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   Table of Contents - Current issue
October-December 2019
Volume 17 | Issue 4
Page Nos. 321-423

Online since Friday, February 14, 2020

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Role of computerized tomography in the management of intestinal obstruction in adults Highly accessed article p. 321
Ahmad F El-Hossainy, Fawzy M Mustafa, Mohamad A Shazly, Yousef A Yousef Selim
Background Computed tomography (CT) has become the most important noninvasive imaging tool to diagnose small and large bowel diseases as it has the potential to provide significant information that leads to timely appropriate treatment and thus positively affect the outcome, morbidity, and mortality of patients. Patients and methods Fifty five adult patients who presented with clinical manifestations of intestinal obstruction were registered in the study. CT findings were based on dilated bowel, complete obstruction, partial obstruction, transition point, ascites, closed loop, free air, and other factors as and when required. Patients who had features suggestive of complete or complicated obstruction (strangulation, ischemia) were taken up for surgery on an emergency basis. Patients who showed improvement on conservative management and clinicoradiological features suggestive of uncomplicated partial obstruction were kept on conservative management. Results Complete obstruction was seen in 44% of patients (22 cases) and all of them underwent surgery. Partial obstruction was seen in 56% (28 cases), of which 71.4% (20 cases) were operated upon. Postoperative adhesions were the most common etiology in the study group (26%). Out of 42 patients who were treated by surgery, majority of patients (88%) matched with preoperative CT findings, whereas in 12% of patients, CT findings did not match with intraoperative findings. CT sensitivity was 76.6%, specificity was 75%, positive predictive value was 94.2%, negative predictive value was 40%, and accuracy was 78%. Conclusion Clinical sense still the mainstay for deciding the line of management in cases of intestinal obstruction. CT in this category of patients can help surgeons to perform surgery early and prevent complications. It also helps in preventing unnecessary surgeries in patient who can be treated conservatively.
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The role of percutaneous ultrasound-guided true-cut needle biopsy in patients with sheet-like pleural thickening p. 331
Al Sayed M Tealeb, Mohamad S Shehata, Ismail M Alwakil
Background Pleural biopsy for histological confirmation is the standard diagnostic procedure for pleural diseases. Aim To identify the role of percutaneous ultrasound (US)-guided true-cut needle biopsy in patients with sheet-like pleural thickening. Patients and methods A prospective interventional simple controlled trial was conducted on 60 patients with computed tomographic evidence of pleural thickening. Percutaneous US-guided pleural biopsies using a true-cut needle were performed for pathological tissue characterization; complications were recorded. Results All patients were diagnosed, with only five (8%) patients found to have self-limiting pneumothorax, with no need for a chest tube. Fifty-three percent of patients had a histopathological diagnosis of mesothelioma, 14% had a histopathological result of adenocarcinoma, whereas 33% had chronic fibrosing pleuritis. Conclusion The US-guided procedure has a major advantage as it is being real time, rapid, available bedside, and well tolerated, and no serious complications were observed in good case selection and procedure.
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Outcomes of mid-penile hypospadias repair using two different techniques p. 339
Abdelaziz Yehya, Mabrouk Akl, Mohamed Abd-Alrazek, Ibrahim ElSotohi, Mohamed Negm, Mohamed Abdel Aziz, Ibrahim Gamaan, Alsayed Othman
Introduction Several techniques have been reported for mid-penile hypospadias repair, including Snodgrass tubularized incised plate (TIP) and onlay island flap (OIF) procedures, which are two popular procedures. Aim of the work To compare the outcomes and complication rates for both TIP and OIF techniques. Patients and methods A prospective randomized study was conducted on 140 boys (age range, 1–6 years) with primary mid-penile hypospadias who underwent repair from June 2011 to December 2016 at our university hospitals. The patients were prospectively randomly divided into two equal groups: group A (n=70), underwent Snodgrass TIP urethroplasty, and group B (n=70), underwent OIF. Inclusion criteria only males with fresh mid penile hypospadias without ventral chordee from 1 to 6years old. Exclusion criteria were recurrent cases, presence of ventral chordee, parental refusal or children more than 6years of age. Outcomes were assessed in terms of success rates, operative time complication rates, and cosmetic appearance during follow-up. All children were subjected to full history taking, thorough clinical examination, and routine laboratory investigations (CBC, BT, CT, FBS, urinalysis, liver and renal profile), results were compiled and compared statistically. Results There were statistically significant differences between the two techniques regarding success rate, operative time incidence of complications and cosmetic results. Conclusion Both techniques are reliable and feasible for treatment of mid-penile hypospadias, but there was a statistically significant difference regarding operative time, complications, and cosmetic outcome with TIP procedure. So, the authors preferred it if suitable urethral plate is present.
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Cerebrospinal lactate dehydrogenase and serum procalcitonin in the diagnosis of meningitis p. 344
Sayed M Farouk, Taha S Hussein, Mahmoud I Basstawy, Nagla R Abdel Moniem
Background Meningitis is inflammation of the membranes that cover the brain, spinal cord, and the intervening cerebrospinal fluid.. Aim The aim of this paper was to assess the diagnostic role of cerebrospinal lactate dehydrogenase (LDH) and serum procalcitonin (PCT) in meningitis and to differentiate septic from aseptic meningitis. Patients and methods The cases were divided into septic meningitis (group I), aseptic meningitis (group II), and meningism (group III) and 100 control cases of complaints other than central nervous system (CNS) infection. All patients were evaluated by full clinical examination, laboratory investigation (complete blood count, erythrocyte sedimentation rate, C-reactive protein, and random blood sugar, liver and renal function tests, and blood culture), lumbar puncture for cerebrospinal fluid examination, cerebrospinal LDH by spectrophotometer, serum PCT in selected patients, computed tomography, and MRI in complicated cases. Results Cerebrospinal LDH 100% of 139 cases in septic meningitis and 98% of 104 cases in aseptic meningitis were elevated above normal range. All cases of meningism show normal range. Furthermore, serum PCT testing was positive in all patients with septic meningitis, while serum PCT testing is positive in 35 (34%) patients with aseptic meningitis and negative in 69 (66%) patients and serum PCT-Q testing was negative in all patients with meningism. Controls were assessed for normal serum PCT level. Conclusion Cerebrospinal LDH can be used only as a preliminary screening test, whereas PCT-Q was a good diagnostic marker for distinguishing septic from aseptic meningitis.
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Effect of extracorporeal blood flow on blood pressure, pulse rate, and cardiac output in hemodialysis patients p. 349
Mohammed Z.E Hafez, Hala A El-Ebidi, Ramadan G Mohammed, Omar A Ahmed
Background Intradialytic hypotension (IDH) is a common clinical practice to reduce the extracorporeal blood flow rate (EBFR). Aim The aim of this study is to investigate the effect of changes in EBFR on blood pressure (BP), pulse rate (PR), and cardiac output (COP) in hemodynamically stable patients during hemodialysis (HD). Patients and methods The population of this study consists of 40 patients who were on RD three session weekly. Patients were investigated before and after one conventional HD session. Before the HD session, an echocardiograph was performed to evaluate left ventricular ejection fraction and establish the degree of potential heart failure. Furthermore, arteriovenous fistula recirculation, a confounder of the measurement of EBFR, was excluded at an EBFR of 400 ml/min. Result In this study regarding measure of BP, PR, and COP at EBFR 200, 300, and 400 ml/min, there was a significant increase in systolic BP at an EBFR of 200 ml/min as compared with an EBFR of 300 ml/min and an EBFR of 400 ml/min, but there was no significant change in systolic BP at an EBFR of 300 ml/min as compared with an EBFR 400 ml/min. Regarding diastolic BP, mean arterial pressure, PR, and COP at an EBFR of 200, 300, and 400 ml/min, there was no significant change in mean arterial pressure and COP. Conclusion IDH has been associated with many adverse clinical events including myocardial stunning, cerebral atrophy, and increased mortality. Change of EBFR from 400 ml/min or from 300 ml/min to EBFR 200 ml/min can increase in BP, so it helps in decreased occurrence of complications of IDH, compared with other methods of increasing BP during HD. There is no significant relation between change of EBFR and diastolic BP.
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Molecular docking study of binding modes of amphetamine, cathine, and cathinone to monoamine oxidase B p. 354
Jerah A Ahmed
Background Molecular docking is commonly used in the study of small-molecule–protein interaction. Amphetamine (AMPH), cathine (CATHI), and cathinone (CATHO) bind in silico with monoamine oxidase B (MAO B) with relatively low affinity. Objective The purpose of the study was to determine the binding modes of AMPH, CATHI, and CATHO with the enzyme MAO B. Molecular docking software, AutoDock 4.2, was used to study the interaction of these ligands with MAO B. Materials and methods Molecular docking was performed using the molecular docking software AutoDock, version 4.2. graphic user interface, AutoDock Tools, was used to prepare protein and ligands for docking. Results The estimated ΔG of binding (free energy of binding) was −6.25 kcal/mol for AMPH, −6.05 kcal/mol for CATHI, and −6.24 kcal/mol for CATHO. Respective Ki (inhibitor constant) values were 2.61×10−5 M, 3.69×10−5 M, and 2.69×10−5 M. All three ligands show similar interactions within active site which include hydrophobic and hydrogen-bonding interactions. When compared with binding affinity of known inhibitors of MAO, safinamide, the binding affinity of these inhibitors is substantially less. But, they bind in the same active site and share some common interactions with active site residues. Similarity in binding modes of AMPH, CATHI, and CATHO is due to their similar structures. Conclusion It can be speculated that nervous stimulant activity of AMPH, CATHI, and CATHO could be due to inhibition of MAO. This enzyme catalyzes the oxidative deamination of monoamine neurotransmitters such as serotonin and dopamine and reduces the level of these neurotransmitters. Inhibition of this enzyme might result in more sustained levels of these neurotransmitters. Our docking study shows that AMPH, CATHI, and CATHO inhibit MAO B with free energy ranging from −6.05 to −6.25 kcal/mol and Ki ranging from 2.61×10−5 to 3.69×10−5 M.
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Effect of midazolam, propofol, and dexmedetomidine on postoperative cognitive dysfunction after cardiac surgery in the elderly p. 361
Mofeed A Abdelmaboud
Background Postoperative cognitive dysfunction (POCD) is among the most prevalent and serious life-threatening postoperative complications. Aim The primary outcome was to compare the efficacy of dexmedetomidine, propofol, and midazolam on prevention of POCD during cardiac surgery in the elderly. The secondary outcome is to determine possible complications during the first postoperative day. Patients and methods Ninety elderly patients undergoing cardiac surgery were randomly divided during the cardiopulmonary bypass period into three equal groups. group M: received midazolam 0.1 mg/kg/h, group P: received propofol 1 mg/kg/h, and group D: received dexmedetomidine 0.5 µg/kg/h. Mini-Mental State Examination (MMSE), incidence of POCD, and interleukin 6 (IL-6) were recorded on the day before surgery (M0, F0, L0, respectively), 1 h after extubation (M1, F1, L1, respectively), and 1 week postoperatively (M2, F2, L2, respectively). POCD was diagnosed when the MMSE score decreased two points or more from the preoperative value. Adverse effects (hypotension, bradycardia, laryngospasm, postoperative nausea and vomiting, and hypertension) were recorded. Results As regards MMSE, there were no significant differences among groups except at M1 where it was higher in group D than the other two groups. In groups M and P only, MMSE was significantly higher at M1 than M0 and returned to near preoperative value at M2 in the same group. There were no significant differences regarding the incidence of POCD at F0, F1, and F2. There were no significant differences with respect to blood IL-6, among groups except at L1 where it was significantly higher in both group M and group P than group D. In groups M and P only, IL-6 was significantly higher at L1 than L0 and then returned to near preoperative value at L2 in the same group. Conclusion Dexmedetomidine was a good choice for reducing POCD in cardiac surgery in elderly patients with less side effects.
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Prevention of postdural puncture headache after accidental dural puncture in cesarean sections: a comparative study p. 367
Mofeed A Abdelmaboud, Usama I Abotaleb, Ahmed M Abd Elgaleel
Background Accidental dural puncture (ADP) is one of the most common complications of neuraxial anesthesia in labor with high incidence of postdural puncture headache (PDPH). Aim Primary outcome: to compare the effectiveness of intramuscular neostigmine, intrathecal catheterization (ITC), epidural blood patch (EBP) on the prevention of PDPH. Secondary outcome: to assess the severity of PDPH and possible complications. Patients and methods One hundred and twenty patients exposed to ADP, fulfilling the inclusion criteria were divided into four equal groups. Control group: received conservative treatment when developed PDPH with a visual analog scale (VAS) of more than 4, group N: received intramuscular neostigmine 20 µg/kg and atropine 0.01 mg/kg after ADP, group ITC: ITC at the same site of ADP and left for 48 h and group EBP: received EBP at a level of ADP. VAS was assessed at 6, 12, 24, 36, and 24 h. Pain severity was divided into no pain (VAS<4), mild (VAS 4–5), moderate (VAS 6–7), and severe (VAS>7). Number of patients who required rescue ketorolac analgesia and average diclofenac (mg) consumption during the first 48 h and possible complications were recorded. Results VAS score and pain severity were significantly higher in the control group than other groups, in group N and group ITC than EBP and in group N than group ITC at all examination times. The number of patients who required diclofenac analgesia was significantly higher in the control group than other groups. Average diclofenac consumption during the first 48 h was significantly higher in the control group than other groups, in both group ITC and group N than EBP and in group N than group ITC. Urinary bladder spasm, hypotension, and bradycardia were significantly higher in group N than other groups, and muscle twitching and abdominal cramps were significantly higher in group N than both control and EBP groups. Conclusion EBP was superior to ITC and neostigmine in reducing the incidence of PDPH and pain severity with less complications.
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Correction of neuromuscular foot deformity by a circular frame p. 372
Ibrahim Elsayed A-Abuomira
Background Neuropathic deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces. Neuropathic foot deformities present a formidable challenge to orthopedic, pediatric, and rehabilitation specialists since these deformities are multiplanar, insidious in onset, and most difficult to attribute to and recognize an incipient cause. Aim The aim of our study was to determine the use of a circular frame in the correction of neuromuscular foot deformity. The aim of surgical treatment is to achieve painless foot and stable plantigrade. The use of a circular frame, with or without gradual correction, may allow the patient to be more functional during the period of healing because a circular frame will typically allow partial to full weight bearing during the period of recovery. Patients and methods In this study, 18 feet and ankle deformities in 13 patients were operated upon using the Ilizarov technique and fixator during the period from January 2013 to April 2018. Results The aim of surgery in neuropathic foot is to achieve functional improvements and not just a cosmetically normal limb. Compared with the preoperative status, all patients were satisfied with their gait. The correction period ranged from 2 to 3.5 months. Conclusion We have treated 13 patients affected by neuropathic foot deformities caused by poliomyelitis, meningocele, Charcot–Marie–Tooth syndrome, and post compartmental. Correction of foot deformities and leg-length discrepancy was performed by the Ilizarov method to obtain stable plantigrade and enable wearing of a normal shoe. Multiple surgical techniques were used (closed method, arthrodesis, open method with osteotomy, leg or tendoachilles’ lengthening) in most of the patients, with few complications.
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Efficacy of ultrasound-guided fascia iliaca compartment block with ropivacaine and dexmedetomidine for postoperative analgesia in hip arthroplasty p. 378
Mostafa M Sabra, Mofeed Abdalla, Ahmad S Abdelrahman
Background Suprainguinal fascia iliaca block (FICB) has been reported to provide effective postoperative analgesia in patients with femur fracture. This study aimed to evaluate the effectiveness of FICB with ropivacaine and dexmedetomidine for postoperative analgesia in hip arthroplasty. Patients and methods This prospective, double-blinded, randomized, controlled, clinical study was conducted on 57 patients with American Society of Anesthesiology physical status I–II, aged 50–70 years, undergoing elective hip arthroplasty. Subarachnoid block was given at the L3-4 interspace, and then the patients were divided into three groups according to the drug given in the suprainguinal fascia iliaca after subarachnoid block and before skin incision: group C received 40 ml normal saline, group R received 40 ml ropivacaine 0.2%, and group D received a mixture of dexmedetomidine 2 μg/kg diluted in 0.2% ropivacaine with 40 ml total volume. The primary outcome was evaluation of postoperative analgesia using numerical rating scale, recorded at 30 min and at 1, 3, 6, 9, 12, 15, 18, 21, and 24 h. Analgesic consumption and first analgesic request were the secondary outcomes. Results Numerical rating scale scores were significantly higher in group C when compared with groups R and D, at the 1, 3, and 6h. Postoperative pethidine consumption during the first 24 h was found to be significantly less in group R and group D when compared with group C. There was a statistically significant difference in the group D when compared with group C and group R, with less number of patients who required rescue analgesic in 24 h and prolonged time for first request of rescue analgesic. Conclusion Addition of dexmedetomidine to ropivacaine in FICB was efficacious in decreasing severity of pain, decreasing total analgesic consumption during the first 24 h, and prolonging the time for first request of analgesia in the postoperative period for patients undergoing hip arthroplasty.
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Reference values for left ventricular strain using 2-dimensional speckle tracking in primary school-aged healthy Egyptian children p. 385
Shaimaa A Habib, Ghada M.S Ahmad, Layla A Mohamed, Ragaa A Mohamed
Background The aim was to set normal values of two-dimensional speckle-tracking echocardiography (2D-STE)-derived left ventricular strain is a prerequisite for its routine clinical application in children. The aim of this study was to establish our values of LV systolic strain using 2D-STE in a large cohort of primary school-aged healthy Egyptian children. Participants and methods All studied cases underwent complete physical examination, including anthropometric, heart rate, and blood pressure measurements. Transthoracic echocardiography was acquired in 420 healthy participants, including routine echocardiography study, and tissue Doppler imaging and 2D-STE were performed. Global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) values were determined. Multiple linear regression was performed to define the strongest predictors for GLS, GCS, and GRS. Results A total of 420 children were included, with a mean age of 9.39±1.98 years. GCS values were −33.97±8.86% at the mitral valve and −33.88±8.59% at papillary muscle (PM). GLS values were −21.6±2.59% in apical four-chamber, −21.96±2.34% in apical two-chamber, and −22.17 ±2.58% in apical three-chamber views, whereas the GRS values were 46.34±10.05 at mitral valve and 46.37±9.97 at PM. Further analysis showed that the age was the strongest predictor of GRS and GCS (B=−2.018 and 2.47, respectively, and P<0.001 for both), whereas DBP was the strongest predictor of GLS (R2=0.048, P<0.001). Conclusion This is the first Egyptian report that defines normal reference values for myocardial strain in longitudinal, circumferential, and radial directions assessed using 2DSTE imaging in a large pediatric cohort. There is a need to use age-specific reference values for the adequate interpretation of 2DSTE measurement.
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Prevalence and risk factors of pregabalin misuse among patients with substance use disorder p. 393
Amgad A.M Gabr
Background Pregabalin use disorder is an alarming phenomenon demonstrated in many countries. Some countries classified it as a class C controlled substance in a schedule V controlled substance. Aim The aim was to assess pregabalin use disorder among substance abusers, recognize psychiatric co-morbidity, and identify risk factors to start pregabalin abuse. Participants and methods The study group included 400 Egyptian substance misusers. From addiction and psychiatric outpatient clinics in Al-Azhar University Hospitals in Cairo, Egypt, the participants were diagnosed using DSM V and interviewed using (SCID 1) and urine specimens screened for routine polysubstance and pregabalin by means of a mass spectrometer analysis. Results The prevalence of pregabalin misuse disorder among all patients with substance misuse disorder was 30%. However, first substance is cannabinoids (hashish), with 83.75%, and then tramadol, with 43.75%. The prevalence of co-morbid psychiatric disorders was 45%. We found the use of pregabalin for sleep purpose 32.5% and for anxiety self-treatment 19.2% as the strongest predictors and risk factors for pregabalin abuse. Conclusion Pregabalin misuse disorder is at the fourth rank among all substances misused in Egypt, with a percentage of 30%. The most common reason for pregabalin misuse is to have a good sleep, self-treatment of anxiety, peer pressure, and depression.
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Effects of adding morphine to intra-articular dexamethasone injection on postoperative pain after arthroscopic subacromial decompression shoulder surgery p. 398
Sameh H Seyam, Khaled Elsheshtawy, Mofeed A Abdelmaboud
Background Arthroscopic shoulder surgery is a common method in the surgical treatment of shoulder diseases. We compared a combination of dexamethasone–bupivacaine–morphine against bupivacaine–morphine, as well as bupivacaine alone following arthroscopic subacromial decompression surgery. The study aimed for better quality of postoperative analgesia and lower pain intensity. Patients and methods This prospective, randomized, double-blinded controlled study was conducted on 60 patients undergoing arthroscopic shoulder subacromial decompression surgery. The patients were randomly allocated into three equal groups. All medications were injected intra-articularly at the end of the procedure. In the control group, 10 ml of 0.5% bupivacaine+5 ml isotonic saline (total volume, 15 ml) were injected. In the morphine group, 5 mg morphine diluted in 5 ml normal saline+10 ml of 0.5% bupivacaine was injected. In the morphine–dexamethasone group, 5 mg morphine+400 μg/kg weight dexamethasone completed to 5 ml with normal saline+10 ml of 0.5% bupivacaine was injected. Visual analog score, vital signs, time of first analgesic request, need for supplemental analgesic, and adverse effects were recorded. Results The morphine–dexamethasone group showed a lower visual analog score at rest and movement, delayed time for first analgesic request, more stable vital signs, and less adverse effects as compared with the other groups. Conclusion Addition of intra-articular morphine to dexamethasone and bupivacaine has a remarkable analgesic efficacy, a much-prolonged postoperative pain control, minimal postoperative analgesic requirement, and better patient compliance with minimal side effects.
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Effect of endometrial scratch using a Pipelle catheter on recurrent implantation failure with intracytoplasmic sperm injection p. 404
Madiha M Hanafi, Ahmed M Rammah, Mona A Elkafrawy, Eman M Malatan
Back ground In the last two decades, assisted reproductive technology procedures for culturing and transferring embryos have been continually improved, but the clinical pregnancy rate has not improved substantially over the last 10 years. The most important cause for implantation failure is embryo quality or uterine receptivity, but remains unexplained in many cases. About 75% of conceptus are lost before or at the time of implantation. Aim This work aims to assess the effect of endometrial scratch (ES) using a Pipelle catheter on the outcome of intracytoplasmic sperm injection (ICSI) in patients with recurrent implantation failure. Patients and methods The current study included 130 patients who were divided into two equal groups of 65 patients each. In the scratch group, endometrial local scratch using a Pipelle biopsy catheter on the mid luteal phase of spontaneous menstrual cycle before the ICSI procedure was performed, whereas the control group did not undergo ES. ICSI failure was recorded two or more times in each group. Results In the current study, there were no statistically significant differences between the two groups in age, gravidity and parity, type, duration of infertility, and the number of previous ICSI trials. However, the BMI was higher in the control group. In the current study, there were no statistically significant differences between the two groups in basal hormonal profile follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, prolactin, estradiol, and anti-Müllerian hormone. In this study, there was highly significant increase in the pregnancy rate in the scratch group than the nonscratch group. The number of pregnant cases in the scratch group was 36 (55.4%), whereas in the control group, it was 21 (32.3%), with a highly significant P value of 0.008. In this study, there was no statistically significant difference between positive and negative pregnancy in the basal hormonal profile, except anti-Müllerian hormone and follicle-stimulating hormone levels, P values of 0.040 and 0.000. Conclusion ES in the cycle before the ICSI cycle improved the chemical and clinical pregnancy rates compared with ICSI performed without ES in cases of recurrent implantation failure. It seems that increasing pregnancy rates could be because of the local inflammatory reaction elicited by the endometrial sampling procedure.
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Early detection of left ventricular involvement in patients with Duchenne’s and Becker’s muscular dystrophy p. 409
Shaimaa A Habib, Mohie El Din T Mohamed
Background Patients with Duchenne muscular dystrophy (DMD) and Becker’s muscular dystrophy (BMD) may have asymptomatic cardiac involvement for years before the development of dilated cardiomyopathy and even showed normal conventional echocardiographic parameters. We evaluated those patients with more recent echo modalities for early detection of subtle cardiac changes. Patients and methods Thirty patients [13 with BMD as group 1 (G1) and 17 with DMD as group 2 (G2)] compared with 30 age-matched and sex-matched healthy participants as group 3 (G3). All cases were subjected to history taking, clinical examination, ECG, conventional two-dimensional (2D) echocardiography, tissue Doppler imaging, 2D-speckle tracking echocardiography, and 4D echocardiography for measurement of left ventricular (LV) dimensions, systolic and diastolic function with focus on strain imaging modality. Results Nine patients of G2 and three patients in G1 had LV systolic dysfunction despite normal 2D-LV ejection fraction. Ten patients in G2 and five patients in G1 had LV diastolic dysfunction measured by LV early diastolic wave velocity over mitral valve measured by conventional Doppler/early diastolic mitral annular velocity by tissue Doppler imaging (E/Ea). Tissue Doppler myocardial performance index was significantly higher in both G1 and G2. 2D-LV septal strain, lateral strain, anteroseptal, 2D-global longitudinal strain (GLS), and 4D-GLS strains were significantly lower in G1 and G2. Apical, mid, and basal posterior LV strain were significantly lower in G2 compared with G1. 2D-GLS was lower in G2 compared with G1. Both LV global radial strain and global circumferential strain were significantly lower in G1 and G2. Mid and basal septal strain and basal posterior strain were significantly lower in G2 compared with G1. The mid and basal posterior strains were significantly lower in G2 compared with G1. Conclusion 2D-speckle tracking and 4D echocardiographic study of global and regional strain besides creatinine phosphokinase serum levels may add benefit in early detection of subtle LV dysfunction in patients with DMD and BMD.
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Eosinophilic cholecystitis: a rare cause of acute cholecystitis ‘case report’ p. 417
Abdulkarim Hasan, Khalid Nafie
We report two cases of eosinophilic acute cholecystitis in two male patients aged 43 and 20 years without peripheral eosinophilia.
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Erratum: Prophylaxis or treatment of spinal hypotension during cesarean delivery: phenylephrine versus norepinephrine boluses p. 421

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Erratum: Persistence of transient urinary incontinence after delivery in obese women: a cross-sectional study p. 422

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Erratum: Preoperative ultrasound assessment of gastric content in obese patients p. 423

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