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   2019| April-June  | Volume 17 | Issue 2  
    Online since October 23, 2019

 
 
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REVIEW ARTICLE
Myths about breastfeeding
Hussein Koura
April-June 2019, 17(2):109-113
DOI:10.4103/AZMJ.AZMJ_112_18  
Breastfeeding is an unparalleled way of providing ideal food for healthy growth and development of the infant through its unique biological and emotional influences. WHO recommends exclusive breastfeeding for the first 6 months of an infant’s life, with continued breastfeeding and complementary feeding introduced after the first 6 months up to the age of 2 years. Many factors affect breastfeeding, and they can lead to cessation of breastfeeding. Myths about breastfeeding are considered one of main obstacles for continuation of breastfeeding. Physicians and nurses should be aware about common misconceptions and beliefs that make mothers think their milk is not enough or not suitable. They should be able to explain and advise properly. In this article, the most common myths are discussed, and how to deal with them on scientific bases is clarified.
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ORIGINAL ARTICLES
Assessment of left ventricular functions by strain and strain rate echocardiography in asymptomatic type II diabetic patients
Mohamed Mahmoud
April-June 2019, 17(2):119-131
DOI:10.4103/AZMJ.AZMJ_16_18  
Background and aim The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eye, kidneys, heart and blood vessels, as treatment to reverse this disorder is more likely to be effective at an early (preclinical) stage, defining the mechanism of diabetic cardiomyopathy may be important to its selective treatment. Aim To assess the left ventricle (LV) function using tissue Doppler (TD) strain and strain rate imaging to detect early LV functions affection in type II diabetic patients without overt heart disease. Patients and methods The study included 60 persons presented in Al Azhar University (Asyut branch) Hospital in the period between November 2014 and January 2016. Were divided into two groups: group (1): 30 diabetic patients with normal (ejection fraction) EF and normal coronaries, group (2): 30 individual without diabetes mellitus (DM) with normal EF as a control group. The following was done for the two groups: 1. Complete History taking and complete general and cardiac clinical examination, resting 12 leads electrocardiography (ECG). 2. Laboratory investigation to diagnose diabetes and the control of the disease. 3. Transthoracic echo examination: 4. TD Strain and strain rate of the LV. Results In comparison between group (1) and group (2) the LV strain and strain rate was found to be significantly lower in group (1) as compared to group (2). Among group I, duration of DM was significantly correlated with decreased strain rate in posterior septum only. There was no correlation between methods of control and the degree of control and the impairment of strain and strain rate. From the present study we found that left ventricular strain and strain rate by conventional echo could reveal the presence of subclinical diabetic cardiomyopathy. Conclusions Type 2 DM deteriorates both LV systolic and diastolic performance. Diabetic patients showed some changes in strain and SR of LV walls at rest especially when the duration of diabetes increased. Strain and SR by TD is superior to conventional Doppler in early detection and evaluation of systolic and diastolic dysfunction in type 2 diabetic patients.
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The outcome of sutureless glue-free conjunctival autograft for recurrent pterygium
Ali A Ghali, Riad E Hassan
April-June 2019, 17(2):114-118
DOI:10.4103/AZMJ.AZMJ_15_18  
Aim To evaluate and analyze the surgical outcome of suture-free, glue-free conjunctival autograft after excision in recurrent pterygium. Patients and methods A retrospective study of 23 eyes of 21 patients with recurrent pterygium was done, and excision was performed in all eyes. Free conjunctival autograft was taken from superior quadrant of the same eye, and bare sclera was covered without the use of sutures or fibrin glue, allowing natural autologous coagulum of the recipient bed to act as a bioadhesive. The eye was patched for 48 h. Postoperatively, patients were put on topical eye drops (tobramycin and dexamethasone) for 6 weeks. All patients were examined after 48 h and followed for 1, 4, 12, and 24 weeks for postoperative results and complications. Results Of 23 eyes, only seven (30.43%) had subconjunctival hemorrhage, three (13.04%) had graft recession, and two (08.69%) eyes had totally dislodgement of the graft and three (13.04%) eyes had partial displaced. Overall, four eyes had intraocular pressure more than 25 mmHg after 48 h of operation, and two of them took antiglaucoma drugs to control intraocular pressure during the follow-up period. At the end of follow-up time, only three (13.04%) eyes with graft recession were observed. Recurrence of pterygium was noted in one case. Conclusion Suture-free, glue-free conjunctival autograft after excision in recurrent pterygium is easy, simple, safe, fast, and effective procedure with acceptable recurrence rate.
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Focal laser application versus bevacizumab for treatment of central serous chorioretinopathy
Ali A Ghali
April-June 2019, 17(2):132-138
DOI:10.4103/AZMJ.AZMJ_66_18  
Aim To report and compare the efficacy of macular grid laser versus intravitreal bevacizumab injection (IVBI) in patients with central serous chorioretinopathy (CSCR). Patients and methods A prospective study on 36 eyes of 35 patients with CSCR was conducted. The diagnosis of CSCR was established by fluorescein angiography and optical coherence tomography (OCT). All patients underwent measurement of best-corrected visual acuity, intraocular pressure, dilated fundus examination, and (OCT) imaging at baseline and follow-up visits. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Patients were classified into group A, comprising 19 patients who were treated with macular grid laser and group B, comprising 17 patients who were treated with IVBI. The outcome measures were the resolution of neurosensory detachment, improvement in visual acuity, and resolution of leakage. All cases were evaluated after 3, 6, 12, and 24 weeks. Data were classified into two groups and statistically analyzed. Results In group A, the mean age of patients was 43.6 years (range, 23–52 years), there were 11 (57.89%) males and eight (42.10%) females, and the mean of follow-up period was 9.2 months (range, 7–18 months). The mean log MAR visual acuity score improved from 0.8 to 0.40 after 3 months of follow-up. The mean baseline central macular thickness (CMT) was 466 µm (range, 358–576 µm), which decreased to 309 µm (range, 268–356 µm) after 6 weeks, with statistically significance difference change from the baseline, and to 247 µm (range, 225–319 µm) after 3 months, with statistically significance difference change from the baseline (P<0.001). In group B, the mean age of patients was 39.7 years (range, 42–57 years), there were nine (52.94%) males and eight (47.05%) females, and the mean follow-up period was 9.1 months (range, 6–16 months). The mean log MAR visual acuity improved from 1.00 to 0.40 after 3 months of follow-up. The mean baseline CMT was 454 µm (range, 334–567 µm), which decreased to 312 µm (range, 264–359 µm) after 6 weeks, with statistically significant difference change from baseline, and to 252 µm (range, 232–338 µm) after 3 months, with statistically significant difference change from the baseline (P<0.001). After 3 months of follow-up time, there was no significant difference in mean CMT between booth groups (247 vs. 252 µm). The mean baseline visual acuity improved in both groups, without significant difference between them. No serious adverse effects have been observed in both groups. Conclusion Both macular grid laser and IVBI for CSCR can lead to improvements of visual acuity and hasten recovery period. Macular grid laser may be considered as effective as anti-vascular endothelial growth factor for treatment of CSCR. More studies using larger scales may be needed to clarify the uncertain relationship between pathogenesis and results of treatment.
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Treatment of postoperative shivering after laparoscopic cholecystectomy under general anesthesia: a comparative clinical study
Saeed M Abdallah
April-June 2019, 17(2):190-197
DOI:10.4103/AZMJ.AZMJ_67_19  
Background Postanesthesia shivering is one of the common harmful hazards following general anesthesia, especially with laparoscopic surgery. Postoperative shivering may lead to multiple complications, which may happen owing to increased oxygen demands, precipitating in cardiac and neurological ischemia. Aim This study aims to compare the therapeutic effects of pethidine, ondansetron, and ketamine in preventing postoperative shivering in laparoscopic cholecystectomy under general anesthesia. Patients and methods In this prospective study, patients aged from 26 to 55 years scheduled for elective laparoscopic cholecystectomy under general anesthesia were included. Patients who developed shivering in the recovery room were randomly divided into three groups: the first group [pethidine (P)] received intravenous pethidine (0.5 mg/kg), the second group [ondansetron (O)] received intravenous ondansetron 8 mg, and the third group [ketamine (K)] received intravenous ketamine (0.25 mg/kg). The frequency and degree of shivering was determined immediately after surgery, 15 min after study drugs administration, and 30 min after study drugs administration. Moreover, hemodynamic changes before and after drug administration and adverse effects of the study drugs were examined. Results A total of 95 patients who developed postoperative shivering after laparoscopic cholecystectomy were included in this study. No significant difference was found among the groups regarding treatment and grading of shivering in recovery room 15 min after the study drug administration. No significant difference was found among the groups regarding the recurrence of shivering in recovery room 30 min after study drug administration. There is a significant difference in heart rate changes among the three groups and between group K and group O at 10 and 20 min after the administration of study drugs (P<0.05), and heart rate was higher in group K. There is a significant difference in mean arterial blood pressure among the three groups and between group K and group O at 10, 20, and 30 min after the administration of study drugs (P<0.05), and Mean arterial blood pressure (MAP) was higher in group K. There was no significant difference in oxygen saturation and axillary temperature changes among the three groups at all time before and after administration of study drugs (P>0.05). There was a significant difference among groups P, O, and K regarding sedation, hallucination, and nystagmus, being more in group K, but there was no difference among the groups regarding vomiting and itching. Conclusion The result of this study showed that ondansetron and ketamine effectively managed postoperative shivering with decreased incidence of recurrence of shivering. Ondansetron seems to be the drug to least affect hemodynamics, with less adverse effects than ketamine in comparison with pethidine.
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Role of diffusion-weighted MRI in evaluation of patients with salivary gland tumors
Abdallah M Al-Kheshen, Mohammed S Elfeshawy, Mohammed E Abd-ElGhani, Mahmoud M Abomosalam Ali
April-June 2019, 17(2):173-181
DOI:10.4103/AZMJ.AZMJ_49_19  
Background and objectives Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values give appreciable information about tumor cellularity with tissue contrast between the active and necrotic areas within the tumor. Aim of the work The aim of this study was to investigate the capacity of diffusion MRI to predict benign and malignant salivary gland tumors, using ADC value and DWI. Patients and methods This study included 40 patients (24 male and 16 female). Sixteen patients had malignant lesions and 24 had benign ones. The DWI was obtained with b values including 0 and 800 mm2/s. The ADC was generated by measuring identical images at different b values and represented as ADC map, from which the ADC value was calculated. This was a prospective randomized controlled trial. Informed consent was obtained from parents or guardians. Results The absolute ADC value of lesions was significantly different between benign and malignant salivary gland tumors (P<0.001). The sensitivity of ADC in differentiating benign from malignant lesions in our study was 93.7%, indicating a high true positive rate. Hence, if the average ADC is below 0.85×10−3 mm2/s, there is high probability that the mass will be malignant with high specificity of 95.8%. Results revealed that the mean ADC values of benign and malignant salivary gland tumors were 1.33±0.46×10 and 0.65±0.21×10−3 mm2/s, respectively. The mean ADC value of benign lesions was significantly higher than that of malignant lesions. Conclusion The use of DWI and ADC values can provide better assessment of salivary gland tumors and predict benign and malignant lesions.
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Study of the effect of interleukin-6 gene polymorphism in patients with rheumatoid arthritis
Marwa H Sedira, Omneia A Seoudy, Laila A Ahmed, Shahinaz El Attar, Eman F Mohamed
April-June 2019, 17(2):182-189
DOI:10.4103/AZMJ.AZMJ_55_19  
Background Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. Although the clear etiology of RA remains to be elucidated, it is widely accepted that RA is a complex disease, and both environmental and genetic factors can contribute to disease initiation as well as its evolution. The −174G/C polymorphism of interleukin-6 (IL-6) gene has been reported to be responsible for changes in the expression of IL-6, which could in turn lead to greater inflammation and thus affect the clinical status of patients with RA. Aim To determine the association of IL-6 gene polymorphism with patients with RA by studying the frequency of the polymorphism of IL-6 (−174G/C) gene in those patients compared with healthy participants to predict the risk of development of RA. Patients and methods The study was conducted on 200 (150 patients with RA and 50 age-matched and sex-matched healthy control) adult Egyptian patients. IL-6 (−174G/C) genotypes were determined by PCR-restriction fragment length polymorphism analysis. Results The prevalence of polymorphic genotype of GC and CC and C allele was statistically significantly increased in patients with RA than in control (P<0.001). Conclusion The GC and CC genotype and C allele of IL-6 (−174G/C) may represent a significant genetic molecular marker to predict the risk of RA.
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Assessment of left ventricular functions and its correlation to the severity of liver cirrhosis caused by hepatitis C virus by different echocardiography modalities (two-dimensional speckle-tracking echocardiography study)
Asmaa Ahmed Ali Hassan, Nessren Mohamed Bahaa Elden
April-June 2019, 17(2):154-162
DOI:10.4103/AZMJ.AZMJ_19_19  
Background Cardiovascular abnormalities are associated with liver cirrhosis observed especially under conditions of stress, so it is important to evaluate the cardiovascular function in every patient with cirrhosis. The Child–Pugh scoring system is the most commonly used clinical method for classifying liver cirrhosis. Tissue Doppler imaging and Two-dimensional speckle-tracking echocardiography (2D-STE) are newer imaging modalities able to accurately quantify left ventricular (LV) systolic function. Aim To assess LV functions in patients with chronic liver cirrhosis caused by hepatitis C virus by different echo modalities and correlate the results with the severity of cirrhosis based on Child–Pugh score. Material and methods A prospective study was done in the Echocardiography Unit, Cardiology Department, Al-Zahraa University Hospital, during a period of one year, including 75 participants, with 45 cirrhotic patients and 30 healthy individuals. For all patients, 2D-STE of the LV was measured. Then the patients with liver cirrhosis were divided into three subgroups according to Child–Pugh score, and LV functions were evaluated with conventional echo, tissue Doppler imaging (TDI), and STE. Results By conventional echo, the LV systolic function increased in the diseased group (P=0.004) but decreased when using TDI and STE. Then the patient group was divided into three subgroups based on the Child–Pugh score. By conventional echo parameters, there were normal LV dimensions in the three groups but increased in class C with lowered systolic function by using 2D-STE. Conventionally, LV diastolic dysfunction was diagnosed in 30% but in 75% when using TDI. There is a correlation between severity of liver cirrhosis and LV systolic dysfunction when measured only by 2D-speckle tracking. Conclusion The 2D-STE is considered a useful tool for early detection of LV systolic dysfunction especially in asymptomatic patients with viral liver cirrhosis. The LV diastolic dysfunction occurs earlier in cirrhotic patients. There is correlation between the extent of severity of liver cirrhosis and LV systolic dysfunction.
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Effect of left atrial functions upon the functional capacity in patients with systolic heart failure
Layla A Mohammed, Nadia A Agiba, Asmaa A Aly
April-June 2019, 17(2):198-206
DOI:10.4103/AZMJ.AZMJ_81_19  
Objective To assess left atrial (LA) function and its effect upon the functional capacity in patients with systolic heart failure (HF) using the two-dimensional (2D) speckle tracking echocardiography (STE). Patients and methods This study included 44 patients with systolic HF, ejection fraction less than 40%, sinus rhythm, and New York Heart Association (NYHA) class II–IV. All patients underwent six-minute walk test and conventional, tissue Doppler imaging (TDI), and 2D-STE echo. LA measures included LA dimensions and volumes for calculation of reservoir, conduit, and contractile functions. Peak atrial longitudinal strain (PALS) and peak atrial contractile strain were measured by 2D-STE. Based on NYHA class, patients were divided into group 1 (patients with NYHA II) and group 2 (patients with NYHA III–IV). Results There were no significant differences between both groups regarding demographic data. The 2D ejection fraction was significantly lower in group 2 compared with group I (P<0.05). Group 2 had significantly lower average LA peak systolic velocity (S′) and average LA late diastolic velocity (a′) by TDI compared with group 1, and also group 2 had significantly lower average PALS (16.3±7.2 vs. 11.3±4.4) and average peak atrial contractile strain (10.7±5.4 vs. 5.8±3.3, respectively; P<0.001), compared with group I. There were negative correlations between NYHA class and PALS (r=−0.436, P=0.003), whereas a positive correlation for PALS with six-minute walk distance (r=0.632, P=0.000). PALS was the most significant parameter that can predict limited exercise capacity. Conclusion LA mechanical functions were decreased in patients with systolic HF either measured by STE or TDI. PALS measured by 2D-STE is the most significant parameter correlated with functional capacity.
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Role of MRI in diagnosis and preoperative staging of rectal carcinoma
Mohamed F Abdelmoty, Mohamed S Elfeshawy, Abdo E Elhawary
April-June 2019, 17(2):163-172
DOI:10.4103/AZMJ.AZMJ_44_19  
Background and objectives High-resolution phased-array MRI is recommended as a standard imaging modality for preoperative local staging of rectal cancer with excellent soft tissue contrast, functional imaging ability, and multiplanar capability. With these inherent proprieties, MRI fills a gap in clinical practice and helps accurate local staging of rectal cancer before management decisions. Invention of diffusion-weighted image has also improved utility of MRI in patients with rectal cancer. Addition of diffusion-weighted image to T2-weighted imaging improved accuracy of rectal cancer detection and can facilitate lymph node detection (6% more nodes) than T2-weighted imaging alone. Aim of the work The aim of this study is to detect the role of MRI in diagnosis and preoperative staging of rectal carcinoma. Patients and methods This study was conducted on 40 patients with rectal neoplasms and/or highly suspected clinically to have rectal neoplasms who were referred from oncology medicine department to radiodiagnosis department for MRI preoperative evaluation and staging of rectal neoplasm. A prospective study was conducted using randomized controlled trials. Informed consent from a parent or guardian was obtained. Results Phased array surface coil MRI has proved high agreement with postoperative histopathological examination, reaching 100% in T staging and 90% in N stages and 100% in detection of circumferential resection margin involvement, which match with many previous similar studies. Conclusion Our study results demonstrate that high-resolution MRI has a pivotal role in accurate staging of rectal cancer, prediction of negative circumferential resection margin and involvement of the perirectal and pelvic lymph nodes. Thus, we conclude MRI has a golden standard value in the establishment of the best treatment strategy.
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The effect of age on the CD16-positive cell count in human male blood
Elsayed S Hamed, Esam O Kamel, Mohammad A Kasem
April-June 2019, 17(2):207-214
DOI:10.4103/AZMJ.AZMJ_84_19  
Background Immuno-senescence is a process that affects all cell components of the immune system. Age-associated changes have been demonstrated in different aspects of the innate immunity system, including natural killer cells, neutrophils, and monocytes. Aim To identify and compare the effect of aging on the number of CD16+ve cells in the blood among different age groups of Egyptian human males. Patients and methods A total of 40 male donors (under legal consents) were classified into four groups. Each group involved 10 individuals. Group 1 individuals aged from 5 to 10 years, group 2 individuals aged from 15 to 25 years, group 3 individuals aged 30–40 years, whereas group 4 individuals aged from 50 to 60 years. Samples were obtained from each donor and divided into two parts. One part was subjected to complete blood counting and the other part was investigated by immunohistochemistry to detect CD16+ve cells. The collected data were tabulated and statistically analyzed by analysis of variance test using SPSS program. Results Our results showed a high significant difference among age groups regarding CD16+ve cell count, with higher count in group 4. Conclusion We can conclude that the number of CD16-positive cells is directly proportional to the advancement of age in human males. This increase possibly represents an immune response against the abnormal products of aging.
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Persistence of transient urinary incontinence after delivery in obese women: a cross-sectional study
Doaa M Saleh
April-June 2019, 17(2):139-144
DOI:10.4103/AZMJ.AZMJ_134_18  
Aim Urinary incontinence (UI) is a prevalent condition that can affect up to 50% of the global female population. Recently, it was reported that obesity can affect the risk of postpartum persistent UI. In this study, we aimed to investigate the risk of obesity on the persistence of postpartum persistent UI. Patients and methods We conducted a cross-sectional study on 84 obese women and a similar number of control group during their first year after delivery. The Arabic version of the The International Consultation on Incontinence Modular Questionnaire was used. Data analysis was carried out using SPSS version 22 for Microsoft Windows. Results There were no statistically significant difference between study groups in terms of demographic and clinical characteristics. Concerning UI before urination, the proportion of obese women with UI before urination was significantly higher than the proportion in the nonobese group (54.8 vs. 19%; P<0.001). In addition, there was highly significant difference between two groups in term of stress UI during cough or sneezing (P<0.001). However, there was no significant difference between two groups in terms of UI during sleep and all time UI (P>0.05). Conclusion This study showed that obesity is a significant, independent risk factor for persistent UI after delivery. Nevertheless, further large-scale studies are still needed to confirm our findings.
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Penicillamine as radiation protector against gamma radiation effect on complete blood count parameters of guinea pigs
Yasser M.M El-Dessouky, Mohamed M El-Dessouky, Omnya A El-Batrawy
April-June 2019, 17(2):145-153
DOI:10.4103/AZMJ.AZMJ_137_18  
Background and aim The increasing use of nuclear technology has increased the risk of exposure to radiation. Exposure to radiation induces harms to human beings. The blood and blood-forming organs are one of the most sensitive to radiation. People exposed to high radiation doses had blood count changes, and death may occur owing to acute radiation syndromes. Therefore, radioprotective compounds are very important in clinical radiotherapy. The aim of this study was to examine the effect of penicillamine as a radiation protector agent against gamma radiation effects on complete blood count parameters of guinea pigs. Materials and methods Thirty healthy male guinea pigs were divided into three equal groups: treated irradiated (n=10), irradiated (n=10), and control (n=10) groups. The treated irradiated and irradiated groups were exposed to acute gamma radiation dose (9 kGy). The treated irradiated group received penicillamine (10 mg/kg) 1 h before exposure to radiation. Blood samples were collected soon after radiation and immediately placed in tubes containing EDTA, and these samples were used in the assessment of blood profile. Results Treated irradiated guinea pigs had significant higher red blood cell count, white blood cell count, hemoglobin concentration, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration (P≤0.05). The treated irradiated guinea pigs had significant lower relative distribution width of red blood cells by volume coefficient of variation (%) and platelet count (P≤0.05). Relative width of the distribution of platelets in volume index of the heterogeneity of platelets (%) had no significant difference between the two groups (P>0.05). Conclusion Administration of penicillamine reduced radiation damage to red blood cell count, white blood cell count, hemoglobin concentration, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration.
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