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   Table of Contents - Current issue
Coverpage
January-March 2017
Volume 15 | Issue 1
Page Nos. 1-59

Online since Wednesday, August 23, 2017

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LETTER TO THE EDITOR  

Focusing on 25 primary things in patients at first visit: is anyone bothered? p. 1
Nagesh Kamat
DOI:10.4103/AZMJ.AZMJ_14_17  
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ORIGINAL ARTICLES Top

Developmental sex disorders: the proposed clinically applied new classification p. 3
Yasser Helmy, Essam-Elden M Mohamed
DOI:10.4103/AZMJ.AZMJ_6_17  
Usage of the term developmental sex disorders is still under debate as it leads to confusion, because there are many deficits in the nomenclatures and classification as it did not include any clinical consideration and it is based mainly on genetic karyotype nomenclatures and omits the abnormal psychological developmental sex disorder (gender identity disorder). This study is an attempt to provide a clinically applied new classification to overcome the problems associated with the previous classification and take into consideration the management of each individual case.
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Relation of right ventricular dysfunction to the severity of hepatic cirrhosis by different echo modalities using speckle-tracking echocardiography p. 7
Eman R Zaki, Nessren M Baha El Deen
DOI:10.4103/1687-1693.213588  
Background Speckle-tracking echocardiographic (STE) studies have shown the presence of right ventricular (RV) dysfunction before the advent of RV failure in patients with hepatic cirrhosis. We aimed to evaluate RV function in patients with hepatic cirrhosis and assess the relation of RV dysfunction to the severity of hepatic cirrhosis using different echo-Doppler modalities including STE. Patients and methods This study included 49 patients with various degrees of hepatic cirrhosis and 34 healthy normal individuals (NL). Patients were classified into group A (11 patients), group B (17 patients), and group C (21 patients) according to disease severity using the Child–Pugh score. Conventional echo-Doppler parameters of RV function together with tissue Doppler imaging-derived RV strain and speckle-tracking echo-derived right ventricular global strain (STE-RVGST) were obtained.
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Transcatheter closure of atrial septal defect in children using the Occlutech Figulla occluder device p. 15
Mahmoud Ali, Amal El-Sisi, Hesham Salah El-Din, Sameh Bakhoum, Hossam Kandil
DOI:10.4103/AZMJ.AZMJ_9_17  
Background Percutaneous transcatheter closure of atrial septal defect (ASD) among children using devices other than the Amplatzer septal occluder has not been extensively tested. Objectives We evaluated the efficiency and safety of secundum ASD closure using the Occlutech Figulla ASD occluder in children and the efficiency and safety of secundum ASD closure under transthoracic echocardiography (TTE) guidance in children with less than 12 kg body weight. Patients and methods Forty-two patients (19 girls and 23 boys; mean age 4.8±2.0 years) were enrolled in a prospective cohort study. All patients underwent TTE and transesophageal echocardiography (TEE) to assess the characteristics of the ASD before transcatheter closure. Procedures were performed under fluoroscopic and TTE or TEE guidance. Follow-up was done at 1, 3, and 6 months following the procedure by clinical and TTE examination. Results The mean defect size was 14.9±4.2 mm on TTE and 16.1±4.7 mm on TEE. The mean device size was 17.9±4.9 mm (range 10.5–27 mm). The mean procedure time was 59.6±19.5 min. Thirty-one cases were performed under general anesthesia and TEE guidance, whereas the other 11 cases were performed under general anesthesia and TTE guidance. The device was placed successfully in all 42 patients. A small residual flow was seen immediately after device placement in three (7.1%) patients, which disappeared at 6 months. No complications occurred during the procedure. All patients were asymptomatic during the follow-up period. Conclusion Transcatheter closure of secundum ASD is generally safe and efficient in children younger than 12 years old, and ASD closure under TTE guidance in children less than 12 kg body weight is considered safe and efficient when performed in a tertiary center in the presence of an expert echocardiographer and interventional cardiologist.
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Anticardiolipin antibody in egyptian patients with chronic hepatitis c in correlation with liver injury p. 21
Mahmoud H Hemida, Shaaban S Alazhari, Ahmed El Borae Kabil, Abd El Halim Assem Elsherif, Mohamed Abd El Hameed Khedr
DOI:10.4103/AZMJ.AZMJ_50_16  
Background The presence of anticardiolipin (ACL) antibodies in chronic hepatitis C may be owing to induction of neoantigens by chronic viral infection, which may be because of disruption of liver cell membranes. The occurrence of these ACL antibodies may be observed because of recognition of these neoantigens by the immune system. Aim The aim of the work was to study the prevalence and clinical significance of ACL antibodies in chronic hepatitis C infection and their relationship with disease progression. Participants and methods Our study was performed on 90 individuals recruited from Gastroenterology and Hepatology Outpatient Clinics and Internal Medicine Department of Kafr Sheikh Institute. The participants were divided into the following three groups: group A consisted of 30 patients with chronic hepatitis C virus (HCV) infection with compensated liver cirrhosis, group B consisted of 30 patients with chronic HCV infection with decompensated liver cirrhosis, and group C consists of 30 individuals as control. All patients and control were subjected to full history taking, full clinical examination, complete blood count, liver function tests, renal profile, pelvis–abdominal ultrasound, and serum levels of ACL immunoglobulin G and α-fetoprotein. Results The results showed that seven (23%) of the HCV-positive patients in group A and 18 (60%) of the HCV-positive patients in group B were ACL immunoglobulin G-positive in comparison with none in the control group (0%). Conclusion The prevalence of ACL antibodies is increased during HCV infection, and HCV should be regarded as a possible causative factor in the antiphospholipid syndrome.
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Is bronchial asthma a risk factor for chronic kidney disease? p. 27
Zeinab R Adawy, Rayyh A Mohamad-Saleh, Taghreed Abdul-Aziz M Ismail
DOI:10.4103/AZMJ.AZMJ_13_17  
Introduction Bronchial asthma is a chronic, inflammatory lung disease with exacerbations. Patients with asthma have higher risks of coronary heart disease, diabetes mellitus, and hypertension, although the impact of asthma on other vital organs is not yet verified. Chronic kidney disease (CKD) is a major global problem. In addition to well-known risk factors of CKD, there might be other previously underestimated or unrecognized risk factors that are not yet discovered. Aim The aim of this study was to determine the frequency and factors associated with CKD among asthmatic patients. Patients and methods An analytical, cross-sectional study was conducted on 118 patients known to have bronchial asthma and 118 healthy individuals; all of them were subjected to spirometry. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study group equation. Results Development of CKD was significantly higher among asthmatic patients than in healthy individuals (17.4 vs. 0.8%, respectively). GFR was higher in the well-controlled asthmatic group than in the uncontrolled group (96.3±18.1 vs. 90.1±20.3), but this difference was statistically insignificant. Occurrence of CKD was significantly higher among those with asthma for 20 years or longer than those with asthma for less than 20 years (45.5 vs. 2.4%, respectively). GFR was negatively correlated to age, BMI, and disease duration with high statistical significance, and was positively correlated with all parameters of pulmonary function test (FVC%, FEV1%, FEV1/FVC, and PEFR%) and partial O2 pressure with high statistical significance. Significant predictors for the development of CKD among asthmatic patients were longer disease duration and higher BMI. However, high partial O2 pressure was protective for the development of CKD. Conclusion Bronchial asthma can be associated with CKD. Prolonged disease duration and higher BMI were the most common predictors for the development of CKD.
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Evaluation of the protective effect of ginseng against gentamicine-induced nephrotoxicity in adult, albino rats: a histochemical and immunohistochemical study p. 35
Sayed A Raheem, Abdel R Meselhy, Sohier A Hafiez, Nasser A Naby
DOI:10.4103/AZMJ.AZMJ_4_17  
Background Caspase-3 plays an important role in apoptosis. In this study, we determined the protective effect of ginseng against gentamicine-induced nephrotoxicity in albino rats. The aim of this study was to investigate the protective effect of ginseng on the expression of caspase-3 in gentamicine-induced nephrotoxicity. Materials and methods A total of 40, adult, albino rats weighing 250±20 g were divided into four groups (10 rats each) and treated by intraperitoneal injection for 10 days with 1 ml of isotonic saline (group 1), gentamicine 100 mg/kg/day (group 2), gentamicine 100 mg/kg/day plus ginseng 100 mg/kg/day (group 3), and gentamicine 100 mg/kg/day for 10 days and then ginseng 100 mg/kg/day for another 10 days (group 4). After the last injection, blood urea and creatinine levels were calculated, and tissue samples were obtained for haematoxylin and eosin, Masson trichrome, periodic acid-Schiff (PAS), and caspase-3 staining. Results In group 2, body weight of rats decreased, serum urea and creatinine levels increased, and glomerular and tubular histological changes were observed, compared with the control group. When ginseng and gentamicine were given together (group 3) or when ginseng was given after gentamicine (group 4), body weight, serum urea and creatinine, and histological features showed improvement. Significant reactivity of caspase-3 in the distal renal tubules was observed in group 2 as compared with weak reactivity in group 3 and group 4. Conclusion Gentamicine has the ability to induce nephrotoxicity, mainly tubular, and ginseng may improve this nephrotoxicity.
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The effect of ginger on experimentally induced atherosclerosis in the aorta of rabbits: a histological and immunohistochemical study p. 43
Essam O Kamel, Wail M Gad El-rab
DOI:10.4103/AZMJ.AZMJ_3_17  
Background Atherosclerosis is a major disease of arteries, related to age and plasma cholesterol levels. Objective The objective of this study was to investigate the possible effects of ginger on experimentally induced atherosclerosis in the aorta of rabbits. Materials and methods Thirty, male rabbits aged 6 weeks were used in this study and were divided into three groups: group I included 10 male rabbits fed an ordinary diet for an experimental period of 8 weeks; group II included 10 male rabbits fed an ordinary diet mixed with 1% cholesterol powder at a dose of 200 mg/kg body weight for a period of 8 weeks; and group III included 10 rabbits fed an ordinary diet mixed with 1% cholesterol powder and were treated with ginger powder (4 g/kg of the dried rhizome) dissolved in saline solution daily for 8 weeks. The thoracic aorta was dissected and then processed for light microscopic studies. Results Our results showed an apparent decrease in the thickness of both tunica intima and tunica media in the ginger-treated group. There was no intimal invasion of smooth muscle cells. Regular wavy elastic fibers were noticed in the media with apparently normal smooth muscle cells distributed in between. In addition, there was no apparent difference in the CD34 reaction of endothelial cells in the ginger-treated group when compared with the control group. Conclusion Ginger has an attractive role in modulating atherosclerosis in the aorta of rabbits.
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Peripheral neuropathy in stable chronic obstructive pulmonary disease: Is the phrenic nerve more affected compared with other peripheral nerves? p. 52
Atef W El-Rifai, Sherif M El-Shazli
DOI:10.4103/AZMJ.AZMJ_5_17  
Background Chronic obstructive pulmonary disease (COPD) is a multicomponent disease with extrapulmonary manifestation. Peripheral nerve affection may be one of the results or mechanism of COPD. Objective The aim of this study was to evaluate peripheral neuropathy in patients with stable COPD and whether these changes are more or less marked in the phrenic nerve when compared with other peripheral nerves. Patients and methods Eighty patients with COPD and 60 healthy individuals as a control group were included. All were subjected to the following: (i) full history taking; (ii) clinical and neurological examination; (iii) chest radiography; (iv) high-resol ution computed tomography scanning of the chest; (v) arterial blood gases analysis at room air; and (vi) spirometric tests. Results There was a statistically significant increase in smoking packs/year, respiratory rate, hemoglobin, and white blood cells in the COPD group. There was a significant decrease in oxygen saturation, pH, arterial oxygen tension, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, and forced vital capacity% in the study group when compared with the control group, whereas there was a significant increase in CO2 tension in the COPD group. There was a significant increase in the distal latency of all nerves and a significant decrease in the amplitude and conduction velocity of all nerves, except the amplitude of the phrenic nerve in the COPD group. The difference for phrenic nerve amplitude was statistically nonsignificant. In the COPD group, abnormal motor activity in the median, ulnar, common peroneal, and phrenic nerves of 30, 22.5, 35, and 22.5%, respectively, was reported, whereas abnormal sensory activity in the median, ulnar, and sural nerves of 30.0, 27.5, and 42.5%, respectively, was reported. Finally, we found a statistically significant increase in nerve abnormalities with increased severity of the disease. Conclusion COPD had a significant affection on peripheral nerves, either motor or sensory. In addition, COPD had a significant affection on the phrenic nerve and muscle of the diaphragm. However, this affection of the phrenic nerve was confined to grades III and IV and was the least affection of studied nerves.
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ERRATUM Top

Erratum: The potential osteogenic effect of stem cells in mandibular distraction in goats p. 59

DOI:10.4103/AZMJ.AZMJ_41_17  
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