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  Citation statistics : Table of Contents
   2016| April-June  | Volume 14 | Issue 2  
    Online since October 21, 2016

 
 
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ORIGINAL ARTICLES
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
DOI:10.4103/1687-1693.192652  
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.
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CASE REPORT
Spontaneous common bile duct perforation in an adult female patient presenting with severe epigastric pain mimicking acute pancreatitis
Muhammad Abd El-Gawad Shawky, Amro Metwally Hassan, Mohammed Fakhry Mohammed, Hamdy Mahfouz Moustafa, Abd El-Monem Abd El-Fatah Mohammed, Mohammed Abd El-Tawab Eid
April-June 2016, 14(2):46-48
DOI:10.4103/1687-1693.192649  
Spontaneous common bile duct (CBD) perforation is a rare event, and mostly occurs in infants with CBD stones and rarely occurs in adults. A 19-year-old female patient presented to us with severe acute epigastric pain mimicking acute pancreatitis, together with vomiting, abdominal distention, and tenderness. Abdominal radiograph and upper gastrointestinal tract endoscopy were normal. Abdominal ultrasound and computed tomography showed retroperitoneal collection near the pancreas. Diagnostic aspiration showed greenish yellow turbid aspirate with very high bilirubin in ascitic fluid than in serum. The case complicated with biliary peritonitis. Laparotomy was performed, and revealed posterior CBD perforation. Peritoneal washing was carried out with removal of about 6 l of bile. Cholecystectomy with CBD exploration was performed, and the CBD was closed over a T-tube and external drainage was carried out. The patient stayed in hospital for 17 days postoperatively and was discharged after removal of the T-tube and drain. She came for follow-up after 1 month from discharge in a very good general condition.
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LETTERS TO THE EDITOR
Tears do not save lives but blood does: giving life to the moribund
Nagesh Kamat
April-June 2016, 14(2):43-44
DOI:10.4103/1687-1693.192650  
  - 687 82
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
DOI:10.4103/1687-1693.192648  
  - 899 89
ORIGINAL ARTICLES
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
DOI:10.4103/1687-1693.192645  
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.
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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
DOI:10.4103/1687-1693.192653  
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.
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Serum hyaluronic acid as a noninvasive marker of hepatic fibrosis in chronic hepatitis c patients
Soheir M Abd-Elghany, Eman E Ahmed Ibrahem, Samy Z El-Sayed, Sara Mohammed, Amal A Morsy
April-June 2016, 14(2):67-75
DOI:10.4103/1687-1693.192654  
Background Patients with chronic hepatitis C virus (HCV) infection are often asymptomatic with few clinical signs of liver disease. Recognition of the presence of fibrosis or cirrhosis is difficult without liver biopsy, but with the availability of effective treatments, such as interferon, and the potential for progression to hepatoma in some cases, an accurate measure of the stage of disease is important. Serum hyaluronic acid (HA) has been identified as a potential marker of fibrosis or cirrhosis. Aim of the work The aim of this study was to evaluate the serum level of HA as a noninvasive marker of hepatic fibrosis in comparison with liver biopsy and indirect serum fibrosis markers such as AST/ALT ratio and aspartate transaminase to platelet ratio index (APRI) in chronic HCV patients. Patients and methods Our patients were classified into three groups: group 1 included 20 patients with mild hepatic fibrosis (F1 stage); group 2 included 20 patients with moderate hepatic fibrosis (F2 stage); and group 3 included 20 patients with marked hepatic fibrosis and cirrhosis (F3 and F4 stages). The control group included 20 normal volunteers. Serum HA level evaluation, liver function tests, and complete blood count were carried out for all groups, whereas liver biopsy was performed only for patients to determine the stage of liver fibrosis. Results There was a highly significant increase in serum HA level in group 2 and group 3 in comparison with the control group and a significant increase in group 1 in comparison with the control group. However, there was highly significant increase in group 3 in comparison with group 1 and group 2 and a significant increase in group 2 in comparison with group 1. The cutoff point for HA level was greater than 42.18 ng/l to discriminate between the patient and the control group, with a sensitivity of 91.7% and a specificity of 95.0% for HA. The cutoff point for HA level was greater than 81.68 ng/l to discriminate between group 1 (mild fibrosis) and group 2 (moderate fibrosis), with a sensitivity of 100% and a specificity of 70%. The cutoff point for HA level to discriminate between group 2 (moderate fibrosis) and group 3 (severe fibrosis and cirrhosis) was greater than 167.98 ng/l, with a sensitivity of 90% and specificity of 80%. There was a significant positive correlation between serum HA level and APRI. Conclusion HA is a promising reliable simple noninvasive marker for assessing liver fibrosis in HCV-infected patients with high sensitivity and specificity. There was a positive correlation between serum HA level with stages of hepatic fibrosis and APRI.
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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
DOI:10.4103/1687-1693.192643  
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.
  - 1,386 179
Superficial venous surgery as a management for chronic venous leg ulcers
Mohamed Mohamed Mogahed, Wessam Mostafa Abdellatif
April-June 2016, 14(2):81-84
DOI:10.4103/1687-1693.192644  
Background Venous leg ulcer (VLU) is a chronic problem affecting thousands of patients annually. The aims of this study were to evaluate the effectiveness of saphenous vein surgery as a management for chronic VLUs and to determine which group of patients will gain more benefit from surgery. Patients and methods A prospective study was conducted over a period of 4 years on 40 patients (32 males and eight females) with chronic VLUs CEAP 6 (indicating skin changes with active ulceration) and isolated superficial venous system insufficiency. Patients were divided into two groups: group A included 20 patients who underwent compression alone and group B included 20 patients for whom surgery on the superficial saphenous system was performed followed by compression. The patients were followed up for ulcer healing rate, healing time, and incidence of recurrence for at least 12 months. Results The rate of ulcer healing was 65% in group A within 14–24 weeks and 100% in group B within 8–16 weeks. The recurrence rates were 30% in group A and 10% after surgical correction in group B within 12 months of follow-up. Conclusion Surgical correction of incompetent superficial saphenous veins improves ulcer healing rate, healing time, and reduces recurrence in patients with isolated superficial venous system incompetence.
  - 791 56
Surgical correction of cleft earlobes Hassen
Ahmed Sabry Hassen
April-June 2016, 14(2):85-88
DOI:10.4103/1687-1693.192646  
Background Earlobes are considered as an important element in the cosmetic feature of the entire ear and face. Several techniques have been suggested to repair the torn earlobe. These corrections have been done to restore the natural appearance and shape of the ear for cosmetic, professional, or social reasons. Aim The aim of the present study was to present and discuss the technique used in the Unit of Plastic Surgery at Al-Azhar University Hospital, New Damietta, Egypt, for the repair of earlobe clefts. Settings and design A prospective study was carried out on the procedures used to repair split earlobes in our hospital. Materials and methods We present a personal and geometrical modification of the double-lobed flap carried out on 24 patients with split earlobes. Results The anatomical curvature of the earlobe was restored apart from reducing the skin retraction without causing scars or adding skin grafts. Conclusion We proved that our technique has many advantages and improved cosmetic results.
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Study of predictive value of capillaroscopic pattern and serum level of interleukin-17 in rheumatoid vasculitis patients
Hamdy K Koryem, Manal Y Tayel, Sarah S Eltawab, Reham F Moftah, Omneya E Elazzazy
April-June 2016, 14(2):89-94
DOI:10.4103/1687-1693.192647  
Objectives The aim of this study was to investigate nailfold capillaroscopic (NC) abnormalities and serum interleukin (IL)-17) level among rheumatoid arthritis (RA) patients with or without vasculitis. Patients and methods The study was carried on a group of RA Egyptian patients (n=40) who were diagnosed with RA based on ACR criteria. These 40 patients were further divided into two groups. Group 1 included RA patients with clinical signs of skin vasculitis and NC changes (n=6). Group 2 included RA patients with no clinical signs of skin vasculitis and no NC changes (n=34). All patients were subjected to demographic data collection, clinical examination, Disease Activity Score (DAS) 28 calculation, laboratory measurement (including erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, anticyclic citrullinated peptide, and IL-17), and NC examination. In addition, group 1 (n=6) was further subjected to electrophysiological evaluation by peripheral nerve conduction studies. Results Significantly elevated levels of IL-17 and characteristic NC changes were seen in RA vasculitis patients. Conclusion Rheumatoid vasculitis is associated with significantly elevated levels of serum IL-17 and characteristic NC changes.
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Hearing profile and postural sensory integration deficits in Parkinson's disease
Gehan A Al Zarea, Ali A Ali, Ahmed M.A. Mahmoud, Ahmed I Abbas
April-June 2016, 14(2):95-100
DOI:10.4103/1687-1693.192651  
Objective The objectives of this study were to evaluate auditory function and postural instability in Parkinson’s disease (PD) patients, and to correlate audiological findings and postural instability with the severity and duration of PD. Patients and methods The severity of motor symptoms and staging were ascertained with the Unified Parkinson’s Disease Rating Scale and the Hoehn and Yahr Scale, with identification of the side most affected by PD and the disease duration. Audiologic evaluation consisted of history taking, otoscopic examination, pure-tone audiometry, acoustic immittance measures, speech audiometry, and brainstem auditory-evoked potentials. Sensory Organization Test was also conducted. Of 55 PD patients, 31 were enrolled in this study, along with 31 healthy age-matched and sex-matched controls. Results and conclusion Our PD patients showed high-frequency, age-dependent unilateral or bilateral hearing loss, significant increase in wave V peak latency and I–V and III–V interpeak latencies, and significant decrease in composite score, vestibular score, and visual score and significant increase in preferential visual score in comparison with controls. All these findings were significantly correlated to disease severity and duration.
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