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ORIGINAL ARTICLES
Prevalence of occult hepatitis C virus in patients with HCV-antibody positivity and serum HCV RNA negativity
Hani A Aboalam, Hebat-Allah G Rashed, Mohamed A Mekky, Hanan M Nafeh, Osman A Osman
May-August 2016, 1(2):12-16
DOI:10.4103/2357-0121.192539  
Introduction and aim Chronic hepatitis C infection is a global problem with an increasing burden on healthcare, particularly in Egypt. Even with the advent of highly sensitive techniques, a subset of patients with positive hepatitis C virus antibody (HCV-Ab) and negative HCV-viremia remain challenging to treat. Therefore, we tried to determine the prevalence of occult HCV infection (OCI) in peripheral blood mononuclear cells (PBMCs) of patients presenting with a positive serologic test for anti-HCV-Ab and negative serum HCV-RNA-PCR (spontaneously cleared patients) and followed up those patients. Patients and methods Between March 2010 and March 2015, a prospective study was designed to include all consecutive patients with HCV-Ab positivity and HCV-RNA negativity who attended the Assiut Unit for treatment of viral hepatitis - the National Committee for Control of Viral Hepatitis. A total of 25 patients were recruited. Spontaneous clearance of serum HCV infection was approved on the basis of HCV-Ab positivity using two third-generation enzyme-linked immunosorbent assay tests and serum HCV RNA negativity on three consecutive occasions, each 6 months apart. Follow-up serum HCV RNA levels were evaluated for patients with OCI every 6 months. The RNA extraction step was performed by a protocol modified from that of the QIAamp viral RNA kits. Blood samples for separation of PBMCs were collected from all patients. PBMCs were obtained using Ficoll-Hypaque density gradient of EDTA anticoagulated blood according to the manufacturer's instructions (Lymphoflot). Detection of HCV viral load was performed with the kit supplied by Applied Biosystem (HCV RT-PCR Kit lot No.). Results A total of 25 patients (21 men, mean age 36.2 ± 9.1) cleared HCV spontaneously (HCV-Ab positive and serum HCV RNA negative). Genomic HCV RNA was detected in PBMCs of three (12%) of 25 patients. These three patients with OCI were followed up for 18 months by measuring their serum HCV RNA using highly sensitive real-time PCR every 6 months. Only one patient became overt HCV with a low level of viremia. Conclusion OCI was detected in a considerable prevalence in patients who cleared HCV spontaneously, that entails corporations of HCV-viral assay in PBMCs into the diagnostic algorithm.
  729 91 1
Association between albuminuria and abnormal cardiac findings in patients with type 2 diabetic nephropathy: role of urine albumin excretion
Ghada A Mohamed, Marwa A Gaber
May-August 2016, 1(2):1-5
DOI:10.4103/2357-0121.192537  
Background Diabetic patients have higher morbidity and mortality from cardiovascular diseases compared with nondiabetic patients, particularly in the case of patients with high urinary albumin excretion (UAE). The main aims of our study were to detect abnormal cardiac findings in patients with type 2 diabetic nephropathy (DN) and its relation to increased levels of UAE. Patients and methods Our descriptive cross-sectional study consisted of 105 diabetic patients with documented DN who attended the diabetic outpatient clinic of the Internal Medicine Department, Assiut University Hospital, and underwent routine investigation, glycated hemoglobin (HbA1c), 24 h UAE, and transthoracic echocardiography. Results We evaluated 105 patients with type 2 DN (56 men and 49 women) who were divided into two groups: group I included those with microalbuminuria (39%) (age: 54.3 ± 14.4 years) and group II included those with macroalbuminuria (61%) (age: 59.7 ± 7.9 years). There was a significant relationship between the degree of albuminuria and occurrence of left ventricular hypertrophy and segmental wall motion abnormality in both groups (P < 0.001 and P = 0.032, respectively). Conclusion Our data indicate a possible link between abnormal cardiac findings and progression of DN. We suggest that assessment of cardiac morbidity by means of echocardiography in patients with DN be mandatory for early preventive strategies.
  320 59 -
The nephroprotective effects of ginkgo biloba extract (EGb761) against l-NG-nitroarginine methyl ester-induced hypertension in rats: role of oxidative stress and inflammatory markers
Ahmed M Abd-Eldayem, Hanan S. M. Farghaly, Ahmed O Abdel-Zaher
September-December 2016, 1(3):79-85
DOI:10.4103/2357-0121.199358  
Background Ginkgo biloba extract 761 (EGb761) was studied for its nephroprotective effects in experimentally induced hypertension. Hypertension is increasingly a cause of end-stage renal diseases. Increased cytokine release and oxidative stress are mechanisms that appear to be involved in the pathogenesis of hypertensive renal damage. EGb has antioxidant and anti-inflammatory effects and can attenuate hypertensive renal damage. Methods and results Male adult Wistar rats were used in this study. Hypertension was induced in these rats by administering l-NG-nitroarginine methyl ester (l-NAME) (10 mg/kg/day, intraperitoneal) for 12 weeks. Another group of rats received l-NAME and EGb761 (100 mg/kg/day, orally) starting from the ninth week to the end of treatment. It was found that the blood pressure was reduced at the end of 12th week in rats treated with EGb761 compared with l-NAME-treated (hypertensive) rats. EGb761-treated rats showed lower renal tissue malondialdehyde level and renal tissue tumor necrosis factor-α level when compared with l-NAME-treated rats (hypertensive). Conclusion EGb761 has antihypertensive effect; it can protect the kidney from hypertension through the reduction of renal inflammation and oxidative stress.
  292 51 -
Role of medical management in otitis media with effusion Journal of Current Medical Research and Practice
Mohammed A Mohammed, Wafaa T Elsherief, Mohammed M Osman, Aida A Abdelmaksoud
May-August 2016, 1(2):24-27
DOI:10.4103/2357-0121.192541  
Introduction Otitis media with effusion (OME) is a common disease characterized by the retention of fluid and inflammatory byproducts in the middle ear without any clinical symptoms of acute infection. Objective The aim of the study was to evaluate the benefits of medical management and watchful waiting before surgical intervention in patients with OME. Patients and methods A total of 130 patients with OME, aged newborn to 35 years, were selected for this study. All patients received medical treatment in the form of amoxicillin for 10 days as first trial therapy; if no improvement was seen with amoxicillin, clavulanic acid was given for another 10 days as second trial therapy. Patients with persistent effusion after medical treatment were followed up for 3 months for spontaneous regression (watchful waiting, third trial therapy). Patients with persistent effusion after 3 months were subjected to surgical management according to the predisposing factor. Results A total of 86 (66.2%) patients showed complete recovery with medical management. Of them, 29.2% (38 patients) responded after the first trial of medical therapy, 26.1% responded after the second course, and 35.3% showed spontaneous recovery on watchful waiting. Conclusion An initial trial of medical therapy with watchful waiting for 3 months should be practiced before surgical intervention.
  277 57 -
Anti-C1q antibodies as a marker for disease activity in systemic lupus erythematosus and lupus nephritis
Eman A.H. Omran, Nadia M Ismail, Eman Mosad, Yasmine S Hussein
September-December 2016, 1(3):47-53
DOI:10.4103/2357-0121.199353  
Background Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory autoimmune disease that is characterized by a number of immunological abnormalities. Disease onset is triggered by ill-defined environmental factors in genetically susceptible individuals. C1q plays a key role in apoptotic cell and immune complex removal, and hence it is a very important functional molecule in SLE pathogenesis. Investigation of the relationship between peripheral lymphocyte apoptosis and serum levels of anti-C1q autoantibodies in SLE patients suggests that increased serum levels of anti-C1q autoantibodies are responsible for apoptosis and may play a pathogenic role in SLE patients, especially in active disease. Objectives The aim of this study was to measure the serum level of anti-C1q in SLE patients, and to evaluate the correlation between anti-C1q and SLE disease activity, especially renal activity. Patients and methods Fifty SLE patients diagnosed according to the Systemic Lupus International Collaborating Clinics classification criteria 2012 and 33 healthy volunteers who were age and sex matched were included in the study. SLE activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and renal activity was assessed using the renal SLEDAI. Anti-C1q was estimated using enzyme-linked immunosorbent assay kit. Results Serum anti-C1q was significantly higher in SLE patients (64.86 ± 27.88 U/ml) compared with healthy controls (30.15 ± 13.93 U/ml) (P < 0.000). There was a significantly positive correlation between anti-C1q and the SLEDAI (P = 0.035, r = 0.299) and the renal SLEDAI (P = 0.025, r = 0.316). Anti-C1q has a sensitivity and specificity of 92.7 and 66.7%, respectively, a positive predictive value of 92.7%, negative predictive value of 66.7%, and 88.0% accuracy for detecting SLE disease activity, whereas for lupus nephritis diagnosis anti-C1q has a sensitivity and specificity of 94.12 and 50.0%, respectively, a positive predictive value of 80.0%, negative predictive value of 80.0%, and 80.0% accuracy. Conclusion Our results support the finding that anti-C1q level might be used as a marker for SLE activity and not lupus nephritis in adult SLE patients.
  249 65 -
Differential expression of MOC-31, Hep Par 1, and N-cadherin in primary carcinoma and metastatic adenocarcinoma in the liver
Mohammed A Ahmed, Fatma A Badary, Etemad H Yassin, Said A Mohammed, Madiha M El-Attar
September-December 2016, 1(3):54-60
DOI:10.4103/2357-0121.199354  
Background Immunohistochemistry plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) and in its distinction from other primary and metastatic neoplasms. In this study, we examined the expression of MOC-31 (Anti-epithelial cell adhesion molecule monoclonal antibody, clone number-31), hepatocyte paraffin 1 (Hep Par 1), and N-cadherin in primary carcinoma and metastatic adenocarcinoma (AC) in the liver. Aim The aim of this study was to evaluate the usefulness of MOC-31, Hep Par 1, and N-cadherin in the differential diagnosis of primary carcinoma and metastatic AC in the liver. Materials and methods The present study included 56 specimens from cases of primary and metastatic liver tumors, including 20 primary HCCs in the liver, five intrahepatic cholangiocarcinomas, and 31 metastatic ACs in the liver. They were studied to evaluate MOC-31, Hep Par 1, and N-cadherin expression using immunohistochemistry. Results The sensitivity of MOC-31 for AC in the studied group was 97.2%, whereas its specificity was 90%. The sensitivity of Hep Par 1 for HCC was 75%, whereas its specificity was 100%. The sensitivity of N-cadherin for primary liver carcinoma was 72%, whereas its specificity was 83.9%. Using the combination of the three antibodies, a final diagnosis could be established in 52 of 56 (92.9%) cases of studied group. In conclusion, a panel of these three antibodies can be helpful in the distinction between primary carcinoma and metastatic AC in the liver.
  204 43 -
Delays associated with maternal near-miss cases admitted in Women's Health Hospital, Assiut University
Shaimaa S Abdel-Raheem, Ghada S. T Al-Attar, Dalia G Mahran, Mohammad H Qayed, Zainel-Abidin Z. H Alib, Essam El-Din R. A Othman
January-April 2017, 2(1):1-9
DOI:10.4103/JCMRP.JCMRP_22_16  
Introduction Maternal near-miss (MNM) is recognized as a new concept and has emerged as an adjunct to investigation of maternal deaths as the two represent similar pathways. A conceptual model that had helped us to explain the underlying preventable causes of MNM by examining three phases of delay on maternal healthcare utilization was developed by Thaddeus and Maine. By identifying and reducing the three delays, we will have the greatest impact in reducing MNM and hence maternal deaths. Aim The aim of this study was to describe the extent, main types, and contributed factors for three delays in care associated with MNM among women admitted in Women's Health Hospital, Assiut University, Egypt. Methods A prospective case–control study was conducted over a period of 1 year from 1 May 2014 to 30 April 2015 at Women's Health Hospital, Assiut University; 342 MNM women and 684 age-matched control women were included in the study. The criteria we used for the identification of MNM were generally based on the presence of different levels of organ dysfunction, which have been identified as recommended by WHO. Data were collected through two approaches: record review and direct interview before discharge. Delays experienced by the study population were collected according to the three-delay model of Thaddeus and Maine. Results A high proportion of the MNM group had experienced delay irrespective of the type, with statically significant differences from their controls. Nearly 50% of near-miss cases were more likely to have experienced two or more types of delays compared with 7.7% of controls. Financial problems, fear of being maltreated in hospitals, lack of awareness about signs of obstetric complications, lack of participation in decision making, lack of antenatal care, negative attitude of healthcare worker, and lack of blood availability were associated with delays among MNM cases compared with controls. Having experienced third delay within the intermediate facilities (referral status) was the highest significant predictor that contributed to MNM by delay types. Conclusion and recommendations Third delay experienced by the women within the intermediate facilities (referral status) was the most prevalent delay among studied women. Reformation of healthcare system on multiple levels and improvement of the socioeconomic status of women are necessary in Upper Egypt to overcome causes of delay among MNM cases.
  166 80 -
Peripheral neuropathy in chronic obstructive pulmonary disease
Olfat M El-Shinnawy, Eman M. H Khedr, Mohamed M Metwally, Alaa El-Din Thabiet Hassan, Ahmad M Shaddad
January-April 2017, 2(1):17-24
DOI:10.4103/JCMRP.JCMRP_24_16  
Introduction Peripheral neuropathy in chronic obstructive pulmonary disease (COPD) has received scanty attention. The purpose of this study was to evaluate objectively the functional changes in the peripheral nervous system in COPD by different electrophysiological parameters and to determine the frequencies of these changes in patients with COPD. Aim Assessment of peripheral nerve conduction by evaluation of the motor and sensory nerve conduction (SNC) in COPD patients. Patients and methods In this case–control study, we recruited 25 COPD patients and matched 25 healthy controls. Motor and SNC studies for ulnar and median nerves were evaluated by means of electrophysiological nerve study. Motor nerve conduction velocity and sensory nerve conduction velocity (SNCV), distal latencies (DLs), and amplitude of compound motor action potential were recorded. Arterial blood gases including partial pressure of oxygen and carbon dioxide (PaO2and PaCO2), oxygen saturation (SaO2), and arterial pH were measured. Pulmonary function test was done and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured. Results There was a significant difference between COPD patients and the control group in all spirometric and gasometric parameters recorded, except for the arterial pH. On studying motor nerve conduction through median and ulnar nerves, there was an increase in DL, decrease in motor nerve conduction velocity, and longer F-wave latency in the COPD group than in the control group in both nerves. SNC study of the median nerve revealed a decrease in SNCV and an increase in DL in the COPD group than in the control group. Median nerve motor neuropathy was proved in 28% of patients, ulnar nerve motor neuropathy was proved in 36% of patients, whereas sensory nerve study of median nerve proved that 68% of patients have sensory axonal neuropathy and 12% have demyelinating sensory neuropathy. Median nerve Distal Latency (DL) shows negative correlation with FEV1and FEV1/FVC ratio. SNCV of the median nerve was positively correlated to oxygen tension level. Conclusion The incidence of neuropathy is high. The rate of axonal neuropathy was significantly higher than other types. Our study showed a significant positive correlation between the degree of hypoxemia and severity of neuropathy, whereas it showed negative correlation between spirometry parameters (FEV1and FEV1/FVC ratio) and median nerve DL.
  183 55 -
Real-time quantitative polymerase chain reaction detection of minimal residual disease in acute lymphoblastic leukemia: a single-center experience
Shabaan Redwaan, Hesham Abdelraheem, Taghreed K Eldin, Hosny Badrawy, Eman M Nagiub Abdelsalam
September-December 2016, 1(3):31-37
DOI:10.4103/2357-0121.199351  
Background Monitoring of minimal residual disease (MRD) has become a frontline clinical practice in the treatment of virtually all childhood acute lymphoblastic leukemia (ALL) cases and in many cases of adult patients with ALL. The MRD diagnostics has proven to be the strongest prognostic factor allowing for risk group assignment into different treatment arms. The MRD techniques need to be sensitive (≤10–4), which means, the ability to detect one malignant cell among 10 000 normal cells; broadly applicable; accurate; reliable; fast; and affordable. Aim The objective of this study is to evaluate the analysis of immunoglobulin heavy chain (IGH) or T-cell receptor (TCR) gene rearrangements as targets for MRD assessment in ALL, allowing early detection of relapsed cases, compare with the results of morphological evaluation of the same cases and to risk stratify patients with ALL according to the MRD assessment as a prognostic marker independent and superior to other conventional risk factors. Patients and methods Overall, 30 patients (15 males and 15 females) with age ranged from 1 to 25 years old were included in this study. Patients were subjected to full medical history, clinical examination, laboratory examinations such as complete blood count, bone marrow aspirate smear examination, cytochemistry, and immunophenotyping. The molecular studies done by real-time PCR were performed using consensus primers and allele-specific primers for (IGH) or (TCR) gene rearrangements as targets to detect MRD. The ALL cases were assessed by real-time quantitative PCR at the time of diagnosis and at the end of induction chemotherapy, and comparative cycle threshold (Ct) relative quantification method was used for quantitative gene expression. Results The results showed discrepancy between the morphologic examination for ALL assessment depending on the 5% blast index as an indicator of remission or nonremission; morphological nonremissions (>5% blast) were detected in eight (26.7%) cases whereas 22 (73.3%) cases showed morphological remissions (<5% blast). Real-time quantitative PCR for IGH/TCR gene rearrangements was done for 30 patients. Of the 22 cases that showed morphological remission, there were 18 (81.8%) cases which were MRD positive (i.e. not in molecular remission) and four (18.2%) cases which were MRD negative (i.e., in molecular remission). Patients who showed nonremission morphologically (right cases) were confirmed to be MRD positive. None of the patient's clinical variables such as age, sex, total leukocyte count, and ALL immunophenotype have been identified as predictors of MRD risk. Conclusion Approximately 81% of ALL cases previously diagnosed as being in the remission state depending on the morphologic assessment only tend to harbor MRD as evident by positive MRD assessment using real-time PCR. The molecular assessment of MRD allows early detection of relapse with chance of intervention and tailoring of treatment according to the patients' need. It was found that there was no relation between MRD results and risk stratification in ALL according to age and white blood cell at diagnosis; this confirms that detection of MRD of leukemic cells can be considered a superior prognostic marker of relapse, independent from conventional prognostic factors. The risk classification in ALL based on MRD results could be used to guide the final treatment strategy and predict early relapse; this should allow prediction of response and relapse while patients are still in the state of clinical remission and morphological remission too.
  174 62 -
Cognitive dysfunction in chronic obstructive pulmonary disease
Mohamed M Metwally, Eman M Khedr, Olfat M El-shinnawy, Alaa EL-din Th. Hassan, Ahmad M Shaddad
January-April 2017, 2(1):10-16
DOI:10.4103/JCMRP.JCMRP_23_16  
Background Chronic obstructive pulmonary disease (COPD) is an increasingly common disease among older adults that has been linked to other comorbid conditions with serious morbidity and mortality, including cognition impairment. However, it remains poorly understood in COPD. The aim of the study The aim of this study is to evaluate cognitive dysfunction in COPD and to relate it to the severity obtained from spirometric and gasometric evaluation of COPD patients. Patients and methods In this case–control study design, 25 COPD patients and 25 age-matched and sex-matched healthy control patients were compared. Wechsler Adult Intelligence Scale-III (WAIS-III) and Mini-Mental State Examination (MMSE) were used to evaluate cognition in COPD patients. Results There was significant impairment of MMSE with a cognitive dysfunction reported in 72% of the COPD group. There was significant impairment in all components of WAIS-III, namely the verbal IQ, performance IQ, total scale IQ, and deterioration index in the COPD group than in the control group.WAIS-III scale was positively correlated to both oxygen tension and saturation, denoting the utmost role of hypoxemia in the pathogenesis of cognitive dysfunction in COPD patients. Receiver operator characteristics curves were plotted for the use of both oxygen tension and saturation, denoting good use of oxygen tension and saturation as a predictive value for impairment of MMSE and WAIS-III scale and hence cognitive dysfunction. Results Cognitive dysfunction is a fixed finding that occurs in the course of COPD. Hypoxemia seems to play the principal role in cognitive disorders. Spirometric parameters seem to be closely related to the progression and prediction of the course of those disorders.
  184 49 -
Skin level of microRNA-369-3P in patients with psoriasis and its correlation with disease severity
Eman R. M Hofny, Hanan Morsy, Ashraf Hasaballa, Howida Twisy
January-April 2017, 2(1):32-34
DOI:10.4103/JCMRP.JCMRP_28_16  
Background Psoriasis is a common autoimmune skin disease characterized by intense proliferation and abnormal differentiation of keratinocytes. Recently, some microRNAs (miRs) have been proven to show an aberrant expression in psoriasis and may play a role in the pathogenesis of the disease. Objectives The aim of this study was to detect skin miR-369-3p levels in patients with psoriasis and its correlation with disease severity with measurement of one of its regulated psoriasis-related genes, SIRT, and to find the correlation between the studied parameters. Patients and methods Skin tissues were collected, and skin miR-369-3p and SIRT1 gene levels were measured. The Psoriasis Area and Severity Index scores of patients and the correlation with skin miR-369-3p levels were evaluated. Correlation between miR-369-3p and SIRT1 gene was also evaluated. Results Skin miR-369-3p levels were higher in patients with psoriasis than those in healthy controls (P = 0.01). Skin miR-369-3p had an insignificant positive linear relation with Psoriasis Area and Severity Index scores in psoriasis patients (r = 0.079, P = 0.772). Insignificant negative correlation was found between miR-369-3p and SIRT1 gene levels in skin. Conclusion The expression of miR-369-3p is increased in skin tissues from psoriasis patients. Further studies are needed to clarify the role of miR-369-3p in the pathogenesis of psoriasis.
  196 26 -
Malignant lymphoma in Hadhramout Sector, Yemen: a retrospective study of 170 cases classified according to the WHO classification
Mariam A. A. Humam, Naela A Al-Nakhbi, Adnan A Melkat, Tomna M Almontaser, Abdulla S Binnabhan
May-August 2016, 1(2):6-11
DOI:10.4103/2357-0121.192538  
Introduction Malignant lymphoma is a primary neoplasm of lymphoid tissue. It is the third most common cancer in children worldwide. There are two broad categories of malignant lymphomas: non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). Both have different microscopic features, follow different treatment modalities, and have different prognoses. Aim of the work The aim of the study was to determine the different types of lymphoma in all age groups, and find its relation to sex and site of lymph node involvement in Hadhramout Governorate. Materials and methods This is a retrospective descriptive study of 170 cases of lymphomas retrieved from the archives of the National Oncology Center, Hadhramout, during the period between 2008 and 2013. The diagnosis was assessed with immunohistochemical results and categorized according to the WHO classification of lymphoid neoplasms. Results Out of 170 patients, 116 (68.2%) had NHL and 54 (31.8%) had HL. A male predominance was observed (103/170, 60.6%). B-cell lymphomas were the most frequent type of NHL (95/116, 81.9%) and diffuse large B-cell lymphoma was the most common pattern of NHL (58/95, 61.1%), followed by Burkitt's lymphoma (20/95, 21.1%). The distribution of HL showed predominance of nodular sclerosis classical HL (38/54, 70.4%). The proportion of lymph node involvement of lymphomas was higher than extranodal involvement, being seen in 91/116 cases (78.5%) of all NHLs and 49/54 cases (90.8%) of all HLs. Conclusion NHL is the most common type of malignant lymphoma, and diffuse large B-cell lymphoma is the most common pattern among all NHL types, whereas nodular sclerosis classical HL is the most common type of HL. The nodal involvement of malignant lymphoma is higher than extranodal involvement.
  179 41 -
Role of dynamic multidetector computed tomography using 'eee' phonation in the diagnosis of various laryngeal lesions
Shimaa Farghaly, Sami Abd El Aziz, Ezzat Saleh, Eman Sayed, Hazem Abu Zeid
May-August 2016, 1(2):17-23
DOI:10.4103/2357-0121.192540  
Objective The aim of the study was to determine the effectiveness of dynamic multidetector computed tomography (MDCT) using 'eee' phonation in the detection and delineation of extension of various laryngeal lesions in comparison with conventional nonfunctional MDCT. Patients and methods The study included 60 patients with suspected laryngeal pathology who underwent precontrast and both prephonation and during-phonation contrast-enhanced MDCT. Each imaging study was evaluated for pyriform sinus and ventricle involvement, vocal cord mobility, and local tumor staging of malignant laryngeal lesions. All patients subsequently underwent direct laryngoscopy. Detailed endoscopic findings were reported and compared with MDCT findings. Results Dynamic MDCT using 'eee' phonation is effective in the assessment of pyriform sinus and ventricle involvement with high sensitivity (100% for both), high specificity (97.83 and 97.44%, respectively), and high accuracy (98.3% for both), compared with lower accuracy of conventional nonfunctional MDCT, which is 78.3% and 93.3%, respectively. It is also highly accurate in the assessment of vocal cord mobility (94.6%) and it increases the accuracy of MDCT in local tumor staging of malignant laryngeal lesions to 80.4% compared with 76.1% accuracy of conventional nonfunctional MDCT. Conclusion Dynamic MDCT using 'eee' phonation is effective in the detection and delineation of extension of various laryngeal lesions and is more accurate than conventional nonfunctional MDCT.
  174 46 -
Magnitude and pattern of maternal near-miss cases admitted to Women's Health Hospital, Assiut University
Shaimaa S Abdel-Raheem, Dalia G Mahran, Ghada S. T. Al-Attar, Mohammad H Qayed, Zein E. A. Zareh, Essam El-Din R. A. Othman
September-December 2016, 1(3):92-99
DOI:10.4103/2357-0121.199360  
Introduction Maternal near-miss (MNM) is one of the related concepts to maternal mortality. MNM is a special category of survivors, whose stories provide unique insights and valuable information on maternal mortality. Measuring MNM beside maternal mortality and identifying its causes is essential, and should be calculated regularly for the purpose of planning, monitoring, and evaluation of provided maternal healthcare. Objectives The objectives of the study were to determine the magnitude and to identify the patterns of MNM among cases admitted to Women's Health Hospital, Assiut University, Egypt. Methodology This paper is a part of a larger case–control prospective study; however, for this analysis, we are presenting only the findings of the MNM cases. (The full profile of the cases and controls was presented in another paper.) The study was conducted at Women's Health Hospital, Assiut University and included 342 MNM cases by total coverage of all eligible cases who met the criteria of MNM identification published in WHO bulletin (2011) throughout the 12 months' period of the study. A checklist was used to collect data from the hospital records of eligible respondents. Results During the 12 months' period of the study, there were 17 503 deliveries and 16 972 live births. The maternal mortality ratio was 276 per 100 000 live births and the MNM incidence ratio was 20 per 1000 live births. This means that there was one maternal death for every seven cases of MNM. The mean age of MNM cases was 28.4 ± 8.5, whereas the mean gestational age of MNM was 35.66 ± 8.6 weeks. The main direct obstetric causes of MNM were hypertensive disorders of pregnancy (49.8%), obstetric hemorrhage (38.3%) and dystocia (32.5%). On the other hand, cardiovascular disorder was the most prevalent nonobstetric cause among MNM cases (48.8%). The peak frequency of the cases occurred during the summer season. Conclusions and recommendations MNM and maternal mortality are alarmingly high. Hypertensive disorders of pregnancy and obstetric hemorrhage were the two main direct obstetric causes of near misses that require strict and quick management protocols.
  172 39 -
Risk factors of upper-arm lymphedema after breast cancer treatment
Yehia Safwat, Mohammed Shaalan, Mohsen Mokhtar, Mokhtar Hamood
January-April 2017, 2(1):73-78
DOI:10.4103/JCMRP.JCMRP_6_17  
Background Lymphedema is one of the most problematic complications after breast cancer treatment. The risk factors (RFs) for breast cancer-related lymphedema (BCRL) are multifactorial and are not fully understood. Aim The aim of this study was to determine the RFs for breast cancer-related upper-arm lymphedema. Patients and methods This is a case–control study including patients with arm lymphedema as cases and patients without arm lymphedema as controls. The included patients had breast carcinoma (n = 128) and all had operable breast cancer that could undergo locoregional therapy (surgery ± radiotherapy). Diagnosis of lymphedema was made by the measurement method, in which a difference of up to 2 cm either above or below the olecranon process between the two arms is generally accepted for diagnosis of lymphedema. Assessment of lymphedema and RFs was performed by logistic regression. Results Univariate analysis showed significant difference between the groups of patients with and those without lymphedema with respect to older age (0.016), BMI greater than 30 (0.007), hard work (0.004), ipsilateral dominant arm (0.021), history of injury (0.001) and infection (0.001) to the ipsilateral arm, positive lymphadenopathy (0.020), advanced stage of cancer (0.009), positive human epidermal growth factor receptor-2/neu receptor (0.001), level III axillary dissection (0.001), and lack of information about BCRL and/or not following prophylactic advice (0.001). Meanwhile, multiple logistic regression analysis showed only old age (0.005), history of injury (0.016), cellulitis (0.033), level III axillary dissection (0.011), lack of information about BCRL, and not following prophylactic advice (0.012) to have a significant relation to lymphedema. Conclusion Healthcare personnel and patients must be aware of the prevention and early treatment of lymphedema.
  172 33 -
Prevalence of respiratory disorders among primary aluminum workers, and their relation to the duration of exposure and smoking habits
Hala H Aboufaddan, Hussein H Zayet, Lamiaa H Shaaban, Ashraf A Ewis, Shimaa A Elghazally
September-December 2016, 1(3):61-66
DOI:10.4103/2357-0121.199355  
Introduction and study methods A cross-sectional study was conducted to describe the pattern of respiratory disorders and some associated risk factors among 260 aluminum-exposed workers and 80 nonexposed workers. Data were collected by a respiratory symptoms questionnaire. Spirometry and chest radiography were performed on all participants. Results The aluminum-exposed workers suffered significantly more from chronic cough, phlegm, wheezes and breathlessness (34.2, 42.3, 42.3 and 36.9%, respectively) compared with nonexposed workers (P < 0.05). Mean values of spirometric measurements regarding FVC%, FEV1%, FEV1/FVC and PEF25–75% as percentages of predicted were significantly lower among exposed workers (84.15 ± 15.02, 88.77 ± 17.65, 106.15 ± 14.72 and 81.34 ± 29.1, respectively) compared with nonexposed workers (P < 0.05).The interpretation of chest radiographies revealed that abnormal chest rdaiographies were significantly more predominant in exposed workers than in the nonexposed group (P < 0.05). There was a significantly higher occurrence of asthma among exposed workers (8.1%) compared with nonexposed workers (1.2%), with P value 0.03. The prevalence of respiratory symptoms, abnormal ventilatory function measurements and abnormal radiographies were higher among the exposed workers who were smokers and in those with duration of exposure of more than 25 years. Conclusion The occurrence of respiratory symptoms, airway diseases, ventilatory function abnormalities and abnormal rdaiographies were higher among the exposed workers, especially those who were smokers and had a duration of exposure of more than 25 years. For prevention of these hazards, general and personal measurements must be performed, for example, engineering, personal protective equipments and more medical care for workers (pre-employment and periodic medical examinations).
  158 46 -
Construction of an Arabic computerized cognitive skill battery for the diagnosis of children with specific learning disabilities
Wafaa M. A. Farghaly, Mohammed A Ahmed, Taha A. H. Elmestikawy, Reda B Abdel-Rasool, Mohammed S. H. Farghaly, Montser S Omar, Amr S Ramadan, Mohammed Salamah, Mohammed A Abdel-Hameed, Adel T Mohammed
September-December 2016, 1(3):38-46
DOI:10.4103/2357-0121.199352  
Objective Most of the previously designed Arabic tests for the assessment of specific learning disabilities (SLDs) are noncomputerized and do not pay attention to many of the cognitive skills that are believed to have an important role in the early stages of literacy development and its relations with learning disabilities. Computer usage supports and enhances children's creativity, self-esteem, and cooperative learning. Therefore, we aimed to design an Arabic computerized cognitive skill battery for the detailed assessment of children with SLD, through the assessment of their auditory as well as visual processing skills, to identify their points of weakness that might contribute to their learning disability. Participants and methods This study was carried out in Assiut city, Egypt. All fourth grade students from six chosen public primary schools (n = 858 students) were interviewed except those who were absent during their school visits (n = 142 students), or those who did not complete the test battery (n = 56 students). The rest of the sample (660 students) completed the test battery. The study included four stages. The first stage included identification of students with SLD with previous standardized tests [the Arabic reading test, the writing test (it is the sum of the script part of visuomotor test, which was specifically designed for this study, plus spelling part of Arabic reading test), the Math test, and the Wechsler Intelligence Scale for Children-Revised to assess their IQ level]. The second stage included battery construction by seven expert staff members (this took 1 year from 1 October 2012 to 30 September 2013). The third stage included application of the newly constructed battery in a pilot study to 10 normal students (9–10-year-old) to ascertain clarity of the tests of the battery. The fourth stage included test standardization. Results The reliability of the battery was proven using Cronbach's α correlation coefficient (α≥0.7), interitem correlations (all values are positive and highly significant), and corrected item-total correlation coefficient (all values >0.3). Validity was proven with judgment validity, construct validity (factorial analysis) (all loadings ≥0.5), contrasted group validity, and predictive validity (sensitivity and specificity). Conclusion The constructed battery was thus proven to be highly reliable and valid for the assessment of SLDs among Arabic reading children, and thus remediation programs can be directed properly and early.
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Prevalence of microscopic colitis in Upper Egypt among patients with chronic diarrhea and patients with irritable bowel syndrome
Omar M Saleh, Ashraf M Osman, Madiha M Al-Attar, Abeer M Rifai
September-December 2016, 1(3):67-71
DOI:10.4103/2357-0121.199356  
Aim The aim of this study was to evaluate the prevalence of microscopic colitis (MC) in patients with chronic watery diarrhea and irritable bowel syndrome–diarrhea (IBS-D) predominant. Patients and methods We studied 61 patients with chronic nonbloody diarrhea and normal endoscopic findings prospectively for 2 years' duration; 37 patients had chronic watery diarrhea for investigation and 24 had IBS-D predominant. Results Our results showed that 18 (29.5%) patients had MC, 10 (16.4%) patients had collagenous colitis, and eight (13.1%) had lymphocytic colitis. Four (16.7%) patients out of the 24 patients with IBS-D predominant had MC. Abdominal pain, nocturnal diarrhea, and weight loss are the most common clinical presentation in MC. Conclusion MC is not uncommon in Upper Egypt patients with chronic watery diarrhea and normal colonoscopic findings. Biopsy of normal colonic mucosa in patients with chronic watery diarrhea is emphasized to reach to definite diagnosis of MC.
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Validation of right ventricular pacing response during supraventricular tachycardia in mechanistic diagnosis (transition zone)
Doaa A Fouad, Sherif H Zaki, Hosam H Elaraby, Ahmed Abdelgaleel, Marwan S Mahmoud
January-April 2017, 2(1):25-31
DOI:10.4103/2357-0121.210303  
Background Right ventricular pacing (RVP) during supraventricular tachycardia (SVT) produces progressive QRS fusion before the QRS morphology becomes stable. This transition zone (TZ) may provide useful information for differentiating orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal re-entrant tachycardia and atrial tachycardia independent of entrainment success. Methods and results We studied the effect of properly timed RVP on atrial timing during the TZ in 63 patients with SVT who had RVP within 40 ms of the tachycardia cycle length. The TZ during RVP includes progressively fused QRS complexes and the first paced complex with a stable QRS morphology based on analysis of the 12-lead ECG. We also measured the stimulus–atrial (SA) interval from the end of the TZ and with each QRS complex thereafter until pacing was terminated or ventriculoatrial block occurred. A fixed SA interval was defined as variation less than or equal to 10 ms during RVP. Atrial pre-excitation, postexcitation, or SVT termination with abrupt ventriculoatrial block was observed within the TZ in 19 of 22 patients with ORT. A fixed SA interval was established within the TZ in 22 of 22 patients with ORT. At least one of these two responses was observed in all patients with ORT. Only four patients out of 36 with atrioventricular nodal re-entrant tachycardia showed atrial pre-excitation within TZ and only four patients showed fixed SA within TZ. None of the atrial tachycardia patients had atrial timing perturbed or a fixed SA interval established within the TZ. Conclusion During RVP within 40 ms of the tachycardia cycle length, ORT is the likely mechanism when atrial timing is perturbed or a fixed SA interval is established within the TZ.
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The effect of maternal hypothyroidism on the postnatal development of the pituitary–thyroid axis in albino rats: a histological, morphometric, and immunohistochemical study
Mohamed R Shehata, Dorreia A Mohamed, Manal M. Samy El-Meligy, Ashraf E Bastwrous
January-April 2017, 2(1):79-97
DOI:10.4103/JCMRP.JCMRP_7_17  
Background The adequate functioning of the maternal thyroid gland plays an important role in ensuring that the offspring develop normally. Therefore, maternal hypothyroidism and hyperthyroidism are associated with offspring abnormalities. Aim of the work This study was carried out to examine the effect of maternal hypothyroidism on the postnatal development of the pituitary–thyroid axis in the albino rat. Materials and methods Thirty pregnant female albino rats were divided into two groups. Group I was the control group and group II was the hypothyroid group whose rats were given carbimazole in a dose of 5 mg/rat/day through the intragastric intubation from the gestational day 10 until the postnatal day 20. The offspring of both groups were killed at the ages of newborn, 10, 30, and 60 days. The pituitary and thyroid glands were extracted from the pups of control and treated animals and processed for light and electron microscopy and morphometric analysis. In addition, an immunohistochemical study was carried out on the pituitary specimens for the detection of thyrotrophs. Results The present study revealed that the maternal hypothyroidism caused morphological changes in the pituitary–thyroid axis of the offspring. The changes started to appear in the newborn age and persisted throughout the postnatal life. The light microscopic examination revealed shrunken thyroid follicles. The follicular epithelial height increased and was composed of tall columnar cells with a vacuolated cytoplasm. The colloid decreased or was completely absent. Regarding the pituitary gland, there were many large pale vacuolated cells with dark nuclei and sometimes the vacuolation affected most of the cells. The electron microscopic examination of the thyroid follicular cells and thyrotrophs showed ultrastructural signs of an increased activity, which included dilated endoplasmic reticula, well-developed Golgi, enlarged mitochondria, and a decreased number of the secretory granules. Large cytoplasmic vacuoles were also observed. The immunohistochemical study of the pituitary gland revealed an increased number of thyroid-stimulating hormone immunopositive cells. The morphometric analysis of the pituitary and thyroid sections showed a significant decrease in the thyroid follicular diameter and a significant increase in the thyroid follicular epithelial height and in the number of the thyrotrophs per reference area. Conclusion From this study, it could be concluded that the experimentally induced maternal hypothyroidism disturbed the pituitary–thyroid axis of the offspring.
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Remediation of central auditory processing disorders in children with learning disability: a comparative study
Samah M Ahmed, Somaia M Tawfik, Mohamed S Bakr, Emad K Abdelhaleem, Enass S Mohamed
September-December 2016, 1(3):86-91
DOI:10.4103/2357-0121.199359  
Objective The primary objective of this study was to compare the outcome of central auditory processing rehabilitation when using two different strategies. In the first strategy, the computer-based remediation program was used (temporal processing and phonemic awareness training). In the second strategy, the informal remediation program was used (temporal processing and phonemic awareness training). Patients and methods Fifty children with learning disability due to central auditory processing disorder were selected from primary schools in Assiut city. They were subjected to psychophysical test battery. It comprised dichotic digits test, pitch pattern sequence test, and electrophysiological test (cortical P1). They were divided into two equal groups, groups A and B. Each group was subdivided on the basis of age into three subgroups. Group A received the formal Auditory Training (AT) and group B received the informal AT for a minimum duration of 2 months. Re-evaluation of those children was carried out using the same test battery used in the diagnosis. Results The children were evaluated 1 month after training. There was a statistically significant difference in all psychophysical tests and electrophysiological P1. Subjective improvement was noticed also at the level of the questionnaire and school reports. Conclusion Both formal and informal remediation material used in this study proved to be effective and promising auditory training strategy for ameliorating central auditory disorder by remodeling the plasticity of the CANS.
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Impact of hepatitis B on male reproductive hormones
Rofaida R Shehata, Kamal Mohammed Abdel Hafez, Ehab Fawzi, Emad Eldin Kamal, Sahar Hassany, Mohammed Zakaria
May-August 2016, 1(2):28-30
DOI:10.4103/2357-0121.192542  
Background Hepatitis B virus infection is a serious disease affecting more than 400 million people worldwide. It has serious effects on reproductive hormones. Aim of the work The purpose of the study was to evaluate some of the hormones in male patients with chronic hepatitis B. Patients and methods The participants of the study were classified into two groups: 73 patients with chronic hepatitis B without liver cirrhosis (group 1), ranging from 18 to 46 years in age, and 31 healthy volunteers constituting the control group (group 2), ranging in age from 19 to 37 years. Serum levels of follicle-stimulating hormone, luteinizing hormone, total testosterone, free testosterone, estradiol (E2), prolactin, and sex hormone binding protein were measured in all patients. All reproductive hormones were measured by enzyme-linked immunosorbent assay. Liver function tests, detection of hepatitis markers, and abdominal ultrasonography were performed for exclusion of liver cirrhosis. Results As regards sex hormone binding protein, prolactin, total testosterone, and luteinizing hormone, there was a significant difference between patients and controls (P = 0.000). Conclusion Hepatitis B virus has serious effects on reproductive hormones.
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Novel molecular diagnostic marker in the evaluation of cartilage destruction in patients with rheumatoid arthritis
Ghada Hassan, Elbadry Aboelnour, Osama Ibrahiem, Ebtsam F Mohammed
September-December 2016, 1(3):72-78
DOI:10.4103/2357-0121.199357  
Aim The aim of this study was to evaluate the serum levels of cartilage oligomeric matrix protein (COMP) in rheumatoid patients in correlation with disease severity and cartilage destruction and to evaluate the therapeutic effectiveness of slow-remitting agents such as leflunomid on this marker of cartilage destruction. Patients and methods Fifty patients with rheumatoid arthritis (RA) diagnosed on the basis of the 2010 ACR/EULAR Rheumatoid Arthritis Classification Criteria and 20 age-matched and sex-matched controls were enrolled in the study. C-reactive protein, erythrocyte sedimentation rate (ESR), rheumatoid factor, anti- cyclic citrullinated peptide, and COMP were determined. Patients were classified into two groups according to Disease Activity Score-28: group 1 (29 patients) included patients with severe activity with a score of greater than 5.1; and group 2 (21 patients) included patients with moderate activity with a score of greater than 3.2 and less than and equal to 5.1. The studied patients were classified into two groups on the basis of the time of receiving leflunomid therapy (20 mg daily after initial therapy 100 mg daily for 3 days) for 3 months: group 3 received before treatment and group 4 received after treatment. Results Serum COMP was significantly higher in patients with RA when compared with controls (P = 0.000). The COMP levels were found to be positively correlated with Joint space narrowing score (JSN) (r = 0.832, P = 0.000) and erosion score (r = 0.863, P = 0.000) of radiography and negatively correlated with rheumatoid factor (r=−0.313, P = 0.027); however, COMP levels did not correlate with age (r = 0.231, P = 0.106), duration of disease (r = −0.060, P = 0.678), Disease Activity Score-28 (r = −0.098, P = 0.498), C-reactive protein (r = −0.242, P = 0.090), ESR first hour (r = −0.096, P = 0.509), ESR second hour (r = −0.101, P = 0.484), or anti-cyclic citrullinated peptide (r = 0.041, P = 0.775). Conclusion COMP could be a useful biomarker for the detection of early cartilage and bone destruction and in the follow-up of disease severity and treatment in RA.
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Laryngopharyngeal reflux: an overview on the disease and diagnostic approach
Asmaa M Hassan, Ashraf M Osman, Mohamed A. A Ghaliony, Emad K. Abd Elhaleem, Khaled A. M Elbeh
January-April 2017, 2(1):67-72
DOI:10.4103/JCMRP.JCMRP_5_17  
Background Laryngopharyngeal reflux (LPR) can be defined as chronic symptoms or laryngeal mucosal damage caused by the abnormal reflux of gastric contents into the upper airway. LPR plays an important role in up to 50% of laryngeal complaints that present in the otolaryngeal clinic, and the symptomatology of LPR has more different presentation. LPR is suspected in the presence of symptoms of hoarseness, dysphagia, cough, globus, excessive mucus, throat pain, throat clearing, and laryngospasm. Diagnosis of LPR is confirmed using the following: reflux symptom index (RSI), laryngoscopic examination [reflux finding score (RFS)], and esophagogastroduodenoscopy. Patients and methods A cross-sectional study was conducted on 60 patients with typical gastroesophageal reflux disease (GERD) symptoms and laryngeal complaints; these studied patients were recruited from patients who attended the outpatient clinic of Tropical Medicine and Gastroenterology, and Phoniatric Unit, Assiut University Hospital. The symptom questionnaire and the classification proposed by Belafsky and his colleagues (RSI) are used and upper endoscopy is performed for the diagnosis of GERD patients. Nasofibrolaryngoscopy for all these patients was performed to compare the results (RFS). Psychiatric assessment was performed by a psychiatric specialist using symptoms checklist revised 90. Patients with a score more than 60 will be re-evaluated using the following questionnaires: Hamilton checklist of symptoms of depressive illness and Hamilton rating scale for anxiety. Results All studied patients showed positive RSI (100%) and diagnostic endoscopy showed GERD in 58 (96.7%) patients, and 32 (53.3%) of them were found to have a positive finding in laryngoscopy; the findings were as follows: vascular congestion and vocal cord hyperemia in 32 (100%) patients, vocal cord edema in 26 (81%), phonatory gap in 13 (40%), subglottic edema in 12 (37%), vocal cord swelling in 10 (31.25%), and contact granuloma in eight (25%). A positive significant correlation was detected between phonasthenia symptoms, mostly lump sensation, hoarseness, throat clearing, and dry mouth (symptoms), and laryngeal finding (RFS), except for difficulty in swallowing saliva. There is a strong association between psychological symptoms and the presence of LPR; the most commonly detected manifestation was anxiety, and there was a positive significant correlation with anxiety and a negative significant correlation between depression and reflux symptoms. Conclusion RSI and RFS could be useful for the diagnosis and evaluation of LPR in patients with GERD complaining of laryngeal symptoms. Psychological intervention can improve the general well-being and quality of life of patients with gastrointestinal symptoms.
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Comparison of chirp and click-evoked brainstem response stimulus in children with moderate and severe sensorineural hearing loss
Amal M El-Attar, Sayed M Enass, Mossa M Hoda Abu, Mahran M Sanaa
May-August 2017, 2(2):99-104
DOI:10.4103/JCMRP.JCMRP_1_17  
Introduction Auditory brainstem response using click stimuli enable global objective estimation of hearing threshold. Recently, it has been suggested that a chirp stimulus may produce a synchronous response from a large portion of basilar membrane. The chirp was designed to produce simultaneous displacement maxima along the cochlear partition by compensating for frequency-dependent traveling-time differences. Material and methods In this study, response characteristic of both click and chirp stimuli are compared in children. We compared latency and amplitude of wave V at different intensity levels and waves I and III at high level. Results and conclusion Results show that wave V on using chirp stimuli could be detected easier with shorted in latency and larger in amplitude than in click auditory brainstem response. However, click stimulus was better than chirp stimulus at high-intensity levels with respect to the identification of waves I and III.
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