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   Table of Contents - Current issue
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April-June 2017
Volume 15 | Issue 2
Page Nos. 61-126

Online since Tuesday, November 21, 2017

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ORIGINAL ARTICLES  

Central proliferative diabetic retinopathy: evaluation and management Highly accessed article p. 61
Mohamed I Elkasaby, Hazem Mohamed Azab, Maged Adly Naguib, Ali Hendy El Ghamdi, Mostafa Mahmoud Darwish
DOI:10.4103/AZMJ.AZMJ_32_16  
Aims The aim of this study was to evaluate the outcome of central proliferative diabetic retinopathy (PDR) after pars planavitrectomy. Patients and methods This prospective, observation, randomized study included 90 eyes of 64 patients with central PDR who underwent pars planavitrectomy by a single vitreoretinal surgeon. Patients were followed up on the second postoperative day, at 1 week, 2 weeks, and at 1, 3, 6, and 12 months after surgery. Clinical outcomes were recorded at every visit. Results Ninety eyes of 64 patients with severe PDR that involved the macula and central retina were studied. Of 36 patients 16 (44.4%) patients were female, whereas 20 (55.5%) patients out of 36 were male. Their ages ranged from 20 to 70 years. Out of 36 patients 12 (33.3%)had bilateral PDR. 20 of 36 (55.5%) patients had type І diabetes mellitus and 16 (44.4%) of 36 patients had type ІІ.
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Erectile dysfunction in male patients with severe chronic obstructive pulmonary disease p. 67
Hamdy M Hasan, Eisa I Afify, Tareq M Tawfik, Ismail M Al Wakeel, Fawzy M Abd El Fattah
DOI:10.4103/AZMJ.AZMJ_57_16  
Background Chronic obstructive pulmonary disease (COPD) is a common chronic disease, which diminishes the patient’s functional capacity and quality of life. Only few studies have been published on the occurrence of erectile dysfunction (ED) in COPD patients. Objective The aim of this work was to study the prevalence of ED in COPD patients and its relation with other clinical and laboratory parameters. Patients and methods The study included 30 patients with severe chronic stable COPD (diagnosed and staged according to the American Thoracic Society guidelines) and 30 healthy volunteers. Assessment of erectile function was carried out for all participants using the International Index of Erectile Function (IIEF-5) Questionnaire. Results Both COPD patients and controls were age matched. On comparing the 6 min walk test results between the two groups, there was a highly significant decrease in the distance×weight parameter in COPD patients (19.687±3.104 kg/km) than in normal controls (35.24±4.35 kg/2 km). Evaluation of erectile function was carried out using the questionnaire of IIEF. The mean score of erectile function was significantly decreased in COPD patients than in the normal control group (P<0.05), and the results showed that 76% of all patients with COPD were found to have ED compared with 23% in healthy controls. ED in COPD patients was graded as mild [three cases (10%)], mild to moderate [4 (13%) cases], moderate [four (13%) cases], and severe ED [12 (40%) cases], whereas the ED in the control group was mild [four (13%) cases] and mild to moderate [three (10%) cases]. Correlation analyses showed a linear relationship (positive correlation) between IIEF-5 and forced expiratory volume in 1 s (%), forced vital capacity (%), peak expiratory flow (%), PaO2, SO2 (%), and distance×weight. Conclusion ED is a frequent problem in patients with COPD. The limitations of physical activity in the pathophysiology of COPD seem to interfere with the sexual function of these patients.
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The prevalence of human papillomavirus genotypes (HPV-6, HPV-11, HPV-16, and HPV-18) in the unilateral and bilateral nasal polyps p. 71
Amani M Abd Elwahab, Randa A Abdullah, Gehan S Shalaby, Soad Yehia, Hanaa Aboeliazed
DOI:10.4103/AZMJ.AZMJ_20_17  
Aim The aim of this study was to investigate the prevalence of different genotypes (HP-6, HP-11, HP-16, and HP-18) of human papillomavirus (HPV) in nasal polyps (NPs). Materials and methods This is a prospective, comparative, controlled study. A total of 24 patients with NPs along with 10 patients with deviated nasal septum without NPs (as controls) were enrolled. Biopsy specimens from the patients’ NPs and from nasal mucosa of controls were collected for the detection of the four HP genotypes using PCR-based DNA amplification using the genotype-specific primers (6/E5, 11/L1, 16/L1, and 18/L1). Results An overall 91% (22/24) of patients with NPs were found to be positive for HPV infection, whereas all participants of the control group were negative (P<0.05). Among the HP-positive cases, 19/22 (86.3%) were infected with a single genotype, whereas 3/22 (13.6%) demonstrated a coinfection of HP-11 and HP-18 genotypes. The HP-18 was found to be the most prevalent genotype [8/22 (36.36%)]. However, the occurrence of the HP-6 genotype was higher [6/22 (27.27%)] than that of the HP-11 [5/22 (22.7%)]; HP-16 was not detected in any of the unilateral or bilateral NP specimens. Conclusion Our findings suggest that the HPV infection is associated with the formation of NPs and further investigation is imperative to define a correlation between the two.
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Value of oxytocin in modifying metabolic changes and atherosclerosis in rat model of diet-induced obesity p. 78
Maher N Ibrahim, Mohammed A Alghannam, Randa S Gomaa, Nourelhuda A Elsayed
DOI:10.4103/AZMJ.AZMJ_33_17  
Background Oxytocin (OT) has effects on uterine contraction and milk ejection, but growing evidence suggests that OT plays an important role in the regulation of energy homeostasis and development of obesity. Objective The aim of this study was to investigate the effect of OT in modifying metabolic changes and atherosclerosis in diet-induced obesity rat model and its possible mechanisms. Materials and methods A total of 30 male rats and 60 female adult albino rats were divided into three main groups: male, female, and the ovariectomized group. Each group was subdivided into three equal groups: control, high-fat diet (HFD) fed, and HFD-OT-treated groups. Body mass index, body weight gain and mean arterial blood pressure were measured. Serum cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, nitric oxide, reduced glutathione, malondialdehyde, C-reactive protein, insulin, and glucose were estimated, and atherogenic index was calculated. Aortic artery histopathology was studied. Results In all groups, OT treatment to HFD-fed rats decreased body mass index and weight gain and improved hyperlipidemia, high glucose, low insulin levels, and elevated mean arterial blood pressure caused by HFD. It showed antioxidative stress activity as indicated by decreased C-reactive protein and malondialdehyde (MDA) and elevated nitric oxide and glutathione levels. OT treatment reveled anti-inflammatory action as indicated by aortic histopathology. Conclusion OT administration to HFD-fed rats reduced body mass index and weight gain and improved metabolic changes associated with lipid profile, glucose tolerance, and blood pressure. In addition, it dramatically ameliorated the aortic atherosclerotic changes. This effect is due to its antioxidative stress activity and anti-inflammatory action, and this effect was more prominent in female and ovariectomized female rats. Further studies are recommended for more evaluation of other mechanisms that explain the metabolic action of OT and to clarify the difference in its action on sex and other species of experimental animals.
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Bcl-2, active caspase-9 and inactive caspase-9 levels as markers of apoptosis in the serum and tissue of vitiligo patients p. 85
Eman R.M Hofny, Howayda I Hasan, Nahed A Mohamed, Maysaa S Bamatraf, Ayman M.M Mahran
DOI:10.4103/AZMJ.AZMJ_27_17  
Background Vitiligo is the most common depigmentation disorder of the skin. It is considered a multifactorial disorder. However, its exact etiology is unknown. As the acute inflammatory response is not a general finding in vitiligo, it was hypothesized that melanocytes may die in a controlled manner via apoptosis. Aim This study was done to evaluate Bcl-2, active caspase-9, and inactive caspase-9 levels in vitiligo in order to establish the role of apoptosis in the etiopathogenesis of vitiligo. Patients and methods We examined Bcl-2 (serum and tissue), active caspase-9 (serum) and inactive caspase-9 (tissue) levels of 48 vitiligo patients and 30 healthy volunteers by ELISA using commercial kits and immunohistochemically using the avidin–biotin immunoperoxidase complex technique. The collected data were analyzed by SPSS version 16. Results The mean age of vitiligo patients was 32.6±12.4 years. Of these, 65% of patients were women and 33% of patients have a positive family history. The mean vitiligo area scoring index was 5.84±6.57. Bcl-2 levels in the serum and tissues of patients were significantly lower than in controls. Bcl-2 expression in lesional skin was significantly lower than in the perilesional and unaffected skin. On the other hand, active caspase-9 level in patients’ serum was significantly higher than in controls. Inactive caspase-9 expression in lesional skin was significantly lower than in controls. Inactive caspase-9 expression in lesional skin was insignificantly lower than in the perilesional and unaffected skin. Conclusion Our data strongly support apoptosis rather than necrosis as a mechanism for melanocytes’ destruction in vitiligo.
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Thyroid hormones; plasma level in critical ill patients need prolonged mechanical ventilation p. 92
Abdelazim A.T Hegazy, Essam A Mostafa, Abdel N Ahmed Hussein
DOI:10.4103/AZMJ.AZMJ_22_17  
Background Thyroid function usually downregulates during stressful conditions. Thyroid dysfunction is associated with the mortality of patients under mechanical ventilation (MV) in the ICU. Aim The aim of this study was to measure the thyroid hormonal level in the plasma of critical ill patients on prolonged MV. Patients and methods Fifty patients were participated and completed the present study. The thyroid hormones: thyroid stimulating hormone, tri-thyroxine (T3), tetra-thyroxine (T4), reverse tri-thyroxine (rT3), were collected from the plasma: and tested as follows. The first sample was collected just before initiation of MV; second sample 24 h after initiation of MV; third sample: 24 h after successful weaning from MV. Venous blood samples were collected from each patient in nonheparinized blood collecting tubes, and the samples were allowed to clot at room temperature. All samples were centrifuged within 2 h after withdrawal and stored at 20°C until assayed. Results The investigators have noticed that the patients, who were weaned off from MV in a period of less than 16 days, have good prognosis and who have been for a period of more than 16 days were classified as bad prognosis patients. Plasma levels of thyroid stimulating hormone, T4 and T3 in both good prognostic patients and bad prognostic patients were determined; there are clinical (died in bad group or survived in good prognosis group) and little mathematical difference between both groups, but of no significance statistically. The plasma level of rT3 in both good prognostic patients and bad prognostic patients has a high level in the second sample, and there are clinical and little mathematical difference between both groups but no significance statistically. Conclusion The study of the level of thyroid hormones can give an idea about the progress of management of critically ill patients who undergo prolonged MV.
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Importance of histopathological evaluation of appendectomy specimens p. 97
Mohamed Abd Al-Fatah
DOI:10.4103/AZMJ.AZMJ_19_17  
Background Appendicitis is by far the commonest major emergency general surgical operation. Pathological evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings. The objective of this study was to analyze the clinical benefit of histopathological analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. Patients and methods The clinicopathological data of 460 patients who underwent appendectomies for presumed acute appendicitis were reviewed prospectively. Results There were 265 men and 195 women [sex ratio (male/female): 1.4] aged between 16 and 62 years (mean: 27.6 years). All patients underwent open appendectomy. Histological examination of the surgical specimen showed normal appendix in 28/460 (6%) cases, gross inflammation in 365 (79.3%) cases, gangrenous appendix in 32 (7%) cases, perforation and localized peritonitis in 30 (6.6%) cases, and generalized peritonitis in five (1.1%) cases. Incidental unexpected pathological diagnoses were noted in 39 (8.5%) appendectomy specimens. They included Enterobius vermicularis (n=19), mucinous neoplasms (n=3), neuroendocrine tumors (n=1), granulomatous inflammation (n=12), tuberculosis (n=1), bilharziasis (n=1), and endometriosis (n=2). Other associated pathological findings were ruptured ovarian cyst (n=9), perforated duodenal ulcer (n=3), Meckel’s diverticulum (n=1), disturbed ectopic pregnancy (n=3), and cecal adenocarcinoma (n=2). Conclusion The diagnosis of acute appendicitis has been improved, with a significant reduction in negative appendectomy rates. Routine pathological examination of appendectomy specimens is of value for identifying unsuspected pathologies requiring further postoperative management. Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic examination. It is highly recommended that in order to avoid misdiagnoses, all appendix specimens should be examined histopathologically.
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Risk factors of cardiovascular diseases among population of Arar City, Northern Saudi Arabia p. 104
Ali Ghannam A Almuhawwis, Nagah M.A el-Fetoh, Muhammad Abdullah M Almalki, Muhammad Sari Z Alanazi, Naif Salem H Alshammari, Anwar K Alruwaili, Adel T Alenezi, Muaz B Wali, Zaid Q.B Fawwaz Alshammari, Wasan L Alanazi
DOI:10.4103/AZMJ.AZMJ_26_17  
Background Awareness of cardiovascular diseases (CVDs) and risk factors has been linked to the prevalence of CVDs. Objective The current study was conducted to compare the prevalence of CVDs risk factors among male and female populations in Arar City, Northern Saudi Arabia. Participants and methods A cross-sectional study was carried out in three randomly chosen primary health care centers in Arar City. A total of 401 Saudi nationals were included. Results Most (59.1%) of female and 44.5% of males did not check their blood glucose (P<0.05). The majority (61.7%) of female and 44.1% of males did not check their blood pressure (P<0.05). Most (98.7%) of females and 50.6% of male were nonsmokers. Most (82.6 and 80.5%) of males and females ate fruits less than three times per week, 69.6% of females and 53.5% of males performed light physical exercise, whereas 12.1% of males and 7.1% of females did not perform physical exercise at all (P<0.05). Between male and female, the mean BMI was 27.49±5.4 and 26.23±13.4, the mean intake of fruits per week was 2.80±1.73 and 3.77±1.99 days, and the mean vegetable intake per week was 4.19±1.97 and 5.87±1.85 days, with no significant difference (P>0.05). Conclusion and recommendations The prevention of CVDs is based on the control of several risk factors and associated conditions. Specific studies or programs are needed to raise the awareness of what CVDs are, its risk factors, and how to control or modify it.
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Measurement of liver and spleen stiffness by shear wave elastography as a noninvasive evaluation of esophageal varices in hepatitis C virus-related cirrhosis p. 111
Alaa E Mahmoud Hashim, Mustafa M Shakweer, Farid F Attia, Hany M Awadallah, Fathya M Elraaey, Abdelhakam M Ibrahem
DOI:10.4103/AZMJ.AZMJ_43_17  
Background Several noninvasive methods have been developed to predict esophageal varices (EVs) in patients with cirrhosis aiming to restrict endoscopic screening. Recently, two-dimensional shear wave elastography (2D-SWE) was evaluated for this purpose. The aim of this study was to evaluate the use of 2D-SWE for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) for prediction of EV presence and grading. Patients and methods This study included 100 patients with hepatitis C virus cirrhosis who were subjected to upper endoscopy for detection and grading of EV as well as LS and SS measurements using 2D-SWE. Results There was a significant difference between patients with and without EV regarding LS and SS (P<0.001). The measurement LS at cutoff of 16.2 kPa and SS at cutoff of 42.7 kPa by 2D-SWE predicted the presence of EV with sensitivity of 89.8 and 94.9%, respectively, and specificity of 57.6 and 87.9%, respectively. Moreover, at cutoffs of 19.6 and 51.5 kPa for LS and SS, respectively, the presence of high-risk EV was predicted with sensitivity of 77.5 and 85%, respectively, and specificity of 63.4 and 84.6%, respectively. Conclusion The measurement of LS and SS by 2D-SWE predicted the presence of EV and high-risk EV in patients with cirrhosis, with more sensitivity and specificity for SS than LS.
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Common bile duct exploration with transpapillary stenting versus T-tube drainage for management of irretrievable common bile duct stones p. 117
Ahmed M Hassan, Ahmed Q Mohammed, Muhammad Abd El-Gawad Shawky
DOI:10.4103/AZMJ.AZMJ_16_17  
Background Common bile duct (CBD) stones are present in 10–18% of patients undergoing cholecystectomy for chronic calcular cholecystitis. Treatment of CBD stones is still controversial. However, CBD stones can be treated by cholecystectomy plus CBD exploration or by precholecystectomy or postcholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages. If CBD exploration is performed and biliary decompression is needed after stone removal, the placement of transpapillary stent (TS) shows promising results in avoiding T-tube–related complications. Aim We aimed to evaluate the efficacy and complications of two approaches used for the management of CBD stones: intraoperative transpapillary CBD stent and T-tube external biliary drainage. Patients and methods Between May 2015 and May 2016, 24 patients underwent CBD exploration for treatment of irretrievable CBD stones. Included patients were randomly subjected to either CBD TS or T-tube drainage for management of irretrievable CBD stones after failure of ERCP. Results CBD exploration and TS placement (15 patients) was achieved either by a choledochotomy or through the cystic duct. There was no mortality in our series. Patients with a T-tube external biliary drainage (nine patients) had more surgery-related complications and a longer hospital stay. Postoperative ERCP to remove the CBD stent was successful in all cases. Conclusion Surgical transpapillary CBD stenting seems to be an effective method for management of irretrievable CBD stone with less surgical-related complications and less hospital stay and should be the first option in management of such patients.
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Serum levels of adiponectin and visfatin in patients with lichen planus: a case-controlled study p. 122
Sahar A Ismail, Ibrahim Mwafey, Sotohy A Mohamed
DOI:10.4103/AZMJ.AZMJ_45_17  
Background The association of adipokines with lichen planus (LP) is still obscure. Data regarding their effect on other immunological and inflammatory disorders suggest a probable role of adipokines in the pathophysiology of LP. Objective The objective of the study was to investigate serum levels of adiponectin and visfatin in patients with LP compared with healthy controls and to consider their relation to disease duration and obesity markers. Patients and methods A case-controlled study was conducted, which included 49 patients with LP and 40 healthy controls. Adiponectin and visfatin serum levels were measured using enzyme-linked immunosorbent assays. Results Patients with LP showed lower serum levels of adiponectin than healthy controls, with significant inverse correlation with disease duration, BMI, and waist circumference. Cutaneous and mucocutaneous LP showed lower serum levels of adiponectin than oral LP. Visfatin serum level was higher in patients with LP compared with healthy controls, with significant positive correlation with BMI and waist circumference. Conclusion Our data suggested that adiponectin and visfatin act together through modulation of the inflammatory setting of patients with LP. Because of the significant correlations of adiponectin and visfatin with obesity markers, the physical complications of obesity should be emphasized to patients with LP.
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