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   Table of Contents - Current issue
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January-March 2020
Volume 5 | Issue 1
Page Nos. 1-120

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REVIEW ARTICLES  

The role of transcranial magnetic stimulation in acute Bell's palsy p. 1
Noha Abo El Fetoh, Nihal A Fathi, Rania M Gamal Eldein, Marian S Shehetta
DOI:10.4103/JCMRP.JCMRP_156_18  
This review discusses the reported data in studies using transcranial magnetic stimulation (TMS) in acute Bell's palsy (BP). These studies displayed the role of TMS in confirming the diagnosis and providing prognostic information about outcome of acute unilateral BP. In summary, two TMS roles have been discussed in these reviewed studies when employing TMS in patients with BP: firstt, the role of TMS as a diagnostic tool for BP when a lesion is of peripheral and lower motor in nature either applied over the ipsilateral parieto-occipital region (canalicular stimulation) or over the contralateral facial area of the motor cortex (cortical stimulation), and the second role of TMS is providing data about its prognostic value in recovery and BP outcome. The overall TMS studies are valuable in prognosis of BP regarding recovery and sequelae.
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Irritable larynx syndrome (Internal and external correlates) p. 7
Emad K Abdel Haleem, Eman S Hassan, Dalia G Yassen, Amira H. Abd El-Aal Aref
DOI:10.4103/JCMRP.JCMRP_73_18  
Irritable larynx is a condition of laryngeal dysfunction at which there is abnormal spasmodic closure of both vocal folds during inspiration. Patient complains of many symptoms as stridor, dysphonia, chocking, globus sensation, and dyspnea. These symptoms are not specific for irritable larynx only, but; they are frequently confused with other disorders such as gastroesophageal reflux, asthma, and different causes of chronic cough. The golden method for diagnosis is to visualize both vocal folds abducted during inspiration in acute attack by indirect laryngoscopy. To review recent available literature concerning irritable larynx syndrome to get essential recent data as a primary step for understanding this disorder.
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ORIGINAL ARTICLES Top

Evaluation of bone mineral density and vitamin D in patients with systemic lupus erythematosus and their relation to disease activity p. 14
Essam A M. Abda, Mohamed Esmail, Mohamed Z Abd Elrhman, Nadia M Ismail, Zeinab S Noaman, Samar H Goma
DOI:10.4103/JCMRP.JCMRP_157_19  
Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple systems and is associated with an inflammatory status. The aim of our study is to estimate the serum level of vitamin D and bone mineral density (BMD) in SLE patients and their relation to disease activity. Patients and methods: Ninety SLE patients, fulfilling the updated American College of Rheumatology criteria 2012 and 60 age-matched and sex-matched controls were included in this study. The level of serum 25-hydroxyvitamin D (25(OH)D3) and dual-energy radiograph absorptiometry were done for patients and controls. Results: There was significant difference between systemic lupus erythematosus disease activity index (SLEDAI) score and vitamin D (P <0.02). There were significant difference (P <0.01) between SLE and control with BMD of total lumbar (L1–L4) and total hip and highly significant difference (P <0.001) with neck of the femur, Ward's angle of the femur, trochanter of the femur, and the radius. There was significant difference (P<0.05) between SLE and control groups regarding T score of lumbar spine (L1–L4) (P <0.03), neck of the femur (P<0.01), and total hip bone (P <0.02). Our results showed that there was significant difference between SLEDAI score and T score of neck of the femur (P <0.02) and radius bone (P <0.012), while there was no significant difference between SLEDAI score and T score of total hip, lumbar spine (L1–L4), Ward's angle of the femur, and the trochanter of the femur. Conclusion: Vitamin D deficiency and low BMD are common in SLE patients. There was significant difference between SLE patients and control group regarding vitamin D, BMD, and T score at different sites.
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Audit on neonatal exchange transfusion in the Neonatology Unit of Assiut University applying American Academy of Pediatrics 2004 guidelines p. 23
Ahmed M Elnaggar, Amira M Ahmed, Ghada O Elsedfy
DOI:10.4103/JCMRP.JCMRP_138_19  
Introduction: Exchange transfusion (ET) still has an important role in the Neonatal ICU of Assiut University Children Hospital as an emergency procedure for management of severe cases of hyperbilirubinemia. Therefore, this audit study was done on 26 patients for 1 year to detect the adherence to the American Academy of Pediatrics (AAP) 2004 guidelines, which are already implanted in the unit. The procedure involves incremental removal of the infant's blood having high bilirubin levels and/or antibody-coated red blood cells and simultaneous replacement with fresh donor blood providing fresh albumin with binding sites for bilirubin. Patients and methods: This study included 26 infants admitted at the Neonatal ICU of Assiut University Children Hospital for whom ET was done over 12 months from firstt day of September 2017 to the end of August 2018. The data were collected by recording the investigations done before and after ET and observation by the Neonatal ICU of Assiut University Children Hospital staff during ET in comparison with the checklist, which is already implanted in the unit and is based on the AAP 2004 guidelines. Results: Of the 26 studied infants, 73% had ABO incompatibility, where 19.3% had RH incompatibility and 7.7% have other diagnosed breast milk jaundice by exclusion of other causes, subgroup incompatibility, and polycythemia. Coombs test was done in 31% and not done in 69% of the studied cases. All the studied cases were given medication during ET in the form of calcium gluconate intravenously. Conclusion: AAP 2004 guidelines have been partially followed in ET in the studied cases, but there were some shortcomings that can affect the outcome. The study recommends avoiding these shortcomings.
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Endoscopic surgical excision of third ventricular colloid cyst in upper Egypt: results of 2 years of practice p. 27
Mohamed A Ragaee, Khaled Ismail
DOI:10.4103/JCMRP.JCMRP_156_19  
Background: Colloid cyst is a benign rare lesion that originates in the third ventricle. Headache, vomiting, visual deterioration, and memory deficits are the most common presenting symptoms. Endoscopic excision of colloid cyst is one of the recent advances in the field of minimally invasive neurosurgery. Aim: The aim was to assess the efficacy and safety of the endoscope for excision of the colloid cyst. Patients and methods: In this study, we review our experience in 14 patients who presented to us in two University Hospitals in south of Egypt in 2 years (2016 and 2017). The authors used LOTTA ventriculoscope with HOPKINS wide-angle straightforward telescope 6°. Results: Of fourteen patients, 13 (92.9%) improved completely postoperatively, and only one (7.1%) patient who had visual deterioration did not improve after surgery. Total to near-total excision was done in 11 (78.6%) patients, and evacuation of the cyst with partial excision was done in three (21.4%) patients. Conclusion: Endoscopic excision of third ventricular colloid cyst is a safe minimally invasive approach that can be used in patients who present with colloid cyst without the need to do cerebrospinal fluid diversion (shunt).
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Helicobacter pylori eradication therapy in patients with immune thrombocytopenic purpura: a single-center experience p. 32
Nabila Faiek, Safinaz Hussein, Reham Badr
DOI:10.4103/JCMRP.JCMRP_154_19  
Objective: The aim was to determine the frequency of Helicobacter pylori infection in patients with immune thrombocytopenic purpura (ITP) and to detect the effect of its eradication therapy on platelet count response in H. pylori-positive patients. Patients and methods: H. pylori stool antigen enzyme immunoassay test was done for 54 patients with ITP. H. pylori-positive patients received standard triple therapy for 2 weeks. Platelet count response to H. pylori eradication therapy was evaluated 2 and 3 months after the treatment. Results: H. pylori infection was positive in 38 (70.4%) patients with ITP. Eradication of H. pylori was achieved in 30 (78.9%) patients (responder group). There were statistically significant increases in platelet count (among the responder group) after H. pylori eradication therapy at 2 and 3 months (P < 0.05). Conclusion: Eradication of H. pylori infection in patients with ITP is associated with significant increase in platelet counts.
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Laryngeal ultrasound as a bedside tool in detecting postextubation stridor in patients with respiratory illness p. 36
Ashraf Z El-Abdeen Mohammed, Lamiaa H Shaaban, Hosam E. G. Mohammed El-Malah, Shereen F Gad, Maiada K Hashem
DOI:10.4103/JCMRP.JCMRP_97_18  
Context Postextubation stridor is a serious complication in respiratory ICU. Laryngeal ultrasound (US) could be helpful in its diagnosis. Aim The aim was to evaluate accuracy of laryngeal US in detecting postextubation stridor in patients with respiratory illness. Patients and methods A prospective observational study was conducted. A total of 167 mechanically ventilated patients were consequently included over a 2-year period. Laryngeal US air column width (ACW) was measured just after intubation and at the time of extubation. Air column width ratio (ACWR) (ACW before extubation/ACW after intubation) and air column width difference (ACWD) at the time of extubation (ACW with cuff deflated-ACW with cuff inflated) were calculated. Statistical analysis Statistical Package for the Social Sciences statistical software computer program version 20 and Medcalc v. 11.6 were used. Nonparametric tests were used. Results Among the included patients, 17 (10.2%) patients developed stridor. Both ACWR and ACED were significantly lower in patients with stridor than those without stridor (0.798 ± 0.051 vs 0.893 ± 0.056,P < 0.001; 0.541 ± 0.326 vs 1.237 ± 0.442,P < 0.001, respectively). The optimum cutoff value to detect postextubation stridor was less than or equal to 0.86 for ACWR, showing area under the curve of 0.894, 82.4% sensitivity, and 84% specificity and was less than or equal to 0.65 mm for ACWD, showing 76.5% sensitivity, 90% specificity, and area under the curve 0.896. Conclusions US is a valuable tool in detecting postextubation stridor. US -guided ACWR and ACWD could be accurate methods for predicting postextubation stridor in RICU.
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The efficacy, safety, and stability of tacrolimus 0.03% ointment in treatment of nonsegmental vitiligo p. 41
Nagwa E AbdElazim, Haidy A Yassa, Ayman M. Mahran
DOI:10.4103/JCMRP.JCMRP_72_19  
Background Topical immunoarm adulators have been successfully used as a monotherapy or in combination with other therapeutic modalities in vitiligo treatment. Topical tacrolimus has been reported to promote melanoblast differentiation and groth. Additionally, it promotes a favorable environement that enhances the proliferation of melanocytes/ melanoblasts through an interaction with keratinocytes, and thereby repopulating vitigiginous skin lesions. Aim To detect the effect of tacrolimus ointements in treatment of nonsegmental vitiligo. Method A total of 35 patients with vitiligo were enrolled in Tacrolimus this randomized placebo-controlled study. Two vitiliginous patches were chosen in each patient. The firstt lesion (A) was treated by tacrolimus 0.03% ointment, and the second lesion (B) was treated by panthenol cream as a placebo. Treatment course was 3 months, and follow-up was done for three extra months. Vitiliginous patches were assessed at baseline and monthly for 6 months. Results Moderate to excellent response was observed in 25.7% of lesions A compared with 0% of lesions B (P = 0.002). Disease duration has a negative effect on therapeutic response. No adverse effects were noted to tacrolimus ointment except for mild erythema in 6% of the patients. Coclusion Given its immunomodulatory properties and lack of cutaneous adverse effects, tacrolimus is a potential therapeutic alternative for vitiligo, with an improved benefit-risk ratio.
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Evaluation of comma-shaped incision with a sacral flap in surgical treatment of pilonidal sinus p. 46
Mina R.A.R. El Nahal, Mohammed Y.F. Aly, Ragai S Hanna, Gamal A Makhlouf, Gamal A Hameed Ahmed
DOI:10.4103/JCMRP.JCMRP_100_19  
Background: Pilonidal sinus disease is an infection in the subcutaneous fatty tissue, mainly in the natal cleft. Although surgery is the best line of treatment with a favorable prognosis, recurrences and wound complications do occur in some cases. The aim of our study is to evaluate the coma-shaped incision with sacral flap for the management of chronic pilonidal sinus. Patients and methods: Our study is prospective. All patients presented to the General Surgery Department, Assiut University Hospital by de novo chronic pilonidal sinus in the period from March 2017 to June 2018 were included in our study. Comma-shaped incision with sacral flap was planned to all patients. Data on patient demographics, operative time, blood loss, hospital stay, complications, and recurrence rate were evaluated. Results: We included 30 patients. They comprised 22 men and eight women with a mean age of 34 years. The mean operative time and hospital stay were 27 min and 1 day, respectively. Two (6.6%) patients developed superficial wound infection and two (6.6%) patients developed seroma and one (3.3%) patient developed recurrence. Conclusion: Comma-shaped incision with sacral flap provides good results and low recurrence rate. Further prospective studies of a larger number of patients are needed.
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Thyroid dysfunction among chronic hepatitis C patients and its relation to Interferon therapy p. 50
Lobna F El Toony, Marwa A Mohammed, Lobna A El-Wahid Ahmed
DOI:10.4103/JCMRP.JCMRP_122_18  
Background: Thyroid dysfunction (TD) represents an extrahepatic manifestation of chronic hepatitis C (CHC). Moreover, the currently approved treatment of CHC is often associated with TD. However, it remains debatable if TD is mainly virus or treatment related. The aim of this study was to assess the incidence of TD and to identify its predictors in treated and untreated CHC-infected patients. Patients and methods: A total of 1290 patients with CHC were evaluated for TD for 48 weeks: 200 were untreated (control group) and 1090 were treated with pegylated interferon α (PEG-IFN-α) plus ribavirin (treatment group). Results: The incidence of TD was more evident by the end of treatment (week 48); it was found to be 15.5%, mostly in the form of hypothyroidism (8.4%), whereas the least incidence was detected by week 12 (9.1%), mostly in the form of hyperthyroidism (5.2%). Generally, hyperthyroidism was higher than hypothyroidism in multiple folds, but in the end, hypothyroid cases became more dominant. Males were more affected, but the prevalence of hypothyroidism was more in females (10.1%) than males (8.0%). TD was not related to sex, age, BMI, pretreatment viral load, pretreatment laboratory characteristics, post-treatment biochemical tests, treatment duration, severity of hepatic inflammation and fibrosis, type of biopsy used, or virological outcome, but PEG-IFN formulation was related, particularly IFN-α-2a. TD did not lead to dose reduction or therapy withdrawal. Conclusion: Both hepatitis C virus and IFN-α therapy have been found to be inducing thyroid disorders in patients with CHC virus infection. Antiviral therapy of CHC possibly induces de novo or exacerbates pre-existing silent TD especially subclinical hypothyroidism. The role of CHC per se in TD remains to be determined.
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Platelet indices and blood cell ratios in acute coronary syndrome and their predictive values p. 57
Neveen A E. Hassan, Taghreed M Kamal El-Ddin, Tarek A. H. Nagib Kafafy, Esraa H Mahran
DOI:10.4103/JCMRP.JCMRP_51_19  
Background Platelets have a chief role in the pathogenesis of acute coronary syndrome (ACS), where plaque rupture is followed by platelet activation and thrombus formation, leading to coronary artery occlusion. When platelets are activated, they become bigger in size, which can be measured by both mean platelet volume (MPV) and platelet distribution width (PDW). Aim The aim of this study was to evaluate the predictive value of blood count parameters, including platelet indices such as MPV, mean platelet component, plateletcrit, PDW, and mean platelet mass and blood cell ratios such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, white blood cell to mean platelet volume (WMR) in ACS. Patients and methods This work was carried out at the Clinical Pathology and Cardiology Departments at Assiut University Hospital during the period between January 2017 and December 2017. It included two groups of participants: 250 patients with ACS (patient group) and 100 apparently healthy age-matched and sex-matched individuals (control group). Results Mean age of the patient group was 57.41 ± 12.15 years, with range between 31 and 90 years old. Of 250 patients with ACS, 187 (74.8%) patients were males. The patient group had significantly higher MPV, PDW, WMR, and neutrophil-to-lymphocyte ratio in comparison with the control group, but the control group had higher mean platelet component and platelet-to-lymphocyte ratio (P < 0.05). Both groups had insignificant differences regarding plateletcrit and mean platelet mass. Low hemoglobin and increased MPV and WMR were predictors for development of major cardiac events in patients with ACS. Conclusion Low hemoglobin and increased RDW, MPV, and WMR were predictors for the development of major adverse cardiac event in patients diagnosed with ACS.
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Evaluation of audiovestibular function in patients exposed to extracorporeal shock wave lithotripsy p. 63
Mohamed S Bakr, Ahmed M Abd Elmoneim, Amira M. A. El-Oseily, Mai M. A Abu Elleil
DOI:10.4103/JCMRP.JCMRP_34_18  
Background and aim: The noise given off by the extracorporeal shock wave lithotripsy (ESWL) device during treatment may put hearing and vestibular system at risk. Therefore, this study attempts to explore the effect of the noise generated by the ESWL device on hearing and vestibular systems of patients receiving such a method of management. Patients and methods: Thirty patients (60 ears), who were candidates for management by ESWL were examined. Each patient of this study underwent the following: (a) basic audiological evaluation including: pure-tone audiometry, speech audiometry, and middle ear immittance measurement; (b) transient evoked otoacoustic emissions; (c) vestibular evaluation: videonystagmography. Results: There was increase in pure-tone thresholds of both ears in the post-ESWL as compared to pre-ESWL sessions at high frequencies (2–4 kHz). There was a statistically significant difference between response level in dBSPL of both ears at pre-ESWL and post-ESWL sessions at frequencies (2, 3, and 4 kHz). Two (6.7%) patients in the study developed unilateral weakness in the post-ESWL sessions. There was a significant difference in positioning and positional tests between pre-ESWL and post-ESWL sessions.
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Clinical audit on management of hepatic encephalopathy in children admitted to Gastroenterology and Hepatology Unit of Assiut University Children Hospital p. 71
Johnny M Maken, Fatma A Ali, Nagla H Ibrahim
DOI:10.4103/JCMRP.JCMRP_87_17  
Introduction Hepatic encephalopathy (HE) is an important metabolic disturbance in children. It is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, after exclusion of brain disease. Patients and methods A clinical audit on management of HE was applied according to the guideline protocol used in Gastroenterology and Hepatology Unit of Assiut University Children Hospital. The study included 52 children with HE who were admitted to Gastroenterology and Hepatology Unit over 1-year period from the 1st of March 2016 to the 28th of February 2017. Results Detailed history intake was recorded in most cases, except history of drug intake, which was not recorded in 23.15% of cases; history of reversal of sleep rhythm, which was not recorded in 17.3% of cases; and history of behavioral changes, which was not recorded in 9.6% of cases. Data of examination were recorded in most cases, except for fetor hepaticus, which was recorded in 42.3% of cases; asterixis, which was recorded in 36.5% of cases; and neurological examination, which was recorded in 91.2% of cases. Basic and mandatory investigations in the diagnosis of HE were done. The standard treatment of HE has been applied except admission to the ICU and prophylactic endotracheal intubation were not applied. Moreover, oral branched-chain amino acids and rifaximin were not given. Conclusion The international guidelines for the management of HE have been followed by the Gastroenterology and Hepatology Unit of Assiut University Children Hospital in most treatment lines and that some of the default is owing to poor-resource setting and lack of medication.
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Impact of urethroplasty on male sexual function p. 79
Ahmed M ELtaher, Adel A Kurkar, Ahmed K Hassab-ELnaby, Ahmed M Ali
DOI:10.4103/JCMRP.JCMRP_68_18  
Purpose To evaluate the impact of anterior urethroplasty on male sexual function. Patients and methods A total number of 35 patients with anterior urethral stricture who underwent urethroplasty at Assiut Urology and Nephrology Hospital from March 2015 to March 2016 were included in the study. The mean age was 36.1 ± 11.1 years (range: 25–56 years). Evaluation of postoperative erectile function was done using a validated questionnaire (International Index of Erectile Function-5 questionnaire) at 3 and 6 months posturethroplasty, while evaluation of ejaculatory and orgasmic function was done by using ejaculation/orgasm score at 3 and 6 months posturethroplasty. Results The mean age of the included patients was 36.1 ± 11.1 years (range: 25–56 years). As regards the incidence of Erectile dysfunction (ED) after urethroplasty, 3 months posturethroplasty, nine (25.7%) patients developed ED, with statistically significant difference (P = 0.001). At 6 months posturethroplasty, just two (5.7%) patients showed ED, with no statistically significant difference (P = 0.15). As regards the incidence of ED according to the etiology of urethral stricture, there was no statistically significant difference between postinflammatory and post-traumatic cases at 3 months (P = 0.636) and at 6 months (P = 0.234). According to the length of urethral stricture, the impact on erectile function after urethroplasty was greater in shorter urethral stricture segment (1.9 ± 0.2 cm) than in longer urethral stricture segment (3.1 ± 1.3 cm) with no statistically significant difference between the two groups (P = 0.514). ED occurred in anastomotic urethroplasty (39.1%) more than free graft urethroplasty (0%), with statistically significant difference (P = 0.012). Conclusion Anterior urethroplasty has a probability of causing transient ED in as much as 25% of patients, with recovery of erectile function occurring in 78% of cases within 6 months of urethroplasty. The incidence of ED is higher in patients undergoing anastomotic repair than in patients undergoing free graft urethroplasty. Urethral reconstructive surgery has a minimal effect on ejaculatory and orgasmic functions.
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Comparative study between cytological and histopathological analysis results of hemithyroidectomy in treatment of solitary thyroid nodule p. 85
Mostafa T Ahmed, Mahmoud Thabet Ayob, Mostafa A Abdel Naeem Mohamed
DOI:10.4103/JCMRP.JCMRP_141_18  
Aim: The aim of this study was to compare the outcome results of cytological examination by fine-needle aspiration cytology to histopathological examination by hemithyroidectomy in patients with solitary thyroid nodule. Patients and methods: We prospectively reviewed 30 consecutive patients had primary hemithyroidectomy for management of solitary thyroid nodule, carried out over a year (from January 2017 to January 2018) at Assiut University Hospital Surgical Department. Results: There were 24 women and six men with a mean age 34.67 years (range, 19–70 years). Preoperative findings of fine-needle aspiration cytology of these were: 17 (56.7%) patients had colloid nodule, 10 (33.3%) follicular neoplasm, and three3 (10%) hyperplastic nodule. Biopsied lesions were found to be malignant on pathological evaluation in two (6.6%) patients with follicular neoplasm, hemithyroidectomy was adequate definitive treatment in 28 of 30 (93.3%) patients. Conclusion: In a review of the experience at Assiut University Hospital Surgical Department, hemithyroidectomy was the optimal initial and definitive surgical approach for most patients with benign and indeterminate cytology and had undergone thyroid surgery for suspicion of cancer.
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Prevalence and risk factors of depressive symptoms in low-risk pregnancy p. 91
Mohamed MF. Fathalla, Esraa Badran, Mohamed Fawzy, Omayma Ismail Ahmed
DOI:10.4103/JCMRP.JCMRP_86_19  
Objective To demonstrate the prevalence and risk factors of antenatal depression among low-risk pregnant women residing in Assiut, Egypt. Patients and methods A total of 100 pregnant women were recruited from primary health centers who met the inclusion criteria, and they were evaluated using the Arabic version of the validated Edinburgh Postnatal Depression Symptoms (EPDS) questionnaire before and after 20 weeks of pregnancy. Women who scored EPDS more than or equal to 13 were subjected to the Arabic version of Beck Depression Inventory to evaluate the severity of depressive symptoms. Correlations were made with demographic and obstetric risk factors. Results Overall, 18% scored EDPS more than or equal to 13 at the firstt visit compared with 32% at the second visit. In the firstt visit, two women were classified by Beck Depression Inventory as severe (11%), nine women as moderate (50%), and seven as mild (38.9%). At the second visit, six women were classified as severe (18%), 20 as moderate (62%), and six as mild (18%). Age, presence of husband, socioeconomic state, living at family home proved statistically significantly associated with depressive symptoms. Moreover, parity, unwanted pregnancy, known female fetus, and number of living female offsprings proved statistically significantly associated with depressive symptoms. There was a significant relationship between EPDS in firstt visit and EPDS in second visit. Logistic regression analysis showed that age, low socioeconomic level, unwanted pregnancy, and number of living female offsprings were positive predictors of antenatal depression, but the association lacked statistical significance. Conclusion Depressive symptoms are common in second half of the pregnancy. Age, socioeconomic level, absence of husband, parity, unwanted pregnancy, and number of living female offsprings are risk factors for depressive symptoms during pregnancy.
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Duplex screening for carotid artery stenosis in patients with peripheral arterial disease in Assiut University Hospital p. 96
Omar M Abdel Hakam, Hassan B El Badwy, Ayman E Hassaballah, Mahmoud I Ahmed
DOI:10.4103/JCMRP.JCMRP_8_19  
Introduction Carotid atherosclerosis is one of the several etiological factors for stroke and is considered an important health problem with a high burden of disease in the western world and in developing countries. Aim This study is aimed at investigating the prevalence of asymptomatic carotid artery stenosis (ACAS) in patients with peripheral arterial disease (PAD) and identifying the predictive factors of ACAS in patients with PAD. Patients and methods Between September 2016 and August 2017, 750 patients with PAD (Fontaine IIb–IV) underwent percutaneous transluminal angioplasty in the Department of Vascular Surgery. Patients aged less than 50 years old and those who had a previous cerebrovascular event or carotid artery intervention were excluded (n = 105). The remaining 645 patients underwent preoperative screening for ACAS using carotid duplex ultrasonography examination. The degree of internal carotid artery (ICA) stenosis was determined by the criteria of Society of Radiologists in Ultrasound Consensus Conference. Results We found that 302 (46.8%) patients had patent carotid arteries without any evidence of atherosclerotic plaque, whereas 343 (53.2%) patients had ACAS. The prevalence of significant ICA stenosis (≥70% stenosis) was 2.8%. ICA occlusion was detected in 0.6%. Univariate analysis revealed that age older than 65 years (P = 0.013), male sex (P = 0.022), hypertension (P < 0.001), and ischemic heart disease (P = 0.016) are predictive factors of critical carotid artery stenosis, which is defined as peak systolic velocity more than 230 cm/s with diameter reduction of at least 50%. Discussion and conclusion Patients with chronic lower extremity PAD with either ischemic rest pain or tissue loss (nonhealing ulcers or gangrene), which is defined as critical limb ischemia, and patients with disabling claudication who need revascularization, particularly, males older than 65 years, who have a concomitant hypertension and ischemic heart disease, can be good candidates for carotid screening with carotid duplex ultrasonography.
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Clinical audit on management of post-burn sepsis in pediatric intensive care unit p. 102
Zienab M Mohey Eldeen, Azza A El-Tayeb, Asmaa G Abdel-Nasser Fathy
DOI:10.4103/JCMRP.JCMRP_125_18  
The aim of this study: Is to assess how much the adopted protocol of management of post. burn sepsis in pediatrics is applied in intensive care unit in AUCH and to detect outcomes of these admitted cases. Objectives: To review the specific infections common in pediatric burns, including their categorization, diagnosis, and treatment. Background: Burn injury in children continues to be a major epidemiologic problem around the globe. Nearly a fourth of all burn injuries occur in children under the age of 16, the majority are under the age of five (1) . Children account for almost half of the population with severe burn injury and children below five years of age account for 50–80% of all childhood burns . Most childhood burns occur in the home; scalds are the most common burn type (accounting for 60–70% of all hospitalized burn patients, followed by flame and contact burns (2). .Burn sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. (3). Methods: The target population were all pediatrics patient who referred to PICU in AUCH after 24 hours post burn for management of septic shock along the peroid of one year from August 2015 to July 2016. Data is collected by reviewing medical records of burned patients admitted to PICU during the study duration. Result: The study included 50 cases with post burn sepsis diagnosed according to criteria in the recommended guideline. Their ages ranged from 1-18 years, 30 cases were males and 20 cases were females. Scald burn represented 76% of the studied cases. Conclusion: Among hospitalized pediatric burn patients , the majority were below 6 years and commonest cause of burn was scald.. Mortality was 44% among the studied cases .Sepsis is common in the pediatric burn patient and can markedly increase morbidity and mortality.
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Possibility of association of hypertension and ischemic heart disease with primary hyperuricemia p. 109
Noor El-Deen Abd El-Azeem M. Elhefny, Mona H Elzohri, Sara Mostafa Taher
DOI:10.4103/JCMRP.JCMRP_9_19  
Background The relations between serum uric acid and cardiovascular disease are complex, so in the past five decades, more than 40 epidemiologic and clinical studies involving up to 150 000 individuals have been carried out to assess this association. Objective This study aimed to investigate the association between high uric acid levels and cardiovascular disease and hypertension. Patients and methods A total of 40 patients with primary hyperuricemia selected from Internal Medicine Department, Rheumatology Unit, Assiut University Hospital, were included in this study. Age of the studied patients ranged between 23 and 87 years. None of the patients were diabetic, hypertensive, had ischemic heart disease, or were smoker. Moreover, none of them had gout, kidney diseases, or liver cirrhosis. All of the studied patients had normal abdominal ultrasonographic findings with normal urine analysis and normal BMI. Incident hypertension was defined as newly detected blood pressure of at least 140/90 mmHg, which was examined along with ischemic changes by echocardiography. Results Overall, 37.5% patients were discovered to be hypertensive and 32.5% patients had ischemic changes on echocardiography. Conclusion There is a strong and significant association between high uric acid levels and ischemic heart disease and hypertension, and this relationship is independent of traditional risk factors.
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Role of diffusion-weighted magnetic resonance imaging in detection of neonatal hypoxic-ischemic encephalopathy p. 115
Alaa A Sayed, Nagham N M. Omar, Nafisa H Refaat, Mohammed K Mahmoud
DOI:10.4103/JCMRP.JCMRP_62_19  
Background Hypoxic-ischemic encephalopathy (HIE) is a critical pediatric disease with challenges in diagnosis. Many diagnostic tools have been used to diagnose this condition. Among all these tools, MRI with the advanced sequence; diffusion-weighted imaging (DWI) plays a more vital role in early detection of this condition. In this research we emphasized the role of DW-MRI in the diagnosis of HIE. Aim of work The aim of this work is to evaluate the role of DW-MRI in detection and grading of HIE. Patients and methods This is a prospective study performed for 1 year (from January 2017 to January 2018). The studied group included 20 full-term neonates admitted to NICU of Assiut University Hospital with provisional diagnosis of HIE. All patients underwent brain imaging by conventional and DW-MRI. Results There was a moderate significant agreement between conventional MRI and DWI (P = 0.023) regarding both diagnosis and grading of HIE. Conclusion MR-DWI is the preferred modality of imaging in diagnosis and grading of hypoxic-ischemic injury due to its high sensitivity and easy interpretation with no need for contrast administration.
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