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  Citation statistics : Table of Contents
   2016| July-September  | Volume 14 | Issue 3  
    Online since February 15, 2017

 
 
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ORIGINAL ARTICLES
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
DOI:10.4103/1687-1693.200147  
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.
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Evaluation of children with peripheral hypotonia by electroneuromyography
Kamel M Hewedi, Mohie El-Din Tharwat Mohamed, Mohamed S Yussef
July-September 2016, 14(3):134-139
DOI:10.4103/1687-1693.200154  
Background Hypotonia is the phenotype of several clinical conditions that do not always lead to a favourable outcome. Thus, it is important to make an immediate and prompt diagnosis with the help of neurophysiological examinations. Objective The objective of this study was to assess infants and children presenting with peripheral hypotonia by nerve conduction study and electromyography to identify the most common cause of peripheral hypotonia in a sample of Egyptian children. Patients and methods Thirty-nine patients who had clinical criteria of peripheral hypotonia were included in this study, which was supported by negative brain MRI findings. These cases underwent complete neurological history, examination, nerve conduction study and electromyography. Results Peripheral neuropathy was observed in 18 (46.2%) cases, 11 (28.2%) had myopathic affection, seven (17.9%) had anterior horn cell (AHC) affection and three (7.7%) had the neuromuscular junction disorder. Conclusion Peripheral hypotonia in infants and children is an important disorder; therefore, it is essential to study these cases carefully. The most common neuromuscular disorder was peripheral neuropathy, whereas the least common cause was neuromuscular junction disorder.
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CASE STUDY
Idiopathic granulomatous gastritis with severe gastrointestinal bleeding
Nazim Gures, Mustafa Erol
July-September 2016, 14(3):146-147
DOI:10.4103/1687-1693.200150  
A 54-year-old woman presented at the emergency service with acute gastrointestinal bleeding. Her haemoglobin level was 6.5 mg/dl and she had hypovolemic shock symptoms. Emergency endoscopy showed a severely bleeding area near the cardia but no open vessel was visualized. As the bleeding could not be stopped by endoscopic intervention and another nonbleeding multiple erosive focus was seen close to the pylorus laparotomy, total gastrectomy was performed. The patient was discharged on postoperative day 6 without any complication. Interestingly, the pathologic examination of the bleeding lesion revealed a granulomatous inflammation. Additional searches to determine the source of the granulomatous inflammation (tuberculosis, Helicobacter pylori, Crohn’s disease, etc.) yielded negative results; hence, the case was classified as idiopathic granulomatous gastritis.
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ORIGINAL ARTICLES
Peptide tyrosine tyrosine (PYY) as a new strategy for treating obesity
Ahmed Mostafa Mahmoud
July-September 2016, 14(3):101-108
DOI:10.4103/1687-1693.200146  
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.
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The predictive value of electroencephalography in recurrence of the first-ever unprovoked idiopathic seizure
Nabil Abd Al Hakim Metwally, Mahmod Mohamad Hasan, Yaser Hamed Mostafa
July-September 2016, 14(3):140-145
DOI:10.4103/1687-1693.200153  
Aim of the study We aimed to study the role of electroencephalography (EEG) and its predictive value for recurrence after the first-ever seizure. Patients and methods Patients who presented with first idiopathic seizure attack were included in this prospective study. The study group included 70 patients (39 male and 31 female). Their ages ranged from 1 to 58 years. All patients included were subjected to history taking and full analysis of the seizure, full neurological examination, routine laboratory tests, neuroimaging, and EEG evaluation, and then all patients were interviewed monthly for 3 successive months. Results Sixteen patients (23%) had focal seizures and 54 patients (77%) had generalized seizure. Nocturnal seizures were found in 45.7% of patients, whereas diurnal seizures were found in 54.3% patients. Aura was recorded in 17% of cases, whereas postictal state (confusion, headache, muscle ache, and Todd’s paralysis) occurred in 60% of cases. Past history of febrile seizures was present in 17% of cases, family history of epilepsy was positive in 10% of cases, and 31.4% of cases had positive consanguinity. Abnormal EEG was found in 54.3% of patients [31.4% of patients had generalized epileptiform discharge, 15.7% of patients had focal epileptiform discharge with or without secondary generalization, and 7.2% of patients had no specific changes (focal or generalized slowness)] and lastly normal EEG was found in 45.7% of patients. After 3 months of follow-up, 37 patients (52.9%) had recurrence of seizure: 75.6% of patients had generalized seizures and 24.4% of patients had focal seizures. The percent of recurrence among patients with abnormal EEG was 70.3% and that among those with normal EEG was 29.7%. As regards EEG findings, there were a significant correlation between abnormal EEG and generalized epileptiform discharge and recurrence of seizure. Conclusion EEG, especially during the first 48 h after seizure, had a prognostic value for recurrence of seizure.
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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
DOI:10.4103/1687-1693.200148  
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.
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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
DOI:10.4103/1687-1693.200149  
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.
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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
DOI:10.4103/1687-1693.200151  
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.
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Impacts of HIV/AIDS health facilities in the care and management of HIV clients at Kaduna state, Nigeria
Noel O Sani, Idris A Nasir, Kingsley C Iyadi, Oyama M Njor
July-September 2016, 14(3):130-133
DOI:10.4103/1687-1693.200152  
Background In the last two decades, nongovernmental organizations have played tremendous roles in the prevention and control of HIV infections in developing countries. Objective of the study This prospective study evaluated the impacts of an HIV/AIDS health facility and its roles in care, treatment, and management of HIV-infected clients at the Centre for Integrated Health Programmes Kwoi, Kaduna state, Nigeria. Materials and methods This study involved staff (technical, operations, and managerial) and HIV/AIDS clients. Out of 2259 clients who attended a pretest counseling session, 997 (44.1%) of them came individually, 1251 (55.4%) as groups, and 11 (0.5%) as couples. All staff (n=54) and 200 randomly selected HIV clients were administered structured questionnaires to collect data on their perception toward services provided by the facility. Results Findings from the staff revealed that HIV counseling, testing, care, and treatment were fully functional. However, the center had only 40% staff strength and 55% availability of service equipment; 70% of the clients were contacted for HIV voluntary counseling and testing through outreach, whereas 30% were contacted through routine outpatient visit. The facility managerial staff revealed that there was 60% funding of the healthcare center and these were wholly by the US government/international nongovernmental organizations. Out of the 200 clients interviewed, 70% accepted that the center was accessible, 85% were satisfied with the care provided by the center, and 100% consented to the fact that the services were 100% free; 90% of the clients suggested the need for more funding of the facility, and 96.7% of the clients requested for improvement in the quality of services provided. Conclusion The HIV healthcare facility has essentially assisted in the care, treatment, and management of HIV infected persons. However, there is need for more support (possibly from host government) by providing resources needed for adequate and efficient execution of HIV healthcare services.
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