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Chronic subdural hematoma: complication avoidance
Ahmed Abdel Salam Shakal, Ehab Ezzat El Gamal, Ashraf Mohamed Farid
January-March 2014, 42(1):6-13
Background and objective Chronic subdural hematoma (CSDH) is defined as the presence of a typical neomembrane, typical liquefied blood within the hematoma cavity, and 3 weeks of more of acute subdural hematoma. It has been classified into separate, laminar, homogenous, and trabecular types. This study analyzed the complications after burr hole evacuation in CSDHs and the best methods to avoid or at least minimize them. Materials and Methods A total of 28 patients who were suffering from complications after evacuation of CSDH were analyzed. Data on patients and treatment protocol were collected. Medical problems were also managed. Complications were studied as regards their causes and avoidance. Results The highest incidence of complications is observed in the seventh decade of life. Recurrence was the most common complication especially in the separate type. The recurrence rate was higher among patients operated through a single burr hole. Extradural hematomas, although rare, were observed in three patients. Acute subdural hematoma and cerebral infarction had the worst prognosis. Conclusion Subgaleal dissection and insertion of a subgaleal drain are important for absorption and suction of the residual air and blood. In addition, intraoperative copious saline irrigation and postoperative meticulous follow-up are important for patients with a high risk of recurrence, especially those with hematomas of the separate type. During evacuation of the hematoma, we must avoid sudden decompression of the brain as it leads to cerebral infarction or intracranial hemorrhage. It is important to inform the anesthetist before performing the drainage that the blood pressure should be closely monitored and maintained at normal levels while infusing normal saline during surgery to avoid hypotension, which may lead to infarction. Any source of blood from the extradural space must be adequately dealt with.
  3,691 207 -
A new cutoff value for fecal calprotectin level in differentiating functional from organic causes of chronic diarrhea
Shahira El-Etreby, Hazam Hakim, Maha Ragab, Raghda Farag, Ehsan Rizk, Sahar Alsayed, Hanaa Abdeen
October-December 2013, 41(4):336-341
Background The gold standard to establish inflammatory bowel disease diagnosis remains in the hands of endoscopists and pathologists. A challenge is thus to distinguish symptoms of inflammatory bowel disease from that of irritable bowel syndrome. Aim of this work The aim of this study was to evaluate the clinical usefulness of fecal calprotectin level as a noninvasive marker in order to distinguish patients with diarrhea in need of intensified follow-up from those who do not need further workup. Patients and methods From a total of 150 patients presented with chronic diarrhea with or without bleeding per-rectum in the outpatient clinic of Specialized Medical Hospital, only 60 were involved in this study. Stool analysis and culture were carried out. Measurement of fecal calprotectin was done using the ELISA kit. Inflammatory biomarkers, such as erythrocyte sedimentation rate and C-reactive protein and perinuclear anti-neutrophil cytoplasmic autoantibodies (P-ANCA) and cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA), were tested. Full colonoscopy with histopathological examination was performed. Results The frequencies of diseases on the basis of diagnostic colonoscopy and pathological examination were as follows: 19 patients with irritable bowel syndrome (31.67%), 41 patients with nonorganic gastrointestinal (GIT) disease versus organic GIT diseases (68.33%), 32 patients with ulcerative colitis (53.33%), two patients with Crohn's disease (3.33%), two patients with diverticulitis (3.33%), two patients with eosinophilic gastroenteritis (3.33%), and two patients with cancer colon (3.33%). There was a remarkable difference between organic GIT diseases versus nonorganic groups as regard fecal level of calprotectin (P < 0.001). Fecal calprotectin value of at least 350 μg/g with a receiver operating characteristic value of 0.931 [95% confidence interval (CI) 0.864-0.971] was diagnostic of ulcerative colitis with a sensitivity of 81.82% (95% CI 64.5-93), specificity of 85.19% (95% CI 66.3-95.8), positive predictive value of 86.32%, and negative predictive value of 80.39%. Conclusion Calprotectin, a fecal marker, is helpful as an adjunctive tool in overall evaluation of patients with nonspecific symptoms and as a diagnostic tool in those with inflammatory disease. It is less invasive than colonoscopy and can help to guide management in a more cost-effective manner.
  3,123 123 1
Long saphenous vein harvesting site infection after coronary artery bypass grafting
Khairy Gaballah, Mohamed Abo Elnor
October-December 2013, 41(4):306-309
Introduction Coronary artery bypass grafting is a very common surgery with highly successful outcomes; however, wound complications from harvesting the long saphenous vein (LSV) can be a major source of postoperative morbidity. The aim of this study was to identify the incidence of LSV harvesting site infection in coronary artery bypass grafting and to detect the possible risk factors. Patients and methods Between September 2009 and December 2010, 100 patients who were diagnosed with coronary artery disease were included in our study and were admitted at Shebien El-Kom Teaching Hospital. All patients who developed major leg wound complication were assessed daily during the postoperative period using the ASEPSIS scoring system and 10 risk factors were analyzed and compared with the entire cohort of patients undergoing similar bypass procedure during the same time period. Results LSV harvesting site infections (ASEPSIS score >20) were identified in 12 patients (12%), including nine patients with mild infection (ASEPSIS score 21-30), two with moderate infection (ASEPSIS score 31-40), and one with severe infection (ASEPSIS score >40). Of the 10 variables evaluated using multivariate analysis, age, sex, obesity, smoking, diabetes, peripheral vascular disease, level of LSV harvesting, usage of intra-aortic balloon pump, Cardio-Pulmonary Bypass (CPB) time, and use of internal thoracic artery graft were identified as significant independent predictors of major leg wound complications (P < 0.05). Conclusion Identification of independent risk factors for infection is important to develop strategies that prevent infection and to allow for recognition of patients at high risk who may need more careful monitoring so as to prevent development of infection.
  2,885 149 -
A comparison of isosorbide mononitrate, misoprostol, and combination therapy for preinduction cervical ripening at term: a randomized controlled trial
Ahmed T Soliman
October-December 2013, 41(4):310-317
Aim The purpose of this study was to compare the efficacy, safety, and acceptability of isosorbide mononitrate (IMN), misoprostol, and combination therapy for cervical ripening before induction of labor at term. Patients and methods A prospective, double-blind, placebo-controlled, randomized clinical trial was carried out on 196 term and post-term nulliparous women with unfavorable cervices who were assigned randomly to receive either 40 mg of IMN (n = 65), 50 ΅g of misoprostol (n = 65), or both of them (n = 66) in the posterior vaginal fornix. Changes in the Bishop score and cervical length, progress, and outcomes of labor and adverse effects were assessed. Results Combination therapy was more effective than IMN or misoprostol alone. Successful induction (vaginal delivery within 24 h of initiation of cervical ripening) was significantly higher in the misoprostol (60%) and the combination therapy (62.1%) groups compared with the IMN (27.7%) group (P < 0.0001). The mean duration (h) from treatment initiation to delivery was greater for IMN (26.7 ΁ 7.5) than for misoprostol (16.5 ΁ 6.7) and combination therapy (14.8 ΁ 6.2) groups (P < 0.0001). Oxytocin was needed more in the IMN group (93.8%) than in the misoprostol (21.5%) and combination therapy (25.8%) groups (P < 0.0001). IMN was safer and more acceptable than misoprostol and combination therapy. The cesarean rate was not significantly different among groups, but the major indications were different: dystocia (54.5%) in the IMN group versus a persistent nonreassuring fetal heart rate pattern (57.9%) in the misoprostol and (47.6%) the combination therapy groups (P = 0.01). Conclusion Combination therapy was more effective than either IMN or misoprostol alone for preinduction cervical ripening at term. However, IMN was safer, well tolerated, and more acceptable.
  1,936 191 -
A study of different parameters of human extremities and its relationship with human height in residents of eastern India
Biswa Bhusan Mohanty, Divya Agrawal, Pratima Baisakh, Pusparaj Samantsinghar, Sanjay Kumar, Prafulla Kumar Chinara
January-March 2015, 43(1):1-8
Introduction Height is defined as distance between vertex of head and surface. Reconstruction of the stature from various parameters is quite valuable for identification & for establishing the individuality of a person. Aims and Objectives The present study was done to determine the stature from parameters of upper limb & lower limb of individuals having age group of 17-25. Materials and Methods Authors have studied 213 male and 87 female, healthy subjects in Department of Anatomy, IMS & SUM Hospital, Bhubaneswar. All individuals were measured for height and arm, forearm, hand & foot length. Observation and Results The data thus obtained has been tabulated & subjected to statistical computation to derive the regression equations. Conclusion The results concluded that height has a definite correlation with the parameters. This conclusion is of utmost importance to anthropologist and forensic experts for estimation of stature from mutilated, decomposed or fragmentary skeletal remains.
  1,951 152 -
Balloon dilatation sinuplasty: concept, procedure, and debate
Ahmed Elguindy
October-December 2013, 41(4):301-305
Chronic rhinosinusitis affects millions of people every year. When medical treatment by antibiotics and steroids is not effective, then functional endoscopic sinus surgery is indicated. The aim of this article is to define the concept of balloon dilatation sinuplasty (BDS), to describe its technique and to review the current literature for the indications, contraindications, complications, outcomes and follow-ups of patients submitted to this procedure. The review showed that Balloon Dilatation Sinuplasty is a feasible, safe and effective procedure. It can be used an alternative in the treatment of CRS patients as a stand-alone medical procedure or as a hybrid surgical one with conventional instruments and/or with microdebriders
  1,011 911 -
Ultrastructural characteristics of synovial fluid cells in rheumatoid arthritis and osteoarthritis
Amal A Abd-El-Hafez, Ali El-Deeb, Mervat Esmail, Rehab Al Sernagawy
January-March 2014, 42(1):21-30
Aim The aim of the study was to evaluate the range of activation changes of polymorphonuclear leukocytes and the ratio of apoptosis and necrosis in synovial cells of patients with rheumatoid arthritis (RA) and osteoarthritis (OA), to study and compare the ultrastructural features of synovial fluid (SF) cells from RA and OA patients, to correlate it to activities of the diseases, and to produce microscopic translation to the events that occurred in the joint. Patients and methods Synovial effusions were aspirated from the knee joints of patients with RA (seven samples) and with primary OA (14 samples). Cytospin preparations were processed for transmission electron microscopy and assessed for the incidence of the neutrophil granulocytes, the dominating cell population in the arthritic SF, apoptosis, and cytophagocytic cells (CPCs) in the SF. Results In all samples under investigation, most of the synovial effusion cells had intact ultrastructure with a certain amount of apoptotic cells dominating over the cells with signs of necrosis and with few CPC. The highest rate of apoptosis was discovered in the synovial effusions of patients with RA and the lowest in those with OA; in addition, the incidence of CPC was lower in patients with OA. In RA, the current disease activity correlated with the incidence of the neutrophil granulocytes and of the apoptotic cells. Conclusion These data suggest that, in RA, despite exposure to the antiapoptotic signals, apoptosis of the synovial effusion polymorphonuclear leukocytes is maintained at a significantly higher level than in OA, providing elimination of the neutrophils accumulating in the joint cavity, and thus stimulating resolution of joint inflammation.
  1,738 141 -
Imaging of cherubism: case report and review of the literature
Rasha Elshafey
January-March 2014, 42(1):42-45
Cherubism is a rare osseous disorder of children and adolescents. Although the radiologic characteristics of cherubism are not pathognomonic, the diagnosis is strongly suggested by bilateral relatively symmetric jaw involvement that is limited to the maxilla and mandible. Imaging typically shows expansile remodeling of the involved bones, thinning of the cortexes, and multilocular radiolucencies with a coarse trabecular pattern. Here, we report one child aged 5 years who underwent clinical, radiologic, genotyping, and histopathological evaluation. The patients' sex, age, and physical characteristics and clinical-radiological presentation were recorded.
  1,652 119 -
Antipyretic effect of ethanolic extract of Moringa oleifera leaves on albino rats
Ayon Bhattacharya, Rasmirekha Behera, Divya Agrawal, Pratap K Sahu, Sanjay Kumar, Sudhanshu S Mishra
April-June 2014, 42(2):74-78
Objective The aim of the study was to evaluate the antipyretic activity of ethanolic leaf extract of Moringa oleifera using Brewer's yeast-induced pyrexia model. Materials and methods It was a randomized controlled experimental study. A total of 60 rats were taken, dividing them in six groups, each containing 10 rats. Ethanolic extract of M. oleifera (EMO) was administered at 50, 100, 200, and 400 mg/kg doses orally to the respective four groups. The control group was fed with normal saline at 2 ml/kg. A 20% suspension of Brewer's yeast in normal saline was injected subcutaneously at a dose of 10 ml/kg body weight below the nape of neck of rats in all groups. Pyrexia developed after 10 h of Brewer's yeast injection and the temperature was recorded. Animals which showed a rise in body temperature to at least 39°C were included in the study, allowing a minimal of six rats in each group, total of 36 rats. Drugs were given after development of pyrexia and temperatures were recorded. Paracetamol at 100 ml/kg orally was taken as the standard drug. Results The ethanolic leaf extract of M. oleifera showed significant (P < 0.05) antipyretic activity at 100, 200, and 400 mg/kg. Paracetamol showed significant antipyretic activity from 15 min of drug administration to 12 h. EMO at a dose of 50 mg/kg did not show antipyretic effect. The onset of action of EMO 100 mg/kg was found to be 2 h and that of 200 and 400 mg/kg was found to be 30 min. For all the doses, the antipyretic effect lasted up to 12 h. Conclusion The ethanolic leaf extract of M. oleifera exhibited significant (P < 0.05) antipyretic activity at 100, 200, and 400 mg/kg.
  1,479 176 -
A case of acute respiratory distress syndrome with Plasmodium vivax malaria
Pulin Gupta, Vikas T Talreja, MS Dhananjaya, Sakshi Mittal
October-December 2014, 42(4):151-153
Malaria is an important treatable cause of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in the tropics and in the returning traveller in the nonendemic areas. ARDS is an important complication in severe, complicated Plasmodium falciparum malaria and has been described rarely in Plasmodium vivax and Plasmodium ovale malaria also. Malarial ALI/ARDS is more common in adults than in children. Pregnant women and nonimmune individuals are more prone to develop this condition. Increased alveolar capillary permeability resulting in intravascular fluid loss into the lungs appears to be the key pathophysiologic mechanism. The diagnosis of malaria is confirmed by slide microscopy supported by the use of rapid antigen tests. Patients with malarial ARDS should be managed in an ICU. Careful attention must be paid to haemodynamic stabilisation and optimising fluid balance. We hereby present a case of a 28-year-old man who presented with ARDS and P. vivax malaria demonstrated by slide microscopy.
  1,559 74 1
Serum levels of amino terminal of probrain natriuretic peptide (NT-Pro BNP) as a diagnostic and prognostic biomarker in children with dilated cardiomyopathy
Amr M Zoair, Wegdan H Mawlana, Amal S El-Bendary, Eman A Nada
April-June 2014, 42(2):53-57
Background The amino terminal fragment of proB-type natriuretic peptide (NT-proBNP) has become commonly utilized as a sensitive marker for cardiac dysfunction in adults. However, its value in children with dilated cardiomyopathy (DCM) has not been widely investigated. We aimed to evaluate the serum levels of NT-proBNP as a diagnostic and prognostic biomarker of left ventricular dysfunction in children with DCM. Patients and methods The level of NT-proBNP was measured in 20 critically ill children with DCM and in 20 age-matched control children. Results There was highly significant increase in serum NT-proBNP level in patients with DCM as compared with the control group. At cutoff level of 1500 pg/ml, the sensitivity of NT-proBNP as a diagnostic biomarker in children with DCM was 85% and the specificity was 100%. There were significant positive correlations between serum NT-proBNP level and left ventricular systolic and diastolic diameters, whereas significant negative correlations were present between serum NT-proBNP level and ejection fraction and fraction shortening in children with DCM. Conclusion Serum NT-proBNP levels could play a role as a diagnostic and prognostic biomarker (with high sensitivity and specificity) of left ventricular systolic dysfunction in children with DCM.
  1,022 390 -
Prophylactic bilateral internal iliac artery ligation for management of low-lying placenta accreta: a prospective study
Waleed Refaie, Muhammad Fawzy, Ahmed Shabana
October-December 2014, 42(4):146-150
Background Morbidly adherent placenta is one of the most feared complications causing high morbidity and mortality in obstetrics. Cesarean hysterectomy is still the main procedure in the current management of patients diagnosed with morbidly adherent placenta. Objective To evaluate the efficacy of prophylactic bilateral hypogastric arteries ligation on maternal outcome in diagnosed cases of morbidly adherent placenta. Design Prospective study. Setting Obstetrics and Gynecology Department, Mansoura University Hospital, Egypt. Methods This was a prospective cohort study of 51 pregnant women with a history of previous cesarean sections and diagnosed with low-lying abnormally adherent placenta. All patients underwent prophylactic internal iliac artery ligation after fetal delivery and before extraction of the placenta, the placenta was removed manually in a piecemeal manner and any remaining bleeding points from the placental site were then controlled by hemostatic sutures. Results Bilateral internal iliac artery ligation was performed in patients with invasive placenta (accreta and increta) (46/51 = 90.1%) and satisfactory hemostasis was achieved in 38 patients (38/46 = 82.6%). In five patients with placenta previa increta (5/17 = 29.4%), there was uncontrolled blood loss; thus, we proceeded to cesarean hysterectomy. The mean intraoperative blood loss was 1255 ± 589 ml. Blood transfusion was necessary in 35 patients (35/46 = 76%) during the operations. The mean hemoglobin and hematocrit 1 day after the operation were 9.8 ± 1.3 and 31.4 ± 2.3, respectively. Conclusion Prophylactic bilateral internal iliac artery ligation before extraction of placenta accrete seemed to be an effective technique to decrease cesarean complications and avoid emergent peripartum hysterectomy.
  1,210 140 -
Management of placenta accreta by uterine artery embolization: A case report
Neeta Natu, Kailash Patel, Nootan Chandwaskar, Akanksha Chauhan, Avneet Arora, Ravindra Kumar
January-March 2015, 43(1):36-38
Placenta accreta is one of the most serious complications of pregnancy and is frequently associated with severe obstetric hemorrhage, usually necessitating hysterectomy. Here, we are appending a case in the literature one with placenta accreta with previa. Uterine artery embolization was performed for the management of postpartum hemorrhage after subtotal hysterectomy.
  1,216 125 -
Relationship of distal femoral morphometrics with anterior cruciate ligament injury using MRI
Sameh A Khodair, Usama E Ghieda, Amr S Elsayed
April-June 2014, 42(2):64-68
Objective The aim of the study was to compare the distal femoral morphology in anterior cruciate ligament (ACL) noninjured and injured patients and to explore differences between men and women. Patients and methods Retrospective study of MRI measurements of the distal femur of 159 patients was conducted; notch width (NW), bicondylar width (BCW), and notch index (NI) were measured in 72 patients with ACL injury and in 87 patients without ACL injury. All patients underwent knee arthroscopy. The measured values in both ACL-injured and non-ACL-injured male and female individuals were analyzed; P value less than 0.05 was considered to be statistically significant. Results There were significant differences in NW and BCW between male and female individuals with non-ACL injury (P = 0.000), whereas no statistically significant difference was noted regarding NI (P = 0.789). There was statistically significant difference in the male group with ACL injury regarding NW and NI (P = 0.000), with no significant statistical difference regarding BCW. In the female group, there were significant differences (P = 0.000) in the bone morphology between ACL-injured and non-ACL-injured individuals, including NW, BCW, and NI. Conclusion There was difference between male and female distal femur morphologies. In both sexes, patients with small NI and NW are at high risk for ACL injuries.
  1,210 103 -
Assessment of daytime sleepiness and reliability test of Epworth sleepiness scale in young individuals
Debalina Sahoo, Harshida Gosai, Ujjwal Sahoo, Pratik Akhani, Arvind Kanchan, Jaman Mohan Harsoda
April-June 2014, 42(2):79-82
Background The Epworth Sleepiness Scale (ESS) is a brief, self-administered questionnaire to measure the daytime sleepiness (DS) in young individuals. It measures an individual's usual level of DS or average sleep propensity in daily life. The scale also estimates whether someone is experiencing excessive sleepiness, which possibly requires medical attention. Aim The aim of the study was to assess the level of DS as well as to assess the reliability of ESS in young individuals. Settings and design The study was designed as a cross-sectional questionnaire-based study. Participants and methods A total of 120 apparently healthy participants belonging to both sexes were evaluated at baseline and after 6 months. The anthropometric measurements included BMI and neck width, ESS scores, DS by the mean levels of chance of dozing, O 2 saturation, and pulse rate. Statistical analysis The reliability of ESS scores and its correlations with various parameters were assessed using paired T-test. Results The mean levels of chance of dozing and ESS scores were significantly lower during daytime in female individuals. ESS scores were significantly correlated with BMI, neck width, and pulse rate; however, there was no correlation between ESS scores and O 2 saturation. The ESS scores as well as the above-mentioned results did not change significantly even after 6 months, indicating good reliability. Conclusion The ESS is appropriate for measuring DS in young individuals, and it also enables characterization of individuals with sleep-related disorders.
  1,181 112 -
Sentinel lymph node biopsy using blue dye as guidance for central neck dissection in patients with clinically node-negative papillary thyroid carcinoma
El-Sayed Mahmoud Abd-Elwahab, Hany Abd-Elfatah El-hady, Olfat Abd-Elaziz Khaled
April-June 2014, 42(2):58-63
Background Sentinel lymph node biopsy has recently been used to detect occult lymph node metastases. Occult lymph node metastasis of papillary thyroid carcinoma (PTC) can be detected by sentinel lymph node (SLN) biopsy, but studies in larger patient cohorts undergoing complete central neck dissection are required to assess the diagnostic accuracy of SLN. Materials and methods A total of 25 consecutive patients with clinically and ultrasonographically node-negative PTC were enrolled and underwent sentinel lymph node biopsy. After injection of 0.2-0.3 ml methylene blue around the tumor or 0.5-1.0 ml into the thyroid nodule, blue-stained SLNs were collected from the central compartments. Results SLNs were identified in 21 of 25 patients (84%); of these, 14 SLNs were positive and seven SLNs were negative by hematoxylin and eosin staining. The false-negative rate was detected in two patients (8%), identified by immunohistochemical staining. The non-SLNs were positive in five patients (20%) from positive SLN patients, and no positive non-SLNs were present in negative SLN patients. Conclusion SLN biopsy in patients with PTC without gross clinical or ultrasonographical lymph node involvement was able to detect occult metastasis and may have the potential to select patients who require central neck dissection using methylene blue dye technique in PTC, and it is a safe and technically feasible procedure.
  1,160 93 1
Cerebellar hematomas: management dilemmas
Ehab Ezzat El Gamal, Ashraf Mohamed Farid
October-December 2013, 41(4):358-363
Objectives The aim of the study was to evaluate and investigate the best guidelines for conservative and surgical management of cerebellar hematomas of different etiologies. Patients and methods A prospective and retrospective study was conducted on 36 consecutive patients (20 male and 16 female) admitted to the Tanta Neurosurgical Department during the period from July 2007 to December 2012. We followed the fourth ventricular grading scale, hematoma size, and the Glasgow coma score in our decision-making on the basis of the clinical and neuroimaging studies. Surgical evacuation was performed on 20 of 36 patients. Cerebrospinal fluid diversion was performed on 10 patients (intraoperative external ventricular drainage, ventriculoperitoneal (VP) shunt, Endoscopic third Ventriculostomy (ETV)) either alone or as adjunctive to the surgical evacuation. Sixteen patients did not undergo surgical evacuation. Glasgow coma score was 12 or greater in 20 patients, 8-11 in 11 patients, and 7 or less in five patients. Results The degree of fourth ` ventricular compression was grade I in six patients, grade II in 19, and grade III in 11. Hydrocephalic changes were evident in 19 patients. Intraventricular hemorrhage was detected in computed tomography scans of 16 patients. Thirty-three patients had a history of hypertension, whereas the other three were suffering from bleeding tendencies due to hepatic diseases. Twenty-six patients had good outcome, whereas 10 died due to either recurrence after evacuation because of uncontrollable blood pressure or associated supratentorial hemorrhages or GCS of less than 7 on admission. Conclusion The surgical management of intracerebellar hematomas is still the main strategy; hence, we should correlate the hematoma size, fourth ventricular grade, medical condition of the patient, and initial clinical presentation in the decision-making.
  1,178 73 -
The effect of a late-evening protein-containing snack on nitrogen balance in cirrhotic patients
Ferial S.E. El-Kalla, Loai O Mansor, Hanan A El-Bassat, Shaimaa Mishaal, Jehan F Attia
April-June 2014, 42(2):47-52
Purpose The aim of the study was to evaluate the effect of a late-evening protein-containing snack on nitrogen balance in cirrhotic patients. Patients and methods Thirty cirrhotic patients were divided into the following groups: group I, comprising 15 patients who received a late-evening 300-cal, 15-g protein-containing snack daily for 15 days; and group II, comprising 15 patients who received a late-evening supplement of amino acids (branched and essential) containing 22-g protein daily for 15 days. All patients were subjected to full history taking, clinical examination, and pelviabdominal ultrasound. Liver function tests, complete blood picture analysis, and estimation of blood urea and serum creatinine, urinary nitrogen loss, urea concentration in both serum and urine, and nitrogen balance were performed for all patients. Results There was a significant increase in the mean level of serum albumin and red blood cell counts. The mean nitrogen balance significantly increased in both groups but more in patients who received branched chain amino acid (BCAA) supplementation. The mean serum ammonia significantly decreased in group II patients who received a late-evening BCAA supplementation, but not in patients of group I who received a late-evening protein-containing snack. There was no statistically significant difference in the levels of serum bilirubin or fasting blood glucose in either group. Conclusion The results of the present study suggest that late-evening snacking with either a small protein-containing meal or a BCAA supplement improves the level of alanine transaminase, aspartate aminotransferase, serum albumin, nitrogen balance, ammonia, urea, and the general condition of the patient. The patients receiving BCAAs respond better than the snack group. A BCAA mixture as a late-evening snack is a favorable nutritional intervention for liver cirrhosis patients to repair hypercatabolism and sarcopenia and improve their nutritional status, such as nitrogen balance and serum albumin. These results need to be further confirmed in a larger number of patients and for a longer period of time.
  1,087 137 -
Knowledge attitude and practices of ultrasound safety in pregnancy among healthcare providers in Riyadh, Saudi Arabia: a survey study
Ahmed T ElOlemy, Mohammed S Almuwannis, Majed S Alamiri, Khudhair M Alkhudair
July-September 2015, 43(3):98-107
Purpose The present study aimed to assess knowledge, attitudes, and practices of safety of ultrasound during pregnancy among healthcare providers in Riyadh, Saudi Arabia. Materials and methods This cross-sectional descriptive survey was conducted in Riyadh city, Saudi Arabia, between January and March, 2014. Six hospitals were selected randomly, one from each health sector in the kingdom. All Obstetrics and Gynecology physicians, Radiologists, General practitioners, family physicians, Sonographers, and nurse practitioners in the selected hospitals were the target of the study. They answered a questionnaire containing 30 items. Results Fifty-two percent of 685 respondents who completed the survey were nurse practitioners, 11.5% were sonographers, and 36.6% were physicians, most of them radiologists (n = 110/251). Sixty percent disapproved of keepsake ultrasound examinations. 75.9 and 84.7% of the respondents were not familiar with the term thermal index (TI) and mechanical index (MI), respectively. Only 7% of respondents knew the answer to the specific question on the TI and MI correctly, and 24.5% knew that TI and MI are displayed on the sonographic monitor during the examinations. In terms of Doppler examination, 38.2% never performed a Doppler examination during the first trimester, in contrast to 19.3%, who always performed it. Conclusion There was poor knowledge of ultrasound safety in pregnancy among healthcare providers: physicians, sonographers, and nurse practitioners. This lack of knowledge is an alarm signal for the health authorities; thus, there is a need for training programs for all healthcare providers. Most participants rarely performed a Doppler examination during the first trimester and did not advise nonradiology doctors to scan.
  1,036 167 1
Circulating obestatin level in diabetic and obese rats
Ghada M Abou Fard, Nermin M Madi, Abeer A Abo Zade
January-March 2014, 42(1):1-5
Background Obestatin has been discovered as a product of the ghrelin gene. Its physiological actions are still a matter of debate. It is likely to be involved in the control of adipocyte function. It has been already shown that obestatin secretion is negatively modulated by food intake. Aim In this study, we investigated plasma obestatin level in diabetic and obese rats and studied the correlation of this hormone with glucose, homeostasis model assessment of insulin resistance, BMI, triglycerides, and total cholesterol in these two metabolic disorders. Materials and methods A total of 30 male albino rats were divided into three groups: the control group, the diabetic group, and the obese group. Plasma obestatin levels were measured and plasma glucose, insulin, triglyceride, total cholesterol, and BMI were also evaluated. Results Diabetic rats showed significant increase in all studied parameters except plasma obestatin, insulin, and BMI, which showed significant decrease as compared with the control group. However, the results of obese rats showed significant increase in all studied parameters except plasma obestatin, which showed significant decrease compared with either control or diabetic rats, but plasma glucose was significantly decreased as compared with diabetic rats only and homeostasis model assessment of insulin resistance was significantly increased as compared with control rats. The results revealed that plasma obestatin was negatively correlated with all studied parameters in both diabetic and obese rats and positively correlated with insulin in diabetic rats, whereas it had insignificant correlation with BMI in diabetic rats and with insulin in the obese group. Conclusion The decrease in obestatin levels was associated with metabolic disorders and this may contribute, in part, to the pathophysiology of diabetes and obesity.
  1,033 169 -
Evaluation of the role of multidetector computed tomography in biliary obstruction
Abdel Monem Nooman Darwish, Asem Ahmed El Fert, Amr Mohamed El Badry, Eman Moussa
October-December 2013, 41(4):318-326
Objective The aim of the study was to evaluate the role of multidetector computed tomography (MDCT) cholangiography in detecting the cause and the level of biliary obstruction and also evaluating the global performance of combined axial, multiplanar reformatting (MPR), and minimum-intensity projection (MinIP) image reconstructions. Patients and methods Between January 2012 and August 2012, this study was performed on 30 patients with clinical and biochemical signs (increased serum levels of bilirubin and/or alkaline phosphatase) suggesting bile duct obstruction who referred to the CT unit in Tanta university hospital from the department of tropical medicine and infectious diseases. These patients were examined by 16-channel CT using a three-phase contrast protocol. The results obtained were compared with the results of histopathological and operative data in patients who underwent surgery. Results Our study showed that MDCT cholangiography was accurate in detecting the presence and the level of biliary obstruction in all 30 cases examined (100%), whereas it could define the cause of obstruction correctly in 93.3% of the cases. The overall performance of MPR and MinIP reconstruction in addition to conventional MDCT images showed a synergic effect to conventional axial CT images, showing an improvement in visualization in 83.3% and additional value in 30 and 16% of the cases, respectively. Conclusion MDCT cholangiography is a noninvasive and fast imaging tool in the assessment of patients with biliary obstruction. MPR and MinIP images provide an improvement of visualization of the biliary system and additional diagnostic value for differentiation of benign from malignant biliary obstruction. It represents a valuable supplement to conventional MDCT imaging of hepatopancreatic disorders.
  1,090 96 -
A comparative study of Duplex Doppler ultrasound and blood indices as noninvasive predictors of oesophageal varices in cirrhotic patients
Mona Shehata, Lobna A AboAli, Khalid El-Shafey, Marwa El-Hossary
July-September 2014, 42(3):83-91
Background Endoscopic surveillance of oesophageal varices (OV) in cirrhotic patients is expensive and uncomfortable for the patients. Therefore, there is a particular need for noninvasive predictors for OV. Objective The aim of the present study was to evaluate the accuracy of ultrasound indices and blood indices as noninvasive OV predictors among cirrhotic patients. Patients and methods A total of 61 cirrhotic patients were enrolled in this study and were divided into two groups: 21 patients without OV and 40 patients with OV who were further subdivided into 24 patients with small OV and 16 with large oesophageal varices (LOV). P2/MS, serum fibrosis markers (APRI, FIB4, Lok score, and Forns index), abdominal ultrasonography [portal vein diameter (PVD), splenic index], platelet count/spleen diameter ratio (PC/SD), and Doppler ultrasonography [portal vein velocity, splenoportal index, hepatic and splenic impedance indices, and hepatic venous waveform (HVWF)] were assessed in all patients. Results P2/MS was the best predictor of OV and LOV [area under the curve (AUC) 0.88 and 0.787, respectively] followed by PC/SD (AUC 0.77 and 0.715, respectively). PVD, serum fibrosis markers, and serum albumin had the least accuracy for OV prediction. For LOV predictions, Lok score had good accuracy (AUC 0.785) followed by serum albumin, PVD, APRI, and Forns index (AUC 0.72, 0.738, 0.734, and 0.738, respectively). Monophasic HVWF showed a good positive predictive value (85%) and specificity (80.95%) for prediction of OV and good sensitivity (81.25%) and negative predictive value (81.25%) for LOV. Conclusion P2/MS can identify OV and LOV in cirrhosis with high accuracy followed by PC/SD. Monophasic HVWF is a good noninvasive predictor of OV and LOV in cirrhotic patients.
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Hemodynamic analysis of portal hypertension in patients with liver cirrhosis
Aly A Elbarbary, Mohamed M Elbedewy, Amr M Elbadry
October-December 2014, 42(4):130-137
Objective The aim of this study was to evaluate the role of duplex Doppler ultrasound in portal vein and upper gastrointestinal endoscopy in the assessment of signs of portal hypertension in patients with liver cirrhosis. Patients and methods This study included 50 patients and 20 apparently healthy individuals as controls. All of them were subjected to a thorough assessment of history, complete clinical examination, and some important laboratory investigations. Also, color duplex Doppler ultrasound was performed for all the participants and upper gastrointestinal endoscopy only for the patients. Results We found that portal vein diameter, congestion index, arterial pulsatility index, and arterial resistive index were significantly higher in the patients than in the controls, whereas portal vein flow velocity and the liver vascular index were significantly lower in the patients than in the controls. Conclusion Duplex Doppler ultrasonography remains the first step in the evaluation of patients with liver cirrhosis and portal hypertension. The best hemodynamic parameter in the assessment of portal hypertension is the congestion index, whereas arterial indices are less prone to variability and are more reproducible compared with venous indices. Upper gastrointestinal endoscopy is the gold standard in the treatment of esophageal varices and also effective in preventing recurrent variceal bleeding.
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Obestatin and l-carnitine as a defensive strategy against fertility disorders induced by obesity in male rats
Magdi A El-Damarawi, Mahmoud E Salama
July-September 2014, 42(3):103-111
Aim This study was designed to investigate the usage of obestatin (OB) and l-carnitine (LC) as a defensive strategy against fertility disorders induced by obesity in male rats. Materials and methods The study was carried out on 50 male Wistar rats, which were divided into five groups as follows: the control group, untreated obese rats, obese rats treated with OB, obese rats treated with LC, and obese rats treated with both OB and LC. Results The induction of obesity resulted in significant increase in body weight, plasma level of triglyceride, total cholesterol, low-density lipoprotein-cholesterol, and thiobarbituric acid reactive substance as compared with the control group. In addition, it produced significant lower activities of superoxide dismutase, catalase, and glutathione peroxidase antioxidant enzymes (GHP-Px) in testicular tissue. There was reduced plasma testosterone, follicle stimulating hormone, luteinizing hormone, and low-density lipoprotein-cholesterol and decreased sperm count and motility. OB significantly lowers body weight, plasma levels triglyceride, total cholesterol, low--density lipoprotein-cholesterol, and testicular thiobarbituric acid reactive substance level. These changes were coupled with significant increase in antioxidant enzymes activities in testicular tissue with significant increase in testosterone plasma level and sperm count and motility. This was accompanied by insignificant increase in plasma follicle stimulating hormone and luteinizing hormone levels. LC produced similar but better changes in all parameters except body weight. Moreover, the concomitant administration of both OB and LC to obese rats resulted in more improvement in all parameters than that were noticed in group III or IV. Conclusion The results of the study verified the possible combined use of OB and LC as a defensive strategy against fertility disorders induced by obesity. OB has the upper hand as anorexigenic agent, whereas LC is superior against obesity as a case of secondary hypogonadism.
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The role of multidetector computed tomography in the diagnosis of traumatic orbital lesions in emergent settings
Mohamed Dawoud, Alsiagy A Salama, Hanaa Abd Elatif, Ahmed Ghoneim
April-June 2015, 43(2):60-65
Introduction The aim of this study was to evaluate the role of multiple detector computed tomography in the diagnosis of traumatic orbital lesions in emergent settings. Patients and methods Thirty patients (34 eyes) with eye injuries were included in this study. All patients were subjected to full history taking, clinical evaluation, and radiological assessment using multidetector computed tomography examination of the orbit. Both axial and coronal images were acquired with 3 mm sections. Cases were classified into four groups according to the anatomic site of lesions - orbital fractures, ocular lesions, adnexal lesions, and retrobulbar lesions. Results Diminution of vision was the most common presenting symptom (56.7%), and a compound orbital fracture was the most common eye injury following trauma (53.3%). Computed tomography (CT) showed positive findings including orbital fractures, ruptured globe, foreign bodies, and retrobulbar edema. Conclusion CT is the optimal imaging modality for revealing traumatic orbital injury. In an emergency setting, CT completes the clinical examination and allows appropriate care to be given for a wide range of traumatic lesions such as bony orbital fracture, lens traumatic complications, and posterior chamber sequels.
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