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   Table of Contents - Current issue
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September-December 2017
Volume 2 | Issue 3
Page Nos. 151-198

Online since Monday, June 25, 2018

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REVIEW ARTICLE  

No chest tube protocol in video-assisted thoracic surgery procedures Highly accessed article p. 151
Moustafa M El-Badry, Hussein Elkhayat, Gamal A Makhlouf, Ahmed Ghoneim
DOI:10.4103/JCMRP.JCMRP_22_17  
The urge for less pain, earlier mobility, low financial cost, and better cosmetic outcome has driven the everlasting pursuit of thoracic surgeons for smaller incisions, low port number, and shorter hospital stay. Management of chest tubes is pivotal in the postoperative care of patients submitted to thoracic surgeries. However, thoracic surgeons have traditionally managed chest tubes based more on their experience and personal preference rather than guided by an evidenced-based approach. Chest tubes increase the rate of postoperative pain and hospital stay, and the removal of a chest tube improves ventilator function and reduces chest pain after pulmonary resection. Removing a chest tube sooner not only has financial benefits but also has beneficial functional effects for the patient. Upon witnessing the benefits of early removal of chest tubes after video-assisted thoracic surgery procedures, some surgeons are starting to adopt a no chest tube protocol especially in thoracic procedures, in which the lung is left untouched. Upon reviewing the papers published on avoiding chest tubes in video-assisted thoracic surgery procedures, it showed that such a technique can be safely used without affecting the quality of the procedures. Moreover, it can lead to a more favorable postoperative course.
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ORIGINAL ARTICLES Top

Smoking profile among male resident doctors at Assiut University Hospitals p. 153
Atef F Al Karn, Wafaa Gadallah, Alaa A Kasem
DOI:10.4103/JCMRP.JCMRP_19_17  
Introduction Doctors act as role models, information providers, and risk behavior modifiers. Therefore, studying their smoking habits and attitudes is important. The aim of this study was to explore smoking habits among young doctors, and to study their knowledge, attitude, and action toward smoking. Materials and methods This is a field study with a total of 229 male residents (24–28 years). Women were not included as they rarely smoke. A questionnaire was filled including details of smoking profile and attitudes toward smoking. Results Regular smokers constituted 11.3%, occasional smokers 3.1%, ex-smokers 0.9%, and never-smokers 84.7%. Smoking was 29.7% among married men compared with 9.7% in single men (P < 0.01). In all, 74.3% were cigarette smokers, and 20% used a water-pipe. In all, 77.1% started smoking while studying at the Faculty of Medicine. To pass stress was the cause for starting in 77.1%, and 75.8% continued smoking because they believed it is anxiolytic. Hospital resident house was the place where they mostly smoked (81.8%). In all, 21.2% of the smokers smoke also at work, and 12.1% smoke even in front of patients. Knowing or hearing about smoking cessation methods was as follows: 59.8% behavioral therapy, 76.9% nicotine replacement therapy, 17.9% varenicline, and 0.9% bupropion. A total of 99.6% of smokers had heard about the electronic cigarette; 94.3% strongly agreed that giving advice to stop smoking is one of the doctors' jobs. However, 27.5% always, 7.4% mostly, 21.4% occasionally ask about smoking history. In addition, among the doctors who ask about smoking history, only 14.7% always ask and 45% mostly give advice for discovered smokers to quit. Conclusion These results highlight the need to protect young physicians from taking the habit of smoking, and to motivate and educate them to help their smoking patients to quit.
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Prevalence of ovarian hyperstimulation in normal responders receiving letrozole in assisted reproductive technology: A randomized controlled trial p. 157
E Ihab, M Alaa Eldeen, A Elwany, Amr Sh
DOI:10.4103/JCMRP.JCMRP_31_17  
Introduction The use of letrozole, a selective aromatase inhibitor, induces follicular maturation. Randomized controlled trials addressing the utility of letrozole in normal responders are few. We evaluated whether incorporation of letrozole could be effective in decreasing ovarian hyperstimulation syndrome (OHSS) in normal responders undergoing intracytoplasmic sperm injection cycles. Objective The objective of this study was to compare the aromatase inhibitor (letrozole) with low-dose gonadotropins versus the standard long protocol for controlled OHSS in normal responder women undergoing intracytoplasmic sperm injection in terms of OHSS. Patients and methods This was a randomized noninferiority clinical trial registered in clinicaltrials.gov (NCT02429999). This study was conducted in Assiut University Fertility Center, from January 2015 to April 2016, and included 61 normal responder women randomized in a 1: 2 ratio. Twenty-one women (study group) received letrozole at a 10 mg daily dose from days 3 to 7 together with follicle-stimulating hormone (FSH) 75 IU/day from day 5. Gonadotropin-releasing hormone antagonist (orgalutran 0.25) is given when the follicle size is equal to 14 mm until human chorionic gonadotropin injection. Forty women (control group) received 0.1 mg decapeptyl from day 21 in the preceding cycle and continuously stimulated by FSH (150–225 IU/day) from day 2. The total dose of FSH received, number of mature oocytes, good-quality embryos, and OHSS were evaluated in both groups. Statistical analysis was done using Student's t-test and χ2-test when appropriate. Results Comparable rates for maturation index, fertilization, and good-quality embryos were yielded by both groups. The incidence of OHSS was significantly lower in the letrozole group compared with the long protocol group (P = 0.03). Conclusion Minimal stimulation protocol using letrozole with gonadotropins may form an effective tool to decrease the incidence of OHSS in in-vitro fertilization cycles in normal responding women.
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Prevalence, knowledge, and attitude toward complementary and alternative medicine use among patients with chronic hepatitis C in Upper Egypt p. 162
Soha S Abdel-Moneim, Ahmad F Al-Sayed Hasanain, Zeinab R Mohammed
DOI:10.4103/JCMRP.JCMRP_34_17  
Background Complementary and alternative medicine (CAM) encompasses different types of treatments and procedures that are based on traditions and are not scientifically sound; however, they are still used to 'complement' physician-prescribed drugs. Unfortunately, we lack local studies about CAM usage in patients with chronic hepatitis C (CHC) in Egypt. Aim The aim was to establish CAM prevalence among patients with CHC attending Assuit University Hospital and explore the knowledge and attitude toward using CAM among patients with CHC while using the interferon-based therapy and direct-acting antiviral drugs (DAAs). Patients and methods A cross-sectional survey using a screening questionnaire was used to collect data from patients attending Assiut University Hospital from April 2015 to April 2016. Results Of 750 patients, knowledge about CAM was positive among 610 (81.3%) patients, a positive attitude toward CAM was seen among 570 (76%) patients, and 479 (63.9%) patients stated using CAM. Of the 250 patients who used DAAs, 194 (77.6%) have used CAM, and 19 (9.7%) of them would continue on CAM after the use of DAAs. Conclusion A total of 479 (63.9%) patients used CAM in the study (285 undergoing interferon-based therapy and 194 at DAAs). Approximately, two-thirds of patients have used more than one type of CAM during the course of their disease. A small percentage (9.7%) of patients is still willing to continue using CAM even after the use of DAAs.
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Levator recession with adjustable sutures in management of upper eyelid retraction p. 167
Omar Mohammed Ali, Abd El-Nasser A. Mohammed, Hazem Abdel EL-Motaal Hazem, Shymaa Kamel Ibrahim
DOI:10.4103/JCMRP.JCMRP_27_17  
Purpose To assess the efficacy of levator recession with adjustable sutures in treatment of upper eyelid retraction. Patients and Methods Patients with upper eyelid retraction were included in this prospective, non-randomized, interventional case series study. All patients underwent correction of upper eyelid retraction with levator recession using adjustable sutures ,and were followed up every week for a month, then monthly for three months. In each visit, the margin reflex distance (MRD1) and palpebral fissure (PF) were measured. Results The included patients of the present work were classified into 3 groups: Group A: lid retraction secondary to over correction of ptosis, group B: thyroid related lid retraction, and group C congenital lid retraction. Among the 17 patients that participated in the follow-up examination, mean age ± SD was 21.12 ± 13.73 years (range 7–52 years). Eight were males and nine were females. Mean ± SD (range) of central height of the palpebral fissure was 13.79 ± 1.37 mm (10–16 mm) preoperatively, and 11.04 mm (9–12 mm) at follow up. Mean ± SD (range) of MRD1 was 6.77 ± 0.86 mm (5–8 mm) preoperatively, and 4.78 mm (4.5–5 mm) at follow-up. Conclusion Levator recession with adjustable sutures is effective technique in treatment of upper eyelid retraction of all degrees with different causes. However,increase the number of cases with long term follow up are recommended.
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Depression among Egyptian patients with psoriasis attending Assiut University Hospital p. 173
Wageeh A N. Hassan, Ahmed A Abdel-Rahman, Hisham D Gaber, Khaled M Hassan
DOI:10.4103/JCMRP.JCMRP_28_17  
Aim Psoriasis is an immune-mediated genetically determined common dermatological disorder. Psoriasis has the potential for significant psychological and social morbidity. Depression is the most common psychiatric disorder associated with psoriasis. The aim of this study was to evaluate depression among patients with psoriasis attending Assiut University Hospital. Patients and methods This was a cross-sectional study consisting of 100 patients with psoriasis who met the inclusion criteria. All eligible patients were subjected to the following tools: beck depression inventory, psoriasis disability index, and short form-36 quality of life questionnaire. Results and conclusion The results show that depression is highly significant among patients with psoriasis. The overall prevalence of depression was 76% among patients with psoriasis, and 60% of the patients presented with moderate and severe depression. There was a significant negative correlation between depression and quality of life. There was a significant positive correlation between depression and duration of psoriasis. Female sex and long duration of the disease were found to be risk factors for the occurrence of depression among patients with psoriasis.
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Preliminary results of internal fixation of symphyseal disruption using Assiut Symphyseal Plate: a novel biplanar plate design p. 177
Osama Farouk, Mohamed Y Hassanein, Aly M Mohamed, Faisal F Adam
DOI:10.4103/JCMRP.JCMRP_17_17  
Introduction Plate fixatio n remains the primary method of internal fixation of symphyseal fractures. Literature shows great controversy on ideal plate design for symphyseal fixation. The aim of this study is to evaluate reduction and fixation capabilities of Assiut Symphyseal Plate (ASP). Patients and methods Traumatic symphyseal injuries in 14 patients were fixed with ASP between November 2013 and June 2016. The plate is a biplanar titanium locked plate designed in Assiut University Hospital. Radiological and functional outcomes were assessed at 2, 6, and 12 months postoperatively. Results Seven patients had fracture pelvis tile type B and seven had fracture pelvis tile type C. Satisfactory reduction was achieved (Dujardin criteria; symphyseal distance <5 mm) in 12 patients. No significant loss of reduction occurred over 1 year postoperatively. Functional outcome (Majeed functional score) was excellent in 11 cases, good in two cases, and fair in one case. Conclusion ASP can be used in the fixation of symphyseal injuries safely with good radiological and functional outcome. Further studies are needed to compare results with conventional plates.
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Clinical audit on the management of acquired platelet disorders in Assiut University Children Hospital p. 183
Abdelrahman M Ahmed, Mohamed H Ghazaly, Eman A Asker
DOI:10.4103/JCMRP.JCMRP_16_17  
Introduction Platelet disorders lead to defects in primary hemostasis and produce signs and symptoms different from coagulation factor deficiencies (disorders of secondary hemostasis). Primary hemostatic disorders are characterized by prolonged bleeding time and the characteristic physical examination in the form of mucocutaneous bleeding. Initial laboratory evaluations for patients with acquired platelet disorders include complete blood count and peripheral blood smear. Treatment of patients with suspected acquired platelet disorder is generally specific to the underlying disorder. Patients and methods Data of children older than 1 month of age admitted with bleeding tendency caused by acquired platelet disorders during 1 year were collected and analyzed, and clinical management was compared with the standard management guidelines according to the American Society of Hematology 2011. Results In all patients, complete blood count was performed, whereas peripheral blood smear was performed only for 46 (60.5%) cases. Bone marrow examination was performed in 30 (39.5%) cases and it was indicated in 23 (77%) of these cases, whereas in seven (23%) cases it was done for purpose of research with guardian consent. Medical treatment (in the form of intravenous immunoglobulin and/or corticosteroids) was provided to seven (9%) cases in whom treatment was not indicated. Intravenous immunoglobulin was administered to 22 (29%) cases, and there was a delay in its administration to 10 (45%) of these cases because of unavailability. Corticosteroids were administered to 26 (34%) cases; eight (31%) of these cases received it for a longer time than indicated. Anti-D immunoglobulin was not administered to any patient.
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Sonographic and laparoscopic findings in women presenting with chronic pelvic pain p. 186
Hasan S Kamel, Ahmed M Abu-Elhassan, Mahmoud A Abdel-Aleem, Amany A Ibrahim
DOI:10.4103/JCMRP.JCMRP_70_17  
Objective The aim of this study was to assess the value of transvaginal ultrasound (TVS) examination in predicting the etiological factors of chronic pelvic pain (CPP) in comparison with laparoscopic findings. Patients and methods This is a prospective observational study. This study was conducted in Women Health Hospital, Assuit University. A total of 40 patients, 20 with CPP and 20 seeking for fertility as a control group, undergoing TVS before diagnostic laparoscopy were included in the study. TVS examination was performed. Ultrasound hard markers were documented (anatomical abnormalities – e.g. endometrioma or hydrosalpinx). The woman was then assessed for the presence or absence of ultrasound soft markers (reduced ovarian mobility, site-specific pelvic tenderness, and the presence of loculated peritoneal fluid in the pelvis). Then diagnostic laparoscopy was performed. Assessment of the value of TVS in predicting the etiological factors of CPP in comparison with laparoscopic findings was the main outcome measure. Results Laparoscopy diagnosed pathological lesions in 18 (90%) CPP patients, of whom 10 (55.5%) patients had endometriosis, 10 (55.5%) had pelvic adhesions, 1 (5.5%) had ovarian cyst, 3 (16.6%) had tubal block, and 1 (5.5%) had subserous fibroids. The diagnostic accuracy of ultrasound hard marker examination of CPP was 30%, which increased to 80% by the addition of ultrasound soft marker examination. Conclusion Inclusion of site-specific pelvic tenderness, ovarian mobility, and the presence of loculated peritoneal fluid in the pelvis as indirect ultrasound-based markers of pelvic pathology improved diagnostic accuracy of TVS and hence improved the detection and exclusion of significant pathology in women with CPP and may lead to a reduction in the number of unnecessary laparoscopies carried out on women with CPP.
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Platelet apoptosis in pediatric immune thrombocytopenia p. 192
Osama B Sedeek, Ashraf E Abdelsalam, Heba A. Abd El Hafeez, Zeinab A Zahran
DOI:10.4103/JCMRP.JCMRP_50_17  
Introduction Immune thrombocytopenia (ITP) is a disorder characterized by immune-mediated accelerated destruction and suppressed production of platelets. The etiology of ITP is not yet known, and the diagnosis continues to be one of exclusion. Apoptosis is the physiologically most common form of programmed cell death. The anucleated platelets and megakaryocytes both possess a functional apoptotic machinery that controls their survival and dictates their lifespan. Aim We aimed to assess platelets apoptosis in pediatric patients with ITP and to correlate it with the clinical outcome of the disease. Patients and methods The study included 40 pediatric patients with acute ITP and 20 controls. Detection of platelet apoptosis was done with annexin V and CD41 by flow cytometry. Results Platelet count was significantly decreased in patients with ITP, and mean platelets volume was significantly increased in patients with ITP. The percentage of total apoptotic platelets and early and late apoptosis of platelets were significantly increased in patients with ITP than the controls. The patients with brief duration of thrombocytopenia were younger than patients with prolonged duration of thrombocytopenia. Platelets count and mean platelets volume were significantly increased in the patients with prolonged duration than patients with brief duration of thrombocytopenia. Moreover, the percentage of total apoptotic platelets and early apoptosis of platelets were significantly decreased in patients with brief duration than patients with prolonged duration of thrombocytopenia. Conclusion This study demonstrates an increase in platelets apoptosis in pediatric ITP.
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