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   Table of Contents - Current issue
October-December 2017
Volume 45 | Issue 4
Page Nos. 161-225

Online since Monday, March 12, 2018

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The use of autologous platelet-rich fibrin membrane in hypospadias surgery: a preliminary study Highly accessed article p. 161
Ibrahim M El-Sayed, Walid A Moustafa, Enas A El-Zamarany, Mohamed S Sadaka
Background Hypospadias, a congenital anomaly with an incidence of 1/300, is a very challenging problem. Despite advances in hypospadias repair surgery, urethrocutaneous fistula remains a very common complication with a reported incidence varying from 4 to 28%. The use of an intermediate layer between the neourethra and the skin is one of the most important techniques used to reduce the likelihood of fistula formation and postoperative complications. Aim The aim of this study was to evaluate the effect of platelet-rich fibrin membrane (PRF) on the success rate of tubularized incised plate (TIP) repair and its postoperative complications. Patients and methods The study was carried out on 20 patients who were admitted to the Plastic and Reconstructive Surgery Department, Tanta University Hospitals, for hypospadias surgery throughout the period from the first of May 2015 to the end of April 2016. Urethroplasty was performed using the TIP technique. PRF membrane was applied and sutured over the sutured urethra as an intervening layer between the skin and neourethra. The perioperative course and postoperative complications were recorded. Results Twenty patients were included in this study. Their mean age at surgery was 2.45 years (range: 1–4 years). No intraoperative complications were encountered. Glanular edema occurred in two patients. Wound infection occurred in one patient. None of the patients had hematoma, wound dehiscence, or flap necrosis. With a mean follow-up of 6 months, urethral fistula occurred in two patients. Conclusion The PRF patch is a safe and efficient technique as an intermediate layer in TIP repair, and it helps to reduce the incidence of postoperative complications especially when healthy tissue is not available as an intervening layer.
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Safety measures among workers occupationally exposed to ionizing radiation in Tanta University Hospitals p. 166
Asmaa A El-Feky, Rania M El-Sallamy, Ali A El-Sherbeni, Hagras El-Mursi Hagras
Background Nowadays, there are wide applications of ionizing radiation in medicine, which can lead to serious health hazards to healthcare workers (HCWs) and nearby environment if safety measures are not properly applied. Aim The aim of the present work was to assess applied safety measures in workplace and the practice of HCWs occupationally exposed to ionizing radiation in Tanta University Hospitals. Patients and methods This study was cross-sectional survey study conducted at Diagnostic Radiology Department (11 units), Radiotherapy Department (two units), and Nuclear Medicine Unit (two units) in Tanta University Hospitals. The study participants were 225 HCWs. The study tools included workplace observation checklist and observational checklist for the practice of HCWs toward safety measures. Results Radiation safety measures were insufficient in 54.4 and 50% of diagnostic radiology units, and radiotherapy units, respectively, but were sufficient in all nuclear medicine units. The majority of HCWs did not wear personal protective clothes and equipment, but they used lead aprons more than any other personal protective clothes and equipment. Conclusion There was an insufficient application of radiation safety measures in the workplace as well as insufficient protective practices by HCWs. Therefore, HCWs are more prone to the hazardous effects of ionizing radiation rendering us recommending an ongoing audit system to ensure that all aspects of safe work (radiation safety standards) are being strictly adhered to and holding more basic and refreshing training courses that are needed to raise staff safety practice and good performance.
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Universal neonatal hearing screening program in private hospital, Qatar p. 175
Hanaa H Elsanadiky, Pretty O Afifi
Background Newborn hearing screening is now the accepted standard of care in several countries and is becoming increasingly more established worldwide. The early detection of hearing loss is important to avoid complications in language development. Aim The aim of this study was to evaluate two-stage neonatal hearing screening program in a single private hospital in Doha, Qatar. Patients and methods A total number of 10 310 babies were tested from May 2011 to May 2016. A universal two-stage hearing screening (universal neonatal hearing screening) protocol was used. Transient-evoked otoacoustic emissions (TEOAEs) were used twice for hearing screening of all babies. The first-stage screening was performed at the first 2–3 days of life before discharge from the hospital, and the second-stage screening was performed after 2 months. Auditory brainstem response (ABR) was assessed later for babies who failed TEOAEs. Results Most of the studied neonates were delivered by means of caesarian section (55%) with a mean weight of 3.19±0.46 kg. All (100%) neonates attended the first-stage hearing screening, and only 27.8% of neonates attended the second stage. The most frequent risk factor was prematurity (54.6%). The percentage of high-risk babies was 19.1% from the total neonates for the 3 years recorded for high risk. 10.3% attended the second stage and only one-fourth underwent diagnostic ABR. A percentage of 0.001–0.003 hearing disorder was recorded. Conclusion Two-stage neonatal hearing screening protocol should include automated ABR and not only TEOAEs.
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A randomized clinical trial to evaluate the efficacy of single versus multiple gastric lavage in the management of patients with acute organophosphorus poisoning p. 181
Shaimaa A.M El-Gendy, Inas H El-Mehallawi, Abdelhamid M Elwy, Ibrahim El-Sayed El-Ghrabawy
Background Despite lack of supporting evidence gastric lavage (GL) is one of the most commonly used decontamination method for organophosphorus (OP) ingestion in developing countries. Aim This study was designed to evaluate the outcome of patients with OP pesticide poisoning treated with GL with regard to timing and frequency of the procedure. Patients and methods In this study, GL was planned to be administered to patients with OP pesticide poisoning after initial stabilization irrespective of lavage given in peripheral hospitals. Therefore, some patients received one procedure (single GL) and some received more than one procedure (multiple GL). Early GL was defined as GL given within 2 h of poison exposure and late GL was referred to performing the procedure after 2 h. Results During the study period, 40 patients with OP pesticide poisoning received GL comprising 11 who received early single, nine who received late single, 10 who received early multiple and 10 who received late multiple GL. Mortality, respiratory failure incidence, ICU admission and incidence of mechanical ventilation (MV) were not significantly different between patients receiving early single, late single, early multiple and late multiple GL. There was significant difference between patients who received early single, late single, early multiple and late multiple GL regarding the duration of MV, hospital stay duration, and atropine and oximes ampoules needed. Conclusion Multiple GL created insignificant reduction in overall mortality from OP poisoning; yet early and multiple GL proved to be more effective than single GL in reducing the incidence of respiratory failure, ICU admission and MV and in decreasing hospital stay duration and atropine and oximes therapy amount significantly.
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Acute kidney injury in patients with liver cirrhosis p. 192
Nabil M Lasheen, Abdalla A Elsawy, Nashwa M Nor Eldin, Kamal M Okasha
Background Acute kidney injury (AKI) is a common complication of cirrhosis and confers a poor prognosis. There are many different causes for the development of AKI among patients with cirrhosis. Aim The aim was to study the incidence of AKI in cirrhotic patients and the different causes of AKI among them. Patients and methods Our study was conducted on 900 cirrhotic patients who were investigated in order to detect the incidence and causes of AKI. They were subjected to thorough history taking, complete clinical examination, investigations including: blood urea and serum creatinine, serum albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time and activity, international normalized ratio, complete blood count, total leukocytic count, C-reactive protein (CRP), hepatitis C virus antibodies, hepatitis B surface antigen, and pelvic-abdominal ultrasonography. Results AKI was found in 43.6% of the cirrhotic patients studied. The most predominant type was the prerenal AKI. Hepatorenal syndrome was found in 25.2% of patients. Septic causes included (spontaneous bacterial peritonitis in 24.2% of patients, chest infection in 22.6%, and urinary tract infection in 18.6%). Upper gastrointestinal bleeding was reported in 13% of cases. Postrenal causes were reported in 4.3% of cases, while intrinsic renal causes were found in 1% of cases. In 5.3% of cases, the cause of AKI was unidentified. We found that hemoglobin and serum albumin were significantly lower in patients with AKI compared with those without AKI. We found a significant positive correlation between serum creatinine and each of the following laboratory parameters: total leukocytic count, CRP, and international normalized ratio. On the other hand, we found a significant negative correlation between serum creatinine and hemoglobin and serum albumin. The CRP was the most independent risk factor in our patients. Conclusion AKI incidence in cirrhotic patients is significantly high. Prerenal AKI is the most predominant type. Sepsis was the most important prerenal causes of AKI in our cirrhotic patients. Anemia, hypoalbuminemia, hyperbilirubinemia, gastrointestinal bleeding, and sepsis increase the risk of AKI among cirrhotic patients.
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Effects of nicorandil and dexamethasone on ovalbumin-induced bronchial asthma in a rat model p. 198
Waleed Barakat El-Bahouty
Background Recent researches suggest that oxygen and its related species (oxidants) may contribute to the pathogenesis of a number of important lung diseases. Endogenous and exogenous reactive oxygen species play a major role in airway inflammation and are determinants of asthma severity. Aim The aim of this work was to study the antioxidant activity of nicorandil drug in bronchial asthma as an attempt to minimize the dose and side effects of using corticosteroids. Materials and methods The study was carried out in 50 rats weighing 120–150 g, subdivided into five groups each of which consisted of 10 rats. Group 1 rats were given normal saline intragastric and served as the control group; group 2 rats were given ovabumin; group 3 received dexamethasone 1 h before ovalbumin (OVA) challenge till last challenge (after 24 days); group 4 received nicorandil 1 h before OVA challenge till last challenge (after 24 days); group 5 received dexamethasone and nicorandil 1 h before OVA challenge till last challenge (after 24 days). At the end of the experiment (24 days), animals were kept on overnight fasting and were killed by decapitation. Lung sections were collected and then divided into two portions: one for histopathology and the other part of lung sections were homogenized and prepared for estimation of lung malondialdehyde, glutathione peroxidase, and tumor growth factor-β1 (TGF-β1). Blood samples were collected from all studied groups and lifted for clotting at 37°C and then centrifuged for separation of plasma for estimation of TGF-β1, tumor necrosis factor-α, and interleukin-6. Results The study showed that nicorandil administration whether alone or with dexamethasone, significantly reduced serum and tissue levels of inflammatory markers (TGF-β1, tumor necrosis factor-α, interleukin-6) and also significantly decreased lung malondialdehyde, TGF-β1 together with elevation of antioxidant activity presented by elevation of serum glutathione peroxidase.
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Cigarette smoking among medical students and some associated risk factors p. 206
Mira Maged Mohamed Abu-elenin, Asmaa Abd Elraheem Omar Atalla, Rania Mostafa El-Salamy
Background Tobacco is a leading cause of preventable mortality and morbidity. College students are at high risk of smoking as they are prone to higher availability of cigarettes. Although medical students are aware about the health hazards of tobacco smoking, they, as well as physicians, smoke. Aim This study aimed to explore the characteristics of cigarette smoking problem and associated risk factors among medical students in Faculty of Medicine, Tanta University. Materials and methods A cross-sectional study was carried out on students from Tanta University, Faculty of Medicine in Egypt. Multistage random sampling technique was used. A valid specially designed self-administered questionnaire was used to collect data including age, sex, parents’ education, smoking status, family member smoking habit, and self-reported causes of smoking. Results Of 252 students, 138 were male and 114 were female. The prevalence of current smokers was 12% and ex-smokers was 6.3%; most of them were male (90.0%), and 13.1% were heavy smokers with a statistically significant association with higher parents’ education. The most commonly reported cause of cigarette smoking was stress (42%). There was a statistically significant association between quitting trials and cessation of this habit (P=0.01). Smoking habit among family members and the presence of smoking peers were significantly associated with smoking status (P=0.001, 0.008). Conclusion Cigarette smoking is a common problem among medical students despite their awareness about the health hazards of tobacco. Specific training and counseling should be part of the curriculum at medical schools.
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Serum serotonin as a potential risk factor in female suicide attempts by poisoning, in different menstrual cycle phases p. 213
Abdelmoty M Kabbash, Ehab S Ramadan, Abdel M.A El-Fotoh Abo El-Wafa, Aisha E.A Fattah El-Mihy
Background Suicide is a major public and mental health concern worldwide today. It lies behind exceeding numbers of deaths every year. This necessitates studying the causes and risk factors involved in suicidal behavior. Suicide attempts are found to be more common in women, with higher risk during the low estrogen phases of the menstrual cycle. Serotonin is a neurotransmitter that is proved by many studies to be involved in suicidal behavior. A relation between circulating estrogen levels and serotonergic function is supposed by some studies to explain the link between female suicide attempts and low estrogen phases of the menstrual cycle. Aim The aim of this work was to study serum serotonin level as a potential risk factor in female suicide attempts in the different menstrual cycle phases. Also, this study aimed to investigate the potential correlation between serum serotonin and estrogen levels. Patients and methods This cross-sectional study was carried out on two groups: the suicidal group that included women with suicide attempts who came to Tanta Poison-Control Center during the period from the beginning of July 2015 to the end of December 2015, and the control group that included 25 nonsuicidal apparently healthy female volunteers. The menstrual cycle phase was assessed for those women; the serum serotonin level was estimated by specific ELISA techniques, and the suicidal intent of the suicidal group was assessed by Pierce’s suicidal intent scale. Results and conclusion This study demonstrated that the suicide attempters had significantly lower serum serotonin levels. This significance was observed to be in the menstrual and the whole luteal phases. A significant inverse correlation was found between serum serotonin levels and Pierce’s suicidal intent scale for the women who attempted suicide in the late luteal and menstrual phases. Also, a significant positive correlation was found between serum estrogen and serotonin levels.
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Dexmedetomidine in preeclamptic patients undergoing caesarean section under general anesthesia p. 220
Nosaiba K Ezz El-Arab, Salama I El-Hawary, Ashraf E El-Zeftawy, Rabab M Mohammed
Background Dexmedetomidine is used as a sedative in surgical and other procedures in nonintubated adult and pediatric patients. It has been successfully used in laboring parturients as it provides maternal hemodynamic stability and anxiolysis. Aim The aim of this study is to assess the effects of dexmedetomidine in preeclampsia patients under general anesthesia as regards: pressor response to laryngoscopy and intubation, doses of anesthetic agents, muscle relaxants and narcotics, uterine contractility and neonatal effect, postoperative recovery, and postoperative analgesic requirements. Patients and methods This study was carried out on 60 parturients with preeclampsia who were scheduled for elective caesarean delivery. Patients were divided randomly into two groups: DEX group, patients received 1 µg/kg intravenous dexmedetomidine 10 min before induction and a maintenance dose with 0.4 µg/kg/h during surgery, and the control group: patients did not receive dexmedetomidine (n=30/group). Changes in maternal heart rate, mean arterial blood pressure, time from induction to delivery, full anesthesia time (especially during stress of intubation), and depth of anesthesia were monitored by bispectral index. The total dose of propofol, rocuronium and fentanyl consumption, uterine contraction after placental delivery, Apgar score, postoperative recovery profile, postoperative pain, and postoperative analgesia were also assessed. Results Heart rate was significantly lower in the DEX group than in the control group. The mean arterial blood pressure was significantly lower in the DEX group than in the control group from the induction till after extubation. Also there was significant decrease in the total consumption of propofol, fentanyl, and muscle relaxant in the DEX group than in the control group, while both groups were comparable in uterine contraction, Apgar score, and awareness. Conclusion This study suggests the effective use of dexmedetomidine in pre-eclamptic patients undergoing elective cesarean as it stabilizes the maternal hemodynamic parameters during intubation and after intubation with negligible effect on the fetus.
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