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   2016| January-March  | Volume 14 | Issue 1  
    Online since April 18, 2016

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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.
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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.
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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.
  1,834 255 1
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.
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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.
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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.
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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.
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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.
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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.
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The future medicine
Abd E. M. Ali Hussein
January-March 2016, 14(1):7-7
  1,106 126 -
Editorial introduction (bridging the gap)
Emadeldeen A Salah
January-March 2016, 14(1):6-6
  1,003 132 -
Hamdy M Moustafa
January-March 2016, 14(1):1-1
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