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   Table of Contents - Current issue
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October-December 2016
Volume 14 | Issue 4
Page Nos. 149-202

Online since Friday, June 23, 2017

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ORIGINAL ARTICLES  

Impact of dual hepatitis B and C infection on disease severity and treatment outcome: updated review Highly accessed article p. 149
Gamal Esmat, Tamer Elbaz
DOI:10.4103/1687-1693.208929  
Hepatitis B, C are commonly present together. They both share same routes of transmission. Dual infection carries a wide, variable range of virological, clinical profiles. Even in terms of management, large debates arose due to related issues such as priority for treatment, fate of the second virus if the primary one is eradicated.
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Inclusion of the fracture level in short-segment fixation of unstable traumatic thoracolumbar spine fractures p. 153
Samir A Elshoura, Mostafa A Elsamea
DOI:10.4103/1687-1693.208930  
Introduction The diagnosis, classifications, and treatment of injuries of the thoracolumbar spine continue to attract controversy. Objective The present study evaluated the efficacy of treatment of unstable thoracolumbar burst fractures by transpedicular screw fixation including the fractured vertebra. Patients and methods From January 2013 to March 2015, 40 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in Al-Azhar University Hospital, Damietta. Results Forty (25 male and 15 female) patients with age ranging between 16 and 66 years (mean 41.8%) were operated upon by posterior transpedicular screw fixation. According to the American Spinal Injury Association scoring system, all patients were grade E. The mean of kyphotic deformities measured preoperatively was 18.4±5.5° and after 12 months of follow-up it was 9.0±4.1°. Conclusion By applying the transpedicular screw fixation of the unstable fractures of the thoracolumbar spine, a stable fracture fixation can be achieved; this kind of fixation prevents secondary spine deformities.
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The potential osteogenic effect of stem cells in mandibular distraction in goats p. 158
Eman B Elshal, Sayed B Ahmed, Alaa El Deen Jamal Ben Taleb, Yasser N El Hadidi, Marwa El Kassaby, Khaled Abd El Meneim Abd El Kader, Salah Abd El Fatah
DOI:10.4103/1687-1693.208934  
Background Mandibular distraction osteogenesis is a powerful reconstructive tool for the repair of lower-jaw deformities. Mesenchymal stem cells (MSCs) have been initially identified in bone marrow as nonhematopoietic stem cells that may differentiate into different tissues. Objective The objective of this study was to construct an original experimental model for mandibular distraction osteogenesis in the lower jaw, followed by MSC injection that could produce a sufficient quantity and quality of intramembranous bone. Materials and methods Seventeen goats (Capra aegagrus hircus), each weighing about 10–15 kg, were divided into three groups: zero control (n=3), positive control (injured with spontaneous cure) (n=7), and treated (injured and treated by stem cells) groups (n=7). A monodirectional distractor was designed and fixed. Distraction was performed at a rate of 1 mm per day for 10 days to create a distracted gap of 10 mm. In the treated group, after 10 days of distraction, the prepared stem cells (three million cells) were applied in the distracted gap on two doses every 10 days. The treated and positive control group had 30 days of consolidation to allow healing and maturation of the distracted bone. After animal sacrification, histological and radiographic assessments were carried out. Results Cone beam computed tomography examined the radiographic bone density of the newly formed bone, and there was a statistically significant increase in the bone density in the treated group compared with the control group. There was a significant increase in trabecular bone thickness and decrease in osteoid bone percentage in the treated group as compared with the positive control, indicating more rapid bone maturation. Conclusion MSC injection into the distracted mandible induced osteogenesis in the lower jaw of the goats and improvement in bone regeneration.
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Endoscopic band ligation combined with argon plasma coagulation versus band ligation alone for eradication of esophageal varices p. 169
Ali Ghweil, Shamarden Bazeed, Mohamed Alsenbsy, Heba Saleh, Mohamed El Kassas, Bahaa Abbas, Gamal Esmat, Hamdy Moustafa
DOI:10.4103/1687-1693.208932  
Background and aim Bleeding esophageal varices are the gravest complications of liver cirrhosis, with a high mortality. Although band ligation is considered the gold standard in the eradication of varices, it is plagued by a high recurrence rate after variceal eradication. The aim of the study was to assess safety and efficacy of endoscopic band ligation plus argon plasma coagulation (APC) versus endoscopic band ligation alone for the prevention of variceal recurrence and rebleeding. Patients and methods This prospective randomized comparative study was carried out on 100 patients admitted to Tropical Medicine and Gastroenterology Department, Qena University Hospital, during the period from March 2012 to complete follow-up on March 2014. Patients were randomized into two groups: group 1 included 50 patients who were subjected to endoscopic band ligation plus APC, and group 2 included 50 patients who were subjected to variceal band ligation. Results On comparing the results of the two groups as regards the incidence of variceal recurrence during the follow-up period, combined treatment group with band ligation plus APC had a significant low recurrence rate in comparison with band ligation alone treated group. As regards post-treatment complications in the combined treated group, there was transient fever (≥38°C) in 36% of patients, retrosternal pain (5–7 days) was reported in 20% cases, and bleeding during argon application occurred in one patient 2%. The development of severe complications did not occur in any of the patients. Mortality was reported in 10 cases in group 1 (three cases died by causes not related to liver disease). Conclusion Combined band ligation plus APC is safe and effective in prevention of variceal recurrence and rebleeding. The reported side effects were mild and reported mainly in older patients with child class C.
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Ventilation tubes versus cartilage tympanoplasty with cortical mastoidectomy: a clinical and audiological comparative study in the treatment of middle ear atelectasis p. 176
Mohammad M Wafaie, Abdelaziz Mohamed Hassan Elsherif, Yosry Othman, Mohammad S Bakr, Mohammad Hussien
DOI:10.4103/1687-1693.208936  
Background Atelectasis of the middle ear is a collapse of the middle ear space formed by extreme atrophy of the tympanic membrane. It is still a controversial issue regarding its etiology, and little has been published about its progression. Objective The aim of the study was to compare clinical and audiological outcomes in the treatment of atelectatic ear using ventilation tube versus cartilage tympanoplasty with cortical mastoidectomy. Patients and methods This study was conducted on 40 ears with atelectasis, diagnosed clinically, endoscopically, and audiologically. Twenty ears were subjected to ventilation tube insertion and the other 20 ears underwent cartilage tympanoplasty with cortical mastoidectomy. An audiogram was done 3 months postoperatively after the graft was fully taken and was then repeated after 6 months. Results Group 1 (cartilage tympanoplasty with cortical mastoidectomy group) included 20 ears, and group 2 (ventilation tube insertion group) included 20 ears. For group 1, the clinical results were the same at 3 and 6 months. Graft was taken in 18 (90%) ears and was broken with residual perforation in two (10%) cases. Mean hearing gain for this group was 17.44±7.35 dB after 3 months and 22.25±6.59 dB after 6 months. Mean air–bone gap was 22.25±3.55 dB preoperatively, 7.56±5.55 dB at 3 months, and 6.75±5.76 dB after 6 months. For group 2, after 3 months the tube was in place in all cases (100%). After 6 months, the tube was in place in 16 (80%) ears. There was extrusion in four (20%) ears − two (10%) of them had residual perforation, one (5%) had recurrent disease, and one retained normal hearing. Mean hearing gain for group 2 was 25.01±4.51 dB at 3 months and 21.83±5.42 dB at 6 months postoperatively. Air–bone gap was 21.14±3.48 dB preoperatively, 3.69±1.84 dB at 3 months, and 5.81±1.78 dB after 6 months. Conclusion Tube insertion showed a better clinical prognosis in second-stage atelectatic ears than in the third-stage ears. On the other hand, cartilage tympanoplasty showed better clinical prognosis in third-stage atelectatic ears than in second-stage ears.
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Immunohistochemical expression of β-catenin in osteoblastoma and osteosarcoma p. 182
Noha E.D Hassab El-Naby, Afaf T El-Nashar
DOI:10.4103/AZMJ.AZMJ_59_16  
Introduction Osteosarcoma (OS) is the most prevalent primary malignant tumor of bone in adolescents. Osteoblastoma (OB) is a rare benign bone tumor with a few aggressive variants. The differentiation between OS (low-grade types) OB (especially aggressive variant) by microscopic examination alone can be difficult, especially when using small biopsy specimens. Recently, the Wnt/β-catenin pathway has emerged as an essential pathway in bone development. Aim The aim of this study was to evaluate the immunohistochemical expression of β-catenin in OS and OB and its possible role in tumor diagnosis and prognosis. Materials and methods In total, 28 biopsies of OS (18 male and 10 female) and 12 cases of OB (10 male and two female) were examined for β-catenin immunostaining. Results β-Catenin showed cytoplasmic expression in 5/28 (17.9%) OS samples and in 8/12 (66.7%) OB samples, with a statistically significant relationship (P>0.008). Conclusion β-Catenin is a valuable tumor marker to differentiate between OS and OB, especially the aggressive variant.
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Contribution of indoleamine 2,3-dioxygenase in preeclampsia p. 190
Mona F.M El-Karn, Hayam G Sayyed, Safwat A Mohammed, Nemah M.A Abdulrab
DOI:10.4103/AZMJ.AZMJ_47_16  
Background Preeclampsia (PE) is a complex, multiorgan disease that leads to maternofetal morbidity and mortality. Increasing evidence now indicates that PE may have an immunological cause. Indoleamine 2,3-dioxygenase (IDO) is an immunomodulatory intracellular enzyme that suppresses immune response. The present study aimed to determine whether alterations in the level of IDO contribute to PE and its relation to the severity of PE. Patients and methods A case–control study was carried out on 80 pregnant women, who were divided into two groups − 40 PE patients and 40 ethnically matched, healthy, controls. Enzyme-linked immunosorbent assay was used to determine placental IDO protein concentrations. In addition, Pearson’s correlation with systolic blood pressure (as an indicator of PE severity) was estimated. Results Placental concentration of IDO was significantly lower in the PE group than in the control group, and there was an inverse association between IDO and severity of the PE. Conclusion The present study demonstrated that IDO might contribute to the pathogenesis of PE.
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Impact of controlling hypothyroidism on auditory dysfunction p. 196
Naema Ismail, Kandeel Hanaa, Reda Behairy, Asmaa Shoaeb
DOI:10.4103/AZMJ.AZMJ_55_16  
Background Hypothyroidism is defined as deficient thyroidal hormone production, and may be congenital or acquired. Aim The aim of the study was to determine the presence of auditory disorder in a group of Egyptian women with hypothyroidism and to detect the effect of medical treatment of hypothyroidism on auditory function. Patients and methods Forty hypothyroid women, their ages ranging from 30 to 60 years, were divided into two groups: group 1 (recently diagnosed group), which consisted of 20 drug-naive patients (this group was studied before and after treatment in the form of thyroid hormone replacement); and group 2, which consisted of 20 chronic patients out of medical control. All patients were submitted to history, full clinical examination, pure tone audiometry (PTA), immittancemetry, and auditory brainstem response. Results Sensorineural hearing loss was found among the hypothyroid patients of bilateral mild to moderate hearing loss. Statistically insignificant improvement of PTA threshold was present in the recently diagnosed group after treatment. There was a statistically significant improvement in absolute latencies of waves III and V and interpeak latencies of I–III and I–V in the recently hypothyroid post-treatment group. There were insignificant correlations between the levels of free thyroxin 4 and thyroid-stimulating hormone and auditory changes in hypothyroid patients. There was a statistically significant (positive) correlation between thyroid peroxides antibody and PTA threshold at 250, 500, 4000, and 8000 Hz for all studied groups. However, there was a statistically insignificant (positive) correlation between thyroid peroxides antibody and changes in auditory brainstem response. Conclusion The auditory changes in hypothyroid patients is reversible and may improve after treatment with thyroid replacement hormones (l-thyroxine).
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