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Impact of dual hepatitis B and C infection on disease severity and treatment outcome: updated review
Gamal Esmat, Tamer Elbaz
October-December 2016, 14(4):149-152
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.
  219 923 -
Peptide tyrosine tyrosine (PYY) as a new strategy for treating obesity
Ahmed Mostafa Mahmoud
July-September 2016, 14(3):101-108
Background Obesity is a risk factor for obesity-related disorders such as type 2 diabetes mellitus, vascular disease, osteoarthritis, sleep apnea, and malignancy. Obesity cohinder the individual work capacity, and the cost for managing obesity complications is high. Objective The objective of this research was to study the role of pancreatic polypeptide family including neuropeptide Y and peptide tyrosine tyrosine (PYY) in obesity development and its metabolic changes. Materials and methods Twenty-seven adult female albino rats of a local strain were randomized into three equal groups for 5 weeks: sham-operated group, ovariectomized nontreated group, and ovariectomized treated group received PYY3–36 at a dose of 50 μg/kg, by intraperitoneal injection twice daily during the fifth week. Results Peripheral PYY3–36 administration reduces food intake, body weight gain, and serum glucose in ovariectomized obese female rats. Conclusion PYY system may offer a new therapeutic strategy for obesity management and its metabolic abnormalities.
  385 359 -
The Durazo technique is beneficial in Egyptian liver transplant programs
Abd Elrazek M Ali Hussein
January-March 2016, 14(1):2-5
For nearly four decades, the American people have partnered with the people of Egypt to promote an environment where all groups in Egyptian society – including women and minorities – can lead healthy, productive lives. USAID's program in Egypt, helped scientists and researchers collaborate with American universities aiming to learn about modern American scientific innovations. I was lucky that I have collaborated with one of the most premier USA universities in Hepatology and Liver surgery; UCLA, where I can apply all the liver new techniques I have learned in UCLA in Egypt. Durazo technique is one of very interesting method-post liver transplant, would decrease morbidities and mortalities not only in USA and Egypt, but also Globally.
  581 88 -
Prevalence and predictors of spontaneous bacterial peritonitis: does low zinc level play any role?
Asmaa N Mohammad, Laila M Yousef, Hamdy S Mohamed
January-March 2016, 14(1):37-42
Introduction Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening complication of cirrhosis. Several large studies have identified additional risk factors for the development of SBP. Zinc deficiency has been found to be frequent in cirrhotic patients. Aim of the work The aim of the present study was to evaluate the frequency, possible risk factors and the role of zinc in the development of first-time and recurrent SBP. Methodology A total of 176 cirrhotic ascetic patients admitted to the Hepatology Department in Sohag University Hospital were enroled in the study. SBP peritonitis was diagnosed through history-taking and through examination and laboratory investigations, including ascetic fluid study and the detection of serum zinc level. Results Of the 176 cirrhotic patients, SBP was diagnosed in 54 (31%); in total, 40 patients (23%) had single and 14 (8%) had recurrent episodes of SBP. Out of the 23 studied clinical and laboratory variables, we found that the prolonged use of proton pump inhibitor (PPI) (P = 0.001), lower prothrombin concentration (P = 0.03), ascetic protein level less than or equal to 1 g/dl (P < 0.0001) and zinc deficiency (P = 0.001) were independent risk factors for the development of SBP in cirrhotic patients; using multivariate analysis, only low protein in ascites less than or equal to 1 and low zinc status were predictors of SBP. Conclusion In our study, the frequency of SBP was 31%; overall, 23% of the patients had first-episode and 8% had recurrent SBP. The use of PPI, low platelet count, ascetic protein content and zinc deficiency were the predictors for the development of SBP; only low protein in ascites less than or equal to 1 and low zinc status were independent predictors of SBP.
  539 100 2
Modified PPIs (a search for the better)
Hussein Abdel-Hamid
January-March 2016, 14(1):8-10
'Modified PPIs' is the term given to proton pump inhibitors (PPIs) introduced after the four conventional PPIs – omeprazole, lansoprazole, pantoprazole, and rabeprazole – all of which have similar actions and limitations and are produced by similar technologies. Modified PPIs include isomeric PPIs, dual delayed release PPIs, immediate release PPIs, and long half-life PPIs, which are manufactured by different technologies to overcome certain limitations of conventional PPIs. This modified category includes esomeprazole (Nexium), dexlansoprazol (Dexilent), omeprazole-sodium bicarbonate mixture (Zegred), and S.tenatoprazole. Although some of these new products have better efficacy, longer duration of action, can be taken with disregard to meals, and have better nocturnal effect, we still lack the ideal PPI.
  482 118 -
Bacterial catheter-associated urinary tract infection in the Intensive Care Unit of Assiut University Hospital
Sherine A Aly, Rania A Tawfeek, Ismail S Mohamed
April-June 2016, 14(2):52-58
Objective The aim of this study was to identify the risk factors and common pathogens associated with catheter-associated urinary tract infection (CAUTI) in the ICUs of Assiut University Hospital, Egypt. Methods Urine samples were collected from patients suffering from CAUTI according to the case definition of Centers for Disease Control and Prevention. The samples were subjected to culture on different culture media, and all positive colonies were identified according to their biochemical profile and antibiograms. Klebsiella isolates were further tested for extended-spectrum β-lactamase production. Results The overall bacterial CAUTI incidence rate was 11% (15/136 patients). Female sex, old age (>60 years old), diabetes mellitus, and prolonged duration of catheterization (>6 days) were found to be risk factors for the development of bacterial CAUTI. Klebsiella was the commonly isolated microorganism (8/16, 50%). All Klebsiella isolates were found to be phenotypically Extended-spectrum β lactamase producers, and five of these isolates contained either blaTEM or blaSHV genes. Conclusion This study revealed the high incidence of bacterial CAUTI (11%) in ICUs of Assiut University Hospital. ESBL-producing Klebsiella spp. is responsible for about 50% of bacterial CAUTI cases. All isolated microorganisms were found to be multidrug resistant. Strict implementation of infection control procedures appears to be necessary to control the spread of multidrug resistant organisms.
  406 89 -
Epidemiological evaluation and outcome of pure abdominal trauma victims who underwent surgical exploratory laparotomy
Abd-El-Aal A Saleem, Osama A Abdul Raheem, Hassan A Abdallah, A Mohamed Yousef
January-March 2016, 14(1):24-28
Objective The aim of this study was to evaluate the epidemiological profile, surgical treatment, and outcome of patients suffering from pure abdominal injuries who underwent exploratory laparotomy in the emergency department of Aswan University Hospital, Egypt. Patients and methods This was an evaluation and assessment of observational and descriptive study with prospective approach through interviews of 80 patients with pure abdominal trauma who were subjected to surgical treatment in the form of exploratory laparotomy and evaluation of their medical records. Results The most affected individuals were male patients younger than 49 years, most of them with low educational level and single. There was a predominance of trauma in the rural areas that mostly occurred at night-time and evening. Blunt trauma was the most common type of abdominal trauma, and road traffic accidents were the most frequent mechanism of trauma. The upper abdomen was the most affected region. Pain was the most common presenting symptom, and the spleen was the most affected organ. The hospital stay ranged from 1 to 11 days. Most patients were discharged with permanent sequelae; there were six deaths. Conclusion Blunt trauma was the most common type of abdominal injury. Road traffic accidents were the most common mechanism of blunt trauma, and stab wounds were the most common type of penetrating injuries. A number of risk factors were identified in this study, which include the type of abdominal trauma, presence of chronic diseases, delay in early transport from the site of trauma to the emergency department, and age of patient. Despite the magnitude of traumas, the outcome was satisfactory.
  386 88 1
Evaluation of primary repair of common bile duct in common bile duct stones
Mohamed A Abdel-Raheem, Abdelmonem A Mohamed, Emad A Ibrahim, Mohamed B Gaber
January-March 2016, 14(1):29-32
Background Despite advancements in gallbladder surgery with the introduction of endoscopic and laparoscopic techniques, many surgeons, especially in the developing world, still perform open cholecystectomy with common bile duct (CBD) exploration for choledocholithiasis. Aim of the study The purpose of the study was to report the outcomes of open CBD exploration without the use of T-tubes. Materials and methods A prospective study of open CBD exploration and primary closure was performed without T-tube drainage. Preoperative investigations, the surgical techniques, and perioperative outcomes were recorded. Results Fifty patients had CBD exploration. In 45 patients this was performed by means of a supraduodenal choledochotomy, and in five of these patients free passage into the duodenum could not be achieved using catheters, irrigation, and dilators. These were completed with a choledochoduodenostomy. Conclusion In a limited resource setting, there is still a role for open CBD exploration and primary closure without the necessity of T-tubes and stents as evidenced by a good perioperative patient outcome.
  379 73 -
BMI and breast cancer in upper Egypt
Abeer F Amin
January-March 2016, 14(1):33-36
Background and aim BMI may be an important factor affecting breast cancer outcome. Materials and methods The present study included 100 patients who were newly diagnosed with breast cancer at Assiut University Hospital. Their BMI was measured, and the relation of BMI to the stage of breast cancer and age was determined. Results Patients' ages ranged from 27.0 to 72.0 years. Overall, 45% of the patients were between the ages of 50 and 60 years, and their mean age was 50.6 years. Stage I, II, III, and IV breast cancer were diagnosed in 14, 64, 12, and 10% of the patients, respectively. Around 29% of the patients were overweight and 35% of them were obese. There was a significant positive correlation between age and BMI (P = 0.000). In addition, there was a significant positive relation between BMI and the stage of breast cancer at diagnosis, with a statistical significant difference (P < 0.05). Conclusion Overweight and obese breast cancer patients were more often older, and this was significantly associated with later stages at diagnosis.
  373 77 1
Diagnostic challenges of tuberculosis peritonitis in upper Egypt
Nahed A Makhlouf, Gamal A Makhlouf, Ahmed Soliman, Mahmoud F Sherif, Hebat-Alla G Rashed
July-September 2016, 14(3):115-121
Background Tuberculosis (TB) is a major global health problem. Peritoneal tuberculosis involves the omentum, intestinal tract, liver, spleen, or female genital tract in addition to the parietal and visceral peritoneum. It accounts for ∼1–2% of all cases of tuberculosis. Aims of the study The aims of this study was to analyze the clinical, laboratory, and imaging findings in patients with TB peritonitis and to evaluate the diagnostic methods. Patients and methods This prospective, observational study was carried out on patients with obscure ascites. All patients were subjected to history taking, clinical examination, and laboratory investigations. Ascitic fluid analysis and calculation of serum-ascites albumin gradient were done. Abdominal ultrasound (US) and computed tomography scans were performed. Laparoscopic-guided biopsies from peritoneal tubercle and unhealthy omentum were taken for histopathology and culture analysis. Results The study included 22 cases. Approximately 77.3% were female. The mean age was 42.6±15.1. More than two-thirds of the cases had fever, pain, and abdominal swelling. No portal hypertensive ascites was found in 86.4% of cases. Ascitic fluid cytology revealed lymphocytes in 91%. In abdominal US, ascites was the only finding in 59% of cases; however, adhesion was found in 22.8% of cases. Lymphadenopathy was observed in 13.6% of cases undergoing abdominal US. During laparoscopy, small tubercles on the peritoneum, omentum, and/or intestine with extensive adhesions were the predominant findings. Regarding the histopathologic findings, TB granuloma was predominant in 80% of cases. Conclusion TB peritonitis was common among middle-aged females. Ascites and adhesions were the commonest findings. Laparoscopy and histopathology were the best diagnostic modalities.
  349 99 -
The role of methylene blue in laparoscopic sleeve gastrectomy
Osama A Abdul Raheem, Mohamed Yousef, Abd-EL-Aal Ali Saleem Mohran, Hassan A Abdallah, Asmaa Gaber
July-September 2016, 14(3):122-125
Introduction Methylene blue (MB) is a molecule that has been playing important roles in microbiology and pharmacology for some time. It has been widely used to stain living organisms and to treat methemoglobinemia, and lately it has been considered as a drug for photodynamic therapy. Nowadays, it is used in the treatments of basal cell carcinoma, Kaposi’s sarcoma, melanoma, and virus and fungal infections. MB has low toxicity and no adverse effects. Patients and methods This study was conducted in Aswan University on female and male patients. Our study was done on 70 patients, who had an average age of 29.8 years, with minimum of 25 years and maximum of 35 years. Patients were studied preoperatively with complete investigations, a multidisciplinary workup including specialist counseling (internal medicine, psychiatry, and anesthesiology), and complete performance status evaluation. Patients were well informed about the surgical procedure, with all potential advantages and possible complications and adverse effects. Then they were proceeded to laparoscopic sleeve gastrectomy and the uses of intraoperative MB to confirm any leaks from the stapler line. Postoperative data regarding fever, tachycardia, vomiting, abdominal pain and distention, abdominal ultrasound for any collection, and complete blood count were recorded. All the above data were collected and analyzed to obtain statistically relevant results. Results Apart from mild abdominal pain and tenderness, and low-grade fever, no collection appeared clinically or by ultrasound examination in all cases. All patients received oral fluids on the third postoperative day, and no vomiting developed. White blood cell count was done for all patients, and they were normal except five patients who developed chest infection with low-grade fever which improved with antibiotic. Before discharging the patients, abdominal ultrasound was done for all, and no collection of fluid appeared. Conclusion Intraoperative MB usage is a safe and effective technique in detecting gastric leak during laparoscopic sleeve gastrectomy.
  381 54 -
Effects of adopting preventive measures on malaria parasitemia among pregnant women in Kaduna state, Nigeria
Idris Abdullahi Nasir, Mustapha Jelili, Amos Dangana, Peter Omale Musa, Adamu Babayo, Yahaya Usman, Nkechi B Ugboaja, Maryam Muhammad Zakari
July-September 2016, 14(3):126-129
Background There are several malaria preventive measures. The availability of a particular method does not guarantee its adherence and effective usage. This eventually may not provide the desired results for the fight against malaria. Pregnant women are at higher risk of contracting malaria, and therefore it is necessary that they should be protected against the infection. Objective of the study This cross-sectional study investigated the significant roles of various preventive measures against malaria infection among pregnant women attending four selected secondary health facilities in Kaduna state, Nigeria. Materials and methods Blood samples were collected from 353 pregnant women attending selected hospitals. Malaria parasite microscopy was conducted on the basis of standard protocols. Structured questionnaires were used to obtain data with regard to subject knowledge and practice of preventive measures against malaria. Results Out of the 353 subjects tested, 79 (22.4%) had malaria parasitaemia. One hundred and fifteen (32.6%) subjects used no preventive measure, 45 (12.7%) used sulfadoxine-pyrimethamine prophylaxis, 53 (15.0%) used insecticide treated nets (ITNs), 72 (20.4%) used indoor insecticide house spray, while 68 (19.3%) used > 1 preventive measures. Out of the 79 subjects infected with malaria, 57 (72.2%) do not know how to prevent malaria, while 22 (27.8%) had prior knowledge of malaria prevention. Highest cases (41 [51.9%]) of malaria parasitaemia were recorded in women with no knowledge of preventive measures during pregnancy, while women who used > 1 measures have the least cases (5 [6.3%]) of malaria parasitaemia. There was statistical association between the use of preventive measures and decreased malaria parasitaemia (P < 0.0001). Conclusion Findings from this study revealed that there is need for more sensitization campaigns on available malaria preventive measures. Also, the combination of preventive methods should be considered by pregnant women in order to minimize their chances of acquiring malaria.
  374 58 -
Dieulafoy's lesion: new diagnosis using high-definition endoscopy and treatment with isoamyl-2-cyanoacrylate (Amcrylate)
Abd Elrazek M Ali Abd Elrazek, Mohammad Fakhry, Aly Ragab, Khaled Abd Elazeem
January-March 2016, 14(1):11-13
Dieulafoy's lesion (DL) is a rare but important cause of gastrointestinal (GI) bleeding, accounting for up to 6% of the cases of nonvariceal bleeding in the upper GI tract and 1–2% of all GI hemorrhages. Mortality rates are similar to those of other causes for GI bleeding. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured GI lesion is suspected. In our seven-case study, we think it was feasible to use high-definition Fujinon intelligent chromoendoscopy to diagnose DL. Isoamyl-2-cyanoacrylate (Amcrylate) was effective and safe for treating DL as well as were other strategies, including ethanolamine oleate, band ligation, and n-butyl-2-cyanoacrylate. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.
  328 76 -
Prevalence of Helicobacter pylori infection in patients with portal hypertensive gastropathy owing to liver cirrhosis in Upper Egypt
Khaled Abd-Alazeim Eid, Muhammad Abd El-Gawad Shawky, Amro Metwaly Hassan, Ahmed Qasem Mohammed, Mostafa Ismail Mohammed
July-September 2016, 14(3):109-114
Background Gastrointestinal bleeding and anemia in patients with liver cirrhosis are common problems caused by various etiologies such as bleeding esophageal and gastric varices, bleeding peptic ulcer whether Helicobacter pylori or non-H. pylori related, portal hypertensive gastropathy (PHG), and other causes. Impairment of the gastric protective barriers and production of inflammatory cytokines such as tumor necrosis factor-α and interleukins, which occur because of colonization of gastric mucosa by H. pylori, may make the stomach more susceptible to the effects of portal hypertension. Aim of work The aim of this study was to investigate the prevalence of H. pylori infection and its association with PHG in patients with liver cirrhosis. Patients and methods Overall, 50 patients with liver cirrhosis and PHG (cases) and 50 patients with cirrhosis without PHG (controls) were enrolled in this study. H. pylori stool antigen rapid bedside test and upper endoscopy were done for patients in both groups to diagnose PHG and H. pylori infection. Results The prevalence of H. pylori infection among patients with PHG was higher than those without PHG (34 vs. 10%, respectively; P=0.031), and prevalence of H. pylori infection was 22% among the whole of the studied groups. There was no correlation between H. pylori infection and severity of PHG (P=0.381), Child score, Model for End-Stage Liver Disease score, or serum albumin level. However, our study showed a significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG (P=0.002). Conclusion There is significant association between H. pylori infection and PHG, but there is no significant correlation between H. pylori infection and the severity of PHG or the severity of liver cirrhosis. Also, there is significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG.
  319 83 -
Editorial introduction (bridging the gap)
Emadeldeen A Salah
January-March 2016, 14(1):6-6
  268 87 -
Noninvasive prediction of HCV-4 SVR by 2D US: a randomized study using data mining algorithm
Abd Elrazek M. Ali Abd Elrazek, Khaled Abdelazeem, Mohammad Abd Elfattah, Mahmoud Foad, Khaled Salama, Abduh Elbanna, Shymaa E Bilasy, Mohamed Fakhry, Hamdy Mahfouz
January-March 2016, 14(1):14-18
Objective and aim Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. Antiviral therapy is the cornerstone for the treatment of chronic HCV infection once diagnosis is confirmed by PCR. The goal of antiviral therapy is to eradicate HCV RNA or attain sustained virological response (SVR). In many countries worldwide, including Egypt, HCV infection is treated with a combination of pegylated interferon α and ribavirin (RBV). Liver fibrosis/cirrhosis stage influences the response to pegylated interferon α and RBV. Even with new oral therapies such as Sovaldi many patients have to continue to be on combination regimens of interferon/RBV or RBV alone. In the current study, we aimed to use data mining analysis to determine sonographic pictures that can successfully predict SVR in HCV-4 patients before the antiviral therapy. Methods Eighty-two patients were enrolled in this study and they underwent two-dimensional ultrasound examination before the antiviral therapy. The sonographic data obtained were analyzed with Rapidminer version 4.6 to create a decision tree algorithm for the prediction of SVR. Results The absence of significant liver fibrosis was a predictive parameter of SVR mainly in those patients without a sonographic picture of cirrhosis. The resulting tree yielded an accuracy, sensitivity, and specificity of 85.82 ± 10.79, 68.75, and 96.00%, respectively, upon 10-fold cross-validation. Conclusion In the current study we used decision tree algorithm, one of the most important computational methods and tools for data analysis and predictive modeling in applied medicine, to predict SVR in HCV-infected patients. Two-dimensional ultrasound can give predictive information regarding the treatment outcome before interferon therapy for HCV-4.
  288 64 -
Evaluating the effect of midodrine on renal resistance index in patients with liver cirrhosis and ascites
Hamdy M Moustafa, Khaled Abdel-Azeem Eid, Amro M Hassan, Ahmed Abd-Elrady Ahmed
January-March 2016, 14(1):19-23
Background Portal hypertension, which occurs as a consequence of liver cirrhosis, leads to splenic vasodilatation and alterations in the systemic circulation. Arterial vasodilatation in the splanchnic circulation appears to play a central role in hemodynamic changes and in the decline in renal function in cirrhosis. Peripheral vasodilatation, which occurs as a part of alterations in the systemic circulation, may decrease the renal blood flow and subsequently raise plasma renin activity. Midodrine is a α agonist and acts as a peripheral vasoconstrictor; therefore, it may reduce plasma renin activity and improve renal function. Aim of the work The aim of the study was to evaluate the relationship between renal resistive indices (RIs) in cirrhotic patients before and after oral administration of 7.5 mg midodrine three times daily for 3 days. Patients and methods The study was conducted on 40 patients with liver cirrhosis and ascites and on 40 healthy controls from October 2014 to March 2015 at Al-Azhar University Hospital, Assiut, where all patients were subjected to history and clinical examination as well as to routine investigations such as total bilirubin, albumin, international normalized ratio, and serum creatinine. Patients underwent an abdominal ultrasound with duplex Doppler examination of the kidneys, and RI was calculated before and 3 days after oral intake of midodrine. Results Patients with liver cirrhosis and ascites had significantly higher RI in the right kidney (0.69 ± 0.101 vs. 0.57 ± 0.055,P < 0.001) and in the left kidney (0.69 ± 0.097 vs. 0.59 ± 0.047,P < 0.001) compared with healthy controls. After oral administration of midodrine for 3 days, RI showed significant improvement (RI = 0.928,P < 0.001) in the right kidney and in the left kidney (R = 0.993,P < 0.001). RI had significant positive correlation with Child–Pugh score (R = 0.75,P < 0.001, in the right kidney and R = 0.75,P < 0.001, in the left kidney) and significant positive correlation with Model for End-Stage Liver Disease score (R = 0.536,P < 0.008, in the right kidney and R = 0.487,P < 0.005, in the left kidney). Conclusion Oral midodrine improved renal hemodynamics as assessed by RI in cirrhotic patients. RI is correlated with severity of liver disease as assessed by Child–Pugh and Model for End-Stage Liver Disease scores.
  291 51 -
The future medicine
Abd E. M. Ali Hussein
January-March 2016, 14(1):7-7
  266 74 -
Hamdy M Moustafa
January-March 2016, 14(1):1-1
  246 91 -
Rate of development of incisional hernia 1 year after urgent midline laparotomy
Abd-El-Aal A Saleem, Hassan A Abdallah, Osama A Abdul Raheem, Mohamed A Yousef
April-June 2016, 14(2):59-66
Objective The aim of the present study was to determine the rate of development of incisional hernia at 6 months and 1 year in patients suffering from peritonitis (potentially septic wounds) and other patients suffering from intraperitoneal hemorrhage (IPHge) (aseptic wounds) who had undergone urgent midline laparotomy. In addition, we aimed to evaluate different surgical techniques and suture materials used for abdominal closure and the prevalence of postoperative complications among the studied groups in the Emergency Department of Aswan University Hospital, Egypt. Patients and methods This observational and descriptive study included evaluation and assessment of interviews of 160 patients divided into two groups (A and B). Group A included 80 patients suffering from peritonitis and group B included 80 patients suffering from IPHge. All patients submitted to the surgical treatment in the form of emergency exploratory laparotomy and evaluation of their medical records, involving different surgical techniques and suture materials used for abdominal closure. Postoperative follow-up was set at 6 months and 1 year for the development of incisional hernia. Results Analyses of 160 patients in the two groups indicated that the incisional hernia rate increased significantly from 7.5% at 6 months to 17.5% at 1 year after urgent midline laparotomy in all studied patients (P=0.007). There was a significant increase in incisional hernia rate in group A in comparison with group B at 6 months (12.5 vs. 2.5%; P=0.02) and at 1 year (25 vs. 10%; P=0.01) follow-up after urgent midline laparotomy. Regarding the techniques of closure of urgent midline laparotomy and the used suture materials (Vicryl and Prolene), there was an insignificant deference as regards the development of incisional hernia between subgroups A1 and A2 at 6 months (P=0.50) and at 1 year (P=0.30), and also between subgroups B1 and B2 at 6 months (P=0.49) and at 1 year (P=1.0) follow-up after urgent midline laparotomy. Conclusion The incisional hernia remains the most common complication after midline laparotomy, representing 7.5% at 6 months and 17.5% at 1 year follow-up in the present study. Incisional hernia was significantly increased in patients suffering from peritonitis than in those patients suffering from IPHge at 6 months and at 1 year after urgent midline laparotomy. Regarding the surgical techniques and suture materials used for closure of urgent midline laparotomy, there was an insignificant difference as regards the development of incisional hernia between closure of urgent midline incision by continuous suture plus some interrupted sutures in between using slowly absorbable multifilamentous suture material [Vicryl (polyglactin)] and continuous suture only using nonabsorbable monofilamentous suture material [Prolene (polypropylene)] at 6 months and 1 year between subgroups A1 and A2, and between B1 and B2.
  283 48 -
An Indian study of postural variation in peak expiratory flow rates in healthy, adult, male participants
Ajith Pakkala, Amrith Pakkala
April-June 2016, 14(2):49-51
Background Peak expiratory flow rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR showing postural variation that follows a specific pattern in asthmatics and healthy individuals has been identified. Adequate data are not available for postural variation in normal individuals who are students of professional courses with a sedentary lifestyle. Lung volumes in normal individuals were significantly higher in the standing position. Some studies have reported that in healthy participants spirometric indices were higher while standing in comparison with the sitting position, whereas other studies have reported no differences between spirometric values obtained in the lying, sitting and standing positions. Hence, this study was undertaken to study the postural variation in PEFRs in healthy, adult, male participants in south India. Materials and methods PEFR was recorded in 50 adult, healthy, male participants aged 18–23 years who were students of professional courses. Mini Wright’s peak flow meter was used to measure the PEFR. Three readings were taken in the standing and lying positions. The best of the three recordings was considered as the final value. Results PEFR was decreased while lying down compared with standing in the participants studied, and the quantum of difference was noted. Conclusion With postural changes, the PEFR significantly differs on the basis of whether the measurements are taken in the standing or in the lying posture in healthy participants. The effect of posture may be of importance in recording PEFR, and changing to a better posture may be especially useful for those with weak expiration.
  287 43 -
Malpractice: a story of a low socioeconomic country
Hamza H Khan, Muhammad H Farooq Khan, Ghulam H Khan, Abid N Khan Adil
April-June 2016, 14(2):45-45
  271 42 -
Is bronchial asthma a risk factor for chronic kidney disease?
Zeinab R Adawy, Rayyh A Mohamad-Saleh, Taghreed Abdul-Aziz M Ismail
January-March 2017, 15(1):27-34
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.
  258 49 -
Vitamin D deficiency and its correlation to hemoglobin A1C in adolescent and young adult type 1 diabetes mellitus patients
Amira M Elsayed, Ghada A Mohamed
April-June 2016, 14(2):76-80
Background Some studies have described the relationship between autoimmune diabetes or type 1 diabetes mellitus (T1DM) and vitamin D deficiency. Few studies correlate between vitamin D deficiency and glycemic control. Purpose This study was conducted to appraise the status of vitamin D in adolescent and young adult T1DM patients and to correlate its deficiency to glycated hemoglobin (HbA1c). Patients and methods Around 63 Kuwaiti patients with T1DM were recruited in a descriptive cross-sectional study in April 2015. Serum level of vitamin D [25(OH)D] was measured using enzyme-linked immunosorbent assay, and glycemic control was measured by HbA1c using autoanalyzer. The relationship between vitamin D levels and HbA1c was analyzed by Spearman’s correlation. Among the participants, 21 (33.3%) were male and 42 (66.7%) were female. The mean age was 18.41±6.19, and the mean diabetes duration was 6.98±4.99. The mean vitamin D concentration was 47.29±2.91 nmol/l, with 38.1% of participants identified to have vitamin D deficiency and 19% identified to have vitamin D insufficiency. There were high levels of HbA1c (10.08±2.28), with a significant inverse correlation between HbA1c and vitamin D (r=−0.374 and P=0.003). Conclusion Low vitamin D in T1DM is extremely highly and closely correlated to HbA1c. We recommend that evaluation of the level of vitamin D in type 1 diabetic patients is very critical, and vitamin D supplementation may improve glycemic control.
  239 65 -
Central proliferative diabetic retinopathy: evaluation and management
Mohamed I Elkasaby, Hazem Mohamed Azab, Maged Adly Naguib, Ali Hendy El Ghamdi, Mostafa Mahmoud Darwish
April-June 2017, 15(2):61-66
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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