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   Table of Contents - Current issue
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May-August 2019
Volume 4 | Issue 2
Page Nos. 109-230

Online since Tuesday, July 9, 2019

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ORIGINAL ARTICLES  

Clinical reaudit on management of diabetic ketoacidosis in Assiut University Children Hospital p. 109
Mahmoud R Abdel Badie, Gehan M Kamal, Ismail L Mohamad
DOI:10.4103/JCMRP.JCMRP_129_18  
Introduction Diabetic ketoacidosis (DKA) is one of the most common causes of admission in emergency unit and pediatric ICU in Assiut University Children Hospital. It is one of the important causes of mortality and morbidity in children with diabetes. DKA is a complex metabolic state of hyperglycemia, ketosis, and acidosis resulting from absolute or relative insulin deficiency. Patients and methods The study includes pediatric patients presented with DKA to emergency unit and pediatric ICU of Assiut University Children Hospital. It was done on 100 pediatric patients over 1 year from March 2017 to February 2018. This reaudit was done to evaluate the degree of compliance of management of DKA in relation to the guidelines in comparison with the previous study on the same topic that applied the same guidelines (International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2014). Results Overall, 63% were females and 39% were in the age group older than 10 to 15 years. Resuscitation fluids were administered in 95% of cases on admission. All cases received insulin therapy with the start of resuscitation fluids. Glucose 5% was correctly added to intravenous fluids when blood glucose had fallen to ~14–17 mmol/l (250–300 mg/dl) in all cases. Conclusion Guidelines have been followed in the management of DKA in the studied cases, but there were some defects that can affect the outcome of management of DKA. The study recommends avoiding these defects.
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Evaluation of the use of the Ambu_aScope 2TM in laparoscopic common bile duct exploration p. 115
Salah I Mohamed, Mohamed K Ewis, Ahmed M Ibrahim Taha, Mohamed G Abdellah Ashry
DOI:10.4103/JCMRP.JCMRP_86_18  
Introduction Cholelithiasis is a common disease, occurring in 5–22% people in the western countries. The management of common bile duct stones (CBDS) could be adopted in two main lines. The first line is through laparoscopic cholecystectomy and common bile duct (CBD) exploration in one session, the other is endoscopic retrograde cholangiopancreatography then laparoscopic cholecystectomy. In this study we evaluate a novel device with cases of laparoscopic CBD exploration which is Ambu_aScope 2TM which is mainly used as a bronchoscope in cases of difficult intubation, however we evaluate the capability of such device to perform accurately in CBD exploration. Aim of the work This is a prospective randomized study to investigate the outcome of using Ambu_aScope 2TM in laparoscopic CBD exploration in the management of patients with CBDS. Patients and methods Equipment: a recent case report described the use of the Ambu_aScope 2TM in an open CBD exploration. They showed that they were able to perform a successful procedure in their patient. Patient population: all patients who were scheduled for laparoscopic CBD exploration, in whom Ambu_aScope 2TM was used were included in our study during the period from October 2016 till February 2018. Results Eighteen patients underwent laparoscopic CBD exploration. Two patients converted to open due to difficult stone extraction that was distal and impacted and the other was due to sever adhesions from previous acute cholecystitis. All cases were done using the Ambu_aScope through choledotomy in CBD. The Ambu_aScope was used to visualize the CBD and extract the stones either by Fogarty's catheter done in nine cases or dormia basket in the rest of cases. Conclusion Laparoscopic CBD exploration is considered one of the corner stones in the CBDS management. The Ambu_aScope 2TM was approved and satisfactory to the operating surgeons as regarding the handling of the instrument, orientation, quality of image, and feasibility of stone extraction through the working port.
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Effects of exposure to gibberellic acid during pregnancy and lactation on the postnatal development of the renal cortex in the albino rat p. 121
Sayed A. S. Hassan, Hoda A. M. Abdel-Aziz, Heba K Mohamed, Martha E Adly
DOI:10.4103/JCMRP.JCMRP_67_18  
Background Gibberellic acid (GA3) is one of the plant growth regulators that are widely used in Egypt, to increase the growth of fruits and vegetables. Little is known about the effects of GA3 on the mammalian tissues. Aim of the work This work was aimed to reveal the effects of exposure to GA3 during pregnancy and lactation on the postnatal development of the renal cortex in the albino rat. Materials and methods Forty pregnant females, weighing 200–300 g, were divided into two equal groups: group A (control) and group B (experimental). The pregnant rats of group B were given GA3 in a dose of 0.2 g/l of drinking water (equivalent to 55 mg/kg of body weight) from the 14th day of pregnancy until day 21 after delivery. The same dose of GA3 was given to the offsprings after weaning (day 21) till adulthood (3 months). The offsprings were sacrificed at the following ages: newborn, 10 days, and adult (3 months). Kidney specimens were processed for light microscopic examination, electron microscopic examination, and immunohistochemical study. In addition, morphometrical and statistical analysis of the renal cortical thickness was done. Results The renal glomeruli and the convoluted tubules showed degenerative changes in the three treated studied ages with delayed development of the glomeruli in addition to extravasation of blood and inflammatory cellular infiltration in the interstitial tissue. Conclusion and recommendation GA3 has harmful effects on the histological development of the renal cortex. So, it should be used cautionary.
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Morphine as an adjuvant to local anesthetics in axillary brachial plexus block in forearm and hand surgery p. 131
Kawthar H Mohamed, Khaled A Abdelrahman, Ahmed N Elameer, Ibrahim H Ali
DOI:10.4103/JCMRP.JCMRP_35_19  
Background The axillary brachial plexus block is a popular nerve block for forearm, wrist, and hand surgery. The use of local anesthetic peripheral nerve blocks for surgical anesthesia and postoperative pain management has increased significantly with the advent of ultrasound-guided techniques. The discovery of peripheral opioid receptors led to the clinical application of adding opioids to local anesthetics for peripheral nerve blocks. This study is done to evaluate effect of morphine on onset, duration, and quality of analgesia when added to local anesthetics in axillary brachial plexus block and to detect any complications that occurred with this technique. Patients and methods In this prospective controlled clinical trial, 60 adult patients aged 18–60 years scheduled for orthopedic surgery of the forearm and hand with axillary brachial plexus block were selected and randomly allocated to two groups. Placebo group received 24 ml bupivacaine 0.5%, and morphine group received 24 ml bupivacaine 0.5%+5 mg morphine. The onset and duration of sensory and motor blocks, duration of analgesia, and adverse events (such as nausea and pruritus) during perioperative period were recorded. Results Onset of touch and pain block was faster in morphine group, with P values of 0.016 and 0.025, respectively. Onset of motor block was similar in the two groups. Duration of touch block was longer in morphine group, with P value of 0.022. Duration of motor block showed no change between the two groups. Duration of analgesia was longer in the morphine group, with P value of 0.001, with lower consumption of analgesia. No complications were recorded perioperatively. Conclusion We concluded that morphine provide better postoperative analgesia when injected with local anesthetics in ultrasound-guided axillary brachial plexus block without an increase in the frequency of complications.
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Terlipressin infusion during Whipple procedure: effect on blood loss and transfusion needs – a randomized clinical trial p. 137
Mahdy M Magdy, Ibraheim A Osama, Sayed A Jehan, Abbas S Mostafa
DOI:10.4103/JCMRP.JCMRP_40_18  
Context Multivisceral resections including Whipple procedure are among the foremost common oncologic procedures during which massive bleeding and transfusion might happen intraoperatively or postoperatively. Terlipressin is a synthetic vasopressin analog with relative specificity for the splanchnic circulation where it causes vasoconstriction, with a hypothetical reduction in blood loss during abdominal surgeries. Aims We aim to assess the effect of terlipressin infusion on blood loss and blood transfusion requirements during Whipple procedure. Settings and design The current study was a prospective single center randomized placebo-controlled trial. The study was carried out in Al Rajhy Liver Hospital, Assiut University, Egypt between May 2016 and July 2017. Patients and methods In this trial 40 patients scheduled for Whipple procedure were randomly assigned either to receive terlipressin at the beginning of surgery as an initial bolus dose of (1 mg over 30 min) followed by a continuous infusion of 2 μg/kg/h throughout the procedure and gradually weaned over the first 4 h postoperatively (terlipressin group) or to receive the same volume and rate of 0.9% saline for the same duration (control group).The primary outcome was the amount of intraoperative blood loss. Statistical analysis used Statistical analysis was established using SPSS, version 16.0. Results The amount of intraoperative blood loss was significantly lower in the terlipressin group (690.00 ± 449.44) in comparison with the control group (1020.00 ± 284.88). Five (25%) patients received blood transfusion in the terlipressin group compared with 13 (65%) patients in the control group (P = 0.011). Significantly greater number of packed red blood cells units were transfused to the control group (P = 0.013). Conclusion Terlipressin infusion during Whipple procedure was associated with less bleeding and lower rates of blood transfusion requirements compared with placebo.
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Nutritional assessment of cirrhotic patients with variable severity p. 144
Magda S Hassan, Abeer S. Eldin Abdel Rehim, Medhat A Khalil, Yasmin A Mahmoud Osman
DOI:10.4103/JCMRP.JCMRP_14_18  
Introduction Malnutrition presents in more than half of cirrhotic patients. It is varied from 20% in compensated liver disease to 80% in decompensated liver disease. This study aimed at assessing the frequency of malnutrition and relation between the malnutrition and degree of liver severity. Patients and methods This study was carried out in Tropical Medicine and Gastroenterology Department at El-Rajhy Hospital in Assiut University, Egypt, from December 2015 to December 2016 on 101 patients diagnosed with liver cirrhosis. Based on their medical profile, the liver disease severity was determined by Child–Pugh, model for end-stage liver disease, and model for end-stage liver disease sodium scores, then nutritional status of the patients was assessed by different methods including anthropometric diameters (BMI, triceps skinfold thickness, mid-arm circumference, and mid-arm muscle circumference), body composition analysis, subjective global assessment, creatinine–height index, prognostic nutritional index (PNI), and controlling nutritional status (CONUT), and finally, we assessed the relation between the nutritional status and the severity of liver disease. Results The frequency of malnutrition among the studied patients varied from 25.7% by BMI to 98% by PNI and CONUT. There was difference in degree of malnutrition between the different groups of liver disease; however, this variation was not significant when anthropometric measures and body composition analysis were used but was statistically significant when subjective global assessment, creatinine–height index, PNI, and CONUT were used. Conclusion The nutritional status of cirrhotic patients is an important tool, together with Child and model for end-stage liver disease scores, for the prediction of prognosis of such patients. All the nutritional assessment tools are needed together with no substitution of one method by another for precise assessment of malnutrition among cirrhotic patients.
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Nasalance scores of Egyptian hearing impaired children p. 152
Emad K Abdel Haleem, Mohamed S Bakr, Eman S Hassan, Nada A Kamel
DOI:10.4103/JCMRP.JCMRP_57_18  
Context Speech of prelingual hearing impaired (HI) speakers is commonly characterized by the presence of resonance abnormalities which is related with nasality. Aim To investigate and compare nasalance scores of Egyptian HI children including cochlear implant (CI) and hearing aid (HA) users with normal hearing (NH) children. Settings and design It is an observational case–control study. Patients and methods The study consisted of group I: 41 HA children, group II: 24 CI children, and the control group: 31 age-matched and sex-matched children with NH. Nasometer II 6200 was used for evaluation of their nasalance scores. Statistical analysis used IBM SPSS, version 20, was used. Kruskal–Wallis and one-way analysis of variance tests were performed to compare the mean differences between the nasalance scores of the three studied groups. While Mann–Whitney and post-hoc tests were used for pairwise comparison. A correlation analysis was computed between the nasalance scores and many parameters using Spearman's and Pearson's coefficients. Results For oral sentence, both CI and HA children showed higher nasalance values in comparison with NH children. However, lower nasalance scores were observed for the nasal sentence. CI experience and enrollment into language therapy were found to have an effect on nasalance scores. Conclusion Resonance quality of the HI children is still at risk despite the fact that a significant number of them demonstrate normal resonance.
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Immunological and biochemical parameters in patients with hepatitis C virus nephropathy before and after direct hepatitis C virus antiviral agents p. 158
Effat A. E. Tony, Mohamed A Tohamy, Refaat F Abdelaal, Ayman A Mahmoud
DOI:10.4103/JCMRP.JCMRP_91_18  
Background Chronic hepatitis C is associated with multiple extrahepatic manifestations that may affect the infected patients. Egypt is the country with the highest incidence of hepatitis C virus (HCV) infection in the world. Hepatitis C-induced kidney disease is a devastating complication in patients with HCV infection. The development of multiple direct-acting antivirals (DAAs) has revolutionized the HCV infection treatment. Aim The aim was to determine the changes in immunological and biochemical parameters in patients with HCV nephropathy who receive DAA. Patients and methods The study included 30 patients diagnosed with HCV nephropathy according to the inclusion criteria and were tested for the immunological (C3, C4, rheumatoid factor) and biochemical parameters (urea, creatinine, urine analysis, 24 h proteins), before receiving their direct HCV antiviral agents for 12 weeks. Then participants were followed up regarding their immunological and biochemical parameters directly after termination of treatment. Results A total of 18 (60%) patients received sofosbuvir and daclatasvir with ribavirin, whereas 12 (40%) patients were on ombitasvir, ritnoprevir, and paritaprevir with ribavirin. Levels of transaminases were significantly improved after direct HCV antiviral agents in the current study. Significant improvement in the mean levels of blood urea and creatinine after direct HCV antiviral agents post-therapy when compared with their levels before treatment (49.16 ± 15.52 and 285.11 ± 39.07 mg/dl at pretreatment versus 25.44 ± 9.37 and185.03 ± 31.07 mg/dl after treatment respectively, with P < 0.05) with significant reduction in 24-h urinary protein following the antiviral therapy. Our study showed significant improvement in C3 and C4 levels after therapy with DAA. After 12 weeks of the therapy, all patients had negative HCV RNA by PCR at follow-up. Conclusion HCV infection is a major medical burden in patients with chronic kidney disease. However, HCV infection itself can cause chronic kidney disease. Effective antiviral agents play an important role in improvement of HCV-related nephropathy and other extrahepatic manifestations.
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A study on weight loss outcomes after laparoscopic sleeve gastrectomy p. 164
Samy M Osman, Ahmed M Ali, Mahmoud S Marzouk
DOI:10.4103/JCMRP.JCMRP_145_18  
Background Obesity increases the likelihood of various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, osteoarthritis, and depression. The most effective treatment for obesity and its associated comorbidities is bariatric surgery in its various forms. Patients and methods A prospective and a retrospective study is carried out on 54 patients with BMI more than or equal to 40 kg/m2 or BMI more than or equal to 35 kg/m2 with comorbid conditions who underwent laparoscopic sleeve gastrectomy (LSG). Results Weight loss follow up was done at 1, 3, 6, and 12 months. The weight loss was measured in terms of absolute weight loss (kg), change in BMI and percentage of excess weight loss (%EWL) which was as follows. Body weight: after LSG, the mean body weight significantly declined to 36.9% of initial weight at 1 year. BMI: postoperative BMI declined from 46.51 ± 7.02 to 29.5 ± 5 kg/m2 after 1 year. %EWL: the %EWL was about 70.6 ± 14.8 at 1 year. The proportion of patients having successful weight loss (%EWL < 50%) were 92.6%. Conclusion LSG is a low-risk procedure that can significantly reduce the BMI, with near 70% EWL with success rate about 92% after 1 year.
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The effect of pregnancy on female sexual function: a cross-sectional study p. 170
Alaa Mobasher, Sahar A Ismail, Dina Habib, Doaa Abu-Taleb, Shaymaa Saleh, Ahmed M Abbas
DOI:10.4103/JCMRP.JCMRP_83_17  
Objective The current study aims to evaluate the effect of pregnancy in its different trimesters on the female sexual function. A cross-sectional study was conducted at Assiut University Hospital, Assiut, Egypt. Patients and methods We included consecutive healthy sexually active pregnant women aged between 18 and 40 years who had attended the antenatal care clinic of Assiut Women Health Hospital between June 2014 and May 2015. We used the Arabic version of the female sexual function index (FSFI) in the interview to evaluate the sexual functions or problems during the past month. The cutoff score used to indicate sexual dysfunction was 28.1. Results A total of 600 healthy sexually active women were enrolled in this study: 300 women with uncomplicated pregnancy and 300 nonpregnant women. The percentage of women having total female sexual dysfunction during pregnancy was 63.3% compared with 61.2% of nonpregnant women. The percentage of women having total female sexual dysfunction was 70, 44, and 72% in the first, second, and third trimesters, respectively. The second trimester women had the highest total FSFI score, which was not significantly different from the total FSFI score in nonpregnant women (P = 0.922). Conclusion The current study reports no differences in the prevalence and indices of sexual function between pregnant and nonpregnant women. However, the second trimester represents the peak of sexual function throughout pregnancy, and the problem of sexual dysfunction is the highest during the third trimester.
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Role of prazosin in management of scorpion sting in pediatrics: a comparative study p. 174
Asmaa H Shoreit, Azza A Eltayeb, Samira S Ali
DOI:10.4103/JCMRP.JCMRP_132_18  
Background Scorpion stings represent an important and serious public health problem worldwide owing to their high incidence and potentially severe and often fatal clinical manifestations. Children are at greater risk of developing severe cardiac, respiratory, and neurological complications owing to lesser body surface area. Prazosin, a postsynaptic alpha blocker, is an effective drug in the treatment of serious scorpion envenomation with significant sympathetic symptoms. Aim of the study To study the role of prazosin in the management of scorpion envenomation in children at Assuit University Children Hospital. Patients and methods The study included 60 patients with scorpion stings admitted to Assuit University Children's Hospital from November 2016 to November 2017. Their ages ranged from 1 to 18 years. Patients were randomized into two groups: group A underwent conventional therapy and prazosin and group B underwent conventional therapy. Results Our results showed that addition of prazosin to antivenom induced earlier clinical recovery than in cases treated with conventional therapy. Administration of prazosin is one of the most useful strategies to reduce mortality in scorpion envenomation. A total of 60 cases of scorpion envenomation were observed during the study time period. Male children predominated over female. Conclusion Scorpion sting envenomation is an acute life-threatening emergency, and recovery from scorpion sting is hastened by simultaneous administration of scorpion antivenom plus prazosin compared with antivenom alone.
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Prevalence of maternal and fetal complications after general anesthesia for cesarean section in patients with class II HELLP syndrome in Assiut University Hospital p. 180
Golnar M Fathy, Zein Al-Abdeen Zareh Hassan, Mohammed G Abdelraheem, Diaa AbdelAal Alnashar, Amr T Mostafa
DOI:10.4103/JCMRP.JCMRP_137_18  
Background The low platelet count, associated with HELLP syndrome (HS) has often favored the choice of general anesthesia for the cesarean section (CS); however, general anesthesia in such cases is not a risk-free approach. General anesthesia is associated with increased risk of complications. Aim of work To evaluate the safety of general anesthesia in patients with class II HS scheduled for elective CS as regards maternal and fetal complications. Patients and methods In this prospective, observational study carried out at the maternal hospital in Assiut University Hospitals. We included all patients with class II HS scheduled for elective CS under general anesthesia who were admitted to the women health hospital during the 1 year. The study collected data about the incidence of neurological complications, incidence of intraoperative hemodynamic instability (hypotension, hypertension, bradycardia, and tachycardia), and effect of general anesthesia on fetal outcome including umbilical blood gas and Apgar score. Results The incidence of intraoperative and postoperative complications is higher in HS patients compared with CS in normal parturients as regards intraoperative hypertension, tachycardia, and postoperative neurological complications. Conclusion HS patients are at an increased risk of complications during CS under general anesthesia and alternative types of anesthesia like spinal or epidural anesthesia should be considered.
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Short-term surgical outcomes of laparoscopic colorectal cancer resection in Assiut University Hospital p. 188
Hussein I Ahmed, Mahmoud R Shehata, Hany A.E. Ali, Ahmed M Ali, Tarek A Mostafa
DOI:10.4103/JCMRP.JCMRP_140_18  
Background Laparoscopic surgery has progressively replaced open colorectal surgery in recent decades owing to better short-term outcomes. The current study was designed to detect the short-term surgical outcomes of laparoscopic colorectal cancer resection. Patients and methods A prospective study was conducted including 30 patients diagnosed with surgically treatable colorectal cancer in Department of General Surgery, Assiut University Hospital. Results A total of 30 patients underwent laparoscopic colonic or rectal resections between January 2017 and January 2018. They were followed up for 1 year. There were significantly improved short-term surgical outcomes in the form of less blood loss, earlier return of bowel function, and decreased hospital stay. Histological examination revealed that proximal and distal margins were free of tumor cells in all surgical specimens. Conclusion Laparoscopic colorectal cancer resection provides many clinical benefits in the form of small incision, shorter hospital stay, faster recovery, and faster return of intestinal function. In addition, it shows no significant increase of intraoperative and/or postoperative complications, and with similar oncological radicality, morbidity and mortality rates, compared with open surgery.
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The effects of adding dexamethasone to epidural bupivacaine for lower limb orthopedic surgery p. 192
Mohamed R Adel-Aziz, Mohamed G Abdelrahim, George M Nagiub
DOI:10.4103/JCMRP.JCMRP_79_17  
Introduction Dexamethasone when given epidurally with local anesthetics is known to reduce postoperative pain and postoperative analgesic consumption in several types of surgical procedures. Objective The objective of this study was to evaluate the effect of epidural dexamethasone on postoperative analgesia in patients who were undergoing lower limb orthopedic surgery. Patients and methods It is a prospective, randomized, double-blinded comparative study carried out in Assiut University Hospital, Egypt. It included 50 patients divided into two equal groups (25 in each), who underwent lower limb orthopedic surgery. The saline group: who received 15 ml epidural plain bupivacaine (0.5%)+2 ml normal saline (BS) and the dexamethasone group: who received 15 ml epidural plain bupivacaine (0.5%)+8 mg dexamethasone (2 ml) (BD). Postoperatively, when the pain score of at least 4, the rescue analgesia was given in the form of fentanyl and bupivacaine epidurally and paracetamol (perfalgan) 1 g was given routinely for all patients intravenous drip/8 h. Pain was evaluated by visual analog scale every 4 h in the postoperative 24 h. Time to first request for analgesia and total dose of rescue analgesia (epidural fentanyl/bupivacaine) in the first, 24 h postoperative was recorded. Results Dexamethasone significantly reduced the first, 24 h postoperative pain score (visual analog scale), and postoperative epidural fentanyl consumption (70.00 vs. 43.40 μg) in the first, 24 h postoperative. Dexamethasone also significantly prolonged the time to first request for analgesia (3.38 ± 0.072 vs. 15.24 ± 2.03 h). Conclusion Epidural dexamethasone with bupivacaine offers favorable effects on postoperative analgesia in lower limb orthopedic surgery.
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Enhancement of bupivacaine caudal analgesia using nalbuphine compared with fentanyl in children undergoing inguinal hernia repair p. 196
Sanaa Abdallah, Esam Abdallah, Nagwa M Ahmed
DOI:10.4103/JCMRP.JCMRP_18_19  
Introduction General anaesthesia in paediatrics is used usually accompanied with caudal block (CB) to allow for rapid and smooth recovery from anaesthesia and also for better control of pain associated with various surgical interventions especially those in the lower half of the body. However, CB using local anaesthetics alone provides short duration of analgesia. Therefore, various additives are being tested for providing longer duration of pain control. Opioids are one of the most beneficial additives to local anaesthetics in CB. Some researchers studied the analgesic efficacy of adding fentanyl or nalbuphine to different local anaesthetics in separate studies. In this trial, we wished to compare effects of adding fentanyl or nalbuphine to the local anaesthetic (bupivacaine: 0.125%) in single-shot CB. Patients and methods A total of 60 children scheduled for hernia repair operations under general anaesthesia combined with combined anaesthesia were divided into three groups: group C received caudal bupivacaine plus normal saline, group N received caudal bupivacaine plus nalbuphine and group F received caudal bupivacaine plus fentanyl. Anaesthesia was maintained with sevoflurane. Intraoperative standard monitoring was denoted every 15 min till the end of surgery which was allowed to start 15 min after caudal injection. Postoperatively, haemodynamics, pain score, adverse effects, sedation and agitation state were assessed. Results There were significant differences in postoperative pain score and sedation as group N had prolonged analgesia and prolonged sedation time than group F and group C with comparable incidence of adverse effects. Conclusion Adding nalbuphine 0.2 mg/kg to bupivacaine 0.125% provides better postoperative pain control than adding fentanyl 1 μg/kg to bupivacaine in the same concentration with comparable incidence of adverse effects.
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Risk factors of malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma p. 203
Muhammed M Ashmawy, Abdelmajeed Mahmoud, Muhammad A El-Masry, Abdallah A Abdelaal
DOI:10.4103/JCMRP.JCMRP_23_19  
Introduction Hepatocellular carcinoma (HCC) is the sixth most commonly occurring cancer in the world and the second largest contributor to cancer mortality. In Egypt, liver cancer forms 11.75% of the malignancies of all digestive organs and 1.68% of the total malignancies. HCC constitutes 70.48% of all liver tumors among Egyptians. Malignant portal vein thrombosis (PVT) is a common phenomenon and is associated with poor prognosis. Knowing the risk factors of malignant PVT in HCC helps us in the management of the disease. Objective The objective of this study was to evaluate the risk factors of malignant PVT in cirrhotic patients with HCC. Patients and methods This was a case–control study that included 100 patients of HCC on top of liver cirrhosis. A total of 50 patients had HCC with malignant PVT, and the other 50 patients had HCC without malignant PVT, in the Internal Medicine department and Al-Raghy Liver Hospital between May 2016 and May 2017. Results This study showed that raised Model For End-stage Liver Disease score [odds ratio (OR)=1.34, 95% confidence interval (CI)=1.32–3.76; P = 0.02], low serum albumin (OR = 3.21, 95% CI = 2.11–3.21; P = 0.00) and raised α-fetoprotein (OR = 2.11, 95% CI = 1.09–4.11; P = 0.01) were independent predictors for malignant PVT in patients with HCC on top of liver cirrhosis. Conclusion High Model For End-stage Liver Disease score, low serum albumin and raised α-fetoprotein are major risk factors for malignant PVT in cirrhotic patients with HCC, and HCC with malignant PVT is associated with other comorbidities, high rates of hospital admission, larger tumor size and more recurrent tumors.
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Effect of some preanalytical variables on some screening tests of coagulation: a single center experience p. 209
Nabila M Thabet, Sherif H Galal, Alyaa Abd-El Rasoul Sayed Refae
DOI:10.4103/JCMRP.JCMRP_6_19  
Background Preanalytical circumstances are significant in laboratory assessment. Prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (Fbg), measurements are basic coagulation tests used to evaluate variations of coagulation systems. Aim Investigate to what extent the storage temperature and time influence the results of routine coagulation tests (PT, APTT, and Fbg). It included a total of 120 participants were assayed for different storage temperatures. Patients and methods The platelet poor plasma was assayed for baseline values for PT, APTT, and Fbg on Sysmex 1500 apparatus, and then it was assayed for different storage temperature and time. Results The PT results showed no significant difference when compared with the baseline when samples were kept at 4°C for 12 h storage and at −20°C for 12 h. The APTT results showed significant difference when compared with the baseline at all temperatures. The Fbg results showed no significant difference when compared with the baseline when the sample were kept at 4 and −20°C for 24 h. Conclusion It is not recommended that the PT samples in normal persons be stored at room temperature but can be stored at 4 or −20°C for 12 h. APTT samples in normal persons cannot be stored up to 12 h at any temperature. Fbg samples in normal persons cannot be stored up to 24 h at any temperature. So estimation of APTT and Fbg must be done as early as possible.
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Effect of vitamin 'C' on C-reactive protein in patients with end-stage renal disease on hemodialysis p. 216
Maher Abd-El Gaber Abd-El Naser, Essam Abd-El Mohsen Mohammed, Mahmoud Ahmad Sayyed
DOI:10.4103/JCMRP.JCMRP_26_19  
Background and objectives Chronic inflammation is the most important cause of cardiovascular disease in patients undergoing hemodialysis (HD), and vitamin C – as a major antioxidant – could be effective to suppress inflammation. This study was done to determine the effect of vitamin C on C-reactive protein (CRP) in patients with end-stage renal disease (ESRD) on HD. Patients and methods The study included 80 adult patients with ESRD on regular HD who were divided randomly into two groups: In the intervention group, 250 mg of vitamin C was injected intravenously immediately at the end of each HD session three times a week for 8 weeks. In the control group, no intervention was performed. Level of CRP was measured at the baseline and at the end of the study in all patients. Results The mean age of enrolled patients was 53.98 ± 7.93 years. Out of the studied group; 62 (51.6%) patients were women. The most frequent cause of nephropathy was diabetes mellitus followed by combined diabetes and hypertension. As regards baseline level of CRP, there was no significant difference between the two studied groups. The level of CRP at the end of the study was significantly low in the intervention group (7.8 ± 6.1 mg/dl) in comparison to the control group (17.3 ± 12.2 mg/dl). Conclusion Intravenous supplementation of vitamin C in patients with ESRD on HD may modify the level of CRP and hence may protect against cardiovascular disease complications in such patients.
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The use of ultrasound and multidetector computed tomography in abdominal trauma patients at Assuit University Hospitals: a clinical audit study p. 220
Ibrahim A I. Mohamed, Hisham M K. Imam, Nisreen A A. Mohamed
DOI:10.4103/JCMRP.JCMRP_30_19  
Aim Quick diagnosis of hidden intra-abdominal injuries is mandatory to prevent morbidity and mortality in abdominal trauma patients. This is a clinical audit study aiming to evaluate the practice of ultrasonography (US) and multidetector computed tomography (MDCT) in the diagnosis of abdominal trauma patients. Patients and methods This clinical audit study was conducted from November 2017 to January 2018 in Assiut University Hospital on patients undergoing an abdominal US and abdominal MDCT scanning for the diagnosis of abdominal trauma. Results Of the 65 traumatized patients with positive focused assessment of sonography in trauma (FAST), 55 of them underwent MDCT examination while the rest of them were in critical condition and underwent immediate surgical intervention. There were 65 patients, 54 men and 11 women with a mean ± SD age 23.9 ± 14.9. Regarding the mode of trauma, the majority of the cases were due to blunt abdominal trauma (72.3%) while 27.7% had penetrating trauma. The overall sensitivity and specificity of US in the detection of solid organ injury are 45.5 and 96.3%, respectively. The sensitivity of FAST examination in the detection of intraperitoneal collection reached 98%. Conclusion US with FAST examination is the modality of choice in the initial evaluation of traumatized patients while contrast-enhanced MDCT is the imaging modality of choice in evaluating hemodynamically stable traumatic patients.
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The effect of hormonal contraception and intrauterine device on the pattern of menstrual cycle p. 225
Asmaa Ali Abd Elwadood, Gamal H Sayed, Elwany D El-Snosy, Kamal M Zahran
DOI:10.4103/JCMRP.JCMRP_28_19  
Background Many women discontinue their contraceptives owing to dissatisfaction with the method. Unscheduled bleeding is one of the main reasons cited by women for stopping a birth control method. Improving counseling and management of these adverse effects will aide in increasing satisfaction with contraceptive methods. Objective The aim of the work is to study the effects of hormonal contraceptives and intrauterine device on the pattern of menstrual cycle. Patients and methods This study was a descriptive study in family planning clinic at Women's Health Hospital, Faculty of Medicine, Assiut University, and Childhood and Maternity Care Center in the city of Dirout, Assiut, Egypt, on women using hormonal contraceptives or intrauterine devices. This study was done by using interviewing questionnaire. Results It was observed that the progestogen-only hormonal contraceptives like progestin-only pills (POPs), Depo-Provera, and Implanon produced disturbances in bleeding pattern in the majority of their users. With POPs, it was found that 22.4% of users were amenorrheic and 77.6% were menstruating. The menstrual cycle was regular in 57.9% and irregular in 42.1%. Menstrual disorders were found in 42.1% in the form of polymenorrhea in 62.5% and metrorrhagia in 32.5%. With Depo-Provera, it was found that 76.5% of users were amenorrheic and 23.5% were menstruating. The menstrual cycle was regular in 36.4% and irregular in 58.3%. Menstrual disorders were found in 58.3% in the form of oligomenorrhea in 21.4%, polymenorrhea in 42.9%, and metrorrhagia in 35.7%. With Implanon, it was found that 50.8% of users were amenorrhoeic and 49.2% were menstruating. The menstrual cycle was regular in 53.3% and irregular in 46.7%. Menstrual disorders were found in 46.7% in the form of oligomenorrhea in 50%, polymenorrhea in 14.9%, and metrorrhagia in 35.7%. Combined oral pills produced much better cycle control as compared with any of the other hormonal contraceptives. There were regular cycles in 83.7% of study users and irregular cycles in 16.3%. Menstrual disorders were found in 48.8% of study users. In this group, hypomenorrhea was seen in 66.7% and metrorrhagia was seen in 33.3%. The use of copper intrauterine device (IUD) was associated with regular menstrual cycles in 87.5% of study users and irregular in 12.5%. Menstrual disorders were found in 42.2% of study users. In this group, dysmenorrhea was found in 68.5%, metrorrhagia in 29.6%, and menorrhagia in 48.1% of these women. Conclusion This study concluded that hormonal contraceptive methods and IUD can affect the pattern of menstrual cycle and are considered risk factors for irregularity in vaginal bleeding patterns and discontinuation of the method.
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