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   Table of Contents - Current issue
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July-September 2020
Volume 5 | Issue 3
Page Nos. 237-340

Online since Monday, August 10, 2020

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REVIEW ARTICLE  

Use of hydroxyprogesterone caproate injection for prevention of preterm labor in women with different risk factors: a mini review p. 237
Ayman H Shaamash, Mohammed K Ali, Khalid M Attyia
DOI:10.4103/JCMRP.JCMRP_54_19  
Preterm birth is delivery before 37 weeks of gestation it remains a global challenge with an incidence of 11.1% (1). Progestogens are the only medications that their use showed reduction in incidence of preterm birth (2.3) they are used in asymptomatic women who are at increased risk of preterm birth based on their history and ultrasound finding of short cervical length, their use is supported and guideline recommendation published by Society for Maternal Fetal Medicine publications committee 2012 ,American collage of Obstetricians and gynecology committee on practice bulletin 2012 and European Association of PerinatalMedicine.
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OBSERVATIONAL COHORT STUDY Top

The role of circulating tumor cells as a prognostic marker in the adjuvant setting of patients with breast cancer p. 241
Summar Elmorshidy, Ola N Abdel Fattah, Hoda H Eissa, Douaa M Sayed, Samir S Mohamed
DOI:10.4103/JCMRP.JCMRP_144_18  
Background Still, there is no clinically reliable marker to detect micrometastasis or breast cancer relapse. This study aimed to evaluate the role of circulating tumor cells (CTCs) as a biomarker in patients with nonmetastatic breast cancer. Patients and methods CTC quantification was carried out using flow cytometry for 50 patients with breast cancer postoperatively: before starting, after three cycles, and at the end of adjuvant chemotherapy. The relationship between CTCs and other tumor characteristics and outcomes were studied. Results The median follow-up duration was 35 months. Before starting adjuvant chemotherapy, CTCs were positive (cutoff point ≥5/7.5 ml) in 36% of the patients and decreased to 20% after finishing chemotherapy (P = 0.04). CTCs were detected in 88.9% (n = 16 of 18) of node-positive patients and in 11.1% of node-negative patients (n = 2 of 18, P = 0.04). No significant association was found with tumor size, grading, or hormone receptor status. Distant metastasis was detected in 20% (n = 10 of 50) of patients and was significantly associated with CTCs more than or equal to 5 in 80% of them (n = 8 of 10) (P = 0.01). The presence of more than or equal to 5 CTCs at baseline was associated with a reduction in both the disease-free survival and overall survival (P < 0.001 and P = 0.003, respectively). Baseline CTCs more than or equal to 5/7.5 ml were confirmed as an independent prognostic factor in multivariate Cox hazard regression analysis for disease-free survival (hazard ratio = 3.71; 95% confidence interval = 1.62–8.48; P = 0.002) and overall survival (hazard ratio = 3.14; 95% confidence interval = 1.34–7.37; P = 0.009). Conclusions The current work suggested that the presence of more than or equal to 5 CTCs/7.5 ml at baseline would predict early disease recurrence and reduce the overall survival in patients with nonmetastatic breast cancer receiving adjuvant chemotherapy.
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ORIGINAL ARTICLES Top

Expression of programmed death ligand-1 in B-cell acute lymphoblastic leukemia p. 248
Amal M Gaber, Hanan G A. El Azeem, Mohammed A. Y A. Malek
DOI:10.4103/JCMRP.JCMRP_159_19  
Background Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy in the world. Patients with good prognostic factors have excellent survival rates with further improvement over the last decades. However, refractory ALL and relapsed ALL after hematopoietic stem cell transplantation are still associated with a poor prognosis. Immune checkpoints have gained attention in recent years in the field of oncology as a mechanism of cancer to evade immunity, but their status in B-ALL has yet to be investigated. Aim The aim was to assess programmed death ligand-1 (PDL-1) expression in newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL). Materials and methods This study was directed on 45 patients with newly diagnosed B-ALL. Surface expression of PDL-1 on the blast cells was evaluated by multicolor flow cytometry. Results The study participants exhibited a mean PDL-1 expression of 16.28%, ranging from 8.5 to 70.45%. Conclusion This study has revealed that patients with newly diagnosed B-ALL could express PDL-1 to allow cancer cells to evade the immune system, demonstrating PD-1/PDL-1 as a universal target for therapy.
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Hepatoprotective and antiobesity effects of mirabegron, a novel β3-adrenoceptor agonist, on carbon tetrachloride-induced hepatotoxicity in obese rats p. 254
Mohamed M Elbadr, Hala M El Badre
DOI:10.4103/JCMRP.JCMRP_40_19  
Introduction Mirabegron is a selective β-3 receptor agonist that is used now for the management of overactive urinary bladder disease. It has potential antiobesity and antidiabetic effects. The aim of the present study was to evaluate the possible hepatoprotective and antiobesity effects of mirabegron against carbon tetrachloride (CCl4)-induced hepatic toxicity in obese rats. Materials and methods Five groups of animals were used in the experiment. The first group was used as a control nonobese group. The second group included obese control rats that were fed on a high-fat diet. The third group was obese rats with hepatotoxicity, which was induced by injection of CCl4. The fourth and fifth groups were obese rats with hepatotoxicity and treated with mirabegron (10 mg/kg orally) and silymarin (25 mg/kg orally), respectively. After 30 days of treatment, blood samples were used for evaluation of hepatic function markers and the liver homogenate was used for the determination of malondialdehyde and reduced glutathione levels as indicators of oxidative stress. Results Mirabegron 10 mg and silymarin 25 mg/kg caused a significant reduction of body weight and Lee index of obese rats. CCl4 caused abnormalities in liver enzymes with an increase in oxidative stress markers. Treatment with mirabegron and silymarin caused improvement of hepatic function parameters and a significant reduction of malondialdehyde and increase in glutathione. Conclusion Mirabegron has a modest antiobesity effect and is useful in the treatment of hepatotoxicity. It also has antioxidant activity, which may be responsible for its effectiveness in the treatment of CCl4-induced hepatotoxicity.
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Association of serum phosphate with valvular and vascular calcification in patients with end-stage renal disease p. 262
Abdalla Kelani, Ahmed A Obiedellah, Abolhasan Haseib, Mostafa A Nashwa, Essam M Abdel Aziz, Noha G Abdelmalik
DOI:10.4103/JCMRP.JCMRP_49_19  
Aim This study aims to evaluate the calcifying effect of phosphorus on vascular smooth muscle by detecting the association between serum phosphorus and valvular and vascular calcification. Patients and methods The study included 40 patients who were diagnosed to have end-stage renal disease within the last 5 years with their age ranging from 18 to 40 years. The patients were divided into two groups according to the duration of dialysis: group I included patients on regular hemodialysis for less than 1 year and group II included patients on regular hemodialysis for 1–5 years duration. All patients were subjected to full history taking and clinical examination: laboratory investigations (urea, creatinine, parathyroid hormone (PTH), calcium, phosphorus, liver function test, sodium, potassium level), measurement of coronary artery calcification by multi-slice computed tomography (MSCT) coronary calcium scoring, vavular calcification by echocardiography, and carotid intima media thickness by gray scale ultrasound. Results Coronary calcium score, valvular calcification, and carotid intima media thickness had insignificant correlation with age, duration of dialysis, serum calcium, and parathormone hormone; however, all of them had positive moderate significant correlation with serum phosphorous level. Conclusion Hyperphosphatemia has an effective role in the progression of valvular and vascular calcification; so, good control of hyperphosphatemia may participate in preventing and delaying the progress of cardiovascular calcification and subsequently decrease cardiovascular morbidity and mortality in end-stage renal disease.
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Renal cortical thickness as an indicator of renal insufficiency in chronic kidney disease p. 268
Hassan I Megally, Mohamed Z Mohamed, Walaa H Mohamed, Maha A D. Mohamed
DOI:10.4103/JCMRP.JCMRP_55_19  
Background Chronic kidney disease (CKD) is one of the common causes of renal failure. Renal sonography is an essential diagnostic tool in nephrology. Renal sonographic dimensional parameters could be of great utility, providing indirect but valuable information about the morphostructural changes occurring in the kidney in the course of CKD. Aim To determine whether there is a relationship between renal cortical thickness and renal length measured on ultrasound and the degree of renal insufficiency in patients with CKD. Patients and methods From December 2016 to October 2017, 50 patients with clinically stable chronic renal insufficiency participated in this study. Renal sonographic parameters including length of the kidney, cortical thickness, and renal echogenicity were measured. Serum creatinine was used for estimated glomerular filtration rate using Cockcroft and Gault equation for all patients. Results The most common cause of CKD in our patients was systemic lupus (22%) followed by hypertension (16%). The mean renal length was 97.6 ± 12.2 mm, the mean cortical thickness was 9.38 ± 1.79 mm, the mean serum creatinine level was 2.46 ± 1.74 mg/dl, and the mean value of estimated glomerular filtration rate using Cockcroft and Gault equation was 60.95 ± 53.78 ml/min. There was a high statistically significant relationship between cortical thickness and creatinine clearance (r = 0.67,P < 0.001), and also statistically significant correlation of renal length with creatinine clearance (r = 0.42, P = 0.002) was reported, but the strongest relationship was for mean cortical thickness. Conclusion Renal cortical thickness measured at ultrasound appears to be more closely related to the degree of renal impairment in patients with CKD than renal length.
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Study of the accuracy and diagnostic yield of chest radiographs in children with cardiac diseases p. 274
Salah-Eldin A Amry, Duaa M Raafat, Neveen A Tawfik
DOI:10.4103/JCMRP.JCMRP_61_19  
Introduction The chest radiograph (CXR) still has an important role in the diagnosis of heart diseases. We aim by this study to evaluate the use of CXR in the Pediatric Cardiology Unit in Assiut University Children Hospital for children (4–10 years old) with suspected heart disease. Patients and methods This was a 6-month, case series clinical study undertaken in the inpatient Pediatric Cardiology Unit, Assiut University Hospital, Assiut City, Egypt, between the first of March 2017 and the 31st of August 2017. Results It was observed that the percentage frequency of cases with true chamber enlargement and/or hypertrophy among cases diagnosed as having computed tomography ratio of more than 50% in the CXR was 64%, and CXR sensitivities for cardiac chamber enlargement in comparison with the gold standard test (ECHO) were 93.9% for the right atrium, 87.5% for the left atrium, 68.4% for the right ventricle, and 68.4% for the left ventricle. The CXR specificities for cardiac chamber enlargement in comparison with ECHO were 71.4% for the right atrium, 88.2% for the left atrium, 90.3% for the right ventricle, and 87.1% for the left ventricle. Conclusion Auditing the guidelines of interpretation of the CXR for children aged 4–10 years that were used in the pediatric cardiology unit of Assiut University Hospital for Children, the following could be concluded: The sensitivities and specificities of CXR in diagnosing specific chamber enlargement are still inadequate; depending on echocardiography in such data is the most accurate; and chest roentgenogram is accurate in detecting cardiac site and situs.
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Evaluation of the efficacy of accelerated hepatitis B vaccine among students of Assiut Nursing School and College p. 279
Abdel G A. Soliman, Mohamed A A. Ghaliony, Mohamed Z Abdel Rahman, Mohamed A M. Omar
DOI:10.4103/JCMRP.JCMRP_116_19  
Introduction Hepatitis B (HB) vaccine prevents infection with hepatitis B virus, thus reducing the incidence of chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and transmission of infection to susceptible individuals. Vaccine-induced immune response is defined as anti-HBs titer greater than 10 mIU/ml after complete vaccination schedule. Aim The aim was to evaluate the efficacy of accelerated HB vaccine among students of Assiut Nursing School and College. Participants and methods This study included 100 students of Assiut Nursing School and College, and 10% of them had received only a single dose of HB vaccine previously (in the period 6–12 months before the study) but had not completed the vaccination schedule, and their prestudy anti-HBs titer was less than 10 mIU/ml. Prevaccination testing of HBs Ag, Anti-HBs, Anti-HBc IgG, and HCV-Ab was negative. A vaccination schedule of 0, 1, and 2 months was used. Then, anti-HBs were measured one month after the last vaccine dose to detect antibody response by third-generation ELISA. Results Postvaccination anti-HBs titer was significantly higher in comparison with its prevaccination level (4.072.62 before vs 66.44±11.61 after vaccination; P=0.01). The authors found that students receiving a single dose of HB vaccine in the period 6–12 months before the study had high anti-HBs titer either before the study (9.78±2.01) and after the study (179.50±40.11) in comparison with those not receiving a vaccine dose recently. Conclusion Seroprotection rate was 100%, that is, all enrolled participants show postvaccination anti-HBs titer greater than 10 mIU/ml, and students with a higher prevaccination anti-HBs titer had a higher postvaccination anti-HBs antibody titer.
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Efficacy of autologous platelet-rich plasma combined with microdermabrasion compared with platelet-rich plasma alone on postacne scars p. 284
Azza M Abdel-Meguid, Hisham Z Abdel Hafez, Sohair K Sayed, Reem R Hasanen
DOI:10.4103/JCMRP.JCMRP_158_19  
Background Acne is an inflammatory disorder of the pilosebaceous units. The severity of acne scarring depends on delays in treating acne patients. Objective To assess the effect of platelet-rich plasma (PRP) in cases of postacne scar and compare the effect of PRP alone and in combination with microdermabrasion on postacne scars. Patients and methods Twenty adult facial postacne scar patients were enrolled. Goodman and Baron's scale and ECCA scale were used to determine the severity of acne scars. PRP was injected after microdermabrasion on the right side of the face, while PRP was injected alone on the left side of the face. This was done regularly each month for three sessions. Evaluation of improvement was assessed by Goodman and Baron qualitative scale and ECCA scale for each patient both at the baseline and 1 month after the last session, along with photography. Results There was an increase in the scar outcome in the side treated with combined therapy, but it did not reach a significant level between both sides of the face by all objective methods of assessment. Conclusions PRP alone or in combination with microdermabrasion is an effective modality for the treatment of postacne scars.
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Computed tomography perfusion imaging of colorectal cancer in correlation with tumor grades p. 290
Peter E M. Saba, Afaf A. E K. Hassan, Mostafa A M. Al-Sharkawy, Lamiaa M Refaat
DOI:10.4103/JCMRP.JCMRP_3_20  
Objective Preoperative evaluation of tumor grading has essential implications in the treatment and prognosis in patients with colorectal cancers (CRCs). The aim of this study was to find the correlation between computed tomography (CT) perfusion parameters of CRC and each grade of it and the determination of the most important predictive parameters of CT perfusion for poorly differentiated CRCs. Patients and methods The study included 51 patients with colorectal carcinoma, pathologically proven by endoscopic biopsy. The patients underwent CT perfusion using a 16-row CT scanner. Quantitative values for blood flow, blood volume, mean transit time, and permeability surface were determined. Then the correlation between CT perfusion parameters and postoperative histopathological tumor grades was evaluated. Results Among CT perfusion parameters, there were significant differences in blood flow and blood volume between well-differentiated, moderately, and poorly differentiated CRCs (83.77±17.29 ml/100 g/min, 98.80±34.07 ml/100 g/min, 48.50±22.29 ml/100 g/min) and (7.20±2.32 ml/100 g, 7.44±3.73 ml/100 g, 4.62±3.03 ml/100 g), respectively. There were no significant differences as regards other perfusion parameters. Conclusion Among CT perfusion parameters, blood flow and blood volume can be used as predictive parameters for CRC grading. They show significantly lower values in poorly differentiated CRCs than in moderately differentiated and well-differentiated CRCs.
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A descriptive study on acute gastroenteritis with convulsion: 1-year analysis p. 295
Mohamed A E. Desokey, Fardous H Abd-Elaal Abd-Elhafez, Nagla H I. Abu-Faddan
DOI:10.4103/JCMRP.JCMRP_5_20  
Introduction Several etiologies explain the occurrence of seizures with acute gastroenteritis, such as electrolyte abnormalities and dehydration, a high fever, infectious fragments of pathogens crossing blood-brain barrier and causing significant central nervous system damage, septicemia, intracranial hemorrhage, and hypoglycemia. The aim of this study was to detect the frequency and etiology of convulsion in children with acute gastroenteritis admitted to Assiut University Children Hospital during 1 year from January 2017 to the end of December 2017. Patients and methods This is a one-year descriptive study that was carried out on 130 patients having acute gastroenteritis with convulsion, aged from 1 month to 5 years. Patients were divided according to the age into two groups: group 1, from 1 to 12 months of age, and group 2, from more than 1 to 5 years. All cases were subjected to full history, complete physical examination, and investigations, which included complete blood count, serum electrolytes, renal function tests, arterial blood gases, random blood sugar, and blood culture, which was done only when sepsis is suspected. Results The results show that the frequency of convulsion was 4.6%. The most common cause was electrolyte disturbance, which was noticed in 106 (81.5%) cases, followed by central nervous system infection, which was noticed in 39 (30%) cases, then septicemia and hypoglycemia, which were noticed in 13 (10%) cases each, then febrile convulsion, which was noticed in 11 (8.5%) cases [regarding febrile convulsions, there was a statistically significant difference between the two age groups (P = 0.027)], and lastly, intracranial hemorrhage, which was noticed in five (3.8%) cases. Conclusion Convulsion is one of the most serious complications associated with acute gastroenteritis. A younger age group (1–12 months) is more susceptible to complications than the older age group. Electrolyte disturbance is still a major cause of convulsion with acute gastroenteritis.
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Microperc versus miniperc for the management of medium-sized renal stones: a comparative two-center clinical study p. 301
Amr A Gaber, Medhat Abdallah, Hassan Abolella, Esam Othman, Bianchi Giampaolo, Michael Truss
DOI:10.4103/JCMRP.JCMRP_6_20  
Objective To date, there is very little evidence directly comparing the outcomes between Mini-percutaneous nephrolithotomy and Micro-percutaneous nephrolithotomy. Because of this evidence gap, we wanted to compare miniperc and microperc with an ultimate purpose to determine which modality is preferred for different stone characteristics. Our hope is that these findings may help guide which technique is most suitable for a given renal stone burden. Patients and methods This is a retrospective collaborative multi-institutional study between Dortmund Teaching Hospital (Germany) and Modena University Hospital (Italy) in which we compared two matched groups of patients. The first group (32 patients) underwent miniperc for medium-sized renal stones in Dortmund, and the second group (19 patients) underwent microperc in Modena. Both groups were matched according to age, sex, BMI, and maximum stone diameter according to preoperative plain KUB films. Results The primary stone-free rates in the miniperc and microperc groups were similar (93.8 vs. 84.2%, P = 0.262). Mean operative time for miniperc was significantly shorter than that of microperc (45.6 ± 18.9 vs. 68.7 ± 35.2 min, P = 0.004). The overall complication rate was 11.7%, with no significant difference between the two groups (12.5% for miniperc vs. 10.5% for microperc, P = 0.604). Mean hospital stay in miniperc was significantly longer than that of microperc (4.7 ± 1.6 vs. 3 ± 1.5 days,P < 0.001). Conclusion Our current data show that microperc is emerging as an effective and safe treatment option for intermediate-sized kidney stones, with outcomes comparable even to miniperc, which is already a well-established treatment with high safety profile in experienced hands.
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Relationship between mean macular thickness and visual acuity in diabetic patients p. 306
Miadaa H Hassaneen, Mohammed T A. Elmoneim, Wael M A. Soliman, Mohamed S Hussien
DOI:10.4103/JCMRP.JCMRP_7_20  
Objective The aim of the study was to correlate the relationship between optical coherence tomography (OCT) changes and visual acuity in patients with diabetic retinopathy (DR) compared with nondiabetic healthy persons. Patients and methods This study was done at Alforsan Eye Research Center, Assiut, Egypt. OCT was done at the center in the period from January 2018 to October 2018. This study was performed on 142 eyes of 71 adults who were divided into two groups. The first group was the diabetic group that included 102 eyes of 51 patients, whereas the second group was the nondiabetic group that included 40 eyes of 20 control. Results In this study, the mean macular thickness in normal individuals was (224.61 ± 8.8 μm). The authors found that the mean macular thickness of the diabetic patients included in this study was (327.9 ± 11.2 μm), which represents a statistically significant increase in thickness compared with the control (P < 0.001). Central macular thickness (CMT) measured by OCT was significantly correlated with best corrected visual acuity (r=−0.375 which represents a moderate significant negative correlation). Conclusion This study indicated that the CMT in OCT has a negative moderate correlation with visual acuity, which means that patients with decreased macular thickness have better visual acuity. The authors also reported a positive mild correlation between age in years and CMT, which means that increase in the age of patients was associated with an increase in CMT.
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Evaluation of stereotaxy in the management of brain abscess p. 311
Mostafa M Kashef, Mohamed A Ragaee, Wael M Ali, Abdin K A. Kasim, Radwan N Mahmoud
DOI:10.4103/JCMRP.JCMRP_10_20  
Background Stereotaxic surgery began in 1908, when Sir Victor Horsley and Robert Clarke introduced their apparatus. Brain abscess (BA) is a life-threatening condition and has different modalities of treatment. One of these modalities is stereotactic aspiration. Aim The aim of the study was to evaluate and demonstrate the outcome of stereotactic-guided aspiration of BA. Patients and methods This is a prospective, descriptive study that included 20 patients with different intracranial abscesses aspirated by stereotaxy. Inclusion criteria: deep-seated abscesses that are located near or within eloquent structures. Multiple BAs differ in size with the largest one with mass effect. Compromised patients with poor general condition are considered to be poor candidates for open surgery. Exclusion criteria: all patients who will need surgical excision due to any cause such as posterior fossa abscess, large superficial BA close to the cortical surface. The authors did computerized tomography scan with contrast for all patients preoperatively, within the first 72 h postoperatively and after 6 months. Results The authors aspirated BAs from 20 patients of whom 14 were men. Most of these patients had single abscess (n=17). The most common presenting symptom is headache which is found in 16 patients. The most common sites for abscesses were brain stem and basal ganglia in half of the patients. The only complication found postoperatively was hemorrhage in only two patients. Only two (about 10%) cases showed residual abscess in 6 months follow-up. Conclusion The authors found that stereotaxy is very helpful in the cases with localization of the abscess, reducing morbidity and mortality of the cases, leading to save the resources.
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Prognostic value of electroencephalography pattern in prediction of survival and early myoclonus after cardiac arrest p. 316
Silvana M Nageeb, Hamdy N A. El Tallawy, Khaled A Elmaghraby, Reda Badry
DOI:10.4103/JCMRP.JCMRP_12_20  
Background Evolution of the electroencephalography (EEG) background pattern is a robust contributor to the prediction of poor or good outcome of comatose patients after cardiac arrest (CA). Aim The aim of the study was to use EEG as a prognostic tool for the prediction of survival after CA and the incidence of early postanoxic myoclonus. Patients and methods We enrolled 40 patients, post-CA. A 30-min EEG was performed on all patients, as soon as possible after the patients had arrived in the ICU using a portable EEG. Results Out of the 40 patients studied, 29 (72.5%) were alive while 11 (27.5%) patients were dead: Regarding patterns of EEG, 86.2% of alive patients had a benign pattern, while 63.6% of dead patients had a highly malignant pattern. Regarding the cerebral performance category (CPC), 79.3% of alive patients had cerebral performance grade 1 (CPC 1) while 54.5% of dead patients had CPC 4. Frequency of seizures after resuscitation was significantly higher in dead patients (45.5%) versus 17.2% in alive patients (P = 0.03). Conclusion Benign EEG patterns and CPC 1 and CPC 2 were correlated to good outcome in patients post-CA in comparison to malignant EEG pattern and CPC 3 and CPC 4, respectively. Presence of early posthypoxic myoclonus had been invariably related to poor outcome.
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Management of postcholecystectomy biliary injury in Assiut University Hospital clinical audit p. 322
Mohy E D. El-Shafei, Ashraf A Helmy, Mohamed A F. Ahmed
DOI:10.4103/JCMRP.JCMRP_14_20  
Introduction Laparoscopic cholecystectomy, first introduced in France in 1987, has rapidly substituted open cholecystectomy for the treatment of symptomatic cholelithiasis. Bile duct injuries have remained an important complication and have become more frequent in the era of laparoscopic cholecystectomy. Aim The aim was to compare the management of post-cholecystectomy biliary leakage in patients in Assiut University Hospital with management guidelines through planning for improving our management of biliary leakage, correction of obstacles to achieve less morbidity and less mortality which result from biliary leakage. Patients and methods An observational study was conducted on 30 patients with post-cholecystectomy biliary injuries admitted in the Surgery Department of Assiut University Hospitals from 2017 to 2018. All patients were grouped into either surgical or endoscopic, percutaneous drainage managed groups. Results The most common presentation postoperatively is bile leakage in 14 of the patients (46.66%), followed by jaundice in six patients (20%), and abdominal pain in four patients (13.3%); only two patients discovered during operation has bile duct injury (6.66%) and in the postoperative period in the first month (86.6%). The most common type of bile duct injury occur in open cholecystectomy (73.33) more than in laparoscopic (26.66). Cholangiogram was done in 25 patients. The main cholangiographic picture was minor leakage in about 52% from Cystic duct (CD), stricture above the level of CD in 8%, and common bile duct (CBD) ligation injury in 40%. Conclusion In conclusion the most common type of post-cholecystectomy problems are biliary leakage, followed by ligation of CBD, missed CBDSs, and finally biliary stricture. Endoscopic management is relatively simple, reversible, and minimally invasive. Thus, endoscopic management should be an integral part of the therapeutic algorithm in majority of patients with significant biliary tract injuries.
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The use of GeneXpert Mycobacterium tuberculosis/rifampicin assay in diagnosis of pulmonary tuberculosis in children p. 327
Mohammed S Abdelwahab, Fardous H Abdel-Aal, Shereen M Galal
DOI:10.4103/JCMRP.JCMRP_16_20  
Introduction Rapid diagno sis of tuberculosis (TB) is essential for early disease management. GeneXpert (GX) test is a novel rapid diagnostic modality. In this study, we aimed to evaluate the diagnostic role of GX test in diagnosing pulmonary tuberculosis (PTB) in children as well as detection of rifampicin (RIF) resistance. Patients and methods This was a cross-sectional study that included 80 patients suspected to have PTB based on clinical data together with at least one of the followings: a positive tuberculin skin test or QuantiFERON-TB Gold In-Tube test result, a positive blood TB PCR result, or a positive Ziehl–Neelsen staining result. Results PTB was more common in older females. Extrapulmonary manifestations and hilar lymphadenopathy were more frequent in younger age. Both positive tuberculin skin test and positive GX were more frequent in older age. Positive GX was found in 30 (37.5%) cases, and RIF resistance was detected in two (6.6%) of them. Positive GX results were more frequent in sputum than gastric aspirate samples. Positive GX results were more frequent with absent Bacillus Calmette–Guérin scar, and with hemoptysis, failure to thrive, cavitary lung lesions, and lower mean hemoglobin. Conclusion GX detects many more cases than blood PCR and Ziehl–Neelsen stain. GX had 70% sensitivity and 95% specificity in diagnosing PTB, with overall diagnostic accuracy of 86.67%, with better performance in older children who could expectorate. RIF resistance was ∼6.6%.
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Assessment of radiological evaluation of penetrating chest trauma patients at the Radiodiagnosis Department, Assiut University Hospital: an audit study p. 332
Moustafa T K. Al-Hussaini, Eman A El-Hamd Ahmed, Nisreen A A Mohammed
DOI:10.4103/JCMRP.JCMRP_17_20  
Introduction Penetrating chest trauma is one of the most common forms of trauma presented to Assiut University Hospital. Each year, more than 300 cases of penetrating chest trauma are encountered in the emergency unit. Firearm shots and penetrating stabs are the most common causes, yet it may be a result of industrial accidents, falls, collisions, or blast injuries. The presentation of penetrating thoracic trauma can vary widely, from stable patients with few complaints to hemodynamically unstable patients requiring immediate life-saving interventions. Even apparently stable patients with penetrating chest injuries can deteriorate precipitously; and a focused evaluation must be rapidly performed to assess for life-threatening conditions. Penetrating chest trauma is generally less common but more deadly than blunt chest trauma. According to small retrospective reviews, chest injuries are a relatively common cause of preventable death among trauma patients. Patients and methods This study was conducted in patients who are presented by penetrating chest trauma to the Assiut university hospital trauma unit during the period from the 1st of October to the 31st of December 2017. After history taking and clinical examination, all patients were subjected to chest radiography in the radiology department, followed by multislice computed tomography (MSCT) chest in seven cases who needed further imaging. Aim The aim of the study was to determine the need for multislice computed tomography of the chest in patients with penetrating trauma to the chest after initial radiographic screening at Assiut University Hospital during a period of 3 months. Results This study was conducted on 47 patients presented with penetrating chest trauma to the Trauma Unit – Assiut University Hospital, from October 1 to December 31, 2017; about 85% of them did not need further assessment by multislice computed tomography of chest. Conclusion In the majority of penetrating chest trauma cases, a 'chest radiography' was sufficient for diagnosis and management of the patients.
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Role of diffusion-weighted magnetic resonance imaging in the characterization of uterine neoplasms p. 337
Mohamed N. Abd El Hafeez, Eman A Ahmed, Ehab M Mohammad, Hisham A El Sayed, Mohamed Abdel-Tawab
DOI:10.4103/JCMRP.JCMRP_19_20  
Context Uterine malignant neoplasms are considered a frequent major cause of mortality. Aims To detect the role of diffusion-weighted images in assessing uterine neoplasms. Settings and design Department of Radiology, Assiut Faculty of Medicine, Egypt. Department of Obstetrics and Gynecology, Assiut Faculty of Medicine, Egypt. Patients and methods Our study included 20 patients with uterine neoplasms. All patients were examined by pelvic advanced MRI techniques with diffusion MRI. Statistical analysis Categorical data were reported in frequencies and percentages. Quantitative data were reported as mean (SD) and evaluated for statistically significant differences between both groups utilizing independent Student's t test. Results The apparent diffusion coefficient value in benign uterine lesions is equal to 1.088 ± 0.146 and for the malignant lesions it is equal to 0.658 ± 0.178 with a P value of 0.000 which is highly significant. A cutoff apparent diffusion coefficient value of 0.85 × 10-3 mm2/s for malignant lesions resulted in 91.7% sensitivity, 100% specificity, 100% positive predictive value, 88.7% negative predictive value, and 91.67% accuracy. Conclusions Diffusion-weighted image has a great role in differentiating malignant and benign uterine neoplasms.
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