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   Table of Contents - Current issue
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April-June 2019
Volume 47 | Issue 2
Page Nos. 45-94

Online since Monday, May 18, 2020

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ORIGINAL ARTICLES  

Predictive variables of mortality after acute ischaemic stroke in Tanta University Hospital p. 45
Ahmed M.M El-Husseiny, Yassar A.A El-Heneedy, Hazem A.R Fayed, Wael A.F.A Rahman
DOI:10.4103/tmj.tmj_75_17  
Background Acute ischaemic stroke (IS) is a major cause of mortality and long-term morbidity. Aim The aim of this study was to evaluate the predictors associated with increased mortality in acute IS. Patients and methods This prospective study was conducted on 251 patients with acute IS admitted to the Department of Neuropsychiatry, Tanta University, over 6 months, and these patients were followed-up for another 6 months. Patients were divided into group I, which included 66 patients who died after acute IS, and group II, which included 185 patients who survived after acute IS. All patients were subjected to full history taking and general and neurological examinations; stroke severity was assessed by National Institute of Health Stroke Scale; type of stroke was determined by Oxfordshire Community Stroke Project Classification and Trial of Org 10172 in Acute Stroke Treatment classifications, ECG, routine laboratory investigations and brain imaging. Patients were followed-up by Modified Rankin Scale. Results Patients in group I had a higher mean age (81.45±12.390). Diabetes mellitus and ischaemic heart disease were more prevalent in group I (68.2 and 90.9%, respectively). Coma was observed to be more in group I (37.88%). The mean of National Institute of Health Stroke Scale and Modified Rankin Scale was higher in group I (19.42±3.53 and ≥4, respectively). Total anterior circulation infarct and stroke of the large artery were more prevalent in group I (59 and 63.6%, respectively). Cerebral edema and leukoaraiosis were observed to be more in group I (87.9 and 80.3%, respectively). Conclusion Early mortality after acute IS is usually due to neurological complications. Septic conditions are considered one of the major causes of post-IS death after the first month.
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Preliminary study on the role of toll-like receptor-4 antagonist in treatment of Trichinella spiralis infection p. 52
Dina A Elguindy, Dalia S Ashour, Maha M Shamloula, Ibrahim A Aboul Assad
DOI:10.4103/tmj.tmj_17_18  
Background Trichinella spiralis is one of the most widespread zoonotic parasitic nematodes in the world. There is an increasing interest in developing new antihelminthic drugs for Trichinella. Toll-like receptor-4 (TLR4) is closely related to T. spiralis infection, and its deficiency is associated with rapid expulsion of T. spiralis worms. Aim The aim of this study was to explore the effect of TLR4 antagonist (curcumin) on the course of experimental trichinellosis. Materials and methods Mice were divided into two main groups. Group I was the control group (90 mice), which was subdivided into the following: subgroup Ia (10 mice), with noninfected nontreated mice (negative control); subgroup Ib (40 mice), with infected nontreated mice (positive control); and subgroup Ic (40 mice), with noninfected treated with curcumin. Group II was the infected and treated group (50 mice), where infected mice received curcumin starting 2 h after infection and continued for 10 successive days after infection. For each group, total adult and muscle larval count were estimated, and the small intestines and muscles were removed for further studies. Results This results showed a significant decrease in the mean number of adults and larvae in the infected treated group compared with the infected control mice, with an extremely significant percentage of reduction of 53%. Regarding the histopathological changes, there was a marked increase in the inflammatory reaction surrounding the adult worms in the small intestines and the encysted larvae in muscles of the infected treated group compared with the infected nontreated group. Curcumin leads to degeneration of the capsule around the larvae in the skeletal muscles of the infected treated group. There was a significant increase in nuclear factor-κB expression by small intestinal tissues in T. spiralis infected treated group (group II) as compared with the infected nontreated group (group Ib). Conclusion This study revealed that curcumin has an antiparasitic activity against both stages of T. spiralis. Thus, it could be a promising drug for treatment of T. spiralis infection.
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Comparison between substance-induced psychosis and primary psychosis p. 62
Abd Allah M Shaheen, Mai A.E Eissa, Gamal T Shamma, Wesam A.E Ghareeb
DOI:10.4103/tmj.tmj_28_18  
Background Distinguishing between substance-induced psychosis (SIP) and primary psychosis is crucial for understanding illness and providing optimal treatment. Substance use is widespread and causes concern for many reasons, particularly the psychotogenic properties of many substances. Aim The purpose of this study was to differentiate SIP from primary psychosis. Patients and methods A cross-sectional comparative study on 100 patients of both genders who were divided into two groups: group I included those with SIP and group II included those with primary psychosis; 18–65 years old was collected from the Neuropsychiatry Department, Tanta University and from the Centre of Psychiatry, Neurology and Neurosurgery. The study was conducted from July 2016 to July 2017. Psychosis was assessed by positive and negative syndrome scale. Arabic version of the addiction severity index was used to assess the severity of addiction and drug screen of urine once the patient was admitted. Results There was a significantly older age among group II (primary psychosis) with a mean age of 34.540±10.017. There were more men in group I, all patients were men in group I. Group II shows significantly more unemployed patients (45 patients, 90%). Unmarried patients were significantly more among group II. There were more patients with a family history of addiction among group I (35 patients, 70%) and more patients with a family history of psychiatric disorders among group II (30 patients, 60%). The number of patients presented with visual hallucination was higher among group I (33 patients, 66%). The number of patients presented by negative symptoms in group II was higher (42 patients, 84%). The total score of positive and negative syndrome scale was higher among group II. Conclusion There is a great difference between SIP and primary psychosis.
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The possible role of repetitive transcranial magnetic stimulation in dysphagia following brain stem infarctions p. 68
EISayed A.M Tageldin, Mohamed K.M Khalil, Wafik S Bahnasy, Basem H Fouda
DOI:10.4103/tmj.tmj_18_18  
Background Dysphagia is a very common manifestation of brain stem infarctions, which is usually severe enough to need special feeding programs including nasogastric tube application. Repetitive transcranial magnetic stimulation (rTMS) can modulate the cortical excitability and enhance the recovery of swallowing dysfunctions. Aim To evaluate the possible therapeutic role of rTMS in accelerating recovery of dysphagia following brain stem infarctions. Patients and methods This study was conducted on 30 dysphagic patients following brain stem infarctions; 15 received real rTMS and 15 received sham rTMS on bilateral supratentorial cortical swallowing areas. Every patient underwent 10 rTMS sessions repeated five times per week for 2 successive weeks. Scheduled dysphagia severity was evaluated using The Dysphagia Outcome and Severity Scale at stroke onset, after the first rTMS session, and then at 7, 30, and 60 days after the last rTMS session (visits 0, 1, 2, 3, and 4, respectively). Results There was significant improvement of dysphagia in patients who received real rTMS compared with those who received sham rTMS during visits 1 and 2. The improvement was maintained through visits 3 and 4, but without significant difference. Conclusion Bilateral application of real rTMS on cortical swallowing areas for patients with dysphagia following brain stem infarctions has a potential rapid maintained improving effect of swallowing functions with decreased burden of aspiration in the early poststroke period until recovery takes place.
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Prospective randomized study comparing transversus abdominus plane block and spinal fentanyl added to bupivacaine for postoperative analgesia after cesarean section p. 74
Ahmed E Nasef, Lubna M Abo-Elnasr, Nabil A El-Sheikh, Ahmed E Mohamed
DOI:10.4103/tmj.tmj_45_17  
Background Cesarean section is a very common surgery and so postoperative pain in cesarean section is a major problem; different modalities of analgesia exist. Transversus abdominus plane (TAP) block is a simple and safe technique and can be used for postoperative analgesia after lower abdominal surgeries. Aim The aim of this study was to compare between postoperative analgesic effect of TAP block and spinal fentanyl added to bupivacaine in patients undergoing cesarean section. Participants and methods This study was carried out on 80 pregnant women presented for elective cesarean section who met the American Society of Anesthesiology II status. The patients were randomized into two equal groups (40 patients in each group). − Group I (spinal fentanyl group): patients received intrathecal 2.5 ml heavy bupivacaine 0.5% plus 25 µg fentanyl. Group II (TAP block group): patients received intrathecal 2.5 ml heavy bupivacaine 0.5% and then TAP block with 40 ml bupivacaine 0.25% (20 ml each side). Heart rate and mean arterial blood pressure were recorded postoperatively; postoperative pain was assisted by visual analog scale (VAS) score, time of postoperative first rescue analgesia, and total amount of rescue analgesia consumption. Results As regards hemodynamics (heart rate and mean arterial blood pressure) there was significant difference between both groups; at 2 h in group II it was lower than group I. Comparison of VAS score among both groups have shown that there was significant difference at 2 h as group II showed extended postoperative analgesia as the VAS score started to elevate at 6 h. Time of first rescue analgesia was significantly shorter in group I than in group II. Pethidine consumption was significantly lower in group II than in group I. Conclusion TAP block is a simple and safe technique and may be a potential alterative to spinal opioid for analgesia after cesarean section with no or minimal effects on hemodynamics, more prolonged analgesia, and less pethidine consumption and no or minimal complications.
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Effects of berberine on high-fat/high-sucrose-induced nonalcoholic steatohepatitis in experimental rats p. 80
Elrefaei Eman, Elhorani Hemat, Hibishy Hanaa, Qaseem Safwat
DOI:10.4103/tmj.tmj_15_18  
Background Nonalcoholic steatohepatitis (NASH) is the most common chronic liver disease in the world, characterized by hepatic steatosis, inflammation, hepatocyte injury with or without fibrogenesis, which might lead to cirrhosis. Berberine (BBR) is a natural isoquinoline alkaloid with very impressive health benefits. Aim The aim of the study is to evaluate the protective effect of BBR in experimental NASH induced by high-fat/high-sucrose diet in male albino rats. Materials and methods Sixty male albino rats were divided randomly into four equal groups: group I (normal control group), group II (BBR-treated control group), group III (NASH group), and group IV (BBR-treated NASH group). Levels of peroxisome proliferator gamma receptor coactivator one alpha (PGC-1α) in hepatic nuclear extract were measured by enzyme-linked immunosorbent assay, while the activity of cytosolic glycerol-3-phosphate dehydrogenase 1 in the liver tissue homogenate, liver enzymes, lipid profile, and plasma ferric reducing/antioxidant power were measured spectrophotometrically. Results There was a statistically significant decrease of hepatic PGC-1α, plasma ferric reducing/antioxidant power, serum high-density lipoprotein-cholesterol along with a significant increase in the activity of glycerol-3-phosphate dehydrogenase 1, liver enzymes as well as hyperlipidemia in the NASH group were compared with both normal control and BBR-treated control groups. These pathological disturbances were significantly ameliorated by BBR supplementation. Conclusion The present study provided unequivocal evidence that disturbed hepatic PGC-1α and altered redox status acted as major contributing factors for the pathogenesis of high-fat/high-sucrose-induced NASH in rats. It also shed some light on the potential therapeutic value of BBR in NASH, partly accredited to its hypolipidemic and antioxidant effects, in addition to upregulating the levels of PGC-1α in hepatic nuclear extracts.
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Comparative study between different scores predicting outcome in mechanically ventilated patients p. 87
Eman M.A Abedo, Fawzy A.El-Naga El-Emery, Bassem I El-Shafey, Sabry M Ameen, Mohamed S Hantera, Ayman S Eldib
DOI:10.4103/tmj.tmj_40_17  
Background The use of severity scoring systems was considered as a predictor of mortality in mechanically ventilated patients with respiratory failure due to respiratory and nonrespiratory causes. Aim To compare some new and simplified scores with traditional scores as predictors of outcome of mechanically ventilated patients with acute respiratory failure due to respiratory and nonrespiratory causes. Patients and methods The present study was carried out on 30 patients with respiratory failure due to respiratory and nonrespiratory causes who were mechanically ventilated and classified into three groups with respect to the cause of respiratory failure: group І included 10 mechanically ventilated patients due to chronic obstructive pulmonary disease exacerbation, group ІІ included 10 mechanically ventilated patients due to pneumonia, and group ІІІ included 10 mechanically ventilated patients due to nonrespiratory cause. Clinical and demographic data and routine investigations were done for all patients and then acute physiology and chronic health evaluation score (APACHE ІІІ) score was measured within 24 h of admission. Moreover, other scores including oxygenation index (OI), integrative weaning index (IWI), alveolar–arterial gradient (A–aO2), arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio, and PaO2 were measured after 4 h, 24 h and after 3 days of ventilation. Results Nonsurvivors had significantly longer duration of ventilation, higher APACHE ІІІ score with cutoff value more than 57, higher OI mostly after 3 days of ventilation, significantly lower PaO2/FiO2 ratio as compared with survivors, IWI was significantly lower in nonsurvivors only in group І, pA–aO2 was significantly higher in nonsurvivors, and PaO2 had insignificant relation with mortality. Conclusion APACHE ІІІ score, PaO2/FiO2 ratio, A–aO2, and OI after 3 days of ventilation were the parameters that independently predicted mortality of mechanically ventilated patients, and also IWI predicted mortality only in group І and PaO2 did not predict mortality in all groups.
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