more frequent in infancy, while generalized seizures were more frequent in late childhood and adolescence. Generalized tonic-clonic seizures (GTCS) were the most frequent type of seizures.

CONCLUSION:
Prevalence of childhood and adolescence epilepsy in Upper Egypt was not so much different from other developing countries. Idiopathic epilepsy was more prevalent than structural/metabolic cases. Perinatal complications, CNS infections, and head injury were the most frequent etiologies, and generalized tonic-clonic seizures were the most frequent seizure type.

Author Info:
1
1Department of Neurology, Assuit University, Assiut, Egypt.
2
2Department of Neurology, Minia University, Minya, Egypt.


Authors:
Hadhoud, M.A.E.Email Author,  Darweesh, A.M.,  Gabra, R.H.,  Khalifa, H.,  Elserogy, Y.

Title:
Assessment of cognitive functions in the euthymic phase in patients with bipolar i disorder attending the outpatient clinic of Assiut University Hospital

Abstract:
Background Kraepelin separates psychoses into two distinct groups, dementia praecox and manicdepressive insanity. The latter was characterized by an episodic course and benign prognosis. This forms the basis of our modern concept of bipolar disorder. Cognitive dysfunction has been described in patients with bipolar disorder during manic and depressive phases, but recent investigations have demonstrated persistent neuropsychological impairment in euthymic bipolar patients, which poses a challenge to Kraepelin's dichotomy. Objective The study aims to assess remitted euthymic bipolar patients in terms of cognitive impairment. Patients and methods A cross-sectional study with a sample size of 100 euthymic bipolar patients and 50 matched normal controls was evaluated by the Wechsler Adult Intelligence Scale-Revised, Memory Assessment Scale, Brief Visuospatial Memory Test-Revised, and audio-evoked potential (P300) to assess the cognitive function. Results Comparison of cognitive functions of euthymic bipolar disorder patients and normal controls show a highly statistically significant affection in various domains of cognitive function especially in attention, mental flexibility, verbal and nonverbal learning, memory and speed of information processing in euthymic bipolar patients. Conclusions and recommendations Persistence of impairment of cognitive functions during the euthymic phase in bipolar disorder patients that need attention during their psychiatric assessment. © 2018 Institute of Psychiatry, Ain Shams University.

Author Info:
Psychiatry Unit, Neurology and Psychiatry Department, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt


Authors:
Hammam, N.a,bEmail Author,  Gheita, T.A.c

Journal:
Rheumatoid Arthritis: Risk Factors, Health Effects and Treatment Options

Title:
The effect of smoking on rheumatoid arthritis development: Clinical and serological manifestations and comorbidities

Abstract:
Rheumatoid arthritis (RA), an immune-mediated disease, is characterized by joint inflammation and systemic manifestations, which affects up to 1% of the adult population. RA is thought to arise due to the interacting effects of genetic and environmental factors, resulting in changes in immune system function. The genetics of RA are complex, however, carriage of the human leukocyte antigen (HLA)-DRB1 shared epitope (SE) is the most important genetic risk factor for RA, responsible for approximately 40% of genetic susceptibility to the disease. A number of environmental risk factors contribute to RA susceptibility, such as smoking, infections, and periodontitis. Cigarette smoke represents a mixture of toxic substances including nicotine, carbon monoxide, carcinogens, organic compounds and free radicals. Smoking is suggested to have a vital role in the pathogenesis of RA and it is known to modulate the immune system both humoral and cellular autoimmunity through numerous mechanisms. Smoking is a strong generator of anti-cyclic citrullinated peptide antibody (ACPA) and is known to associate with rheumatoid factor (RF). Evidence showed that smoking interacts with HLA-DRB1 and it is responsible for increasing the susceptibility to develop RA, mainly seropositive-RA. Epidemiologic researches have demonstrated that the smoking rate amongst RA patients is higher than in matched populations and it differs with gender. Smoking status and intensity (number of cigarettes/day) modulate both RA disease severity and outcome. For several years, the evidence was restricted to active smokers, however recent works showed that the risk of development of RA is found to be elevated in both former and passive smokers. Moreover, passive smokers reported high disease activity levels than never smokers in RA patients. In addition to the detrimental effects of tobacco on RA manifestations, heavy smoking is associated with serious comorbidities that required hospitalizations. Patients with RA who smoke, experience high cardiovascular events and respiratory tract infections and through these diseases, smoking is responsible for a higher mortality rate. Smoking cessation should not just be encouraged according to the general health recommendation but should be tailored for RA patient specifically. Evidence demonstrated the potential benefits of smoking cessation at any time after RA diagnosis. In this chapter we will review the current knowledge about the contribution of smoking as a risk factor for RA development and the possible mechanism of action. In addition, we will highlight the association of smoking habits with clinical, serological, radiographic damage statuses and comorbidities of RA. The benefits of designed smoking cessation intervention on RA outcomes will be discussed. © 2018 Nova Science Publishers, Inc.

Author Info:
aRheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Asyut, Egypt
bUniversity of Alberta, Edmonton, AB, Canada
cRheumatology and Clinical Immunology Department, Faculty of Medicine, Cairo University, Cairo, Egypt


Authors:
Hassanien, M.a,  Rashad, S.a,  Mohamed, N.b,  Elawamy, A.c,  Ghaly, M.S.dEmail Author  View Correspondence (jump link)

Date of Publishing:
Volume 2018, Issue 3, 1 July 2018, Pages 210-216

Title:
Non-invasive Oxygen-Ozone therapy in treating digital ulcers of patients with systemic sclerosis

Abstract:
Background: Digital ulcers (DUs) in systemic sclerosis (SSc) result from recurrent Raynaud's phenomenon (RP) and microtrauma with high impact on quality of life. Medical use of ozone (triatomic oxygen) was initiated in the 19th century. Ozone has multiple therapeutic effects in wound healing due to the property of releasing nascent oxygen, which has been shown to stimulate antioxidant enzymes. We aimed to assess the effects of ozone therapy on the healing of scleroderma DUs and determine levels of expression of vascular endothelial growth factor (VEGF), and endothelin-1 type A receptor (ETAR) autoantibodies in the wounds after treatment. Subjects and Methods: Fifty SSc female patients with DUs, were randomized into ozone group (I) (n=25) trea ted with calcium channel blockers plus oxygenozone treatment and control group (II) (n=25) treated with calcium channel blockers only. Ozone group recei - ved noninvasive oxygen-ozone treatments for 30 minu - tes per day for 20 days using the ozone generator devi - ce. The rapeutic effects were graded into 4 levels according to Zhang and other researchers. The wounds sizes were measured at baseline and day 20, respective - ly. Expressions of VEGF and ETAR autoantibodies proteins were determined by immune-histochemical exa - mination. Results: Demographics and clinical characteristics of the 2 groups showed no significant differences at baseline. At day 20, the effective healing rate was significantly higher in group (I) than in group (II), where it represented 96% (24/25) in ozone group versus 44% (11/25) in control group (p=0.007). After treatment, the wound sizes in both groups were significantly smaller than before treatment. In group (I), the wound size reduction was significantly more than in group (II) (0.75 ± 0.30 versus 2.44 ± 0.80 mm), (p < 0.001). At day 20, VEGF was significantly higher in ozone group (I), than in control group (II), (83.96±9.68) versus (67.92±6.55), (p < 0.001) while, ETAR was signi ficantly lower in ozone group (I), than in control group (II), (3.14±1.12 versus 4.59±1.24), (p < 0.001). Conclusion: Ozone therapy may be beneficial tool in the treatment of DUs in SSc patients, where it promotes the wound healing through a potential induction of VEGF and down-regulation of ETAR at sites of the ulcers. © 2018 Sociedade Portuguesa de Reumatologia.

Author Info:
aRheumatology and Rehabilitation, Faculty of Medicine, Asyut University, Egypt
bBiochemistry, Faculty of Medicine, Asyut University, Egypt
cAnesthesia, Faculty of Medicine, Asyut University, Egypt
dRheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Egypt


Authors:
Hofny ERM1, Abdel-Motaleb AA1, Ghazally A1, Ahmed AM2, Hussein MRA2.

Title:
Platelet-rich plasma is a useful therapeutic option in melasma.

Abstract:
BACKGROUND:
Melasma is a cosmetically disfiguring disorder of facial pigmentation.

OBJECTIVES:
We evaluated the value of platelet-rich plasma (PRP) in the treatment of melasma using two different delivery techniques: microneedling using dermapen versus microinjections using mesoneedles.

PATIENTS AND METHODS:
Twenty-three adult Egyptian melasma patients were enrolled. Wood's light was used to determine the histological type of melasma. Autologous PRP was delivered into the lesional melasma skins through microneedling with dermapen on the right side of the face and intradermal microinjections using mesoneedles on the left side of the face (for each patient). The treatment was done regularly (three sessions, each month). The response to PRP therapy was measured using melasma area and severity index (MASI) and modified melasma area and severity index (mMASI) that were calculated before and after three treatment sessions. Hemi-MASI was used to compare the effectiveness of the two delivery techniques.

RESULTS:
Following PRP treatment, MASI and mMASI scores decreased significantly from 11.86 ± 5.25 to 6.96 ± 4.82, and from 5.71 ± 2.56 to 2.90 ± 2.05, respectively (p < .000,). A statistically significant decrease was noted in the hemi-MASI score on each side of the face following PRP treatment (p < .000), but there was no significant difference in comparing both sides.

CONCLUSIONS:
Our study provides the first indication about the value of PRP as a useful and new therapeutic option in melasma. Moreover, our study was the first to compare PRP delivery through microneedling versus microinjections.

Author Info:
1
a Faculty of Medicine , Department of Dermatology, Venereology and Andrology , Assiut University Hospitals , Assiut , Egypt.
2
b Faculty of Medicine , Department of Pathology , Assiut University Hospitals , Assiut , Egypt.


Authors:
Mahran DG1, Farouk O2, Ismail MA3, Alaa MM2, Eisa A2, Ragab II4.

Title:
Effectiveness of home based intervention program in reducing mortality of hip fracture patients: A non-randomized controlled trial.

Abstract:
PURPOSE:
The study was done to investigate whether a postoperative intervention program is effective in reducing mortality and improving mobility in two comparative hip fracture patients over one year postoperatively.

METHODS:
A non-randomized controlled trial study with an intervention group of hip fracture patients and historical control group with 12 months follow up. One hundred twenty four admitted hip fracture patients to the Trauma Unit of Assiut University Hospitals, aged 50 years and older were included from 1st July to 31st December 2014. They were divided into 64 and 60 patients as intervention and control groups respectively. Weight, height and bone mineral density were measured and baseline characteristics were taken. The intervention was a postoperative care program in the form of education sessions with an explanatory leaflet on discharge for nutrition and physical exercise program at home. Follow up phone calls were done at 3 months, 6 months and one year postoperatively by one assessor. Physical mobility was assessed by 24 items Western Ontario And McMaster Universities Osteoarthritis Index (WOMAC).

RESULTS:
Mortality was significantly higher in the control group, WOMAC score was significantly better among intervention group through follow up. By multivariate Cox survival analysis, advancing age, no intervention, osteoporosis, postoperative complications, chest infections and heart attacks were significant predictors for mortality.

CONCLUSION:
A significant improvement in mobility and reduction of mortality was achieved by application of a postoperative care program that could be incorporated into the hip fracture patients' care pathway

Author Info:
1
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: daliaym2001@yahoo.com.
2
Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
3
Adult Nursing Department, Faculty of Nursing, Assiut University, Assiut, Egypt.
4
Adult Medical Surgical Nursing Department, Faculty of Nursing, South Valley University, Qena, Egypt.


Authors:
Maksoud, N.A.aEmail Author,  Aal, K.A.aEmail Author,  Ghandour, N.aEmail Author,  El-Baz, M.bEmail Author,  Shaltout, E.aEmail Author  View Correspondence (jump link)

Date of Publishing:
Volume 8, Issue 1, 1 December 2018, Article number 6

Title:
Assessment of Hematotoxicity and Genotoxicity among paint Workers in Assiut Governorate: a case control study

Abstract:
Background: Occupational exposures to hazardous chemicals in paints cause serious health hazards in painters. The present study was designed to evaluate the possibility of hematotoxic and genotoxic effects of paint chemicals among painters in Assiut Governorate, Egypt. In addition the role of oxidative stress and apoptosis in mechanism of such toxic effects were studied. Methods: A case control study was performed on 50 male painters and 50 non-exposed healthy subjects, who were included as a control group after informed consent. Venous blood samples were obtained and analyzed for determination of total and differential blood count as hematotoxic markers as well as serum malondialdehyde (MDA) as an oxidant stress markers and total antioxidant enzymes. In addition, human B-cell lymphoma-2 (Bcl-2), caspase-3 and 8-hydroxyguanosine (8-OHdG) were assayed as markers of apoptosis and genotoxicity. Results: There was a statistically significant difference between paint workers and controls as regard total and differential blood count, serum MDA and total anti-oxidant levels. Also, statistical significant differences in caspase-3, Bcl-2 levels and 8-OHdG were observed. Conclusions: Chronic occupational exposure to paints increased the risk of hematotoxicity and genotoxicity in painters. Oxidative stress and apoptosis play a major role in such mechanism. Periodic medical examination and application of protective devices is necessary. © 2018, The Author(s).

Author Info:
aDepartment of Forensic medicine and Clinical toxicology, Assiut University Faculty of Medicine, Asyut, Egypt
bdepartment of Medical Biochemistry, Assiut University Faculty of Medicine, Asyut, Egypt


Authors:
Marin-Peña, O.aEmail Author,  Lund, B.b,  Ayeni, O.R.c,  Dantas, P.d,  Griffin, D.e,  Khanduja, V.f,g,h,  Said, H.G.i,  Tey, M.j,  Dickenson, E.e,  Kay, J.c,  Mascarenhas, V.k,  Sadakah, M.A.l,  Sunil Kumar, K.H.f,  Tahoun, M.j  View Correspondence (jump link)

Journal:
ESSKA Instructional Course Lecture Book: Glasgow 2018

Abstract:
Hip arthroscopy has become very popular in the last decade. Numbers are increasing rapidly worldwide. More than 11,000 hip arthroscopies were performed at the English public health system from 2002 to 2013. It means an increase of more than 700%. Similar numbers were published in North America, with an increase of more than 350% in the period 2004-2009. During a similar period on the opposite side of the globe, Korean researches published a twofold increase between 2007 and 2010. In the midterm, there is a projected increase of 1388% by 2023 [1]. © ESSKA 2018.

Author Info:
aOrthopedic Surgery and Traumatology Department, University Hospital Infanta Leonor, Madrid, Spain
bOrthopedic Department, Hospitalsenheden Horsens, Horsens, Denmark
cOrthopedic Surgery and Traumatology Department, McMaster University, Hamilton, ON, Canada
dDepartment of Orthopaedic Surgery, Hospital CUF Descobertas, Lisbon, Portugal
eDepartment of Orthopaedic Surgery, Warwick Medical School, University of Warwick, Coventry, United Kingdom
fAddenbrooke’s - Cambridge University Hospital, Cambridge, United Kingdom
gUniversity of Cambridge, Cambridge, United Kingdom
hThe Bone and Joint Journal, Cambridge, United Kingdom
iOrthopaedic and Trauma Surgery Department, Assiut University Hospital, Asyut, Egypt
jDepartment of Orthopaedic Surgery, Hospital del Mar, UAB, Barcelona, Spain
kMSK imaging Unit, Imaging Center, Hospital da Luz, Lisbon, Portugal
lOrthopaedic and Trauma Surgery Department, Tanta University Hospital, Tanta, Egypt


Authors:
Mokhtar, D.M.a,  Abd-Elaziz, D.M.b,  Youssef, H.b,  Taha, A.b

Date of Publishing:
Volume 13, Issue 3, September 2018, Pages 345-353

Title:
Applied histological and chemical analysis for detection of adulteration of minced meat and sausage

Abstract:
Meat and meat products were undergone to adulteration due to its high price, which might be causing many diseases and economic losses for consumers. Fifty samples of minced meat and sausage (25 each) were collected randomly from supermarkets in Assiut city. The samples were subjected to histological and chemical analysis for detection of adulteration. Histologically, adulteration was detected in minced meat and sausage by addition of smooth muscle fibers of hollow organs, heart muscles, spongy bone, thyroid glands, adipose tissue, lung, blood vessels, intestine, proventriculus, ruminant stomach, tendons, cartilage, fascia, nerve trunk, brain, plant tissues include poppy seeds, color additives, cysts and parts of parasites. By ATPase histochemistry, fetal tissue in minced meat and sausage were suspected to add with abundant dark (slow-contracted) muscle fiber than light (fast-contracting) ones. Adulteration of minced meat and sausage with bone tissues was a statistically significant difference (p <0.05) and adulteration with plant cells was a statistically significant difference (p <0.01). The results of the histological examination showed that the total adulteration in minced meat and sausage samples were 88% and 100%, respectively. The chemical analysis revealed that the percent of adulterated samples were (8) 32% and (10) 40% when estimating protein contents in minced meat and sausage, respectively, while the adulteration was 100% in each of them by estimating the fat contents in the examined samples. The study proved that the histological technique with chemical analysis were effective complementary methods for qualitative evaluations of meat products adulteration. Copyright © 2018 American Scientific Publishers All rights reserved.

Author Info:
aDepartment of Anatomy and Histology, Assiut University, Assiut, 71526, Egypt
bDepartment of Food Hygiene, Assiut University, Assiut, 71526, Egypt


Authors:
Nassr, A.A.a,bEmail Author,  Shamshirsaz, A.A.a,  Sanz Cortes, M.a,  Gibbons, W.E.c,  Belfort, M.A.a,  Espinoza, J.a

Date of Publishing:
Volume 52, Issue 5, November 2018, Pages 677-678

Title:
Unusual course of hyperreactio luteinalis in twin pregnancy complicated by twin–twin transfusion syndrome

Author Info:
aDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
bDepartment of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
cDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States


Authors:
Nhola LF1, Abdelmoneim SS2, Villarraga HR1, Kohli M3, Grothey A3, Bordun KA4, Cheung M4, Best R4, Cheung D4, Huang R1, Barros-Gomes S1, Pitz M5, Singal PK4, Jassal DS6, Mulvagh SL7.

Title:
Echocardiographic Assessment for the Detection of Cardiotoxicity Due to Vascular Endothelial Growth Factor Inhibitor Therapy in Metastatic Renal Cell and Colorectal Cancers

Abstract:
BACKGROUND:
Cardio-oncology is a recently established discipline that focuses on the management of patients with cancer who are at risk for developing cardiovascular complications as a result of their underlying oncologic treatment. In metastatic colorectal cancer (mCRC) and metastatic renal cell carcinoma (mRCC), vascular endothelial growth factor inhibitor (VEGF-i) therapy is commonly used to improve overall survival. Although these novel anticancer drugs may lead to the development of cardiotoxicity, whether early detection of cardiac dysfunction using serial echocardiography could potentially prevent the development of heart failure in this patient population requires further study. The aim of this study was to investigate the role of two-dimensional speckle-tracking echocardiography in the detection of cardiotoxicity due to VEGF-i therapy in patients with mCRC or mRCC.

METHODS:
Patients with mRCC or mCRC were evaluated using serial echocardiography at baseline and 1, 3, and 6 months following VEGF-i treatment.

RESULTS:
A total of 40 patients (34 men; mean age, 63 ± 9 years) receiving VEGF-i therapy were prospectively recruited at two academic centers: 26 (65%) were receiving sunitinib, eight (20%) pazopanib, and six (15%) bevacizumab. The following observations were made: (1) 8% of patients developed clinically asymptomatic cancer therapeutics-related cardiac dysfunction; (2) 30% of patients developed clinically significant decreases in global longitudinal strain, a marker for early subclinical cardiac dysfunction; (3) baseline abnormalities in global longitudinal strain may identify a subset of patients at higher risk for developing cancer therapeutics-related cardiac dysfunction; and (4) new or worsening hypertension was the most common adverse cardiovascular event, afflicting nearly one third of the study population.

CONCLUSIONS:
Cardiac dysfunction defined by serial changes in myocardial strain assessed using two-dimensional speckle-tracking echocardiography occurs in patients undergoing treatment with VEGF-i for mCRC or mRCC, which may provide an opportunity for preventive interventions.

Author Info:
1
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
2
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Orman Heart Center, Assiut University, Assiut, Egypt.
3
Department of Oncology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
4
Institute of Cardiovascular Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
5
Section of Hematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
6
Institute of Cardiovascular Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Hematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
7
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: smulvagh@mayo.edu.


Authors:
Omedè, P.a,  Bertaina, M.a,  Cerrato, E.b,  Rubio, L.c,  Nuñez-Gil, I.c,  Gili, S.a,  Taha, S.d,  Macaya, C.c,  Escaned, J.c,  D'Ascenzo, F.a

Journal:
Journal of cardiovascular medicine (Hagerstown, Md.)

Date of Publishing:
Volume 19, Issue 11, 1 November 2018, Pages 650-654

Title:
Radial and femoral access for interventional fellows performing diagnostic coronary angiographies: the LEARN-Cardiogroup II, a prospective multicenter study

Abstract:
RESULTS: Overall, 201 patients were enrolled. Fellows chose right radial, left radial or femoral access in 164 (82%), 20 (10%) and 17 (8%) cases, respectively. All-cause bleedings were lower in radial cohort (4 vs. 19%; P = 0.001) mainly driven by minor bleedings (4 vs. 18%, P = 0.012). Also, overall complications were less frequent with the radial approach (18 vs. 30%, P = 0.03) and radial artery occlusion did not differ between right vs. left side (4 vs. 5%, P = 0.76). Procedural time (minutes) was similar between radial and femoral site (23 ± 9 vs. 22 ± 10, P = 0.91), as well as time of X-ray exposure (6 ± 3 vs. 4 ± 2, P = 0.11), DAP (Gy/cm: 17 ± 11 vs. 18 ± 12, P = 0.74) and amount of contrast medium (ml: 106 ± 81 vs. 84 ± 43, P = 0.89). Success for access was significantly higher with radial artery (89 vs. 71%, P = 0.004).

BACKGROUND: Safety and efficacy of radial and femoral access for coronary angiography performed by cardiology fellows remain to be evaluated.

METHODS: In this multicenter prospective study, cardiology fellows selected the access site (among femoral, right and left radial artery) for coronary angiography. All bleeding events related to the access site and all complications (a composite of all bleedings and artery occlusion) were the co-primary safety end points. Success for each access site, procedural and radiological times and single components of primary outcome were the secondary ones.

CONCLUSION: Radial artery is the most exploited access by cardiologist fellows, leading to reduction in minor bleedings and higher success compared with femoral access. No differences in procedural time and radiation exposures were recorded.

Author Info:
aDivision of Cardiology, Città della Salute e della Scienza, India
bDivision of Cardiology, 'AOU San Luigi e Centro di Emodinamica unità interaziendale', San Luigi- Rivoli, Italy
cDivision of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
dDivision of Cardiology, Assiut University Hospital, Assiut, Egypt


Authors:
Othman, E.R.,  Abdullah, K.S.,  Abbas, A.M.Email Author,  Hussein, M.,  Elsnosy, E.,  El-Nashar, I.H.

Date of Publishing:
Volume 23, Issue 4, December 2018, Pages 324-330

Title:
Evaluation of endometrial and subendometrial vascularity in obese women with polycystic ovarian disease

Abstract:
Introduction: The study aims to evaluate the effect of obesity on the endometrium in women with polycystic ovarian disease (PCOD) through evaluation of endometrial and subendometrial vascularity by two-dimensional (2D) ultrasound, Doppler and three dimensional power Doppler (3DPD). Methods: A prospective case-control study, conducted in a tertiary University hospital between February 2016 and December 2016. The study included 50 women with PCOD and 50 fertile regular menstruating women divided according to their body mass index (BMI) into normal weight and overweight/obese groups. Endometrial thickness and pattern combined with Doppler examination of the uterine vessels for measurement of Resistance index (RI) and pulsatility index (PI) were assessed. Evaluation of endometrial and subendometrial blood flow was performed by 3DPD using Virtual organ computer-aided analysis program. Results: No significant difference in the endometrial pattern or thickness between all study groups. Endometrial volume was significantly lower in the overweight/obese PCOD women and overall in the PCOD women compared to the control group (p < 0.01). Uterine artery RI was significantly higher in the PCOD women compared to the control group (p = 0.004), but no difference in uterine PI. Vascular indices of endometrial and subendometrial blood flow were significantly lower in the overweight/obese PCOD women than the normal weight PCOD women. Conclusions: The endometrium is negatively affected by obesity in women with PCOD. Additionally, PCOD women had lower endometrial and subendometrial blood flow than non-PCOD women. Therefore, overweight/obese PCOD women should be encouraged to reduce their body weight in order to improve the endometrial receptivity. © 2018 Middle East Fertility Society


Authors:
Othman MAM1,2, Rajab E3, AlMubarak A4, AlNaisar M5, Bahzad N6, Kamal A7.

Title:
Erythropoietin Protects Against Cognitive Impairment and Hippocampal Neurodegeneration in Diabetic Mice

Abstract:
Administration of erythropoietin (EPO) is neuroprotective against a variety of experimentally-induced neurological disorders. The aim was to determine if EPO protects against hippocampal neurodegeneration as well as impairment of cognition and motor performance, associated with long-term diabetes. BALB/c mice were randomly allocated between control, diabetic and EPO-treated diabetic groups. EPO-treated diabetic mice were administered EPO 0.05 U/kg/day i.p. three times/week for 10 weeks. Cognition was assessed by Morris water maze. Brain samples were processed for light microscopic evaluation of hippocampus. Controls showed gradual improvement of cognitive performance in water maze when comparing latency (p < 0.01) and distance swum to reach the platform (p = 0.001). There was a similar trend for improvement in EPO-treated diabetics (p < 0.001). Latency did not improve in diabetic animals indicating lack of learning (p = 0.79). In probe trials, controls and EPO-treated diabetics spent more time in the training quadrant than expected by chance (p < 0.001). Diabetics did not show memory recall behavior; performance was significantly worse than expected by chance (p = 0.023). In diabetics, there was neurodegeneration in hippocampus and reduction in number of granule cells (p < 0.01) in the dentate gyrus. EPO treatment improved these neurodegenerative changes and preserved numbers of granule cells (p < 0.1, compared to controls). Erythropoietin treatment is protective against cognitive deficits and hippocampal neurodegeneration in diabetic mice.

Author Info:
1
Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, 329 Manama, Bahrain. manalamo@agu.edu.bh.
2
Department of Histology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt. manalamo@agu.edu.bh.
3
School of Medicine, Royal College of Surgeons in Ireland, 228 Busaiteen, Bahrain. erajab@rcsi-mub.com.
4
Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, 329 Manama, Bahrain.. Ahmmed_ad@hotmail.com.
5
Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, 329 Manama, Bahrain.. ameralansari@gmail.com.
6
Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, 329 Manama, Bahrain.. noora.bahzad@gmail.com.
7
Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, 329 Manama, Bahrain.. amerha@agu.edu.bh.


Authors:
Abbas, A.M.Email Author,  Michael, A.,  Nasif, F.,  Ali, S.S.

Date of Publishing:
Volume 34, Issue 1, February 2018, Pages 46-48

Title:
Spontaneous Rupture of Subserous Uterine Vein in a 35-Weeks Pregnant Woman Who Presented with Massive Hemoperitoneum

Abstract:
Background: Hemoperitoneum is a life-threatening complication if it occurs during pregnancy. Ruptured uterine veins, arteries, or uterovarian vessels are among the rare causes of this condition. Case: A spontaneous rupture of a subserous uterine vein occurred at 35 weeks of gestation in a 32-year-old woman after development of an acute abdomen. Abdominal exploration revealed an intact uterus with no definite bleeding point apart from the congested subserous vein on the lower uterine segment. Successful delivery of the fetus and resuscitation of the mother were performed. Results: The patient's postoperative course was uneventful, and she was discharged on the sixth day, in good condition, with her infant. Conclusions: Sudden onset of abdominal pain and signs of hypovolemic shock with no external bleeding can indicate intraperitoneal hemorrhage. Abdominal exploration is urgently needed to evaluate the cause of hemorrhage and stop the source of bleeding. © 2018, Mary Ann Liebert, Inc.

Author Info:
Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Al-Azhar Street, Assuit, 71511, Egypt


Title:
Overview of prevention and management of acute bronchiolitis due to respiratory syncytial virus.

Abstract:
Respiratory Syncytial Virus (RSV) is the most common cause of Acute Bronchiolitis (AVB) in infants. AVB causes significant morbidity and mortality worldwide, most deaths occurring in the developing world. AVB causes respiratory distress in infants, leading to respiratory failure in some cases. Disease is more severe in infants with risk factors, such as prematurity, chronic cardiac and lung disease and immunodeficiency. Areas covered: Despite major advances in supportive care in the developed world, which has led to a significant reduction in mortality, treatment remains symptomatic and supportive. No specific antiviral treatment has yet proven to be effective. Prevention of disease with monoclonal antibodies has proven to reduce illness severity in those with risk factors, however, this is prohibitively expensive, particularly for the developing world. Prospects for vaccine development are improving. However, because most disease is in young infants, maternal immunization is necessary. However, due to the transient nature of RSV immunity and the circulation of multiple subtypes, vaccines proven to be effective in adult challenge models have yet to be translated to protection in infants. Expert commentary: Despite advances in preventative treatments, adherence to evidence-based guidelines provides the best prospect for successful reduction in morbidity and mortality.

Author Info:
1
a Paediatric Intensive Care, Paediatric Intensive Care Unit , St. Mary's Hospital , London , UK.
2
b Department of Paediatrics , Assuit University , Assiut , Egypt.


Title:
Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: Presentations, causes and treatment strategies

Abstract:
Uremic syndrome of chronic kidney disease (CKD) is a term used to describe clinical, metabolic and hormonal abnormalities associated with progressive kidney failure. It is a rapidly growing public health problem worldwide. Nervous system complications occur in every patient with uremic syndrome of CKD. Areas covered: This review summarized central and peripheral nervous system complications of uremic syndrome of CKD and their pathogenic mechanisms. They include cognitive deterioration, encephalopathy, seizures, asterixis, myoclonus, restless leg syndrome, central pontine myelinosis, stroke, extrapyramidal movement disorders, neuropathies and myopathy. Their pathogenic mechanisms are complex and multiple. They include (1) accumulation of uremic toxins resulting in neurotoxicity, blood brain barrier injury, neuroinflammation, oxidative stress, apoptosis, brain neurotransmitters imbalance, ischemic/microvascular changes and brain metabolism dysfunction [e.g. dopamine deficiency], (2) metabolic derangement [as acidosis, hypocalcemia, hyperphosphatemia, hypomagnesemia and hyperkalemia]; (3) secondary hyperparathyroidism, (4) erythropoietin and iron deficiency anemia, (5) thiamin, vitamin D and other nutritional deficiencies, (6) hyperhomocysteinemia, and (7) coagulation problems. Expert Commentary: Nervous system complications of uremia contribute to the patients' morbidity and mortality. Optimizing renal replacement therapy, correction of associated metabolic and medical conditions and improved understanding of possible pathogenic mechanisms of these complications is a major target for their prevention and treatment.

Author Info:
1
a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt


Authors:
Hassan AKM1, Mohamed HSE1, Mohamed AM1, Ahmed TAN1, Kishk YT1.

Title:
Predictors of no-reflow in patients undergoing primary percutaneous coronary intervention. Thrombus aspiration was protective

Author Info:
Department of Cardiology, Faculty of Medicine, Assiut University, Egypt.


Authors:
Hassan AKM1, Abd-El Rahman H1, Hassan SG1, Ahmed TAN1, Youssef AAA1.

Title:
Validity of tortuosity severity index in chest pain patients with abnormal exercise test and normal coronary angiography

Abstract:
BACKGROUND:
Coronary tortuosity (CT) had different definitions and scores in literature with unclear pathophysiological impact.

OBJECTIVES:
To study degree of CT and it's relation to ischemic changes in patients with angina but normal coronary angiography (CA).

METHODS:
We conducted a prospective study at University hospitals between May 2016 and January 2017. We included 200 consecutive patients who underwent CA due to chest pain assumed to be of cardiac origin, and their CA was normal (no diameter stenosis >30%, nor myocardial bridging). Patients were prospectively divided into 2 groups based on the presence (n = 113) or absence (n = 87) of ischemic changes during stress study and compared for clinical, echocardiographic and CA characteristics. A newly proposed Tortuosity Severity Index (TSI) was developed into significant (mild/moderate CT with more than 4 curvatures in total, or severe/extreme CT with any number of curvatures) or not significant TSI (mild CT with curvatures less than or equal to 4 curvatures in total).

RESULTS:
Patients with ischemic changes had the highest rate of CT (76.5 vs 18%, p = 0.004) compared to those without. CT mostly affects the left anterior descending (LAD) coronary artery in mid and distal segments. Females, elderly, and hypertensives with left ventricular hypertrophy were strongly related to CT. Multivariate logistic regression analysis identified CT with significant TSI as the only predictor of ischemic changes in these patients (OR = 6.2, CI = 2.5-15.3, P = <0.001).

CONCLUSIONS:
Coronary tortuosity is a strong predictor of anginal pain among patients with normal CA, despite positive stress study. This finding is more pronounced among elderly, hypertensive female patients.

Author Info:
1
Department of Cardiology, Faculty of Medicine, Assiut University, Egypt.


Authors:
Hegab AE1, Ozaki M1, Meligy FY2, Nishino M1, Kagawa S1, Ishii M1, Betsuyaku T1.

Title:
Calorie restriction enhances adult mouse lung stem cells function and reverses several aging-induced changes

Abstract:
Aging is associated with decreased lung function and an increased incidence of lung infections. Several studies have suggested that long-term calorie restriction (CR) promotes health and longevity and results in the reduced risk of several diseases. The effect of CR is thought to be through improving the function of tissue stem cells. Stem cell function is known to decline with aging. In this study, we examined the effects of aging on lung epithelial and stem cells, and the effect of CR on young and old lungs. We found that aging results in a decrease in tracheal basal stem cells. CR induced an increase in basal stem cells in both young and old mice. In addition, aging induced lung inflammation, and CR tended to reduce baseline lung inflammatory cell infiltration in young mice, and significantly reduced aging-induced lung inflammation. Furthermore, aging reduced the number and function of mitochondria in lung and increased level of mitochondrial ROS. CR increased the number and function of mitochondria both in young and old mice. Moreover, aging reduced lung stem cell colony forming efficiency (CFE), and CR increased the CFE in both young and old mice. Finally, CR improved epithelial cell survival in injured lungs of young mice. In conclusion, aging causes several structural and functional changes/impairments in lung epithelial cells. CR induces several potentially beneficial changes in lung epithelial cells, even when it is initiated at an older age, including reversal of some aging-induced changes.

Author Info:
1
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
2
Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Khedr EM1, Fawi G2, Abbas MA3, El-Fetoh NA4, Zaki AF3, Ahmed MA4, Soliman RK5, Gamea A3.

Title:
Prevalence of cervical and lumbosacral compressive radiculopathies in Qena governorate/Egypt: Population-based survey

Abstract:
OBJECTIVES:
The aim of the study was to estimate the crude prevalence rate (CPR) of compressive radiculopathies in Qena governorate/Egypt.

PATIENTS AND METHODS:
10 areas in Qena governorate were selected by random sampling, involving 9303 inhabitants with 57.3% urban residents and 42.7% rural residence. Patients were diagnosed using a screening questionnaire for the diagnosis of cervical and lumbosacral radiculopathies. All positive cases were referred to Qena University Hospital where they underwent full neurological examination, neuro-imaging, and neurophysiological investigations.

RESULTS:
Out of 9303 inhabitants included in the study (1057 families), 49 cases were recruited positive on initial survey and 32 cases were confirmed after clinical examination, neuroimaging and neurophysiological examinations, giving a CPR of 10.1/1000 in those aged over 30 years. Compressive radiculopathy was more common in males than females (13 versus 6/1000) and in rural than urban populations (15 versus 7/1000). No cases were recruited below 30 years old. The highest age specific prevalence was at ≥60 years with a CPR of 26/1000. 11 cases had cervical radiculopathy while 21 cases had lumbosacral radiculopathy (CPR of 3.7 and 6.6/1000 respectively). The highest age specific CPR for males was earlier than females at 50-59 versus ≥60 years.

CONCLUSION:
The overall CPR of compressive radiculopathy in the general population in Qena governorate/Egypt is similar for cervical radiculopathy but higher for lumbosacral radiculopathy than a previous Egyptian study but mid-way compared to other countries.

Author Info:
1
Faculty of Medicine, Department of Neuropsychiatry, Assiut University, Assiut, Egypt. Electronic address: emankhedr99@yahoo.com.
2
Faculty of Medicine, Department of Neuropsychiatry, Sohag University, Sohag, Egypt.
3
Faculty of Medicine, Department of Neuropsychiatry, South Valley University, Qena, Egypt.
4
Faculty of Medicine, Department of Neuropsychiatry, Assiut University, Assiut, Egypt.
5
Faculty of Medicine, Department of Radiology, Assiut University, Assiut, Egypt.


Authors:
Menshawy A1, Ghanem E1, Menshawy E1, Taher Masoud A2, El-Sharkawy M3, Taher A3, Mahmoud M3, Khamis Y4, Haggag H3,5, Khalifa M6, Samy A3, Abbas AM6.

Title:
Early versus delayed removal of indwelling urinary catheter after elective caesarean delivery: systematic review and meta-analysis of randomized controlled trials

Abstract:
BACKGROUND:
Timing of removal of the indwelling urinary catheter after elective caesarean delivery (CD) is controversial. Early removal could be associated with fewer urinary symptoms.

OBJECTIVE:
This review aims to evaluate the evidence from published randomized clinical trials (RCTs) about the outcomes of early versus delayed removal of indwelling urinary catheter after elective caesarean delivery (CD).

DATA SOURCES:
Electronic databases were searched using the following MeSH terms (early Or Late Or immediate OR delayed removal) AND (Urinary catheter) AND (caesarean section OR caesarean delivery OR CS) Methods of study selection. All RCTs assessing the timing of removal of urinary catheter were considered for this meta-analysis. One hundred seventy-two studies were identified of which three studies deemed eligible for this review. Quality and risk of bias assessment were performed for all studies.

DATA EXTRACTION:
Two researchers independently extracted the data from the individual articles and entered into RevMan software. The relative risk (RR), the weighted mean difference (WMD) and 95% confidence interval (CI) were calculated. The extracted outcomes were significant bacteriuria, urinary symptoms (urinary retention necessitating recatheterization, dysuria, urinary frequency, urgency) postoperative oral rehydration and length of hospital stay.

RESULTS:
Three RCTs (early removal: n = 298 and delayed removal: n = 311) were included. The pooled estimate showed that early removal significantly reduced dysuria (RR = 0.60, 95% CI [0.38, 0.95], p = 0.03), urinary frequency (RR = 0.32, 95% CI [0.16, 0.66], p = 0.002) and significant bacteriuria (RR = 0.49, 95% CI [0.30, 0.83], p = 0.007) than delayed removal.

CONCLUSIONS:
This meta-analysis suggests that early removal of the indwelling urinary catheter in patients who underwent elective CD showed significant less dysuria, less urinary frequency and a decrease in the incidence of significant bacteriuria.

Author Info:
1
a Faculty of Medicine , Al-Azhar University , Al-Azhar Medical Students' Association , Cairo , Egypt.
2
b Faculty of Medicine , Fayoum University , Fayoum , Egypt.
3
c Department of Obstetrics and Gynaecology , Faculty of Medicine , Cairo University , Cairo , Egypt.
4
d Department of Obstetrics and Gynaecology , Faculty of Medicine , Beni-Suef University , Egypt.
5
e Department of Obstetrics and Gynaecology , University of Würzburg , Würzburg , Germany.
6
f Department of Obstetrics and Gynaecology , Faculty of Medicine , Assiut University , Assiut , Egypt.


Title:
Protective effect of tetrahydrobiopterin on hepatic and renal damage after acute cadmium exposure in male rats

Abstract:
Cadmium (Cd) has been recognized as one of the most important environmental and industrial pollutants. This study investigated the impact of acute exposure to Cd on oxidative stress and the inflammatory marker interleukin-6 (IL-6) in the plasma of rats and the histological picture of liver and kidney, as well as to examine the potential protective effect of tetrahydrobiopterin (BH4).

METHODS:
Rats were divided into control group, Cd group that received a single intraperitoneal (i.p.) dose of 4 mg/kg b.w. of CdCl2 and BH4+ Cd group that received a single dose of BH4 (20 mg/kg, i.p.) and subsequently exposed to a single dose of Cd 24 h after the BH4 treatment.

RESULTS:
Cd increased the plasma levels of hepatic enzymes (ALT and AST), urea, creatinine, malondialdehyde (MDA), and IL-6 and decreased the superoxide dismutase (SOD) activity. Also, it induced histopathological alterations in the liver with severe degeneration, especially in centrilobular zones. Renal tubular epithelium showed vacuolated cytoplasm and dense nuclei. VEGF expression was mild. Ultrastuctural changes were seen in some renal tubules. The nuclei appeared distorted with electron dense chromatin. Mitochondria with destructed cristae were observed. BH4 pretreatment had protective effects, since it significantly reduced the levels of IL-6 and ameliorated the alteration in oxidative status biomarkers induced by Cd. Improvement of histopathological alterations was observed in Cd-groups. The nuclei were vesicular euchromatic, intact mitochondria and normal appearance of the filtration membrane. Moderate expression of VEGF was noted.

CONCLUSION:
This study has provided clear evidence for the protective efficacy of BH4 against experimental Cd toxicity.

Author Info:
1
a Department of Medical Physiology, Faculty of Medicine , Assiut University , Assiut , Egypt.
2
b Department of Medical Physiology, College of Medicine , King Khalid University , Abha , Saudi Arabia.
3
c Department of Histology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Sayed AEH1, Abd-Elkareem M2, Abou Khalil NS3.

Title:
Immunotoxic effects of 4-nonylphenol on Clarias gariepinus: Cytopathological changes in hepatic melanomacrophages

Abstract:
Melanomacrophage centres (MMCs) play a key role in the immune response in fish. They are considered sensitive bio-monitoring structures with roles in the assessment of toxicant impacts. The aim of this study was to examine the potential histopathological effect of 4-nonylphenol (4-NP) on hepatic MMCs in Clarias gariepinus. To achieve this objective, adult male fish were divided randomly and equally into two groups: a control group and a group that was exposed to 4-NP (dissolved in water at a dose of 0.1 mg/L) for 21 days. The 4-NP-intoxicated hepatic MMCs contained numerous necrotic macrophages. Superoxide dismutase 2 was immuno-expressed in the hepatic MMCs in both groups, with no significant difference. Histomorphometric examination revealed that the sizes and numbers of MMCs were dramatically higher in the livers of 4-NP-exposed C. gariepinus than in control fish. Following 4-NP challenge, in the liver, the abundance of lipofuscin and haemosiderin pigments increased, and single-pigmented macrophages, aggregated groups of deformed red blood cells (RBCs) and macrophages were present near blood vessels and hepatic sinusoids. These results reveal that 4-NP exerts immunological effects on hepatic MMCs in C. gariepinus and support the utility of MMCs as a cytological biomarker for aquatic exposure to 4-NP.

Author Info:
1
Zoology Department, Faculty of Science, Assiut University, 71516 Assiut, Egypt. Electronic address: alaasayed@aun.edu.eg.
2
Anatomy, Histology and Embryology Department, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
3
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Sharma A1, Kishore H1, Singh V2, Shawky Abdelgawaad A3,4, Sinha S1, Kamble PC3, Jorule K1, Agrawal R1, Mathapati S1, Deepak P1.

Title:
Comparative Study of Functional Outcome of Anterior Cervical Decompression and Interbody Fusion With Tricortical Stand-Alone Iliac Crest Autograft Versus Stand-Alone Polyetheretherketone Cage in Cervical Spondylotic Myelopathy

Abstract:
STUDY DESIGN:
Retrospective analysis of prospectively collected data.

OBJECTIVE:
The aim of the study was to compare the outcome of anterior cervical decompression and fusion (ACDF) with stand-alone tricortical iliac crest autograft versus stand-alone polyetheretherketone (PEEK) cage in cases of cervical spondylotic myelopathy.

METHODS:
Prospectively collected data of 60 patients in each group were compared.

RESULTS:
There was statistically significant improvement noted in postoperative Modified Japanese Orthopaedic Association (MJOA) follow-up scores with comparison pairs of preoperative versus 6 months, preoperative versus 1 year, and 3 months versus 6 months, 3 months versus 1 year in both groups. But improvements in MJOA scores were statistically insignificant between 6 months and 1 year (P = .0639) for the autograft group when compared with PEEK cage group (P = 0001). The mean loss of segmental lordosis on follow-up X-ray for the autograft group was (5.89 ± 2.90°), which was significantly higher (1.88 ± 2.77°) than the mean loss seen in the PEEK cage group (P = .01). This was most evident between 6 months and 1 year, resulting in plateauing of the improvement in MJOA score between 6 months to 1 year in the autograft group. While there was no statistical difference between fusion rates between the groups for 1 and 2 levels of ACDF, overall fusion rates were significantly better for 1-level ACDF (95.74%) when compared with 2-level ACDF (76.00%).

CONCLUSION:
ACDF with PEEK cage is the fusion technique of choice for cervical fusion with fewer complications and better functional recovery in the treatment of cervical spondylotic myelopathy.

Author Info:
1
Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India.
2
Helios Klinikum Erfurt, Thüringen, Germany.
3
Seth GS Medical College and KEM Hospital, Mumbai, India.
4
Assiut University Hospital, Egypt.


Authors:
Yong PJ1, Williams C2, Bodmer-Roy S2, Ezeigwe C3, Zhu S3, Arion K3, Ambacher K3, Yosef A4, Wong F5, Noga H5, Britnell S3, Yager H3, Bedaiwy MA6, Brotto LA7, Albert AY7, Lisonkova S8, Allaire C6.

Title:
Prospective Cohort of Deep Dyspareunia in an Interdisciplinary Setting

Abstract:
INTRODUCTION:
Deep dyspareunia is a common symptom in women, including in half of women with endometriosis, but little is known about its response to treatment and predictors of persistent deep dyspareunia over time.

AIM:
To follow up deep dyspareunia severity over a 1-year prospective cohort at an interdisciplinary center, and to identify baseline predictors of more persistent deep dyspareunia at 1 year.

METHODS:
Prospective 1-year cohort study at a tertiary referral center for pelvic pain and endometriosis, where a range of interdisciplinary treatments are provided at a single center (surgical, hormonal, physical, and psychological therapies). Exclusion criteria were menopause, age >50 years, and never previously sexually active. Primary outcome (deep dyspareunia severity) and secondary outcome (sexual quality of life) were followed up over 1 year. Ordinal logistic regression was performed, controlling for baseline severity of deep dyspareunia, to identify baseline predictors of deep dyspareunia severity at 1 year.

MAIN OUTCOME MEASURE:
Primary outcome was severity of deep dyspareunia on an 11-point numeric rating scale (0-10), categorized into absent-mild (0-3), moderate (4-6), and severe (7-10); secondary outcome was sexual quality of life measured by the Endometriosis Health Profile-30.

RESULTS:
1-year follow-up was obtained for 278 subjects (56% response rate at 1 year; 278/497). Severity of deep dyspareunia improved over the 1 year (McNemar test, P < .0001): the proportion of patients in the severe category decreased from 55.0% to 30.4%, the moderate category remained similar from 17.7% to 25.0%, and the absent-mild category increased from 27.3% to 44.6%. Sexual quality of life also improved (56% to 43% on the sex subscale of the Endometriosis Health Profile-30) (Welch t test, P < .001). On ordinal regression, severity of deep dyspareunia at 1 year was independently associated with younger age (OR = 0.94, 95% CI = 0.91-0.97, P = .008), and with a higher baseline depression score on the Patient Health Questionnaire-9 (OR = 1.07, 95% CI = 1.03-1.11, P = .01).

CLINICAL IMPLICATIONS:
Clinicians should consider employing an interdisciplinary approach for deep dyspareunia, and screening for and treating depression symptoms in these women.

STRENGTH & LIMITATIONS:
Strengths of the study include its prospective nature, and assessment of deep dyspareunia specifically (as opposed to superficial dyspareunia). Limitations include non-randomized design, and the patients lost to follow-up over the 1 year.

CONCLUSION:
Over 1 year in an interdisciplinary setting, improvements were observed in deep dyspareunia and sexual quality of life, but younger women and those with more severe depression at baseline had more persistent deep dyspareunia at 1 year. Yong PJ, Williams C, Bodmer-Roy S, et al. Prospective Cohort of Deep Dyspareunia in an Interdisciplinary Setting. J Sex Med 2018;15:1765-1775.

Author Info:
1
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada. Electronic address: paul.yong@vch.ca.
2
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada.
3
BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada.
4
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Assiut University, Assiut, Egypt.
5
BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada.
6
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada.
7
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada.
8
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.


Authors:
Elwany, E.,  Omar, S.,  Ahmed, A.Email Author,  Heba, G.,  Atef, D.

Date of Publishing:
Volume 18, Issue 3, September 2018, Pages 596-600

Title:
Antenatal dexamethasone effect on Doppler blood flow velocity in women at risk for preterm birth: Prospective case series

Abstract:
Background: Maternal administration of corticosteroids is essential to improve fetal lung surfactant production and hasten the fetal lung maturity in women at risk for preterm birth. Objectives: The current study aims to evaluate the effects of dexamethasone on fetal and uteroplacental circulation in pregnancies at risk for preterm birth after 24 hours of its administration. Methods: A prospective cross-sectional study was carried out in a tertiary University Hospital and included 52 pregnant women with singleton pregnancies. Doppler studies were performed on maternal uterine arteries, umbilical artery, fetal middle cerebral artery (MCA) and fetal descending aorta and just before dexamethasone administration and repeated 24 hours after completion of the course. Results: There was a statistically significant difference between all Doppler indices in the umbilical artery (PI= 1.09±0.4 and 1.05±0.39, RI= 0.66±0.14 and 0.63±0.14; p=0.001), fetal MCA (RI= 0.86±0.12 and 0.83±0.13, PI= 2.19±0.72 and 2.15±0.72; p=0.001) and aorta (RI= 0.9±0.55 and 0.87±0.55; p=0.001, PI= 1.91±0.44 and 1.89±0.44; p=0.040) in comparison before and 24 hours after maternal dexamethasone administration respectively. Also uterine artery PI was significantly different (0.9±0.27 and 0.87±0.26; p=0.001). Conclusion: Antenatal dexamethasone for women at risk of preterm birth improves the fetal and uteroplacental blood flow at 24 hours after its administration. © 2018 Elwany et al.

Author Info:
Department of Obstetrics and Gynecology, Woman’s Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Arafa, A.E.a,  Elbahrawe, R.S.a,  Shawky, S.M.b,  Abbas, A.M.c

Date of Publishing:
Volume 23, Issue 3, September 2018, Pages 184-188

Title:
Epidemiological and gynecological correlates with female genital mutilation among Beni-Suef University students; cross sectional study

Abstract:
Objective: This study aims to evaluate the prevalence of FGM/C among university students in Beni-Suef, Egypt and detect the possible socio-demographic and gynaecological associations. Study design: A cross-sectional study had been conducted on 1723 females attending all faculties of Beni-Suef University (n = 28) and representing all academic years were selected using a multi-stage random sampling to participate in this study. By the beginning of the second term of the academic year 2016/2017, students were interviewed using a questionnaire included questions about the socio-demographic charcteristics, gynecological history, exposure to FGM/C and its justifications, sources of knowledge about FGM/C, gynecological manifestations associated with menstrual flow during the past 12 months and the pain relief methods they used during the same period. Results: Slightly less than half of our students (47.3%) were circumcised. Students residing in rural areas and those with illiterate parents were more likely to experience FGM/C (p <.001). Family and friends were the main sources of knowledge about FGM/C, but uncircumcised girls resorted more to school teachers and TV/Internet for information about FGM/C (p <.001). Most of the uncircumcised (98.2%) and the circumcised girls (73.5%) believe that the practice should not be justified, while the justifications were mainly religious and social. Dysmenorrhea and backaches were highly incident among the girls with no association between these symptoms and FGM/C. Conclusions: FGM/C is less prevalent among the university girls in Beni-Suef. Residential, parental level of education, religious and traditional issues are among the most potential risk factors for FGM/C. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Public Health, Faculty of Medicine, Beni-Suef University, Egypt
bDepartment of Obstetrics & Gynecology, Faculty of Medicine, Beni-Suef University, Egypt
cDepartment of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt


Authors:
Arafa, A.E.a,  Khamis, Y.b,  Hassan, H.E.c,  Saber, N.M.c,  Abbas, A.M.d

Date of Publishing:
Volume 23, Issue 1, March 2018, Pages 44-47

Title:
Epidemiology of dysmenorrhea among workers in Upper Egypt; A cross sectional study

Abstract:
Objective: To investigate the epidemiology of dysmenorrhea amongst women in two textile factories in Beni-Suef, Egypt compared to non-working controls. Study design: A cross sectional study. Setting: Beni-Suef, Egypt. Materials and methods: The study was conducted on 554 working women in two textile factories in Beni-Suef and 1081 non-working women, matched for age and residence. A structured questionnaire was used and a team of data collectors interviewed the women. The questionnaire included questions about the socio-demographic characteristics of women, history of dysmenorrhea during the past 12 months, associating symptoms, pain relief methods, and sources of information. Results: The study reported higher rates of dysmenorrhea during the past 12 months (94.6%) amongst the working women, compared to their controls (90.7%) (p < 0.05). Backaches, generalized aching and nervousness were the most likely symptoms reported with menstruation72.2%, 56.3% and 41% respectively. More than half of the working women who experienced dysmenorrhea reported drinking herbal fluids and taking analgesics to alleviate their symptoms, while 43% had to take sick leaves due to their condition. Women in the study group resorted mostly to family members to get information about menstruation and menstrual disturbances. Conclusions: Dysmenorrhea is highly prevalent among women working in the textile factories in Beni-Suef. Further research should focus on the adaptive strategies used by women to avoid the negative impacts of dysmenorrhea. Structuring occupational health programs that handle the menstrual disorders amongst the working women, especially in the industrial settings, should be considered. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Public Health, Faculty of Medicine, Beni-Suef University, Egypt
bDepartment of Obstetrics and Gynecology, Faculty of Medicine, Beni-Suef University, Egypt
cDepartment of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt
dDepartment of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt


Authors:
Abdelhafez, A.H.K.a,  Taha, O.a,  Abdelaal, M.a,bEmail Author,  Al-Najim, W.b,c,  Le Roux, C.W.b,c,d,  Docherty, N.G.b,d

Journal:
Bariatric Surgical Practice and Patient Care

Date of Publishing:
Volume 13, Issue 1, March 2018, Pages 25-32

Title:
Impact of Abdominal Subcutaneous Fat Reduction on Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus

Abstract:
Background: The effect on type 2 diabetes mellitus (T2DM) when adipose tissue is removed is controversial. This study aimed to evaluate and compare the effect of the abdominoplasty and bariatric surgery on glycemic control in patients with T2DM. Methods: Patients with T2DM undergoing abdominoplasty for cosmesis were studied (n = 25). Subjects were 36.9 ± 1.3 years with a preoperative body mass index (BMI) of 40.6 ± 0.5 kg/m2 and mean glycated hemoglobin (HbA1c) of 7.4% ± 0.2%. Fifteen matched patients undergoing bariatric surgery were selected as a comparator group. Weight, BMI, waist circumference (WC), random blood glucose (RBG), and HbA1c were evaluated at baseline and 3, 6, and 12 months postsurgery. Results: By 12 months, abdominoplasty reduced weight by 5.6 ± 0.3 kg p < 0.01), and HbA1c was reduced to 6.8% ± 0.3% (p < 0.01). After 12 months, bariatric surgery reduced BMI from 42.2 ± 1 kg/m2 to 26.6 ± 0.4 kg/m2 (p < 0.01). HbA1c reduced from 7.9% ± 0.4% to 5.5% ± 0.2% (p < 0.01). WC was similar between both groups at 3 months, although HbA1c reductions were superior after bariatric surgery. Conclusions: Reducing subcutaneous adipose tissue with abdominoplasty results in a small improvement in glycemic control in patients with T2DM. Despite equivalent WC at 3 months, bariatric surgery outperformed abdominoplasty on all metabolic parameters then and thereafter. © 2018, Mary Ann Liebert, Inc. 2018.

Author Info:
aPlastic Surgery Department, Assiut University Hospital, Assiut, 71111, Egypt
bDiabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
cInvestigative Science, Imperial College London, London, United Kingdom
dDepartment of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden


Authors:
Nassr, A.A.,  Ness, A.,  Hosseinzadeh, P.,  Salmanian, B.,  Espinoza, J.,  Berger, V.,  Werner, E.,  Erfani, H.,  Welty, S.,  Bateni, Z.H.,  Shamshirsaz, A.A.,  Popek, E.,  Ruano, R.,  Davis, A.S.,  Lee, T.C.,  Keswani, S.,  Cass, D.L.,  Olutoye, O.O.,  Belfort, M.A.,  Shamshirsaz, A.A

Date of Publishing:
Volume 43, Issue 2, 1 February 2018, Pages 123-128

Title:
Outcome and Treatment of Antenatally Diagnosed Nonimmune Hydrops Fetalis

Abstract:
Introduction: The objectives of this study were to evaluate the outcome of nonimmune hydrops fetalis in an attempt to identify independent predictors of perinatal mortality. Material and Methods: A retrospective cohort study was conducted including all cases of nonimmune hydrops from two tertiary care centers. Perinatal outcome was evaluated after classifying nonimmune hydrops into ten etiological groups. We examined the effect of etiology, site of fluid accumulation, and gestational age at delivery on postnatal survival. Neonatal mortality and hospital discharge survival were compared between the expectant management and fetal intervention groups among those with idiopathic etiology. Results: A total of 142 subjects were available for analysis. Generally, nonimmune hydrops carried 37% risk of neonatal mortality and 50% chance of survival to discharge, which varies markedly based on the underlying etiology. Ascites was an independent predictor of perinatal mortality (p value = 0.003). There was nonsignificant difference in neonatal mortality and hospital discharge survival among idiopathic cases that were managed expectantly versus those in whom fetal intervention was carried out. Discussion: The outcome of nonimmune hydrops varies largely according to the underlying etiology and the presence of ascites is an independent risk factor for perinatal mortality. In our series, fetal intervention did not offer survival advantage among fetuses with idiopathic nonimmune hydrops. © 2017 S. Karger AG, Basel.

Author Info:
aDepartment of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Hospital Pavilion for Women, Houston, TX, bDepartment of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, cDepartment of Pediatric Medicine, Neonatology, and dDepartment of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, eDepartment of Pediatric Medicine, Neonatology, Stanford University School of Medicine, Stanford, CA, and fMichael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; gDepartment of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Shady, N.W.a,  Sallam, H.F.a,  Ali, S.S.b,  Abbas, A.M.b

Date of Publishing:
Volume 23, Issue 1, March 2018, Pages 63-67

Title:
Effect of intraperitoneal and incisional port site lidocaine on pain relief after gynecological laparoscopic surgery: A randomized controlled study

Abstract:
Objective: To evaluate the role of Intraperitoneal and port site use of local anesthetic (Lidocaine HCl) in gynecological laparoscopy for postoperative pain relief. Study design: A prospective randomized controlled study. Setting: Aswan University Hospital-Egypt. Materials and methods: We included patients undergoing laparoscopic surgery in the laparoscopy unit either diagnostic or operative. They were classified into two groups: group A (patients underwent diagnostic laparoscopy) and group B (patients underwent operative laparoscopy). Each group was randomized to two sub groups. subgroup 1 or 2; subgroup 1 (control) which comprised 18 patients who were given routine care for surgery and 50 ml normal saline intraperitoneal washing and subgroup 2 (study), which included 18 patients who were given routine care plus pre- and post-incisional subcutaneous injection of 2% lidocaine HCl (xylocaine) 1 ml at each portal site and 10 ml 2% intraperitoneal lidocaine (200 mg) in 50 ml normal saline. The primary outcome of the study is the difference in mean pain score postoperatively between groups. Results: There was significant reduction of the pain 1, 2, 4 and 8 h post-operatively shown by visual analogue scale pain scores in subgroup B2 compared to subgroup B1 and in subgroup A2 compared to subgroup A1 (P-value = 0.000). There was no significant difference in the incidence of nausea, vomiting, shoulder tip pain between both groups. Also there was no significant difference regards time of resumption of intestinal peristalsis and operation duration between subgroups. Conclusions: This study clearly depicts that incisional and intraperitoneal infiltration of lidocaine is an easy, safe, inexpensive, and noninvasive method that provides good analgesia during the early post-operative period and also provides early recovery from laparoscopic surgery. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Obstetrics & Gynecology, Faculty of Medicine, Aswan University, Egypt
bDepartment of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt


Authors:
Abbas, A.M.,  Michael, A.,  Ali, S.S.,  Abdalmageed, O.S.

Date of Publishing:
Volume 23, Issue 3, September 2018, Pages 251-253

Title:
Placenta percreta presenting with marked hemoperitoneum in the first trimester of pregnancy: A case report

Abstract:
Placenta percreta is defined as abnormal infiltration of placental tissue through the uterine wall. Placenta percreta detected in the first trimester of pregnancy is very rare and only few cases were reported. Here we present a case of 27-year-old female patient G3P2, pregnant 10 weeks with previous 2 cesarean sections presented with marked hemoperitoneum. Abdominal exploration revealed placenta percreta invading the uterine scar causing uterine rupture. Conservative management was done with uterine repair and bilateral uterine artery ligation. No placental tissue was left in situ. The patient was discharged from the hospital in a good health. © 2017 Middle East Fertility Society


Authors:
Abbas, A.M.,  Hussein, R.S.,  Ali, M.N.,  Shahat, M.A.,  Mahmoud, A.-R.

Date of Publishing:
Volume 23, Issue 1, March 2018, Pages 81-83

Title:
Spontaneous first trimester posterior uterine rupture in a multiparous woman with scarred uterus: A case report

Abstract:
Uterine rupture (UR) is a life threatening peripartum complication with high incidence of maternal morbidity and mortality. Posterior wall uterine rupture is a rare presentation especially in the first trimester. Herein, we experienced a case of spontaneous UR in a 24-year-old gravida 3 para 2 pregnant woman at gestational age of 10 weeks presented with acute abdomen. Clinical and ultrasonographic findings were suspicious towards ruptured ectopic pregnancy. However, abdominal exploration revealed posterior wall UR away from the site of lower segment cesarean scar. The tear was repaired in three layers and the patient was discharged after 4 days of hospital stay. UR should be considered in any pregnant woman with hemoperitoneum, Posterior uterine wall rupture is a rare presentation in the first trimester, but must be kept in mind as early intervention is the only way to save the mother's life. © 2017 Middle East Fertility Society


Authors:
Abbas, A.M.,  Ali, S.E.-E.A.,  Michael, A.,  Ali, S.S.

Date of Publishing:
Volume 23, Issue 1, March 2018, Pages 77-80

Title:
Successful fertility-preserving management of a case of placenta percreta invading the urinary bladder and anterior abdominal wall: A case report

Abstract:
Placenta percreta is defined as abnormal infiltration of placental tissue through the uterine wall with invasion into nearby organs such as bladder or rectum. When placenta precreta is complicated by bladder invasion, mortality rates have been projected as high as 9.5% for the mother and 24% for the fetus. Here we reported a case of 31-year-old female patient G4 P3, pregnant 36 weeks & 4 days, previous 2 cesarean sections with placenta percreta invading the urinary bladder and anterior abdominal wall. Delivery of single living female fetus weight 3100 g with conservative management of the uterus. No placental tissue was left in situ. The patient and her infant were discharged from the hospital in a good health. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
bAssiut University Hospital, Faculty of Medicine, Assiut University, Egypt


Authors:
Abbas, A.M.,  Abdelkader, A.M.,  Elsayed, A.H.,  Fahmy, M.S

Date of Publishing:
Volume 23, Issue 2, June 2018, Pages 143-147

Title:
The effect of slow versus fast application of vulsellum on pain perception during copper intrauterine device insertion: A randomized controlled trial

Abstract:
Objective: The study aims to investigate the effect of slow versus fast vulsellum application on the cervix on the perceived pain during copper intrauterine device (IUD) insertion. Study design: We conducted a randomized controlled trial at a tertiary university hospital from October 2016 to May 2017 included women desiring copper IUD insertion. We randomized the participants in a 1:1 ratio to slow and fast vulsellum application during IUD insertion. The primary outcome measure was the subjects’ self-reported pain using a 100 mm Visual Analogue Scale (VAS) during cervical tenaculum placement. We considered a 20 mm difference in VAS scores as clinically significant. The secondary outcomes included the difference in pain scores during IUD insertion and five minutes after insertion, the amount and duration of vulsellum site bleeding. Results: The study included 200 women (n = 100 in each group). Women in the slow vulsellum group had significant lower pain scores during tenaculum placement, IUD insertion and 5 min post-insertion (p =.0001). However, the difference in pain scores did not show a clinical significance. The duration needed to control the bleeding in fast vulsellum group was 2.34 min versus 1.87 min in the slow vulsellum group (p =.006). Additionally, the VAS score for the amount of bleeding was significantly higher in the fast than the slow vulsellum group (2.83 ± 1.38 vs. 1.97 ± 1.45. p =.008). Conclusions: Slow vulsellum application could reduce the pain scores during IUD insertion as compared with fast vulsellum application. Moreover, it is associated with less amount and duration of bleeding from the vulsellum puncture sites. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
bDepartment of Obstetrics & Gynecology, Faculty of Medicine, Aswan University, Aswan, Egypt


Authors:
Al-Hussaini TK1, Yosef AH1, El-Nashar IH1, Shaaban OM1.

Title:
Repeated recovery of immature oocytes in a woman with a previous history of empty follicle syndrome

Abstract:
The empty follicle syndrome (EFS) is defined as a failure to aspirate any oocyte (s) from the follicles after ovarian hyperstimulation in preparation for IVF/ICSI. It is a frustrating and vague syndrome; and a controversial one concerning its existence, causes and possible treatment. Recurrent EFS or the recovery of immature oocytes thereafter is a more challenging problem. Delayed injection after leaving the immature oocytes for in vitro-maturation (IVM) has been suggested to be a possible option if immature oocytes are retrieved. Here, we present a case of repeated retrieval of a few immature oocytes after a first incidence of EFS. IVM was tried twice for those immature oocytes. Unfortunately, in this case IVM was unsuccessful and the oocytes failed to mature in vitro. Assistance is required for future management of these unfortunate couples.

Author Info:
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, El-Salama IVF/ICSI Centre, Assiut, Egypt.


Authors:
Altraigey, A.,  Ellaithy, M.,  Atia, H.,  Abdelrehim, W.,  Abbas, A.M.,  Asiri, M.

Journal:
Journal of Maternal-Fetal and Neonatal Medicine

Title:
The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial

Abstract:
Objective: To endorse the impact of chewing gum on the intestinal functions’ restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD). Methods: Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 h after recovery at least for half an hour and at 2-h interval during daytime. The second group received oral fluids 6 h postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the time of initiating breast-feeding and the cost of hospital stay. The study was prospectively registered at ClinicalTrials.gov (NCT02386748). Results: The study included 372 women randomized into three groups (124 women in each group). Chewing gum significantly improved intestinal recovery with faster onset of bowel movements, first audible intestinal sounds, passage of flatus and passage of stool (p =.0001). It was associated with significantly shorter duration of hospital stay and parenteral therapy duration (p =.0001). Abdominal distension, vomiting and ileus postoperatively were significantly higher in nonchewing gum groups. Neither paralytic ileus nor side effects were recorded with gum use. Conclusion: Chewing gum, within 2 h postoperatively, is a simple, safe and well-tolerated intervention that can boost rapid intestinal recovery and shorten hospital stay after planned cesarean deliveries. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

Author Info:
aDepartment of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
bDepartment of Obstetrics and Gynaecology, Benha University, Benha, Egypt
cDepartment of Obstetrics and Gynaecology, Ain Shams University, Cairo, Egypt
dDepartment of Obstetrics and Gynaecology, Zagazig University, Zagazig, Egypt
eDepartment of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt


Authors:
Daef EA1, Elsherbiny NM1, Agban MN1, Riad KF2, Mohammed LF3.

Title:
Bloodstream Infections in Febrile Neutropenic Pediatric Cancer Patients: Microbiological and Sepsis Biomarkers Insight

Abstract:
The diagnosis of blood steam infections (BSIs) in febrile neutropenic pediatric cancer patients (FNPCP) remains a challenge. Although blood culture is the most accurate method; yet the delay in results has urged the need for reliable biomarkers for early diagnosis. The objectives of this study were to identify the bacterial causes of BSIs in FNPCP at SECI and their antimicrobial susceptibility patterns. Also, to assess the value of procalcitonin (PCT), interleukin 6 (IL6), and interleukin 10 (IL 10) for early diagnosis of BSIs. This study included 68 FNPCP with a total of 85 fever episodes. Blood cultures were done at the onset of fever. Identification of the organisms was carried by Vitek 2 system and the antimicrobial susceptibility testing by disc diffusion. The levels of PCT, IL-6 and IL-10 serum levels were measured by ELISA. Blood stream bacterial infection was detected in 29.4% (25/85). Most were Gram positive cocci in 53.6 % (15/28). There were high percentages of multidrug resistant organism (MDRO) (73.3% and 92.3% among Gram positive and negative bacteria, respectively). The least percentage of resistance was to linezolid (0%) and amikacin (15.4%). The levels of the biomarkers were significantly higher in patients with positive bacterial cultures compared to those with negative cultures (P < 0.001). IL -6 had the best sensitivity (96%) (AUC 0.975, cut off 0.925ng/L) with considerable specificity (88.3%). Combined PCT & IL-6 had the highest sensitivity (96%) and specificity (98.3%). We conclude that the percentage of BSIs among FNPCP was considerable. Gram positive bacteria were the commonest causes. High percentages of MDRO were reported. The most efficient antimicrobials were linezolid and amikacin. IL-6 alone had the best sensitivity for early diagnosis of BSIs. The combination of PCT and IL 6 showed the best performance.

Author Info:
1
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Department of Cancer Biology , South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Authors:
Gadelmoula M1, Abdel-Kader MS2, Shalaby M1, Abdelrazek M2, Moeen AM1, Zarzour MA3, Mohammed N3, Fornara P3.

Title:
Laparoscopic versus open pyeloplasty: a multi-institutional prospective study

Abstract:
INTRODUCTION:
To prospectively compare the perioperative and functional outcomes of laparoscopic (LP) and open pyeloplasty (OP) in three academic institutions.

MATERIAL AND METHODS:
Between September 2012 and September 2016, 102 patients with primary uteropelvic junction obstruction (UPJO) underwent pyeloplasty (51 LP and OP for the other 51 patients). Demographic data, perioperative parameters, including operative time, estimated blood loss, complications, length of hospital stay, and functional outcome were compared, and SF-8 Health Survey scoring was recorded for each group.Patients were followed up by ultrasound (US) and /or intravenous urography (IVU) at 3, 6 and 12 months. A MAG-3 renal scan was performed at 3 months postoperatively.

RESULTS:
The mean operative time was significantly shorter in the open group (153.2 ±42 min vs. 219.8 ±46 min; P <0.001). Compared to OP, the mean postoperative analgesia (Diclofenac) requirement was significantly less in the LP group (101.1 ±36 mg vs. 459.1 ±123 mg; P <0.001). The median hospital stay was significantly shorter for LP (2.7 ±1.8 days vs. 9.09 ±7.3 days; P <0.001). The median follow-up period was 19.7 months (12-28 months). The success rate was 96.1% in the OP group and 94.1% in the LP group.

CONCLUSIONS:
In spite of being a technically demanding procedure, LP offers faster recovery and higher patient satisfaction. In our hands, OP still has a shorter operative time and relatively lower retreatment rate.

Author Info:
1
Assiut University, Urology and Nephrology Hospital, Department of Urology, Assiut, Egypt.
2
Department of Urology, Qena Faculty of Medicine, South Valley University, Egypt.
3
Department of Urology and Kidney Transplantation, Martin-Luther University, Halle (Saale), Germany.


Authors:
Hetta HF1, Ez-Eldeen ME2, Mohamed GA2, Gaber MA3, ElBadre HM3, Ahmed EA4, Abdellatief RB4, Abd-ElBaky RM5, Elkady A6, Nafee AM1, Zahran AM7, Ahmad M8.

Title:
Visfatin Serum Levels in Obese Type 2 Diabetic Patients: Relation to Proinflammatory Cytokines and Insulin Resistance

Abstract:
Visfatin, an adipocytokine with insulin-mimetic activity, has been previously reported to associate with obesity. Herein, we aimed to investigate the serum level of visfatin and association with proinflammatory markers and insulin resistance in obese type 2 diabetic patients. A case control study was carried out among 80 diabetics and 40 non-diabetic healthy controls, after obtaining Anthropometric measurements and blood pressure. Serum level of visfatin and C-reactive protein (CRP) were measured by Enzyme Immunoassay. Interleukin 6 (IL6), tumor necrosis factor α (TNF-) were measured by ELISA and the homeostasis model assessment for insulin resistance was calculated as a marker of insulin resistance. Compared to healthy controls, diabetic patients showed a significant high serum levels of visfatin (40.33±9.98 vs 19.03±8.22), (P= 0.001), IL6 (12.06±2.69 vs 6.02±3.03), (P < 0.0001), TNF- (13.53±2.54 vs 8.70±3.40), P < 0.0001) and CRP (7.77±1.61 vs 6.01±1.99), (P=0.003). Also there was a strong positive correlation between serum level of visfatin, IL6, TNF- and CRP and some anthropometric characteristics including (WC,BMI and insulin resistance). Furthermore, among 80 diabetic patients, serum level of visfatin was positively correlated with IL6 (r=0.47, P < 0.0001), TNF- (r=0.62, P < 0.0001), CRP (r=0.4, P=0.002) respectively. In conclusion, there is a strong positive correlation between visfatin serum level and the inflammatory markers IL6, TNF- and CRP in type 2 diabetic patients. There is also a positive correlation with insulin resistance and BMI which indicates association of visfatin with obesity and type 2 diabetes mellitus.

Author Info:
1
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Microbiology & Immunology, Faculty of Pharmacy, Minia University, Minia, Egypt.
6
Sohag General Hospital, Sohag, Egypt.
7
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
8
College of Nursing & College of Science, King Saud University, Riyadh, Saudi Arabia.


Authors:
Mostafa, A.M.a,  Khamis, Y.b,  Helmy, H.K.c,  Arafa, A.E.d,  Abbas, A.M.e

Date of Publishing:
Volume 23, Issue 1, March 2018, Pages 68-71

Title:
Prevalence and patterns of female sexual dysfunction among overweight and obese premenopausal women in Upper Egypt; a cross sectional study

Abstract:
Objective: Obesity is a growing public health concern. Many reports link obesity to female sexuality. The purpose of this study is to assess the prevalence and patterns of female sexual dysfunction (FSD) among overweight and obese premenopausal women in Beni-Suef, Egypt. Study design: A cross sectional study. Setting: Beni-Suef, Egypt. Subjects and methods: 150 premenopausal non-pregnant married women were enrolled for the study. Socio-demographic characteristics and obstetric history were collected using a self-administered questionnaire. Sexual dysfunction was assessed using the Arabic version of female sexual function index (ArFSFI). Results: The mean age of the participating women was 31.2 ± 7.3 years and the mean BMI was 27.5 ± 1.9 kg/m2. Circumcision was reported by 59.3% of women. Precisely, 42 (28%) of women had FSD. Pain, lubrication and arousal were the most common reported problems 69.3%, 53.3% and 52%, respectively. Obese women were more likely to have desire, arousal and lubrication problems compared to the overweight. FSFI total score correlated negatively with age of women, marriage duration and parity (p < 0.05), but did not correlate with BMI (p > 0.05). Conclusion: Problems in pain, lubrication and arousal were the most common patterns of sexual dysfunction among overweight Egyptian women. Further research over the effect of certain interventional programs on FSD should be considered. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Dermatology and Andrology, Faculty of Medicine, Beni-Suef University, Egypt
bDepartment of Obstetrics & Gynecology, Faculty of Medicine, Beni-Suef University, Egypt
cDepartment of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt
dDepartment of Public Health, Faculty of Medicine, Beni-Suef University, Egypt
eDepartment of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt


Authors:
Sobhy A1, Fakhry M M2, A Azeem H3, Ashmawy AM4, Omar Khalifa H5.

Title:
Significance of biglycan and osteopontin as non-invasive markers of liver fibrosis in patients with chronic hepatitis B virus and chronic hepatitis C virus

Abstract:
Several studies were performed to evaluate the degree of liver fibrosis by non-invasive markers. We aimed to assess the diagnostic value of both biglycan (BGN) and osteopontin (OPN) as non-invasive markers of hepatic fibrosis in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). This study was performed on 100 patients with CHB virus, 100 patients with CHC virus and 100 normal controls. All participants were subjected to the following laboratory tests: hemoglobin, platelet, alanine aminotransferase, aspartate aminotransferase, albumin, international normalized ratio, HBs Ag, hepatitis C virus (HCV) antibody, hepatitis B virus DNA, HCV RNA, liver biopsy, BGN and OPN. We found that BGN level was significantly increased in the CHB group compared with the controls (p<0.001), but the level was not different between the CHC group and the controls (p<0.96). OPN was increased in both the CHB and CHC groups compared with the controls (p<0.001). Positive correlation was found between fibrosis stages and BGN level of the CHB group (r=0.64; p<0.001) and between fibrosis stages and OPN level of the CHB (r=0.63; p<0.001) and CHC (r=0.59; p<0.03) groups. The area under the curve (AUC), sensitivity and specificity of BGN were 1.0, 100% and 100% in predicting fibrosis in patients with CHB, and 0.50, 26% and 78% in predicting fibrosis in patients with CHC. OPN had an AUC of 0.997, sensitivity of 96% and specificity of 100% in predicting fibrosis in patients with CHB, and 0.974, 96.5% and 100% in predicting fibrosis in patients with CHC. In conclusion, BGN and OPN could be considered non-invasive markers for liver fibrosis assessment.

Author Info:
1
Clinical Pathology Department., Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
2
Gastroenterology and Hepatology Department, Faculty of Medicine., Al-Azhar University, Assiut.
3
Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
4
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Public Health andCommunity Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.


Authors:
Abbas, A.M.aEmail Author,  Wagdy, W.M.b,  Salem, M.N.c,  Abdelqader, A.M.a

Date of Publishing:
Volume 23, Issue 1, March 2018, Pages 52-56

Title:
Effect of oral diclofenac potassium plus cervical lidocaine cream on pain perception during hysterosalpingography: A randomized, double-blind, placebo-controlled trial

Abstract:
Objective: The current study aims to investigate the analgesic effect of combining oral diclofenac potassium and cervical lidocaine cream for alleviating pain during HSG. Study design: A randomized double-blind controlled trial. Setting: Assiut University Hospital, Assiut, Egypt. Materials and methods: Reproductive-aged infertile women scheduled for HSG were recruited and randomized (1:1) to diclofenac plus lidocaine or Placebo group. All women received oral 50 mg diclofenac potassium or placebo tablets one hour before HSG, then 3 ml of lidocaine 5% cream or placebo was applied to the anterior cervical lip, followed by 3 ml placed in the cervical canal using a sterile needless syringe. The study outcomes was the participant's self-rated pain perception utilizing a 10-cm Visual Analogue Scale (VAS) during speculum placement, cervical tenaculum placement, injection of the dye, 5 min and 30 min post-procedure. Results: One hundred forty women were enrolled (n = 70 in each group). Oral diclofenac plus lidocaine cream significantly reduce the median VAS pain scores during injection of the dye (4 vs. 7), 5 min post-procedure (2 vs. 4) and 30 min post-procedure (1 vs. 2.5) with p = 0.0001 at all steps. No significant differences in VAS score after speculum or tenaculum placement. Conclusions: Utility of oral diclofenac potassium one hour before HSG combined with cervical lidocaine 5% cream significantly alleviate the induced pain during and 30 min after the HSG procedure. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
bDepartment of Radiology, South Valley University, Qena, Egypt
cDepartment of Obstetrics and Gynecology, Sohag University, Sohag, Egypt


Authors:
Abbas, A.M.aEmail Author,  Abo-Elela, N.A.b,  Mosa, E.M.b

Date of Publishing:
Volume 23, Issue 1, March 2018, Pages 57-62

Title:
Effect of oral hyoscine-N-butyl bromide on pain perception during hysterosalpingography: A randomized, double-blind, placebo controlled trial

Abstract:
Objectives: The current study aims to investigate the analgesic effect of oral hyoscine-N-butyl bromide (HBB) for alleviating pain during hysterosalpingography (HSG). Study design: Randomized, double-blind, placebo-controlled study. Study setting: Assiut University Hospital, Egypt. Materials and methods: The study was conducted between March and May 2016. Infertile women scheduled for HSG were randomized (1:1) to HBB or Placebo group. All women received oral 20 mg HBB or placebo tablets 30 min before the procedure. The primary outcome was the participant's self-rated pain perception utilizing a 10-cm Visual Analogue Scale (VAS) with 0 = no pain, and 10 = worst imaginable pain during the HSG procedure. Results: Ninety-four women were enrolled (n = 47 in each group). No difference in the baseline characteristics. Oral HBB does not reduce the median VAS pain scores during injection of the dye (3.75 vs. 4.5, p = 0.195), immediately post-procedure (3 vs. 3, p = 0.102) and 30 min post-procedure (2 vs. 2.5, P = 0.745). No significant differences in women satisfaction score (p = 0.302). The rate of side effects was higher in the HBB group especially nausea (14.9%) and dizziness (10.6%) (p = 0.0001). Conclusion: Utility of oral HBB 30 min before HSG has no benefit in alleviating the induced pain during and 30 min after the HSG procedure. © 2017 Middle East Fertility Society

Author Info:
aDepartment of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
bDepartment of Radiology, Assiut University, Assiut, Egypt


Authors:
El Wasify, M.a,  Fawzy, M.b,  Barakat, D.c,  Youssef, U.e,  El Wasify, M.a,  Saleh, A.d,f,  Helmy, K.f,  Hamed, S.A.b

Title:
The Sociodemographic and Clinical Characteristics of Tramadol Dependence among Egyptians and Their Relationship to the Associated Insomnia

Abstract:
Tramadol dependence is a public health problem in Egypt. We aimed to determine the sociodemographic and clinical characteristics of tramadol abuse among Egyptians, the frequency and degrees of insomnia among tramadol abusers, and the relationship between the associated insomnia with sociodemographic and clinical characteristics. Included in this study were 400 subjects (mean age, 30.72±9.61 y) who were tramadol dependent. The subjects were assessed using Structured Clinical Interviewing using DSM-IV (SCID-I), Severity of Dependence Scale (SDS), and Insomnia Severity Index. We found that the mean age at onset of tramadol intake was 21.57±6.71years, and the dose of tramadol/day was 1550.6±438.8 mg; the duration of tramadol dependence was 6.29±4.35 years, and score of SDS was 10.19±2.55. There were 4 main causes of tramadol abuse: premature ejaculation/erectile dysfunction, particularly in male individuals, novelty seeking, escape from troubles, and peer pressure. In total, 69% of subjects had insomnia with a mean score of Insomnia Severity Index of 16.3±3.7. In multiple regression analysis for subjects with insomnia, the variables that were found to be significantly associated with insomnia were as follows: Age at onset, dose and duration of tramadol dependence, and SDS scores. To conclude, insomnia is common in subjects suffering from tramadol dependence and is associated with dose, duration, and severity of tramadol dependence. © Copyright 2018 Wolters Kluwer Health, Inc. All rights reserved.

Author Info:
aDepartment of Psychiatry, Faculty of Medicine, El Mansoura University, El Mansoura, Egypt
bDepartment of Neurology and Psychiatry, Assiut University, Hospital of Neurology and Psychiatry, Floor #7, Room #4, Assiut, 71516, Egypt
cDepartment of Psychiatry, Faculty of Medicine, Ain Shams University, Egypt
dPsychiatry and Addiction Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
eDepartment of Psychiatry, Zagazig University, Zagazig, Egypt
fNew Nozha Hospital, Alexandria, Egypt


Date of Publishing:
Volume 24, Issue 2, June 2018, Pages 83-92

Title:
Abdominoscrotal hydrocele: A systematic review and proposed clinical grading

Abstract:
Introduction: Abdominoscrotal hydrocele is a rare hydrocele variant in pediatrics and adults. Besides the historical concerns, controversies in etiology and management of abdominoscrotal hydrocele warrant studying. Subjects and methods: A systematic review was conducted based on a multilingual search of the world literature of abdominoscrotal hydrocele through electronic engines (Google Scholar and MEDLINE/PubMed). The demographic and clinical characteristics are critically addressed and a clinical grading system is proposed. Results: From the 487 delivered articles, 320 articles were eligible to this review including only 21 case series. They delivered 579 abdominoscrotal hydrocele cases. Abdominoscrotal hydrocele affects pediatrics more than adults with significantly increased rate of reporting in the last decades. Full or incomplete case descriptions were found in 558 cases versus 21 cases with deficient description. Abdominoscrotal hydrocele has been reported from 45 countries and India has the highest rate. Eight proposed hypotheses were differentiated for etiology and grouped according to the direction of fluid formation and hydrocele growth. Associated congenital anomalies include contralateral hydroceles and cryptorchidism. Complications result from compression, hemorrhage, infection, torsion, and coincident malignancy. A clinical grading system considering the increased anatomical, pathological or clinical complexities has been proposed and provided two categories; simple and complex abdominoscrotal hydroceles with further sub-classes. Conclusions: Abdominoscrotal hydrocele is rare, but the number of the reported cases is far larger than the previously reported numbers. Etiology follows multiple hypotheses and management is speculative. Proposed clinical grading may support differentiation of severity of the associated cumulative risks. © 2018 Pan African Urological Surgeons Association

Author Info:
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt


Date of Publishing:
Volume 12, Issue 1, 1 October 2018, Pages 33-38

Title:
Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 3. Urological Electrosurgical Never Events

Abstract:
Introduction: Surgical fires are unique topics that belong to surgical never events and deserve urological attention. Materials and Methods: A retrospective search of our hospital records was done for the states of electrosurgical never events in the period from July 2001 to June 2016. The included events were classified according to the site of occurrence in relation to the patient's body and possibilities of human involvement. The events were studied for the type, extent, damages, personnel involvements, complications, and management. Results: Of more than 82,000 urological interventions, 18 cases (0.022%) of electrosurgical never events were detected. Four subcategories were differentiated: electrosurgical theater fires (33.3%), electrosurgical contact skin burns (38.9%), electrosurgical internal injuries (16.7%), and electrocutions (11.1%). Electrosurgical theater fires included 3 ignition fires with fire skin burns and 3 device explosions. Fires only occurred with the use of alcoholic skin disinfectants. Contact skin burns resulted from inadvertent direct electrosurgical contacts, with 2 burns on the back, 3 burns on the lower limbs, 1 burn at the penile shaft, and 1 burn at the suprapubic region. Only 1 case of contact skin burn required plastic surgery. Electrosurgical internal in-juries involved the intestine, spleen, and urethra and were followed by major complications. Electrocutions involved a doctor and a patient with multiple bone fractures in the former. Conclusion: Urological electrosurgical never events are very rare incidents and were differentiated into 4 clinical subcategories. Human involvements varied from absence to major devastating complications. Reduction of these events depends on the adjusted use of electricity-based armamentarium. © 2018 2018 The Author(s) Published by S. Karger AG, Basel.

Author Info:
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut, EG-71515, Egypt


Authors:
Gadelkareem, R.A.aEmail Author,  Reda, A.aEmail Author,  Khalil, M.aEmail Author,  Farouk, M.aEmail Author,  Abdelraouf, A.M.bEmail Author,  Mohammed, N.a,c

Date of Publishing:
Volume 24, Issue 2, June 2018, Pages 108-113

Title:
Laparoscopic excision of a giant adrenal myelolipoma and review of the literature

Abstract:
Introduction: Adrenal myelolipoma is a rare benign tumor. It is usually asymptomatic with variable sizes, where the small lesions are usually managed conservatively and the large and symptomatic ones indicate open or laparoscopic adrenalectomy. Observation: A 45-year-old obese male patient presented with an accidentally-discovered right adrenal mass during abdominal sonographic examination. The mass was clinically-palpable in the right lumbar region. Abdominal computed tomography described a well-circumscribed lesion displacing the right kidney downwards with compression and displacement of the inferior vena cava. It was heterogeneous with 16 cm × 14 cm × 8 cm dimensions and low attenuation appearance. Adrenal myelolipoma was suspected and the patient was counseled for the laparoscopic approach with high possibilities of conversion to open surgery. Laparoscopic excision was done by expert surgeons with demanding dissection from the surroundings, especially the liver and inferior vena cava, but, the mass was successfully removed. The postoperative course was short and uneventful. Histopathological examination confirmed the diagnosis of adrenal myelolipoma. Conclusions: Laparoscopic excision of giant adrenal myelolipoma is a challenging procedure, but it seems to be a feasible promising approach. Expert surgeons are recommended when operating large tumors, especially, in the obese patients. © 2018 Pan African Urological Surgeons Association

Author Info:
aAssiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
bDepartment of Anesthesia and Intensive Care, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
cUrology Department, Martin-Luther University, Halle, Germany


Authors:
Gadelkareem, R.A.aEmail Author,  Khalil, M.M.a,  Mohammed, N.a,b,  Makboul, R.c,  Badary, F.A.c

Date of Publishing:
Volume 24, Issue 1, March 2018, Pages 63-66

Title:
Laparoscopic excision of a large symptomatic and kidney-displacing adrenal myelolipoma: A case report

Abstract:
Introduction: Adrenal myelolipoma is a rare tumor. Traditionally, open surgical adrenalectomy was the standard treatment for symptomatic myelolipoma. However, laparoscopic excision is a promising alternative approach. Observation: A 38-year-old obese male patient presented with right loin pain of many months duration. Imaging studies revealed a large well-defined high fat content right adrenal mass displacing the right kidney. Adrenal tumor markers were within normal suggesting a non-functioning lesion. In spite of some technical difficulties and adjustments, laparoscopic excision was done, successfully, with uneventful recovery and short convalescence. Histopathological examination described mature adipose tissue with myeloid cells and confirmed the diagnosis of adrenal myelolipoma. Conclusions: Laparoscopic excision of large adrenal myelolipoma may indicate some technical adjustments, but it seems to be a feasible and advantageous approach even in obese patients. © 2018 Pan African Urological Surgeons Association

Author Info:
aAssiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
bMartin-Luther University, Halle, Germany
cPathology Departement, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Sayed, J.A.a,  Kamel, E.Z.aEmail Author,  Riad, M.A.F.b,  Abd-Elshafy, S.K.a,  Hanna, R.S.c

Date of Publishing:
Volume 34, Issue 4, October 2018, Pages 115-122

Title:
Dexmedetomidine with magnesium sulphate as adjuvants in caudal block to augment anaesthesia and analgesia in paediatric lower abdominal surgeries

Abstract:
Purpose: To investigate the implication of dexmedetomidine and magnesium sulphate addition to bupivacaine in caudal anesthesia in paediatric lower abdominal surgeries. Study design: Randomized controlled trial. Setting: Paediatric University Hospital. Subjects: 120 children undergoing surgeries in the lower half of the body under general anaesthesia with a supplementary caudal block using 1 ml/kg bupivacaine 0.25%. Methods: Participants were randomly allocated into four groups; group C (saline as an additive to bupivacaine), group MG (50 mg magnesium sulphate added to bupivacaine), group D (1 µg/kg dexmedetomidine added to bupivacaine), and group MGD (the same doses of both dexmedetomidine and magnesium sulphate were added to bupivacaine). Time to first analgesia request (1ry outcome), and pain assessment by The Face, Legs, Activity, Cry, Consolability (FLACC) score just after recovery, then every 30 min in the early two hours, then at the 4th, 6th, 12th,18th, and 24th hours were compared between the groups. Results: Time to first analgesia request was significantly longer in the three study groups compared to group C with p < 0.001 (median values of 5, 14.5, 13.5, and 20.47 h in groups C, D, MG, and MGD in consequence). FLACC scores were significantly higher in group C in comparison to the other study groups by the early 2nd, 4th, and 6th postoperative hours. The group MGD has significantly lowest FLACC at the 6th postoperative hour. Conclusion: The combination of dexmedetomidine and magnesium sulphate with bupivacaine caudal block can prolong the time to first analgesia request. © 2018

Author Info:
aFaculty of Medicine, Assiut University, Assiut, Egypt
bDepartment of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
cDepartment of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Zahran, A.M.a,  Abdel-Meguid, M.M.b,  Ashmawy, A.M.c,  Rayan, A.d,  Elkady, A.e,  Elsherbiny, N.M.f,  Hetta, H.F.f

Date of Publishing:
Volume 25, Issue 2, 1 June 2018, Pages 45-52

Title:
Frequency and Implications of Natural Killer and Natural Killer T Cells in Hepatocellular Carcinoma

Abstract:
A complex role of the immune system has been highlighted in the development and progression of hepatocellular carcinoma (HCC). Natural Killer cells (NK) and natural killer T cells (NKT) cells are among the innate immune lymphocytes that predominate in the liver and can prevent tumor growth and metastasis. The aim of the study was to measure the percentages of NK and NKT cells among a sample of Egyptian patients with HCC and to find the association between their frequencies and disease progression. The study included 2 groups; the HCC patient group (n=40) and the healthy control group (n=20). Blood samples were drawn from all subjects for complete blood picture, liver enzymes and alpha fetoprotein serum level measurement. Flow cytometric analysis was performed for CD3 and CD16/56 for determining the percentages of NK and NKT cells. The frequencies of NK cells and NKT cells were significantly decreased in HCC patients (6.58± 1.76 and 5.26 ± 1.13 respectively) as compared to healthy controls (9.01±1.62 and 6.88 ± 1.88 respectively) (P < 0.001 and 0.0008 respectively) and in HCC patients with metastasis (6.01± 1.11 and 5.07± 1.10 respectively) than HCC patients without metastasis (7.75± 1.98 and 5.89± 0.88 respectively) (P= 0.004 and 0.03 respectively). We concluded that the reduced percentages of NK cells and NKT cells in HCC patients especially in those with metastasis point to their important roles in the occurrence and progression of HCC. Copyright© by the Egyptian Association of Immunologists.

Author Info:
aDepartment of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
bDepartment of Clinical & Chemical Pathology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
cDepartment of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
dDepartment of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt
eSohag General Hospital, Sohag, Egypt
fDepartment of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Albeh, K.A.a,  Elserogy, Y.a,  Sherif, T.M.b,  Noaman, M.M.a,  Khalifa, H.aEmail Author,  Esam, N.a

Date of Publishing:
Volume 25, Issue 3, 1 July 2018, Pages 116-121

Title:
Hormonal level and serum serotonin in patients with first episode mania: A casecontrol study

Abstract:
Objective This study was performed to provide data on the underlying laboratory findings as part of the pathophysiology of manic symptoms in first episode bipolar-I manic disorder and to finda correlation between laboratory findings and severity of disorder. Patients and methods A total of 30 patients with first episode bipolar-I manic disorder according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria participated in the study. They were referred from the outpatient clinic of psychiatry at Assiut University Hospital and from the private clinics of the staff members of neuropsychiatry, who were evaluated with the Young Mania Rating Scale (YMRS) to assess the severity of bipolar disorder and laboratory assessment which include: serum cortisol level (a.m. and p.m. tests), serum thyroid hormone level (T3, T4, and thyroid-stimulating hormone), and serum serotonin level. A total of 15 healthy controls matched with the patient groups in age, sex, and socioeconomic status were assessed using the same tools. Results We found that the mean thyroid-stimulating hormone, T3 and, serum serotonin levels were higher in cases than in controls whereas the mean T4 and cortisol p.m. levels were lower in cases than controls and a positive significant correlation was found between the YMRS score and T3, T4, and cortisol p.m. level. Conclusion The underlying laboratory findings are a specific pathophysiology of manic symptoms and there is a positive correlation between laboratory findings and severity of manic symptoms evaluated with the YMRS. © 2018 Lippincott Williams and Wilkins. All rights reserved.

Author Info:
aDepartment of Neuropsychiatry, Assiut University Hospital, Assiut, 71511, Egypt
bClinical Pathology, Assiut University Hospitals, Assiut, Egypt


Authors:
Gomaa, A.A.-W.aEmail Author,  Abdel Aziz, N.M.b,  Thabet, R.H.a,  Fouly, H.A.c,  Altellawy, S.H.d,  Gomaa, G.A.e

Date of Publishing:
Volume 38, Issue 1, 1 February 2018, Pages 60-67

Title:
A Pilot Study of a Topical Intervention for Treatment of Female Sexual Dysfunction

Abstract:
Purpose/Background Many investigators reported that pharmacological treatment of female sexual dysfunction (FSD) has been a promising field yet to be explored. The purpose of this pilot study was to investigate the efficacy and safety of a topical cream containing small concentrations of three vasodilators with different mechanisms of action in treating FSD. Methods In this randomized, controlled pilot trial, premenopausal (n = 30) and postmenopausal (n = 30) cases of 21- to 62-year age range with FSD were allocated randomly into 15 given placebo or 15 given active cream in each group. The women included had FSD for more than a 6-month duration and a total score of Female Sexual Distress Scale-Revised of at least 15. Assessing sexual function by measuring female sexual function index (FSFI) during five clinic visits, one at the end of baseline week and at the end of each week of the 4-week treatment period. The primary end point was changed from baseline FSFI total scores to week 4 treatment. Secondary end point included the changes from baseline arousal, desire, orgasm, and satisfaction scores to week 4 treatment. Findings/Results The sexual problem reported by patients was orgasmic or/and arousal disorders. In premenopausal cases, active cream led to a high significant increase in mean change FSFI total score from the baseline to week 4 compared with placebo (1.7 ± 1.886 vs 13.35 ± 4.646, respectively; P < 0.0001). Greater improvement of mean change of orgasm and arousal domain score was also observed (0.3 ± 0.45 and 0.35 ± 0.39 vs. 2.66 ± 0.63 and 1.87 ± 0.168, respectively; P < 0.0001). In postmenopausal cases, there were significantly greater improvements with active cream in all sexual functions compared with placebo cream (P < 0.0001). In triple cream, mean change of FSFI total score, orgasm domain score, and arousal score domain were 14.85 ± 6.33, 1.87 ± 0.168 and 2.66 ± 1.182, whereas in the placebo cream, they were 1.54 ± 2.1,0.7 ± 0.76 and 0.22 ± 0.44, respectively. Meanwhile, orgasm scores increased significantly after the use of placebo cream. No serious adverse effects were reported during treatment. Implications/Conclusions The results of the pilot trial suggest that topical cream containing small concentrations of three vasodilators may act synergistically, and was effective in improving arousal, orgasmic, and satisfaction disorder with a safer profile for premenopausal and postmenopausal women with FSD. Further studies are recommended to be conducted using a large number of nondepressive and depressive patients. © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Author Info:
aDepartment of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
bDepartment of Gerontology, Faculty of Nursing, Egypt
cDepartment of Obstetrics and Gynecology, Faculty of Nursing, Egypt
dDepartment of Psychology, Faculty of Arts, Assiut University, Egypt
eDepartment of Dermatology, University Hospital, Assiut University, Egypt


Authors:
Eloseily, E.M.a,  Cron, R.Q.bEmail Author

Journal:
The Microbiome in Rheumatic Diseases and Infection

Author Info:
aAssiut University Children's Hospital, Assiut, Egypt
bUniversity of Alabama at Birmingham, Birmingham, AL, United States


Authors:
Emad, Y.aEmail Author,  Gheita, T.a,  Darweesh, H.a,  Klooster, P.b,  Gamal, R.c,  Fathi, H.d,  El-Shaarawy, N.e,  Gamil, M.f,  Hawass, M.g,  El-Refai, R.M.a,  Al-Hanafi, H.h,  Abd-Ellatif, S.i,  Ismail, A.j,  Rasker, J.b

Title:
Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: Correlations with clinical manifestations and disease activity

Abstract:
The aim was to explore possible correlations of antibodies to extractable nuclear antigens (ENA) with clinical manifestations and disease activity indices in systemic lupus erythematosus (SLE) patients. A total of 70 consecutive SLE patients (64 females) were included. Disease activity was assessed by SLE activity index (SLEDAI), and British Isles Lupus Assessment Group (BILAG). Anti-Ro/SSA correlated positively with, headache (r=0.24, p=0.04), blurring of vision (r=0.25, p=0.03) andSLEDAI (r=0.25, p=0.04) and negatively with C3 (r=–0.35, p=0.003). Anti-Ro/SSA correlated with anti La/SSB antibodies (r=0.69, p<0.001), but not with anti-DNA, anti-RNP and anti-Sm antibodies. Anti-La/SSB antibodies correlated with headache (r=0.26, p=0.03), SLEDAI (r=0.25, p=0.03) and negatively with C3 (r=–0.34, p=0.004). Anti-La/SSB did not correlate with anti-RNP or anti-Sm antibodies. Anti-Sm antibodies correlated with disease duration (r=0.34, p=0.003), 24 hours urinary proteins (r=0.31, p=0.008), SLEDAI (r=0.31, p=0.009), BILAG renal score (r=0.29, p=0.02) and negatively with age at onset (r=–0.27, p=0.02), WBCs (r=–0.29, p=0.014) and C4 (r=–0.25, p=0.049). In multivariate analyses, anti-Ro/SSA antibodies remained associated with headache, blurring of vision and C3 and anti-La/SSB antibodies remained associated with C3 and with headache. Anti-Sm antibodies were independently associated with disease duration and total SLEDAI scores, wh le anti-RNP antibodies remained significantly associated with BILAG mucocutaneous scores only. Antibodies to ENAs are associated with clinical aspects of SLE and may play a role in the assessment of disease activity. Insight into these ENAs may lead to new approaches to diagnostic testing, accurate evaluation of diseaseactivity and lead to target approach for SLE. © 2018, Page Press Publications. All rights reserved.

Author Info:
aRhumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
bFaculty of Behavioral, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, Netherlands
cRheumatology and rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
dRheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
eRheumatology and Rehabilitation Department, Suez Canal University, Ismailia, Egypt
fInternal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
gNephrology Department, Al-Shorta Hospital, Cairo, Egypt
hClinical and chemical pathology department Faculty of Medicine, Cairo University, Cairo, Egypt
iDepartment of Rheumatology and Rehabilitation at Al-Azhar University, Cairo, Egypt
jDermatology department, Al-Azhar University, Cairo, Egypt


Authors:
Hasanain, A.F.A.aEmail Author,  Zayed, A.A.-A.H.b,  Abd-ellatief, R.B.c,  Nafee, A.M.A.d

Title:
Efficacy and safety of cholecalciferol-augmented anti-tuberculosis therapy for treatment of naïve patients with pulmonary tuberculosis: A randomized, controlled, clinical study

Abstract:
Background/objective: Vitamin D deficiency may contribute to the therapeutic failure of antituberculosis therapy (ATT). The aim of this study is to explore the role of adding cholecalciferol to the standard ATT in improving the therapeutic outcome among the naïve patients with pulmonary tuberculosis (TB). Methods: A randomized, controlled, clinical study, which included 496 naïve patients with pulmonary TB, was carried out. The patients were randomly allocated to two groups. Group-A included 247 patients who received ATT, while group-B included 249 patients who received ATT with cholecalciferol. Results: The rate of therapeutic failure among the study population was 29.4%; it was significantly lower among patients of group-B compared to those of group-A (22.1% (95% CI 14.7–26.2) vs 38.1% (95% CI 31.5–46.1), p 0.036). In addition, the rate of early therapeutic response was significantly higher among patients of group-B compared to those of group-A (35.3% (95% CI 29.6–42.3) vs 19.4% (95% CI 15.1–24.6), p 0.041). Incidence rate of adverse effects was 19.3%; it was higher (although not statistically significant) among patients of group-A compared to those of group-B (21.9% vs 16.9%). Conclusions: In conclusion, cholecalciferol-augmented ATT can be more efficacious in treating naïve patients with pulmonary TB compared to the standard ATT. In addition, adding vitamin D3 to ATT provides extra protection against the hepatic and muscular adverse effects of ATT. © 2018 Tuberculosis Association of India

Author Info:
aDepartment of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Egypt
bDepartment of Chest Diseases and Tuberculosis, Assiut University, Egypt
cDepartment of Pharmacology, Assiut University, Egypt
dDepartment of Microbiology and Immunology, Assiut University, Egypt


Authors:
Hofny, E.R.M.a,  Hasan, H.I.b,  Mohamed, N.A.c,  Bamatraf, M.S.a,  Mahran, A.M.M.a

Journal:
Journal of the Egyptian Women's Dermatologic Society

Title:
Serum and tissue levels of total antioxidant capacity in nonsegmental vitiligo

Abstract:
Background Vitiligo is the most common depigmentation disorder of the skin. Oxidative stress is implicated as one of the probable events involved in vitiligo pathogenesis, possibly contributing to destruction of melanocytes. The role of oxidative stress has not been fully understood in the etiopathogenesis of vitiligo. Objective To evaluate total antioxidant capacity (TAC) in the serum and tissue of patients with nonsegmental vitiligo. Patients and methods We examined TAC levels in serum and tissue of 48 patients with nonsegmental vitiligo and 30 healthy volunteers by colorimetric method using a commercial kit. The collected data were analyzed by SPSS version 16. Results The mean age of vitiligo patients was 32.6±12.4 years. Overall, 65% of patients were females, and 33% of patients have positive family history. The mean vitiligo area scoring index score was 5.84±6.57. TAC levels in sera and tissues were significantly lower in patients with vitiligo than in controls. Moreover, TAC levels were lower in the lesional skin than in the serum, perilesional, and unaffected skin of the patients. Decreased TAC levels were identified to be associated with unstable cases. Conclusion We proved a defective antioxidant system in vitiligo in the form of abnormally low serum and tissue levels of TAC. These findings provide further support for a free radical-mediated damage, especially on the tissue level, as an initial pathogenic event in destruction of melanocytes in vitiligo. Therefore, these findings support the role of antioxidant therapy in vitiligo. © 2018 Egyptian Women's Dermatologic Society.

Author Info:
aDepartments of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut University Hospital, Assiut, 71515, Egypt
bDepartments of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
cDepartments of Biochemistery, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Pestana, R.C.a,  Hassan, M.M.bEmail Author,  Abdel-Wahab, R.c,g,  Abugabal, Y.I.c,  Girard, L.M.c,  Li, D.c,  Chang, P.c,  Raghav, K.c,  Morris, J.d,  Wolff, R.A.c,  Rashid, A.e,  Amin, H.M.f,  Kaseb, A.c

Date of Publishing:
Volume 9, Issue 102, 1 December 2018, Pages 37721-37732

Title:
Clinical and prognostic significance of circulating levels of angiopoietin-1 and angiopoietin-2 in hepatocellular carcinoma

Abstract:
Angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) play critical roles in angiogenesis in hepatocellular carcinoma (HCC). In addition, recent data suggest that Ang-1/Ang-2 are involved in regulating the immune response. The aim of our study was to explore the clinical prognostic significance of plasma Ang-1 and Ang-2 in HCC. We prospectively enrolled and collected data and blood samples from 767 HCC patients treated at MD Anderson Cancer Center between 2001 and 2014. Controls consisted of cirrhotic patients (n = 75) and healthy volunteers (n = 200). The cutoff value was the median level of each angiogenic factor. Overall survival (OS) was estimated by Kaplan–Meier curves and compared by the log-rank test. Higher plasma Ang-2 was significantly associated with advanced clinicopathologic features of advanced HCC and lower OS. Median OS was 61.8 months (95% confidence interval [CI], 45.1–78.5 months) for low Ang-2 compared with 28.5 months (95% CI, 24.8–32.1 months) for high Ang-2 (p < 0.001). In contrast, higher Ang-1 was associated with longer OS. Median OS was 37.2 months (95% CI, 31.0–43.4 months) for high Ang-1 compared with 26.2 months (95% CI, 22.2–30.3 months) for those with low Ang-1 (p = 0.043). In conclusion, our findings indicate that plasma Ang-1 and Ang-2 levels are potential diagnostic and prognostic biomarkers in HCC. Copyright: Pestana et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License 3.0 (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Author Info:
aDepartment of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
bDepartment of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
cDepartment of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
dDepartment of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
eDepartment of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
fDepartment of Hemopathology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
gDepartment of Clinical Oncology, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt


Authors:
Temsah, M.-H.A.a,b,dEmail Author,  Al-Sohime, F.M.a,d,  Bashiri, F.A.a,c,d,  Al-Eyadhy, A.A.a,d,  Hasan, G.M.e,  Alhaboob, A.A.a,d

Date of Publishing:
Volume 23, Issue 1, January 2018, Pages 62-65

Title:
Respiratory support attitudes among pediatric intensive care staff for spinal muscular atrophy patients in Saudi Arabia

Abstract:
Objectives: To explore therapeutic attitude of healthcare providers practicing in pediatric critical care in Saudi Arabia toward patients with Spinal Muscular Atroph (SMA) Type I, and to explore their awareness about the International Consensus statement for SMA care. Methods: A cross-sectional survey was conducted in April 2015 during 6th Saudi Critical Care Conference, targeting physicians and respiratory therapists practicing in Pediatric Critical Care. Results: Sixty participants accepted to participate in this survey. Out of those who answered the questionnaire, 44 were included in the analysis. Majority (66%) of participants were unaware of the International Consensus guidelines for SMA. Endotracheal intubation was reported as an acceptable intervention in SMA patients with acute respiratory failure by 43% of participants. Similarly, chronic home ventilation was agreed by 41% of participants. Conclusion: A nationwide adaptation of the International SMA Consensus guidelines for children with SMA I is recommended, aiming to decrease variability and standardize their management across various healthcare facilities in Saudi Arabia. © 2018, Saudi Arabian Armed Forces Hospital. All rights reserved.

Author Info:
aCollege of Medicine, King Saud University, Riyadh, Saudi Arabia
bPrince Abdullah Bin Khalid Coeliac Disease Research, King Saud University, Saudi Arabia
cDivision of Pediatric Neurology, King Saud University Medical city, Riyadh, Saudi Arabia
dDepartment of Pediatric, King Saud University Medical City, Riyadh, Saudi Arabia
eDepartment of Paediatrics, Faculty of Medicine, Assiut University, Egypt


Authors:
Yousif, H.M.aEmail Author,  Mohammed, R.A.b,  Missawi, H.M.c,  Elsawaf, Z.M.a,  Albasri, A.M.a

Journal:
Journal of Taibah University Medical Sciences

Title:
Histopathological patterns of primary malignant ovarian neoplasms in different age groups in Almadinah Almunawwarah region, KSA

Abstract:
Objectives: In the literature, the epidemiological pattern of ovarian neoplasms in different age groups in the Almadinah Almunawwarah region in KSA has not been completely elucidated. Moreover, an unusually frequent diagnosis of adult granulosa cell tumour (AGCT) has been observed in patients in Almadinah Almunawwarah, KSA. This study aimed to describe the pattern of ovarian neoplasms in different age groups in the Almadinah Almunawwarah region with particular emphasis on AGCT. Methods: Histopathological records of all ovarian specimens diagnosed from 2011 January to 2016 December were collected from the Maternity and Children Hospital in Almaadinah Almunawwarah, KSA. Hematoxylin and eosin (HE)-stained microscopic slides of serous and mucinous epithelial borderline neoplasms and of malignant epithelial, sex cord-stromal and germ line neoplasms were identified and examined. The tissue sections from the AGCT were stained immunohistochemically with BRCA-1 antibody. Results: A total of 301 ovarian specimens were obtained. Of the specimens, 217 (72%) were neoplastic and 84 (28%) were non-neoplastic. In total, 135 (63%) of the neoplastic specimens were benign, 16 (7%) were borderline tumours, and 66 (30%) were malignant tumours. Moreover, 41 (62%) of the malignant tumours were surface epithelial carcinomas, 17 (26%) were sex cord-stromal tumours, and 8 (12%) were germ cell tumours. The incidence of AGCT was unusually high, which accounts for 26% (16/66) of all malignant ovarian neoplasms. Altered BRCA-1 expression was observed in only two specimens. Conclusion: In this study, malignant ovarian neoplasms accounted for 30% of all neoplastic ovarian specimens, and the incidence of AGCT was remarkable. Such tumours did not show a significantly altered expression of BRCA-1. Further studies must be conducted to explore the underlying molecular causes of this condition. © 2018 The Authors

Author Info:
aDepartment of Pathology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
bDepartment of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
cDepartment of Histopathology and Cytopathology, Maternity and Children Hospital, Almadinah Almunawwarah, Saudi Arabia


Authors:
Fathi, N.a,  Goma, S.H.aEmail Author,  Ismail, N.M.a,  Ghandour, A.M.a,  Youssef, S.S.a,  Mohammed, N.A.b,  Mosad, E.c

Date of Publishing:
Volume 40, Issue 1, January 2018, Pages 45-49

Title:
Expression of anti-heterogenous nuclear ribonucleoprotein (anti-hnRNP) in limited systemic sclerosis patients: Relation to radiographic findings of the hand

Abstract:
Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease with vascular, fibrotic and immune changes of skin and some internal organs. Anti-heterogeneous nuclear ribonucleoproteins (anti-hnRNP) were found in SSc patients. Aim of the work: To assess anti-hnRNP A1 and A2 autoantibodies in limited SSc patients and to find their relation to clinical and hand radiographic characteristics. Patients and methods: 26 limited SSc patients and 16 matched control were studied. Skin thickness was scored according to the modified Rodnan skin score method (mRss) and radiologic examination by plain X-ray of the hand and wrist was performed anti-hnRNP A1 and A2 were measured in patients and control. Results: All patients were females with a mean age of 37.5 ± 11.24 years and mean disease duration of 7.84 ± 1.19 years. 96.2% of cases showed juxta-articular osteoporosis, 38.5% with marginal erosions, 73.1% with surface erosions, 42.3% with subchondral cyst, 42.3% with metacarpophalangeal subluxation, 11.5% with marginal sclerosis, 80.8% with resorption of distal phalanges, 38.5% with resorption of distal ulna and 34.6% with calcinosis. Anti-hnRNPA1 was positive in all the patients but the anti-hnRNPA2 was positive in 21 (80.8%). Anti-hnRNP A1 and A2 showed significant difference between patients and control (5.66 ± 4.18 ng/ml vs 2.88 ± 0.82; p < 0.01 and 1.82 ± 0.36 vs 0.73 ± 0.08; p < 0.02, respectively). There was no significant correlation between the markers with the mRss or radiographic changes. Conclusion: Joint affection in SSc is more frequent than expected. Anti-hnRNP A1 and anti hnRNP A2 antigens may be useful markers for SSc patient although no significant relation was found with radiologic findings. © 2017 Egyptian Society of Rheumatic Diseases

Author Info:
aPhysical Medicine, Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt
bDiagnostic Radiology Department, Assiut University Hospital, Assiut, Egypt
cClinical Pathology Department, South Egypt Cancer Institute, Assiut, Egypt


Authors:
Gamal RM1, Gamal WM2, Ghandour AM1, Abozaid HSM3, Mohamed ME4, Emad Y5, Abdel Galeel A6.

Title:
Study of the osteoprotegerin/receptor activator of nuclear factor-kB ligand system association with inflammation and atherosclerosis in systemic sclerosis.

Abstract:
OBJECTIVE:
we aimed to study systemic sclerosis patients in order to assess osteoprotegerin/Receptor activator of nuclear factor-kB ligand (OPG/RANKL) system and find the relation of these biomarkers with the clinical features of the disease, the carotid intima thickness, markers of inflammation, lipid profile, and other laboratory characteristics.

METHODS:
both the level of (RANKL), (OPG) in sera of participants, in 30 (SSc) patients and the atherosclerotic changes affecting the common carotid artery were measured and, were compared to 30 healthy controls matched for age and sex. All participants were assessed clinically and subjected to the Revised Medsger SSc severity scale and underwent carotid Doppler ultrasound examination.

RESULTS:
OPG, RANKL, and RANKL/OPG were 1.9 ± 0.4 ng/ml, 24.3 ± 17.25 ng/ml, and 13.5 ±9.8 versus 0.77 ± 0.25 ng/ml, 7.13 ± 3.02 ng/ml, and 9.6 ± 3.1 in the SSc patients and the controls with significance (P = 0.001, P = 0.001, P = 0.045) respectively. The OPG- RANKL axis in the SSc patients correlated significantly with carotid intima thickness, arthritis, arthralgia, inflammatory markers, Medsger joint, Medsger vascular, Medsger skin, and dyslipidemia.

CONCLUSION:
In cardiovascular risks, OPG serum level might increase as a preventive compensatory mechanism to neutralize the RANKL level increment. The determination of the OPG-RANKL system is a diagnostic indicator for the intensity of vascular calcification and atherosclerosis in SSc patients.

Author Info:
1
a Rheumatology& Rehabilitation department , Assuit University , Assuit , Egypt.
2
b Vascular Surgery department , Qena university hospital, South Valley University , Qena , Egypt.
3
c Rheumatology& Rehabilitation department , Sohag University , Sohag , Egypt.
4
d Microbiology& Immunology department , Assuit University , Assuit , Egypt.
5
e Rheumatology& Rehabilitation department , Cairo University , Egypt.
6
f Cardiovascular Medicine Department , Assuit University , Assuit , Egypt.


Authors:
Kilicoglu G1, Ozturk-Engin D2, Tireli H3, Cağ Y4, Sengöz G5, Senbayrak S6, Erdem H7; ID-IRI study group.

Title:
Radiological data in microbiologically confirmed central nervous system tuberculosis

Author Info:
1
Department of Radiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
2
Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. Electronic address: dr.deryaengin@gmail.com.
3
Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
4
Department of Infectious Diseases and Clinical Microbiology, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey.
5
Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey.
6
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
7
Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey.


Authors:
Rashed AM1, Abdel-Wahab N1,2, Moussa EMM3, Hammam N4,5.

Title:
Association of hand grip strength with disease activity, disability and quality of life in children and adolescents with Juvenile Idiopathic Arthritis.

Abstract:
BACKGROUND:
Juvenile idiopathic arthritis (JIA) affects wrist and hand joints leading to decrease hand function and patients' daily living activities. The assessment of hand grip strength (HGS) in children and adolescents with JIA is of major importance, and the association of HGS with JIA disease activity, disability and quality of life has not been explored. The primary objective of this study was to evaluate hand grip strength (HGS) in children and adolescents with Juvenile Idiopathic Arthritis (JIA) compared to matched healthy peers. The secondary objective was to explore the relationship between HGS and JIA disease activity, disability, and quality of life.

METHODS:
This study involved 23 patients with JIA and 46 age and sex matched healthy controls. Hand held dynamometer was used to evaluate HGS for all study participants. Anthropometric parameters for all study participants were measured. Disease activity, physical function, and quality of life were assessed for the JIA group using juvenile arthritis disease activity score (JADAS-27), juvenile arthritis functionality scale (JAFS), and pediatric quality of life inventory (PedsQL) respectively. Laboratory marker of inflammation, erythrocyte sedimentation rate (ESR), and plain radiography of hands were performed for all patients.

RESULTS:
Hand grip strength of children and adolescents with JIA was significantly weaker compared to matched controls (p < 0.001). Hand grip strength had a significant inverse correlation with JADAS-27 (r = - 0.467, p = 0.025), JAFS (r = - 0.650, p = 0.001) and a significant direct correlation with PedsQL (r = 0.438, p = 0.036). In addition, HGS was negatively correlated with ESR and duration of morning stiffness (r = - 0.489, p = 0.018 and r = - 0.201, p = 0.359, respectively). HGS was detected as an independent predictor of disease activity, disability, and quality of life in JIA patients in multivariate linear regression.

CONCLUSIONS:
Assessment of HGS could be a simple non-invasive tool for assessing disease activity, disability and quality of life in JIA patients in clinical practice.

Author Info:
1
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
3
Department of Radiology, Assiut University Hospitals, Assiut, Egypt.
4
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt. hammam@ualberta.ca.
5
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 Street, Edmonton, AB, T6G2G4, Canada. hammam@ualberta.ca.


