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   Table of Contents - Current issue
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July-September 2017
Volume 45 | Issue 3
Page Nos. 115-159

Online since Wednesday, November 29, 2017

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ORIGINAL ARTICLES  

Evaluation of the potential cardiotoxic effects in acute organophosphate toxicity as a prognostic factor Highly accessed article p. 115
Ayman El-Sheikh, Ahmad Hashem, Mona Elgohary, Arwa Abo Elfadl, Heba Lashin
DOI:10.4103/tmj.tmj_5_17  
Background/aim Organophosphorus compounds are the most commonly used pesticides as a result of their easy availability. They are highly toxic compounds for human beings. The study aimed to evaluate the potential cardiotoxic effects in acute organophosphate toxicity as a prognostic factor. Patients and methods This study was carried out on 48 organophosphate acutely intoxicated adult patients. All participants were subjected to the following: sociodemographic study, patient’s history, clinical examination, laboratory investigations, ECG (ECG changes were graded as minor, moderate, and severe), and echocardiography. Results Regarding acute organophosphorus poisoning (OPP) severity, patients with mild, moderate, and severe intoxication represented 18.6, 35.4, and 45.8 of the studied patients, respectively. Of acute OPP patients, 81.25% had abnormal ECG with ischemic changes in 66.7% of patients and arrhythmia in 43.6%. Inverted T-wave and elevated ST segment were the most frequent among ischemic findings while atrial fibrillation was the most frequent arrhythmic finding. The ECG changes induced by acute OPP were graded as moderate in 68.75% of patients and severe in 12.5%. Only one case of acute OPP was diagnosed as acute myocardial infarction. No cases with minor ECG grading were recorded. There was a statistically significant difference between acute OPP severity and ECG grading. Patients with acute OPP have shown a mean QTc interval of 0.46±0.062 s. In all, 47.9% of patients reported prolonged QTc interval. QTc interval was significantly more prolonged in severely intoxicated patients. Conclusion ECG grading and corrected QT interval are a predictor for both primary and major outcome in patients with acute OPP.
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Role of autophagy and oxidative stress in experimental diabetes in rats p. 122
Asmaa H Okasha, Hanaa H Gaballah, Soha S Zakaria, Salwa M Elmeligy
DOI:10.4103/tmj.tmj_2_17  
Background Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia owing to defects in insulin secretion, insulin action, or both. The exact pathogenesis of β-cell failure in type 2 DM is still unclear. However, autophagy and oxidative stress have emerged presently as major contributing factors in the development of type 2 diabetes and β-cell failure. Aim The aim is to assess the levels of beclin-1 (autophagy regulator) and some oxidative stress markers in animal models of high-fat diet-streptozotocin-induced diabetes and to study the effect of 4-phenylbutyrate (4-PBA) on them. Materials and methods The study was conducted on 60 male albino rats that were divided randomly into three equal groups: group I (control group), group II (diabetic group), and group III (diabetic rats treated with 4-PBA). Pancreatic tissue levels of beclin-1 were measured by enzyme-linked immuosorbent assay, whereas pancreatic tissue levels of reduced glutathione (GSH) and plasma levels of advanced oxidation protein products (AOPPs) and glucose were measured spectrophotometrically. Results The levels of beclin-1, AOPPs, and glucose were significantly increased in diabetic group compared with control group, whereas the levels of GSH were significantly decreased. Moreover, 4-PBA significantly decreased the levels of beclin-1, AOPPs, and glucose, whereas it increased GSH levels. Conclusion Autophagy and oxidative stress are involved in the pathogenesis of type 2 DM. Moreover, 4-PBA (a chemical chaperone) attenuated autophagy and exhibited antioxidative stress effects in rats with high-fat diet-streptozotocin-induced diabetes.
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Bortezomib in multiple myeloma: treatment response and survival outcome p. 129
Eslam S.M Bassiony, Ashraf F Barakat, Amr A.E Ghannam, Essam A Abozena
DOI:10.4103/tmj.tmj_21_17  
Background Bortezomib, a first-in-class proteasome inhibitor, was approved by the Food and Drug Administration in 2003. Bortezomib has come a long way since its development as one of the most effective drugs currently available for treating multiple myeloma. With improved efficacy of combination regimens, we have seen increasing use of its therapeutic spectrum ranging from frontline induction to maintenance therapy. Bortezomib has been integrated into the treatment of myeloma at every disease stage. Aim The aim of this study was to evaluate the disease response and survival outcome in patients with multiple myeloma who were treated with bortezomib as first-line or second-line treatment who had recurrent or refractory disease after systemic chemotherapy. Patients and methods This retrospective study included 23 patients with multiple myeloma who were treated at Clinical Oncology and Nuclear Medicine Department, Tanta University Hospital, Faculty of Medicine, Tanta University, and were diagnosed between January 2012 and January 2016. Nine patients received bortezomib as a first-line treatment, whereas 14 patients received it as a second-line treatment. Results Bortezomib shows better response rate and survival outcome especially in patients who received it as the first line of treatment. About 52.5% of patients show partial response or better response. Conclusion Bortezomib with dexamethasone gives a response rate and survival outcome better than conventional treatment, dexamethasone alone, or bortezomib single agent. However, bortezomib combination with other chemotherapeutic agents gives more response rate than bortezomib with dexamethasone.
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Relationship between serum Fetuin-A and insulin resistance in patients with hyperthyroidism p. 135
Samar R Ammar, Tamer A Elbedewy, Hala M Nagy, Nesreen A Kotb
DOI:10.4103/tmj.tmj_4_17  
Background Fetuin-A is a multifunctional hepatic secretory protein that is involved in the pathology of many disorders. Recent epidemiological studies showed that serum Fetuin-A was associated with insulin resistance and its comorbidities, such as metabolic syndrome and type 2 diabetes. Hyperthyroidism involves a significant increase in the level of tissue metabolism and is often accompanied by abnormal glucose tolerance and insulin resistance. Aim The aim of this work is to study the relationship between serum Fetuin-A and insulin resistance in patients with hyperthyroidism. Participants and methods Our study was carried out on 35 newly diagnosed patients with hyperthyroidism (group I) and 20 healthy individuals matched for age and sex as controls (group II). Fetuin-A, fasting insulin, fasting blood glucose, free T3, free T4, thyroid stimulating hormone, total serum calcium, and high-sensitivity C-reactive protein were measured before and after euthyroidism was established. Results Significantly higher levels of serum Fetuin-A were noted in the patient group before treatment compared with the control group. There was a significant decrease in serum Fetuin-A in the patients after treatment in comparison with before treatment. There was an insignificant difference between the patients after treatment and the control group in terms of serum Fetuin-A. Fetuin-A was correlated positively with Homeostasis Model of Assessment-Insulin Resistance, High-sensitivity C-reactive protein, fT3, and fT4, whereas there was a negative correlation between thyroid stimulating hormone and Fetuin-A. Conclusion This study provides direct evidence for a relationship between serum Fetuin-A and insulin resistance in patients with hyperthyroidism.
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Role of high-fructose diet in experimental induction of nonalcoholic steatohepatitis in rats p. 141
Assmaa M.F. Abdel-Aziz El Sheikh, Sobhy A El-Hamid Hassan, Manal M El-Batch, Soha S Zakareia
DOI:10.4103/tmj.tmj_33_16  
Background Nonalcoholic steatohepatitis (NASH) is the most common chronic liver disease in the Western world and has rapidly become an important cause of liver failure and hepatocellular carcinoma. Obesity is considered the primary risk factor for NASH. Aim The aim of this study was to clarify the role of high-fructose diet in the pathogenesis of steatohepatitis. Materials and methods This study was conducted on 40 male albino rats, equally divided into two groups. Group 1 (control) received standard caloric diet and plain drinking water. Group 2 (induced NASH group) received standard caloric diet and had free access to 70% (weight/volume) fructose-enriched drinking water for 5 weeks. All rats were weighed and killed, and then serum was collected for estimating triglycerides, total cholesterol, serum alanine aminotransferase, and serum aspartate aminotransferase levels, as well as liver tissue sampling was used for histopathologic examination and for estimation of tissue triglycerides level. Results Compared with the control group, rats with induced NASH group showed an increased weight gain and significant hypertriglyceridemia and hypercholesterolemia, as well as significant increases in serum alanine aminotransferase and aspartate aminotransferase levels, which were associated with increased hepatic triglycerides level. Conclusion NASH can be experimentally induced in rats using a high-fructose diet. Steatohepatitis is associated with obesity as indicated by significant increase in body weight, hypertriglyceridemia, hypercholesterolemia, and hepatic hypertriglyceridemia.
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Assessment of hospital waste management in Tanta University p. 146
Amira K. El-Dawla Mokhtar El-Shinawey, Asmaa Abdel-Reheem Atalla, Khalil M Abbas, Samir Abd El-Mageed Atlam
DOI:10.4103/tmj.tmj_19_17  
Background Healthcare waste represents one of the most important environmental problems in the world because of the potential environmental hazards and public health risks, and its management is an integral part of infection control programs. Aim The aim of this study was to assess hospital waste management in Tanta University, Tanta, Gharbia Governorate, Egypt. Study design This is a cross-sectional descriptive study. Patients and methods This study was carried out in Tanta University Hospitals. Its target included eight hospitals and 14 outpatient clinics affiliated to Tanta University with a healthcare waste management team in them. Observational checklist was the tool used and was filled by the researcher. Results The study revealed that the application of administrative aspects was insufficient in 16.4% of departments. Concerning minimization and transport of waste, 96.7% of departments had insufficient level. Sufficient level was found among only 18 and 13.1% as regards sorting and collection of waste, respectively. Treatment and final disposal of waste was insufficient in 91.8% of departments. In all departments, personal protective equipment (PPEs) were insufficient while training was sufficient in more than one-fourth of the departments (26.2%). Conclusion The departments did not perform the sufficient level of health care waste management (HCWM), except in sorting and collection of waste (18 and 13.1% of the departments, respectively).
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Saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity in women with unexplained infertility p. 155
Mohamed Helmy Draz, Tarek Mohammed El-Sabaa, Shahinaz Hamdy El Shorbagy
DOI:10.4103/tmj.tmj_49_17  
Background Uterine abnormalities, congenital or acquired, are implicated as one of the causes of infertility. Embryo implantation depends on the quality of the ovum, the condition of the endometrium as well as the uterine cavity. Hence, it is recommended to diagnose and treat these abnormalities in patients with unexplained infertility. Objective The aim of this study was to compare the diagnostic accuracy between saline infusion sonography (SIS) and hysteroscopy (HS) to evaluate uterine cavity pathologies among women with unexplained infertility. Patients and methods This study was carried out on 50 women with unexplained infertility in the Department of Obstetrics and Gynecology at Tanta University Hospital, from March 2015 to December 2015. Patients were subjected to an ultrasound assessment of uterine cavity using saline as the contrast medium (SIS) and then followed by HS on a later date. Examination was performed after cessation of menstruation, but before the 10th day of the menstrual cycle (early-proliferative phase of the same menstrual cycle). The uterine cavity was inspected for irregularities such as synechiae, polyps, and submucous myomas, as well as uterine malformations. Sensitivity, specificity, accuracy, and positive and negative predictive values of SIS and diagnostic HS to detect intracavitary abnormalities were compared. Results In this study, HS was more sensitive (100 vs. 85%), with the same specificity (100 vs. 100%), and more accurate (100 vs. 94%) than SIS. HS also had a higher predictive value (100 vs. 100% positive predictive value, 100 vs. 90% negative predictive value) than SIS during the evaluation of patients with unexplained infertility. Conclusion Infertile women should be screened for possible uterine cavity abnormalities. HS is still considered the gold standard to diagnose intrauterine pathology as it is more sensitive and more accurate than SIS. However, SIS has the advantages of being a simple, well-tolerated, noninvasive, cheap, affordable, shorter duration, and accurate method for uterine cavity evaluation. Thus, SIS can be used as an alternative technique for the evaluation of uterine cavity abnormalities when HS is not available.
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