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EDITORIALS
Kasr Al Ainy, the story of a palace that became a medical school
Nadia A El Dib
January-April 2015, 21(1):1-6
DOI:10.4103/1687-4625.155653  
Kasr Al Ainy, the palace built by Ahmed Ibn Al Ainy, in the years (A.D.1466-1468) by the Nile shore in the area known till now as Mouth of Khalig. This palace played an important part in the history of Cairo and Egypt which extends till now. It was used as a governmental building, a Chateau, a military hospital and a primary school till the year 1837. Mohamed Ali Pasha introduced the European military system in Egypt and wanted to provide it with the medical aid. He assigned Dr. Clot Bey, from France to establish a medical school in Abu Za'abal to prepare doctors for the army in the year 1827. It was after 10 years that the medical school was transferred to Kasr Al Ainy as a medical school and hospital. Kasr Al Ainy witnessed all the changes that occurred in Egypt till now, serving all the Egyptians and non-Egyptians.
  2,530 161 -
ORIGINAL ARTICLES
Diagnostic usefulness of the random urine Na/K ratio in predicting therapeutic response for diuretics in cirrhotic patients with ascites
Mohamed El Basel, Ahmed El Mazny, Ahmed Emam, Amal El Shehaby
May-August 2015, 21(2):60-65
DOI:10.4103/1687-4625.162394  
Background Ascites is a major complication of liver cirrhosis that carries a poor prognosis. Diuretics are used in treatment of ascites in addition to salt restriction. Monitoring of diuretic response can be achieved by measurement of 24-h urinary sodium. Aim of the study The aim of the study was to evaluate the accuracy of using spot urinary sodium/potassium ratio as an alternative to 24-h urinary sodium in assessment of dietary sodium compliance in patients with liver cirrhosis receiving diuretics. Patients and methods Sixty patients presenting with liver cirrhosis and ascites were admitted at Cairo University Hospital. All the patients were subjected to full history taking, clinical examination, laboratory investigations including liver function tests, renal function tests, 24-h urine sample (for measuring of sodium) and spot urine sample (for sodium and potassium). The studied patients were divided into two groups: diuretic resistant group (those with 24-h urinary sodium <78 mEq) and diuretic sensitive group (with 24-h urinary sodium >78 mEq). The patients in diuretic resistant group were 18 patients (30%) and those in diuretic sensitive group were 42 patients (70%). Results Spot urine Na/K ratio was significantly lower in patients in the diuretic resistant group (2.4 ± 2.2) than in the sensitive group (4.7 ± 2.3) (P < 0.05). The cutoff point of Na/K ratio that showed highest accuracy was 3.0. Conclusion This study revealed highly significant correlation between 24-h urinary sodium and spot urine sodium/potassium ratio with sensitivity 75% and specificity 91.67% at cutoff point of 3.
  1,691 140 -
Spasticity is modifiable through phototherapy in patients with relapsing remitting multiple sclerosis: A randomized controlled study
Shimaa A Essa, Yousry M Mostafa, Shereen M Fathi, Haythem M Elhafez, Ayatullah F Ahmed, Neveen M. El Fayoumy
September-December 2016, 22(3):81-90
DOI:10.4103/1687-4625.195887  
Background Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system of unknown reason or definite cure, heavily impacting the patient's mobility and overall quality of life. Purpose Through this study the authors propose safe, alternative phototherapies for the early management of MS. Study design This is a repeated-measures randomized control trial. Materials and methods Twenty-four patients with relapsing remitting MS, of both sexes, aged 25–45 years, completed the study; they were randomly assigned to four groups. Seven patients in the control group (group 1) received monthly intravenous infusion of 1 g solu-medrol therapy for MS; six patients in group 2 received solu-medrol plus low-intensity laser therapy (LILT) at 850 nm; six patients in group 3 received solu-medrol plus broadband ultraviolet B radiation (BB-UVBR) (280–320 nm); five patients in group 4 received solu-medrol and scanner LILT and BB-UVBR. All three groups received a total of 12 sessions over a period of 3 days/week. Expanded disability status scale (EDSS) and H-reflex latency were assessed before treatment, after treatment, and at 3 months’ follow-up. Results There was statistically significant reduction (P = 0.009∗∗) in H-reflex latency but not in H/M ratio (P ≥ 0.05) in the LILT group (group 2), whereas EDSS was significantly reduced (P = 0.011∗) by 1 point in the BB-UVBR group (group 3). These results were maintained 3 months after treatment. Conclusion This study suggests that LILT can efficiently reduce spasticity in the short term in patients with relapsing remitting MS. While BB-UVBR therapy alone is more efficient in ameliorating the disability status (EDSS), and combining LILT with UVBR, surprisingly, might have an undermining effect.
  601 1,001 -
Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt
Mabrouk El-Sheikh, Ghada Al-Ghazaly
May-August 2015, 21(2):47-54
DOI:10.4103/1687-4625.162384  
Background and objectives Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy and many studies have shown strong correlation between HD dose and clinical outcome measured by Kt/V. This study was conducted to evaluate HD adequacy in patients with end-stage renal disease to identify the prevalence and causes of inadequate HD and the impact of HD adequacy on patient outcomes. Patients and methods This cross-sectional study was conducted on 100 patients in the HD unit at Tanta University Hospital. All patients gave their consent and were informed about the study purpose. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. Statistical analysis was carried out for all collected data using SPSS 18. Statistical significance was determined at a P-value less than 0.05. Results The results revealed inadequate HD dose in 60% of the study population. The results also showed that, with increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings clearly showed a strong positive correlation between dialysis dose and Hb level, serum albumin level, normalized protein catabolic rate, and physical health. Conclusion A significant percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of the dialysis session, patients' complaints, and well-functioning vascular access.
  1,361 204 -
Study of diurnal variation in peak expiratory flow rates in healthy men in South India
Jenny Jayapal
September-December 2015, 21(3):73-75
DOI:10.4103/1687-4625.177804  
Background Peak expiratory flow rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR shows hour-to-hour variation that follows a specific pattern in asthmatics and in healthy individuals. Adequate data are not available on the diurnal variation in normal individuals who are students in professional courses and living a sedentary lifestyle. Hence, this study was undertaken to study the diurnal variation in PEFRs in healthy men in South India. Participants and methods PEFR was recorded in 50 adult healthy male students who were nonsmokers, between 18 and 23 years of age and studying in professional courses (MBBS, BDS, Nursing and MSc). Mini Wright's peak flow meter was used to measure the PEFR. PEFRs were recorded at 7-8 a.m., 10-11 a.m., 1-2 p.m., 4-5 p.m. and 7-8 p.m. for 2 consecutive days. Results On analysis of PEFR records of each individual, it was seen that there was an overall dip in the morning at 7-8 h PEFR, which increased during the daytime, peaking in the afternoon at 4-5 p.m. and eventually decreased in the night. Participants did not show the peak PEFR values at the same time point: 16% of participants had a rise in PEFR in the early morning hours; afternoon (1-2 p.m.) peak was observed in 22% of participants; and evening (4-5 p.m.) peak was observed in 36% of participants. Only 2% of participants showed a peak in the night time (7-8 p.m.) PEFR values. Conclusion This study provided the preliminary reference data of diurnal variation of PEFR in healthy adults. As there is a variation in the PEFR recorded during different time points of the day, it is advisable to record the PEFR at the same time point to compare the PEFR between individuals.
  293 1,079 -
Metabolic syndrome and coronary artery disease in young Egyptians presenting with acute coronary syndrome
Noha Hassanin, Soliman Gharib, Mohammed Z El Ramly, Mohammed Abdel Meged, Ahmed Makram
January-April 2015, 21(1):27-33
DOI:10.4103/1687-4625.155666  
Rationale The aim of this study is to determine the relationship between metabolic syndrome and the extent of coronary artery disease (CAD) in young adults presenting with acute coronary syndrome. Background Metabolic syndrome is associated with subsequent development of type II diabetes mellitus and cardiovascular disease. Individuals with metabolic syndrome are at a higher risk of developing myocardial infarction and CAD. Patients and methods This study was carried out at Kasr Al Ainy Hospital at Cairo University and the Sohag Specialized Cardiac and Digestive System Center. One hundred and twenty-two patients presented with acute coronary syndrome during the period of the study from January 2011 to January 2012. Eighty-five were men (69.7%) and 37 were women (30.3%). Patients were classified into two groups according to the presence or absence of metabolic syndrome to determine the effect of metabolic syndrome on severity of coronary lesions in comparison with nonmetabolic patients. Correlation was assessed between the number of metabolic risk components and coronary lesion severity using the SYNTAX score. Results The metabolic risk score was determined; patients with a significant metabolic score of at least 3 risk score constituted 66.4% of the total cohort (n = 81 patients). Patients were subjected to coronary angiography. Totally occluded vessels were found in 33.3% of metabolic syndrome patients and in 26.8% of non metabolic syndrome patients (P < 0.05). The SYNTAX score was used to assess the severity of CAD; it was found to be statistically significantly higher in patients with metabolic syndrome than those without (P = 0.001). Conclusion Patients with metabolic syndrome have more severe CADs. Preventive measures against metabolic syndrome and its components are very important and could help avoid the large economic burden of secondary prevention.
  1,149 197 -
EDITORIALS
White coats as source of infection in hospitals: a paradigm for students and physicians
Salman Assad, Hamza Hassan Khan
January-April 2015, 21(1):7-7
DOI:10.4103/1687-4625.155654  
  898 163 -
ORIGINAL ARTICLES
Coroner autopsies originating from complaints to the police in a Nigerian Urban centre
Akhiwu Wilson Oberaifo, CC Nwafor
January-April 2015, 21(1):11-15
DOI:10.4103/1687-4625.155659  
Introduction Coroner autopsies are post-mortem examinations performed at the instance of the law. The aim of this study is to determine the pattern and causes of death in coroner autopsies performed by a police pathologist. Materials and methods Autopsy registers and reports of the pathology section of police clinic Benin City, Edo State, Nigeria, from 2008 to 2012 were reviewed with respect to their demographic features, cause and manner of death. Results A total of 982 coroner autopsies were performed during the period, involving 773 males and 209 females, yielding a sex ratio of 3.7 : 1. The age group 20-29 years was the most commonly involved, accounting for 28.5% of cases. Accidental deaths were the commonest type of deaths (41.3%), followed by deaths because of homicides (40.8%); natural death was a distant third cause, accounting for 14.6%, whereas suicides and undetermined deaths accounted for 1.2 and 2.1%, respectively. Road traffic accidents were responsible for most accidental deaths (85.7%). Homicidal deaths were mainly by gunshots (66.5% of cases). Cardiovascular system diseases were the leading cause of natural death, with myocardial infarction and complications of hypertension each accounting for 44.4%. Conclusion Efforts to reduce road traffic accidents and control the number of guns in the hands of civilians should be intensified. The incidence of myocardial infarction is on the rise and health education is advocated to help reduce its adverse effects.
  939 82 -
Double rectangular suture sulcus reconstruction in the management of aphakia with absent capsular support
Ihab Saad Othman, Sherif A Eissa
January-April 2015, 21(1):16-21
DOI:10.4103/1687-4625.155662  
Aim This study aimed to describe a new method of sulcus fixation of intraocular lenses (IOLs) with total or partial loss of capsular support. Materials and methods This was a prospective nonrandomized comparative clinical trial, where two groups were managed for IOL scleral fixation in the absence of capsular support. Group A included 12 cases with classic ab externo two-point sclera fixation and group B included 16 cases with the double rectangular suture sulcus reconstruction (DRSSR). The etiology of aphakia in group A included congenital cataract managed by lensectomy (three cases), trauma (six cases), and complicated phacoemulsification (three cases). In group B, aphakia was because of congenital cataract in two cases, trauma in five cases, hypermature cataract in three cases, and complicated phacoemulsification in two cases. A unique subset of group B included four eyes with posterior chamber IOL subluxation or dislocation managed by DRSSR. The main outcome measures included final best-corrected visual acuity (BCVA), lens stability, and complications. Results All 28 eyes had stable or improved BCVA and the mean postoperative BCVA had improved significantly from 6/30 to 6/7.5 (P = 0.004). There were no statistical differences between groups A and B in postoperative BCVA (P = 0.403), complications (P = 0.25), and astigmatism (P = 0.113). Group 2 B cases with subluxated and posterior dislocated IOLs were managed by DRSSR, with no need for exteriorizing the IOL, with excellent centration. Conclusion The DRSSR seems to be a safe method of providing an adequate bed for IOL stabilization in the absence of capsular support. This method is particularly useful in dislocated or subluxated IOLs that need repositioning under a closed globe with minimal manipulations.
  862 79 -
Comparison of the cardiovascular risk profile of young Egyptian and Saudi medical students
Alaa-El-Dine H Mahmoud, Mohammed F Faramawi
January-April 2015, 21(1):34-38
DOI:10.4103/1687-4625.155669  
Background Mortality and morbidity from chronic heart disease are increasing markedly worldwide. This significant increase was also observed in young adults. Studies carried out in Saudi Arabia have shown that the prevalence of cardiovascular risk factors is high in the young Saudi population. Objective Our objective was to compare the prevalence of cardiovascular risk factors in young Middle Eastern medical students aged 18-25 years (Egyptian and Saudi students). Results The prevalence of cardiovascular risk factors was high among both Saudi and Egyptian medical students, particularly sedentary life style, obesity, and abdominal obesity. The prevalence of smoking was 29.7% in the two population. Besides a significantly higher prevalence of obesity, abdominal obesity, and reported family history of premature coronary heart disease among the Saudi sample and a significantly higher prevalence of hypertension among Egyptian men compared with Saudi men, the prevalence of risk factors among the two samples did not differ significantly. A relatively high proportion of both samples (23.9% of the Saudi sample and 16.7% of the Egyptian sample) was at an increased risk of developing fatal cardiovascular disease within 10 years. Conclusion Besides the higher prevalence of obesity and reported family history of premature coronary heart disease, there was no statistically significant difference between the risk profiles of both samples.
  869 70 -
Lactational breast changes/lobular hyperplasia mimicking masses: how can we differentiate from true pathological masses?
Amr Farouk Ibrahim Moustafa, Ola Magdy Mohammed Shetat, Mohammed Samy Said El-Azab, Mohammed Mohammed Mohammed Gomaa, Mona Alabrak, Hania M Fadl
May-August 2016, 22(2):41-48
DOI:10.4103/1687-4625.188606  
Objective The aim of this study was to evaluate the role of sonomammography in the characterization of clinically palpable breast masses during pregnancy and lactation with differentiation of true and false (lobular hyperplasia/lactational changes) masses. Materials and methods One hundred patients with clinically palpable breast masses during pregnancy and lactation were evaluated by means of ultrasound (US). Mammography was performed only for 23 patients. Mammographic and sonographic findings were evaluated retrospectively. When US or mammography revealed a benign lesion, no further diagnostic evaluation was necessary. However, when US or mammography demonstrated a suspicious lesion, biopsy was performed. Results US showed lobular hyperplasia/lactational breast changes categorized as Breast Imaging-Reporting and Data System 2 (BI-RADS 2) in 13 cases, a lesion with the criteria of benignity categorized as BI-RADS 2 in four cases, BI-RADS 3 in 68 cases, BI-RADS 4 in three cases, and BI-RADS 5 in 12 cases. Mammography showed normal dense breast categorized as BI-RADS 1 in four cases, lesions with criteria of benignity categorized as BI-RADS 3 in six cases, BI-RADS 4 in two cases, and BI-RADS 5 in 11 cases. Trucut biopsy established the pathological diagnosis in 22 cases. Conclusion Most of the pregnancy-associated breast masses are benign. Nevertheless, a strict assessment of any lesion is required, to exclude malignancy and to rule out lactational breast changes/lobular hyperplasia that may present as lump. US is the most appropriate radiologic method for evaluating breast disorders in women during pregnancy and lactation.
  794 80 -
Serum lipoxin A4 as a biomarker for systemic lupus erythematosus
Manal M SedkyAbdou, Dina Abbas Effat, Lamiaa Ali Mansour, Noha Mahmoud Abd El Baky, Mona Mohsen Abdel Salam
May-August 2015, 21(2):55-59
DOI:10.4103/1687-4625.162390  
Introduction Systemic lupus erythematosus (SLE) is an immune-complex mediated autoimmune disease characterized by protean clinical manifestations and fluctuating disease course. It was proposed that progression and flares of lupus and lupus nephritis are due to decreased production of lipoxin A4 (LXA4) and enhanced production of leukotrienes by the renal tissue and/or infiltrating leukocytes and macrophages. Objective The aim of this study was to assess the levels of serum LXA4 in SLE patients and in healthy controls, and to correlate them with various clinical and laboratory data as well as renal biopsy and disease activity indices. Patients and methods Forty adult female SLE patients were included in this study. The SLE patients were divided into two groups: group I included 20 patients without nephritis and group II included 20 patients with nephritis. Forty apparently healthy age-matched women served as the control group. Patients and controls were assessed for serum LXA4 using enzyme linked immunosorbent assay. Disease activity was assessed using systemic lupus erythematosus desease activity index (SLEDAI) and renal SLEDAI. Renal biopsy was performed for patients with lupus nephritis. Results SLE patients showed a higher median level of serum LXA4 compared with the control group (0.24 vs. 0.15 ng/ml), but with no significant statistical difference (P = 0.097). Moreover, there was no statistically significant difference in serum LXA4 between SLE patients with and without nephritis and the control group (P = 0.142). There was no significant correlation between serum LXA4 and various clinical and laboratory data, as well as renal biopsy and disease activity index. Conclusion LXA4 was suggested to be an important biomarker to search for in SLE. Our study showed no significant statistical difference between SLE patients and the control group as regards serum LXA4. Assessment of urinary LXA4 is recommended as it may be more valuable than serum LXA4 in reflecting organ affection in SLE, as well as disease activity, and comparing it with serum LXA4 level.
  763 89 -
Effect of exposure to second-hand smoke on serum levels of N-terminal pro-brain natriuretic peptide
Safaa A. A. Khaled, Azza M El-amir
January-April 2015, 21(1):22-26
DOI:10.4103/1687-4625.155665  
Background and objectives Exposure to second-hand smoke is as hazardous as exposure to first-hand smoke, and can cause cardiovascular disease. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a valid negative biomarker of left ventricular (Lv) dysfunction. The current study investigated the effect of exposure to second-hand smoke on serum levels of NT-proBNP, aiming to use NT-proBNP as a screening tool of Lv dysfunction in passive smokers. Participants and methods A total of 60 passive smokers and 20 matched controls were enrolled in the study; their ages range from 20 to 35 years. History of cardiovascular or pulmonary disease was an exclusion criterion. Demographic, anthropometric, and passive smoking data were collected through a self-administered questionnaire and physical examination. The extent of passive smoking was assessed by calculating the pack per year history. Serum levels of NT-proBNP were measured using an electrochemiluminescence assay for each participant. Results Analysis of data showed that passive smokers were currently exposed to second-hand smoke, 91.7% were living with the smoker, and 8.3% smoker's colleagues. Serum levels of NT-proBNP were 251.2 ± 46.9 and 148.3 ± 29.7 pg/ml in passive smokers and controls, respectively. Also, there was a significant difference (P < 0.0001, 105.4 ± 11.64) in serum NT-proBNP between passive smokers and controls. Serum NT-proBNP was correlated with both the duration and the amount of exposure to second-hand smoke (r = 0.313 and 0.763, P = 0.015 and 0.0001, respectively). Interpretations and conclusion These results showed that exposure to second-hand smoke could increase serum levels of NT-proBNP. Accordingly, an elevated NT-proBNP could be a strong predictor of Lv dysfunction in passive smokers.
  737 73 -
Disease characteristics of systemic sclerosis among Egyptian patients
Mohamed El Basel, Noha Khalil
May-August 2015, 21(2):41-46
DOI:10.4103/1687-4625.162378  
Introduction Scleroderma, or systemic sclerosis (SSc), is a chronic connective tissue disease that has been classified as one of the autoimmune rheumatic diseases. The usual hallmarks of SSc are autoimmunity, inflammation, widespread small-vessel vasculopathy affecting multiple vascular beds, and progressive interstitial and vascular fibrosis in the skin and internal organs. Aim of the work The aim of the study was to determine the disease characteristics and frequency of different clinical manifestations among Egyptian patients. Patients and methods Seventy-five patients with SSc, all fulfilling the criteria of the American College of Rheumatology for classification of scleroderma, were selected for this study. They were being followed up in Cairo University Internal Medicine department. The patients' data were collected by a review of their medical records. We compared the frequency of symptoms in scleroderma patients with both diffuse cutaneous and limited cutaneous sclerosis (dcSSc and lcSSc). Results Fourteen patients out of 75 (18.7%) had dcSSc and 61/75 (81.3%) had lcSSc. We found that within the limited subtype 11/61 (18%) were male and 50/61 (82%) were female, with a male to female ratio of 1: 4.6. Within the diffuse subtype, 3/14 (21.4%) were male and 11/14 (78.6%) were female, with a male to female ratio of 1: 3.7. Raynaud's phenomenon was the first presenting manifestation (in 77.3%), followed by arthritis (in 12%) and skin tightness (in 9.3%). Conclusion SSc is more common in the female population than in the male population. lcSSc is more common than dcSSc.
  723 72 -
The use of noninvasive continuous cardiac output to monitor the hemodynamic effects of propofol-fentanyl versus propofol-ketamine induction
Alaa A.A. Niazi
May-August 2015, 21(2):66-71
DOI:10.4103/1687-4625.162399  
Background Noninvasive continuous cardiac output monitoring method utilizing ECG and a pulse oximeter wave was based on hemodynamic analysis combined with pulse wave transit time. Propofol injection may induce a significant decrease in blood pressure. The use of ketamine with propofol may reduce the dose and the hemodynamic effect of propofol. Patients and methods Sixty female patients, ASA I and II, undergoing dilatation and curettage were divided into two equal groups. The first group received propofol (1 mg/kg) + fentanyl (1 μg/kg), whereas the second group received propofol (1 mg/kg) + ketamine (0.5 mg/kg) as induction agents. Continuous cardiac output monitoring was performed using pulse wave transit time technology. Hemodynamic data such as oxygen saturation through pulse oximetry, heart rate, and blood pressure were recorded every minute. Results Statistically significant differences between both groups were observed in diastolic, systolic, mean blood pressure, heart rate, and cardiac output. The propofol/fentanyl group showed a significant decrease in diastolic, systolic, and mean blood pressure, heart rate, and cardiac output compared with the propofol/ketamine group. Conclusion Noninvasive cardiac output measurement utilizing ECG, noninvasive blood pressure, and a pulse oximeter is a reliable method. Hemodynamic parameters including blood pressure, heart rate, cardiac output, and cardiac output index decreased with the induction of propofol and fentanyl combination, but were stable with the use of a propofol and ketamine combination.
  687 84 -
Dynamic ventilatory functions in assessment of pulmonary system in gutkha users
Amrith Pakkala, Chitradurga Palaiah Ganashree, Thippeswamy Raghavendra
January-April 2015, 21(1):8-10
DOI:10.4103/1687-4625.155657  
Background There are diverse opinions about the degree of adaptability of the respiratory system in delivering the physiological needs in case of tobacco users. Role of the normal respiratory system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. One view holds that the respiratory system is not normally the most limiting factor in the delivery of oxygen; others hold the absence of structural adaptability to physical training as the cause of limitation of the pulmonary system. The role of ventilatory functions in evaluating the respiratory functions in gutkha users has not been studied adequately in previous studies. Hence, there was a need for this study. Materials and methods Pulmonary function tests were performed before and after maximal exercise testing to assess dynamic lung functions in two groups: gutkha chewers and nongutkha chewers. Results On studying the differences in dynamic lung functions in two groups of nongutkha chewers and gutkha chewers, there was no difference in forced vital capacity and forced expiratory volume in 1 s, before or after exercise testing. The other flow rates maximum mid-expiratory flow, peak expiratory flow rate, and mid-expiratory flow 25-75% were on the higher side in nonchewer individuals, which were consistently maintained after exercise testing. A higher adaptability of the respiratory system to the training stimulus in the form of a higher elastic recoil pressure of the lungs and a lower resistance of medium to small airways is suggested as the mechanism of adaptability in this study.
  639 81 -
Efficacy of antenatal exercises on maternal and neonatal outcomes in elderly primigravida
Ali A Gehan, SA Khadiga, GA Amir, A Eman
September-December 2015, 21(3):109-114
DOI:10.4103/1687-4625.177813  
Background and purpose Elderly primigravida and their offspring have traditionally been considered to be at increased risk of adverse maternal and neonatal outcomes because of associated pregnancy and labor complications. This study was designed to examine the efficacy of antenatal exercises on maternal and neonatal outcomes in elderly primigravida. Participants and methods Sixty elderly primigravida women (age range: 35-40 years) at 14 weeks' gestation were divided randomly into two equal groups (A and B). Group A performed antenatal exercises for 6 months, whereas group B continued their lifestyle after receiving specific advice for each trimester. The exercise program parameters were based on the American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy. Assessment of labor pain was performed using the Present Pain Intensity scale. Results Participants in group A showed a statistically significant difference in the intensity of labor pain when cervical dilatation was between 7 and 8 cm (P = 0.000), duration of first stage of labor (P = 0.026), and neonates' APGAR scores at the first and the fifth minute of life (P = 0.000) compared with participants in group B. There was no statistically significant difference between groups in the intensity of labor pain when cervical dilatation was between 3 and 5 cm (P = 0.775) and mode of delivery (P = 0.630). Conclusion Antenatal exercises are very effective in decreasing adverse effects and labor complications in elderly primigravida and their neonates.
  561 89 -
Thrombotic microangiopathy in lupus nephritis patients
Hanan A Kotb, Abir N Mokbel, Ahmed A Elmaghraby, Sawsan AE Fadda
January-April 2016, 22(1):12-17
DOI:10.4103/1687-4625.182553  
Objective The aim of the present study was to evaluate the impact of thrombotic microangiopathy (TMA) on renal involvement in patients with lupus nephritis (LN). Patients and methods This study included 50 systemic lupus erythematosus patients with LN who had been referred for renal biopsy. Patients underwent clinical and laboratory assessment for disease activity and damage. The biopsy specimens were classified according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification, activity and chronicity indices, and assessed for renal TMA lesions. Results TMA was found in 7/50 LN patients (14%). Patients with TMA lesions had significantly higher systolic and diastolic blood pressure (P = 0.018 and 0.019, respectively), higher serum creatinine (P = 0.031), lower estimated glomerular filtration rate (P = 0.023) and higher consumption of C3 (P = 0.002) than that of those without TMA lesions. Lupus anticoagulant positivity was significantly more frequent in patients with TMA (P = 0.001). There was a significant association between the detection of TMA and LN class IV. LN patients with TMA had significantly higher renal activity indices (P = 0.022). Chronicity index was higher in patients with TMA, but it did not reach a statistical significance. Conclusion TMA is not an uncommon vascular change in patients with LN, especially in those with diffuse proliferative glomerulonephritis (class IV LN). It is associated with lupus anticoagulant positivity, C3 hypocomplentemia and higher renal biopsy activity index. TMA was significantly associated with renal impairment and systemic hypertension. Thus, TMA may be an important cause of renal injury and renal dysfunction in a subset of patients with LN, a histological entity associated with worse renal prognosis.
  475 102 1
SHORT COMMUNICATION
Exploring the role of population surveys in the health sector
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
January-April 2015, 21(1):39-40
DOI:10.4103/1687-4625.155671  
Globally, health-related information is one of the main pillars of any national health system, which enables policy makers in making evidence-based decisions, planning and resource allocation, program monitoring and evaluation, strengthening of the healthcare delivery system, and development of the community as a whole. In the modern era, different sources of health information have been utilized on the basis of the objective to be fulfilled. However, most of those routine sources do not provide the required comprehensive insights about health and disease in the community, which mark the need for population-based surveys to supplement the routinely collected data and statistics. In conclusion, population-based health survey is an indispensable managerial tool to obtain comprehensive health information, and thus play a crucial role in the strengthening of the healthcare delivery system.
  521 54 -
ORIGINAL ARTICLES
A study of biofilm on endotracheal tubes in pediatric intensive care unit
Bassant Meligy, Sahar Khairat, Amal Sayed, Magda Azmy, Dalia K Ismail, Shaimaa Yahia
September-December 2015, 21(3):87-93
DOI:10.4103/1687-4625.177808  
Aim This study was performed to evaluate the existence of biofilm in the endotracheal tube (ETT) of mechanically ventilated children, and to study a microbial link between biofilm flora and bacteria causing ventilator-associated pneumonia (VAP). Patients and methods This was a prospective study conducted on 20 children with ETT who were evaluated for biofilm existence using scanning electron microscopy. Results A total of 20 children were enrolled in the study. Of them, 17 (85%) children showed biofilm formation on the luminal surface of ETT. A significant relationship was observed between duration of intubation and biofilm stage. Of the 17 positive cases with biofilm formation, colonization of the inner ETT surface occurred in 14 (70%) cases and 17 isolates were recovered. Five isolates were Gram positive, whereas the majority of isolates were Gram-negative bacilli. Seventeen patients developed pneumonia. All patients who developed biofilm also developed VAP. The occurrence of multidrug resistance among detected microorganisms was high. Conclusion We concluded that the density of ETT biofilm increased with increased duration of intubation. We also concluded that ETT colonization with biofilm-producing organisms increased the risk of developing VAP with highly resistant microbes.
  419 112 -
Wuchereria bancrofti microfilariae and quantitative circulating antigen detection in selected endemic areas in Egypt
Iman R Abdel-Shafi, Eman Y Shoeib, Samar S Attia, Jose M Rubio, Ayman A El-Badry
January-April 2016, 22(1):34-40
DOI:10.4103/1687-4625.182556  
Back ground and objective Wuchereria bancrofti is responsible for 90% of cases of lymphatic filariasis throughout the tropics and in some subtropical areas worldwide, including Egypt. To combat this disease, the WHO has launched a program aiming to eliminate lymphatic filariasis by the year 2020 in all the endemic countries using mass drug administration (MDA) to interrupt the disease's transmission. The aim of the present work was to study W. bancrofti infection in selected endemic areas in Egypt by performing parasitological examination and enzyme-linked immunosorbent assay (ELISA) antigen detection test, and to analyze the demographic, clinical, and MDA data of the study population in relation to W. bancrofti infection. Patients and methods A total of 300 blood samples were collected from residents in endemic areas in five governorates. Parasitological examination and Og4C3 ELISA test were performed to identify W. bancrofti infection. Results Microfilariae were identified in one individual while circulating filarial antigens (CFAs) were detected in 10 individuals. Statistical analysis of the collected data showed that CFAs were significantly higher in the male population than in the female population, whereas analysis regarding other demographic, clinical, and MDA data showed no statistical significance. Conclusion The study results showed that CFAs are still detected in endemic communities in Egypt, and that the prevalence is higher in the male population than in the female population. Although the Og4C3 ELISA test is a useful research tool for the study of W. bancrofti infections, its cost and format hinder its wide use in endemic areas.
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The effect of cerebrolysin treatment on skeletal muscle healing in adult albino rat: a histological and immunohistochemical study
Gamal H Mohamed, Mohamed H Shaaban
September-December 2016, 22(3):91-98
DOI:10.4103/1687-4625.195888  
Objective The aim of this study was to evaluate the role of Cerebrolysin in muscle healing in vivo. Materials and methods Twenty adult albino rats were used in this study. Both right and left gastrocnemius muscles of the albino rats were cut at 60% of their length from their distal insertion through 75% of their width and 50% of their thickness and then sutured with simple sutures using absorbable catgut sutures. The gastrocnemius muscles of all albino rats were injected directly in the lesion with 100 ng/ml/kg of cerebrolysin at 1, 3, and 5 days after laceration. The sham control muscles were subjected to the same treatment but were injected with the same volume of physiological normal saline. One week after the injury the animals were killed and the gastrocnemius muscles were removed and processed for paraffin sectioning and stained with hematoxylin and eosin, Bcl-2 (B-cell lymphoma 2), and P53 (tumor suppressor gene) immune peroxidase stains. Results There was a significant increase in the mean myonuclei/myofiber diameter ratio and the size of the regenerating myofibers as an index of muscle regeneration in the cerebrolysin-injected group compared with the control. It is anticipated that cerebrolysin is a potent stimulator of muscle regeneration in vivo. It has also been found that regenerating myofibers were located both in the deep and the superficial areas of the injured site of muscles only when treated with cerebrolysin, thereby demonstrating greater initial healing when the injured muscle is treated with cerebrolysin. Cerebrolysin retarded apoptosis in neutrophils, macrophages, and other inflammatory cells by activating the anti-apoptotic Bcl-2 (B-cell lymphoma 2) protein leading to accumulation of these inflammatory cells. Conclusion This study has shown that injections of cerebrolysin into an injured muscle improved muscle healing in vivo. Also, documents the occurrence of a protective Bcl-2 in inflammatory neutrophils and macrophages, which were expressed in cerebrolysin-treated muscles, leading to enhancement of the effect of these inflammatory cells. We have also found that Inflammatory cells play a role in satellite cell activation and proliferation but, the tumor suppressor gene p53, which is recognized as a central regulator of cell cycle and apoptosis, had no role in muscle regeneration in this in-vivo study.
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Protective effects of nebivolol on acetic acid-induced ulcerative colitis in rats
Dina A Aly Labib, Olfat G Shaker, Lobna O Elfarouk
September-December 2016, 22(3):99-108
DOI:10.4103/1687-4625.195889  
Background Ulcerative colitis (UC) is a chronic inflammatory disease of large intestine. Overproduction of free radicals, lowered antioxidant capacity and abnormal apoptosis are involved in pathogenesis. Nebivolol, a β blocker with vasodilatory, antioxidant, anti-inflammatory effects, can play future role in therapies for UC. Aim of the study The purpose of this study was to evaluate the protective effect of nebivolol against acetic acid (AA)-induced UC in rats. Methods Male wistar rats were pre-treated orally with nebivolol 5 mg/kg/d, 10 mg/kg/day, for seven days, before and 3 days after induction of colitis (by intra-rectal administration of 2 ml of 4% AA). Colonic macroscopic scoring and histopathological examination were done. Colonic content of thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH), superoxide dismutase (SOD) and myeloperoxidase (MPO) activities were assessed. Apoptosis was monitored by determining caspase-3 gene expression. Serum levels of interleukin (IL)1-β, SOD, TBARS and tumour necrosis factor (TNF)-α were measured. Results In AA- group, serum levels of TBARS, TNF-α and IL-1β were significantly increased. SOD activity was significantly reduced. Caspase 3 protein expression was upregulated. Colonic content of TBARS and the activity of MPO were elevated. GSH concentration and activity of SOD were significantly reduced, compared to control group. In nebivolol pretreated groups (5 and 10 mg/kg/d) and sulfasalazine group, all parameters were near normal. Nebivolol significantly decreased colonic macroscopic scoring and wet colon weight compared to AA group. The coloprotective effect of nebivolol was confirmed by histopathological examination. Conclusion Nebivolol has a protective effect against AA- induced colitis, through its anti-inflammatory, anti-oxidant and anti-apoptotic effects.
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Vitamin D protects diabetic rats from neuropathic changes by improving insulin sensitivity and upregulating vitamin D receptors
Laila A El-Sayed, Ola M Tork, Hanan Seddiek, Radwa M Taha, Noha I Gomaa
September-December 2015, 21(3):115-124
DOI:10.4103/1687-4625.177819  
Background There is emerging evidence of neuroprotective roles for vitamin D. However, its role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its exact mechanism of action in neuroprotection are still unclear. The present work was designed to examine the effect of vitamin D supplementation on insulin sensitivity and nerve conduction velocity with and without insulin treatment in a diabetic model. Materials and methods This study was carried out on 50 male adult rats. They were divided into five groups: a control group, a diabetic group, in which T2DM was induced; a diabetic insulin-treated group, in which diabetic rats were treated with insulin alone; a diabetic vitamin D-treated group, in which diabetic rats were treated with vitamin D alone; and finally, a diabetic with combined insulin and vitamin D treatment group. At the end of the experimental period, blood samples were obtained from all animals for measurement of serum glucose and insulin, together with the oxidative stress marker malondialdehyde (MDA) and inflammatory markers interleukins 1β and 10 (IL1β and IL10). Nerve conduction velocity was performed on a dissected sciatic nerve. In addition, vitamin D receptor (VDR) gene expressions in pancreatic (VDR-P) and sciatic nerve (VDR-N) tissues were estimated and the homeostasis model assessment for insulin resistance index was calculated for each group. Results Data showed a significant reduction in nerve conduction velocity of the sciatic nerve, together with increased insulin resistance in diabetic rats that paralleled increased MDA and IL1β and decreased IL10. Administration of insulin alone, vitamin D alone, or both combined after induction of diabetes improved the nerve conduction velocity. This improvement was accompanied by significant enhancement of VDR-P and VDR-N gene expression, together with reduction in oxidative stress and inflammatory state. Conclusion The improvement of insulin sensitivity and neuroprotection with vitamin D supplementation in T2DM is related to restoration of VDR-P and VDR-N expression. Thus, vitamin D could be a novel approach to lower neuropathic risk in diabetes.
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Protective effects of remote ischemic preconditioning against cisplatin-induced hepatotoxicity in rats
Ola M Tork, Amal F Dawood, Nermeen B Sadek, Laila A Rashed
September-December 2015, 21(3):94-100
DOI:10.4103/1687-4625.177811  
Background As cisplatin (CP) remains one of the most effective antineoplastics used in chemotherapy, strategies to protect tissues against CP toxicity are of clinical interest. A major dose-limiting side effect in CP-based chemotherapy is hepatotoxicity. Remote ischemic preconditioning (rIP) represents a noninvasive model for organ protection. The present study was designed to examine, in vivo, the CP-induced hepatic injury and to find the protective probability of rIP in this model in relation to an inflammatory mechanism and the hepatic energetic activity. Materials and methods Twenty-four adult male albino rats were divided equally into three groups that were treated as follows: (i) control group, (ii) CP group (single intraperitoneal injection of CP 7 mg/kg body weight), and (iii) preconditioned group. rIP was induced with three 10-min ischemia/10-min reperfusion cycles of the right hind limbs just before CP injection. The animals were killed 14 days after the treatment. Among all groups, the gene expression of nuclear factor 0κB (NF-κB), coenzyme Q10 (Mito.Q10), an autophagy marker LC3 and fatty acid-binding protein L-FABP was assessed by real-time reverse transcription-PCR in the rat liver tissue, in addition, the serum levels of liver enzymes alanine aminotransferase and aspartate transaminase were measured. Results CP induced an increase in hepatic NF-κB and mitochondrial dysfunction as reflected by the decrease in Mito.Q10 and a significant reduction in the mitochondrial clearance mechanism: mitochondrial autophagy, which is known as mitophagy. Further, CP significantly decreased the expression of the main protein involved in fatty acid transport, L-FABP, which is also considered an effective endogenous antioxidant. However, these alterations were ameliorated in preconditioned rats. Conclusion We can assume that the alleviative outcome of rIP in CP-induced hepatotoxicity could be because of induction of anti-inflammatory and antioxidant responses associated with the upregulation of mitochondrial function.
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