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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 46 | Issue 2
Page Nos. 83-161

Online since Wednesday, October 31, 2018

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ORIGINAL ARTICLES  

Value of adding autologous adipose-derived stem cells to intranasal submucosal fat implant for management of empty nose syndrome p. 83
Wesam S Ibrahim, Magdy E Saafan, Naglaa A Bayomi
DOI:10.4103/tmj.tmj_25_18  
Background Empty nose syndrome (ENS) is an iatrogenic disorder caused by too much nasal turbinate resection. Stem cell therapy can be used to repair, replace, or restore the biological function of a damaged tissue or organ. Aim To evaluate the role of adding autologous adipose-derived stem cells (ADSCs) therapy to intranasal submucosal fat implant for management of ENS and to compare its efficacy and safety to improve nasal functions in patients with ENS. Patients and methods Fifty-two patients having ENS were randomly distributed in two equal groups: group I was subjected to endoscopic intranasal submucosal fat implant injection and group II was subjected to intranasal submucosal fat implant with ADSCs injection at the site of inferior turbinate stump. Subjective evaluation was done by reviewing the SNOT-25 test, whereas objective evaluation was done by nasal endoscopy and nasal clearance test. Histopathological examination and reverse transcription-PCR were done to assess mucosal regeneration. Results Postoperative objective evaluation by anterior rhinoscopy and nasal endoscopy showed rapid healing with no signs of implant infection, rejection, or allergic reaction in both groups. Both groups experienced a statistically significant improvement in both SNOT-25 and mucociliary clearance tests after surgery. There was a positive statistical significant between the two groups from 6 months postoperatively. Both histopathological examination and reverse transcription-PCR showed evidence of mucosal regeneration in group II patients by detection of mucin-4 and lysozyme expression in regenerated nasal mucosa. Conclusion Adding ADSCs to intranasal submucosal fat implant augments the results and durability of improvement and also restores the anatomical and physiological functioning of nasal mucosa.
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Pulse oximetry in comparison to arterial blood oxygen saturation in children with bronchial asthma coming to the emergency room p. 93
Ramy R El-Sberbihy, Ahmed A Abo El-Ezz, Yasser M Abd El-raouf, Abd Elhady M Taha
DOI:10.4103/tmj.tmj_64_17  
Background Bronchial asthma is currently defined as a chronic inflammatory disorder of the airways. Hypoxia is a universal finding in acute exacerbations of asthma. However, respiratory failure with PaO2 below 60 mmHg or PaCO2 above 45 mmHg occurs in no more than one-third of patients. Pulse oximetry allows noninvasive measurement of arterial oxygen saturation (SpO2), without the risks associated with arterial puncture. Aim The aim of this study was to evaluate pulse oximetry as a valid tool to predict respiratory failure in children with acute severe attack of bronchial asthma as compared with the standard arterial blood gas (ABG) analysis. Patients and methods The study was carried out on 50 children, 30 of them were patients with acute bronchial asthma and 20 of them were healthy controls. All patients and controls were subjected to the following: Full history taking, clinical examination such as pulse oximetry and investigations which included chest radiography, echocardiography, and ABG analysis. Results There was no significant difference between asthmatic and control groups regarding age, sex, weight, and height. We found that respiratory rate and heart rate was higher in asthmatic patients than controls. We demonstrated a negative correlation between PaCo2 and SPO2 and between PaO2 and PaCO2, and a positive correlation between SaO2 and SPO2 and between PaO2 and SPO2. Oxygen saturation measured by pulse oximetry (SpO2) was greater than oxygen saturation measured by the ABG analyzer, but this difference was not statistically significant. Conclusion Arterial oxygen saturation measured by pulse oximetry can be used as a tool to diagnose respiratory failure in an emergency setting where ABG facility in not available.
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Single-shot spinal anesthesia with heavy bupivacaine in two regimens versus continuous spinal anesthesia in elderly patients undergoing hip surgery: a prospective randomized controlled study p. 99
Aliaa M.A.R Abdel Kader, Kamal E Ali Hekal, Yaser M Amr Ragheb, Amr A Magdy
DOI:10.4103/tmj.tmj_30_17  
Background Elderly patients with hip fracture are a medical challenge. Spinal anesthesia (SA) is effective, rapid, has minimal effect on mental status, reduces blood loss, and thromboembolic complications. The continuous spinal anesthesia (CSA) produces more sensory–motor blockade with fewer hemodynamic effects. Intrathecal opioids can achieve successful SA using decreased doses of local anesthetics. Aim The aim of this study is to compare the safety and the efficacy of single-shot SA with heavy bupivacaine in two regimens versus continuous SA in elderly patients undergoing hip surgery. Patients and methods This study was carried out on 60 patients aged 65 years or older patents scheduled for hip surgery. Patients were randomized into three groups (n=20): group A SA with hyperbaric bupivacaine 7.5 mg, group B spinal fentanyl anesthesia (SFA) SA with hyperbaric bupivacaine 5 mg+25 μg fentanyl, and group C (CSA) with continuous SA. Heart rate (HR), mean arterial pressure (MAP), onset, duration, and the level of sensory block and onset, duration and score of motor block were recorded. Complications, amounts of fluids, and/or blood products and the use of vasopressors, total doses of bupivacaine, need for sedation, supplementation, and anesthetic failure were recorded. Assessment of pain was done using by visual analog score for 6 h postoperatively. Results MAP showed significant decrease in group A. The onset of sensory block and time to reach T10 showed significant increase in group C. Time of regression of sensory block T12 showed significant decrease in group C. The onset of motor block showed significant increase in group C. The duration of the motor block showed significant decrease in group C. Scores of motor block in the three groups show insignificant difference. Conclusion CSA had the advantage of being significantly hemodynamically stable and lower dose of local anesthetics and ephedrine than SA. Besides, intrathecal opioids improve the quality of spinal block.
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Evaluation of short-term outcomes of totally extraperitoneal laparoscopic inguinal hernia repair using a polyester anatomical mesh p. 108
Ahmed W Elzayady, Gamal I Moussa, Hamdy S Abdallah, Sherif A Saber
DOI:10.4103/tmj.tmj_66_17  
Background Laparoscopic hernia repairs have been gaining worldwide popularity, especially totally extraperitoneal (TEP) repair. The choice of prosthesis became a very important factor as a determinant of the outcome. Polyester anatomical mesh provides enough coverage of hernia defect with many benefits of its polyester-based chemistry. Aim The aim of the study was to assess the short-term outcomes of laparoscopic TEP repair using a polyester anatomical mesh regarding its safety, efficacy, and impact on patient’s quality of life (QOL). Patients and methods A prospective assessment of 20 adult patients with uncomplicated inguinal hernia, who underwent laparoscopic TEP repair using polyester anatomical mesh between June 2015 and May 2016 at Tanta University Hospitals. The patient’s QOL was checked preoperatively, at 3 and 6 months postoperatively (PO) using the visual analog scale. The follow-up period was 6 months. Results The mean age of the patients was 46.18±18.35 years. The mean operative time was 69.7±25.1 min. There were no conversions to other procedures or major complications. The most common operative complication was peritoneal tears in seven (33.3%) hernias. Most common PO complication was small hematoma at the umbilical port in two (10%) patients, which resolved spontaneously. The mean time to return to daily activities was 4.1±0.54 days. There were no recurrences or mesh-related complications. The patient’s QOL significantly improved 6 months PO. Conclusion Laparoscopic TEP inguinal hernia repair using polyester anatomical mesh without fixation is feasible and safe. It is associated with no chronic pain, no recurrence, minor complications, and better QOL.
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The effect of aspartame ingestion in pregnant female albino rats on placental and fetal weights, umbilical cord length, and histology of fetal pancreas p. 114
Azza M.M Aboshanady, Manal El-Sayed El-Sawaf, Abdel-Rahman Abu-El-Enain Abdel-Aziz, Mona M.A Attia
DOI:10.4103/tmj.tmj_5_18  
Background and aim Sugar is one of the commonest causes of weight gain and diabetes. Aspartame is one of the most commonly used artificial sweeteners worldwide to replace sugar. This study aimed to study the effects of aspartame in pregnant female albino rats on fetal and placental weights, length of umbilical cord, and possible histological changes in fetal pancreas. Materials and methods Thirty-six adult female albino rats and nine adult male albino rats weighing between 220 and 250 g were used. Each four female rats were housed with one male rat to allow mating. Pregnant rats were divided into three groups (n=12 each): control group (group І), low-dose-treated group (group ІІ), and high-dose-treated group (group ІІІ). The low-dose-treated group received 14 mg/kg aspartame and the high-dose-treated group received 40 mg/kg aspartame daily from the first day of pregnancy to the 20th day of pregnancy. Results This study showed a highly significant reduction of maternal weight gain, placental weight, fetal weight, and umbilical cord length in both aspartame-treated groups. Fetal pancreas showed histopathological changes in both aspartame-treated groups as evidenced by light and electron microscopy. All the results in this study were dose related. Conclusion The use of aspartame during pregnancy might reduce fetal and placental weights and umbilical cord length and alter the histology of fetal pancreas.
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Cerebrospinal fluid flowmetry using phase-contrast MRI technique and its clinical applications p. 121
Hend G Elsafty, Ashraf M ELAggan, Mohammed A Yousef, Manal E Badawy
DOI:10.4103/tmj.tmj_55_17  
Background and aim and aim Cine phase-contrast (PC) MRI is a useful noninvasive imaging technique in evaluating the dynamics of cerebrospinal fluid (CSF) in the evaluation, follow-up, surgical decision, and postoperative survey of certain disease processes, such as normal pressure hydrocephalus, aqueduct stenosis (AS), postendoscopic third ventriculostomy, and arachnoid cysts cases. The aim of this study was to determine the value of cardiac-gated cine-PC-MRI in characterizing CSF flow in patients with CSF flow disorders. Patients and methods The study included 30 patients with 10 persons as the control group and 20 patients who were suspected to have CSF flow abnormalities. Two imaging techniques were applied: the axial plane for flow quantification and the sagittal plane for a qualitative assessment. Results Among the 30 patients, quantitative analysis revealed the mean value to be 22 μl as the average aqueductal stroke volume in the control group. In the normal pressure hydrocephalus group, systolic velocities as well as stroke volume values were higher than those of the controls. In the AS group, lack of significant aqueductal CSF flow was noticeable. Both peak systolic and diastolic velocities were found to be statistically significantly lower in patients with AS than in the control group. In arachnoid cyst cases, CSF flow study with cine PC-MRI enables visualization of flow communication between cysts and neighboring CSF compartments. Two cases were assigned as communicating cysts and four cases were noncommunicating. Conclusion Assessment of CSF flow indicates the potentials of using PC-MRI adjunct to routine MR for the clinical study of CSF-related diseases.
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Serum S100B protein as a prognostic biomarker for neurological outcome after in-hospital cardiac arrest in children p. 133
Ahmed M Abd Elsalam, Ahmed A AboElezz, Amal S El-Bendary, Amr M Zoair
DOI:10.4103/tmj.tmj_37_17  
Background Survivors of cardiac arrest often require lengthy intensive care admission, rehabilitation, and ongoing treatment of chronic complications as a result of poor function outcomes. S100B protein has emerged as a candidate peripheral biomarker of blood–brain barrier permeability and central nervous system injury. Aim This study aimed to evaluate the serum levels of S100B protein as a prognostic biomarker for predicting neurological outcome after in-hospital cardiac arrest and cardiopulmonary resuscitation (CPR) in children. Patients and methods Thirty infants and children underwent CPR after in-hospital cardiac arrest; blood samples for the evaluation of S100B were drawn after 1 and 24 h after initiation of CPR. Neurological assessment for survivors was done 6 months after cardiac arrest using the cerebral performance category (CPC) score, which was used also immediately following CPR for all patients (including those who died 24 h after CPR). Fifteen healthy children were enrolled as a control group. Results There was highly significant increase of serum S100B protein in postarrest patients at 1 and 24 h as compared with the control group (P<0.001); significant increase in patients at 1 h as compared with patients at 24 h (P<0.05); and highly significant increase of serum S100B protein in dead patients (n=25) as compared with survivors (n=5) (P<0.001). There was highly significant positive correlation between the duration of CPR and the CPC score and S100B protein level (P<0.001).The cutoff value of S100B protein at 1 h (as a prognostic biomarker) was 1430 ng/l with 76% sensitivity and 94% specificity, whereas the cutoff value of S100B protein at 24 h was 227 ng/l with 75% sensitivity and 91% specificity. Conclusion S100B protein was potentially useful as a prognostic biomarker (with high sensitivity and specificity) for neurological outcome after cardiac arrest, as its levels significantly correlated with CPC score of the survivors 6 months after cardiac arrest and with the duration of CPR.
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Serum galectin-9 level in patients with atopic dermatitis p. 139
Tarek E Amin, Abeer A Hodeib, Jehan A Elsharnouby, Shaimaa E Elgedawy
DOI:10.4103/tmj.tmj_71_17  
Background Atopic dermatitis (AD) is a common chronic inflammatory skin disease of unknown etiology. It is characterized by peripheral eosinophilia, mast cell activation, and predominance of T-helper-2 cells. Galectin-9 is a potent eosinophilic chemoattractant. It also alters T-cell balance by negatively regulating T-helper cells, resulting in T-helper-2 polarization. Inhibition of endogenous galectin-9 may improve the course of the disease. Aim The aim of this study was to evaluate serum level of galectin-9 in patients with AD to assess its possible role in pathogenesis of the disease. Patients and methods The current study included 20 patients with AD and 10 age-matched and sex-matched healthy individuals who served as a control group. Patients were divided into three groups, mild, moderate, and severe, according to their Six-Area, Six-Sign Atopic Dermatitis score. Peripheral venous blood sample was taken from each participant, and serum was examined by enzyme-linked immunosorbent assay for quantitative evaluation of galectin-9. Results Galectin-9 was significantly increased in patients with AD compared with the control group. The difference between the three studied groups was statistically significant regarding serum galectin-9 level. There was significant positive correlation between serum galectin-9 level and severity of the disease. In contrast, no significant correlations were found between serum galectin-9 level and age, sex of the patients, and duration of the disease. Conclusion Serum galectin-9 level was significantly elevated in patients with AD. This increase was positively correlated with disease severity. This suggests a possible role of galectin-9 in the pathogenesis of AD. New treatment strategies that are directed toward lowering galectin-9 level may be a hope for future perspectives of the treatment of AD.
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Prospective randomized study to evaluate urinary liver-type fatty acid binding protein in early detection of diabetic nephropathy in type 2 diabetic patients p. 145
Eeem Awny, Nahed Elwan, Kamal Okasha, Ghada A Suliman
DOI:10.4103/tmj.tmj_54_17  
Background The early diagnosis of diabetic nephropathy (DN) is important to avoid the adverse outcomes of renal failure among diabetics. Although microalbuminuria has been recognized as a significant predictive marker for the early diagnosis of DN, some diabetics may develop DN without an apparent microalbuminuria. Therefore, sensitive and specific markers are required to detect DN in its early stages. Aim The aim of this work was to estimate the liver-type fatty acid binding protein (L-FABP) level in type 2 diabetes mellitus (T2DM) patients with DN and shed more light on its value and clinical significance. Materials and methods The present study was carried at the Clinical Pathology Department in Tanta University. It included 30 patients with T2DM, who attended the Outpatient Clinic of Internal Medicine Department, Tanta University Hospital, and fulfilled the criteria of the American Diabetes Association, 2015. The control group included 20 healthy individuals. The participants were subdivided into the following groups: group 1 included 10 T2DM patients with normoalbuminuria, eight women and two men. Their ages ranged from 55 to 75 years. Group 2 included 10 T2DM patients with microalbuminuria, five women and five men. Their ages ranged from 45 to 72 years. Group 3 included 10 T2DM patients with macroalbuminuria, four women and six men. Their ages ranged from 49 to 67 years. Group 4 included healthy individuals who served as a control group, nine women and 11 men. Their ages ranged from 43 to 75 years. Results The present study found that there was no significant difference between the three patient groups in disease duration, fasting, and postprandial blood glucose. There was a significant difference between the three patient groups in glycated hemoglobin, albumin in urine, glomerular filtration rate, and serum creatinine. There was a significant difference in L-FABP between the three patient groups and the control group. Conclusion Urinary L-FABP level was significantly increased in diabetic patients with DN compared with the control group. The levels of urinary L-FABP in each DN group were significantly increased according to the severity of DN. The high levels of L-FABP in urinary excretion were associated with deteriorating renal function in patients with T2DM. This association was frequently observed even in patients with normoalbuminuria
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Coronary artery bypass grafting surgery in chronic hemodialysis patients p. 152
Ibrahim M Yassin, Farouk M Oueida
DOI:10.4103/tmj.tmj_8_18  
Background and aim Off-pump coronary artery bypass grafting (CABG) can be ideal for revascularization of chronic hemodialysis patients when the targets are easily accessible. Full revascularization usually necessitates the use of cardiopulmonary bypass (CPB) if the targets are not easily accessible. Either conventional CABG with cardioplegic arrest or on-pump beating-heart CABG can be used. The early and long-term outcomes are still controversial. We sought to compare the early and long-term outcomes of the three different methods of revascularization of this patient category. Patients and methods This was a retrospective analysis of randomized three selected equal groups, with 25 patients each revascularized with a different technique. Patients were operated from January 2008 to June 2016 in our institution. Group I underwent conventional CABG with cardioplegic arrest, group II underwent off-pump CABG, and group III underwent on-pump beating-heart CABG. Results The postoperative bleeding amount (P<0.001), length of hospital stay (P<0.001), and length of postoperative intensive care unit stay (P<0.001) were significantly lower in the off-pump and on-pump beating-heart CABG groups than in the conventional CABG group. No significant difference was found regarding 30-day mortality and morbidity rates including stroke, pneumonia, arrhythmia, intestinal complication, and low cardiac output syndrome. On-pump beating-heart CABG significantly reduced the duration of CPB compared with conventional CABG. There were no statistical differences in the freedom from cardiac events (P=0.143), but on-pump beating-heart CABG provided better long-term survival than conventional CABG (P≤0.01). Conclusion Off-pump CABG when safely implemented is the best option for complete revascularization of chronic hemodialysis patients. On-pump beating-heart CABG is a safe procedure that provides optimal operative exposure in chronic hemodialysis patients. The use of CPB and the elimination of cardioplegic arrest may be beneficial for the short-term and long-term survival of chronic hemodialysis patients.
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